What is the difference between a recovery coach, a peer recovery support specialist and a professional recovery coach?

Posted on September 3, 2015 by Melissa Killeen
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Melissa Killeen

I published my book Recovery Coaching – A Guide to Coaching People in Recovery from Addictions in 2013. A recovery coach, a peer recovery support specialist and a professional recovery coach’s duties and responsibilities have expanded significantly since then. The organizations that offer recovery coach training numbered around 50 in 2013. Today, the number has grown to 250. Recovery coach certification training is one of the fastest growing aspects of the coaching field, with many states establishing recovery coaching and peer recovery support-specialist certifications. Yet, for many people who seek to achieve basic recovery coaching information, the process of training, certification, credentialing or licensing are baffling. With all of this growth and change, anyone who is interested in being a recovery coach is very confused about the necessary training, what to call this training and even what to call themselves! I want to make an attempt to clear up this confusion and answer these questions:

  • What is the difference between a recovery coach, a peer recovery support-specialist and a professional recovery coach?
  • On what kind of certification should a future recovery coach focus?
  • What are the guidelines for certification of a recovery coach?

(Some of the answers to these questions will appear in upcoming posts.)

What is a Recovery Coach?

A recovery coach is a person that works with and supports individuals immersed in an addiction(s), and coaches people in recovery from the abuse of alcohol and drugs, gambling, eating disorders or other addictive behaviors. Sometimes recovery coaches who work with people with addictions have been referred to as a peer recovery support specialist, a recovery support specialist (RSS), a sober companion, recovery associate or quit coach. In all cases these terminologies describe the same job description; a person who meets with clients in order to aid in their recovery from addiction(s). Even though many certifications for recovery coaches are classified as peer recovery support practitioner certifications. I prefer to use the term recovery coach in describing a person coaching an individual in recovery from addiction, instead of using the term “peer,” mainly because there is no requirement that a recovery coach be a peer (meaning they are an addict in recovery). Although it may be believed having experiential knowledge is a best practice for a recovery coach, it could be a recovery coach has knowledge of addiction and recovery perhaps by knowing an addict, having a family member with an addiction or taking courses in the treatment field.

I have kept the term “non-clinical” out of this definition of a recovery coach because over the course of several years, I have seen drug and alcohol counselors, family and marriage therapists (MFTs), licensed clinical social workers, interventionists (LCSWs), psychotherapists and psychiatrists, train to be recovery coaches and then add coaching to their resume. I hear from these individuals that they embrace the coaching approach, and merge the knowledge they have as a clinician or interventionist with recovery coaching methods.

Some individuals seek recovery and sobriety from addictions by frequenting a recovery community organization (RCOs) or recovery support center. An RCO is an independent, non-profit organization led and governed by representatives of local communities of recovery. There are recovery coaches at these recovery community organizations. These coaches have very diverse backgrounds. I have met coaches that were addicts, homeless, offenders, teachers, lawyers and highly educated individuals, who choose to help another person in recovery. I have seen these coaches espouse 12-step ideologies as well as non-12-step recovery models such as Buddhist Recovery, Moderation Management, Kundalini Yoga or Harm Reduction. Sometimes, the recovery coaches at these centers receive a salary from the RCO, however, the client is not charged for the recovery coaching services. RCO recovery coaches can also be volunteers, opting to perform their coaching duties for no reimbursement at all.

Lastly, recovery coaches can be employed by treatment centers or sober living homes and receive compensation from them. In cases such as this, the client is billed for the coaching services from the centers or homes. I know many a recovery coach who has opened a transitional living home or a supportive sober living environment. They coach the people who reside at these locations and their presence adds to the quality of the recovery experience.

Is recovery coaching covered by insurance?

Unfortunately, the answer to that question is no. No independent health insurance company covers the services of a recovery coach working with an individual in recovery from an addiction. There is currently only one state, New York, that has an arrangement with the state’s Medicaid offices to reimburse for recovery coaching for individuals who are diagnosed as dependent on a substance. Other states, Tennessee, Maryland and Massachusetts, are formulating similar Medicaid payment plans, but these reimbursements are not yet in place.

What is a peer to peer recovery support specialist?

A nearly universal definition of a peer to peer recovery support specialist is an individual with lived experience who has initiated his/her own recovery journey and assists others who are in earlier stages of the healing process of recovery from psychic, traumatic and/or substance-use challenges and, as a result, can offer assistance and support to promote another peer’s own personal recovery journey. A peer to peer recovery support specialist is also called a peer, peer support-practitioner, peer mentor, or a certified peer. All of these terms basically describe the same job description. More and more, this job description is focused on the peer to peer recovery support specialist working with a person in mental health recovery.

The certified peer to peer recovery support specialist workforce is relatively new in the behavioral health field, with state-recognized certification programs first emerging in 2001. Within this short time frame, states have recognized the potential of peer specialists to improve consumer outcomes by promoting recovery. Many social service agencies pay the peer’s salary, and the client does not pay for the coaching. In the mental health/behavioral health field, when referred by a social services agency or mental health treatment organization, reimbursement for a peer to peer recovery support specialist is covered by a health plan or Medicaid.

Peer to peer recovery support specialists can also work independently from an agency and be reimbursed by the client or a family. Peer to peer recovery support specialists can also choose to provide these services as a volunteer and receive no financial reward.

What is a professional recovery coach?

A professional recovery coach, is sometimes referred to as a recovery life coach. A professional recovery coach has experience and training in the recovery models, and training as a professional coach. These professional and credentialed coaching programs are sometimes referred to as life coaching training. A professional recovery coach can receive training from any of the 250 organizations that train recovery coaches, and select not to receive the certificate from a state certification board or the IC & RC (see the certification information in next week’s post). A professional coach can receive training from the ICF – International Coach Federation’s accredited coach training programs, and apply for a credential issued by the ICF.

A professional recovery coach can assist a client with a variety of coaching interventions including, but not limited to recovery from addictions, dealing with mental health diagnoses, divorce, financial downturns, grieving, career change and even family relationship issues. The client is billed for the coaching services from the professional recovery coach. Again, healthcare plans do not reimburse for these coaching services.

Stay tuned for next week’s post on certification for recovery coaches.

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Substantial R.O.I. from Funding Recovery Programs

Posted on August 27, 2015 by Melissa Killeen
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Melissa Killeen

“Most crucially, everyone must be aware of how logical and smart treatment is from a purely financial standpoint.” – Dr Richard Juman, president of the New York State Psychological Association

Can there be a substantial R.O.I. (return on investment) from government-funded recovery programs? How can funding recovery programs provide high returns on the funding investment when a new report from the CDC says opioid use is at epidemic proportions? When heroin deaths nearly quadrupled from 2000 to 2013? And the trend is worsening: heroin-related
deaths, grew a staggering 39.3% from 2012 to 2013. There were about 44,000 drug drug-addiction-9847058overdose deaths in the U.S. in 2013, more than 16,000 of them involving powerful prescription painkillers such as Vicodin and OxyContin. [i] Each day, 44 people in the United States die from overdose of prescription painkillers.[ii] How much funding can the government forecast to pump into this epidemic? Addressing the impact of substance use alone is estimated to cost hundreds of billions each year. Is there enough government money to make a dent? We have to, at least, try.

Substance abuse is costly to our nation, exacting over $600 billion annually in costs related to healthcare, lost work, lower productivity and crime. Research from the Massachusetts Opioid Task Force and Department of Public Health established that mental and substance use disorders are among the top conditions that result in significant costs to families, employers, and publicly funded health systems. In 2012, an estimated 23.1 million Americans aged 12 and older needed treatment for substance use. By 2020, mental and substance-use disorders will surpass all physical diseases as a major cause of disability worldwide. [iii]

In June 2006, the Washington State Institute for Public Policy, whose mission is to carry out practical, non-partisan research on issues of importance to Washington State, was directed by the Washington Legislature to estimate whether treatment for people with alcohol, drug, and mental health disorders offers economic advantages, or a R.O.I. (return on investment). By reviewing “what works,” literature, and estimating monetary value of benefits, they reached these conclusions:

  1. The average substance use treatment program can achieve roughly a 15 to 22 percent reduction in the incidence or severity of these disorders.
  2. Treatment of these disorders can achieve about $3.77 in benefits per dollar of treatment costs. This is equivalent to a 56 percent rate of return on investment.
  3. Estimated that a reasonably aggressive implementation policy could generate $1.5 billion in net benefits for people in Washington with $416 million in net taxpayer benefits, and the risk of losing money is small.[iv]

But still, state and federal legislators are hesitant to fund intervention, treatment, and recovery programs.

“Together we must challenge individuals, communities, cities, counties, regions, states, and the nation to be accountable for the outcomes of the justice systems at every level of government.”
— James Bell

Approximately one-quarter of those people held in U.S. prisons or jails have been convicted of a drug offense.[v] The United States incarcerates more people for drug offenses than any other country. With an estimated 6.8 million Americans struggling with drug abuse or dependence, the growth of the prison population continues to be driven largely by incarceration for drug offenses.[vi] Where does this spiral of incarceration instead of treatment stop?

For example, the average cost for a year of an offender treatment program is $5,000, whereas a year of imprisonment costs over $31,000, and far more in areas like New York City where the average annual cost per inmate was $167,731 in 2012. Court ordered addiction treatment programs can seriously reduce prison costs.[vii]

The Pennsylvania Commission on Crime and Delinquency (PCCD) examined the return-on-investment for seven programs (e.g. Big Brothers and Big Sisters, Strengthening Families, and Multisystemic Therapy programs) that are supported by the state’s Commission and Department of Public Welfare. It was concluded that these programs represent a potential $317 million return to the Commonwealth in terms of reduced correctional costs, lessened welfare and social services burden, and increased employment and tax revenue. The researchers estimated that the programs produced returns of $1 to $25, for every dollar invested, and could generate cost savings as great as $130 million for a single program.[viii] Are these facts overlooked by legislators in state and federal government?

Maryland voters believe by a five-to-one margin that the drug problem is getting worse. The same poll showed that voters believe by a two-to-one margin that there are too many people in prison, and 86% of respondents favor judges having the option to order drug treatment rather than prison for some offenders. [ix] Have the voters spoken?

“Recovery with justice allows us to bury the ghosts of the past and to live with ourselves in the present.” — William White

So in this election year, I urge you to contact your local state representatives, contact your state senators and congressmen/women and urge them to increase funding for substance-addiction treatment and implement reforms that will send addicts to treatment programs like Drug Court or COPS, (Office of Community Oriented Policing Services) versus prison.

William White just posted an excellent letter to our presidential candidates that outlines the impact opioid addiction has on individuals, families, and communities. White requests a policy statement by the candidates in the 2016 Presidential campaign. Copy this letter and send it to the candidates you support: http://www.williamwhitepapers.com/blog/

And remember:

There are 23 million people in long-term recovery, and we vote.

 

References used in this blog

[i] The American Association for the Treatment of Opioid Dependence (AATOD) March 18, 2015 10:51 AM, Accessed on August 23, 2015 at: http://finance.yahoo.com/news/only-1-9-substance-abuse-145129124.html

[ii] Understanding the Epidemic, Center for Disease Control, access on August 23, at: http://www.cdc.gov/drugoverdose/epidemic/index.html

[iii] Massachusetts Opioid Task Force and Department of Public Health Recommendations on Priorities for Investments in Prevention, Intervention, Treatment and Recovery, http://www.mass.gov/eohhs/docs/dph/substance-abuse/opioid/report-of-the-opioid-task-force-6-10-14.pdf  Accessed August 23, 2015

[iv] Washington State Institute for Public Policy, accessed on August 23, 2015 at: http://www.wsipp.wa.gov/ReportFile/945/Wsipp_Evidence-based-Treatment-of-Alcohol-Drug-and-Mental-Health-Disorders-Potential-Benefits-Costs-and-Fiscal-Impacts-for-Washington-State_Full-Report.pdf

[v] Number of people in federal or state prison for drug offenses: Harrison, Paige, and Allen J. Beck. Prisoners in 2005. Washington, DC: Bureau of Justice Statistics. Estimate of jail inmates held on drug offense derived from James, Doris J. 2004. Profile of jail inmates, 2002. Washington, DC: Bureau of Justice Statistics.

[vi] U.S. Department of Health and Human Services, Substance Abuse and Mental Health Services Administration, Office of Applied Studies. 2005 National Survey on Drug Use & Health: Detailed Tables. Table 5.1A Online at www.drugabusestatistics.samhsa.gov/NSDUH/2k5NSDUH/tabs/Sect5peTabs1to82.htm#Tab5.1A

[vii] The American Association for the Treatment of Opioid Dependence (AATOD)March 18, 2015 10:51 AM, Accessed on August 23, 2015 at: http://finance.yahoo.com/news/only-1-9-substance-abuse-145129124.html

[viii] EpisCenter, Penn State University, Cost-benefit Assessment of Pennsylvania’s Approach to Youth Crime Prevention Shows Dramatic Return on Investment access on August 23, 2015 at: http://www.episcenter.psu.edu/sites/default/files/Fact%20Sheet%20-%20Cost%20Benefit%20of%20PA%20Prevention.pdf

[ix] Justice Policy.org accessed on August 23, 2015 at: http://www.justicepolicy.org/uploads/justicepolicy/documents/04-01_rep_mdtreatmentorincarceration_ac-dp.pdf

[ix] Maryland Voter Survey. (December, 2003). Bethesda, Maryland: Potomac Incorporated.

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Adverse Childhood Experiences Study

Posted on August 20, 2015 by Melissa Killeen

ACE Pyramid ImageThe Adverse Childhood Experiences (ACE) Study is one of the largest investigations ever conducted to assess associations between childhood maltreatment and later-life health and well-being. The study is a collaboration between the Centers for Disease Control and Prevention and Kaiser Permanente’s Health Appraisal Clinic in San Diego[i].

More than 17,000 Health Maintenance Organization (HMO) members who underwent a comprehensive physical examination were also asked to provide detailed information about their childhood experience of abuse, neglect, and family dysfunction. The initial phase of the ACE Study was conducted at Kaiser Permanente from 1995 to 1997. More than 17,000 participants completed a standardized physical examination and an ACE survey. No further participants will be enrolled, but the study group is tracking the medical status of the baseline participants.

The ACE Study findings suggest that certain experiences are major risk factors for the leading causes of illness, including addiction, leading to poor quality of life,  as well as death. It is critical to understand how some of the worst health and social problems in our nation can arise as a consequence of adverse childhood experiences. Realizing these connections is likely to improve efforts towards prevention and recovery.

Compared to persons with no adverse childhood experiences, the risk of heavy drinking, self-reported alcoholism, and marrying an alcoholic were increased twofold to fourfold by the presence of multiple adverse childhood experiences, regardless of parental alcoholism. Subsequent reviews of the study found that the prevention of adverse childhood experiences and treatment of persons affected by adverse childhood experiences may reduce the occurrence of adult alcohol problems[ii]. Adverse childhood experiences seem to account for one-half to two-thirds of serious problems with drug misuse by adolescents[iii].

Children in alcoholic households are more likely to have Adverse Childhood Experiences. The risk of alcoholism and depression in adulthood increases as the number of reported adverse experiences increases. Depression among adult children of alcoholics appears to be largely, if not solely, due to the greater likelihood of having had Adverse Childhood Experiences in a home with alcohol-abusing parents[iv].

Clearly, children that have experienced emotional, physical or sexual abuse in their early childhood are at a severe risk for addiction. To show you how small an amount of abuse is needed to tip the scales of raising a healthy child or an at risk child, read the last series of questions from the ACE Questionnaire, which are highly revealing questions.

  1. Did a parent or other adult in the household swear at you, insult you, put you down or humiliate you?
  2. Did a parent or other adult in the household push, grab, slap, or throw something at you?
  3. Did you often or very often feel that no one in your family looked out for each other, no one felt close to or supported each other?[v]

This survey gives you an idea how delicate and impressionable a young child is.

For a sample of the ACE Questionnaire, click on this link: http://www.cdc.gov/violenceprevention/acestudy/questionnaires.html

 

References used in this blog:

[i] [i] “The Relationship of Adult Health Status to Childhood Abuse and Household Dysfunction“, published in the American Journal of Preventive Medicine in 1998, Volume 14, pages 245–258.

And

http://www.cdc.gov/violenceprevention/acestudy/index.html

[ii] Addict Behav. 2002 Sep-Oct;27(5):713-25.

Adverse childhood experiences and personal alcohol abuse as an adult.

Dube SR1, Anda RF, Felitti VJ, Edwards VJ, Croft JB.

[iii] Pediatrics. 2003 Mar;111(3):564-72.

Childhood abuse, neglect, and household dysfunction and the risk of illicit drug use: the adverse childhood experiences study.

Dube SR1, Felitti VJ, Dong M, Chapman DP, Giles WH, Anda RF.

[iv] Psychiatr Serv. 2002 Aug;53(8):1001-9.

Adverse childhood experiences, alcoholic parents, and later risk of alcoholism and depression.

Anda RF1, Whitfield CL, Felitti VJ, Chapman D, Edwards VJ, Dube SR, Williamson DF.

[v] Center for Disease Control web site

http://www.cdc.gov/violenceprevention/acestudy/questionnaires.html

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