1 / 28

The Intersection of Prevention and Recovery: Community

The Intersection of Prevention and Recovery: Community. ADAA Management Conference 2009 Virgil Boysaw and Sue Jenkins, Presenters. Objectives. Describe elements of Recovery Oriented Systems of Care Identify the conceptual foundation for prevention services in a ROSC system

helmut
Download Presentation

The Intersection of Prevention and Recovery: Community

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. The Intersection of Prevention and Recovery: Community ADAA Management Conference 2009 Virgil Boysaw and Sue Jenkins, Presenters

  2. Objectives • Describe elements of Recovery Oriented Systems of Care • Identify the conceptual foundation for prevention services in a ROSC system • Describe similarities and opportunities for partnership in SPF and ROSC processes • Identify cross-functional skills that support partnerships between prevention and treatment professionals

  3. How does a Recovery Oriented System of Care change the delivery of addiction treatment services?

  4. Alcohol and Drug Use in the Community • Continuum from non-use to regular heavy use • Diagnostic classifications • Substance Abuse and Substance Dependence • Wider span of problematic use is not captured in diagnostic classifications

  5. Natural Recovery • When problems are of later onset and lower severity, many persons resolve them on their own or through brief intervention outside specialized addiction treatment • Sustained abstinence • Sustained moderated AOD use • Continued sub-clinical problems • Move between patterns

  6. Community vs. Clinical Populations • Marked differences • Greater personal vulnerability • Family history of substance use disorders • Child maltreatment • Early puberty • Early age of onset of AOD use • Personality disorders during early adolescence • Substance using peers • Greater cumulative lifetime adversity

  7. Clinical Populations • Greater severity and intensity • Greater AOD related consequences • Higher rates of developmental trauma and posttraumatic stress disorder • Higher co-occurrence of other medical/psychiatric illness • Greater personal and environmental obstacles to recovery • Lower levels of recovery capital

  8. Community vs. Clinical Populations • Natural recovery is the predominant pathway of resolution for transient substance-related problems and less severe substance use disorders • professionally directed treatment is the dominant pathway of entry into recovery from substance dependence

  9. Recovery Rates • Community studies of recovery from alcohol dependence report long-term recovery rates approaching or exceeding 50%.

  10. Past Models of Addiction • All based on acute models of care

  11. Acute Care Model of Treatment Services are delivered in a uniform series of encapsulated activities • screening, • admission, • a single point-in-time assessment, • a short course of minimally individualized treatment, • Discharge and brief “aftercare”, followed by termination of the service relationship.

  12. Acute Care Model • Focused on symptom elimination for a single primary problem • A professional expert directs and dominates decision-making throughout this process. • Services transpire over a short period of time. • pre-arranged, time-limited insurance payment designed specifically for addiction disorders and “carved out” from general medical insurance

  13. Acute Care Model • At discharge, “cure has occurred:” long-term recovery is then viewed as self-sustainable without on-going professional assistance. • Evaluation of success occurs at a single point-in-time follow-up, typically just months after treatment. • Post-treatment relapse is viewed as the failure (non-compliance) of the individual, rather than potential flaws in the design of the treatment protocol.

  14. Evidence from Acute Care Models • Low Treatment Compliance • 50% of outpatients drop out of treatment within one month • 40% of court-ordered patients do not complete treatment • Relapse Rates are High • About 60% use drugs within six months following treatment discharge (Hubbard, Flynn, Craddock, & Fletcher, 2001); (Watkins, Pincus, Tanielian, & Lloyd, 2003)

  15. Addiction/Chronic IllnessCompliance Rate Relapse Rate (O'Brien & McLellan, 1996)

  16. Recovery-Oriented System Goals • Intervene earlier in the progression of the disease • Improve treatment outcomes • Support sustained recovery

  17. Acute Care Model → Recovery Oriented System of Care Abstinence → Wellness Recovery Support Services Sober or supported housing Transportation Childcare Legal services Educational/vocational supports • Outreach • Engagement and intervention services • Recovery guiding or coaching • Post treatment monitoring and support

  18. Recovery Oriented System of Care • Improved Quality of Treatment • Emphasis on outreach, access and engagement • Evidence based practices • Individualized treatment, more choices • Increased family involvement • Integration with physical health and mental health services • Change in nature of helping relationship

  19. Recovery Oriented System of Care • Active Relationship with Community “The community, not treatment, is the agent of recovery” • Advocacy • Confront AOD promotional forces in the local community • Promote pro-recovery policies • Recovery resource development • Recovery community centers • Alternative peer recovery support groups • Stigma reduction efforts

  20. How does the Strategic Prevention Framework change the provision of prevention services?

  21. Strategic Prevention Framework • Create communities in which people have a quality life including • healthy environments at work and in school; • supportive communities and neighborhoods; • connection to families and friends and • an environment which is free of alcohol, tobacco, and other drugs and crime free (SAMHSA/CSAP, 2006)

  22. Strategic Prevention Framework • Prior to SPF, prevention was defined as an intervention in which specific groups, families or individuals were targeted (i.e. selected or indicated) • The goal of this approach was to build individual protective factors while reducing risk factors (NIDA 1997, 2003)

  23. S PF Goals • Bring the power of individual citizens and institutions together • Create a comprehensive plan that everyone has a stake in and owns • Foster continued systems approaches as the community experiences the outcome of its investments • Hold community institutions responsible (CSAP, 2006)

  24. SPF Measures • By consumption amount, consequences associated with consumption and success in preventing the problems associated with use • Across the lifespan (not just with youth) • Based on evidence-based research and empirical data • As outcomes at the population level (not just program level)

  25. Unified Model • Prevention can be enhanced to address any and all factors that lead to use or lessening of wellness or loss of sustained recovery by adapting current prevention strategies to a Recovery and Wellness model (grounded in a Chronic Care model) (Hogan, Gabrielson, Luna, & Grothaus, 2003)

  26. Recovery and Wellness Model • Focus is on building resiliency • The strength individuals and communities attain by reducing risk factors and increasing protective factors • Rather than addressing a single problem or condition, it simultaneously considers a potential wide-ranging set of ATOD-involved problems

  27. Recovery and Wellness Model • Rather than focusing on individuals at risk, it studies the entire community • Rather than basing prevention strategies on single assumptions about deterministic behavior, it employs interventions that alter the social, cultural, economic and physical environment in such a way as to promote shifts away from conditions that favor the occurrence of ATOD- involved problems. (Holder, 1998)

  28. Reference Special Report A Unified Vision for the Prevention and Management of Substance Use Disorders: Building Resiliency, Wellness and Recovery – A Shift from an Acute Care to Sustained Care Recovery Management Model Complied by: Michael T. Flaherty, PhD Institute for Research, Education and training in Addictions (IRETA)

More Related