THE CORNERSTONES OF RECOVERY
Treatment of addiction as a chronic disease was the focus of the first document in this Health Care Reform series. This publication discusses the supports that help stabilize a person to create the best opportunity for long-term recovery. A person with a drug or alcohol problem may undergo inpatient or intensive outpatient treatment, but that care is not an end in itself. Just as with any other chronic illness, diabetes for example, the initial treatment begins a lifelong change in how the patient conducts his or her life. The chances of sustaining recovery depend a great deal on the person building what is known as recovery capital. Recovery capital was discussed in detail in the first brochure “Focus on Chronic Care." The term recovery capital refers to basic human needs that include a place to live, a job, and a network of family, friends and colleagues. The greater the individual’s recovery capital, the less the likelihood of relapse. Funding for some of the supports described in this document should become available as the Patient Protections and Affordable Care Act (PPACA:2010) is implemented. Policy shifts are expected that would move a small amount of federal dollars to pay for supports and services as the law requires coverage of more treatment by private and public insurance.
THE FOUR SUPPORTS OF EFFECTIVE RECOVERY
1. CASE MANAGEMENT
In many cases, the basic needs to support an individual’s recovery can be identified, set up and coordinated through case management services. These interventions not only improve the quality of life for individuals, they also reduce the cost of care by promoting access to outpatient treatment and recovery support services, which are less costly than acute residential care.
RECOVERY CASE MANAGEMENT IS OFTEN:
* Individualized and person-centered
* Strength and empowerment based
* Family and community driven
* Outcome-focused to sustain recovery
Elements of Recovery Case Management
Assessment of the individual is essential in identifying the person’s individual needs, strengths, resources, barriers, preferences and goals, that take into account all aspects of the person. This may include medical, behavioral, financial, social/living environments, educational and employment areas resulting in identification of conditions for a thorough person-centered plan.
Development of a person-centered plan is done in partnership between the affected person and the recovery case manager. It empowers the individual through the recognition of resources and strengths, while addressing all services and support needs to sustain that individual’s recovery.
Access to services connects the affected person to necessary care including medical, behavioral, social and other services as appropriate to the needs outlined in the person’s individual plan. This includes integrating and defining the concept of personal “medical homes,” a vision and goal of National Health Care Reform that takes a holistic approach. Ongoing case management will assist the person in transitioning through several levels of care in line with the outcome goals, and would help to identify potential preventable relapses.
Supportive housing “in its broadest definition is housing linked with social services tailored to the needs of the population being housed. Supportive services can be either on-site or off-site,” according to a report by Diane Glauber. The distinguishing characteristic of supportive housing projects is that they provide a platform for residents to access a potentially wide range of counseling and other social services. Housing First approaches are based on the concept that a recovering person’s first and primary need is to obtain stable housing, and that other issues that may affect him/her can and should be addressed once housing is obtained. Studies have shown that most individuals with an addiction draw on services from many federal, state, and local resources, including hospitals, detoxification centers, and correction facilities, among others. Permanent supportive housing lessens dependence on these resources and therefore reduces public costs. Other outcomes of providing housing resources are: better adherence to recovery, higher levels of gainful employment, and fewer problems with the law. Supportive housing is a critical recovery support that may encourage treatment-resistant individuals to take the first step in the recovery process, and then help to sustain their recovery. Evidence of this is found in New Jersey’s Medication Assisted Treatment Initiative (MATI)1, which has piloted supportive housing for opiate-addicted clients in Atlantic City and Camden. MATI clients in those cities have shown supportive housing to be vital in sustaining recovery.
3. EMPLOYMENT AND JOB TRAINING
Employment plays an integral role in the recovery process. Work offers the individual in recovery the ability to build self-esteem and confidence by providing the person with the opportunity to invest in something in which he or she can be successful. Individuals see working as equivalent to normalcy, as being a part of society2. Employment becomes the primary vehicle for reintegrating the recovering individual into the community as a productive and contributing member of society and makes him/her feel worthwhile and self-confident; it becomes a means for social readjustment3. It also plays a critical role in the reduction of the occurrence and severity of relapse4. In someone whose daily life lacks the routine and stability afforded by work, addiction poses a very definite and gratifying, if rather stereotyped, pattern of behavior… In essence, it becomes a substitute for employment5. Some of the support services that are needed include skills assessment and development, job coaching, career exploration or placement, job shadowing or internships, résumé writing, interviewing skills, and tips for retaining a job. Other services include training individuals in a specific skill or trade in order to prepare for, find, and obtain competitive employment. Services also include vocational assessment, and job referral.6
4. IMPROVING THE QUALITY OF CARE
Vital to addiction treatment is removing obstacles that bar entry to care or that interrupt the continuum of care. This is precisely the goal of the Network for the Improvement of Addiction Treatment (NIATx). In addition to making treatment available, this recovery-oriented model stresses the need to “meet the clients where they are.”7 Nationally, fewer than one in four people addicted to alcohol or drugs receives treatment, and as many as half of those who do successfully access treatment leave their treatment program before its full benefit can be realized. The cost and the client’s readiness are factors, but NIATx has found that often the real issue keeping patients from treatment, or from seeing treatment through, is the actual delivery of services. NIATx aims to improve access to and retention in addiction treatment and help agencies transform their organizational cultures. It will respond to the following needs: get more people into treatment using existing resources; remove organizational barriers that limit treatment access; reduce the field’s high rates of premature drop-out from treatment; and, support and improve the service delivery infrastructure.
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1. Supportive Housing Initiative, 2010, New Jersey Department of Human Services – Division of
Addiction Treatment (DAS) www.state.nj.us/humanservices/das/recovery/housing/index.html;
2. Co-Star, 1993; http://library.ncrtm.org/pdf/V331.069.pdf
3. Platt, 1995; http://psycnet.apa.org/journals/bul/117/3/416.pdf
4. Peters, Witty, & O’Brien, 1993; Platt, 1995; Wolkstein & Spiller, 1998;
5. Valliant, 1988, p.1150; http://adultdev.bwh.harvard.edu/pub_pdf/Vaillant-1988-Relapse.pdf
6. New Jersey Department of Human Services – Division of Addiction Treatment (DAS)
New Jersey Division of Addiction Services website www.state.nj.us/humanservices/das/recovery;
7. NIATx, Network for the Improvement of Addiction Treatment, www.niatx.net, University of Wisconsin