1. Post Treatment: How Do We Support Problem Gamblers in Recovery Mark Vander Linden, MSW Iowa Department of Public Health Jim Wuelfing, NRPP Massachusetts Council on Compulsive Gambling

2. Overview of the Session What do we do now to support recovery? Defining recovery Supporting all pathways to recovery What do we mean by recovery support services? Two state experiences Iowa Massachusetts Where do we go from here?

3. How would you define recovery?

4. A recovery definition A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.

5. Four major dimensions that support a life in recovery Health: Overcoming or managing one's disease(s) as well as living in a physically and emotionally healthy way. Home: A stable and safe place to live. Purpose: Meaningful daily activities, such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income, and resources to participate in society. Community: Relationships and social networks that provide support, friendship, love, and hope.

6. Supporting All Pathways to Recovery Scope of Recovery Primary Primary and Secondary Types of Recovery Abstinence-based Moderation-based Medicated-assisted Context of Recovery Solo Treatment-assisted Peer-assisted Framework of Recovery Religious Spiritual Secular Recovery Identity Neutral Recovery-positive Recovery-negative Recovery Termination In Recovery Recovered Recovering

7. ROSC Recovery oriented systems of care are health and human service organizations that affirm hope for recovery, exemplify a strength- based (as opposed to pathology-focused) orientation, and offer a wide spectrum of services aimed at the support of long-term recovery.

8. Recovery Oriented Systems of Care (ROSC) Focus on A strength-based recovery focus (rather than pathology focus) on all services Long-term recovery moving away from an acute care model for the treatment of a chronic illness Partnerships emphasizing recovery-linked service practices Community components geared toward building recovery capital.

9. Recovery Community Organization Is an independent, non-profit organization led and governed by local communities of recovery. The broadly defined recovery community – people in long-term recovery, their families, friends and allies, including recovery-focused addiction and recovery professionals – includes organizations whose members reflect many pathways to recovery.

10. Defining Peer Recovery Support Peer-based recovery support is the process of giving and receiving non-professional, non-clinical assistance to achieve long-term recovery from severe alcohol and/or other drug-related problems. This support is provided by people who are experientially credentialed to assist others in initiating recovery, maintaining recovery, and enhancing the quality of personal and family life in long-term recovery. From Peer-based Addiction Recovery Support: History, Theory, Practice and Scientific Evaluation by William L. White

11. Recovery Support Services All-Recovery Groups Recovery Training Series Family Support Groups Recovery Housing Project Recovery Social Events Recovery Works! Telephone Recovery Support Recovery Coaching

12. The Iowa Experience

13. Iowa’s ROSC Definition ROSC 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 and problem gambling. A ROSC offers a comprehensive menu of services and supports that can be combined and readily adjusted to meet the individual’s needs and chosen pathway to recovery.

14. V A ROSC is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. Individual Family Community Recovery Wellness Health SAMHSA/CSAT

15. ROSC encompass and coordinates the operations of multiple systems… Individual Family Community Family/ Child Care Housing/ Transportation Financial LegalCase Mgt VSO & Peer Support Physical Health Care PTSD & Mental Health Alcohol and Drug Vocational Educational Spiritual Addiction Services System Mental Health System Primary Care System Child Welfare and Family Services Housing System Social Services Health Insurance DoD & Veterans Affairs Indian Health Services Criminal Justice System Vocational Services HIV Faith Community HealthWellness Services & Supports Systems of Care Recovery Problem Gambling SAMHSA 2010

16. Systems of Care Services & Supports Individual Family Community Evidence Based Practice Cost Effective Perception of Care Retention Access/ Capacity Social Connectedness Safe Housing Reduced Crime Employment Abstinence RECOVERY HEALTH WELLNESS Child Welfare Human Service Housing Vocational Insurance Veterans Affairs DOD Criminal & Juvenile Justice Primary Care Mental Health Addiction Public Health SA/GA Treatment SA/GA Prevention Mental Health Treatment Peer Support Recovery Calls Recovery Peer Coaching Spiritual Life Skills Intervention Sober Living Family Treatment Housing Employment Coalitions Child Care Care Coordination Transportation Education Vocationa l Iowa’s System of Care 16 Medication Assisted Treatment 2011

17. Problem Gambling Recovery Support Services A broad array of client-selected provider or community-based supports and services intended to further enhance and further the client’s recovery journey. Introduced in July 2011 Maximum client benefit = $1,400 or amount approved by IDPH. Based on Access to Recovery (ATR) menu of services

18. Principles of Recovery Support 1. Individuals have the right to choose recovery and the recovery-related services and supports that best meet their needs. 2. Client choice is enhanced by a recovery-oriented system of care that honors each client’s familial, cultural, spiritual, economic and logistical needs. 3. Individualized choice enhances client retention in treatment and strengthens client commitment to and success in recovery.

19. Eligibility to receive Recovery Support Services Resident of the state of Iowa. Admitted to treatment as a problem gambler for a minimum of 30 days. Inability to pay for recovery support service based on one of the following: Client at or below 200% of the Federal Poverty Level Burden of gambling related debt drives the client income at or below 200% of the Federal Poverty Level Client is without other financial resources to pay for the service(s)

20. Recovery Support Services Life skills coaching Individual coaching with clients to develop the skills that help individuals make informed decisions, manage finances, communicate effectively and develop coping and self management skills that assist their recovery. Housing Assistance Short term housing in a safe and recovery-oriented environment for clients with no other housing alternatives conducive to recovery. Housing may be provided in a facility for individuals in recovery or in a facility providing related services in the community. Recovery Peer Coaching Face-to-face meetings and recovery calls between the client and a recovery Peer Coach to discuss routine recovery issues from a peer perspective. A maximum of 4 hours of contact per month will be reimbursed. Electronic Recovery Support Messaging One-way electronic communication sent to a client intended to support recovery, improve health, life quality and wellness.

21. Recovery Support – Supplemental Needs Utility Assistance Assistance provided for the purpose of addressing past due utilities or deposits that will assist in establishing or maintaining their residence. Utility assistance can be used for past due bills that are interfering in the client’s ability to obtain housing. Clothing/Hygie ne Assistance proved to purchase clothing and hygiene products that supports the client’s recovery. Hygiene products are limited to soap, shampoo, toilet paper, toothpaste, deodorant, shaving needs, laundry detergent, feminine hygiene products and dental products. Education Assistance provided for the purpose of completing or continuing educations. This service may be used for GED coursework and testing, English as a second language classes (ESL), or educational materials and tuition at a secondary educational institution. Gas CardsTransportation assistance in the form of gas cards to be given directly to the client for the purpose of transportation to and from an activity related to a client’s recovery. Gas cards may not be used solely for the purpose of transportation to and from work. Client must provide proof of gas purchase.

22. Recovery Support – Supplemental Needs (cont’d) Supplemental Needs Wellness Assistance provided to clients for the purchase of items or services that support improved health. This may include an eye exam or the purchase of eye glasses or contact lenses, fitness memberships (excluding family memberships), smoking cessation, or nutrition counseling. Supplemental Needs Housing Rental Assistance Assistance provided to clients for housing rental costs incurred in the client’s name and conducive to the client’s recovery. Client must provide proof of lease. Rent cannot be paid to a family member. Supplemental Needs Bus/Cab Transportation by bus or cab to and from an activity related to the client’s recovery.

23. The Massachusetts Experience

24. Development of an Internal Policy Affirms support of all employees in recovery List some supports and the willingness to make accommodations Discusses relapse and possible responses.

25. Recovery Rationale Affirms that intervention and treatment works but there is a need to better support recovery Affirms 12 step programs in supporting recovery Discusses singleness of purpose Discusses the need to assist in overcoming obstacles in early recovery Lists recovery support services

26. Recovery Support Services Recovery space An array of weekly 12-step and other self-help meetings at the office Collaborating with the six recovery centers and four recovery high schools Collaborating with Massachusetts Organization for Addiction Recovery Annual weekend retreat All Recovery Retreat Telephone Recovery Support Recovery Coaching Social Enterprise Recovery Advisory Board

27. So... Where do we go from here?

28. Thank you! Any further questions or comments?

29. Contact Information Mark Vander Linden Executive Officer Iowa Department of Public Health 515-281-8802 mark.vanderlinden@idph.iowa.gov Jim Wuelfing Director of Prevention and Recovery Massachusetts Council on Compulsive Gambling 617-426-4554 or jim@masscompulsivegambling.org