Peer Recovery Basics I (25 CEs)

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Activist Roots

Vintage Footage of Early Activists (6:01)

Substance Use Historical Overview The control of the use and sale of mind altering substances in this country was driven by the desire of those in power to eliminate activities and people who were seen as undesirable. The Temperance Movement in the early 20th century was aimed at Irish and German immigrants. Marijuana outlawed in the Southwest in the 1910’s targeted Mexicans and Mexican Americans and opium laws targeted to Chinese immigrants out west. The War on Drugs was started by President Richard Nixon after social use of drugs became acceptable and visible in the 1960’s and 70’s, initiating the criminalization of drug use, possession and sale. Combined with media portrayals, stigma associated with particular drugs has continued, as has criminalization. This is evidenced by the proliferation of negative stereotypes of inner city African American “crack addicts” in the 1980’s and 90’s. President Ronald Reagan instituted mandatory minimum sentencing for drug offenses and the War on Drugs has grown in size and scope along with the federal prison populations.

Test Your Knowledge

When the U.S. government started funding state hospitals, who did they put in charge of them?

Which values of the ex-patient movement serve as the foundation for peer support?

Systemic Change: The Evolution to Comprehensive and Integrative Care

Acute care  Chronic care  Recovery oriented care Not only in mental health and substance use treatment, but in medical, rehabilitation and other wellness environments, care programs are shifting focus from problem centered treatment to comprehensive care. Not far behind is corrections with not only the advent of mental health and substance use treatment provided within the system, but also the recognition of the need for re-entry programs (White, 2008, 2009). What is driving the transition? Money. Research is a close second. Research helps change the way money is distributed. Think return on investment. If someone is paying for another person’s treatment, they will want to know that the money will go a long way to helping the person, in addition to paying for effective treatment. It is the desire to spend money on something that works. In the early days, people went to a hospital, doctor, psychiatrist, or any other treatment provider. They said I have a problem with ___________. The treatment provider did what they could to help the patient get rid of ____________. The mental health field was medicalized this way in the 1940’s. Substance use treatment was limited for a long time. Patients had the option of mutual aid groups such Alcoholics Anonymous, which started in the 1930’s, or they could go to a hospital or asylum. In the 1970’s, substance use treatment started to become more prominent and was based on the nearest model of treatment: medicine. Treatment providers molded services to look like the medical model to get paid by insurance companies. Treatment is expensive and if someone has insurance, they are more likely to seek treatment. This medicalization of substance use treatment became known as the acute care model of treatment. Success was measured by how many people graduated the program and levels of abstinence, or how long one does not use a substance. During this time, research on the effectiveness of mental health and substance use treatment, which were treated separately under the acute care model, began to show that treatment was not as effective as hoped. At the same time, science was discovering more about the brain. Researchers started to show that addiction has a strong influence on brain function and should be treated like a chronic disease instead. When treating a chronic disease, there is an expectation of long term care. For example, people who live with diabetes need lifelong care through medication and monitoring.

Integrated care

Test Your Knowledge

The current addiction recovery model is based upon what kind of care model?

Why did treatment providers in the 1970’s and 1980’s mold services to look like the medical model?

Current State of Affairs

United States leading the world in taking psychotropic drugs

The War On Drugs

Disability (physical, developmental, psychological) Size and Scope of the U.S. Supplemental Security Income Program About 8.3 million people received federally administered payments in December 2014. The average monthly payment in December 2014 was $532. Total payments for the year were almost $55 billion, including more than $3 billion in federally administered state supplementation (SSI Annual Statistical Report, 2015). Profile of Recipients The majority were female (53 percent). Sixteen percent were under age 18, 59% were aged 18 to 64, and 25% were aged 65 or older. • Most (86%) were eligible on the basis of a disability. Six out of 10 recipients under age 65 were diagnosed with a mental disorder. Fifty-eight percent of SSI recipients had no income other than their SSI payment. Thirty-three percent of SSI recipients also received Social Security benefits. Of the people receiving SSI benefits, 1.5%were residing in a Title XIX institution where Medicaid was paying more than half of the cost. Despite their disabilities, about 315,000 recipients (4.3%) were working in December 2014 (SSI Annual Statistical Report, 2015). The rates of mental illness among people with intellectual disabilities ranges from 10-40% and include personality disorders, affective disorders, anxiety disorders and behavior problems (The Arc of Western Wayne County).

Veterans For the people who defend our freedoms, the invisible costs of military involvement can be steep. For those deployed into combat zones, the effects are worse. The United States has been involved in the Global War on Terror since 2001. Rates of injury are high, rates of traumatic brain injury are high, veterans with mental health and substance use issues are high as is the suicide rate among veterans. In 2013, veterans made up 12% of all homeless adults, according to the 2013 Annual Homeless Assessment Report conducted by the U.S. Department of Housing and Urban Development (Blakely, 2014). Twenty seven percent of Army soldiers met the criteria for alcohol abuse in three or four months after returning from Iraq, according to a 2011 study by the National Institute on Drug Abuse (Blakely, 2014). According to a 2012 RAND Corporation study, about 14% of service members previously deployed to Iraq or Afghanistan reported symptoms indicative of probable post-traumatic stress disorder, or PTSD (Blakely, 2014). Between 10% and 20% of Iraq and Afghanistan veterans have suffered a traumatic brain injury (TBI), according to Iraq and Afghanistan Veterans of America estimates. About 10% of all TBI’s diagnosed between 2008 and 2011 were diagnosed in combat theatre (Blakely, 2014). During the past 10 years, the number of Veterans with co-occurring disorders such as posttraumatic stress disorder and substance use problems has increased over three-fold (Hamblen & Kivlahan, 2016). According to a Harvard Medical School professor, "The rate of major depression is five times as high among soldiers as civilians, intermittent explosive disorder six times as high, and post-traumatic stress disorder (PTSD) nearly 15 times as high" (Willingham, 2014). For more statistics on veterans, visit https://www.americanprogress.org/issues/security/news/2014/11/10/101115/remembering-americas-veterans-in-2014/

Global Mental Health

Ambivalence Clients may be pretty sure they want to quit, but not entirely sold on the idea, or maybe they are afraid. Don’t want to admit help is needed.

Coercion When clients coming into treatment centers are forced by the criminal justice system, welfare and child protection agencies, it’s highly likely that most of them will be there willingly, some even defiant about treatment. The antagonistic relationship between the system and those who have experienced the system.

Test Your Knowledge

There are a lot of people in the United States who need substance use treatment but do not receive it.

People who enter the formal treatment system may be different from people who can recover on their own because of:

Peer Services and Peer Providers Overview

What is peer support?

Peer Support: A Shared Journey (4:00)

Peer Support: A Shared Journey Second Installment (4:35)

Test Your Knowledge

When a peer provider invites a client to various recovery focused social events, what type of support is being provided?

A good peer provider is often in recovery themselves, so they know what steps made recovery successful.

The Professionalization of Peer Providers

There are three things to pay attention to:

Test Your Knowledge

Authority to practice as a peer provider is granted by a government agency and called:

What denotes a level of training and professionalism?

Recovery

SAMHSA is a government funded organization that acts as a clearinghouse for best practices and recommendations within the mental health and substance use treatment field with an ever-increasing focus on integrated, comprehensive care. In 2011, they published a definition of recovery that serves as the foundational definition for this course.

Vocabulary and labels

In Real Life

Test Your Knowledge

What type of language can help eliminate stigma?

Recovery means restoring to health and is accomplished

Whole Health Recovery

Addiction & Recovery: A Whole Human Being (5:26)

Are mentally ill getting adequate health care? (7:47)

Financial, education, opportunities

Navigating the Intersection Between Debt and Despondency in the United States: Mental Health, Addiction, Incarceration by John Heinz MSW “…Today, it is impossible to look at the immense disparity found in America and not see the catastrophic and detrimental effects of the global paradigm of debt. In all corners of American society, polarization exists in response to the conflict and social decay this paradigm has caused. The American people are struggling and most do so alone or otherwise in separation. Issues of race, educational opportunity and class arising as a direct response to the inequality inherent in the global system of control. Debt is a systemic disease which levels communities, divides homes and destroys individuals. It is intrinsically linked to wide ranging negative health and social outcomes and impacts all areas of life in the United States and around the world.”

In Real Life

Test Your Knowledge

What does whole person recovery mean?

It is important for a Peer Recovery Providers to teach a client to oversee their own recovery by:

Mental Health Basics

Test Your Knowledge

Module 9: Addictions Science Basics

VIDEO ACTIVITY

Dr. Nora Volkow Explains the Science of Addiction (2:36)

VIDEO ACTIVITY

CNN's Dr. Sanjay Gupta says the brain is "rewired" when someone becomes addicted. (3:14)

Test Your Knowledge

Knowing about the biology of addiction is important to those not working in addiction because many habitual behaviors can be tied into which brain system?

Chronic exposure to drugs of abuse disrupts the brain’s ability to control and inhibit behaviors leading to :

Simplifying addiction as a "brain disease" can lead clients suffering from addiction to believe they are _________.

Addiction Recovery Models

Activity Video

Hazelden's History, Philosophy and Expertise: Hazelden's "Minnesota Model" approach to treatment showcases a legacy of success in addiction treatment. (5:55)

Hazelden's History, Philosophy and Expertise: Hazelden's "Minnesota Model" approach to treatment showcases a legacy of success in addiction treatment. (5:55)

Activity Video

"What is the Harm Reduction Model ?" video by Jeff McDowell (2:33)

Activity Video

Transformation: The Alchemy of Harm Reduction (1:00)

Activity Video

Introducing 12 Step Recovery - Noel McDermott (9:57)

Activity Video

Thoughts On 12 Step Model for Treatment and Recovery video by InspireMalibuCA (1:17)

Activity Video

SMART Recovery introduction video (3:11)

Test Your Knowledge

Alcoholics Anonymous (AA) is the standard by which all other mutual aid societies are judged.

Which recovery model served as a forerunner for peer support being integrated into treatment?

The recovery management model views recovery as ___ term.