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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
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
When problems are of later onset and lower severity, many persons resolve them on their own or through brief intervention outside specialized addiction treatmentSustained abstinenceSustained moderated AOD useContinued sub-clinical problemsMove between patterns
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
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
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
Community studies of recovery from alcohol dependence report long-term recovery rates approaching or exceeding 50%.
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.
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
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.
(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
(O'Brien & McLellan, 1996)
Addiction Alcohol Opioid Cocaine Nicotine
30-50%30-50%30-50%30-50%
50%40%45%70%
Insulin Dependent Diabetes Medication Diet and Foot Care
<50%<50%
30-50%30-50%
Hypertension Medication Diet
<30%<30%
50-60%50-60%
Asthma Medication <30% 60-80%
Intervene earlier in the progression of the disease
Improve treatment outcomes
Support sustained recovery
Outreach Engagement and
intervention services
Recovery guiding or coaching
Post treatment monitoring and support
Abstinence → WellnessRecovery Support Services
Sober or supported housing
Transportation Childcare Legal services Educational/
vocational supports
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
servicesChange in nature of helping
relationship
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
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)
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)
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)
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 dataAs outcomes at the population level
(not just program level)
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)
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
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)
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)