In the first two posts of this series, I initially described the origin and early evolution of what we call the Recovery Alliance Initiative. Those posts were followed by one that described the expansion and clarification of our model and methods within the Alliance effort.
In this post I’ll describe a by-product of our effort up to that point – a recipe we uncovered.
Our effort up to that point included years of planning and holding Summit meetings, as well as my own personal reading and study related to the systems we were involving. Our effort also included lots of very focused and sustained conversations between Tom and me about our intent and methods, each sector specifically, and all the sectors together. I started to notice that certain “ingredients” kept showing up across different sectors or through the time of the lived experience of the one being served. And I started to develop the notion that if or when combined these ingredients seemed to be powerful and effective, in general.
To help elucidate this, there are three sectors in our Alliance that I want to highlight. (By the way, I want to point out that these three sectors serve special populations that are quite different, assist those commonly thought of as supposedly hard to help, and yet are known as being effective). Here are the three sectors:
- Collegiate recovery programs
- Professional monitoring organizations
- Drug Court also known as Recovery Court; Veteran Court.
Eventually I came to realize that these three systems have some structural and functional similarities, and that realization became very interesting to me. All three of them:
- take the long view
- use a multi-year structure
- work in the natural or indigenous environment
- see the family as central rather than peripheral
- work with person-centered goals, and use contingency management.
I have come to see these as an important combination of ingredients. I described my thinking in some detail (Coon, 2015). For those that might be interested, White, Boyle & Loveland (2003) serves as a theoretical and practical substrate to that realization.
But I’ll go even further. These systems seem to at least partially conceptualize and operationalize what has been called initial disease management and later recovery management (for relatively severe, complex, and chronic addiction illness – that is, those to whom it seems to apply) on the path of the person served.
Robert DuPont, MD briefly visited one of our national Summit meetings. In his comments to me Dr. DuPont emphasized the use of eventual full recovery as a starting place in working with people rather than believing without examination or evidence it is not possible for the person we are attempting to help. He emphasized that this stance of eventual full recovery helps push the system, in any modality or sector, to do its absolute best on behalf of the person they serve. Those that might be interested can check out DuPont & Humphreys (2011).
Further though, Dr. DuPont uses Five Year Recovery as the standard of effectiveness (DuPont, Compton, & McLellan, 2015). When Dr. DuPont explained this standard to me, he stated that he means full recovery five-years after the last clinical touch. For example, he described examining the continued favorable outcome for physicians who underwent addiction treatment five years after their five-year professional monitoring had concluded.
Dr. DuPont stated that this standard of full recovery five years after the last clinical touch is relatively new for the care of addiction illness. But he pointed out that it’s the same standard primary healthcare has been using for a long time concerning remission of other chronic serious illnesses, like cancer or heart disease. Starting from that standard of effectiveness pushes the system to do its best, including:
- staying engaged over the much longer term,
- not giving up hope or giving up on helping, and
- stretching the system for the best possible outcome for each individual, and one that will last.
Although a standard of care or benchmark of effectiveness might be a positive aspirational goal for all systems addressing or intersecting with those experiencing severe, complex, and chronic addiction illness, what can we do right now within our existing systems to improve our methods? Over the years, Tom and I have been convinced that one immediate way forward would be to link existing systems in a meaningful way.
- One of those ways is through efforts like our Summit meetings (e.g multi-system working groups formed to tackle change projects that answer needs revealed when siloed sectors meet).
- Another of those ways is to take the long view of the life course of the person served, to consider our systems over the long term from the person’s vantage point, and promote or innovate collaboration from the person’s perspective.
In the next post in this series, I will present concrete practical perspectives that Tom and I have either developed or adopted for the work of the Recovery Alliance.
6 thoughts on “The Recovery Alliance Initiative – A Recipe We Uncovered”
How does the use of medication assisted treatments fit into the 5 year period? Or is the 5 year period based on abstinence?
Thank you for your thoughts.
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Medications for psychiatric problems, primary health problems, and substance use problems might be a normal part of the treatment plan for any one individual, on a per-problem basis, at any point along the individual person’s path. In that way, medications are a tool, not an end per se.
The goal for the individual is their own to define. The clinical goal for the individual might also be envisioned by the clinician. Regardless, full well-being five years after the last clinical touch – that’s the level of remission or quality of life we can strive for as a field.
Medications neither cause nor prevent reaching the best possible result for the person. They might be used at any point along the path, during or after the 5 years.
Thank you for your reply, In my area, there are no recovery residences or sober homes. There are only outpatient clinics and the use of medication is expected to be given for the rest of life. The lines are very long. The comparison of addiction to diabetes is the most used explanation for lifetime use of these addiction medications. As an advocate of peer supported long-term recovery housing, I find this strategy defeating.
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I appreciate your question and comments. Please know my answer as I gave it is only in the abstract and only literal. Naturally, different people are different (even if their diagnosis is the same) and different providers are different (even if their program model is the same). I appreciate your attention to the quality and thoroughness of care. The bottom line is the person we serve and if they are improving. Thanks for your thoughtfulness.
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