We often expect those we serve to:
- be willing to make significant changes,
- sustain effort while making difficult changes that take time,
- and be willing to endure and benefit from practical lessons while making change.
But what about changes our organizations can make? Could some peer support of the organizational change process be helpful? Could some coaching tips in attempting system change toward a recovery orientation be useful?
This post will provide a partial overview of some aspects of organizational change, including contextual considerations, specific components of recovery orientation, the scale of change projects, and practical tips in making and supporting change. Examples of changes toward a recovery orientation will be included, along with citations for further study.
One contextual frame for the general guiding of organizational change is the notion of a helpful and effective “facilitating environment” (borrowed from Winnicott, 1974).
- For a clear picture of this, imagine an intentional ecological space within which there is effective nurturing and facilitation of personal development.
- Now make the relevant planning and related action for that support continuous down the following relevant layers, as outlined by Winnicott:
- the therapist and the laboratory (research efforts and findings),
- the therapist and their supervision (personal and professional development),
- the therapist and counseling (the context and provision of care),
- and finally, the patient and their home (as a system).
Changes consistent with Recovery Orientation can be made at the whole-organization level, entire programs can be modified, and specific practices within programs can be changed at the per-program level. Changes of this scale specific to Recovery Orientation have been achieved and written up for others to study (e.g. Boyle, M., Loveland, D. & George, S., 2010). In this type of planning, consider making changes that target either or both of:
- Disease Management (e.g. symptom suppression)
- Recovery Management (the pursuit of wellbeing).
Look for examples of change others have already made. Be sure to look for evaluation of their effectiveness, and for evaluation of the experience of those using the system. Nowadays, examples abound.
- Specific Disease Management efforts have been written up (e.g. Hamalainen, Zetterstom, et.al., 2018), as have patient experiences with disease management strategies (e.g. Nehlin, Carlsson, & Oster, 2017).
- Recovery Management efforts such as Recovery Coaching (White, 2004) have been archived, as have patient experiences with those kinds of strategies (Eddie, Hoffman, & Vilsaint, et. al., 2019).
Consider both the “New Paradigm” of Care and 5 Year Standard of Effectiveness.
- Practically speaking there is no such thing as “bad improvement”. In this way of thinking, virtually any starting point of change, and any amount of initial change is to be welcomed – both for the patient and for the system.
- Can we move toward that in our systems?
- In their article on a “New Paradigm for Long-Term Recovery” DuPont and Humphreys (2011) discuss the effect of: 1. services provided in the indigenous environment rather than a clinical setting, 2. a multi-year framework, 3. inclusion of person-centered goals, and 4. structured incentives that support positive change. These approaches have been found to be present in collegiate recovery programs, professional monitoring programs, and drug court models – probably going a long way toward identifying common factors for their shared effectiveness with disparate populations.
- Can we move toward that in our systems?
- Regardless of a person’s starting point, initial improvements, and incremental change, full-remission 5 years after the last clinical intervention is the standard for remission (when severe, chronic disease is the problem) and ultimate goal of comparison for eventual service effectiveness (DuPont, Compton, & McLellan, 2015).
- Can we move toward that in our systems?
Practical guidance in basic change principles for organizations and leaders to consider are also widely available. Some are general to any change effort, and some are specific to our work.
- General change related concepts and specific changes with practical relevance (increasing patient retention and decreasing wait times) have been archived for dissemination (e.g. McCarty, Gustafson, Wisdom, et. al., 2017). Practical axioms for leaders such as “When you think you’re going too slow, slow down” and “Don’t be afraid of change – you can always change back” can be very helpful in planning, guiding, and supporting change.
- Even multi-year, multi-program, organization-wide change efforts have been written up and evaluated (Loveland & Driscoll, 2014).
In reviewing these kinds of materials, you might find important changes consistent with Recovery Orientation can be innovated on a smaller scale as well. For example:
- Adding a technology solution blended with recovery coaching, both during and following residential treatment (Coon, 2013)
- Improving effectiveness at linking college-bound emerging adults with Collegiate Recovery Programs (Crowe, Hennen & Coon, 2017)
- Raising staff and student awareness of recovery support systems specific to undergraduate and graduate education, and that are available when later pursuing relevant professional licensure (Coon, 2015)
- Adopting a challenging best practice, such as transitioning to a tobacco-free treatment model (Coon, 2014; Martin, Lee, & Coon, 2018)
- Adding a coaching component and a technology tool for breath testing to an outpatient program (Hennen & Coon, 2020) to raise both retention and wellness.
Over the years, I’ve noticed it is helpful to have some support, encouragement, coaching, and guidance when attempting a change project, or moving a system toward a difficult goal. I have also noticed I’m in need of the same when coaching others in support of system improvement.
Boyle, M., Loveland, D., George, S. (2010). Implementing Recovery Management in a Treatment Organization. In Kelly, J & White, W. L. (Eds): Addiction Recovery Management: Theory, Research, and Practice. Pp. 235-258.
Coon, B. (2013). Center Uses Technology to Help Patients During and After Treatment. Addiction Professional. May 22, 2013.
Coon, B. (2015). Recovering Students Need Support As They Transition. Addiction Professional. 13(1): 22-26.
Coon, B. (2014). An Addiction Treatment Campus Goes Tobacco-Free: Lessons Learned. Addiction Professional. 12(1): 18-20.
Crowe, K., Hennen, B. & Coon, B. March 31, 2017. A Seamless Transition: Linking College-Bound Emerging Adults with Collegiate Recovery Programs. Recovery Campus Newsletter.
DuPont, R. L & Humphreys, K. (2011). A New Paradigm for Long-Term Recovery. Substance Abuse. 32(1):1-6.
DuPont, R. L., Compton, W. M. & McLellan, A. T. (2015). Five-Year Recovery: A New Standard for Assessing Effectiveness of Substance Use Disorder Treatment. Journal of Substance Abuse Treatment. 58:1-5. doi:10.1016/j.jsat.2015.06.024
Eddie, D., Hoffman, L., Vilsaint, C., Abry, A., Bergman, B., Hoeppner, B., Weinstin, C. & Kelly, J.F. (2019). Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching. Frontiers in Psychology. 10:1052. doi:10.3389/fpsyg.2019.01052
Hamalainen M. D., Zetterstom, A., Winkvist, M., Soderquist, M., Karlberg, E., Ohagen, P., Andersson, K. & Nyberg, F. (2018). Real-time Monitoring Using a Breathalyzer-Based eHealth System Can Identify Lapse/Relapse Patterns in Alcohol Use Disorder Patients. Alcohol and Alcoholism. 53(4):368-375. doi:10.1093/alcalc/agy011
Hennen, B. & Coon, B. (2020). Recovery Coaching, Breathalyzer Boost Retention in Outpatient SUD Treatment. Addiction Professional. September 23, 2020.
Loveland, D. & Driscoll, H. (2014). Examining Attrition Rates at One Specialty Addiction Treatment Provider in the United States: A Case Study Using a Retrospective Chart Review. Substance Abuse, Treatment, Prevention and Policy. 9(41). doi.org/10.1186/1747-597X-9-41.
McCarty, D., Gustafson, D.H., Wisdom, J.P., Ford, J., Choi, D., Molfenter, T., Capoccia, V. & Cotter, F. (2017). The Network for the Improvement for Addiction Treatment (NIATx): Enhancing Access and Retention. Drug and Alcohol Dependence. 88(2-3):138-145.
Martin, L., Lee, J. L., & Coon, B. (2018). Implementing Tobacco-Free Policies in Residential Addiction Treatment Settings. Physician Health News. 25 (2): 14.
Nehlin, C., Carlsson, K, & Oster, C. (2017). Patients’ Experiences of Using a Cellular Photo Digital Breathalyzer for Treatment Purposes. Journal of Addiction Medicine. 12(2):107-112. doi:10.1097/ADM.0000000000000373
White, W. (2004). Recovery Coaching: A Lost Function of Addiction Counseling? Counselor. 5(6), 20-22.
Winnicott, D. W. (1974). Fear of Breakdown. International Review of Psycho-Analysis. 1(1-2): 103-107.