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Tag: David Loveland

  • Is Recovery Coaching Effective?

    Is Recovery Coaching Effective?

    manhattan_bridgeTreatment professionals and researchers are calling for a change in the treatment model for substance use disorders (SUD). This change calls for shedding the acute care model (28 days of SUD treatment will fix you) to a continuum of care models, similar to how chronic diseases like diabetes or arthritis are treated. (Humphreys & Tucker, 2002; Institute of Medicine, 2005; McLellan et al., 2000; White, Boyle, Loveland, & Corrington, 2005).

    At the same time, the mental health and the substance abuse treatment fields have merged, creating the behavioral health field. With this merger, the recovery-oriented systems of care model (ROSC) has become the accepted approach to treatment for those with mental and substance use disorders. This holistic approach, rather than focusing on the addiction, considers the whole person and how they interact in real life. ROSC emphasizes that recovery depends on the connection of mind, body, and spirit, motivating addicts to choose to improve their mental health, their physical health, and to embrace a spiritual component of their recovery (SAMHSA, 2011). This multi-system approach has ROSC counselors encouraging visits to the general practitioner, the OBGyn and the dentist. They assess for co-occurring disorders and embrace one-on-one therapeutic treatment and group therapy. And ROSC practitioners embrace mutual support programs, such as AA, NA or even nontraditional mutual support groups like SOS, or Women for Sobriety. A spiritual program is also encouraged. Lastly, the newest introduction to the treatment field is the recovery coach.

    As mental health and addiction treatment services are adopting this recovery-oriented approach, the emphasis on incorporating various forms of recovery coaching or peer-based recovery support into treatment services is growing rapidly. Peer-based recovery support services are defined as

    “the process of giving and receiving nonprofessional, nonclinical assistance to achieve long-term recovery from mental health and substance use disorders” (Borkman, 1999)

    This support is provided by “peers,” “peer-recovery support specialists,” “recovery coaches,” “peer mentors,” or “peer support specialists” who have lived and experienced personal recovery (Borkman, 1999). The peers assist others in initiating, maintaining and embracing recovery from their mental health or substance use disorders.

    As recovery coaches and peers begin to infiltrate treatment centers and recovery support, community organizations, there is a needling question that arises: are recovery coaches effective in the recovery process?

    Studies have been completed on the effectiveness of recovery coaches aiding in individuals achieving long-term recovery since 2005. Many were small studies, some were not exactly scientific, nor could other studies stand up to researcher’s scrutiny. None of the studies had the critical mass to come to a clear conclusion. Ellen L. Bassuk, M.D., Justine Hanson, Ph.D., R. Neil Greene, M.A., Molly Richard, B.A., and Alexandre Laudet, PhD began examining the 1,221 studies that analyze the effectiveness of peer-delivered, recovery support services for individuals in recovery. They wrote a systematic review called Peer Delivered Recovery Support Services for Addictions in the United States: A Systematic Review.

    This compilation of all the current studies is to create an appraisal, and summarization of the success of peer-delivered, recovery support services, using strict scientific criteria. As part of their review process, the 1,221 studies were screened, but only nine studies were deemed to meet the strict review requirements.

    The nine studies examined the effectiveness of recovery support services that were delivered by a peer using a wide range of interventions and models. These studies also examined the variety of locations that offered peer support, including peer-run, drop-in centers (Ja et al., 2009), peer-run, recovery community organizations (Kamon & Turner, 2013), and Veteran’s Administration medical outpatient clinics (Bernstein et al., 2005).

    This review showed peer-delivered recovery support services accomplished the following successful outcomes:

    1. Decreased alcohol use
    2. Decreased drinking to intoxication by reducing the odds of drinking to intoxication by 2.9 percent (Smelson et al. 2013)
    3. Peer participation lowered re-hospitalization rates, meaning only 62 percent of participants from the peer based support group were re-hospitalized compared to 73 percent of those not receiving peer based support (Min et al. (2007)
    4. Increased post-discharge sobriety time was achieved by the individuals receiving the peer intervention (O’Connell et al. 2014)
    5. If peers led groups in life-skills training, those participants had 14.8 fewer days drinking
    6. Peer recovery support affected those discharged from inpatient treatment by maintaining a post-discharge sobriety rate of 43 percent to 48 percent as compared to 33 percent sobriety for those not receiving peer based support (Tracy et al. 2011)

    Overall, the review of these studies indicate that peers involved in recovery support interventions have beneficial effects on participants. While the reviewers can conclude that there is evidence supporting the effectiveness of peer-delivered, recovery support services, they acknowledge that additional research is necessary to determine the usefulness of peer support services. While this knowledge is encouraging, research in this area is just emerging, and there is a strong need to improve outcomes by completing future studies.

    References

    1. Humphreys, K., & Tucker, J. (2002). Toward more responsive and effective intervention systems for alcohol-related problems. Addiction, 97(2), 126–132.
    2. Institute of Medicine (2005). Improving the quality of health care for mental and substance use conditions. Washington, DC: National Academy Press.
    3. McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689–1695.
    4. White, W., Boyle, M., Loveland, D., & Corrington, P. (2005). What is behavioral health recovery management? A brief primer. (Retrieved from www.addictionmanagement.org/recovery%20management.pdf).
    5. Substance Abuse and Mental Health Services Administration (SAMHSA) (2011). SAMHSA’s Working Definition of Recovery. (Retrieved from http://www.samhsa.gov/recovery/).
    6. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press
    7. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press
    8. Ja, D. Y., Gee, M., Savolainen, J.,Wu, S., & Forghani, S. (2009). Peers Reaching Out Supporting Peers to Embrace Recovery (PROPSPER): A final evaluation report. San Francisco, CA: DYJ, Inc. for Walden House, Inc. and the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (Retrieved from http://www.dyja./com/sites/default/files/u24/PROSPER%20Final%20Evaluation%20Report.pdf).
    9. Kamon, J., & Turner,W. (2013). Recovery coaching in recovery centers: What the initial data suggest: A brief report from the Vermont Recovery Network. Montpelier, Vermont Evidence-Based Solutions (Retrieved form https://vtrecoverynetwork.org/PDF/VRN_RC_eval_report.pdf).
    10. Bernstein, E., Bernstein, J., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77, 49–59
    11. Smelson, D. A., Kline, A., Kuhn, J., Rodrigues, S., O’Connor, K., Fisher, W. Kane, V. (2013). A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders. Psychological Services, 10(2), 161–167.
    12. Min, S. Y., Whitecraft, E., Rothbard, A. B., & Salzer, M. S. (2007). Peer support for persons with co-occurring disorders and community tenure: A survival analysis. Psychiatric Rehabilitation Journal, 30(3), 207–213. http://dx.doi.org/10.2975/30.3.2007.207.213.
    13. O’Connell, M. J., Flanagan, E., Delphin, M., & Davidson, L. (2014). Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery supports. Unpublished manuscript.
    14. Tracy, K., Burton, M., Nich, C., & Rounsaville, B. (2011). Utilizing peer mentorship to engage high recidivism substance-abusing patients in treatment. The American Journal of Drug and Alcohol Abuse, 37(6), 525–531
  • How does a Recovery Coach work with a Treatment Team?

    How does a Recovery Coach work with a Treatment Team?

    manhattan_bridge_post_versionRecovery coaching services are starting to be more widely used, more often within the finest treatment centers. Yet, there are still addicts in crisis, or families with loved ones in inpatient substance-abuse treatment that are unaware that such services exist. Many therapists, re-unification specialists’ psychiatrists and LCSWs specializing in addiction treatment have not worked with a recovery coach, even though the recovery coaching profession has existed for over a decade. So it is important for more clinicians, outpatient coordinators, aftercare coordinators and other treatment professionals to understand how a recovery coach can benefit the client’s recovery and how the entire treatment team can work together.

    75% Will Relapse!

    Leaving an inpatient treatment facility, a client is very vulnerable to relapse during the initial days and weeks following their discharge. In fact, within a ninety-day period after discharge, seventy-five percent will have experienced one or more relapses (Godley, Dennis, Funk, & Passetti, 2002). Hiring a recovery coach can keep a client sober, and it is important to link a client to a continuing care program as early as possible. Both of these aftercare tools can be coordinated prior to discharge so the client can extend their sober life style after discharge.

    Research has shown, that coordinating this continuing care program does not guarantee a client will see a therapist, embrace a 12-step program or attend intensive outpatient treatment after discharge. This is where a recovery coach comes in. A recovery coach is called in to meet with the client either at the treatment center and then escort them home, or meet with the client at their home to take them to their first 12-step meeting, the continuing care program, or even therapist appointments. And always, the coach begins working with the client on their recovery plan.

    Who is the Treatment Team?

    Post discharge, or during outpatient treatment the Treatment Team consists of a variety of people, dependent on the client’s case. Key participants on the team can include the recovery coach, frontline clinicians and doctors from the treatment organization; the client’s primary care physician, psychiatrist or therapist; a staff member/social worker from a recovery-based agency or a representative from a community organization such as public housing; child protective services or any religious-based recovery program. The legal system may be involved so a lawyer, a probation officer, or a social worker assigned from the courts, the state’s drunk driving agency or child protective services can also be included. Many times the family is involved as well, whether it is a spouse, or in the case of an adolescent client, the parents or caregivers will participate on the team. (In all aspects of coordinating within the treatment team, a HIPAA disclosure form must be signed by the client allowing the coach and the team to discuss the client’s case).

    In early recovery, I cannot overstate the value of a recovery coach who is a hands-on partner and support person to help a newly sober addict learn all of the life skills that addiction robs from its victims. After 30-60 days in treatment, even a 45-year-old college-educated person has forgotten how to prepare and abide by a basic family budget; how to write a resume; how to do healthy things such as yoga; how to shop in a store and avoid the liquor aisle; have the confidence to walk into a 12-step meeting; or ask the right questions of a 12-step sponsor. These skills are not found in the “manual of the newly recovered” (a manual which does not actually exist). And even when such structure does appear in aftercare plans, sending an addict with 30 or 60 days of new found recovery out into the world to go forth and execute on such a plan is a big challenge, in many cases, one doomed to failure.

    The recovery coach will primarily be responsible for the provision of general treatment and recovery maintenance support in collaboration with the treatment team. The recovery coach responsibilities will include program support, connecting clients to recovery activities in the community, transportation of participants, helping clients get their basic needs met, assistance with navigation of the substance abuse, social services and mental health service systems, facilitation of attendance at support groups, or 12-step meetings and taking toxicology screens. The recovery coach can have daily contact with the client through telephone support and often meets weekly with the client in face-to-face sessions.

    David Loveland, PhD. and Michael Boyle, MA, wrote in the 2005 Manual for Recovery Coaching and Personal Recovery Plan Development an outline specifying that a recovery coach should also provide guidance to create a personal recovery. This personal recovery plan development is the first assignment a client completes when working with a coach.

    In order to work in the same manner that a clinician or a treatment center team member would expect, a recovery coach adopts the same system of notes, documentation and paperwork a clinician uses. The coach will provide the treatment facility and/or the client with documentation on billable services. The coach will complete thorough documentation or progress notes on the client’s recovery process, written in the guidelines required by the facility or that is acceptable to the clinician, such as DAP notes (data, assessment and plan). The coach will communicate frequently with the lead clinician and in the event of a crisis, more frequently with the team.

    Working through Potential Conflicts

    The role of a recovery coach is described in the Recovery Management and the Assertive Continuing Care models. These models may be new to most service providers and front line clinicians. It is important to address potential misconceptions and resistance that can be encountered by a recovery coach and the team. Here are some examples of potential conflicts between a recovery coach and the people they work with:

    • Establishment of clear guidelines of communications.
    • Who speaks to who — The recovery coach speaks to the client and the primary clinician
    • Everything a recovery coach discloses to the primary clinician is to be discussed with the team and the client
    • In the case of a relapse communication guidelines are to be established as to who in the team receives this information
    • Conflict between the treatment goals of the addiction treatment program and recovery coach can happen. It is best if treatment goals are discussed with the coach. The coach will defer to the clinician, most generally.
    • The team will establish guidelines or a contract with the client in the event there is the possibility a client will leave treatment against medical advice/orders (AMO) or be administratively discharged.
    • Sometimes there are ideological conflicts between the professional-based primary addiction treatment model and the strengths-based model, the Assertive Continuing Care or the Recovery Management model used by recovery coaches. These conflicts should be discussed with the team.
    • Rules within treatment facilities may conflict with recovery coach services, such as signing a HIPAA agreement, leaving a therapeutic group to work with a coach, working on other issues before completing specific phases of treatment or treatment programs that discourage working with other people during treatment. The coach is encouraged to work through these differences as best they can.
    • Changes in peoples’ treatment needs as a result of receiving recovery coaching services during a waiting period (e.g., no longer needing residential treatment after achieving some success with a recovery coach and the client can move to a PHP or IOP program).

    As a recovery coach, I enjoy working with a treatment team, and doing so allows me to work with a “net” while bouncing ideas or concerns off of an actively involved person with great interest in the client’s well being. When I am introduced to a clinician and team, it is often the first time the clinicians have worked with a recovery coach. If I am able to speak to the lead clinician prior to beginning a contract, I attempt to do so. Often, I attend the therapeutic sessions, after the client has their sixty-minute session, I will enter the room and spend a half hour or so discussing things with the client and the clinician. At other times, there are separate meetings with the treatment team that do not include the client. Frequently, there are daily and sometimes hourly conversations, text messages or emails with the lead clinician. Every assignment varies.

    The availability of recovery coaches is increasing. Clients can find recovery coaches for free or can pay anywhere up to $250 per hour for a coach. Many coaches have a website and can be found by using a search engine such as Google’s. There is an organization of Recovery Support Centers (http://www.facesandvoicesofrecovery.org/who/arco ) that offer free recovery coaches to clients. Often a treatment center has a recovery coach suggestion.

    In the end, the clinician, lawyer and client will benefit from the collaboration of the recovery coach with the treatment team, and often the coaching relationship with the client continues.