Establishing and sustaining recovery can be a complex process requiring multiple components to withstand the environmental challenges. It has a foundation that it is built on load bearing beams and columns to sustain it, and an outer shell and a roof to provide support and safety from the elements. A great deal depends on a foundation of solid craftmanship. It can be daunting to construct and not always possible to complete without a great deal of assistance. Similarly, recovery is multifaceted. While it is not uncommon for people with less severe forms of the condition who possess high levels of recovery capital to develop and sustain recovery without formal support (Granfield & 1999). Those with more severe forms and negligible resources often require a great deal of support, especially in the early stages of recovery. We should remain cognizant that the economic impact of addiction on society is staggering. Helping people get well (and not just putting plaster over their symptoms), even those with the most severe forms of SUD, remains more cost effective than not doing what is needed to help them heal.
Bringing all the individual elements of recovery together and properly assembling them is a complex process requiring many hands. It is not dissimilar to the process of raising a barn. Every farmer needs a barn but not every one of them has the resources to finance all elements to bring the structure together. This is why, in earlier, more agrarian times, barn raising was a community event. Communities came together to support individual members. Every member of the community could depend on every other member to help them as they could count on their neighbors to assist them in times of need. These communities had a wealth of barn building capacity. Complex and expensive structures were built at lower costs and also strengthened the fabric of the community through shared purpose, mentoring and connections between people. This resulted in significant internal resources within the community. What is now called social capital.
The other method to build a barn is to assemble the various technical experts who can build a great barn, but their efforts do not also result in the strengthening of the community. When a group of specialists build a barn, you end up with one barn, and no broader community building! When a community builds a barn together, it strengthens community resilience. It results in a legion of barn builders that cost less and provide additional benefits to everyone. This is a much less expensive process with broader yield. Marginalized communities without access to a lot of resources in particular can benefit from these community building strategies as they are ill equipped to sustain a cadre of artisans at the standby to build a barn each time one is needed.
The Original Recovery Community Support Program Grants and Recovery Barn Building
Recovery community ‘barn building’ is analogous to how the current iteration of the recovery movement in the US was conceptualized and initially implemented. As described by SAMHSA, in 1998, the Center for Substance Abuse Treatment (CSAT) initiated the Recovery Community Support Program (RCSP) to foster the participation of persons in recovery, their families, and other allies in the development of substance abuse treatment policies, programs, and quality assurance activities at the state, regional, and local levels. It was intended to develop what could be envisioned as communities of recovery barn builders. Cathy Nugent, the initial grant officer for the project recounted how SAMHSA’s stipulated goal was to “identify and nurture their individual and collective strengths and resources, to build connections and community—within their individual grant projects and across projects to create and hold a space for recovery community members to emerge as the experts and leaders in this new enterprise (Stauffer, 2021).”
For a variety of reasons including a change in federal administrations in that era, reticence within government to empower groups of people recovering from drug addiction to be experts in their own right and the prevailing service-oriented care model, the RCSP project quickly shifted from support to build communities of recovery to the provision of recovery-oriented services to the community. Later versions of the grants emphasized services and not community building support. Thus, the power of recovery community has never been fully nurtured or realized.
These same trends were replicated across the nation as states focused on peer recovery support initiatives and not on community building initiatives. The process of moving from a community building orientation to that of a community to be serviced was gradual. Increasingly the system of care embraced is akin to establishing teams of specialized barn builders rather than developing communities of recovery barn raisers that can be expanded and replicated nationally.
We continue to move from supporting the capacity of community to raise its own structures of support to paternalistic oriented models in which credentialed experts provide government funded peer services to the community. A cottage industry of experts in recovery has emerged with all the predictable barriers being erected to ensure that it is a model that can be expanded. Creating an elite cadre of recovery experts and further marginalizing recover community members and reinforcing outsider status for the recovery community.
We are witnessing a proliferation of peer support services. How we envision these roles evolving and how they are financed matter a great deal. One funding strategy receiving increasing focus is funding SUD Services through Medicaid state plans. It is an important strategy that should be expanded, yet it also has limitations. Most people, as they heal from a substance use condition are able to work and do not require long term publicly funded services. If we focus funding for long term recovery and wellness within Medicaid, then we invariably establish a model of dependency that creates incentives for service providers to sustain recipient Medicaid benefits. It is a common experience in recovery that establishing productive roles through self-sustaining income generation as an important facet for many in their healing process. The majority of people in recovery should not rely indefinitely on welfare funding as it can impede them from reaching their full potential, can threaten long term recovery for the benefit recipient and siphons resources out of the community. Funding strategies must include pathways out of welfare dependency.
Another challenge that the professional recovery services model faces is that recovery occurs in community. Each community is highly individualized and diverse in every aspect. As recovery intrinsically involves community it would be nearly impossible for service-oriented models to have outside “experts” build recovery within communities in any manner that is as effective as what each community could build for itself, provided that the community has available the requisite knowledge, skills, and resources.
As our entire system of care has an emphasis on service, it is imperative we recognize the limits of a service orientation. We simply do not have the capacity to do everything that is required to develop and sustain recovery from a service orientation. Additionally, such an orientation erodes community capacity for self-determination, which creates a dependency dynamic. This comes at a time when one of the overarching challenges facing our nation is the erosion of social capital. It is time to revisit our orientation to supporting long term recovery building strategies as part of critically necessary national efforts to revitalize our communities.
Professional recovery experts inevitably will face a conflict of interest as to decisions in their own economic interest or those in the best interest for the community they are funded to assist. Communities brought together where people help and depend upon each other to build the structures they require have little need for experts to tell them what to do or do it all for them. In this light we must be wary of support structures that keep people and communities dependent on outside experts and instead focus on efforts that build and strengthen the recovery capital within communities. This was the heart of the effort within the new recovery advocacy movement, and as warned, we are destined to fail if we continue to rely on support services rather than the building upon the inherent strengths of the community.
Recovery Inclusive Cities
One promising strategy to support the development of community recovery capital is the Inclusive Recovery Cities model emerging out of the United Kingdom. As noted by Best and Coleman (2018), “an Inclusive City promotes participation, inclusion, full and equal citizenship to all her citizens, including those in recovery, based on the idea of community capital. The aim of building recovery capital at a community level through connections and ’linking social capital’ to challenge stigmatization and exclusion, is seen as central to this idea. Inclusive Cities is an initiative to support the creation of Recovery-Oriented Systems of Care at a city level, that starts with but extends beyond substance using populations.” This is an effort to develop communities of recovery barn raisers, in which everyone benefits from being involved. There is evidence that strategies that engage the whole community increase volunteerism, social enterprise, collective trust and efficacy, stabilizes employment, and reduces negative perceptions that society has in respect to addiction and people in recovery.
How do we raise up such models in the US? In the last decade, there has been growing awareness of what has been coined ‘deaths of despair’, in which people lose hope, purpose, and connection. The loss of these fundamental human needs becomes life threatening in ways that impact entire communities. There is a parallel here in respect to how for decades, we have focused research on understanding the pathology of addiction and almost nothing on the healing from it. Where are the systematic efforts here in the US to refocus on solutions instead of the challenges? To effect change here, we must authentically engage the impacted communities in ways that transcend our traditional service delivery system if we want to reverse the trajectory we are on.
We must reach a point where we realize that the solutions we require are community-based. That there is a vast reservoir of untapped potential in our communities. Addressing these needs at the community level not only expand the capacity of communities to meet their own needs but also yield preventative benefits as the capacity development decreases the despair and desperation that is destroying us.
It is time we move beyond recovery barn building and focus on create communities of recovery barn raisers.
Sources
Center for Substance Abuse Treatment Recovery Community Support Program Grantee Accomplishments and Lessons Learned. (2001, June). https://www.chestnut.org/resources/2ad7eab7-6d2e-41b2-b478-68174a0c30d1/CSAT-percent-20RCSP-percent-20Lessons-percent-20Learned-percent-202001.pdf
David Best & Charlotte Colman (2018): Let’s celebrate recovery. Inclusive Cities working together to support social cohesion, Addiction Research & Theory. https://doi.org/10.1080/16066359.2018.1520223
Granfield, R., & Cloud, W. (1999). Coming clean: Overcoming addiction without treatment. New York University Press.
Recovery Community Services Program (RCSP). (2008). https://www.chestnut.org/resources/8b43ad39-884e-480e-a6a6-f20a105f147f/CSAT-percent-20RCSP-percent-20Description.pdf
Stauffer, W. (2021, December 21). Interview #14 Cathy Nugent – Reflections on the Historic 2001 Recovery Summit in St. Paul, Minnesota, and the Start of the New Recovery Advocacy Movement. https://recoveryreview.blog/2021/12/21/interview-14-cathy-nugent-reflections-on-the-historic-2001-recovery-summit-in-st-paul-minnesota-and-the-start-of-the-new-recovery-advocacy-movement/
Substance Abuse: Facing the Costs – Health Policy Institute. (2019, February 13). Health Policy Institute. https://hpi.georgetown.edu/abuse/#:~:text=Substance%20abuse%20is%20a%20preventable
White, W. (2013). Selected Papers of William L. White State of the New Recovery Advocacy Movement Amplification of Remarks to the Association of Recovery Community Organizations at Faces & Voices of Recovery Executive Directors Leadership Academy Dallas, Texas, November 15, 2013. https://www.chestnut.org/resources/5cd82f5d-f9cb-4e50-8391-7eadb9700e34/2013-State-of-the-New-Recovery-Advocacy-Movement.pdf
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