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September Building Communities of Recovery: How Community-Based Partnerships and Recovery Support Organizations Make Recovery Work

Cynthia Moreno Tuohy

09 How CommunityBased Partnerships and Recovery Support Organizations Make Recovery Work

Ask the Expert:  Cynthia Moreno Tuohy , NCAC II, CCDC II, SAP, is the Executive Director of NAADAC, the Association of Addiction Professionals.

1. Question: Are medical model and bible/faith-based model interventions compatible enough to be blended in community-based recovery support programs, so that the programs could be jointly funded? Do you know of any community organizations that are funded from both faith-based funding sources and medical funding sources?

Answer: There may be the possibility of this, depending on the state regulations of acceptable guidelines.  Often, the Medical model follows the rules and administrative codes of the state authority (Alcohol & Drug State level authority) and many of the bible/faith-based do not apply under those regulations.  However, since the Access to Recovery Grants, many bible/faith-based organizations have developed to meet the criteria of the state level regulations.  The core issue in this idea is: do they want to find a way to blend the models.  There may be philosophical differences to each model’s goals.

In your question, referring to medical funding sources, it would depend if you mean private insurance or county block grant funds.  I know there are some organizations that are faith-based that receive county block grants. To find out about those, please contact SAMHSA.  For those that are a medical model paid by insurance, I do not believe that the HMO/PPO/BHO keeps a list, that would be a situation where you would need to call them and ask that question specifically.

2. Question: What do you think of the drug Subutex?  And what is your opinion on why it is monitored so closely by the government while narcotic prescriptions are given without end?

Answer: Medication assisted recovery has a place in the carrier of the toolbox of recovery pathways.  There are issues with any medication and that is why it is important that the prescribers who prescribe them to patients are trained and have assistance and support from addiction professionals. The prescribers only really handle the physical side and the addiction specialists handles the social, psychological, and long term recovery side of it.  This is a good question on why narcotic prescriptions are given out more freely, it may be based on history and prescience, it may be economics and lobbying, it may be a lack of education on the dangers - so the regulations are looser.  In any case, there is now more information and education happening at the Federal level and new bills related to this. We need to see continued education for the decision makers, prescribers, and the public as a whole.

3. Question: My son is 29 years old and an alcoholic through all his 20s. He still lives at home.  He has been to treatment twice (30-days) in past 3 years, done outpatient counseling, and gone to AA meetings.  He has been diagnosed with social anxiety, paranoia symptoms, depression, and severe anxiety.  When he drinks it make his symptoms worse.  He has been unable to hold a job through his 20s more than 3 months because of his mental health issues and alcoholism.  He was a week sober on 9/19. His last job ended last week after only 6 hours.  He is on anxiety and depression medications and also taking Antabuse.  What programs are out there to help support him?  We only have minimal catastrophic medical coverage that has a high deductible.

Answer: First, thank you for coming out with a personal issue, I appreciate your courage!  There are some great programs and professionals who are trained to treat both mental health and substance use disorders….like your son’s.  I am guessing he has been professionally diagnosed with the disorders that you described above, and if not, that is the first step.  Some disorders mimic each other and it is good to be clear on the correct one to treat.  Secondly, there are programs that treat both disorders in a thoughtful and integrated process.  Sometimes, residential care is helpful so that the individual can have an opportunity to learn in a relaxed environment.  Some of these residential homes also help develop work and living skills, such as Westbridge in New Hampshire and Florida.  Some addiction, community health or mental health centers have programs that are skilled at working on these disorders in an integrated process and have public funds to treat people, so the cost is less of an issue.    Antabuse is a difficult medication to take….it may be useful to have your son see a prescriber to look at a medication that is thought to balance the brain and anxiety – like Campral.  It has been found to be effective, does not have huge side effects like Antabuse, and is available by a prescription.  It is in tablet form and will not be diverted to “get high.”  The best place to start is to contact your State Authority – a state office of alcohol and drug/mental health and find out what programs they fund, recommend, and if they have suggestions for you.  Also, encourage and inform your son that there is help available – and there are support groups for people with these dual issues – find where they are in your community – and help him get to those meetings or introduce him to others who can.  He needs to know there is hope and that thousands of people learn to manage these disorders and have a happy and healthy life!  He can as well!

4. Question: What is the most effective tool when the task is about getting parents, adults, teachers, law enforcers, and others to fully appreciate that marijuana is a dangerous substance especially when it is used on those with developing brains.  About a year ago, I had a policeman say to me, "we don't care if they smoke a little weed."  Shortly after a police chief, said "we don't care about what goes on in the woods."  Parents tell me all the time, "I would rather have my kid smoke weed instead of drinking.”  With the thousands of websites giving misinformation about the benefits of marijuana and state by state legalizing it for supposed medical use, what is the best way to cut through all of this and get people to listen to the truth.

Answer: It is interesting that many of the folks saying a “little weed” is not bad for a person are the people who may have smoked in the 60’s and 70’, when the THC (the active hallucinogenic substance) level of marijuana was 3 – 6%.  Today, it may average over 25%, making it a totally different drug than before. Education is the key to supporting this change.  Assisting in education may be the place for you, you can form a group mobilizing folks around this issue. Community Anti-Drug Coalitions of America (CADCA) is an organization that forms community coalitions and may even have one in your community.  I would start with contacting CADCA and to find out what materials, resources, and community groups with technical assistance they have available for you.  Their mission is to “strengthen the capacity of community coalitions to create and maintain sage, healthy and drug-free communities” and you can call then at 1.800.54.CADCA. 

5. Question: My question has five parts and has to do with the complexity of issues that arise with the implementation of drop-in centers designed to serve clients/consumers with assistance from Peer Support Specialists.

a. Is there a neutral body, person or organization that is available to help all members of the community resolve issues that arise out of these system changes as we all go through this transition?
For example, a neutral party to help peers, administrators, counselors, and psychiatrists to step out of their roles and navigate the barriers of understanding with each other is something I see as essential, and is difficult to implement in the local community.

Answer: That depends on the state and how each state is responding to the change in developing Recovery Oriented Systems of Care and the integration of this model in the community or within the state.  Some states have been moving forward with this concept over the past 5-8 years and others are just beginning. Some counties are working on this through their human services departments or social service, addiction, or mental health departments.  Contacting your State Authority on alcohol/drug, mental health, social work departments to learn what is happening in your state is one way to reach into the information pool to see what is happening.  There are also Addiction Technology Transfer Centers in each region in the United States and they may have access to information in your area, check out:

At the National level – we have a project called the “Recovery to Practice” initiative that includes psychiatrists/psychologists, addiction nurses, peer support specialists, social workers and addiction professionals working to create curriculum and training for each of our specific groups. We’re trying to lay the foundation and help develop systems changes to this new environment of community supports, with integration and life-long recovery as the goals of recovery. It is important that all the different groups you mention are involved in the conversation and in the development of the changing systems to be more inclusive of collaboration between the groups.  There is room, and roles and responsibilities, for each group - including the person wanting/needing assistance.  Working together in a multidisciplinary team is the main idea – and that includes the person and their family.

NAADAC is working on this issue as we have recently been added to the group – if you come away from your research without answers or what you are looking for, contact us and we will track it down.

b. There seem to be many issues that arise out of the conflicting roles of professionals and peer support people, especially communications problems due to power and control issues, FEAR and lack of honesty, complicated by traumatic reactions.

Answer: Given the above answer, it’s also important to understand that change can create a fear of the unknown, which is a usual/common reaction.  This is a period of change, with a lack of information, and known roles and responsibilities.  NAADAC along with the RTP Partners are working to bring information, form collaborations, and build a more recovery oriented model of care that respects the client, their family, the peer support specialists and the professionals.  It is new….expect it to take some time.  Together, we are going to make this difference!

c. In addition, I hesitate to ask this question, but I want to know if there is some kind of economic change that can be put in place. Is there an alternative way to pay for peer support specialists instead of paying them for providing 'services' through insurance or through Medicare or Medicaid? Perhaps paying peer support specialists a flat salary out of wellness initiatives or from funds that support proactive prevention strategies, instead of being paid out of the disease treatment end of the health care system.

Answer:  This is a good idea….the questions will be:  1)  how do you show that the services are being given to the correct folks in the correct way ; 2)  what are the outcomes and how are these determined in a standardized way; and  3) who supervises or monitors this to evidence that proactive prevention strategies are being used?  The next questions is – can the “disease model of treatment” be re-designed to be more like the proactive prevention strategies to evidence their work and effectiveness as stated above?  That is another way to look at this piece of the elephant.

d. I am also concerned as to how the peer support specialist's emotional health is monitored, tracked, assessed, by themselves or by others... It has been my experience, and there have been many times that the last one to know I need help is me.

Answer: Your statement is right on….how do we support the peer support specialist, work within an ethical boundary and with a clear scope of practice, and receive the monitoring or clinical/non-clinical supervision needed for client/person care and self care? Working as a multidisciplinary team ensures that there is more support, more resources and less self-hiding.  It takes a whole team to do this work, especially in the long-term. 

e. These are huge system changes, and it feels like the newly trained peer support specialists are being thrown to the wolves, which has the potential to push them backwards in their recovery.

Answer: Yes, this is a concern…however, the addiction profession started out of recovery and we learned along the way that we had to care for our recovery and to get the supports we needed if we were going to be able to care for others and do the work that we felt drawn to do….or that our “Higher Power” directed it our mission to do.  Over the years, we have found that this worked well.  The difficult thing is that as systems change, we are pulled in different directions that we must adhere to in order to do what we want to do…help others.  This will be the challenge in this move to a more community-based, open system of care and support.  Most importantly, we must train and support peer support specialists to watch for their own signs of getting a “little burnt” around the edges and to get the help they need while they are just getting “crispy” and not after they have become totally “burnt.”  NAADAC has training for that and we are happy to share the resources.

6. Question: How do I address issues I may be having with a peer support specialist? Who is the best person in a system of care to bring my concerns to about the peer support specialists that are available to me?

Answer: If the issue is with someone you are working with as a peer support specialist – it may be important to go to them first to explain your issues.  If you feel this is not possible due to possible disregard, or danger, then go to their supervisor or the group that they are working for.  It is important to work with a peer support specialist who is receiving guidance, knows their role, responsibilities, ethical boundaries, resources, and are doing the work with some level of support and supervision.  NAADAC’s Certification Commission is working on a certification for peer support specialists in order to give clear competencies, knowledge and skills that are necessary for the peer support specialist to have to support their life and protect the public.  A lone peer support specialist may not be the best choice – consider: who do they speak to when they are overwhelmed or need help to remain on track? 

Faces and Voices of Recovery (FAVOR) has been working with peer support and other professionals to create guidelines for peer recovery centers so that there are some standardized guidelines and procedures.  This is another resource for those folks.


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