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Peer-Based Recovery Support

Alternative View

AN ALTERNATIVE VIEW ON THE RECOVERY MOVEMENT

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The Recovery Movement

At the risk of being labeled a full blown heretic, I’d like to offer an alternative view on peer support / recovery coaching and “the recovery movement”.

– Side Note: Can we agree that arguing by example is not the best way to approach a healthcare crisis.

An argument by example (also known as argument from example) is an argument in which a claim is supported by providing examples. “This the best way to recover: here are some examples “from my experience”.

A logical argument (or just argument) is a process of creating a new statement from one or more existing statements. An argument proceeds from a set of premises to a conclusion, by means of logical implication, via a procedure called logical inference.

In order to solve “problems” we must first identify the problem that needs solved.

If we identify the wrong problem (or we make up the problem) we can never solve the actual problem. You can put more gas in the car but if the ignition is faulty you will never be able to drive it…not matter how much gas you put in the tank.

WELL THEN…here we go:

The Narrative

There is a narrative in the “recovery movement” that fundamentally goes like this:

  • Recovering people were working in the field.
  • Things were going relatively well, overall.
  • Then Insurance Companies started to play games.
  • Managed Care Organizations and licensing bodies and evil regulators got involved.
  • The field became “over-professionalized”.
  • Recovering people were pulled out of the process.
  • So we need to bring “peer recovery” back.
  • Nothing about us without us. The problem is we have been left out.
  • We need to advocate for peer recovery and inclusion in the process.
  • Once we re-engage recovering people everything will get better.
  • Recovering people will introduce better policy and better practice.
  • People will rush into recovery and everything will improve.
    (FOR THE RECORD: I AGREE. WE NEED INCLUDED IN THE PROCESS.)

The Problem

The problem is… that explanation is largely mythical.

  1. PRIOR TO “PROFESSIONALIZATION”:

    The presence of “more recovering people” in the industry did not make things better. Things were not going well.

    There was a punishing aspect to care. It was one size fits all.

    The echo chamber was established and the lines between home group and therapy group were blurred (this persists today-unfortunately).

    – For more information on pre-professionalization: consider the Minnesota Model and Synanon. The overwhelming majority of programs followed (and still follow) these principles (one way to recover, “confrontation” equals effective treatment etc…).
  2. WITH “PROFESSIONALIZATION”

    Even with professionalization, a fair percentage of people working in the field were in recovery themselves.

    They became “certified addiction counselors” and/or professional therapists.

    Also they worked in administration. They worked in “business development”.

    They still work in business development…(and if you look around on FACEBOOK you will see exactly how little progress has been made in professionalizing addiction treatment marketing)….

    The problem wasn’t over-professionalization.

    The problem was confrontational, one size fits all treatment and no separation between personal recovery and professional treatment.
  3. THE RECOVERY COACH

    “Mobilizing and training” recovery coaches for the sake of creating an army of recovery coaches (in and of itself) is not smart.

    Demanding more recovering people at the table is important; but only if they are professional in their approach and multiple pathway in their beliefs.

    Massive damage is done when a “certified recovery specialist” (or whatever they are called in your respective state) is simply a sponsor with a credential.

    There is a great deal of denial within the peer recovery support workforce. Many people who attend a training and claim to believe in multiple pathways quickly revert to their “recovery of choice” upon completion of the training. That sets the process back 50 years.
  4. THE NEGLECT OF 90%

    Recovering people don’t automatically offer new ideas and/or push new models.

    Every “plan” is essentially some version of “more access to treatment (including M.A.T.)” ; a call for parity; a call for stigma reduction etc…

    For the record (again), there has been an absolute neglect of 90% of people in need. People think that the 90% “treatment gap” is due to lack of access.

Conclusion:

There is zero validity to this perspective. The gap is due to mismanagement and disregard for the most basic elements of SUD.

Including, people DO NOT seek help—the disorder produces irrational behavior and impaired judgement.

Until we solve for that reality…we make only incremental progress.

The paradigm must change from “hit bottom and want it/relapse equals patient failure” to “the professional provider bears responsibility for connection, retention and service effectiveness”.

Until that happens nothing will change…ever. No matter how much gas money you have.

The issue is not over-professionalization.

The mentality that “only a recovering person can help someone with SUD” is problematic.

If this is a healthcare issue we need to act like it is a healthcare issue. This means many people with varied backgrounds will be involved in the solution.

And there will be a need for professionalization of the peer recovery credential.

This is where things breakdown in my mind. I won’t defer to arbitrary authority. It’s basically: appointed authority versus legitimate authority.

How do we reconcile the need for professionalization with the uncomfortable reality of centralized bureaucracy overlooking said professionalization?

Bob Dylan

The Times They Are A Changin’… Bob Dylan

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A NEW DISCIPLINE IS ON IT’S WAY

This is required reading for all our FAVOR Greenville Staff.

Also the YouTurn Staff and Wellness Partners Staff….

AND MY KIDS…. Read this: ***

From Bob Dylan’s The Times They Are A-Changin’ (Witmark Demo – 1963)

Come Mothers and Fathers – Throughout the Land
And Don’t Criticize – What You Can’t Understand
Your Sons and Your Daughters – Are Beyond Your Command

THINGS ARE A CHANGING

Things change whether we want them to or not. One can always lament the loss of the “good old days” and we love to talk about how much better things were “back in the day”.

We also apply revisionist history when discussing our systems and our institutions and conventional wisdom around how to best do life. Further complicating things is the psychological phenomenon of perceiving one’s personal experience as a universal fact.

PARENTING

Let’s examine parenting for example.

For some reason people wax nostalgic for the days when parents could beat the hell out of a kid and call it discipline rather than abuse.

Things are never as good as we remember them. Nostalgic misrepresentation.

Corporal punishment causes much more harm than good, overall. Statistically speaking.

When this topic (corporal punishment) is brought up someone will inevitably make the statement:

“My Dad beat my ass and thank God he did because I turned out the way I am cause he beat my ass”…..

FLAWED ASSUMPTIONS

This statement is flawed on 2 levels:

  • You assume we all want to turn out the way you did. You may have turned out to be an asshole and your report merely reinforces the fact that corporal punishment is a bad thing.
  • You assume that your experience in some way represents a universal fact applicable to the entirety of humanity. As if what worked for you (getting beat) will work for everyone. This is a very arrogant way of thinking.

Furthermore, I got my ass kicked on a regular basis and it sucked and it made my life horrible.

And by your logic…if your “experience” speaks for all of humanity…well then, my experience speaks for all of humanity as well.

This clearly violates the law of non-contradiction, therefore invalidating your original assumption that; “experience equals fact”.

EXPERIENCE DOES NOT EQUAL FACT

We can do so much better. WE CAN ACKNOWLEDGE THAT EXPERIENCE DOES NOT EQUAL FACT.

We can embrace progress and we are allowed to change our mind.

We can risk bringing new ideas into our consciousness and we are permitted to have a different opinion from the group.

We can even debate difficult things without devolving into a childish fit of rage.

IT’S INEVITABLE

Progress and change is inevitable.

It’s coming fast and furious in all areas of life. All societal institutions are subject to be reconceived and reconstructured.

Education, healthcare, military and even the government (we will have more than 2 viable political parties in the near future) are going to overhaul.

If we base our opinion on our own personal experience, reinforced by the opinions of all the other people in our homogeneous tribe, we will resist change.

A ENTIRE COUNTRY IN PERIL

We will get steamrolled.

Technology is not slowing down. Problems are not going away.

Social problems, such as ever increasing overdose deaths and gun violence are not going to magically go away.

The crazy political turmoil and division,  the unprecedented suicide rates (both adolescent and adults) other substance misuse related deaths, and the unchecked mental health crisis are all “trending” in the wrong direction.

This will continue to escalate until our society responds with the full force and urgency consistent with a country in peril.

THE PAIN AND SUFFERING

“When the pain gets great enough” all solutions will be on the table.

“When the pain gets great enough”, “they” will have little concern what our personal experience was and what “tradition” dictates as a solution.

The pain is starting to get great enough!!!

Our beloved addiction treatment industry and recovery services system is going to change as well.

This includes the way we have structured and positioned “Recovery Coaching”.

THE HOLY GRAIL

The preoccupation with making peer support mimic clinical counseling has been part of the challenge and one of the reasons professional recovery support and coaching is not more widespread.

Recovery coaching as a branch of already existing services may help in some ways but it is not transformational.  It is an adjunct.  It’s not different enough.

The “Holy Grail” of a “reimbursable code”  so that recovery organizations can get reimbursed by medicaid and commercial insurance is a chimera.  Furthermore, why do we assume that reimbursement from the existing infrastructure will lead to scalable services?

QUESTION

Why does “Peer Recovery Support” or “Recovery Coaching” or whatever you want to call it,  automatically assume that the insurance reimbursed “Business Model” is the best model?

ANSWER – BECAUSE “THAT’S THE WAY CLINICAL TREATMENT IS REIMBURSED”?

For sure, some isolated organizations in select states will thrive under the current model.

There are some places where the state system is more amenable to supporting independent recovery support.

I believe South Carolina is going to be one of those places.

Furthermore, recovery coaching will continue to be promoted across the country.  But it won’t scale.

Because it’s not paid for by the public system in a manner that promotes growth.

IT’S NOT UNIQUE

Recovery coaching is not a desired service within the private marketplace (businesses, other enterprises, general consumers etc..) aside from some very isolated initiatives such as what we have developed here in Greenville, South Carolina.

But Greenville is just a small piece of the pie.

We want to see a nationwide sea change.  It’s difficult to say this but recovery coaching, on the whole, is not attractive enough to the private market to warrant widespread adoption.

Partly because it’s not unique.  It’s not differentiated.

CONSIDER THIS

  1. Why are all the “Recovery Coaching Training” curriculums essentially the same?
  2. Why do they so closely resemble many of the things we are taught in “Clinical Training”?

In addition to that, the overwhelming majority of people trained as “Recovery Coaches” across the country are not working.

NOTE: ARE WE CREATING A WORKFORCE FOR THE SAKE OF CREATING A WORKFORCE?

A NEW DISCIPLINE

In my realm of influence (FAVOR Greenville and beyond) “Recovery Coaching” will continue to be a core service.

We run recovery centers.  We facilitate all recovery meetings.  We provide one to one coaching.  We do outreach to treatment centers and detox programs.

Of course we will lean on this foundation.

In truth, the majority of our services will be traditional recovery coaching.  It works in these traditional environments. We do this very well and we are committed to continuing our efforts in this area.

20 MILLION PEOPLE

But there are 20 million people out there who are not into the “Traditional” environment.

They all deserve help!

They all deserve a “Solution”!

THEIR FAMILIES ALL DESERVE SOME HOPE.

RESEARCH AND DEVELOPMENT

Therefore, we need to devote a certain amount of time to “Research and Development” as well as “Product Innovation”.

We have developed another venture that will focus on these breakthroughs.

This company does not resemble anything you have previously seen in the recovery support services or addiction treatment space.

NOT ANOTHER REHAB BUSINESS

We aren’t getting into the rehab business (never again) or the recovery housing business or other typical programs that may expand our reach.

I respect those programs and I’ve worked in all those models.

However, it’s not my jam any more and it is not what our companies are focused on.

We are going to pivot to meet the demands of the market and respond to the customer.  We will listen to the customer.

First by identifying who our actual customer is.  Most assume it is the person in need.

But we know that’s ridiculous because the person in need is running from the service.

The customer is the family system (all individuals are part of a family system), the workplace, the school, the community etc…

We work from the customer out to the program.  Fit the program around the customer. Not the customer around the program.

We will develop a new product with the service to back it up and we will approach continuous improvement with the same zeal Zappos approaches “happiness”.

BENCHMARKS AND MENTORS

Our benchmarks and our mentors will come as much from the business world as the addiction treatment and recovery services world.  Actually, probably more from business.

We are obsessed with customer service.

A product and a service that will be judged based on the response from the customer.  Imagine that?

The market will guide our product and the associated service and we will invent a solution.

It will not be called Recovery Coaching so there will be no confusion.

SOMETHING NEW – NOT RECYCLED

Interestingly, the treatment infrastructure is likely to benefit from our efforts.

Since we are hell bent on differentiating ourselves from the historical solution we will go to great lengths to lean on our clinical partners.  We will work closely with clinical providers and partners to maximize the experience for the customer.

This includes private providers and public providers.  We want to strengthen our relationships with state systems.

However, this doesn’t mean we roll people into rehab over and over.

TREATMENT GOES WAY BEYOND REHAB

Our value add is the invention of a new product and service not the reapplication of a legacy product.

“Recovery Coaching” integrated with and supervised by clinical treatment staff is essentially the same as a “Behavioral Tech”.

Techs have existed for 50 years.

We want to provide something that produces ZERO confusion.  Something new…. not recycled.

Our clinical partners will thrive because of our venture into this brave new world.

I may even get invited back to the cool kids table at the annual conferences…..

NOW THAT’S AN OUTRAGEOUS IDEA!

RECOVERY COACHING NEEDS TO BE RE-EXAMINED

Remember, the current “recovery support system” was not ordained by God.

Relatively speaking, its very new.

It’s completely logical that everything needs to be reevaluated and, probably, needs to undergo major adjustments.

First off, who are the experts guiding this?

How many people have even actually provided recovery coaching and/or successfully run an organization?  Not very many.

Relatively speaking we are talking about a very small insular group of people. I would put myself in that group.

FAVOR GREENVILLE IS THRIVING 

That doesn’t mean I’m the authority, and just because there are handful of other places thriving doesn’t mean they are the authority.

We need to acknowledge that we have not even reached adolescence in terms of our field’s development.  Yet we act as if this stuff is stone cold fact.

We can do better. Much better.

It’s completely clear that this is an evolving profession. An evolving service.

Is “the approach”  we currently have the gold standard?  If so who decided that?

Should this model be “locked in” at such an early iteration?

THE NEXT VERSION ???

We have all heard of version 1.0 ; version 2.0 ; version 3.0…when it comes to technology and other industries.

Could that same thinking apply to recovery coaching and recovery services?

Recovery Coaching 1.0 has been the universal approach.

HOWEVER, I challenge the idea that the current manifestation of recovery support/coaching is the most effective version.

Look around, all the stuff that you take for granted in life was invented by someone no smarter than you.

You are permitted to invent a solution…. “They” won’t tell you that.

If you become aware that you are allowed to solve this problem….well then….what would “they” do?

 

The Standard Company Line - Not Me! 2

The Standard Company Line – Not Me!

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When I give a talk I do not follow the standard company line with the generic blah blah blah….

This past year I have done a bunch of talks/presentations on recovery community centers and recovery coaching. All over the country.

I am not confrontational but I am probably a bit direct and I am not always tactful. But with me, what you see is what you get, and there is no question where I stand.

I deliver recovery coaching and run organizations that provide tens of thousands of hours of coaching. I’ve talked to at least 100 parents who have lost a child.

FAVOR GREENVILLE

FAVOR Greenville searches homeless encampments for participants who are enrolled in our program, we are in soup kitchens, schools, hospitals, everywhere.

We work with 8,000 plus families. My opinions are based on practice not theory.

I’m getting old. I don’t have enough time left to go along with things that aren’t impactful and actionable.

I have no time left to promote ideas that are old and stale.

No time for things that are not going to move the needle on recovery.

REAL LIFE EXPERIENCE

Also, before FAVOR Greenville I toiled in the medicaid/state run SUD system on the clinical side.

I’ve done tour of duty in private rehab. I’ve done community mental health, private practice, in-home mental health, in-home family services, had an intervention practice.

This gives me a unique perspective. Again, nothing theoretical about my opinion.

It’s based in real life experience and a boatload of education and academic training. I have strong opinions. I’m willing to adjust when the evidence suggest I’m wrong. But I won’t go along with the company line just because “it’s the way we do it”.

INDEPENDENT RECOVERY ORGANIZATIONS

One subject that gets attention on these trips:

I openly state that independent recovery organizations are a “major” part of the solution.

And that, sadly, they are either completely ignored or given token support in most places.

I point out the tragedy of that reality and I clarify that a peer recovery staff in a treatment setting does not constitute a robust recovery oriented system of care. Posting someone up in detox or IOP does not address the recovery issue.

It’s better than nothing but it’s not the solution.

I talk about RCO’s being essential and I state that RCO’s should have dedicated permanent funding via federal and state drug and alcohol dollars. Significant funding. On par with prevention and treatment.

WHAT DID YOU SAY RICH?

Many times there are state drug and alcohol officials and county drug and alcohol officials in the room when I make these “outrageous” statements. In some places (many places actually) this goes over like a lead balloon.

Officials in state systems do not want to hear that type of talk. But what the hell is wrong with saying that?

It’s 100% true. ONE HUNDRED PERCENT TRUE.

RICHARD JONES UNPLUGGED

However, in other places there are people who want to hear more.

There are groups that agree 100%. There are even system officials who agree.

It’s fascinating to see the difference from state to state.

I have a running joke: I usually get invited to a town only 1 time and not invited back.

Once they get Rich Jones unplugged it’s one and done…. but some are inviting me back.

Oh my… that’s scary isn’t it. What if they listen to me…

A NOTE FROM RICH:

Thank you Lynn Farnquist and Families Against Narcotics for the having me up for a family presentation.

Families Against Narcotics (FAN) was born out of a town hall meeting held in 2007 – a result of two teen heroin overdoses just weeks apart in the small, middle-class suburban community of Fraser, Michigan.

All told, that community suffered 30 overdoses that year. All to heroin. Needing to do something, this determined organization set out to recruit members and educate the public.

Visit Families Against Narcotics

 
FAVOR Greenville Family Group

FAVOR Greenville Family Group – Doing it Right!

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FAVOR Greenville Family Group

This last Monday at FAVOR Greenville our Family Group had 72 people in attendance.

We must be doing something right. I have been doing this type of family group for over 12 years. It predates FAVOR Greenville. I am so lifted up by the courage and the hope that these family members display in the face of overwhelming circumstances.

A Different Type of Monster

I have to say. Things have changed. You can sit back and say “addiction is addiction” but today addiction has dramatically transformed into a different type of monster.

Today’s addiction involves younger people and more dangerous drugs. In 2001 when I got into this process around 18,000 people died of an overdose. In 2017 it was 65,000.

The fear and anxiety that families face today is so pervasive.

You can say that “recovery is the same now as it was then” but 18 year-olds with a fully established heroin addiction were rare-very rare. I’m not saying non-existent…but very, very rare.

Is 65,000 Dead the New Normal

Let’s be clear. Our society is failing to address this issue. Maybe 65,000 dead per year is the new normal.

Should we just accept it? I don’t think so!

Maybe the destruction of a generation and the countless families in despair is the new normal. But let’s be clear, we are not even coming close to touching this issue… or mental health…

It is possible that everyone is doing the best they can under the circumstances. This is no one’s fault. It’s not diabolical and it’s not intentional. Nor is it about individual people, and it’s not about individual programs.

It’s not about one approach over the other. This is not about one “pathway” over the other.

It’s simple…society has evolved. Times change. The culture has changed. It’s a brave new world.

Addiction has Mutated

Addiction has mutated. Mental Health has become more pronounced. Suicide is also at record levels. Anxiety is at record levels. Depression is at record levels.

In terms of physical safety, we live in the safest period of time in human history.

We live in one of the most materially abundant periods of time in human history. Yet emotionally, psychologically, behaviorally, we are in a free-fall.

We are addicted and the country is destroying itself from the inside out. These are facts. Empirical facts.

North Korea… Russia…. Iran… these are not the existential threats facing our country…. We will take ourselves out before Putin or the “rocket man” take us out…

We Need to Change or Just Keep Dying!

There comes a time for a deep and substantial paradigm shift. We can keep all the existing structures and systems and philosophies. But we know what the results will be.

We have been witnessing these results over the past 20 years.

There are many things that we could do differently.

But at its core this requires a fundamental change in thinking. Our core beliefs about how we help people with emotional, mental, addiction, behavioral issues must change.

Our core assumptions about what it takes must change.

The most important: professional services could line up under a healthcare banner as a new discipline that is part of a more comprehensive chronic disease management model.

No more fragmented services. Chronic disease management–period.

In-Home Recovery Services

There is no reason for office based therapeutic services or clinic based therapeutic services. Primary funding sources should pay for in-home services.

You don’t need to be “willing” to be in treatment for a behavioral health issue. You need to become willing over time and the primary responsibility for that transformation falls at the feet of the professional.

The family should be the “identified patient unit” and individual reimbursement should be an after-thought.

There should be a new workforce identified.

Specially Trained Engagement Team

It could include peer recovery support but it doesn’t have to be only peer recovery. A specially trained engagement team. Anyone who can do it well. I don’t care if you are in recovery or not. But you need to love the “damaged soul”.

I think that recovering people would be a logical place to start.

It goes without saying that getting better has nothing to do with working a certain program of recovery.

Multiple pathways. Whatever works. Do more of that.

Recovery Cartel - Richard Jones

The BUBBLE HAS BURST

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The Acute Care Model

It is possible, actually it’s likely, that the delivery of addiction treatment and recovery services will change at a fundamental level. The acute care model, as it currently stands, will essentially go away at the private level. It may endure at the government/publicly funded level.

One macro-level reason—the attention on the opioid crisis has lead to evaluation of the industry for the first time in history. White middle class kids started to die and people in the general public started questioning practices.

We are at the very beginning of that “questioning” process. Watch as the anger grows.

There are so many questionable practices to question.

I’m talking 5 to 10 years from now. Not tomorrow.

  1. Driven by reimbursement policy, emerging best practices, emphasis on value based care, population health, and the horrible results of destination rehab. Most treatment will be local. The end of the destination rehab is near..
  2. Out of network insurance reimbursement continues to change and is becoming more and more unpredictable.
  3. The days of throwing millions of dollars in billing against the wall and seeing what sticks are numbered.
  4. Less and less is going to stick. (ACA was an illusion) Revenue cycle management more difficult.
    This, along with “local” treatment emphasis, will lead to hundreds of centers shutting down. The big boys will survive. And some niche boutiques. But the Walmart rehab days are limited.
  5. There will be a push for addiction treatment services to be delivered and managed primarily through healthcare organizations. This will become best practice and standard of care. Further limiting referrals to the “drug and alcohol clinic”….. this discussion is already occurring nationally.
  6. Professional Recovery Support services will become funded through diverse methods. CMS and commercial insurance will jump in because the cost effectiveness of the service too hard to ignore. Money talks.
    As the model grows and gains momentum and validity. Imitation will run rampant. More “providers” leave the treatment fold and go back to running nursing homes.
  7. Treatment Centers will then attempt to provide Recovery Support Services rather than “clinical” services. Some will convert. Many will butcher it. This will further eliminate many of the instant experts and more programs will shut down.
  8. Hospitals take over the primary deliver of addiction treatment and form partnerships with Recovery Support providers. This is consistent with the management of other chronic diseases (diabetes, asthma, heart health) and the culture of healthcare and infrastructure exists to support Recovery Support services.

The BUBBLE HAS BURST….

This happens in every industry. Fundamental disruption. Creative destruction.

Out of the dust and the rubble a new system will emerge and 10 to 15 years from now it will be the norm. Standard practice. The new system will become “just the way we do it”….

You heard it hear First….. it’s now documented.

#nostradamus | #theearthisround | #askblockbuster

✌✌✌SIDE NOTE…One Group that may avoid this process is government funded system. That system is a monopoly. Like public education it may be untouchable.

Response to President Trump Rich Jones Recovery Cartel

Rich Jones Response to the Trump Announcement

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President Trump said that the ongoing opioid epidemic — which is killing more than 100 people each day — is the “worst drug crisis in American history” and said his administration is declaring it a public health emergency, pledging the nation’s full resolve in overcoming it.

This is my thoughtful response to the Trump announcement.

First, the public proclamation of a “public health crisis” and the associated attention on the DISEASE of addiction is a positive step in and of itself. That cannot be denied. Given the terrible history of stigma and embarrassment and shame associated with the disease it is miracle we are talking openly about this issue.

The President of the United States talking about it as a public health issue is a major breakthrough. Furthermore, much gratitude for the hard work and commitment of the organized recovery advocacy movement.

I don’t mean the treatment center marketers who call themselves “advocates”. I mean organizations such as Facing Addiction, Faces and Voices of Recovery and the grassroots Recovery Community Organizations (RCO) out there. Good work. People listened.

Second, we have no idea “exactly” what Presidents Trumps means with his announcement. Questions still need to be answered, such as:

  • How will the money roll out?
  • Will the money even show up?
  • What initiatives will be funded?

However, we can gain insight and make predictions based on what was discussed…

Third. I am disheartened because there is no acknowledgement or honest discussion regarding the core issue associated with the crisis…

Medically Assisted Treatment (M.A.T.) was suggested as the cure all. More detox beds also discussed. (Do you know only about 20% of people in South Carolina-and probably nationwide-do anything “post detox”?)

These 2 “solutions” are not comprehensive solutions as they fail to recognize or address the fact that only about 3% of the 90% of the “untreated” people actually want help. Do you get that?

There is a treatment gap that exists due to “willingness” not due to access.

I’m sure increasing access will cut into the 90% untreated somewhat— but not at any significant level. YOU ARE PROVIDING SOLUTIONS FOR COMPLETELY DISENGAGED PEOPLE, assuming that they will all sudden show up.

The proposed solutions assume these folks will also magically follow the treatment plan as dictated by the provider.

“DO YOU SERIOUSLY THINK THAT IS HOW THIS WILL GO DOWN?”

Fourth.  Recommending “access” as the answer to the Opioid Epidemic demonstrates a fundamental misunderstanding of the reality of addiction. This is not surprising given the fact that all of our models and all of our research and all of our “traditional” ideas about addiction are founded on the experience of WORKING WITH WILLING PEOPLE.

BECAUSE UNWILLING PEOPLE ARE IGNORED UNTIL THEY BECOME WILLING!!!!

And fifth, my last point.

The answer to our nation’s problem, President Trump, is that what we need is a massive amount of money and support for community based outreach programs and assertive recovery coaching/peer based support services.

Re-allocation of insurance money from “intensive outpatient programs” that are office based and last 8 weeks to community/home based outreach coaching that last 12 month or 18 months. The cost would be essentially the same. It can be done.

WE NEED THOUSANDS OF RECOVERY COACHES OPERATING
IN INDEPENDENT RECOVERY ORGANIZATIONS.

They need to be accountable to independent RCO’s and operate in collaboration with the existing treatment system but NOT under the jurisdiction of the existing infrastructure. The money should come directly to the organization and not funnel through another entity.

Commercial Insurance should contract with the RCO’s for bundled services. The RCO’s should be held accountable and be reimbursed based on engagement rates and retention in recovery rates — not based on “successful completion of a program”.

I will speak for my organization–we will pay the money back if we suck. if we don’t deliver.

NOW THAT is a novel idea isn’t it… Until we think innovation and “new” solutions we are throwing money out the window…

This is all self-evident. It’s all very logical. Someone please forward this to President Trump…

Recovery Cartel Blog

70,000 DEAD? Really – We gotta talk!

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This is a Manifesto and a Plea for Honesty.

As the data rolls in from 2016 it appears the death toll from overdose could actually exceed 70,000.  Let’s talk about the “Elephant in the Room”. Let’s get real… Let’s have a debate. Let’s have a difficult conversation. Are we allowed to disagree?

Is there room for dissenting opinions? I could be wrong. Maybe our current approach to the addiction crisis is the best approach. I don’t think it is, but hey, I’m open-minded. Or do I get kicked out of the club for not toeing the company line?

One thing for sure: 70,000 dead is disgusting. Sickening that we accept this and do not respond in radical ways.

For me, this has become a moral issue. At this point we have a moral and ethical responsibility to address this issue at its core. We hold tight to an antiquated approach that has never been shown to be effective. We just never addressed it before because of the stigma. Addicts are allowed to be mistreated because they are scumbags. The difference in 2017; death rates and media attention have made it harder to ignore.

Furthermore our current systemic approach is an approach that does not even touch 90% of those in need…let alone help them. Is this okay? Is this acceptable?

I don’t think we need more awareness. I think we need more solutions.

Thoughts:

1.) Rehab is not the gatekeeper of recovery.

People figure it out on their on own, people find recovery in many ways. More treatment access is not the answer. You continuously hear “get them into treatment” …as if that’s a solution.

See this article on Myth of Rehab as Gatekeeper of Recovery from the Recovery Research institute.

  • Can we empower rather than preach to the patient/family in need?
  • Can we move our focus away from the “automatic” rehab response?
  • Can providers and membership organizations please police your ranks and get rid of the marketers who spend all day everyday intimidating and bullying people into treatment centers?

2.) Intensive outpatient programs can be effective for people who are motivated and people who complete the entire program.

However, some studies suggest that up to 50% drop out in first 3 months and we know that motivation levels vary greatly. Most people with an addiction issue are not motivated. Outpatient clinics could be more individualized. In the private treatment domain IOP’s have been transformed.

Sober living homes use IOP’s to maximize reimbursement. These programs are actually referred to as rehab by many and most lay people do not understand the difference between an IOP and an inpatient treatment center.

The Florida Model is problematic. IOP is especially useless for people who have been through IOP before. 9 hours a week, delivered in 3 hour groups, 3 times per week, is not the most efficient use of time or money.

Check out this NBC INVESTIGATION by Meagan Kelly from June 25. 2017

The Community Based Experience could be so much more impactful.

  • Could those 9 hours of therapy be delivered in more creative ways?
  • Who dictates this?  – Insurance?  – The provider?
  • Why do we deliver IOP in this prescriptive way?

3.) 12-Step facilitation is effective for people who are willing to do 12 step programs.

The studies around this type of therapy are interesting. There is clearly a benefit but they ignore the reality that 90% of the folks are completely disengaged. We base our approach on the small receptive percentage of the small percentage (10%) that show up for treatment.

  • Should we offer more alternatives?
  • Should we force feed people?
  • Should we wait until they hit bottom and surrender or should we explore all options?

4.) Medication Assisted Treatment comes with all kind of baggage that is not discussed.

The stigma within the stigma. People in MAT are marginalized within recovery rooms. There is an effort for the fellowships and recovery rooms to be politically correct and welcoming. However, the message is loud and clear.

From Narcotics Anonymous Information Pamphlet:

NA and Medically Assisted TreatmentNA and People on Medically Assisted Treatment –
As we stated previously, NA has no opinion on the practices of any organizations or practitioners outside NA. However, within the context of NA and its meetings, we have generally accepted principles, and one is that
NA is a program of complete abstinence. By definition, medically assisted therapy indicates that medication is being given to people to treat addiction. In NA, addiction is treated by abstinence and through application of the
spiritual principles contained in the Twelve Steps of Narcotics Anonymous…..

….Our hope is that those who receive medication to treat addiction will come to meetings and listen to people who are recovering. Through listening and through asking questions before and after meetings, attendees may gain a better understanding of NA and what it has to offer. NA offers a community and a lifestyle that support staying clean, and NA may be compatible for addicts on medically assisted protocols if they have a desire to become clean one day. We understand that addicts whose path is medically assisted treatment may hear many messages in NA meetings. Some NA meetings make no distinction as to whether those receiving medication to treat addiction may share in a meeting, while other NA meetings limit the participation of those who are taking this type of medication.  Click here to download this NA Pamphlet

More Questions to Consider:

  • Can we hang our hopes on MAT without professional recovery coaching to bridge the gap?
  • Shouldn’t we develop a way to integrate MAT into recovery?

5.) The family must be mobilized.

Instead of detachment we can teach responsible influence and individualized family recovery planning.

  • Can we use programs like FAVOR FAMILY RECOVERY to guide people thru a systematic response to loved one’s addiction?

6.) It’s not about money.

Money is not evil. If a program or person is actually making an impact they should be compensated. However, there are really bad providers making a massive payday on the backs of the suffering.

  • Is there a way to incentivize programs away from the rinse and repeat model?
  • Can they be held accountable for rinse and repeat and give money back when services are proven ineffective?
  • Can value based healthcare be applied to addiction treatment services?

7.) Finally… can we get beyond the concept that we can only work with a “willing” client.

The evidenced based practice of motivational interviewing and stages of change theory is promulgated throughout the entire treatment system. However, no one really follows its tenets.

“YOU CANNOT BE A MOTIVATIONAL INTERVIEWING PRACTITIONER AND PRESCRIBE ONLY ONE PATHWAY OF RECOVERY. ITS IMPOSSIBLE.”

The vast majority of our interventions are focused on the preparation and action stages of change even though the vast majority (you could argue 90%) of those with addiction are in the pre-contemplation and contemplation stages of change. NON-SENSE.

  • Can we empower and financially compensate programs that are effective in connecting to unwilling people?
  • Or are we going to hold tight to the idea that a person must hit bottom?  Many of us die on the way to the bottom!

Final Thoughts – Assertive engagement strategies work.

I run a high quality professional recovery coaching organization. We are one of 9 CAPRSS accredited programs in the nation. We are a member of the association of recovery community organizations. We have served over 17,000 people and we have provided more than 40,000 hours of recovery coaching.

The majority of those hours to people who do not necessarily “want” recovery. We serve the “unwilling”. We are engagement experts.

We believe this type of independent, autonomous organization (not affiliated with a treatment organization) is the future of professional recovery services. We know how to do this.

I’m sure there are other new solutions out there as well. Ours is just one of many new ideas. We need to champion new ideas. Adding equine therapy to your program is not innovation. I’m talking brand new ideas. Ideas that make the status quo cringe.

Tell me I’m wrong. Tell me how and where I’m off base. Let’s talk about this.

Richard Jones is the President and Chief Operating Officer of FAVOR Greenville. FAVOR Greenville offers a new and innovative response to the baffling problem of addiction by focusing on assertive engagement, family empowerment and non-traditional community partnerships. WE ARE THE FUTURE. THE PARADIGM SHIFTS HERE… JOIN US.

Multiple pathways

Multiple Pathways Of Recovery

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FAVOR Greenville champions all Pathways to Recovery.  This includes 12-step recovery meetings.  We believe the fellowships of Alcoholics Anonymous and Narcotics Anonymous are a first option for many of our participants.  In nearly all cases it is the first outside resource discussed via recovery planning.  If people are willing, we run with the plan for meeting attendance.  However, we do not believe that recovery is a one size fits all process and there are many ways to find recovery.  All of these are worthy of celebration.  We just want to see your life get better.

Therefore, when we shine light on one size fits all treatment, we are not doing so in reference to AA or NA.  We are doing so in reference to the professionalization of 12-step recovery and a private system that, in many cases, denies the patient access or information regarding alternative pathways of recovery.  With that in mind I wanted to put forth some random thoughts on multiple pathways.

1) Multiple Pathways Exist: Perhaps the most controversial thought concerns the fundamental reality that multiple pathways of recovery exist.  Because of the stigma and shame surrounding addiction relatively little research has been done on recovery.  Our culture, as a whole, considers addiction a “moral failing” so there is little demand or interest in gaining scientific insight into the recovery process.  In addition, many professionals in the field have little concern with research on recovery.  Especially if they have had their own personal experience in recovery.  This leaves a void of knowledge which has, unfortunately, been filled with clichés and conventional wisdom.  To paraphrase Randy Gage and his new book Mad Genius: this void has allowed the mysterious people in charge of the secret system that runs (addiction treatment) to simply proclaim there is only one way to recover.  I don’t know how many individual people believe this.  It is a very difficult thing to assert and still consider yourself a rational person.  However, the herd mentality frequently kicks in and people jump on board with this type of claim even in the face of evidence to the contrary.      

This void has allowed the mysterious people in charge of the secret system that runs addiction treatment to simply proclaim there is only one way to recover.  No one knows who these people are.  They are the ones who established all the things that have “always been done this way” (adapted from Randy Gage, Mad Genius). 

Typically, the pathway most commonly promoted is 12-step recovery found in Alcoholics Anonymous or Narcotics Anonymous.  AA and NA are the most well-known pathways and many have found recovery through these programs.  In fact, they are the most common “formal” pathway of recovery.  My concern has nothing to do with the programs of AA or NA.  My concern is with the professionalization of AA and NA.    I have heard professional counselors proclaim that AA is the only way to find recovery.  I have heard stories of patients being required to complete steps while in facilities that claim to be licensed inpatient rehabilitation facilities.  This is a big problem.  If you find yourself in the presence of a therapist who says something along the lines of “you must do AA in order to recovery” you should look around for other options.  Insurance should not be paying for 12-step sponsorship.  The responsible thing, from a medical perspective, is to promote all pathways of recovery and develop aftercare plans that are truly individualized.

One of the problems with exploring pathways to recovery lies in the definition of recovery.  Does it mean complete abstinence?  Does it mean complete abstinence plus a defined program of self-improvement?  Does it mean complete abstinence plus a “spiritual awakening”?   Is mediation assisted treatment a viable pathway to recovery?  What about the reality of substance use disorder full remission?  In other words, a person had a substance related problem but no longer does.  These individuals may or may not use, either way they are no longer destroying their lives.  How do we characterize these individuals?  I think that is a good thing if their lives are improving.

When you explore substance use in a realistic manner you find much complexity and nuance.  If you are a self-help attendee, you have little responsibility beyond the black and white.  A person is in recovery if they do “the program”.   However, if you are a professional healthcare or treatment provider you have an ethical responsibility to explore all angles and gain a deeper understanding.   For the sake of research there has been a general agreement on recovery as “remission of symptoms”.  It is the most quantifiable variable and from a public health perspective the most important.

In addition to 12-step recovery, The Recovery Research Institute (RRI) out of Harvard lists the following as “clinical” pathways which have been proven effective:  pharmacology, Acceptance and Commitment Therapy, holistic based recovery services, Community Reinforcement Approach, CBT based approaches, Contingency Management, Relapse Prevention Therapy, Motivational Interviewing/MET techniques, 12-step Facilitation, Behavioral Couples Therapy, and Family Therapy.  Among “non-clinical” alternative services you find: Recovery Community Centers, Peer-Based Recovery Support, Education Based Recovery Support, Employment Based Recovery Support, and Faith-Based Recovery Support.  Furthermore, alternative mutual support groups existing including: SMART Recovery, Rational Recovery, Women For Sobriety, HIP Sobriety, LifeRing, Secular Recovery Organizations and many others.

In addition, some achieve recovery or “remission” without any formal help.  From the RRI:

“Some individuals can achieve substance use disorder remission without formal help from professional treatment or mutual-help organization participation”.

Again, because of the mysterious people in charge of the secret system that runs addiction treatment we have allowed our professional systems to ignore these facts.  Even Bill Wilson knew there were many ways to recover.  The following are all quotes from the esteemed Mr. Wilson:

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–“AA has no monopoly on reviving alcoholics.”

–“The roads to recovery are many… any story or theory of recovery from one who has trod the highway is bound to contain much truth.”

–“Upon therapy for the alcoholic himself, we surely have no monopoly.”

–“In no circumstances should members feel that Alcoholics Anonymous is the know-all and do-all of alcoholism.”

Professional organizations, counselors and addiction treatment centers should be held accountable to standards that include a full menu of recovery options.  Are we not “withholding” possible solutions when we discuss only 12-step recovery?  This seems like an advocacy issue that those of us in the recovery management movement should take on.

2) It is likely that “new” pathways will be invented: As we often hear in the rooms of recovery, recognizing and accepting the problem is the first step. If we are in denial of the problem we can never find a solution.  If we are unable or unwilling to look at the situation from a reality based perspective, we will never make a change.

I would argue we are in denial regarding this issue.  90% of the treatment programs in America operate from the same fundamental philosophy, and it is not working.  As it currently stands only 10% of those in need are engaged in services.  It is logical to assume that some of this is the result of a one size fits all approach.  If we opened the door wider more people would walk into the recovery process.  If we offer alternatives and programs that meet people where they are you will see improved engagement.

I also believe there is a shelf life on the current approach.  I do not think this business model is sustainable and people will start to differentiate.  Marketing programs that are all identical will not be effective as you get a more educated and knowledgeable patient base.

And I believe that as soon as we acknowledge the problem we will innovate and develop new solutions.  It is already happening in small pockets around the country.  Including Greenville, South Carolina.  We will develop alternatives that we cannot even envision right now.  Technology will help.  However, I believe the real break-through will occur when we educate, train and supervise a new workforce.  One that emphasizes engagement and connection over dogma and acute care rinse and repeat models.

We will realize that “the way we have always done things” makes no sense.  We will rise up and challenge the mysterious people in charge of the secret system that run the addiction treatment system and develop new protocols, payment systems, and norms.  We will develop an entirely new culture of professional recovery services.  Twenty years from now people will look back on this day and time as the transformation point.  They will wonder why it took so long to make changes.

3) Co-Occurring Recovery will be one of the new pathways: Double trouble or dual diagnosis groups have always existed.  However, they are few and far between and they are not available for many in need.  We know that upwards of 60% of those with a substance use disorder also suffer from some type of mental health issue.  The days of mental health issues being cleaned up via the natural progression of recovery are over.  We can no longer just wait for the person to sober up and see if the depression goes away.  Some studies indicate trauma is present in up to 80% of women in recovery.  Trauma symptoms can be made worse if mishandled and there will be a need for specialized support in these areas.  This is all good stuff.  We have advanced as a society.  We are more informed and educated than we were in the past and our needs have changed.  That is not unusual.  It is predictable and healthy.

In addition, people with mental health issues sometimes struggle to fit into “regular recovery” groups.  Medication is one reason.  Social anxiety would be an example of another reason.  It is likely that new recovery groups will spring up to meet the needs of participants with co-occurring disorders.  At FAVOR Greenville, we are developing a curriculum that certifies a coach as a COD specialist.  This will be a positive development in the fight against addiction. favorgreenvillelogo

4) Medication Assisted RECOVERY will be one of the new pathways: Despite the best efforts of many people in recovery, many people on medication assisted treatment have felt alienated from recovery rooms.  I have no interest in entering into that debate in this blog post.  It would require much more time than I have at the current moment.  Suffice to say, there is likely to coalesce a specific recovery program for people on medication replacement therapy.  A place where they can talk and share openly on all matters including the use of Suboxone or Methadone.  We know this is a very contentious subject in some recovery rooms.  At FAVOR Greenville, we welcome you into the recovery process no matter what stage you are in.  We want you to keep coming back.  Medication assisted or not.  I believe we will see more specific programming and services related to medication assisted recovery.  We know community is exceedingly important to the recovery process and it is going to be necessary to address this glaring issue as we move forward.

In closing I want to reiterate.  At FAVOR Greenville, we are big fans of 12-step recovery.  However, we are also big fans of SMART recovery, Women For Sobriety, FAVOR primary recovery, clinical recovery, medication assisted recovery, and any other recovery you can think of.  Our interest is in seeing your life improve.