Tag Archives: William White

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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A Call for Clinical Humility in Addiction Treatment

Posted on May 26, 2016 by Melissa Killeen

by William White and Chris Budnick,  video featuring Chris Budnick

The history of addiction treatment includes a pervasive and cautionary thread: the potential to do great harm in the name of help.  The technical term for such injury, iatrogenesis (physician-caused or treatment-caused illness), spans a broad range of professional actions that with the best of intentions resulted in harm to individuals and families seeking assistance. My recounting of such insults within the history of addiction treatment (see endnotes 1, 2 and 3, below) also includes the observation that such harms are easy to identify retrospectively in earlier eras, but very difficult to see within one’s own era, within one’s own treatment program, and within one’s own clinical practices.

The challenges for each of us who work in this special service ministry and forwilliam_l_white_portrait_1 the specialized industry of addiction treatment include conducting a regular inventory of clinical and administrative policies and practices to identify areas of inadvertent harm, altering conditions linked to such harm, making amends for such injuries, and developing mechanisms to prevent such injuries in the future. In my own professional life, many of the projects in my later career were products of such an inventory and served as a form of amends for actions I took or failed to take in my early career due to lack of awareness or courage. (See endnote 4 and 5 for two vivid examples.)

There have also been times I have taken the larger field to task for practices I deemed harmful. I have suggested at times that what were perceived as personal failures to achieve lasting recovery could be more aptly characterized as system failures (endnote 6). I have suggested at times that the field was becoming addicted to professional power and money and that the field itself was in need of a recovery process that should include processes of rigorous self-inventory, public confession, and amends (endnote 7 and 8).

The shift from acute care models of addiction treatment to models of sustained recovery management (RM) and recovery-oriented systems of care (ROSC) involves dramatic changes in clinical practices, including a shift in the basic relationship between the service provider and service recipient. The service relationship within the RM/ROSC models shifts from one dominated and controlled by the professional expert to a sustained recovery support partnership, with the provider serving primarily as a consultant to the service recipient’s own recovery self-management efforts. Those who have made this relational shift inevitably look back on areas of potential harm that emerged from the expert relational model they once practiced. And then the question inevitably arises, “How does one make amends for past harm in the name of help within the context of addiction counseling?”

Chris Budnick, an addictions professional in North Carolina and founding Board Chair for Recovery Communities of North Carolina, Inc. (RCNC), recently responded to that question by preparing a formal letter of amends to the individuals, families, and communities he has served. Below is the text of that letter, which was presented at the North Carolina Recovery Advocacy Alliance Summit, February 24, 2016. (The link to the video is: https://www.youtube.com/watch?v=A5MYhZbnhfU

Chris-Budnick LCSW,LCAS,CC,MSWMy name is Chris Budnick and I am a Licensed Clinical Addiction Specialist. I first began working in the addiction treatment and recovery field in 1993. 

There are many components involved in the broad issue of substance use disorders and recovery. Employers, first responders, the criminal justice system, policy makers, politicians, companies, advertisers, treatment providers, addiction professionals, the recovery community, families, and the individual with the substance use disorder. Of all these components, individuals with substance use disorders face the greatest scrutiny, stigma, discrimination and blame. For too long they have stood alone bearing the full brunt of this responsibility while systems of care and policies impacting housing, education, and employment have largely conspired to undermine any chance of sustaining recovery.

Last week I found myself approaching a police department to apologize for failing them. When they reached out to us in the middle of the night seeking services for a young woman we told them “no.”  “We can’t help her tonight.”  She was killed within hours of this decision leaving behind a 2-year-old daughter.  I told the officer that we pledge to do better.

This experience has nudged me to put to paper ideas that I’ve articulated and ideas I’ve only contemplated. I feel compelled as an addiction professional to make amends and pledge to do better.

While I have changed my attitudes and practices over the years, I have not spoken up to say I’m sorry. So here are the things I want to make amends for:

  • I’m sorry for all the barriers you confront when trying to access help.
  • I’m sorry for contradictory “sobriety” and “active use” requirements you encounter when trying to access services.
  • I’m sorry for the harm that has come to you, your family, your unborn children, and your community when you have not been provided services on demand.
  • I apologize for expecting that you will provide all the motivation to initiate recovery when I have assumed no responsibility for enhancing your readiness for recovery.
  • I am sorry for creating unrealistic expectations of you.
  • I’m sorry for provider success statistics that have misled you and your family.
  • I’m sorry that I have discharged you from treatment for becoming symptomatic. I’m even more sorry, though, for abandoning you at your time of greatest vulnerability. And I am sorry for how this failure has contributed to the heartbreak of your loved ones.
  • I am sorry for abandoning you when you have left treatment, either successfully or unsuccessfully.
  • I am sorry for the irritation in my voice when you have returned following a set-back because you didn’t do everything that I told you to do.
  • I am sorry for my arrogance when I’ve assumed that I am the expert of your life.
  • I am sorry for privately finding satisfaction in your failure because it reinforces the fallacy that I know best and if you just do as I say, you’ll recover.
  • I am sorry for not celebrating as enthusiastically your successes when you have achieved them through a different pathway or style then me.
  • I am sorry for being a silent co-conspirator for the stigma that has resulted in systems of punishment and discriminatory policies and practices.
  • I’m sorry for turning you away from treatment because you’ve “been here too many times.”
  • I’m sorry for not referring you to different services when you have not responded to the services I offer.
  • I am sorry for allowing you to take the blame when treatment did not work instead of defending you because you received an inadequate dose and duration of care.
  • I am sorry for reaping the benefits of recovery yet failing to do everything I can to make sure those benefits are available to anyone, regardless of privilege, socio-economic status, education, employability, and criminal history.
  • I’m sorry for being an addiction professional who has not provided you with the recovery supports needed to sustain recovery. More importantly, I apologize for conspiring through silence and inaction with a system that ill prepares you to achieve success.
  • I’m sorry for not calling to check on you when you don’t show up for treatment. I’m sorry for not calling to support you after you leave treatment.
  • I’m sorry for letting society maintain the belief that you used again because you chose to.
  • I’m sorry for not fighting for adequate treatment and recovery support services. All persons with substance use disorders should be entitled to a minimum of five years of monitoring and recovery support services.
  • I’m sorry for not advocating for you to have opportunities to gain safe and supportive housing and non-exploitive employment.
  • I am sorry for being so self-centered that I only think about you in the context of treatment while failing to fully understand the environmental and social realities of your life and how they will impact your ability to initiate and sustain recovery.
  • I am deeply sorry to your loved ones who have been robbed of chances to have a healthy member of their family. I am deeply sorry to your community, who has been robbed of the gifts that your recovery could have brought them.
  • I’m sorry that systems of control and punishment has been the response to communities of color during drug epidemics.
  • I am sorry that through my silence and inaction that I have contributed to belief that persons with substance use disorders are criminals and should be punished.
  • I am sorry for not speaking as a Recovery Ally to families, friends, neighbors, colleagues, policy makers, and public officials about why I support recovery.
  • I’m sorry for all the things that I have left off this list because I’ve failed to regularly solicit your feedback about how effective I have been in supporting you in your recovery.

    This sorrow is the foundation of my commitment to improve the accessibility, affordability, and quality of addiction treatment and recovery support services and to create the community space in which long-term personal and family recovery can flourish.

                                      – Chris Budnick,  Licensed Clinical Addiction Specialist

This is a remarkable statement worthy of emulation. I look forward to the day when leaders prepare such a statement of amends to individuals, families, and communities on behalf of American addiction treatment institutions. I look forward to the day when clinical humility becomes a foundational ethic guiding the practice of addiction counseling.  WW

I honor and applaud Bill and Chris for bringing this message to clinical professionals across the nation. It is time to shed and change these old models that have not been working and embrace these new tenants that Bill, Chris and many others espouse.  Truly such client-centered treatment can change the course of recovery for many. MK

Endnotes:

This post was previously published on William White’s web site- www.williamwhitepapers.com on April 29, 2016. William White and Chris Budnick have authorized this reposting.

 

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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
melissa-new-post

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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