1-9-14 recovery definition webinar final - naadac · 1/8/14 1 defining addiction recovery presented...

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DEFINING ADDICTION RECOVERY

Presented by William “Bill” White January 9, 2014

Download the PowerPoint slides & access CE quiz here:

naadac.org/definingaddictionrecovery

A presenta*on by the NAADAC, the Associa*on for Addic*on Professionals

Misti Storie, MS, NCC

WEBINAR ORGANIZER

Director of Training & Professional Development

NAADAC, the Associa3on for Addic3on Professionals

USING GOTOWEBINAR

•  Control Panel

•  Asking Ques:ons

•  PowerPoint Slides

•  Polling Ques:ons

•  Audio (phone preferred)

naadac.org/definingaddic3onrecovery

A presenta*on by NAADAC, the Associa*on for Addic*on Professionals

A COMPONENT OF THE RECOVERY TO PRACTICE (RTP) INITIATIVE

www.naadac.org/recovery

OBTAINING CE CREDIT

o  The educa3on delivered in this webinar is FREE to all professionals.

o  1.5 CEs are FREE to NAADAC members who aIend this webinar. Non-‐members of NAADAC receive 1.5 CEs for $20.

o  If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)


naadac.org/webinars

A CE cer3ficate will be emailed to you within 21 days of submi[ng the quiz and payment (if applicable) – usually sooner.

o  Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.

Free to NAADAC Members!

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WEBINAR LEARNING OBJECTIVES

o  List at least 3 factors that contributed to the early 21st century rise of recovery as a new organizing construct in the addic3ons field

o  Iden3fy the 3 core ingredients contained within recent governmental/professional consensus panel defini3ons of recovery

o  Dis3nguish recovery and clinical remission

William “Bill” White

WEBINAR PRESENTER

Emeritus Senior Research Consultant

Chestnut Health Systems

[email protected]

www.williamwhitepapers.com

DEFINING ADDICTION RECOVERY

Paradigms, Organizing Constructs & Governing Images in the AOD Problems Arena

DEFINING RECOVERY

1)  Pathology paradigm

2)  Interven3on (clinical and social) paradigm

3)  Recovery paradigm (Berridge, 2012; White, 2007, 2008, in press)

AUDIENCE POLLING QUESTION

Have there been recent efforts to increase the long-term recovery orientation of the service

setting in which you work?

Why Recovery, Why Now?

DEFINING RECOVERY

1)  growth, dispersion and diversifica3on of recovery mutual aid

2)  cultural and poli3cal mobiliza3on of people in recovery

3)  new recovery support ins3tu3ons

4)  shif from acute and pallia3ve care models of treatment RM & ROSC

5)  embrace of recovery orienta3on by SAMHSA & ONDCP (but not yet by NIDA/NIAAA)

6)  recovery as a conceptual bridge in behavioral healthcare integra3on

7)  calls for a recovery research agenda

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amorphous

“Is it like pornography? You can’t define it but you know it when you see it?”

CHALLENGES TO RECOVERY CONSTRUCT RECOVERY IS:

redundant

“We’re already recovery oriented.”

faddish

“a flavor of the month”

imprac*cal

“No one will fund long-‐term recovery support.”

dangerous

“Recovery is a poli*cal Trojan horse aimed at de-‐professionalizing, delegi*mizing, and defunding science-‐based treatment and harm reduc*on services.”

WHY DEFINING RECOVERY IS DIFFICULT

o  Unclear cultural authority/ownership

o  Ambiguity over what one recovering from

o  Varie3es of recovery experience

o  Involves highly controversial issues in the field

PRECISION

captures the essential nature and elements of the recovery experience

White, 2007, p. 230

CHARACTERISTICS OF AN IDEAL RECOVERY DEFINITION

INCLUSIVENESS

encompasses diverse recovery experiences, frameworks, and styles

White, 2007, p. 230


EXCLUSIVENESS

filters out phenomena lacking essential recovery ingredients

White, 2007, p. 230


MEASURABILITY

facilitates self-assessment, professional evaluation, and scientific study

White, 2007, p. 230


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ACCEPTABILITY

to multiple constituents

White, 2007, p. 230


SIMPLICITY

elegant in its clarity and conciseness

White, 2007, p. 230


SOURCES OF EFFORTS TO DEFINE RECOVERY

o  Research studies

o  Government panels

o  Professional consensus panels

o  Communi3es of Recovery

SAMPLE RESEARCH MEASURES

•  Remission

•  Con3nuous abs3nence

•  Essen3ally abs3nent (low level of consump3on)

•  Abs3nence or use without problems at point of follow-‐up

•  Reduced social cost measures, e.g., arrests, hospitaliza3ons, etc.

•  Quality of life measures

SAMPLE RECOVERY DEFINITIONS

DEFINITIONS: GOVERNMENT PANELS

United States -‐ SAMHSA

Recovery from alcohol and drug problems is a process of change through which an individual achieves abs*nence, improved health, wellness and quality of life (Center for Substance Abuse Treatment Recovery Summit, 2010).

United States -‐ SAMHSA

Recovery is a process of change through which individuals improve their health and wellness, live a self-‐directed life, and strive to reach their full poten*al (SAMHSA, 2011) in context of health, home, purpose and community (SAMHSA, 2012)

Sco[sh Government

Recovery is a process through which an individual is enabled to move on from their problem drug use towards a drug-‐free life and become an ac*ve and contribu*ng member of society. ( 2008, P. vi)

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DEFINITIONS: PROFESSIONAL CONSENSUS PANELS

WHO and APA

Early full remission, early par*al remission, sustained full remission, sustained par*al remission; two course modifiers: “on agonist therapy” & “in a controlled environment” (APA, 1994, 2005, p. 179-‐180).

ASAM

Recovery is a state of physical and psychological health such that his/her abs*nence from dependency-‐producing drugs is complete and comfortable (ASAM, 1982)

Beay Ford Ins*tute

Recovery from substance dependence is a voluntarily maintained lifestyle characterized by sobriety, personal health, and ci*zenship. (BeIy Ford Ins3tute Consensus Panel, 2007)

UK Drug Policy Commission Recovery Consensus Group

Recovery is voluntarily sustained control over substance use which maximises health and well-‐being and par*cipa*on in the rights, roles and responsibili*es of society. (UKDPC, 2008)

DEFINITIONS: RECOVERY COMMUNITIES

o  Recovery more than abs3nence, e.g., “emo3onal sobriety,” “dry drunk”

o  Celebra3on of sobriety/clean dates

o  Differences in defini3on of sobriety/clean 3me, e.g., methadone & recovery status

o  Inclusiveness of recovery advocacy organiza3ons, e.g., Faces and Voices of Recovery

o  “You are in recovery if you say you are.” -‐ Connec3cut Community of Addic3on Recovery (CCAR)

AREAS OF GROWING CONSENSUS

Recovery requires a positive, substantive and sustained change in the person-drug relationship.

CONSENSUS AREA #1

Although disagreement con3nues as to whether this change is best measured in terms of:

1)  abs3nence

2)  diagnos3c remission

3)  altered paIerns of use / risk / harm

wellbriety

(“whole health” for Na*ve individuals, families and tribal communi*es

resilience

achievement of health in spite of personal and environmental risk factors

resistance

sobriety and wellness as an act of personal, cultural or poli*cal protest

CONSENSUS AREA #1

Recovery across cultural contexts also involve the concepts of: Recovery is more than remission - more than the subtraction of AOD use and/or related problems from an otherwise unchanged life.

CONSENSUS AREA #2

1)  Posi3ve, substan3ve and sustained change in the person-‐drug rela3onship

2)  Improvement in global health

3)  Repair of person/community rela3onship, e.g., ci3zenship

Remission measures what is subtracted from one’s life (e.g., symptoms); recovery is about what is added to one’s life.

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The use of psychoactive medication as prescribed is not a disqualification for recovery status if other recovery criteria are met.

CONSENSUS AREA #3

“…formerly opioid-‐dependent individuals who take naltrexone, buprenorphine, or methadone as prescribed and are abs3nent from alcohol and all other non-‐prescribed drugs would meet this defini3on of sobriety” (BeIy Ford Ins3tute Consensus Panel, 2007)

To constitute recovery, the changes in substance use, global health and community reintegration must be conscious, voluntary and self-managed.

CONSENSUS AREA #4

AREAS OF CONTENTION Should the term “recovery” be applied only to the resolution of particular types of AOD problems?

CONTENTION AREA #1

•  DSM Substance Abuse as well as Substance Dependence?

•  Subclinical AOD use that poses risk of harm to mul3ple par3es?

AUDIENCE POLLING QUESTION

Should the cessation of tobacco use be included in the definition of addiction recovery?

Does recovery require abstinence from, or a deceleration of, all psychoactive drug use/addiction - including abstinence from nicotine? •  Decelerated drug use and consequences?

•  “Secondary” drug use

•  Use of psychoac3ve medica3ons

•  Tobacco use (nico3ne addic3on)

CONTENTION AREA #2

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Is recovery an all or none proposition or something that can be achieved in degrees?

CONTENTION AREA #3

•  Full versus par3al recovery

•  Contrast between addic3on and mental health fields’ use of these concepts

Can and should the concept of recovery be applied to larger social systems affected by excessive AOD use and related problems?

CONTENTION AREA #4

•  Family recovery

•  Ins3tu3onal, neighborhood, community, cultural recovery

Who has the authority to define recovery at personal, professional, and cultural levels?

CONTENTION AREA #5

•  Role of people in recovery and their families in recovery defini3on panels

•  “Nothing about us without us!”

TAKE HOME POINTS

TAKE HOME POINT #1

Recovery is emerging as a new organizing paradigm for the addiction treatment field and the larger AOD problems arena.

DEFINING RECOVERY

TAKE HOME POINT #2

This is sparking efforts to more clearly define recovery and its related concepts, e.g., recovery management (RM), recovery-oriented systems of care (ROSC).

DEFINING RECOVERY

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TAKE HOME POINT #3

Substantial progress has been made in defining recovery and related concepts, but critical questions remain that involve quite controversial issues and which require the involvement of all significant stakeholders.

DEFINING RECOVERY

TAKE HOME POINT #4

Efforts to define recovery to date have focused on three key dimensions of the recovery experience: •  voluntary, substantial and sustained

changes in the person-drug relationship •  improvements in global health •  repair of the person-community relationship

DEFINING RECOVERY

TAKE HOME POINT #5

How recovery and related concepts are defined will exert significant effects on how the roles of addiction professionals are designed, performed, and evaluated and the degree of hope and the nature of help offered to those they serve.

DEFINING RECOVERY STAGES OF RECOVERY

THANK YOU!

ASKING QUESTIONS

Ask ques3ons through the Ques3ons Pane

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OTHER RTP WEBINARS

www.naadac.org/webinars

Defining Addic*on Recovery •  Thursday, January 9, 2014 @ 3-‐4:30pm ET

What Does Science Say? Reviewing Recovery Research •  Wednesday, February 5, 2014 @ 3-‐5pm ET

The History of Recovery in the United States and the Addic*on Profession •  Thursday, March 6, 2013 @ 3-‐5pm ET

Defining Recovery-‐Oriented Systems of Care (ROSC) •  Thursday, April 3, 2014 @ 3-‐4:30pm ET

Understanding the Role of Peer Recovery Coaches in the Addic*on Profession •  Thursday, May 1, 2014 @ 3-‐4:30pm ET

Including Family and Community in the Recovery Process •  Thursday, May 29, 2014 @ 3-‐5pm ET

Collabora*ng with Other Professions, Professionals, and Communi*es •  Thursday, June 26, 2014 @ 3-‐4:30pm ET

Using Recovery-‐Oriented Principles in Addic*on Counseling Prac*ce •  Thursday, July 24, 2014 @ 3-‐5pm ET

Exploring Techniques to Support Long-‐Term Addic*on Recovery for Clients and Families •  Thursday, August 21, 2014 @ 3-‐5pm ET

WEBINARS ON DEMAND

•  Medica:on Assisted Treatment •  Building Your Business with SAP/DOT •  SBIRT •  Billing and Claim Submission •  Ethics •  Co-‐occurring Disorders •  Test-‐Taking Strategies •  Conflict Resolu:on •  Clinical Supervision •  ASAM Placement Criteria •  DSM-‐5 Proposed Changes

www.naadac.org/webinars

CE credit s:ll available!


WWW.NAADAC.ORG OBTAINING CE CREDIT

o  The educa3on delivered in this webinar is FREE to all professionals.

o  1.5 CEs are FREE to NAADAC members who aIend this webinar. Non-‐members of NAADAC receive 1.5 CEs for $20.

o  If you wish to receive CE credit, you MUST complete and pass the “CE Quiz” that is located at: (look for TITLE of webinar)


naadac.org/webinars

A CE cer3ficate will be emailed to you within 21 days of submi[ng the quiz and payment (if applicable) – usually sooner.

o  Successfully passing the “CE Quiz” is the ONLY way to receive a CE cer*ficate.


William White: [email protected]

Thank You for Par*cipa*ng!

www.naadac.org/recovery

NAADAC, The Associa*on for Addic*on Professionals 1001 N. Fairfax St. Suite 201 Alexandria, VA 22314 p 800.548.0497 f 800.377.1136

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Naadac

[email protected]

NAADAC

1-9-14 recovery definition webinar final - naadac · 1/8/14 1 defining addiction recovery presented...

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