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The First Recovery Management Monograph

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The First Recovery Management Monograph RECOVERY MANAGEMENT William L. White, MA Ernest Kurtz, PhD Mark Sanders, LCSW, CADC First in a series of monographs from the Great Lakes Addiction Technology Transfer Center Chicago, IL Front Cover (back page) Blank Page Published by the Great Lakes Addiction Technology Transfer Center (ATTC) Network. Great Lakes Addiction Technology Transfer Center Jane Addams College of Social Work University of Illinois at Chicago 1640 W. Roosevelt Rd., Ste. 511 (M/C 779) Chicago, Illinois 60608-1316 2006 This publication was prepared by the Addiction Technology Transfer Center (ATTC) Network under a cooperative agreement from the Substance Abuse and Mental Health Services Administration’s (SAMHSA) Center for Substance Abuse Treatment (CSAT). All material appearing in this publication except that taken directly from copyrighted sourc- es is in the public domain and may be reproduced or copied without permission from SAMHSA/CSAT or the authors. Citation of the source is appreciated. Do not reproduce or distribute this publication for a fee without specific, written authorization from the Great Lakes Addiction Technology Transfer Center. For more information on obtaining copies of this publication, call (312) 996-5574. At the time of publication, Charles G. Curie, MA, ACSW, served as the SAMHSA Admin- istrator. H. Westley Clark, MD, JD, MPH, served as CSAT Director and Catherine D. Nugent, MS served as the CSAT Project Officer. The opinions expressed herein are the views of the ATTC Network and do not reflect the official position of the Department of Health and Human Services (DHHS), SAMHSA or CSAT. No official support or endorsement of DHHS, SAMHSA or CSAT for the opinions described in this document is intended or should be inferred. Produced under a cooperative agreement from the U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Center for Substance Abuse Treatment. Center for Substance Abuse Treatment, 1 Choke Cherry Road Rockville, MD 20857, 301.443.5700 Its contents are solely the responsilility of the authors and do not necessarily represent the official views of the agency. Grant No. 6 UD1 TI13593-02-3 iv Blank Page v Blank Page vi Table of Contents Preface.............................................................................................................…… xi Recovery: The Next Frontier................................................................................ 1 The Pathology Paradigm…............................................................................... 1 The Intervention Paradigm…............................................................................ 1 Agitation for Change…...................................................................................... 2 The Recovery Paradigm…................................................................................ 3 Recovery Management…................................................................................. 3 A New Language…........................................................................................... 4 A New Vision…................................................................................................. 5 References and Recommended Reading......................................................... 5 Acknowledgements........................................................................................... 6 The Varieties of Recovery Experience: A Primer for Addiction Treatment Professionals and Recovery Advocates.... 7 Abstract.....….................................................................................................... 7 Keywords.......................................................................................................... 7 Addiction, Treatment, and Recovery Paradigms…........................................... 8 Recovery Definition…....................................................................................... 9 Recovery Prevalence….................................................................................... 10 The Scope and Depth of Recovery…............................................................... 10 Problem Severity and Recovery Capital…....................................................... 14 Pathways and Styles of Recovery…................................................................. 14 Abstinence-based, Moderation-based & Medication-supported Recoveries……............................................................. 15 The Context of Recovery Initiation…................................................................ 17 Recovery Initiation Frameworks (Religions, spiritual, secular).......................... 20 Recovery Initiation Styles….............................................................................. 22 Recovery Identity…........................................................................................... 24 Recovery Relationships…................................................................................. 25 Varieties of Twelve-Step Experience…............................................................. 26 Still Other Varieties…........................................................................................ 27 Recovery Durability…....................................................................................... 28 Recovery Termination….................................................................................... 29 Implications for the Professional Treatment of AOD Problems…..................... 29 Summary and Conclusions…........................................................................... 31 References and Recommended Reading.....................................................… 32 Acknowledgments…......................................................................................... 42 Recovery Management: What if We Really Believed that Addiction Was a Chronic Disorder?.............. 44 Introduction….................................................................................................... 44 Promotional Forces…....................................................................................... 44 Premises…....................................................................................................... 44 Promises and Prospects…............................................................................... 47 vii Model Definition…............................................................................................ 48 Model Principles…............................................................................................ 48 Model Practices…............................................................................................. 49 Engagement and Motivational Enhancement…............................................... 49 Assessment and Service Planning…................................................................ 49 Service Duration and Emphasis….................................................................... 50 Locus of Services….......................................................................................... 50 Role of the Client…........................................................................................... 50 Service Relationship…...................................................................................... 50 Model Evaluation…........................................................................................... 51 Implementation Challenges.............................................................................. 51 Historical and Conceptual Momentum….......................................................... 51 Reimbursement and Regulatory Systems…..................................................... 52 Weak Organizational Infrastructures…............................................................. 52 Science-based Understanding of Long-term Recovery…................................. 52 Integration of Professional/Peer Services…..................................................... 53 Service Capacity…........................................................................................... 53 Ethical Guidelines…......................................................................................... 53 Potential Pitfalls…............................................................................................ 53 Iatrogenic Effects….......................................................................................... 54 Cultural Pessimism…....................................................................................... 54 Institutional Profiteering…................................................................................ 54 References and Recommended Reading…..................................................... 54 Recovery Management and People of Color...................................................... 58 Abstract............................................................................................................ 58 Introduction…................................................................................................... 58 AC and RM Models: The Source of AOD Problems….................................... 60 The RM Solution: Personal, Family and Community Renewal….................... 62 Proactive Engagement….................................................................................. 65 Indigenous Healers/Institutions and the Recovery Management Team…........ 67 People of Color and the Criminal Justice and Child Welfare Systems….......... 70
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