THE JOY IS IN CREATING—NOT MAINTAINING – Coach Lombardi
I stumbled across this quote last night and I strongly agree with Coach Lombardi.
I came out of the public treatment system (with a couple years of private treatment work thrown in there). 13 plus years in very traditional clinical settings.
Systems that were focused on maintenance rather than creativity.
Is the “recovery support system” focused on maintenance or creativity?
Hundreds of “peer support staff” all trained via the same model. A “Medicaid approved” manual.
Tons of “trainer the trainers” all following the same protocols.
People training others out of some manual. With little personal experience or intuition involved.
The movement is moving into “maintenance.
I Would Contend:
We have NOT arrived at best practices in recovery coaching. It’s still a new discipline in need of continuous evolution.
Recovery coaching should have “sub-specialties”.
Recovery coaching requires different skills across different settings.
There is still an over-emphasis on a willing participant. Action-stage of change. Complete and follow a recovery plan.
I hope there is more to come. I hope we have another huge evolution in care.
Also, I have zero interest in maintenance of systems. Create new things or quit and start an coffee shop.
I am in the process of refining family coaching / facilitator certification and it is a very revealing process.
The journey toward a true systems orientation is only beginning.
It’s really troubling how much the family has been ignored, historically, by payers and by extension providers.
The Disease Model
The disease model creates an interesting dynamic. By definition the “disease” is housed within the individual.
Naturally, this results in an over-emphasis on fixing the individual with substance use disorder.
Detachment, tough love, enabling, are all concepts that separate the person with SUD from the family.
These have been guiding principles of “family recovery” over the decades.
There are also some very practical issues that contribute to the emphasis on the individual over the family.
The “Identified Patient”
It is impossible for everyone with a SUD to have a marriage and family therapist assigned to them. In addition, many marriage and family therapists will not engage with a family if the SUD is active.
Make no mistake the family system must be addressed.
You can’t ignore that fact anymore then you can ignore gravity.
It must be addressed even if the “identified patient” is “stable”.
New Dynamics
The new dynamics of the family need to be explored.
The family will sometimes subconsciously sabotage recovery if they aren’t involved in their own process of change. The default behaviors will come back into play.
The new interpersonal patterns need to be worked out. New communication patterns need to be explored.
There is a very serious scale issue.
Engaged
In a perfect world all families would be engaged in comprehensive family work.
That’s not going to happen.
The next best thing would be engagement in family coaching and family recovery facilitation. Scaling this service so that all families can be touched is the goal.
It’s generally accepted that deaths of despair (suicide, overdose) and related issues are the result of a fundamental cultural crisis. Or perhaps the more optimistic view; that it’s a societal shift or transition. Not a crisis.
Either way, we know that everything is changing and many of the traditional institutions of society are proving inadequate.
This includes healthcare and certainly behavioral healthcare (counseling, therapy, treatment, mental health, substance use disorder).
The “institutions of behavioral health” are not immune to this upheaval.
Therapy & Coaching
In the future the fundamentals of therapy and coaching will be redefined.
The therapeutic hour will be delivered/distributed via “touches” that are shorter in duration and higher in frequency.
87% of people prefer asynchronous communication (text primarily) over face to face and/or phone.
Gen Z (born after 1996) will most certainly prefer this approach.
Actually, everyone will prefer this approach.
The Nature of Things
This new model will become the primary approach leading to the dismantling of traditional office based mental health and SUD services.
This new approach will be shown to be exponentially more effective than traditional office based/inpatient services.
This will be the beginning of massive shifts in the helping professions that will arise alongside the inevitable societal shifts on the horizon.
We know this to be the case as it is the nature of things.
It’s the cycle. It’s inevitable. The time is near.
A brave new world awaits.
I hope we don’t lose an entire generation in the meantime.
Recovery Coaching is not fully cooked yet …. I do not accept the idea that the evolution of recovery coaching is anywhere close to being complete…
The training and supervision of recovery coaches is even more unsettled.
There has not been enough experimentation and innovation.
THE FINAL VERSION?
We need people trying new things before we settle on a training model that is essentially an offshoot of clinical trainings. Why are the trainings so similar to clinical trainings??
Also, there are relatively few practicing coaches and providers.
Such a small pool and small cross section.
I just don’t accept the idea that this current model is the “final”version of coaching.
We will continue to iterate and we fully intend to rewrite the training we use to reflect the needs of our community.
BEHIND CLOSED DOORS
Another thing… being open to “multiple pathways to recovery” involves a behavior change on the coach’s part and an attitude shift.
Not just a tacit verbal agreement.
If you say you are “multiple pathways”and then coach the same as when you wear your “sponsor”mask, you should just go be a sponsor.
Being anti MAT “behind closed doors” won’t cut it… many people are on point in public and talk differently behind closed doors.
UNSPOKEN MESSAGES
You can see it in the unspoken messages.
I’ve gone to many events where MAT was clearly marginalized.
There were multiple pathways mentioned, but there was clearly a “preferred” pathway.
I went to one event that strongly emphasized peer support and, in theory, multiple pathways.
However, if I wouldn’t have known what the event was, I would have thought I was at an AA regional convention.
ONE SIZE FITS ALL
A person in MAT supported recovery would be completely marginalized at such an event.
And this was a “national” event focused on recovery.
This is where the world gets to see what recovery support entails.
It just reinforced all the existing stereotypes of one size fits all recovery.
DISGUISED AS COACHING
If recovery coaching is going to be established as a new and necessary professional service we are going to need to go all the way.
We can’t continue to accept sponsorship disguised as coaching.
A week long training does nothing to prevent the above mentioned reality. It’s just a training.
A necessary part of the equation. But only a training.
This profession will fade away unless we get our act together. People outside the echo chamber are not impressed. I spent a lot of time with healthcare organizations nationwide and they are skeptical.
There is an entire world out there who is put off by sponsorship in disguise. Stop it…. you make us all look bad and you are violating the traditions.
COMMITTED TO MULTIPLE PATHWAYS
FAVOR GREENVILLE is committed to the highest caliber coach and we won’t tolerate the alienation of any pathway.
Multiple pathways recovery coaching is an issue of organizational culture…. training does not influence culture.
Training gives you a foundation of understanding and gets you certified.
MORE ABOUT FAVOR GREENVILLE
Based on successful peer-based recovery center models around the country, FAVOR Greenville Center offers a variety of recovery support programs provided by trained and supervised volunteers.
Examples include Recovery Coaching, Outreach Meetings Leaders, Administration, Public Relations, Awareness Ambassadors, and Telephone Recovery Support.
You already have the answers to your problems within you.
It should be our job to help you uncover these answers.
You are a valued person.
You are NOT a liar, cheater and a thief.
Some of these things you may have done, but that is not who you are.
You are in recovery if you say you are in recovery and no one has to approve your membership.
You are a valuable human being.
If You Are Struggling
If you are struggling with a co-occurring disorder such as depression you need to find people who support recovery from mental health JUST AS MUCH as recovery from substance use disorder.
Find helpful people who understand the whole person. Helpful people can be found in a wide variety of places.
Therapist, sponsors, coaches, friends, mentors, co-workers, teachers, people at church, family.
How Much They Care
The most important quality of an effective and supportive person is NOT THEIR KNOWLEDGE or the credentials they hold. The most important quality of a supportive person is how much they care. And they must be genuine.
They need to be honest with themselves and honest with you. It is very hard to get what you need from a phony person. And there are many phony people wandering about in today’s world.
Helpful people are healthy themselves and they are constantly looking to grow.
It’s very hard to help others if you are stagnant.
When you are in the presence of a helpful person you usually feel lifted up.
You feel better about yourself after the interaction. Not worse about yourself.
They do not preach to you or lecture you or talk down to you.
Helpful People Listen
More importantly, helpful people listen.
They listen to learn they do not listen to answer. They are genuinely curious and interested in your world.
There are 2 types of people in this world.
The first type is the person who walks into a room and everyone is happy. The other type is the person who walks out of a room and everyone is happy. Find people who fall into group 2….
If you are in the helping professions and you do not fall into group 2…you may want to rethink your profession. There is no room for miserable human service workers…
Final Note From Rich
You are worthy of a life worth living and there is no one way to get there. You can figure it out but it may be easier with some guidance along the way. FAVOR Greenville Coaches, Michelle Handler and Tricia Lawdahl both stand ready to assist and help you on your journey!
FAVOR Greenville
For More Info and Details About FAVOR Coaches click the button below.
We know that substance use disorders cost the nation over $500 billion per year. These include incarceration costs, lost productivity, costs of treatment, and related healthcare costs. The healthcare costs associated with this group are actually staggering and have been estimated to be as high as $366 billion nationwide.[i] We also know that these costs are increasing year over year. Recovery Coaches are cost effective in terms of personnel costs and incredibly dedicated individuals. The recent attention placed on the opioid crisis also highlights a growing concern around addiction.
Overall, we are becoming more aware and more willing to discuss substance misuse. There appears to be a sense of urgency related to addressing substance use disorders that has not been seen in the past. This is good news.
The question is what do we do about this problem?
We believe that a partnership with healthcare is essential to addressing substance use disorders. One obvious area of intervention is the emergency room.
The tendency is to focus on “addiction” or dependency when examining the impact of AOD problems. And this is certainly a significant issue. Approximately 10% of Americans have a diagnosable substance use disorder.[ii] The healthcare costs associated with this group are staggering and have been estimated to be as high as $366 billion nationwide.
There are over 70 conditions requiring hospitalization directly attributable to substance use disorders.[iii] However, the problem is even more overwhelming when you take into account non-diagnosable yet risky AOD use. For example, consider the following points:
For every one person that is dependent on alcohol, six or more are at-risk or have already experienced problems as a result of their use.[iv]
Approximately 40% of the patients admitted to trauma centers have a positive BAC.[v]
If drug use is included, approximately 60% of patients seen in trauma centers are under the influence of alcohol or drugs when admitted.[vi]
Over 20,000 people enter emergency departments every day for alcohol-related injuries and illnesses.[vii]
The traditional response, at a systems level, is to intervene with only the most severe patients. Those with clearly established “problems” are referred to local treatment providers for outpatient AOD care or to inpatient rehabilitation centers.
Most do not follow through! only about 10% of those needing treatment actually receive treatment leaving 90% of these most severe cases “unengaged” in any type of recovery process.[viii]
This approach has been an exercise in futility.
Essentially, we have come to accept that 9 out of 10 individuals with a diagnosable substance use disorder will not get help. Ostensibly we have come to accept that these individuals will keep showing up at our emergency rooms, physician offices and our intensive care units driving the cost of healthcare through the roof.
If we could engage even 20% more of this group we could dramatically reduce costs.
It has been clearly established that healthcare costs drop by as much as 40% when individuals with substance use disorders are receiving some type of specialty AOD “help”. Consider the following:
A review of over 1,000 patients in a Sacramento chemical dependency program noted a substantial decline in hospital (35%), emergency room (39%), and total medical costs (26%) when compared to a control group.[ix]
Medical costs for people in treatment were $311 lower per month than for those who needed but did not receive treatment.[x]
In one federal study, total medical costs were reduced 26 percent among one group of patients that received addiction treatment.[xi]
A second area of great impact would be intervening with the “risky” group described above.
Through evidenced-based interventions and a new health coaching model we could identify and engage this population and promote a healthy lifestyle. This could be thought of as tertiary prevention rather than treatment and the return on investment would be substantial. Much can be done with this group through strategic and brief interventions.
For example, in a federal study a group of at-risk alcohol users who received brief coaching recorded 20 percent fewer emergency department visits and 37 percent fewer days of hospitalization.[xii]
Based on the above information we have identified the following areas of need:
Our healthcare system needs a service that can increase the treatment/recovery engagement and retention level for their members with a diagnosable substance use disorder; given the fact that 9 out of 10 do not follow through or access treatment despite clear benefits.
Our healthcare system needs a service that can assist in identifying and intervening with those individuals that do not meet diagnostic criteria for substance use disorder yet are engaging in destructive/risky AOD use.
A Solution
Although contemporary medicine has made many breakthroughs and powerful advances, it still remains primarily a disease management system. A focus on acute care and discrete periods of treatment has proven to be insufficient.
However, there is a new paradigm emerging with an emphasis on wellness, prevention and ongoing care. The discipline of health coaching is a growing reality within the continuum of care. Duke University describes health coaching in the following ways:
Health coaching is the missing link in our current health care system.
Health coaching is a new paradigm of care that defines success not as more procedures and tests, but as better patient engagement and outcomes
Health coaching empowers clients to make lasting health behavior changes that are the cornerstones of lifelong well-being
Health coaching bridges the gap between medical recommendations and patients’ abilities to successfully implement those recommendations into their complex lives.[xiii]
Consistent with the philosophy and model of health coaching we suggest a sub-specialty that is specifically designed to meet the needs of healthcare patients with co-occurring AOD issues.
Peer-Based Recovery Coaching provides targeted interventions and support delivered by a professionally trained and supervised recovery expert. Guided by the general principles of shared experience, practical problem-solving, and true empathy Recovery Coaches are able to walk individuals through the labyrinth of available supports.
Recovery Coaches can also ensure follow through on treatment recommendations in the face of patient resistance. Through the use of evidenced-based approaches (Motivational Interviewing) Recovery Coaches are able to engage even the most oppositional patient. In addition, it is possible to embed a case-management philosophy that is guided by the principles of assertive community treatment.
Coaches can employ a strong outreach component visiting people in their homes, using technology to reach out, making strategic phone calls and embracing non-traditional engagement methods (for example: connecting with individuals through recreational activities).
Recovery Coaches are cost effective in terms of personnel costs and incredibly dedicated individuals.
The current system is desperately in need of such an addition to the continuum of care. The use of coaches to increase recovery engagement and retention among AOD patients will help to eliminate the revolving door of medical care that seems to accompany these problems.
The opportunity exists for progressive healthcare organizations to lead the way in solving this seemingly insurmountable problem. Through a partnership with recovery community organizations these organizations will be part of a very unique and innovative community health initiative.
[ii] Substance Abuse Mental Health Services Administration (SAMHSA). (September 4, 2014). National Household Survey on Drug Use and Health (NHSDUH). Rockville, MD.
[iv] Grant, B.F., Dawson, D.A., Stinson, F.S. et al. The 12-month prevalence and trends in DSM-IV alcohol abuse and dependence: United States, 1991-1992 and 2001-2002. Drug and Alcohol Dependence, 2004; 72; 223-234.
[v] Rivara, F.P., Jurkovich, G.J., Gurney, J.G., et al. The magnitude of acute and chronic alcohol abuse in trauma patients. Arch Surg 1993; 128: 907-913.
[vi] Dinh-Zarr, T., Goss, C., Heitmann, E., Roberts, I., DiGuiseppi, C. Interventions for preventing injuries in problem drinkers. In the Cochrane Library. Chinchester, UK. John Wiley and Sons Ltd, 2004: Issue 4.
[viii] Substance Abuse Mental Health Services Administration (SAMHSA). (September 4, 2014). National Household Survey on Drug Use and Health (NHSDUH). Rockville, MD.
[ix] Parthasarathy, S., C. Weisner, et al. (2001). “Association of outpatient alcohol and drug treatment utilization and cost: revisiting the offset hypothesis.” Journal of Studies on Alcohol and Drugs, 62(1): 89-97.
[x] Estee, S. and Norlund, D. (2003). Washington State Supplemental Security Income (SSI) Cost Offset Pilot Project: 2002 Progress Report. R.a.D.A. Division and W.S.Do.S.a.H. Services, Washington State.
[xi] Fleming, Michael, and Marlon Mundt, Michael French, Linda Manwell, Ellyn Stauffacher, and Kristen Barry. “Brief Physician Advice for Problem Drinkers: Long-Term Efficacy and Benefit-Cost Analysis.” Alcoholism: Clinical and Experimental Research 26, no. 1 (January 2002) 36-43.
[xii] Fleming, Michael, and Marlon Mundt, Michael French, Linda Manwell, Ellyn Stauffacher, and Kristen Barry. “Brief Physician Advice for Problem Drinkers: Long-Term Efficacy and Benefit-Cost Analysis.” Alcoholism: Clinical and Experimental Research 26, no. 1 (January 2002) 36-43.
