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Category: opioid epidemic

  • The Recovery Support that is Available Following Overdose

    What subsequently happens to people who experience a drug overdose and are successfully rescued through emergency medical intervention?

    What is their fate after they leave the hospital or other emergency care setting?

    Missing in the media coverage of the unrelenting legions of drug overdose deaths in the United States is an equally important but less heralded story. What happens to people who experience a drug overdose and are successfully revived through emergency medical intervention? What is their fate after they leave the hospital or other emergency care setting? The Connecticut Community for Addiction Recovery (CCAR)  and other  grassroots recovery community organizations (RCOs) nationwide are influencing positive outcomes to overdose by placing recovery coaches with first responders and doctors in the emergency departments in hospitals to advance recovery options for the revived overdose patients.

    The Connecticut Community for Addiction Recovery (CCAR) is one of several hundred recovery advocacy and recovery support organizations (RCOs) rising on the American landscape in the last two decades.  CCAR began piloting an Emergency Department Recovery Coach (EDRC) Program in March of 2017. Through this program, CCAR-trained recovery coaches are on-call for hospital emergency rooms to offer assistance to patients and their families during an emergency room visit resulting from an adverse drug reaction or other alcohol- or another drug-related medical crisis. An evaluation of EDRC services provided between March and November 2017 within four collaborating hospitals revealed the following. CCAR-trained recovery coaches provided recovery support services to 534 patients/families during the 8-month evaluation period with a relatively even distribution of services provided across the four hospitals. Of those served by the EDRC, the majority were in the ER due to an alcohol- or opioid-related condition; 70% were male; and 5% were seen more than once during the evaluation period. Most importantly, of the 534-people interviewed, 528 were assertively linked to a detoxification program, inpatient or outpatient treatment, or community-based recovery support resources.

    A more formal and sustained evaluation of the EDRC program is underway in collaboration with Yale University, and the program is now being expanded to an additional four hospitals. Funding support for the EDRC comes from the Connecticut Department of Mental Health and Addiction Services through support of the federal block grant and a Targeted Response to the Opioid Crisis Grant from the Substance Abuse and Mental Health Services Administration.

    CCAR’s EDRC program has many distinct features worthy of replication and local refinement. Among the more striking of such features are the following-

    • The EDRC program is governed by a formal agreement between CCAR and each participating hospital that delineates the roles and responsibilities of each party.
    • The EDRC program is currently staffed by one Recovery Coach Manager and 9 full-time Recovery Coaches (RCs).
    • Emergency Department Recovery Coaches (EDRCs) are recruited and screened (2 interviews with background and reference checks) based on desired experience, skills, and a good work history, but also for what our EDRC manager, Jennifer Chadukiewicz, calls “a servant’s heart.”
    • All EDRCs go through more than 60 hours of training and spend the first weeks shadowing tenured EDRCs. The training includes the CCAR Recovery Coach Academy© (30 hours) as well as topical trainings, e.g., Narcan (naloxone administration), medication-assisted recovery, ethical decision-making, crisis intervention, and conflict resolution. Hospital specific training includes such areas as fire/general safety, OSHA, blood borne pathogens, infection control, hazardous materials, and HIPPA regulations.
    • EDRC Recovery Coaches are employed by CCAR rather than the hospitals and enter the hospitals as service vendors and “guests” who defer to leadership of ER staff.
    • The RCs are paid a livable wage ($20-$25/hr. to start plus benefits, health insurance, etc.) that allows them to work full time and support themselves and their families while affording time away for rest and self-care.
    • EDRC coverage is provided from 8 am to 12 midnight, seven days a week, 365 days a year.
    • Patients have the option of enrollment in enhanced Telephone Recovery Support (TRS) program (i.e., patients receive daily support calls for the next 10 days and then weekly if desired).
    • EDRC’s provide assertive linkage and transportation (when needed) to treatment and recovery support resources.
    • The EDRCs spend considerable time with community providers and other stakeholders building collaborative relationships that facilitate this patient referral and service linkage process.
    • CCAR provides each hospital emergency department with “prescription pad” style resource handouts that can be attached to discharge paperwork and given to patient friend/family member.

    There are critical windows of vulnerability and opportunity within addiction and recovery careers that serve to plunge one deeper into addiction or mark the catalytic beginning of a recovery process. The reversal of a drug overdose or treatment of other drug-related medical crises can constitute a recovery tipping point.

    The emergency room is not the only critical point of potential intervention to reduce the risk of drug-related deaths and to promote addiction recovery. For persons with a history of addiction, the days and weeks immediately following release from a correctional facility, release from an inpatient or residential detoxification/treatment program without medication support, or cessation of medication-assisted treatment, and even transfer from one medication-assisted treatment provider to another all constitute a zone of heightened risk for re-initiation of risky drug use and death. Altering such risks and tipping the scales toward recovery stabilization, recovery maintenance, and enhanced quality of personal/family life in long-term recovery should be the goals of every community. Recovery community organizations like CCAR are showing us how this can be done.

    This blog was written by William White, Rebecca Allen & Phil Valentine. It was originally posted on the William White web site: www.williamwhitepapers.com on January 18, 2018

    Connecticut Community of Addiction Recovery (CCAR) is one of the nation’s first RCOs, CCAR pioneered what have since become standard RCO service fare: recovery-focused professional and public education, legislative advocacy, recovery community centers, recovery celebration walks and conferences, recovery support groups, training for recovery home operators, face-to-face and telephone-based recovery support services, family-focused recovery education and support services, and collaboration with research scientists on the evaluation of the effects of peer support on long-term recovery outcomes. As an example of its reach, CCAR’s Recovery Coach Academy curriculum has been used in the training of more than 20,000 recovery coaches in more than 33 states and in such countries as Sweden, Vietnam, Canada, and Spain.

  • Recovery Rising – A memoir of William L White

    Recovery Rising is the memoir of foremost recovery researcher and advocate, William L White. It has just been released on Amazon. White, for over five decades has had different roles in the addiction treatment field, beginning in Chicago’s inner city as a street worker working with addicts and the homeless, an addiction counselor, clinical supervisor, treatment administrator, educator, clinical and organizational consultant, and research scientist to being honored as the addiction field’s preeminent historian, one of the fields most visionary voices and a most prolific author.

    In Recovery Rising, William White’s ideas, methods, and organizational studies emerge to give the reader an idea on how dynamic a leader White is in the modern addictions field. These stories, sometimes poignant, sometime humorous always are revealing and informative. Williams White’s life work has been affirmed by this memoir and (hopefully) a younger generation of addiction advocates and professionals will be inspired by his story  to continue his good work.

    This link to his book on Amazon is:

    https://www.amazon.com/Recovery-Rising-Retrospective-Addiction-Treatment-ebook/dp/B07526ZDVD/ref=sr_1_1?s=books&ie=UTF8&qid=1506351061&sr=1-1&keywords=recovery+rising

  • What is a recovery coach?

    In 2013, I published Recovery Coaching – A Guide to Coaching People in Recovery from Addictions, since then the duties and responsibilities of recovery coaches, peer recovery support specialists and professional recovery coaches have expanded significantly.

    In this article, I hope to define some different recovery coaching titles for those interested in becoming a recovery coach, what certifications they should seek, the places they could work and what they can anticipate as compensation for their work.

    What kind of certification should a future recovery coach receive?

    Recovery coach training and certification is a requirement in this field. Coaching certification and training is one of the fastest growing aspects of the healthcare field. The number of recovery coaching training and certification courses has expanded to over 300 institutions nationwide. Many employers require recovery coach and peer recovery support specialist certifications. In the links section of this web site is a state by state listing of all the organizations that offer certifications for addiction recovery coaches. If you are reading this to receive basic recovery coaching information, first decide if you enjoy working with people in recovery from substance misuse or want to work with people in recovery from a mental health or behavioral health disorder.

    Are you interested in working with people in recovery from addictions or in recovery from a mental health or behavioral health diagnosis?

    A nearly universal definition of a peer recovery support specialist or a recovery coach is “an individual with the lived experience of their own recovery journey and wants to assist others who are in the early stages of the healing process from psychic, traumatic and/or substance misuse challenges, thus, this peer can aid and support another peer’s personal recovery journey”. Some certifications for a peer recovery support specialist give an individual the training necessary to work with individuals with a behavioral health disorder or a mental health diagnosis. These certifications include more training on the nature of behavioral health disorders, the medications used to treat these disorders, crisis interventions, life/occupational skills, and trauma informed care. A recovery coach working with people in addiction recovery does not necessarily need these types of training. In this article, I will focus on the recovery coach working with people in recovery from substance misuse.

    The individuals that work with people in recovery from substance misuse are called recovery coaches, as well as peer recovery support specialists (PRSS), peer recovery support practitioners (PRSP), recovery support specialists (RSS), sober companions, recovery associates or quit coaches. In all cases, they support individuals in recovery from addiction(s), which can include alcohol, drugs, gambling, eating disorders as well as other addictive behaviors.

    The basic recovery coaching credential is required. If you want recovery coaching certification, google this term with the region you live in. For addition recovery coaching education, I suggest: adding certification for treating co-occurring disorders, training on the application of Narcan which includes the certification for coaching persons detoxing from an opioid overdose, also certification for counseling individuals in Suboxone or Methadone treatment also called Medication Assisted Treatment (MAT) and Medication Supported Recovery (MSR), certification for spiritual recovery coaches and credentials for coaches working with individuals with behavioral addictions such as sexual compulsivity, internet gaming and gambling disorders. If you would like to work in an inpatient treatment center, drug and alcohol counseling certification maybe required.

    Recovery coaching credentialing has expanded to include coach supervision certification, which is training for individuals who want to manage other recovery coaches. Also there is an elevated level of certification called professional recovery coaching. A professional recovery coach is an individual that has been coaching for several years, has hundreds of coaching hours under their belt, manages other coaches and/or has received other coaching credentials. A professional recovery coach is sometimes referred to as a life recovery coach. A professional recovery coach can receive training from any of the organizations that train peers or recovery coaches, and in addition, they can receive training from the International Coach Federation’s accredited life coach training program or a professional recovery coach certification from Recovery Coaches International. Recently, Connecticut Community of Addiction Recovery (CCAR) has started developing a Professional Coaching Certification.

    Where do you want to work?

    Some recovery coaches seek to work at a recovery community organization (RCOs) or a recovery support center. An RCO is an independent, non-profit organization led and governed by representatives of local communities of recovery. The recovery coaches at these recovery community organizations work with people of all financial means, addicts that are homeless, offenders, even professionals like nurses, teachers, lawyers and highly educated individuals, who have hit bottom. Sometimes, the recovery coaches at these centers receive a salary from the RCO. RCO recovery coaches can also be volunteers, opting to perform their coaching duties for no reimbursement at all.

    Recovery coaches can be employed by treatment centers coaches, developing a coaching relationship with a client outside of the clinical treatment. They can escort a client home from a treatment center and stay with the client for a period of time, insuring they do not relapse after discharge. More half way houses or sober living environments are employing recovery coaches. In fact, many recovery coaches have opened a transitional living home or a supportive sober living environments. They act as a recovery coach and a house manager at the same time, their presence adds to the quality of the recovery experience for the residents. Recovery coaches can work in emergency departments in hospitals, detoxification centers or sobering centers; working with individuals in crisis, either detoxing from an alcohol or opioid overdose.

    Lastly, some recovery coaches run their own coaching business. They will visit clients or talk with them over the phone or on SKYPE. These recovery coaches market themselves by contacting a treatment center’s aftercare coordinator or will seek referrals from therapists. The client is billed directly for the coaching services, there is no insurance coverage for a recovery coach.

    How much do you want to be paid for your services?

    Recovery coaches are paid a variety of rates. A recovery community organization, a treatment center, sober living environment or social services agency recovery coaching rates are from $12-$18 per hour. If a recovery coach receives their salary from a social services agency, or a recovery community organization that agency may have received a grant to run a peer program from the State or Federal government.

    A professional life recovery coach can bill from $35 up to $100 an hour for their coaching services. These professional recovery coaches bill their clients directly and incur expenses for running their coaching practice such as insurance, travel and overhead. This ‘pie in the sky’ $100 per hour fee of a professional recovery coach is not for the inexperienced or newbie coach. There are significant responsibilities a recovery coach has for their client, primarily keeping them free from relapse or overdose, or in other words- keeping them alive.

    Soon, there will be reimbursement from health insurance companies for recovery coaching for individuals who are diagnosed as dependent on a substance. New York has an arrangement with the state’s Medicaid offices to reimburse for recovery coaching for individuals who are diagnosed as dependent on a substance. Other states, Tennessee, Pennsylvania, Maryland and Massachusetts, are formulating similar Medicaid payment plans, but these reimbursements are not yet in place. However, currently, private independent health insurance companies do not cover the services of a recovery coach working with an individual in recovery from an addiction.

    In less than five years the field of recovery coaching has grown significantly. With the advent of the Affordable Care Act and the legislation to fight addiction, the 21st Century CURES and the CARA Acts, recovery coaching is now recognized as one of the most important tools to initiate and maintain long term recovery. This recognition will continue as the benefits from recovery coaching continue to be realized.

     

  • Lions, Tigers, Bears and the Yellow Brick Road to Recovery

    This is a guest post by Steve Devlin, a recovery coach from Philadelphia PA, and a long time friend. I chose to post this over the Holiday weekend, because it brings me such joy, and brings back wonderful memories of watching the Wizard of Oz on TV during the 60’s. Thank-you Steve, and Happy Holidays to all of my readers.

    Over the past week, I have been thinking about the Serenity Prayer and its connection to the Wizard of Oz.  Some of you might be looking at your computer and wonder if I have lost my mind.  I beg for your patience and to hear me out.  First a caveat or two.  I represent only myself in this message.  The second caveat is this message was inspired by a share I heard at a 12-step meeting.  The person who said it gave me permission to use it.  So here we go!

    We all know the Serenity Prayer.  “May God grant me the serenity to accept the things I cannot change, the courage to change the things that I can, and the wisdom to know the difference.”  And almost everyone knows the story of the Wizard of Oz or at least the movie version of the story. Dorothy is not happy with life on the farm, runs away, is swept up in a tornado, lands in a strange place, and gathers three companions on her journey to the Emerald City to meet the Wizard.  On the way, she must deal with witches – good and bad – flying monkeys, and castle guards before she finds she always had the power to grant her wish of returning home.

    So what does this story have to do with the Serenity Prayer, let alone recovery?  We cannot find fulfillment, happiness, or peace in our lives. We run away and just when we realize that we have run too far, we are swept up in the tornado (or drug of our choice).  Its path of destruction destroys the landscape of our lives and carries us far away. Thankfully, when the storm passes we land in a new brightly-colored world filled with sober people singing about the blessings of recovery.  Yet our own work is just beginning.  There is a road we must follow with steps leading to the Emerald City of sobriety.  We also learn that we cannot walk the path alone.  There are still temptations, flying monkeys, people, places, and things calling us back to the darkness.  However, as we follow the path we first find the companion of serenity – the heart to love ourselves and others.  A new heart also gives us the gift of forgiveness and acceptance.

    The second companion is the courage to move forwards even when encountering lions, tigers, and bears.  It is courage which lets us turn over our lives, let go of character defects, and make amends.  It is also courage that lets us pick up the phone or go to a meeting.

    Finally, there is wisdom, which gives us the ability to see choices in our lives and to know what we can and cannot change.  After long periods of feeling tied up like a scarecrow on a post, we are set free to walk a brick road of new life.  Of course, finding these three companions to fight back addiction is only part of the story and the Emerald City is not the ultimate destination.  Our companions bring us to the shining light of recovery, but we must take the gifts back home and use them in our daily lives outside of the rooms.

    I wish recovery was as easy as clicking our heals together.  Finding our way home takes work but with heart, courage, and wisdom we can overcome all the flying monkeys and stay out of the way of tornadoes.  We also learn that the greatest companion of recovery is gratitude which was always just in our own backyard.

    Question: Who are your companions on the brick road?

  • What is a recovery coach?

    What is a recovery coach, a peer recovery support specialist or a professional recovery coach?

    In 2013, I published Recovery Coaching – A Guide to Coaching People in Recovery from Addictions, since then the duties and responsibilities of recovery coaches, peer recovery support specialists and professional recovery coaches have expanded significantly.

    In this post, I hope to help define for those interested in becoming a recovery coach what certifications they should seek, the places they could work and what they can anticipate as compensation for their work.

    What kind of certification should a future recovery coach receive?

    Recovery coach training and certification is a requirement in this field. Coaching certification and training is one of the fastest growing aspects of the healthcare field. The number of recovery coaching training and certification courses has expanded to over 300 institutions nationwide. Many employers require recovery coach and peer recovery support specialist certifications. In the links section of this web site is a state by state listing of all the organizations that offer certifications for addiction recovery coaches.

    If you are reading this post to receive basic recovery coaching information, first decide if you enjoy working with people in recovery from substance misuse or want to work with people in recovery from a mental health or behavioral health disorder.

    Are you interested in working with people in recovery from addictions or in recovery from a mental health or behavioral health diagnosis?

    A nearly universal definition of a peer recovery support specialist or a recovery coach is an individual with the lived experience of their own recovery journey and wants to assist others who are in the early stages of the healing process from psychic, traumatic and/or substance misuse challenges, thus, this peer can aid and support another peer’s personal recovery journey.

    Some certifications for a peer recovery support specialist give an individual the training necessary to work with individuals with a behavioral health disorder or a mental health diagnosis. These certifications include more training on the nature of behavioral health disorders, the medications used to treat these disorders, crisis interventions, life/occupational skills, and trauma informed care. A recovery coach working with people in addiction recovery does not necessarily need these types of training. In this blog, I will focus on the recovery coach working with people in recovery from substance misuse.

    The individuals that work with people in recovery from substance misuse are called recovery coaches, as well as peer recovery support specialists (PRSS), peer recovery support practitioners (PRSP), recovery support specialists (RSS), sober companions, recovery associates or quit coaches. In all cases, they support individuals in recovery from addiction(s), which can include alcohol, drugs, gambling, eating disorders as well as other addictive behaviors.

    The basic recovery coaching credential is very broad. If you want more specific training, one can add certification for treating co-occurring disorders, the application of Narcan which includes the certification for coaching persons detoxing from an opioid overdose, certification coaching individuals in Suboxone or Methadone treatment also called Medication Assisted Treatment (MAT) and Medication Supported Recovery (MSR), certification for spiritual recovery coaches and credentials for coaches working with individuals with behavioral addictions such as sexual compulsivity, internet gaming and gambling disorders.

    Recovery coaching credentialing has expanded to include training for individuals that want to supervise other recovery coaches, or an elevated level of certification called professional recovery coaching.

    A professional recovery coach is an individual that has been coaching for several years, has hundreds of coaching hours under their belt, manages other coaches and/or has received other coaching credentials. A professional recovery coach is sometimes referred to as a life recovery coach. A professional recovery coach can receive training from any of the organizations that train peers or recovery coaches, and in addition, they can receive training from the International Coach Federation’s accredited life coach training program. Recently, Connecticut Community of Addiction Recovery has started developing a Professional Coaching Certification.

    Where do you want to work?

    Some recovery coaches seek to work at a recovery community organization (RCOs) or a recovery support center. An RCO is an independent, non-profit organization led and governed by representatives of local communities of recovery. The recovery coaches at these recovery community organizations work with people of all financial means, addicts that are homeless, offenders, even professionals like nurses, teachers, lawyers and highly educated individuals, who have hit bottom. Sometimes, the recovery coaches at these centers receive a salary from the RCO. RCO recovery coaches can also be volunteers, opting to perform their coaching duties for no reimbursement at all.

    Recovery coaches can be employed by treatment centers coaches often escort a client home from a treatment center insuring they do not relapse in the first 30 days after discharge. More half way houses or sober living environments are employing recovery coaches. In fact, many recovery coaches have opened a transitional living home or a supportive sober living environments. They act as a recovery coach and a house manager at the same time, their presence adds to the quality of the recovery experience for the residents.

    Recovery coaches can work in emergency departments in hospitals, detoxification centers or sobering centers; working with individuals in crisis, either detoxing from an alcohol or opioid overdose.

    Lastly, some recovery coaches run their own business. They will visit clients or call them over the phone or use SKYPE. These recovery coaches market themselves by contacting a treatment center’s aftercare coordinator, maintaining a web site or will seek referrals from therapists. These coaches meet face to face with the client weekly and will work with them over the phone or face to face on a regular basis. The client is billed directly for the coaching services.

    How much do you want to be paid for your services?

    Recovery coaches are paid a variety of rates. A recovery community organization, a treatment center, sober living environment or social services agency recovery coaching rates are from $12-$20 per hour. If a recovery coach receives their salary from a social services agency, or a recovery community organization that agency may have received a grant to run a peer program from the State or Federal government.

    A professional life recovery coach can bill from $35 up to $100 an hour for their coaching services. These professional recovery coaches bill their clients directly and incur expenses for running their coaching practice such as insurance, travel and overhead. This ‘pie in the sky’ $100 per hour fee of a professional recovery coach is not for the inexperienced or newbie coach. There are significant responsibilities a recovery coach has for their client, primarily keeping them free from relapse or overdose, or in other words- keeping them alive.

    Soon, there will be reimbursement from health insurance companies for recovery coaching for individuals who are diagnosed as dependent on a substance. New York has an arrangement with the state’s Medicaid offices to reimburse for recovery coaching for individuals who are diagnosed as dependent on a substance. Other states, Tennessee, Pennsylvania, Maryland and Massachusetts, are formulating similar Medicaid payment plans, but these reimbursements are not yet in place. However, currently, private independent health insurance companies do not cover the services of a recovery coach working with an individual in recovery from an addiction.

    In less than four years the field of recovery coaching has grown significantly. With the advent of the Affordable Healthcare Act and the newest legislation to fight addiction, the 21st Century CURES and the CARA Acts , recovery coaching is now recognized as one of the most important tools to initiate and maintain long term recovery. This recognition will continue as the benefits from recovery coaching continue to be realized.

  • Getting through the tough times

    As a recovery coach, I often see my clients need help getting through the tough times, without using, picking up or acting out. Recently, I personally encountered some rough patches in my life, so, I went to my library of recovery books. Several years ago, when I was experiencing trouble living life on life’s terms, I became an avid reader of Pema Chodron.

    Pema Chodron Celebrates her 80th Year

    Pema Chodron, is a Buddhist nun, she was born in 1936, in New York City, and is celebrating her 80th year. After a divorce, in her mid-thirties, Pema traveled to the French Alps and encountered Buddhist teacher Lama Chime Rinpoche, and she studied with him for several years. She became a novice Buddhist nun in 1974. Pema moved to rural Cape Breton, Nova Scotia in 1984, ­­­to be the director of Gampo Abbey and worked to establish a place to teach the Buddhist monastic traditions (waking before sunrise, chanting scriptures, daily chores, communal meals and providing blessings for the laity). In Nova Scotia and through the Chodron Foundation, she works with others, sharing her ideas and teachings. She has written several books, and in my time of deep spiritual need, I went to her book “When Things Fall Apart”.

    A Compassionate Tool

    Drawn from traditional Buddhist wisdom, Pema’s radical and compassionate advice for what to do when things fall apart in our lives helped me. There is not only one approach to suffering that is of lasting benefit, Pema teaches several approaches that involve moving toward the painful situation and relaxing us to realize the essential groundlessness of our situation. It is in this book, I discovered a simple breathing exercise, I can use during these chaotic times so I can move into a better space. Pema advocates this tool as a breathing exercise, although this exercise could also be considered a mindful meditation.

    I use Chodron’s tool whenever and wherever life hits me below the belt. I share this tool with my clients. It is all about breathing and consciously repeating words to yourself to accompany the breathing. Since we breathe every day, it is indiscernible whether you are using this tool as you travel on the bus commuting home from work, in a conference room with your boss, or when you are feeling low and want to curl up in a ball and die.

    Breathe

    Breathe. Pema explains in her book, when things get way too complicated; step back and breathe. When the force of the world, the politics of the U.S., Great Britain or Italy start weighing heavily on your mind, breathe. When you look at all the pain around you and feel powerless to do anything, breathe.

    Pema explains, inhale and say silently to yourself breathe in the pain, then exhale and say breathe out relief. Then, inhale, and say silently to yourself breathe in the relief, and exhale and say breathe out the pain. I find I need about 15 minutes of conscious breathing, breathing in the pain and breathing out relief, works for me. After doing this, I find I have new energy or something else crosses my path to move me into a more uplifting space.

    Chodron’s exercise places me in a space I need to be. If I continue to be in that “negative space” of worry or feeling powerless, then absolutely nothing will be accomplished that day. I know we all have something to accomplish every day, whether it is just getting out of bed, taking a shower and brushing our teeth or running a Fortune 500 company, this exercise gets us from zero to ten in fifteen minutes. It is the boost we need.

     So, I invite you to try this simple exercise…and remember…keep breathing

     

  • A new ER resource – recovery coaches

    manhattan_bridgeIn Rhode Island, more than 1,000 addicts have been brought from the edge of death due to an opioid overdose, thanks to first-responders and emergency room workers using the new lifesaving drugs Narcan and Naloxone. When patients are overdosing, first-responders or ER nurses administer these new drugs, which reverse an opioid overdose. The ER staff members use it so often it’s become a verb, as in: “we Narcaned him.”

    In 2015, a pilot program to train law enforcement officers to use Narcan and Naloxone prefilled syringes or nasal spray was started in the New Jersey counties of Monmouth and Ocean. It has been successful in reversing over 400 potentially fatal overdoses. Narcan kits are now available in police cars, ambulances, public transportation centers and even at your local CVS. But the growing number of overdoses has stretched the emergency room doctors and nurses to a breaking point.

    When Narcan patients come to the ER, they can be angry and disorientated, when upon waking they find their high is gone. Emergency rooms are handling a lot of overdose patients, and the work can be frustrating. These patients are combative, upset, demeaning, often yelling or physically acting out. ER personnel, not trained in detox reactions, are perplexed. They are being pulled away from the people who have more medically-critical needs.

    In a relatively short period of time, Naloxone and Narcan are emerging as very one-dimensional treatments. They are lifesavers, but don’t treat the real problem that brings the patient into the emergency room. Another similar one-dimensional treatment is using a defibrillator for a heart attack, it saves the life but it doesn’t treat the heart disease. Using Narcan does not treat the disease of addiction.

    As a result, emergency room physicians, first-responders and treatment experts across the country say the same thing, without a mechanism to connect the overdose patients to addiction services, Narcan and Naloxone only create a revolving door in emergency rooms. Some addicts have returned from the edge of death four and five times, thanks to Narcan injections or nasal sprays.

    In Rhode Island’s hospitals, and in hospitals throughout New Hampshire and New Jersey, ER doctors have called on a relatively new resource to help: the recovery coach. These coaches are not ER employees but are part of a new plan to assist ER personnel in dealing with the detoxing victims of an opioid overdose. These recovery coaches work with the detoxing patients, allowing the ER staff to continue with their tasks of treating others that come into an emergency room. These recovery coaches are peers, many of them former addicts trained to work with an overdose patient coming down from the opioid. These coaches are trained to move the patients into long-term treatment programs for their drug addiction.

    “The goal of the LifelineED program is to get individuals who were Narcaned into detox and treatment,” says Sharon Chapman, program supervisor of the LifelineED program at Center for Family Services in Voorhees, NJ. “Our Recovery Coaches and Patient Navigators work with each individual to help get them into a treatment facility. It’s important for these patients to know they’re not alone, we offer support to help the patients and their families as they go through the recovery journey.”

    These recovery coaches offer peer-to-peer support. There’s nothing like being approached by another recovering drug addict who can help you in your time of need, who knows exactly what you’re going through at that moment. Often, they use information and resources that the hospital staff might not have, such as a list of treatment programs, how to go through the intake process, as well as spending time to educate addicts’ families about the treatment process and how to recognize early signs of the addiction. Of course, the patient decides whether they will take part in treatment, but willingness is the strongest when the patient realizes they just have been given a new “lease on life.” Emergency staff acknowledge it’s helpful to have recovery coaches who can spend time with a patient, and can begin moving them into treatment. These coaches know the recovery terrain better than the ER nurses and physicians. Patients have the option to go to a treatment center, or if they choose to go home, they take the recovery coach’s number with them. The recovery coach or the patient navigator will follow up with them, and assists in helping the patient take the next steps towards recovery. Overdose victims are willing to let recovery coaches into their homes to talk about the program immediately after their overdose. Some need time to come to the realization that if they don’t accept the offer of treatment, there may not be another opportunity. Finding the time for a home visit is something that the ER staff could never do.

    Funding for these ER Recovery Coaching programs is popping up all over the United States, since President Obama and Michael Botticelli, the Director of National Drug Control policy, have requested over $1 billion dollars to be placed into the 2017 budget to fight this growing opioid epidemic. This funding request surpasses the $400 million amount Obama signed for in the 2016 budget, which was a jump of $100 million over the 2014 budget, all in hopes of addressing this harrowing epidemic, which has ravaged communities in all corners of the U.S.

    If you are interested in learning more about working in an ER room as a recovery coach, here are some resources:

    Providence Center-AnchorED–

    Holly Fitting

    Phone: (401) 528-0123 / Email: hfitting@provcntr.org

    528 North Main Street,

    Providence, RI 02904

    https://providencecenter.org/services/crisis-emergency-care/anchored

    Attn: Melissa Silvey

    311 Route 108,

    Somersworth, NH 03878

    Phone: (603) 516-2562 / Email: info@onevoicenh.org

    Sharon Chapman, Program Supervisor

    108 Somerdale Rd,

    Voorhees NJ 08043

    http://www.centerffs.org/programs/lifelineed

    Phone: (856) 428-5699 x116 / Email: lifelineED@centerffs.org

    Attn.: Michael Santillo

    16 Spring Street

    Paterson, NJ 07501

    Phone: (973) 754-6784

    http://evasvillage.org/recovery-center.shtml

    • Barnabas Health Opioid Overdose Recovery Program

    Phone: (732) 914-3815

    1691 U.S. 9, Toms River, NJ 08754

  • A Call for Clinical Humility in Addiction Treatment

    by William White and video featuring Chris Budnick

    The history of addiction treatment includes a pervasive and cautionary thread: the potential to do great harm in the name of help.  The technical term for such injury, iatrogenesis (physician-caused or treatment-caused illness), spans a broad range of professional actions that with the best of intentions resulted in harm to individuals and families seeking assistance. My recounting of such insults within the history of addiction treatment (see endnotes 1, 2 and 3 below) also includes the observation that such harms are easy to identify retrospectively in earlier eras, but very difficult to see within one’s own era, within one’s own treatment program, and within one’s own clinical practices.

    The challenges for each of us who work in this special service ministry and for william_l_white_portrait_1the specialized industry of addiction treatment include conducting a regular inventory of clinical and administrative policies and practices to identify areas of inadvertent harm, altering conditions linked to such harm, making amends for such injuries, and developing mechanisms to prevent such injuries in the future. In my own professional life, many of the projects in my later career were products of such an inventory and served as a form of amends for actions I took or failed to take in my early career due to lack of awareness or courage. (See endnote 4 and 5 for two vivid examples.)

    There have also been times I have taken the larger field to task for practices I deemed harmful. I have suggested at times that what were perceived as personal failures to achieve lasting recovery could be more aptly characterized as system failures (endnote 6). I have suggested at times that the field was becoming addicted to professional power and money and that the field itself was in need of a recovery process that should include processes of rigorous self-inventory, public confession, and amends (endnote 7 and 8).

    The shift from acute care models of addiction treatment to models of sustained recovery management (RM) and recovery-oriented systems of care (ROSC) involves dramatic changes in clinical practices, including a shift in the basic relationship between the service provider and service recipient. The service relationship within the RM/ROSC models shifts from one dominated and controlled by the professional expert to a sustained recovery support partnership, with the provider serving primarily as a consultant to the service recipient’s own recovery self-management efforts. Those who have made this relational shift inevitably look back on areas of potential harm that emerged from the expert relational model they once practiced. And then the question inevitably arises, “How does one make amends for past harm in the name of help within the context of addiction counseling?”

    Chris Budnick, an addictions professional in North Carolina and founding Board Chair for Recovery Communities of North Carolina, Inc. (RCNC), recently responded to that question by preparing a formal letter of amends to the individuals, families, and communities he has served. Below is the text of that letter, which was presented at the North Carolina Recovery Advocacy Alliance Summit, February 24, 2016. (The link to the video is: https://www.youtube.com/watch?v=A5MYhZbnhfU)

    Chris-Budnick LCSW,LCAS,CC,MSWMy name is Chris Budnick and I am a Licensed Clinical Addiction Specialist. I first began working in the addiction treatment and recovery field in 1993. 

    There are many components involved in the broad issue of substance use disorders and recovery. Employers, first responders, the criminal justice system, policy makers, politicians, companies, advertisers, treatment providers, addiction professionals, the recovery community, families, and the individual with the substance use disorder. Of all these components, individuals with substance use disorders face the greatest scrutiny, stigma, discrimination and blame. For too long they have stood alone bearing the full brunt of this responsibility while systems of care and policies impacting housing, education, and employment have largely conspired to undermine any chance of sustaining recovery.

    Last week I found myself approaching a police department to apologize for failing them. When they reached out to us in the middle of the night seeking services for a young woman we told them “no.”  “We can’t help her tonight.”  She was killed within hours of this decision leaving behind a 2-year-old daughter.  I told the officer that we pledge to do better.

    This experience has nudged me to put to paper ideas that I’ve articulated and ideas I’ve only contemplated. I feel compelled as an addiction professional to make amends and pledge to do better.

    While I have changed my attitudes and practices over the years, I have not spoken up to say I’m sorry. So here are the things I want to make amends for:

    • I’m sorry for all the barriers you confront when trying to access help.
    • I’m sorry for contradictory “sobriety” and “active use” requirements you encounter when trying to access services.
    • I’m sorry for the harm that has come to you, your family, your unborn children, and your community when you have not been provided services on demand.
    • I apologize for expecting that you will provide all the motivation to initiate recovery when I have assumed no responsibility for enhancing your readiness for recovery.
    • I am sorry for creating unrealistic expectations of you.
    • I’m sorry for provider success statistics that have misled you and your family.
    • I’m sorry that I have discharged you from treatment for becoming symptomatic. I’m even more sorry, though, for abandoning you at your time of greatest vulnerability. And I am sorry for how this failure has contributed to the heartbreak of your loved ones.
    • I am sorry for abandoning you when you have left treatment, either successfully or unsuccessfully.
    • I am sorry for the irritation in my voice when you have returned following a set-back because you didn’t do everything that I told you to do.
    • I am sorry for my arrogance when I’ve assumed that I am the expert of your life.
    • I am sorry for privately finding satisfaction in your failure because it reinforces the fallacy that I know best and if you just do as I say, you’ll recover.
    • I am sorry for not celebrating as enthusiastically your successes when you have achieved them through a different pathway or style then me.
    • I am sorry for being a silent co-conspirator for the stigma that has resulted in systems of punishment and discriminatory policies and practices.
    • I’m sorry for turning you away from treatment because you’ve “been here too many times.”
    • I’m sorry for not referring you to different services when you have not responded to the services I offer.
    • I am sorry for allowing you to take the blame when treatment did not work instead of defending you because you received an inadequate dose and duration of care.
    • I am sorry for reaping the benefits of recovery yet failing to do everything I can to make sure those benefits are available to anyone, regardless of privilege, socio-economic status, education, employability, and criminal history.
    • I’m sorry for being an addiction professional who has not provided you with the recovery supports needed to sustain recovery. More importantly, I apologize for conspiring through silence and inaction with a system that ill prepares you to achieve success.
    • I’m sorry for not calling to check on you when you don’t show up for treatment. I’m sorry for not calling to support you after you leave treatment.
    • I’m sorry for letting society maintain the belief that you used again because you chose to.
    • I’m sorry for not fighting for adequate treatment and recovery support services. All persons with substance use disorders should be entitled to a minimum of five years of monitoring and recovery support services.
    • I’m sorry for not advocating for you to have opportunities to gain safe and supportive housing and non-exploitive employment.
    • I am sorry for being so self-centered that I only think about you in the context of treatment while failing to fully understand the environmental and social realities of your life and how they will impact your ability to initiate and sustain recovery.
    • I am deeply sorry to your loved ones who have been robbed of chances to have a healthy member of their family. I am deeply sorry to your community, who has been robbed of the gifts that your recovery could have brought them.
    • I’m sorry that systems of control and punishment has been the response to communities of color during drug epidemics.
    • I am sorry that through my silence and inaction that I have contributed to belief that persons with substance use disorders are criminals and should be punished.
    • I am sorry for not speaking as a Recovery Ally to families, friends, neighbors, colleagues, policy makers, and public officials about why I support recovery.
    • I’m sorry for all the things that I have left off this list because I’ve failed to regularly solicit your feedback about how effective I have been in supporting you in your recovery.

          This sorrow is the foundation of my commitment to improve the accessibility, affordability, and quality of addiction treatment and recovery support services and to create the community space in which long-term personal and family recovery can flourish.

                                  -Chris Budnick, Licensed Clinical Addiction Specialist

    This is a remarkable statement worthy of emulation. I look forward to the day when leaders prepare such a statement of amends to individuals, families, and communities on behalf of American addiction treatment institutions. I look forward to the day when clinical humility becomes a foundational ethic guiding the practice of addiction counseling.  WW

    I honor and applaud Bill and Chris for bringing this message to clinical professionals across the nation. It is time to shed and change these old models that have not been working and embrace these new tenants that Bill, Chris and many others espouse.  Truly such client-centered treatment can change the course of recovery for many. MK

    End Notes

    This post was previously published on William White’s web site- www.williamwhitepapers.com on April 29, 2016. William White and Chris Budnick authorized this reposting.

    Video: https://www.youtube.com/watch?v=A5MYhZbnhfU

  • Faces and Voices in Recovery Develops an Addiction Recovery Toolkit

    Faces and Voices in Recovery Partnering with Members of Congress to Offer Comprehensive Addiction Resources

    2016 logoFaces & Voices of Recovery, in collaboration with the Addiction Policy Forum and the House of Representatives Bipartisan Task Force to Combat the Heroin Epidemic developed a comprehensive addiction resources toolkit to help the families impacted by the heroin and opioid epidemic. This week, Members of Congress will unveil this toolkit on their websites and in their district offices and will train their office staff to provide key resources to families and individuals in their communities facing addiction. This toolkit is a resource that every recovery community organization, treatment center, doctor’s office, library as well as every family and individual should have access to.

    More Americans die every day from drug overdoses than from car accidents – an average of 129 people per day, with six out of 10 deaths related to opioids. This toolkit was developed in response to the fact that a majority of those who need help with addiction issues are not receiving it. In 2014, only 11 percent of the approximately 22.7 million Americans who needed treatment for substance use received it, according to the Office of National Drug Control Policy.

    “We are honored to partner with Members of Congress to offer individuals, families and communities important resources that will help them find support to achieve long-term recovery. We have offered our expertise for this toolkit and are pleased that Members of Congress understand the importance of making this information easily accessible and available in each Congressional district across the nation.”   -Executive Director Patty McCarthy-Metcalf

    Leading national and community organizations contributed to this comprehensive set of resources that includes resources around prevention, drug treatment, recovery support and general information for families, community organizations, schools, and parents concerned about addiction and seeking support. The groups who contributed to this guide include: Community Anti-Drug Coalition, the National Council, the National Association for Children of Alcoholics, the Partnership for Drug-Free Kids, Shatterproof, Faces & Voices of Recovery, Legal Action Center, National Institute of Drug Abuse, and the Office of National Drug Control Policy.

    In preparing this toolkit, Faces and Voices of Recovery strengthens it’s mission and dedication to organizing and mobilizing the over 23 million Americans in recovery from addiction to alcohol and other drugs, our families, friends and allies into recovery community organizations and networks, to promote the right and resources to recover through advocacy, education and demonstrating the power and proof of long-term recovery.  Faces & Voices of Recovery is the parent organization of the Association of Recovery Community Organizations (ARCO) which unites and supports the growing network of local, regional and statewide recovery community organizations (RCOs). ARCO links RCOs and their leaders with local and national allies and provides training and technical assistance to groups. ARCO helps build the unified voice of the organized recovery community and fulfill our commitment to supporting the development of new groups and strengthening existing ones.

    Link to Tool kit: http://media.wix.com/ugd/bfe1ed_439f2d84f59c4461a4eef39a7b00596d.pdf