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

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?

How would you define recovery?

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.

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.

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

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.

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.

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.

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

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

The Iowa Experience

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.

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.

IndividualFamily

Community

Recovery

Wellness Health

SAMHSA/CSAT

ROSC encompass and coordinates the operations of multiple systems…

IndividualFamily

Community

Family/Child Care

Housing/Transportation

Financial

Legal Case Mgt

VSO & Peer Support

Physical Health Care

PTSD & Mental Health

Alcohol and Drug

VocationalEducational

Spiritual

Addiction Services System

Mental HealthSystem

Primary Care System

Child Welfareand FamilyServices

Housing System

Social Services

Health Insurance

DoD & Veterans Affairs

Indian HealthServices

Criminal JusticeSystem

Vocational Services

HIV Faith Community

HealthWellness

Services & Supports

Systems of Care

Recovery

Problem Gambling

SAMHSA2010

Systems of Care

Services & Supports

Individual Family

Community

Evidence Based

PracticeCost

Effective

Perception of Care

Retention

Access/Capacity

Social Connectedness

Safe Housing

Reduced Crime

Employment

Abstinence

RECOVERY

HEALTHWELLNESS

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

InterventionSober Living

Family Treatment

HousingEmployment

Coalitions

Child Care

Care CoordinationTransportation

EducationVocational

Iowa’s System of Care  

16

Medication Assisted Treatment

2011

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

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.

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)

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.

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/Hygiene

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 Cards Transportation 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.

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.

The Massachusetts Experience

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.

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

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

So . . . Where do we go from here?

Thank you!Any further questions or comments?

Contact Information

Mark Vander LindenExecutive OfficerIowa Department of Public Health515-281-8802 mark.vanderlinden@idph.iowa.gov

Jim WuelfingDirector of Prevention and RecoveryMassachusetts Council on Compulsive Gambling617-426-4554 or jim@masscompulsivegambling.org