SUPPORT TO ADDICTION RECOVERY A Model Developed By the Office of Behavioral Health Services Division on Alcoholism and Drug Abuse October, 2001 Revised, 10/04 Program Development Supported In Part With Substance Abuse Treatment and Prevention Block Grant Funds

Support To Addiction Recovery On-Going Assessment & Evaluation Specialized Programs Withdrawal Management Basic Elements for Pre-Recovery Interim Successful Outcomes Services Intensive Recovery Programs (IRPs) Customer STAR

An Abstinence-Based Model Requires Intensive Engagement of the Customer Requires Ninety-Day Minimum Engagement in Treatment Based on Best Practices for Addiction Services Recognizes That No Single Recovery Plan Is Appropriate for All Individuals Recovery Services Need to Be Readily Available Recognizes That Relapse May Be A Part of Recovery Individual Customers With Co-Existing Psychiatric Disorders Should Have Both Disorders Treated in An integral Way

Addiction Recovery Principles Recovery Is A Long-Term Process and Frequently Requires Multiple Episodes of Care The Process of Recovery Has a Spiritual Component and Is Enhanced by Peer Support, Mentoring, and a Therapeutic Community Approach Among Other Methods Recovery Leads to An Established Life-Change Conducive to a Healthy, Productive Life-Style, and Is Not Merely the Discontinuance of Use of An Addictive Substance

Addiction Recovery Principles (Cont.) Detoxification Is Only The initial Stage of Addiction Recovery And By Itself Does Little to Change Long- Term Use Addiction Recovery Does Not Need to Be Voluntary to Be Effective

Main Components On-Going Assessment and Evaluation Multiple Withdrawal Management Programs PI Shelters Detainee Shelters Withdrawal Management Within Programs Medical Detoxification Services Pre-Recovery Interim Service Providers Intensive Recovery Programs (IRPs)

Main Components (Cont.) Basic Elements to Support Recovery for Successful Outcomes Specialized Programs Women’s Co-Occurring Chronic Other

On-Going Assessment & Evaluation Assessment and Evaluation Are Continual Processes Throughout the Customer’s Involvement with STAR Utilizes ASAM Criteria for Proper Placement May Include Informal as well as Formal Assessment Methods Effective Assessment and Subsequent Care Attends to Multiple Needs of the Individual, Not Just His or Her Use of Substances

On-Going Assessment & Evaluation (Cont.) Includes an Initial Screening for Risk of HIV, STDs, TB, and Hepatitis with Appropriate Referrals for Service Continuous Monitoring of Alcohol and Other Drug Use During Treatment Can Help the Individual Withstand Urges to Use Alcohol and Other Drugs

Withdrawal Management Utilize Withdrawal Protocols Primarily a Non-Medical Model Withdrawal Symptom Management Utilization of Medical Management as an Adjunct to Other Recovery Services Methadone, Naltraxone, Buprenorphrine, other appropriate medications Availability of Medical Detoxification Services (<5%)

Pre-Recovery Interim Services If a Customer Is Assessed and Found Not Yet Ready for Treatment, the Following Pre-Recovery Interim Services Must Be Available Motivational Counseling Pre-Treatment Groups Referral for Public Health Services HIV, TB, etc. Pre-Natal Care Other

Intensive Recovery Programs (IRPS) 90 Day Minimum Engagement Easily Accessible to the Customer Residential, Outpatient, or a Combination Tied-In to Basic Elements for Successful Outcomes Peer Support/Mentors Housing Transportation Child Care Education JobTraining The Criminal Justice System

IRPS (Cont.) Coordination with Community Support Services On-Going Assessment and Evaluation (Both Formal and Informal) Co-Occurring Capable Three Phase Process

IRP – Phase 1 5 to 6 Weeks in Duration 12 to 18 Hours a Week Day and Evening Programming As Needed Didactic – Educational Component Weekend Activities/Involvement

IRP – Phase 2 The Following 6 Weeks Decreasing Intensity with Continuing Community Support More Attention to Individual Needs Vocational Educational Life-Skills

IRP – Phase 3 Transition to the Community Assessment of an Individual’s Progress, Strengths, and Support System Determines Discharge from the IRP Continuing Community Support Service Housing Assistance On-Going Education and Job Training Employment Opportunities Peer Support/Mentoring Identification of Therapeutic Intervention Needs Relapse Prevention/”Aftercare” Groups

Basic Elements for Successful Outcomes Staff (IRP and Community Care Coordinators) Shelter Transportation Child Care Therapeutic Community Model Training (CAC/CIS) and Cross-Training (SA/MH) Access to Vocational and Educational Training Employment Opportunities

IRP Staff Mix of Clinical/Non-Clinical, Recovering/Non- Recovering, Degreed/Non-Degreed Educational Background and Experience Consistent with Job Function Nuturing, Empathetic, and Supportive, but Not Enabling Well-Trained in Job Role Cross-Trained Regarding Co-Occurring Disorders Philosophy of Care Congruent with Best Practices

Clinical Input Into Recovery Process Clinicians Will Be Used to Provide Quality Control Clinicians Will Utilize Assessment Criteria (ASAM Placement, ASI, SASSI, Etc.) Clinicians Will Provide Therapeutic Interventions When Needed as an Adjunct to Recovery

Community Care Coordinators (CCC’S) Outreach After-Care Case Coordination Community Treatment Resources Development Utilization of Local Recovering Individuals as CCC’s Enhances Outcomes for the Custome Utilization of Peer Recovery Network

Peer Support Services Peer Support is: Being open to new ways of thinking about our experience Re-defining help and helping A way of thinking about relationships and power that is mutual Considering the effects of trauma and abuse on people’s self-concept and relationships Mutually supportive and mutually responsible Teaching and learning from each other An opportunity to challenge the status quo About recovery and transformation Peer Support is not: An expert telling you what your experience means Telling someone what to do Superficial power-down relationships Telling you you’re sick and socially unacceptable One way relationships where one person takes responseibility for the other Being told or learning about diagnoses and treatment Protecting people from taking risks that are “too stressful” About stability and maintenance

Shelter (Transitional Living) Comfortable, Home-Like, Family Atmosphere Safe, Secure, Nurturing Therapeutic Community Life-Skills Training Provides for Personal Safety and Safety of Belongings Provides for Secure Medication Management

Transportation Must Be Provided Within the Program Transportation To and From the Program Transportation for Attending Program Elements Must Be Provided as a Part of Community Support Transportation to Vocational and Educational Training Transportation to Peer Support Meetings and Other Support Elements Transportation to Relapse Prevention/”Aftercare” Groups May Be Provided in Collaboration with Other Agencies and Programs

Child Care Required of All Programs Serving Women Must Offer Prevention Programming for the Children Trained Community Volunteers Coordinated by the CDs

Specialized Programs Long-Term Chronic Unit Women’s Programs Co-Occurring Enhanced Unit

Long-Term Chronic Unit Chronic Addicts Only 9 Months to 2 Years in Duration Homeless Unemployed No Support System Multiple Treatment Failures Medically Compromised 9 Months to 2 Years in Duration Court-Ordered or Committed

Provides Physical/Health Care Provides Opportunities for Therapeutic Use of Time Therapeutic Community Approach Educational Groups Peer Support/Fellowships Step-Down Program Strong Discharge Plan Long-Term Chronic Unit (Cont.)

Women’s Programs Emphasis on Pregnant Women and Women with Dependent Children Residential with 6 Month Minimum Stay Must Meet Federal Guidelines for Women’s Programs Groups Specific to Women’s Needs Abuse Anger Management Parenting Others Medical Care Including Pre-Natal Care If Needed Child Care Other

Women’s Programs (Cont.) Must Provide Extensive Wrap-Around Services Must Provide the Basic Elements for Successful Outcomes of STAR

Co-Occurring Enhanced Program All Referrals from MICA Units Access to Psychiatrist Medical and Medication Management, Including Psychotropic Medications Cross-Trained Staff

Outcomes Outcome evaluations must be collected at 3 months, 6 months, and 1 year after discharge Continuing community support services must be provided during this time with a frequency and intensity congruent with the individuals needs

GOOD-BYE Thank You for Your Attention and Support