Addiction Recovery Management (eBook)

Foreword 6
Contents 8
Contributors 10
Chapter 1: Introduction: The Theory, Science, and Practice of Recovery Management 14
Introduction 14
References 19
Part I: Theoretical Foundations of Recovery Management 20
Chapter 2: Addiction Treatment and Recovery Careers 21
Introduction 21
A Life Course Conceptual Framework 22
Drug Use Trajectories 23
Drug Use Trajectories Among the General Population 24
Drug Use Trajectories Among Drug-Dependent Users 25
Distinctive Trajectories Among Drug Users 25
Recovery Careers 27
Conceptualization and Definitions of Recovery 27
Long-Term Follow-Up Studies Informing Recovery 28
Predictors of Recovery 28
Theory-Based Processes Promoting Recovery 30
Addiction Treatment 31
Current Treatment Services for Drug Addiction 32
Treatment Outcomes and Cumulative Treatment Effects 32
Emerging Long-Term Care Models 33
Long-Term Care Interventions 34
Recovery-Oriented Systems of Care 34
Implications and Future Research 35
Improving Understanding of Recovery 36
Developing Empirically Based Long-Term Care Strategies 36
Summary 37
References 38
Chapter 3: Integrating Addiction Treatment and Mutual Aid Recovery Resources 42
Introduction 43
Brief History of 12-Step Treatment 43
Individual Format 44
Project MATCH 44
Intensive Referral 45
Motivational Interviewing 46
Individual TSF for Cocaine Dependence 46
Twelve-Step Directive 47
Group Format 47
Group Project MATCH 47
Group TSF for Cocaine Dependence 48
Making AA Easier/MAAEZ 48
Differences in Sub-group Effects 49
Summary of Key Points 51
References 51
Chapter 4: Processes that Promote Recovery from Addictive Disorders 55
Introduction 55
Theoretical Perspectives 56
Social Control Theory 56
Social Learning Theory 57
Stress and Coping Theory 57
Behavioral Economics and Behavioral Choice Theory 57
Active Ingredients of Community Contexts 58
Support, Goal Direction, and Structure 58
Family Processes 58
Friends and Broader Social Contexts 59
Abstinence-Oriented Norms and Models 60
Family Norms and Models 60
Friend and Peer Norms and Models 61
Self-Efficacy and Coping Skills 61
Rewarding Activities 62
Active Ingredients of Self-help Groups 63
Support, Goal Direction, and Structure 63
Abstinence-Oriented Norms and Models 65
Self-Efficacy and Coping 65
Rewarding Activities 67
Common Components of Stable Recovery 68
Future Directions 68
Specifying Linkages Between Protective Resources and Recovery 69
Clarifying Connections Between Treatment and Protective Resources 70
Tailoring Treatment to Strengthen Resources that Promote Recovery 70
Conclusion 71
Key Points 71
References 72
Chapter 5: Recovery Management: What If We Really Believed That Addiction Was a Chronic Disorder? 77
Introduction 78
Addiction as a Chronic Disorder 78
Recovery as a Time-Sustained Process 80
Evolution of the Acute Care Model of Addiction Treatment 81
Recovery Management: Long-Term Recovery as an Organizing Image 82
Changes in Service Practices 82
Attraction/Access to Treatment 83
Assessment and Level of Care Placement 84
Composition of the Service Team 84
Service Relationships/Roles 85
Service Dose, Scope, and Duration 86
Locus of Service Delivery 86
Linkage to Communities of Recovery 87
Posttreatment Monitoring, Support, and Early Reintervention 88
Summary 89
Key Points 89
References 90
Part II: Research Approaches and Findings 95
Chapter 6: Recovery Management Checkups with Adult Chronic Substance Users 96
Introduction 97
Challenges for Managing Addiction as a Chronic Condition 97
Models of Ongoing Monitoring and Early Reintervention 97
Tracking, Assessing, Linking, Engaging, and Retaining 98
Study Overview 99
Evolution of the RMC Protocol from Experiments 1 to 2 100
The TALER Protocol: A Platform for Implementing RMC 101
Impact of RMC on the Course of Addiction 103
Discussion 106
Implications 107
Summary of Key Points 107
References 108
Chapter 7: Assertive Continuing Care for Adolescents 111
Introduction 112
Treatment System Barriers to Continuing Care 113
Assertive Approaches to Continuing Care 117
Additional Key Features of ACC 120
Research on Assertive Continuing Care 122
Assertive Continuing Care: Initial Study 122
Assertive Continuing Care: Second Study 124
ACC Research to Validate Continuing Care Performance Measure 125
Does Rapid CC Initiation Improve Outcomes for Residential Treatment Noncompleters? 127
Current and Future Research on Assertive Approaches to Continuing Care 129
Summary 130
References 132
Chapter 8: Long-Term Trajectories of Adolescent Recovery 135
Introduction 136
What Happens to Teens After Drug and Alcohol Treatment? 136
What Predicts Adolescent Recovery After Treatment? 140
Recovery Without Treatment for Adolescents 140
Common Patterns of Recovery in Nontreated Youth 141
Predictors of Recovery in Nontreated Samples 144
Conclusions and Directions for the Development of Recovery Models 145
Key Points 147
References 148
Chapter 9: Residential Recovery Homes/Oxford Houses 151
The Oxford House Story 151
Origin and Nature of Oxford Houses 152
Participatory Action Approach 153
Economic Issues 156
Sustainability 160
Oxford House and Gender Roles 161
Psychiatric Comorbidity 163
Conclusions and Future Directions 165
Key Points 167
Authors´ Notes 167
References 167
Chapter 10: Continuing Care and Recovery 170
Introduction 171
What Contributes to the Chronic Nature of Substance Use Disorders? 171
What Are the Implications of Having a Chronic Disorder? 172
Research Findings on the Effectiveness of Continuing Care 173
Limitations of Published Research on Continuing Care 174
Focus on Inpatient Samples 174
Focus on Treatment Completers 175
Focus on Traditional Treatment Models 175
Failure to Consider Which Patients Most Need Continuing Care 175
Focus on Conventional Approaches to Continuing Care 176
Deficits vs. Strengths 176
Little Consideration of Patients´ Preference 177
Fixed vs. Flexible 177
Problems Further Upstream 178
The Engagement Problem 178
The Retention Problem 178
The Transition Problem 179
What We Really Know About Continuing Care and Recovery 179
A New Generation of Continuing Care Studies 179
Possible Solutions to Problems of Engagement and Retention 183
Reduce Patient Burden in Continuing Care Whenever Possible 183
Provide Incentives for Participation 184
Use Leverage When Available 184
Combine Continuing Care with Other Services 185
Actively Link Patients to Other Recovery Supports 185
Making Continuing Care More Recovery-Oriented 186
Summary 187
References 188
Part III: Recovery Management in Practice 191
Chapter 11: Recovery-Focused Behavioral Health System Transformation: A Framework for Change and Lessons Learned from Philadelpia 192
Introduction 192
The History of Recovery-Focused Transformation in Philadelphia 193
The Case for a Guiding Framework 194
Models of Approaching Systems Transformation 194
The Additive Approach 194
The Selective Approach 195
The Transformative Approach 195
Overview of the Change Framework 196
Strategies that Advance Conceptual Alignment 197
Establish a Sense of Urgency 197
Form Powerful Guiding Coalitions to Assist with Developing a Vision 198
Connect the Vision to Other Initiatives and Over Communicate it Times Ten 199
Ensure that Stakeholders Understand the Nature of Transformational Change 199
Utilize a Transparent and Participatory Approach at All Times 200
Create Forums for Knowledge Sharing and Exploration of New Ideas 201
Address Perceived Loss and Facilitate Engagement 201
Mobilize the Early Adopters and Recovery Champions 202
Strategies that Advance Practice Alignment 203
Establish Priorities 203
Identify Practice Changes Associated with the Priorities 203
Develop Mechanisms for Attitudinal Change and Skill Building 205
Empower All Stakeholders 205
Create Short-Term Wins 206
Celebrate the Successes 207
Strategies that Advance Contextual Alignment 207
Align Organizational Structure 208
Address Policy and Fiscal Issues for Long-Term Sustainability 208
Strengthen the Community and Build Indigenous Recovery Capital 209
Move Beyond the Choir - Link It to Other Political Agendas 210
Summary 210
References 211
Chapter 12: Connecticut´s Journey to a Statewide Recovery-Oriented Health-care System: Strategies, Successes, and Challenges 214
Introduction 215
New Collaboration Sets the Stage for the Recovery Movement 216
Phase I: Determine Direction 216
Core Values and Premises 216
Define Recovery and Establish Policy 218
Identify DMHAS as a Health-care Service Agency 219
Establish a Strategic Action Plan 219
Phase II: Initiate and Implement Change in System Integration 221
Spread the Word 221
Quality Improvement and Collaboration 222
Identify and Apply Tools for Change 224
Have a ``Recovery Plan´´ to Protect the Overall Strategic Goal 227
Complete a Lessons Learned Initiative 228
Expand the Resource Base Beyond State Funding 228
Phase III: Increase Depth, Complexity, and Preparedness for Future Phase 229
Access to Recovery 229
Finance and Quality Models 231
Connect the Dots 234
Organizational Structure and Business Plan 235
Key Points: 237
References 238
Chapter 13: Implementing Recovery Management in a Treatment Organization 240
Introduction 241
BHRM Project 241
Implementing BHRM Principles at Fayette Companies 243
Changing Organizational and Administrative Structures 245
Integrating Treatment for Addiction, Mental Health, and Physical Conditions 245
Addressing Culture 246
Reimbursement and Regulatory Challenges 247
The Recovery Coach Model 248
Recovery Capital 248
Research on Case Management 249
Recovery Coach Program at Fayette 250
Research on the Recovery Coach Model 252
Challenges and Modifications of the Recovery Coach Model 254
Adapting a Consumer-Driven Model to a Professional-Driven Treatment Program 254
Maintaining Fidelity of the Recovery Coach Program 255
Next Steps in Fayette Companies´ Transformation 256
Development and Utilization of New Technologies 256
Restructuring Residential Treatment 257
Outpatient Buprenorphine-Assisted Program 259
True-North Solutions Outpatient Program 259
Lessons Learned 260
References 261
Chapter 14: Peer-Based Recovery Support Services Within a Recovery Community Organization: The CCAR Experience 264
Introduction 264
The Beginning 265
The Early Years: Planning and Organizing 267
Foundational Principals 269
You Are in Recovery if You Say You Are 269
There Are Many Pathways to Recovery 270
Focus Is on the Recovery Potential, Not the Pathology 270
Err on the Side of the Recoveree 270
Err on the Side of Being Generous 271
The Recovery Community Center 271
Core Elements of a RCC: Overview 271
Site 273
Administration 273
Programming 274
Volunteers 275
General 275
Volunteer Management System 275
Telephone Recovery Support 276
Recovery Coaching 278
Recovery Housing Project 280
Recovery-Oriented Employment Services 281
All-Recovery Groups 282
Winners Circle Support Group 282
Family Education and Support 282
Recovery Training Series 282
Peer-Led Recovery Social Activities 283
Integrating CCAR Activities with Addiction Treatment 283
Key Points 284
References 284
Chapter 15: The Physician Health Program: A Replicable Model of Sustained Recovery Management 285
The PHP Concept and Its Applicability to the General Population 286
History of PHPs 289
Care Management 290
The PHP Model 291
Key Ingredients 293
Summary of Results of a National Study of PHPs 295
Phase I 295
Phase II 296
Wider Applicability of the PHP System of Care Management 298
Barriers to Wider Application of the PHP Model of Care Management 299
Summary 301
Key Points 302
References 302
Part IV: Future Directions in Recovery Management 304
Chapter 16: Recovery Management and the Future of Addiction Treatment and Recovery in the USA 305
Introduction 306
What is Recovery? Definition and Conceptual Boundaries 306
RM and ROSC Within the Broad Range of Approaches to Substance-Related Problems 307
Models of, and Benefits from, RM and ROSC Transformation and Implementation Initiatives 309
Adoption, Implementation, and Maintenance of RM and ROSC 310
Deepening and Broadening the Transformation to RM and ROSC 314
Conclusions 314
References 315
Appendix 319
RM and ROSC Web Resources 319
Index 320