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The Rationale and Science on Addiction Recovery Support Services PowerPoint Presentation

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Description : Check out this medical PowerPoint presentation titled "The Rationale and Science on Addiction Recovery Support Services" by John F. Kelly, PhD, ABPP, Massachusetts General Hospital, Harvard Medical School, to learn about addiction recovery support services. Learn how these services are designed to help individuals who are struggling with substance abuse and addiction to achieve and maintain sobriety. The rationale for these services is based on the understanding that addiction is a chronic disease that requires ongoing treatment and support to manage. Recovery support services provide a range of interventions that are tailored to the individual needs of each person in recovery, including counseling, therapy, medication-assisted treatment, and peer support.

Tags : Addiction Recovery Support Services, substance abuse, addiction, counseling, therapy, medication-assisted treatment, peer support

Published on : Mar 14, 2023 | Views : 1032 | Downloads : 0

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John F. Kelly, PhD, ABPP Massachusetts General Hospital Harvard Medical School The Rationale and Science on Addiction Recovery Support Services
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Disclosures Neither I nor my spouse/partner has a relevant financial relationship with a commercial interest to disclose.
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Key points Addiction remission can take time and even after full remission; remains susceptible to relapse for many years Recovery is physiologically and psychologicaly stressful Similar to addiction syndrome itself, positive consequences of remission reciprocally influence remission We can influence the chances of sustained remission & recovery by decreasing stress/boosting stress-coping ROSC and RSS are designed to do this; there are existing examples; and many new entities emerging
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Addiction as a chronic illness What can science tell us regarding the need to address addiction as a chronic illness? For long term treatment? For recovery support services?
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The clinical course of addiction and achievement of stable recovery can take a long time … 50-60% of individuals with addiction will achieve full sustained remission (White, 2013) Recovery Priming Recovery Monitoring Recovery Mentoring Opportunity for earlier detection through screening in non-specialty settings like primary care/ED
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Circuits Involved in Drug Use and Addiction All of these brain regions must be considered in developing strategies to effectively treat addiction. Key:PFC: prefrontal cortexACG: anterior cingulate gyrusOFC: orbitofrontal cortexSCC: subcallosal cortexNAc: nucleus accumbensVP: ventral pallidumHipp: hippocampusAmyg: amygdala
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8
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More stress and lowered ability to experience normal pleasures Post-acute withdrawal effects:
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Physiological TheoriesGeneral Adaptation Syndrome (Selye, 1956) Alarm---- Resistance---Exhaustion
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Clinically, we are trained to address the psychiatric and medical pathology; RSSs address recovery capital…. Example: Clinical Pathology: Two 30 yr old men enter treatment with clinically identical levels of severity of opioid and alcohol addiction and psychiatric and medical problems and report the same level of distress and impairment Treatment Plan: Patients are matched based on these clinical profiles to receive the same array of interventions to address clinical needs
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Clinically, we are trained to address the psychiatric and medical pathology; RSSs address recovery capital…. But…. One man is single, he’s from a neighborhood that has a high crime rate/drug and alcohol-related arrests; he didn’t graduate High School, has a father with active AUD with whom he lives, and is unemployed with a criminal record. The other is from a low crime neighborhood, is married with two children, a supportive family, has a master degree and is employed as an engineer with a good job and income. His father has 17yrs of sobriety in AA. Which is more likely to achieve and sustain remission? Move from a “Treatment Plan” to “Recovery Plan” based on pathology AND available recovery capital
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Bi-axial Formulations of Addiction and Recovery Recovery Capital: Achievement of sustained recovery from alcohol or other drug use disorders is not just a function of medical stabilization (e.g. detox) or addressing short-term deficits and psychopathology, but also by building and successfully mobilizing personal, social, and environmental resources that can be brought to bear on maintaining remission and long-term recovery. Edwards and Gross, 1976; Kelly and Hoeppner, 2014
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Reciprocal relationship between remission and recovery capital Adapted from Kelly and Hoeppner (2014)
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RELAPSE Cue Induced Stress Induced Substance Induced Kelly, JF Yeterian, JD In: McCrady and Epstein Addictions: A comprehensive Guidebook, Oxford University Press (2013) Social Psych BioNeuro Recovery Support Services
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Recovery Support Services
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Recovery Phenomenology Common Curative factors… Universality Altruism Instillation of hope Imparting information Cohesiveness Existential factors Imitative behavior Catharsis Development of socializing techniques Interpersonal learning Self-understanding (Yalom, 1995)
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What Do 12-step MHO participants report that they get out of 12-step meetings?
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People with addiction disorders, compared to other forms of mental illness, have tended to seek solutions in groups; the neurobiological basis of this may lie in increases in DA release or accelerated up-regulation of DA D2 receptors in NaCC
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Mutual help Organizations
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TSF Delivery Modes Stand alone Independent therapy Integrated into an existing therapy Component of a treatment package (e.g., an additional group) As Modular appendage linkage component TSF OTH In past 25 years, MHO research has gone from contemporaneous correlational research to rigorous RCTs
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TSF often produces significantly better outcomes relative to active comparison conditions (e.g., CBT) Although TSF is not “AA”, it’s beneficial effect is explained by AA involvement post-treatment.
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Negative Affect Abstinence self-efficacy Social network Spirituality Social Abstinence self-efficacy Recovery motivation Impulsivity Craving Coping skills Empirically-supported MOBCs through which AA confers benefit AA participation in turn is explained by these factors which are similar to the mechanisms operating in formal treatment…
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Also, state of the art instrumental variables analyses, as well as propensity score matching (Ye and Kaskutas, 2013) that help to remove self-selection biases, indicate AA has a causal impact on enhancing abstinence and remission rates.
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Linkage to MHO like AA can lead to much higher rates of full sustained remission (Project MATCH, 1997) TSF treatment can lead to much higher rates of full sustained remission
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Health Care cost offset CBT VS 12-STEP RESIDENTIAL TREATMENT Compared to CBT-treated patients, 12-step treated patients more likely to be abstinent, at a $8,000 lower cost per pt over 2 yrs ($10M total savings) Also, higher remission rates, means decreased disease and deaths, increased quality of life for sufferers and their families
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Peer-based Recovery Support Services
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Formal Peer Support: Recovery Coaching Interacting with peers who have lived experience of addiction and long-term recovery and who support recovery help reduce relapse risk. They can facilitate… Acquisition of coping skills Increases in abstinence self-efficacy Maintenance of recovery motivation Serve as a healthy recovery role model and social contact Provide community service linkages and emotional support
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Sober Living Environments Peer Run/Self-Governing
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Societal Benefits of Oxford Houses Sample: 150 individual completing treatment in the Chicago metropolitan area Design: Randomized controlled trial Intervention: Oxford House vs. community-based aftercare services (usual care) Follow-up: 2 years Outcome: Substance use, monthly income, incarceration rates
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Sober Living Environments are effective…Oxford House vs. Usual Care Sober living had – half as many individuals using substances across 2 yr follow up as usual care 50% more likely to be employed 1/3 re-incarceration rate
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…and, cost-effective Mean per-person societal benefits and costs
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Clinical Models of Long-term Recovery Management
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N=446 adults with SUD, mean age = 38, 54% male, 85% African-American randomly assigned to two conditions: quarterly assessment only quarterly assessment plus RMC Recovery Management Checkups Linkage manager who used MI to review participant’s substance use, discuss treatment barrier/solutions, schedule an appointment for treatment re-entry, and accompany participant through the intake If participants reported no substance use in previous quarter, linkage manager reviewed how abstinence has changed their lives and what methods have worked to maintain abstinence Source: Dennis & Scott (2012). Drug and Alcohol Dependence, 121, 10-17
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Results 1Return to treatment Participants in RMC condition sig. more likely to return to treatment sooner Source: Dennis & Scott (2012). Drug and Alcohol Dependence, 121, 10-17 Of 18 vars tested, the only variables that predicted return to treatment was the intervention
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Recovery Community Centers
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locatable sources of community-based recovery support beyond the clinical setting, helping members achieve sustained recovery by building and successfully mobilizing personal, social, environmental, and cultural resources. Recovery Community Centers are…
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RCCs in the United States There are currently more than 80 centers operating nationally
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There are 35 centers currently operating throughout New England and New York. RCCs in New York and New England
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Residential centers Sober living environments Treatment centers No clinical services on-site 12-step clubhouses Drop-in centers Recovery Community Centers are NOT…
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Principles of RCCs
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Services offered
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Average of 46 visitors per day (SD=37) Between 113-5250 visits per month Members spend 2.4 (SD=1.1) hours at the center during a visit Demographics: Between the ages of 25-59 (65%) Male (61%) White (72%) non-Hispanic (92%). In recovery (95%) Member Characteristics
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Center Referral Sources RCC members are referred to the centers from a variety of sources. Other referral sources include word of mouth (e.g., friends and family).
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Members’ Primary Substance Problems Director estimates cite heroin and other opioids (45%) and alcohol (32%) as the most prevalent primary substances used by center members.
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Recovery Supports In Educational Settings
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…. are secondary schools designed specifically for students in recovery from SUD. Each school operates differently depending on available community resources and state standards, but each recovery high school shares the following goals: To educate all students in recovery from SUD and/or co-occurring disorders To meet state requirements for awarding a secondary school diploma To support students in working a strong program of recovery Recovery High Schools….
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Recovery High Schools There are approximately 35 recovery high schools operating in 15 states A study of 17 recovery schools found that: Students reported 266 days of abstinence since enrollment with continuous abstinence increasing from 20% during the 90 days before enrolling to 56% currently Students’ opinions of the schools were high with 87% reporting overall satisfaction (Moberg & Finch, 2008) A study of graduates of recovery schools found that 39% reported no drug or alcohol use in the last 30 days and over 90% had enrolled in college (Lanham & Tirado, 2011)
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Collegiate Recovery Programs There are almost 50 CRPs recognized by Association of Recovery in Higher Education (ARHE) Data in two model programs suggests relapse rates are very low at approximately 4% to 13% in any given semester Laudet et al., 2014
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SummaryRecovery Process and Rationale for RSSs RSSs open up new pathways to recovery and can enhance and extend the effects of professionally-delivered care by…. Helping change social networks towards those that model and support recovery in the communities in which people live Helping build resilience, buffer stress, and increase recovery coping, confidence and motivation over the long-term Help individuals build further “recovery capital” by providing supports in high risk educational environments like colleges/high schools, providing linkages to employment opportunities, and health/social services Providing ongoing recovery-specific support at little cost reducing burden on professional health services while enhancing remission rates, thereby reducing health care costs.
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