Transcript Recovery Oriented Systems of Care

Detroit Recovery
Oriented Systems of Care
Implications for
Prevention
Calvin R. Trent Ph.D.
General Manager
City of Detroit
Department of Health and Wellness Promotion
Division of Special Population Health Services
Brief Profile: City of Detroit
(“A County Within a County”)
• Population: 951,270 (largest city in
the State of Michigan)
• Racial/Ethnic Composition: 82%
African-American, 10% White, 5%
Hispanic, 1% Asian, <1% American
Indian
• Estimated Number of People
Addicted: 10-12% (or 90,000-108,000)
Detroit: Drug Abuse Patterns and Trends
• Cocaine is the foremost primary illicit
drug of abuse among admissions to
treatment programs.
• Users tend to be over 30, AfricanAmerican or White, and of low
socioeconomic status.
• Cocaine (including crack) was involved
as either primary, secondary, or tertiary
drug in 52% of all treatment admissions
in Detroit/Wayne County in FY2002, and
50% in FY2003.
Detroit: Drug Abuse Patterns and Trends
(cont’d)
•Heroin is the second foremost primary
illicit drug of abuse among admissions
to treatment programs.
•Users are typically male, over the age of
30, African-American and of low
socioeconomic status.
•Heroin was involved as the primary drug
in 29% of all treatment admissions in
Detroit/Wayne County in both FY2002
and FY2003
Detroit: Drug Abuse Patterns and Trends
(cont’d)
•Marijuana also accounts for admissions to
treatment programs in the city of Detroit.
•Users are typically adolescents or young
adults, and predominantly male.
•Marijuana was involved as primary,
secondary, tertiary drug in 29% of all
treatment admissions in Detroit/Wayne
County in FY2003.
Detroit Coordinating Agency (CA)
• Coordinates substance abuse treatment
and prevention services through the
current network of 45 treatment and 33
prevention providers.
• One of 15 specialized local public or
quasi-public entities called Coordinating
Agencies.
• The Detroit CA (that is, the Bureau of
Substance Abuse Prevention, Treatment
and Recovery) is organizationally placed
within the Detroit Department of Health
Detroit Coordinating Agency (CA)
(continued)
and Wellness Promotion (DHWP).
• The Michigan Medicaid behavioral health
“carve-out” model has been in existence
since 10/1/98.
The Old Paradigm: Treatment As Usual
• The target of service in the Acute Care
Model of substance abuse
interventions is the individual.
• The interventions associated with this
model are designed to:
o Alter the beliefs and behaviors thought
to sustain addiction, and
o Lower the biological vulnerability to
addiction.
Recovery-oriented Systems of Care
Recovery-oriented systems of care
(ROSC) are networks of formal and
informal services developed and
mobilized to sustain long-term recovery
for individuals and families impacted by
severe substance use disorders. The
system in ROSC is not a treatment
agency but a macro level organization
of a community, a state or a nation.
Recovery Management
“Recovery management” (RM) is a
philosophical framework for organizing
addiction treatment services to provide
pre-recovery identification and
engagement, recovery initiation and
stabilization, long-term recovery
maintenance, and quality of life
enhancement for individuals and
families affected by severe substance
use disorders.
Looking Forward:
Recovery Management Model of Care
• Individuals with Alcohol and other Drug
problems are nested within complex
relationships between:
o Family
o Culture
o Society
Recovery Management
• Each level of this social ecosystem can
contribute to the development of, help
resolve, or sabotage resolution of AOD
problems.
• Recovery Management interventions
target the whole ecosystem rather than the
individual.
Recovery Management
• Recovery Management moves beyond the
clinical skills of assessment, diagnosis,
and treatment of individuals to
encompass:
o Family reconstruction
o Community resource development
o Nation building
RM with Communities of Color
• Premised on the belief that the
community
o Is experienced through group
solidarity with a historical and
geographical community
o Is an essential dimension of personal
healing and prevention of negative
behaviors
RM with Communities of Color
• From a Recovery Management
perspective, Prevention efforts with
communities of color must not segregate
the threat of addiction from the multiple
risks associated with the lives of
individuals.
RM with Families of Color
•
Addiction is but one wound families of
color have suffered via the
intergenerational transmission of
historical trauma
o The forced breakup of family units in
slavery
o Indian boarding schools and their
aftermath
• The family unit itself needs a
sustained process of recovery from
these wounds.
RM with Families of Color
•
The addiction-related transformation of
family roles, relationships, rules, and
rituals is deeply imbedded within
family members and habitual patterns
of family interaction and will not
spontaneously remit with recovery
initiation
RM with Families of Color
• Developmental stages of family
recovery (over first 3 to 5 years)
o Personal healing
o Realignment of family subsystems
 adult intimate
 parent-child
 sibling
o Family’s relationship with the outside
environment
RM with Families of Color
• Sustained recovery monitoring and
support for family members
(particularly the youth) is as crucial as
it is for the individual recovering from
severe AOD problems.
• Families that do not have sufficient
supports to make these difficult
transitions risk
o Continuing the intergenerational cycle
of addictive behaviors in the children
o Disintegration
Resources for Recovery Management
•
Individuals must have resources to
initiate and sustain the recovery
process.
•
Ultimate goal of RM is to expand each
community’s natural prevention and
recovery support resources:
o Physical
o Psychological
o Social
Resources for Recovery Management
We call these resources Recovery Capital,
defined as:
o The quantity and quality of internal and
external resources that one can bring to
bear in the initiation and maintenance of
recovery.
Resources for Recovery Management
• Successful Prevention strategies must
include the development of resources
to sustain the motivation to reject AOD
as a lifestyle choice.
• We call these resources Prevention
Capital, defined as:
o The quantity and quality of internal and
external resources that one can bring to
bear in support of rejecting AOD use as
a lifestyle option.
RM, Resources, and Youth
• Building a community that is replete with
natural recovery support resources will
also be one that naturally promotes the
development of Prevention Capital in its
youth.
Strategies to Improve Recovery Resources
o Introducing youth and families to
local communities of recovery
o Conducting recovery-focused family
and community education
o Seeding local communities with
visible recovery role models
o Advocating pro-recovery social
policies at all levels of government
o Normalizing conversation about AOD
in cultural institutions (Churches,
School, etc.)
For more information, please visit our
website at
www.drugfreedetroit.org