1. ADAA Management Conference 2009 Virgil Boysaw and Sue Jenkins, Presenters

2.  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

4.  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.  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.  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.  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.  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.  Community studies of recovery from alcohol dependence report long-term recovery rates approaching or exceeding 50%.

10.  All based on acute models of care

11. 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.  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.  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. (Hubbard, Flynn, Craddock, & Fletcher, 2001); (Watkins, Pincus, Tanielian, & Lloyd, 2003)  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

15. (O'Brien & McLellan, 1996) Addiction Alcohol Opioid Cocaine Nicotine 30-50% 50% 40% 45% 70% Insulin Dependent Diabetes Medication Diet and Foot Care <50% 30-50% Hypertension Medication Diet <30% 50-60% Asthma Medication<30%60-80%

16.  Intervene earlier in the progression of the disease  Improve treatment outcomes  Support sustained recovery

17.  Outreach  Engagement and intervention services  Recovery guiding or coaching  Post treatment monitoring and support Abstinence → Wellness Recovery Support Services  Sober or supported housing  Transportation  Childcare  Legal services  Educational/vocational supports

18.  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.  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

21.  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.  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.  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.  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.  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.  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.  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. 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)