ORGANIZATION OF AMERICAN STATES INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION RECOVERY-ORIENTED SYSTEMS OF CARE

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1 ORGANIZATION OF AMERICAN STATES INTER-AMERICAN DRUG ABUSE CONTROL COMMISSION FORTY-FOURTH REGULAR SESSION November 19-21, 2008 Santiago, Chile OEA/Ser.L/XIV.2.44 CICAD/doc.1687/08 13 November 2008 Original: English RECOVERY-ORIENTED SYSTEMS OF CARE H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM GENERAL SECRETARIAT OF THE ORGANIZATION OF AMERICAN STATES, WASHINGTON, D.C OAS Inter-American Drug Abuse Control Commission: CICAD 44 Recovery-Oriented s of Care November 20, 2008 Santiago, Chile H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM Director Center for Substance Abuse Treatment Substance Abuse Mental Health Services Administration U.S. Department of Health & Human Services 1

2 Recovery Oriented s of Care (ROSC) Learning Objectives - Establish a better understanding of the Recovery- Oriented Sytem of Care (ROSC) - Define the system - Define the goals of ROSC Infectious Diseases HIV Hepatitis Tuberculosis Therapy Models Medication-Assisted Treatment (MAT) Methadone Buprenorphine Naltrexone Newer Therapy Models Cognitive Behavior Therapy Motivational Interviewing (MI) Motivational Enhancement Therapy (MET) Cognitive Management/Motivational Incentives 2

3 The Recovery Process Recovery from alcohol and drug problems is a process of change through which an individual achieves abstinence and improved health, wellness, and quality of life. Source: CSAT National Summit on Recovery, Challenges for a Traditional Approach 52.3% of those admitted to U.S. public substance abuse treatment programs in 2006 were re-entering treatment: 21.3% for the second time, 17.4% for the third or fourth time, and 13.6% for the fifth or more time. 1 One recent study found the that median time from first treatment to 1 alcohol-and drug-free year was 9 years with 3 to 4 episodes of treatment. 2 ¹SAMHSA, Office of Applied Studies. Treatment Episode Data Set (TEDS). Highlights National Admissions to Substance Abuse Treatment Services 2 Dennis, M.L. et al, The duration and correlates of addiction and treatment careers, Journal of Substance Abuse Treatment 28 (Suppl. 1): S51-S62 6 3

4 Description of Recovery-Oriented s of Care A recovery-oriented systems of care approach supports person-centered and self-directed approaches to care that build on the strengths and resilience of individuals, families, and communities to take responsibility for their sustained health, wellness, and recovery from alcohol and drug problems. Source: CSAT National Summit on Recovery, Recovery-Oriented s of Care Approach In the recovery-oriented systems of care approach, the treatment agency is viewed as one of many resources needed for a client s successful integration into the community. No one source of support is more dominant than another. Various supports need to work in harmony with the client s direction, so that all possible supports are working for and with the person in recovery. Source: Addiction Messenger, November 2007, Vol. 10 Issue 11, published by the Northwest Frontier ATTC. 8 4

5 Examples of Peer Recovery Support Services Peer-led support groups Assistance in finding housing, educational, employment opportunities Assistance in building constructive family and personal relationships Life skills training Health and wellness activities Assistance in managing systems (e.g., health care, criminal justice, child welfare) Alcohol-and drug-free social/recreational activities Peer coaching or mentoring 9 A Traditional Course of Treatment for a Substance Use Disorder Severe 100 Symptoms Person s Entry into treatment Discharge Remission0 Resource: Tom Kirk, Ph.D Time 10 5

6 A Traditional Service Response Severe 100 Symptoms Remission0 Resource: Tom Kirk, Ph.D Acute symptoms Discontinuous treatment Crisis management 11 A Recovery-Oriented Response Severe 100 Symptoms Continuous treatment response Remission0 Promote Self Care, Rehabilitation Resource: Tom Kirk, Ph.D 12 6

7 Helping People Move Into A Recovery Zone Severe Symptoms Recovery Zone Improved client outcomes Remission Resource: Tom Kirk, Ph.D Time 13 Benefits of Moving into a Recovery Zone Chroniccare approaches, including selfmanagement, family supports, and integrated services, improve recovery outcomes 1 Integrated and collaborative care has been shown to optimize recovery outcomes and improve costeffectiveness 2 1 Lorig et al, 2001; Jason, Davis, Ferrari, & Bishop; 2001; Weisner et al, 2001; Friedmann et al, Smith, Meyers, & Miller, 2001; Humphreys & Moos, 2001) 14 7

8 ROSC support person-centered and self-directed approaches to care that build on the personal responsibility, strengths, and resilience ence of individuals, families and communities (including tribes) to achieve health, wellness, and recovery from alcohol and drug problems. Recovery Individual Family V Community Wellness Health ROSC offer a comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual s s needs and chosen pathways to recovery. Recovery Wellness Family/ Child Care Education Housing/ Transportation Cultural & Spiritual Financial Services & Supports Legal Individual Family Community Adolescent Care Alcohol/Drug Services VSO & Peer Support Case Mgt Vocational PTSD &Mental Health Physical Health Care HIV Services Health 8

9 ROSC encompass and coordinate the operations of multiple systems Recovery Social Services Education Housing Faith Community Child Welfare and Family Services Indian Health Services Wellness Educational Housing/ Transportation Spiritual Family/ Child Care s of Care Services & Supports Adolescent Svcs. Legal Individual Family Community Alcohol/Drug Treatment Financial Vocational VSO & Peer Support Case Mgt Addiction Services PTSD & Mental Health Health Care Health Insurance Criminal & Juvenile Tribal Authorities Justice s DoD & Veterans Affairs Mental Health Primary Care HIV Services Vocational Services Health providing responsive, outcomes-driven approaches to care. Evidence-Based Practice Child Welfare and Family Services Cost Social Services Effectiveness Housing Educational Perception Of Care Retention Education Faith Community Wellness Indian Health Services Housing/ Transportation Spiritual Family/ Child Care Recovery s of Care Menu of Services Individual Family Community Addiction Services Alcohol/Drug Treatment Abstinence Mental Health Vocational PTSD &Mental Health Primary Care Health Care Organized Recovery HIV Services Community Adolescent Financial VSO & Peer Support Vocational Services Svcs. Legal Case Mgt Homelessness Health Insurance Tribal Authorities Criminal & Juvenile Justice Health DoD & Veterans Affairs Access/Capacity Social Connectedness Employment Crime 9

10 ROSC require an ongoing process of systems improvement that incorporates the experiences of those in recovery and their family members. Cost Effectiveness Perception Of Care Retention Evidence-Based Practice Social Services Housing Authority Wellness Child Welfare and Family Services Indian Health Services Educational Housing/ Transportation Spiritual Family/ Child Care Health Insurance Tribal Authorities Recovery s of Care Services & Supports Individual Family Community Addiction Services Alcohol/Drug Treatment Vocational PTSD & Mental Health Ongoing s Improvement Abstinence Health Care Criminal Justice DoD & Veterans Affairs Access/Capacity Social Connectedness Mental Health Primary Care Employment Health Crime HIV Services Vocational Services Adolescent Financial VSO & Peer Support Svcs. Legal Case Mgt Homelessness Goals of a Recovery-Oriented s Approach To support preventive strategies related to substance use problems & disorders; To intervene early with individuals with substance use problems; To support sustained recovery for those with substance use disorders; and To improve individual, family and community outcomes

Jack B. Stein, MSW, Ph.D. Division of Services Improvement Center for Substance Abuse Treatment

Jack B. Stein, MSW, Ph.D. Division of Services Improvement Center for Substance Abuse Treatment Substance Abuse: The Missing Link in a Health/Wellness-Based Health Care System Jack B. Stein, MSW, Ph.D. Director Division of Services Improvement Center for Substance Abuse Treatment Substance Abuse