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Do peers have a unique way of connecting with clients?
As the treatment of addiction moves inexorably toward inclusion in the larger healthcare system, with its standards of evidence-based care, there is also a movement towards the use of peer counselors with “lived experience” with addiction. Are peer counselors able to connect with and help persons struggling with addiction in a unique way? Do the outcomes achieved in employing peers suggest that they should be more widely used, and supported by public funding? Melissa Killeen opens the conversation and highlights a case in which peer counseling played an integral role…Richard Juman
A peer recovery support specialist has many job titles across the United States and around the world. They may be called certified recovery support practitioners, recovery advocates, peer mentors or recovery coaches. They tend to be employed at recovery community support centers, at hospitals, behavioral health agencies or addiction treatment centers. The peer recovery support specialist may be working with substance misusers, traumatic brain injury clients, behavioral health clients or clients that identify with all of these diagnoses. Certified peer recovery support specialists are generally employed by the facilities at an hourly rate for their services; for the client, peer recovery support services are typically free. In this article, I will focus on the peer recovery support specialists working in the addiction field.
Recovery community support centers, financed with state and federal funding, some with funding from churches or individuals, are slowly taking hold and becoming more prevalent. The recovery advocacy organization Faces & Voices of Recovery, developed the Association of Recovery Community Organizations (ARCO) that unites and supports a growing membership of over 100 recovery community support organizations, although there are many organizations which have not yet become members of ARCO. For example, in my neck of the woods, there are currently 12 recovery community support organizations in Pennsylvania and 10 in New Jersey. Recovery community support centers can provide computer training, job interviewing skills training, resume writing, legal assistance, parenting skills training, social services linkages, 12-step meetings and even haircuts! It is important to highlight that these are non-clinical settings. Treatment is not provided – these are healthy places where people with current or past histories of addiction can go as an alternative to hanging out at a bar or on a street corner. Recent research completed by Chyrell Bellamy, MSW, PhD and Michael Rowe, PhD, both assistant professors at Yale University, concluded that working with peers in a recovery community environment may reduce alcohol use, drug use, and criminal justice charges for at-risk populations.
In my view, the most important service that a recovery community support center offers is the assignment of a peer recovery support specialist or recovery coach to work with each client that comes to the center. At the outset, the peer recovery support specialist meets the client and sets up a schedule upon which the client and peer will meet. The format and structure varies widely, with some relationships based on daily phone calls and others on weekly face-to-face visits. The actual length of a coaching engagement will also vary. The McShin Foundation suggests that, as at the community recovery support centers run by the Virginia-based foundation, a 90-day limit is placed on the coaching assignment. However, other organizations, like the Hartford-based Connecticut Community for Addiction Recovery (CCAR), does not place an arbitrary limit on the length of coaching time. Instead, it recommends that standards of goal achievement, like drafting a recovery plan, a relapse prevention plan and/or attaining sobriety goals, be used to determine the length of engagement.
What do peer recovery support specialists actually do for their clients? Here is one example:
In 2013, I helped create the first community recovery center in southern New Jersey, one of only a handful of recovery centers in New Jersey at the time. Heather Ogden-Busch was one of the first people we hired at the Living Proof Recovery Support Center in Voorhees, NJ. At the time, because she had many years of sobriety and experience in sponsorship, she naturally fell into the role of a peer recovery support specialist, or recovery coach. On Heather’s first day at the recovery support center she received a call from a member of her 12-step group. This member relayed the story about another member from the meeting, Beth (not her real name), who had relapsed on heroin. Beth was living in a trailer with her boyfriend, who was also addicted to heroin, and she was not doing well. Beth wanted to stop using. Heather called her immediately.
At the time, Heather was aware that there was some really powerful heroin circulating in the Philadelphia/Camden region. Several young people had overdosed recently, including one of Heather’s sponsees. She relayed this information to Beth, and asked Beth what she wanted to do. Beth said she wanted to get out of her boyfriend’s trailer and go into rehab. She had no job, no money and no connection with her parents, with no possibility of financing a rehab stay. Heather and her colleagues at the Living Proof Recovery Center jumped on the phones to find a detox and a treatment center that would have an opening for Beth.
Within one day, Heather had scheduled an intake appointment for Beth at a detox hospital in New Jersey. Beth would also have a bed reserved for her at a Christian-based treatment center in Brooklyn, NY, if she successfully completed detox. Luckily, Heather knew of another treatment center, also faith-based, in Chicago, with the financing available for the treatment as well as funding for the airplane flight.
Beth was not particularly religious, but knew she needed treatment and agreed to go to detox then to treatment in Brooklyn. Over the weekend, Heather and Beth met together at the recovery center, called the detox hospital and went through the intake process. The same procedure was necessary for the Brooklyn treatment center. Heather and Beth made those calls together. By Monday of the next week, two days after Beth consented to go to detox, Heather had arranged for a sober friend to drive Beth to the northern New Jersey detox hospital. She also had arranged for the same person to drive Beth from the detox to Brooklyn when Beth was discharged.
One week passed, and Beth was being discharged from detox. Unfortunately, the Brooklyn treatment center did not have an immediately available bed, but Beth was next in line for a bed as soon as it was available, in a few days. Beth had to return to her boyfriend’s trailer to wait for the call from the treatment center. Beth did not have a phone, so it was Heather that would field the call from the treatment center. Beth had at least three days to wait and hopefully, remain clean. Heather pulled in all of the support she could muster. Beth had escorts to every NA and AA meeting in the area. Members of the 12-step community drove Beth to Suboxone maintenance appointments. Every night, Heather and Beth talked. Every morning Heather called the treatment center to find out if the bed was available. By Wednesday morning, Beth and Heather were driving up the NJ Turnpike to Brooklyn, and Beth was still clean.
The story doesn’t end there, because the job of a peer recovery support specialist is as important after the client comes out of treatment. Beth was in Brooklyn for 28 days. While Beth was working on her sobriety, Heather was lining up a room at an Oxford House, miles away from the trailer and the addicted boyfriend. Within one day after being discharged from the Brooklyn treatment center, Beth was in an Oxford House, had a temporary sponsor and was enrolled in an intensive outpatient program. Her parents were so proud of Beth’s achievements they had paid for the first two month’s rent at the Oxford House.
Heather remained Beth’s peer recovery support specialist and required Beth to come to the recovery center every day to volunteer. Beth answered the phone, made copies, attended 12-step meetings, and learned about co-occurring disorders. She participated in a resume-writing workshop and a financial planning workshop. Beth got a job as a waitress at a local family-style restaurant that did not serve alcohol and for the first time she opened her own checking account. By her third month at Oxford House, she was able to pay her own rent.
Heather guided Beth to enroll in a co-occurring program associated with her outpatient program. Beth now sees a therapist every week, and a psychiatrist monthly for her psychiatric disorders; because of her low income these services and her Suboxone treatment are free. She came to understand that her drug and alcohol usage was a form of self-medicating her mental illness. Nine months later, Beth remains an active participant in a local recovery support center and she is sober. Every month, her Suboxone dosage is reduced and she will celebrate one year clean from heroin in 60 days. Her goal is to be free from Suboxone and after one year of total sobriety, she can begin the 156-hour training to be a certified recovery support practitioner (CRSP), which is the peer recovery support specialist certification in the state of NJ (www.certboard.org).
This blog post was provided from The Fix by Melissa Killeen, who is a recovery coach, author of the first book on Recovery Coaching: Recovery Coaching a Guide to Coaching People in Recovery from Addictions and the recipient of the 2015 Vernon Johnson Award from Faces & Voices of Recovery at the 2015 America Honors Recovery Awards Gala.
Let’s count down on the top ways you can sabotage a loved one’s recovery, starting with:
#5 LOOK ON THEM AS DAMAGED GOODS
“Well, he’ll never get a decent job with that on his record.”
“She might as well go on being addicted, nobody decent will ever want her anyway.”
“Once a drunk, always a drunk.”
Sound harsh? I’ve heard all this and worse from well-meaning family members and friends who do not recognize the possibility of long-term recovery, or are just afraid to hope anymore.
#4 MANAGE THEIR LIFE FOR THEM
Because obviously your loved one is not capable. So you pay the bills, pick up the kids and put gas in the car. You put your own life on hold while you clean up the messes. You treat your loved one like a little kid while you get him sobered up for work and push him out the door. You shield her from the legal consequences of her using.
#3 DON’T LET THEM CHANGE
Maybe your loved one has gone to treatment, attended meetings, and worked on her recovery. Maybe she has started to change. Remind her of who she really is and where she comes from. If she has family members who also suffered from addiction, say, “The apple doesn’t fall far from the tree.” Assume the worst. Point out the relapses.
#2 KEEP THE SECRET
Don’t tell anyone about your “situation.” If someone at work starts talking about their loved one’s addiction, keep quiet. It’s nobody’s business and they don’t need to know. Don’t let the other members of your family talk about it either.
#1 PLAY THE SHAME GAME
Take note of every screw-up your loved one commits. Don’t forget the vomiting on the neighbor’s car part. Talk about your shame and your ruined life.
My name is Lynn Carlson and I’m a family member of a person in long-term recovery and a Family Member Recovery Coach for Recover Wyoming.
My sister, is a person in long-term recovery from addiction to alcohol.
Not that anybody’s keeping track.
You might think this Sabotage List is a little over-the-top, but I’m telling you, I’ve seen it. Hell – I’ve done most of these things myself.
When my sister was in her active addiction to alcohol, I got this brilliant idea: I would videotape her drunk. Surely when she saw the footage of herself (butt in the air after falling into the bushes) she would be so ashamed she would decide to get sober.
I never actually went through with it – but I wanted to. I would have done pretty much anything if I thought it would bring my sister back from the hole she was in.
Years later, I came to understand that the shame she felt was more extreme than anything I could imagine. When she shed her cloak of shame and worked hard in long-term treatment, and with (I believe) divine assistance, she found long-term recovery.
I did a lot of crazy things to try to manage the chaos that was my sister’s addiction. And in the process I learned. I eventually forgave myself for all of my insane thoughts and actions, because I was doing the best I could.
THERE IS ANOTHER WAY
It can all be done differently, I know this now. Each of the items in this Sabotage List can be flipped.
As family members, friends or lovers of someone in or seeking long-term recovery we can:
We can refuse to look on our loved one as damaged goods. We can visualize and speak often of their promising future in long-term recovery. We can educate ourselves about addiction, participate in the Recovery Movement and share the message that there are over 23 million Americans in long-term recovery. And most challenging of all, we can let ourselves hope.
We can let go of our grip on the reins of our loved one’s life, while taking precautions to ensure the safety of ourselves and other people. We can express confidence that when our loved one takes the right steps to move away from addiction and toward recovery, he will be capable of running his own life. We can allow her to experience the consequences of her actions, because that is a crucial part of her journey toward recovery. We can get on with our own lives, projects and plans – no excuses.
We can recognize the changes in our loved one and embrace them, dealing with any insecurity on our part about how those changes might affect us.
We can stand up and be counted among the millions of people who share our struggle. We can step out of the shadows and share our story. We can seek guidance from our peers: people with lived experience in dealing with a loved one’s addiction. We can offer support to people going through similar challenges. We can let the world know how proud we are of our loved ones and the resilience of our families. We can offer our experiences as an example that shows the promise of recovery.
TURN OUR BACKS ON SHAME:
We can refuse to use shame as a tactic in dealing with a loved one’s addiction. We can replace it with acceptance, hope and love.
If you are new to Faces & Voices of Recovery, welcome. Take advantage of the wisdom and resources offered here.
And from one family member to another, take care of yourself and be patient with your struggles. Most of all, believe in recovery. It’s real.
This blog post was provided by Lynn Carlson, Family Member Recovery Coach, RECOVER Wyoming in Cheyenne, Wyoming, a Charter Member of the Association of Recovery Community Organizations (ARCO).
I’m Merlyn Karst. After a long and successful career in corporate America and while living in California, I retired in the late eighties. I then worked as a consultant and dealt with my own issues resulting from misuse of the drug, alcohol. This led to my becoming an administrator of an alternative sentencing program dedicated to finding solutions other than incarceration for drug related offenses. I coined a phrase – providing reasons and resources to reduce recidivism. Finding a path to long-term recovery, for others and myself, has provided huge recovery dividends. I saw so much evidence that recovery healed families; it made a profound and lasting impression. I found myself to be a sort of “recovery ambassador. “
After moving to Denver, Colorado, I continued to carry the message of recovery. In 2001, I attended a meeting in St Paul, Minnesota, and those attending set out to put a face on and guide the voices of recovery from addiction to alcohol and other drugs. It began with this statement. By our silence, we let others define us. We determined that we could reduce stigma and discrimination through the impact and positive power of our stories of recovery. We also determined the need to change our language, our labels, and our identity. We needed to be, to act, and to speak out, as persons in long-term recovery.
Recovery is a reality for millions. Remember the over-arching question for many things: Who knew? The answer – too few! Our own organization, Advocates for Recovery-Colorado, was also born then and, with Faces & Voices of Recovery, became determined to educate and inform. Faces & Voices of Recovery is now the nation’s leading recovery advocacy organization with an international reach. The nation should be excited about a new and growing addition to the recovery movement, Young People in Recovery (YPR). It has added their powerful and passionate faces and voices. There are several recovery-oriented organizations and state and national agencies that now recognize and embrace the evidence of the reality of recovery. They also recognize the value of those in recovery as peer-to-peer providers of peer recovery services. Who better to carry the positive message.
Consider this statement statement by Carl Sagan, “Extraordinary claims require extraordinary evidence.” There are 23.5 million persons – young and old – in recovery from addiction. This, to many is an extraordinary claim. We contend that we are the extraordinary evidence. In order to achieve understanding and belief, we need to give much more light and life to the evidence. Millions in long-term recovery are now sharing the power of their stories of lived experience with good health, citizenship, and well-being. A statement to those with long-term recovery is: Stand up, stand out, speak out, and be proud about it. Of course, in early recovery, many seek the comfort and cocoon of anonymity. Eventually, it would be great to let everyone see the butterflies. We are many and we are beautiful.
This blog post was provided by Merlyn Karst, founding board member of Faces & Voices of Recovery and current Board Member, Advocates for Recovery in Denver, Colorado, a Charter Member of the Association of Recovery Community Organizations (ARCO).
I hate the words. Enable. Enabler. Enabling.
“He wouldn’t be in so much trouble if his parents didn’t enable him.”
“She’s an enabler.”
“I feel sorry for that family – they’re constantly enabling her.”
They are harsh words, often spoken with a slight hint of scorn. They are words of blame, words that carry a heavy load of shame.
Too often we use words without thinking much about their implications, so let’s take a closer look at “enable.”
“Enable” means to allow, facilitate, permit, make possible. (I love my trusty Thesaurus, which leads me down all sorts of untraveled word pathways.)
Allow means to let, to permit, agree to, consent to, tolerate.
Facilitate means to make easy, make possible, smooth the progress of, help, aid, assist.
Permit means to authorize, sanction, give your blessing to.
I am here to speak for parents of kids in trouble with drugs and for the wives, husbands, fathers, mothers, grandparents, brothers, sisters, aunts and uncles of addicted people.
They may not all agree with what I have to say but I suspect most will.
We do not “consent” to the pain and misery, the shame and fear, the destruction and despair of addiction.
We do not seek to “aid” or “assist” addiction in its efforts to destroy our loved ones.
We do not “make possible” this disease nor do we “tolerate” its horrors.
We do not authorize addiction to walk in our homes, we do not sanction it, nor do we give it our blessing.
We simply do not know – not in the beginning – how to fight back. Addiction enters our lives with stealth and cunning. It disguises itself, talking back to us in ways that make our heads spin. It tortures our emotions so that we begin to believe that we are the ones at fault, causing us to doubt ourselves, encouraging us to cover up, to protect and defend, to run screaming with our hair on fire to the hills.
Addiction takes our hearts and twists them.
It takes our thoughts and contorts them.
It takes our souls and fills them with dread, shame, guilt, and burning fear.
The “enable” word only adds to our guilt and shame and makes us hide in fear and self-loathing from the very people who might be able to help us.
Perhaps we might try to understand – or, as my trusty Thesaurus elaborates, identify, empathize, have compassion for, appreciate, be conscious of – the hellish situation so many of us find ourselves in.
We see the people we love in trouble. At home. At school. In the office. With the law.
Because we love them, because it is our job to protect the people we love, we try to help them. We don’t know, not at first, that they are suffering from a chronic, progressive, deadly disease, and once we suspect it, we cringe from the very thought.
Because addiction is not like cancer, diabetes, heart disease, or asthma. Addiction, like the word “enable,” is whispered.
When our family members are sick with addiction, friends don’t bring us home-cooked meals or fresh-baked cookies.
We don’t open our mailboxes to find heartfelt sympathy cards. No one sends us flowers.
Parents, relatives, teachers, and friends sometimes hint oh-so-subtly that our family’s “problem” stems from ineffective or even abusive parenting.
Insurance companies inform us that they don’t cover addiction treatment – or if they do, they “cap” the amount.
Counselors and health care professionals often tell us we are “over-reacting.”
Doctors prescribe pills to help us calm down, relieve stress, get a good night’s sleep.
Sometimes the people we turn to for help look at us sideways, barely able to hide their contempt.
Perhaps contempt is too harsh a word. But that’s what it feels like. Disapproval. Condescension. Disdain.
So what are we, exactly? What words should be used to describe those of us who struggle to do battle with this disease?
Flawed. Imperfect. Struggling. In need.
In need of what? Help. Hope. Understanding. Compassion.
The irony, I suppose, is that we have compassion aplenty. We remember the old days, when we thought this could never happen to us, the days when we, too, wondered what was wrong with those families whose kids smoked marijuana, snorted coke, or injected heroin. Those days when our children were young and fresh and innocent.
Once upon a time, we, too, thought that we were immune.
Now we know better.
Most of us have become familiar with the concept of modern technology as a “double-edged sword”. Although we find many wonderful benefits in possessing a smart phone, tablet, computers of various forms, or gaming devices, we also have come to recognize there are drawbacks, limitations, and even concerns of various forms of “addiction” lurking in the shadows for those who may find themselves “over-indulging”.
However, for every technological “Yin” we also find an equally present “Yang” – to include various positive aspects of harnessing today’s technology. Given our acceptance that there are always certain drawbacks to be found, let us instead focus on a couple of aspects of this technology that can bear great value in advancing recovery efforts.
Many if not most of us have experienced the long-standing value and success in the development of websites – this has become old news! A number more of us have designed and redesigned Facebook pages to promote our recovery efforts. How about Twitter accounts? This means of communication has grown in use and popularity over the last few years, and we see it being used in various venues today – all the way up to White House’s Office of National Drug Control Policy promoting national recovery-related events.
How about YouTube Channels? YouTube offers another fabulous means of providing visual and auditory communication in highly engaging forms to youth and that of all ages. Not only can we easily and inexpensively create our own videos, but we also have access to thousands of recovery-related video material at our disposal via the Internet.
Another low-cost mechanism for getting the message of recovery out across the globe is through the development of “smart phone” applications. Creating an “app” is not as difficult, time-consuming, or costly as one might imagine. In fact, I found that with just a little “on-line” research, there are app-building programs that are low cost, very user-friendly, and even fun to build. An app-building program allows us to design a recovery message that is tailored specifically to our intended audience.
Whether creating an app for a “one-time-only” event, or for statewide, national, or even global dissemination of information, the combination of “smart phone” and internet access puts the world at our fingertips and gives us one more tool by which to “carry the message” of recovery.
This blog post was provided by John Winslow, Program Director, Dorchester Recovery Initiative, a Charter Member of the Association of Recovery Community Organizations (ARCO).
William White’s 2006 work The Rhetoric of Recovery Advocacy: An Essay on the Power of Language is a powerful paper that suggests an essential focus for our recovery community work. He analyses the impact of the language that we apply to ourselves and that has been assigned to us by others.
Language helps to define us to ourselves, and shapes how others define us. Social policies and laws that are influenced by public perception are a result.
Those existing policies and perceptions reinforce the barriers to recovery of which we are all aware. One of the primary underlying causes of those barriers is the stigma associated with substance use disorders. That stigma has been shaped, in large part, by words.
White’s paper states that we must abandon some words while at the same time establish a ‘pro-recovery language.’
I’d like to focus on the negative aspects of the terms ‘abuse’ and ‘abuser,’ and suggest some actions that we at Rhode Island Communities for Addiction Recovery Efforts (RICARES) have taken and are preparing to take to rid ourselves of a term that White calls ‘one of the most ‘ill-chosen.’
White notes that this was recognized as long ago as 1973 when the National Commission on Marihuana and Drug Abuse criticized the term and stated that “continued use of this term with its emotional overtones, will serve only to perpetuate confused public attitudes about drug using behavior.’
The statement was prophetic.
This term is ill-chosen because:
There are heinous crimes committed by horrible people such as domestic abuse, elder abuse, sexual abuse, animal abuse, and child abuse. At some level of consciousness, people associate substance abuse with that group. We don’t belong there.
If we believe that addiction and the range of substance use disorders are medical conditions, why do we use the term when it is not used for any other condition? People with diabetes are not treated for ‘sugar abuse.’
Our use of the term ‘substance abuse’ has contributed to the reluctance of many people to accept addiction as a biomedical condition, and continue to believe that the most appropriate and effective way to deal with the societal issue of addiction is as a criminal issue rather than as a public health issue.
The Diagnostic and Statistical Manual, 5th edition (DSM-V) has discontinued the designations of ‘abuse’ and ‘dependency.’ The new term is ‘substance use disorder,’ (e.g., alcohol use disorder, cocaine use disorder, etc.). So, the term ‘abuse’ is even diagnostically outdated
Unfortunately, ‘abuse’ has become institutionally embedded. Most states have Departments, Divisions or Offices of Substance Abuse. SAMHSA (the Substance ‘Abuse’ and Mental Health Services Administration) oversees our services and much of our funding.
It is our responsibility, and to our benefit, to continue the effort to abandon ‘abuse’ for ‘substance use disorder’ or ‘substance use condition’ – no one else will.
Some suggested actions:
RICARES has communicated with our SAMHSA Regional representative and asked her to raise the issue at her level. She replied that she would be happy to raise the issue across the constituency groups with whom she interacts and to move it forward to the appropriate policy people.
A RICARES member is enrolled in the Chemical Dependency/Addiction Studies Program at Rhode Island College. She advocated for the revision of ‘abuse’ to ‘substance use disorder’ in all the program-generated literature. This has occurred.
We pointedly make the distinction whenever we speak to relevant groups about recovery. For example, in the last week we have spoken to a clinical group of nursing students and to case managers and clinicians at a community mental health center and hammered the distinction
Whenever we interact with treatment organizational leadership and clinicians, we hammer the distinction.
We shall communicate with leadership and with our allies at the state legislature and ask them to use ‘substance use disorder’ rather than ‘substance abuse’ in all relevant new legislation
We shall communicate with the new leadership at our Department of Behavioral Healthcare and ask them to make the revision in their speech and department-generated literature. We are optimistic about this step as the Department recently changed all their old references for ‘Retardation’ to ‘Developmental Disabilities.’
We shall communicate with the new leadership at the state’s Executive Office of Health and Human Services and ask them to make the revision in their speech and literature.
We know that you can think of many other actions.
Our regional SAMHSA representative noted, “it would help if the noteworthy leaders in treatment and recovery stepped out in favor of revising the terminology.” This is a simple but powerful step that we can take to start the action to, as White states: change the way that we see ourselves and are seen by others, change the language that affects social policies, and “to personally and culturally close one chapter in history and open another.”
This blog post was provided by Ian Knowles, Project Director, Rhode Island Communities for Addiction Recovery Efforts (RICARES), a Charter Member of the Association of Recovery Community Organizations (ARCO).