Tag Archives: Michael Boyle

Is Recovery Coaching Effective?

Posted on June 2, 2016 by Melissa Killeen

20150609_223702 (2)Treatment professionals and researchers are calling for a change in the treatment model for substance use disorders (SUD). This change calls for shedding the acute care model (28 days of SUD treatment will fix you) to a continuum of care models, similar to how chronic diseases like diabetes or arthritis are treated. (Humphreys & Tucker, 2002; Institute of Medicine, 2005; McLellan et al., 2000; White, Boyle, Loveland, & Corrington, 2005).

At the same time, the mental health and the substance abuse treatment fields have merged, creating the behavioral health field. With this merger, the recovery-oriented systems of care model (ROSC) has become the accepted approach to treatment for those with mental and substance use disorders. This holistic approach, rather than focusing on the addiction, considers the whole person and how they interact in real life. ROSC emphasizes that recovery depends on the connection of mind, body, and spirit, motivating addicts to choose to improve their mental health, their physical health, and to embrace a spiritual component of their recovery (SAMHSA, 2011). This multi-system approach has ROSC counselors encouraging visits to the general practitioner, the OBGyn and the dentist. They assess for co-occurring disorders and embrace one-on-one therapeutic treatment and group therapy. And ROSC practitioners embrace mutual support programs, such as AA, NA or even nontraditional mutual support groups like SOS, or Women for Sobriety. A spiritual program is also encouraged. Lastly, the newest introduction to the treatment field is the recovery coach.

As mental health and addiction treatment services are adopting this recovery-oriented approach, the emphasis on incorporating various forms of recovery coaching or peer-based recovery support into treatment services is growing rapidly. Peer-based recovery support services are defined as

“the process of giving and receiving nonprofessional, nonclinical assistance to achieve long-term recovery from mental health and substance use disorders” (Borkman, 1999)

This support is provided by “peers,” “peer-recovery support specialists,” “recovery coaches,” “peer mentors,” or “peer support specialists” who have lived and experienced personal recovery (Borkman, 1999). The peers assist others in initiating, maintaining and embracing recovery from their mental health or substance use disorders.

As recovery coaches and peers begin to infiltrate treatment centers and recovery support, community organizations, there is a needling question that arises: are recovery coaches effective in the recovery process?

Studies have been completed on the effectiveness of recovery coaches aiding in individuals achieving long-term recovery since 2005. Many were small studies, some were not exactly scientific, nor could other studies stand up to researcher’s scrutiny. None of the studies had the critical mass to come to a clear conclusion. Ellen L. Bassuk, M.D., Justine Hanson, Ph.D., R. Neil Greene, M.A., Molly Richard, B.A., and Alexandre Laudet, PhD began examining the 1,221 studies that analyze the effectiveness of peer-delivered, recovery support services for individuals in recovery. They wrote a systematic review called Peer Delivered Recovery Support Services for Addictions in the United States: A Systematic Review.

This compilation of all the current studies is to create an appraisal, and summarization of the success of peer-delivered, recovery support services, using strict scientific criteria. As part of their review process, the 1,221 studies were screened, but only nine studies were deemed to meet the strict review requirements.

The nine studies examined the effectiveness of recovery support services that were delivered by a peer using a wide range of interventions and models. These studies also examined the variety of locations that offered peer support, including peer-run, drop-in centers (Ja et al., 2009), peer-run, recovery community organizations (Kamon & Turner, 2013), and Veteran’s Administration medical outpatient clinics (Bernstein et al., 2005).

This review showed peer-delivered recovery support services accomplished the following successful outcomes:

  1. Decreased alcohol use
  2. Decreased drinking to intoxication by reducing the odds of drinking to intoxication by 2.9 percent (Smelson et al. 2013)
  3. Peer participation lowered re-hospitalization rates, meaning only 62 percent of participants from the peer based support group were re-hospitalized compared to 73 percent of those not receiving peer based support (Min et al. (2007)
  4. Increased post-discharge sobriety time was achieved by the individuals receiving the peer intervention (O’Connell et al. 2014)
  5. If peers led groups in life-skills training, those participants had 14.8 fewer days drinking
  6. Peer recovery support affected those discharged from inpatient treatment by maintaining a post-discharge sobriety rate of 43 percent to 48 percent as compared to 33 percent sobriety for those not receiving peer based support (Tracy et al. 2011)

Overall, the review of these studies indicate that peers involved in recovery support interventions have beneficial effects on participants. While the reviewers can conclude that there is evidence supporting the effectiveness of peer-delivered, recovery support services, they acknowledge that additional research is necessary to determine the usefulness of peer support services. While this knowledge is encouraging, research in this area is just emerging, and there is a strong need to improve outcomes by completing future studies.

References

  1. Humphreys, K., & Tucker, J. (2002). Toward more responsive and effective intervention systems for alcohol-related problems. Addiction, 97(2), 126–132.
  2. Institute of Medicine (2005). Improving the quality of health care for mental and substance use conditions. Washington, DC: National Academy Press.
  3. McLellan, A. T., Lewis, D. C., O’Brien, C. P., & Kleber, H. D. (2000). Drug dependence, a chronic medical illness: Implications for treatment, insurance, and outcomes evaluation. JAMA, 284(13), 1689–1695.
  4. White, W., Boyle, M., Loveland, D., & Corrington, P. (2005). What is behavioral health recovery management? A brief primer. (Retrieved from www.addictionmanagement.org/recovery%20management.pdf).
  5. Substance Abuse and Mental Health Services Administration (SAMHSA) (2011). SAMHSA’s Working Definition of Recovery. (Retrieved from http://www.samhsa.gov/recovery/).
  6. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press
  7. Borkman, T. (1999). Understanding self-help/mutual aid: Experiential learning in the commons. New Brunswick, NJ: Rutgers University Press
  8. Ja, D. Y., Gee, M., Savolainen, J.,Wu, S., & Forghani, S. (2009). Peers Reaching Out Supporting Peers to Embrace Recovery (PROPSPER): A final evaluation report. San Francisco, CA: DYJ, Inc. for Walden House, Inc. and the Center for Substance Abuse Treatment, Substance Abuse and Mental Health Services Administration (Retrieved from http://www.dyja./com/sites/default/files/u24/PROSPER%20Final%20Evaluation%20Report.pdf).
  9. Kamon, J., & Turner,W. (2013). Recovery coaching in recovery centers: What the initial data suggest: A brief report from the Vermont Recovery Network. Montpelier, Vermont Evidence-Based Solutions (Retrieved form https://vtrecoverynetwork.org/PDF/VRN_RC_eval_report.pdf).
  10. Bernstein, E., Bernstein, J., Tassiopoulos, K., Heeren, T., Levenson, S., & Hingson, R. (2005). Brief motivational intervention at a clinic visit reduces cocaine and heroin use. Drug and Alcohol Dependence, 77, 49–59
  11. Smelson, D. A., Kline, A., Kuhn, J., Rodrigues, S., O’Connor, K., Fisher, W. Kane, V. (2013). A wraparound treatment engagement intervention for homeless veterans with co-occurring disorders. Psychological Services, 10(2), 161–167.
  12. Min, S. Y., Whitecraft, E., Rothbard, A. B., & Salzer, M. S. (2007). Peer support for persons with co-occurring disorders and community tenure: A survival analysis. Psychiatric Rehabilitation Journal, 30(3), 207–213. http://dx.doi.org/10.2975/30.3.2007.207.213.
  13. O’Connell, M. J., Flanagan, E., Delphin, M., & Davidson, L. (2014). Enhancing outcomes for persons with co-occurring disorders through skills training and peer recovery supports. Unpublished manuscript.
  14. Tracy, K., Burton, M., Nich, C., & Rounsaville, B. (2011). Utilizing peer mentorship to engage high recidivism substance-abusing patients in treatment. The American Journal of Drug and Alcohol Abuse, 37(6), 525–531
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How many kinds of Recovery Coaches are there?

Posted on November 4, 2012 by Michael

A long history of different types of recovery support services exist in the alcohol and addictions treatment arena. Native Americans used a peer coaching model called a recovery circle in the 18th century to aid fellow alcoholics to recovery (White & Kurtz 2003).  Religious organizations such as the Women’s Christian Temperance Union, the White, Red or Blue Ribbon Reform Clubs in the 1870’s or the non secular Keeley Institute and Keeley Leagues in the early 1900’s embraced peer supported recovery processes for their members (White, 2007 & Eng, 2000 ). In 1932, Bill W began the largest recovery support service,  Alcoholics Anonymous, and from this model many other support groups were spawn.

 Today, numerous recovery advocacy programs utilize a twenty-first century model of peer recovery. A relatively new model uses peer recovery coaching within a community-based recovery support center. These recovery support centers are emerging with notable, documented models in Hartford, Philadelphia, and Chicago (White & Kurtz 2003).

 Recovery coaching is a growing field, emerging from the traditional grass roots models of the 19th century to current day volunteers in community-based recovery support centers and paid recovery coaching positions with high profile movie stars. The relationship between a client and a Recovery Coach could be 24/7 for a month, a face to face meeting with a client for one hour a week, or a 30 minute telephone call, everyday. A Recovery Coach may want to implement a treatment center’s recovery plan or adapt the client’s own plan for recovery, or use both. A Recovery Coach can work within 12-step program, a SMART recovery program with a client, or not. A Recovery Coach can be trained in a coaching program and have three credentials or have 25 years in recovery from crack cocaine and be an ex-con. Either way, it is a very exciting time to be a Recovery Coach.

Here are some examples of recovery coaching assignments:

 Travel or Sober Escort

 Transportation can be a significant challenge to a newly abstinent person. Whether the client is interested in maintaining an ongoing recovery or just needs to stay abstinent for a period of time, getting from point A to point B can be difficult. Commonly called Travel Escorts or Sober Escorts, this version of a recovery coach may be required for client transportation across town, across the state, or across the county.

 Many clients are introduced to a Travel or Sober Escort after an intervention, when immediate transportation to a treatment center is required. In the event a client is in a treatment center for rehabilitation and a death in the family occurs, or they must appear in court, a Travel or Sober Escort will safely transport the client. The Travel or Sober Escort accompanies the client to the event and returns the client to the treatment center after the event concludes. When a client is ready to leave a treatment center and return home, a Travel or Sober Escort will safely transport the client home (Parrish, 2009).

 Long Term or Companion Recovery Coach

 Some recovery coach roles have evolved from a travel or sober escort to a Long Term or Companion Recovery Coach. A Companion Recovery Coach works “full-time” with the client:  days, nights, weekends or extended periods where the coach is by the client’s side 24 hours a day. This long term option can begin with treatment discharge, the client’s first day or weekend home and may develop into a coaching relationship that continues for several weeks, months or longer.

 Returning home from treatment, the client trades a secure, drug-free environment for one where they know there are problems. A Companion Recovery Coach will provide the symbolic and functional safety of the treatment center. A Companion Recovery Coach will introduce the client to 12 step meetings; guide them past former triggers (e.g. liquor stores or strip clubs) and support the client in developing their recovery plan. A Companion Recovery Coach will help the client to make lifestyle changes in order to experience a better quality of life in the first crucial days after discharge from a treatment center.

 Peer Recovery Support Specialist 

 The term, Peer Recovery Support Specialist is purposely used to reflect the collaborative nature of a peer to peer recovery support system that is integral to a community recovery support center program. The Peer Recovery Support Specialist’s primary goal is to help people achieve sustained recovery from their addiction.  The Peer Recovery Support Specialist (sometimes also referred to as a peer recovery coach) is intended to imply a volunteer that will help “coach” people who are working on their recovery. The Peer Recovery Support Specialist will receive no monetary reimbursement for these coaching services (Loveland & Boyle, 2005).

 Today, this non-clinical Peer Recovery Support Specialist meets with clients in a community-based recovery support center, or will go off sight to visit a client. The Peer Recovery Support Specialist ensures there is a contract for engagement, and a personal recovery plan. This recovery plan is drawn up by the client and viewed by the Peer Recovery Support Specialist. The client centered recovery plan is instrumental for the client “buying into” the terms of their recovery. Part of this plan is the stabilization of the client’s recovery capital, e.g. housing stability, improved family life, as well as integrating job seeking or education goals. The plan always outlines a time table for coach monitoring, support and re-intervention when needed, to maximize the health, quality of life and level of productivity of the client.

 Peer Recovery Support Specialists are volunteers linked to client by the community based recovery support centers. This rather new concept of a community recovery support centers are just beginning is beginning to grow, as these centers are now supported by federal and state funding. Center’s contact volunteers from the recovery community and train these volunteers to become Peer Recovery Support Specialists. Slowly community recovery support centers are broadening their reach from urban into suburban communities nationwide (White, 2002).

Family Recovery Coach

The family plays such an important role for a person in recovery, yet is so often neglected by traditional models of recovery. Specially trained Family Recovery Coaches help the family to create a calm, objective, non-judgmental environment. These coaches are knowledgeable in specific models that aid the family coping with the changes that they have gone through living with an active addict or living with a recovering addict. Regardless of an addict’s choices, working with a Family Recovery Coach helps a spouse; partner; or loved ones avoid the mental obsession that plagues so many families affected by addiction and learn to lead sane and productive lives (Buncher, 2012).

 Telephone or Virtual Recovery Coaching

 A Telephone or Virtual Recovery Coaching relationship may be established to continue beyond the face to face meeting of a client and a recovery coach, sober escort or a sober companion coach. The prior face to face coaching relationship was built on trust and re-established honesty for the client, so the Telephone or Virtual Recovery Coach relationship can continue in the same light, with daily or weekly telephone or web based conversations (Bronfman, Fisher, Gilbert & Valentine 2006).

 Today, many treatment centers are embracing virtual recovery coaching and linking Telephone or Virtual Recovery Coaches to clients prior to leaving treatment as a way to continue the connection to the treatment center, as well as meeting guidelines of an ‘aftercare’ program. On line virtual coaching programs has also sprung up recently, either fee based or for free, that will help anyone apply the methods of recovery (e.g. developing a recovery plan and building recovery capital) whether the person has just embraced recovery through a 12-step program or departed from a 30-day stay at a treatment center.

 Legal Support Specialists

 Recently, lawyers dealing with criminal drug cases or drug courts have been requesting a type of recovery coaching to ensure a client, (perhaps under house arrest, enrolled in a drug court outpatient program or pending trial) stays sober as per the law’s mandate (Caine, 2008). Recovery Coaches with the required certification and legal knowledge are contracted for this purpose. Coaches licensed with Licensed Clinical Social Worker, or Certified with Alcohol and Drug Counseling training can perform these tasks. The courts request them to perform a client assessment, then in a letter to the court offer suggested placement in a residential alcohol/drug treatment center, an outpatient treatment program and/or a sober living facility. A Legal Support Specialist – Recovery Coach can also appear in court with the client, validate the assessment and provide transportation to or from courthouse (Caine, 2008).

 This is the second chapter of “Guide to Coaching People in Recovery from Addiction”. A book written by Melissa Killeen, and available as an eBook in January 2013 on Amazon.com

 Part Three: “The Foundational Thinkers in the Recovery Coaching Community” will be  posted next week.

 

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