Peer Support for Substance Use Disorders:
The Future in Kentucky
Tom Hill
Faces & Voices of Recovery
October 8, 2013
Introduction and
Setting the Context
Faces and Voices of Recovery
 Organizing and mobilizing people in
long-term recovery from addiction, our
families, friends, and allies, to speak with
one voice
 Changing public perceptions of recovery
 Promoting effective Federal and State
public policy
 Focusing on the reality of recovery that
is making life better for over 23 million
Americans, their families, and
communities
Addiction Recovery Advocacy Movement
 2001 Recovery Summit; St. Paul, MN
 The recovery movement:
 includes people in recovery from
addiction from alcohol and other
drugs, family members, friends, and
allies
 includes and honors all pathways to
recovery
 encompasses all the diverse
perspectives, cultures, and
experiences of the recovery
community
Current Climate: The Perfect Storm
 Recovery Advocacy Movement
 Recovery-Oriented Systems of Care
 Mental Health Parity and Addiction
Equity Act
 Affordable Care Act
 Managed Care Expansion
 Peer Recovery Support Services
 Criminal Justice and Drug Policy
Reform Movement
Recovery is the Focus
Focus: Recovery and Wellness
Shifting from a crisis-oriented,
professionally-directed, acute-care
approach with its emphasis on discrete
treatment episodes….
…to a person-directed, recovery
management approach that provides
long-term supports and recognizes the
many pathways to health and wellness.
Recovery-oriented Systems of Care
 Build the capacity of communities,
organizations, and institutions to support
recovery
 Build on the strengths of individuals,
families, and communities to foster longterm recovery, health, and wellness
 Expand the menu of services and supports
across the entire recovery continuum
 Ensure people in or seeking recovery
receive dignity and respect
 Lift discriminatory policies and barriers to
recovery
Primary Goals of a ROSC
 Prevent the development of substance
use conditions
 Intervene earlier in the progression of
illnesses
 Reduce the harm caused by substance
use and addiction
 Help people transition from recovery
initiation to recovery maintenance
 Actively promote good quality of life,
community health, and wellness for all
Adapted from Ijeoma Achara
Challenges Currently Facing
Addiction Service Systems
 Unmet Need: < 10 % who need Tx seek treatment
or if they do, arrive under coercive influences
 Low Pre-Treatment Initiation Rates
 Low Retention: > 50 % do not successfully
complete treatment
 Inadequate Service Dose: significant % do not
receive optimum dose of Tx as recommended by NIDA.
 Lack of Continuing Care: only 1 in 5 receive
post-discharge planning
 Recovery Outcomes: most resume using within
3months to one year of discharge from Tx
 Revolving Door: > 60% one or more Tx episodes,
24% 3 or more – 50% readmitted within 1 year.
Adapted from Ijeoma Achara
Service System Progression

Service System Progression
Model 1: Effective Treatment
Primary
Focus
Treatment
Love,
Work, &
Play

Community
Life
Housing,
Faith, &
Belonging
Arthur Evans
Service System Progression

Service System Progression
Model 2: Continuity of Care
Primary
Focus
Love,
Work, &
Play
Detox
Rehab
Tx-1
Tx-2

Peer
support
Community
Life
Housing,
Faith, &
Belonging
Arthur Evans
Service System Progression
Service System Progression
Model 3: Recovery-oriented
System of Care
In the model. clinical care is viewed as one
of many resources needed for successful
integration into the community
Primary
Focus
Faith
Work or
school
Social
support

Community
Life
Treatment &
rehab
Peer
support
Housing
Belonging
Family
Arthur Evans
A New Model
Risk and Resilience Model
What connections are not yet in place for this person and
what needs to be done to establish or cultivate them?
For example
Faith
Work or
school
Social
support

Community
Life
Treatment &
rehab
Peer
support
Housing
Belonging
Family
Arthur Evans
Looking Through a Different Lens
We cannot solve our
problems with the same
thinking we used when
we created them.
Albert Einstein
The Four Laws of Change
Change is from within
In order for development to occur,
it must be preceded by a vision
A great learning must take place
You must create a Healing Forest
The Healing Forest
Recovery-oriented Clinical Services
 Outreach and engagement
 Strength-based screening,
assessment, and service planning
 Expanded and service team
composition and collaborative
relationships
 Focus on community integration
 Linkages to recovery community
 Post-treatment check ups
Adapted from Ijeoma Achara
Fully in the Mix:
Peer Recovery Support Services
 Develop the capacity and
infrastructure of the organized
recovery community to become a
full partner and participant
 Explore range of options
regarding paid and volunteer
peers
 Expand PRSS and increase
service menu options and points
of access
 Integrate PRSS into recovery
community and diverse service
settings, including treatment
Setting the Context:
Recovery Capital
What is Needed: Recovery Capital
Recovery Capital is the breadth and depth of internal and
external resources that can be drawn upon to initiate and sustain
recovery from addiction. (Granfield and Cloud, 1999, 2004; White, 2006)
 Physical:
includes health (access to care),
financial assets, food/clothing/shelter, transportation
 Human: includes culture, values, knowledge,
education, inner- and interpersonal skills, judgment,
and other capacities
 Social: includes connectedness to social supports
and resources, intimate/family/kinship relationships,
and bonds to community and social institutions
Recovery Capital: Amber’s Story
Consequences of Addiction
Can Deplete Recovery Capital









Limited education
Minimal or spotty work history
Low or no income
Criminal background
Poor rental history
Bad credit
Accrued debt and/or back taxes
Unstable family history
Inadequate access to health
care
Creating and Reinforcing
Recovery Capital
Essential Ingredients for
Sustained Recovery:
 Safe and affordable place to live
 Steady employment and job readiness
 Education and vocational skills
 Life and recovery skills
 Health and wellness
 Sober social support networks
 Sense of belonging and purpose
 Connection to family and community
Creating and Reinforcing
Recovery Capital
With Many, a Need to Address:
 Legal issues
 Expunging criminal records
 Financial status: debt, taxes,
budgeting, etc.
 Restoring revoked licenses:
professional, business, driver’s
 Regaining custody of children
 Developing relationship and
parenting skills
 Developing sober social support
networks and community
connections
Building Communities
with Recovery Capital




Build on the strengths and resilience of
individuals, families, and communities to be
responsible for sustained recovery and
wellness
Make services and resources available that
help individuals and families throughout the
recovery process
Build the capacity of communities,
organizations, and institutions to support
recovery: recovery-supportive rather than
recovery-hostile
Lift discriminatory barriers that impede
recovery and wellness
Peer Recovery
Support Services
Peer Recovery Support Services
 Services to help individuals and
families initiate, stabilize, and sustain
recovery
 Provided by individuals with “lived
experience” of addiction and recovery
 Non-professional and non-clinical
 Distinct from mutual aid support, such
as 12-step groups
 Provide links to professional treatment,
health and social services, and support
resources in communities
Elements of a Peer Relationship
 Natural
 Reciprocal
 Accessible
 Potentially enduring
 Non-commercialized
 Non-regulated
William White
What Makes Peer Work Effective?
 Focuses on establishing trust and
building relationship
 Builds on a person’s strengths to
improve Recovery Capital
 Promotes recovery choices and goals
through a self-directed Recovery Plan
 Utilizes recovery community resources
and assets, especially volunteerism
 Provides entry and navigation to health
and social service systems
 Models the benefits of a life in recovery
Benefits of
Peer Recovery Support Services
 Effective outreach, engagement, and
portability
 Manage recovery as a chronic condition
 Stage-appropriate
 Cost-effective
 Reduce relapse and promote rapid
recovery reengagement
 Facilitate reentry and reduces recidivism
 Reduce emergency room visits
 Create stronger and accountable
communities
When Are PRSS Delivered?
Across the full continuum of the
recovery process:
 Prior to treatment
 During treatment
 Post treatment
 In lieu of treatment
Peer services are designed and
delivered to be responsive and
appropriate to all stages of
recovery.
Continuum of Addiction Recovery
Pre-Recovery
Engagement
Recovery
Initiation &
Stabilization
Recovery
Maintenance
Enhancement
of Quality of
Life in Longterm
Recovery
William White
Where Are PRSS Delivered?
 Recovery community centers
 Faith and community-based organizations
 Emergency departments and primary care
settings
 Addiction and mental health treatment
 Criminal justice systems
 HIV/AIDs and other health and social service
agencies
 Children, youth, and family service agencies
 Recovery high schools and colleges
 Recovery residences and Oxford Houses
Peer Recovery Coach
 Personal guide and mentor for
individuals seeking to achieve or
sustain long-term recovery from
addiction, regardless of pathway
to recovery
 Connector to instrumental
recovery-supportive resources,
including housing, employment,
and other services
 Liaison to formal and informal
community supports, resources,
and recovery-supporting activities
NOT Just Recovery Coaches…
 Peer telephone continuing support
 Peer-facilitated educational and
support groups
 Peer-connected and –navigated
health and community supports
 Peer-operated recovery residences
 Peer-operated recovery community
centers
Recovery Community Centers
 Vision: creating a community institution like a
Senior Center
 Provides public and visible space for recovery
to flourish in community: Recovery on Main
Street
 Serves as a “community organizing engine”
for civic engagement and advocacy
 Operates as a “hub” for PRSS and recovery
activities
 Includes participation of family members
 Provides volunteer, service, and leadership
opportunities
 Positions the recovery community as a key
stakeholder with the greater community
Establishing
Accountability
for Peer
Recovery
Support
Services
Recovery Plans
Step 1: Recovery Capital Assessment
Ten Domains:
1. Substance use and abstinence
2. Mental wellness and spirituality
3. Physical and medical health
4. Citizenship and community involvement
5. Meaningful activities: job/career, education, recreation
6. Relationships and social support
7. Housing and safety
8. Risk taking and independence from legal responsibilities and institutions
9. Coping and life functioning
10. Recovery experience
Changing the Questions
Examples
Can you tell me a bit about your hopes
or dreams for the future?
What are some things in your life that
you hope you can do and change in the
future?
 What kinds of activities make you feel
happy and fulfilled?
If you went to bed and a miracle
happened while you were sleeping, what
would be different when you woke up?
How would you know things were
different?
Adapted from Ijeoma Achara
Recovery Plans:
Recommended Elements
 Life Vision: What would you like
your life to look like, be about?
 Recovery Capital Domains: Explore
what’s going well and challenges in
each domain
 Goals: document aspirations and
goals for an improved quality of life
 Priorities: What would you like to
change over the next 3 – 12 months?
Recovery Plan:
Not the same as a Treatment Plan
What’s the Difference?
 Who’s in charge: collaborative team
vs. expert: driven by person in or
seeking recovery
 Timeframe: long-term recovery vs.
treatment episode
 Focus: recovery capital domains vs.
clinical domains
 Strategies: holistic vs. professional
 Goal: process vs. product
Adapted from Ijeoma Achara
Critical Elements for Recovery Planning
 Consult Recovery Capital Assessment
 Articulate goals: short- and long-term
 Identify strengths and areas of
support
 Determine and locate helpful
resources
 Explore challenges and strategies to
overcome
 Pre-action and action steps
 Establish timeline
 Recovery reengagement plan
The Peer Relationship in Recovery Planning
 Peer service roles support people
in making their own choices
 Informed risk-taking is encouraged
even when failure is an option
 Goals and strategies are
determined in partnership and
directed by the person in recovery
 Services are person-centered and
adapted to fit individual needs,
strengths, and preferences
Moving Forward
Foundational Principles of Collaboration
 Complementary, rather than
opposing, paradigms
 Search for potent combinations
and sequences
 Mutual respect for different ways
of knowing and types of
experience
 Philosophy of choice
 Shared goal of people getting and
staying well
Adapted from Ijeoma Achara
Collaboration with Recovery Representation
 Nothing about us without us
(Inclusion as first thought versus
afterthought)
 Representation of multiple
recovery pathways
 Authenticity of representation
 Avoiding problem of double
agentry
 Giving back versus cashing in
William White
Shared Vision for the Future
Common and shared elements:
 To be active agents of change in our
own lives – not passive recipients of
services
 To manage/eliminate and move beyond
our symptoms
 To participate in valued social roles and
relationships
 To embrace purpose and meaning in our
lives and make worthwhile contributions
To not be defined by our illness
To live a self-actutalized life abundantly!
Adapted from Ijeoma Achara
Vision Renewed
 Recovery Works
 Recovery is Possible
 Recovery is an Expectation!
Thank you!
Tom Hill
Director of Programs
Faces & Voices of Recovery
thill@facesanadvoicesofrecovery.org