1. “The culture of recovery in American has deep
historical roots, is growing daily, and is
becoming even more heterogeneous. The
„recovery community‟ today is made up of
diverse individual and groups who, while
differing in their views on how best to initiate and
sustain sobriety, speak with a united voice about
the hope for permanent recovery from
addiction.”
W.L White. Slaying the Dragon: The History
of Addiction Treatment and Recovery in
America.

2. Recovery-oriented Systems of
Care and Peer-led Services
Catherine McAlpine, Ph.D., LCSW-C
Manager, Behavioral Health and Crisis Services
401 Hungerford Drive, Rockville, MD 20850
Catherine.mcalpine@montgomerycountymd.gov

3. We Face Multiple
Challenges
• Reaching those in need of services
• Providing adequate resources
• Developing culturally-
appropriate, evidence-based
interventions
• Building and sustaining a qualified
workforce
• Integrating substance use disorder
3
services into the public health paradigm

4. Workshop Objectives
• Understand the local, State and federal efforts to
support people in recovery beyond providing
treatment.
• Learn the new language of recovery
management as we shift to focus on long-term
support for a chronic disease over brief support
during acute episodes.
• Learn about the growing role for Peer Leaders in
recovery support and how Maryland is moving
toward credentialing Peer Mentors and Peer
Support Specialists.

5. Trends in Attitudes & Social
Policy
Old Think … New Think …
• Punishment • Aid & understanding
• Legal consequences • Treatment/care
• Blame – moral failing • Victim of disease
• Choice or lifestyle • Brain circuits &
• Hitting bottom compulsion
• Self-starting, being ready • Motivation enhancement
• Abstinence • External sanctions
• Behavior • Harm reduction
• 12 Steps • Social or Role functioning

6. Standard Treatment
• Medical Model of Care (1st 3 tasks of treatment)
• Patient receives treatment
• Limited family or community intervention
• No change in work or home environment
• Patient responsible for building peer group
• Recovery is to be immediate (in all areas)
• Punishment for relapse, little empathy
• Limited support for stress of change itself
• Limited attention to grief and loss issues

7. What is Recovery?
• Recover (ri-kūv‟ar), v.:
1) to regain, get back;
2) to regain or return to an
original condition.

8. Vision Statement from
SAMHSA
• A Life in the Community
for Everyone.
• Prevention Works.
• Treatment is Effective.
• People Recover.

9. CSAT’s Public Health
Approach
• Population-based
• Comprehensive and holistic
• Incorporates early
intervention, treatment, recovery
support, and health promotion
• Works across systems and professions
• Involves people in recovery, the
community, the public and private sectors
• Evidence-based
9

10. Enhancing the Continuum of Care to
Provide Recovery-Oriented Approach
Preventio Intervention Treatment Post-Treatment
n
Across the Screening, Brief Menu of Services Continuing Care
Lifespan Intervention,
Referral to Individualized & Recovery Support
Community, Treatment Strength-based Care Services
Individual, &
Family Early Intervention Evidence-based Follow-up
Focused Communication
Pre-treatment Client-Informed
Evidence-
based Evidence-based decision-making Self-Monitoring
Recovery Recovery Support Recovery Support Early Re-intervention
Individual & Services Services
Community Recovering Individual,
Involvement Recovery Individual & Family Member, Ally
Family Member and Community
•
Involvement Involvement
A full continuum should be made available through coordination with multiple systems.
• Individuals should have access to a full continuum of care regardless of the system they
enter or the community in which they live. 10

11. From Yahara House
Recovery: A Working Definition
– Recovery is a process, not a place.
– It is about recovering what was lost:
rights, roles, responsibilities, decisions, potential and
support, and discovering new potentials in life, and
possibilities for growth
– It is about rekindling hope for a productive present and
a rewarding future, and believing that one deserves it!
– Recovery involves people having vision of the life they
want to live, seeing and changing
patterns, discovering symptoms can be managed and
doing it, finding new ways and reasons, doing more of
what works and less of what doesn‟t.
– Recovery is about getting there.

12. Recovery is …
• Grounded in resilience
• Supported by a foundation of hope
• An ongoing, dynamic, interactive process
• An interplay of a person‟s strengths and
vulnerabilities
• A personal journey
• Continuous, even when symptoms recur

13. Recovery-oriented System
of Care (ROSC)
• Includes a wide spectrum of services
• Supports all stages and pathways of recovery
• Addresses access to services
• Includes treatment, alternatives to
treatment, and recovery support services
• Coordinates multiple services
• Building bridges, strengthening communities
and promoting public health

14. A Recovery Oriented System
of Care is …
• Person centered
• Family and other ally involvement
• Individualized and comprehensive
services across the lifespan
• Anchored in the community
• Continuity of care

15. Basic to ROSC Are …
• System-wide education and training
• Ongoing monitoring and outreach
• Outcomes driven
• Research based
• Adequately and flexibly financed

16. Core Concepts of ROSC
are …
• Partnership-consultant relationships
• Strength-based
• Culturally responsive
• Responsive to personal belief systems

17. Developing ROSC requires
…
• Commitment to peer
recovery support
services
• Inclusion of voices and
experiences of
recovering individuals
and families
• Integrated services

18. Recovery System
Medical
Dental Public Transportation
Mental Health
Family Therapy Community Support
Self-Help Groups
Social/Recreation
Internet
Building Life Skills
Evaluation
DSS/DJS
Treatment System
Housing/Supportive Legal
and Independent Judges
Living Outpatient Treatment Lawyers
Parole/Probation
Residential Programs
Vocational
Educational
Faith Organizations
Senior/Child
Day Care
Employment

19. What changes move us
toward ROSC?
• Intervene earlier
• Improve treatment outcomes
• Support sustained recovery

20. Changing Our Perspective

21. Evolving Language Reflects
Changes
• Rosc
• Encounter Notes
• Continuing Care
• Learning Collaborative
• Access to Recovery
• Primary Adult Care
• Expanding Access
• Trainer Network
• Recovery Management

22. Community Integration is
Organic
• Recognize that people recover in
communities, not in programs.
• Focus on services that support life in the
community.
• Locate services/supports in the
community, not in a tx program or institution.
• Support what exists in the natural
community, don‟t re-created in the system.
• Focus government on strengthening
communities, families and individuals.

23. One Theory is a Hierarchy of
Needs
Consider the transition from active addiction as a
lifestyle change. Similar to other health needs.
Mainstream social and psychological supports
meet individual needs for :
• Safety and survival
• Basic needs for food, clothing & shelter
• Affection, interpersonal comfort & contact
• Sense of belonging, group affiliation
• Self-efficacy

24. Social Forces Support Change
• Successful recovery often includes:
– connections to family
– stable sober housing
– employment
– follow-up on healthcare & nutrition
– extended course of treatment
The longer people participate in a treatment
regimen, the more likely they are to remain
abstinent and achieve a sustained
recovery. This has been verified via case
study and research data.

25. Our Challenge
• How must treatment programs
change to become more recovery-
friendly?
– Shifting from an acute care model to a chronic
care model
– Shifting from a sole focus on remission of
symptoms to a focus on wellness
– Shifting from abstinence-only to managing
relapse and understanding harm reduction
– Adopting principles from Prevention –
universal, targeted & individual interventions

26. Concepts of RM
• Pathology model has low rates of
compliance while increasing stigma.
• Natural recovery happens and is a
process we can learn from.
• Effective treatment combined with self-
management and peer support conveys a
message hope, wellness & on-going care.
• Treatment is more effective using proven
practices and principles that get results.

27. Risk and Resilience Model
What resources are not yet in place for this person and what
needs to be done to establish or cultivate them?
For example
Faith
Treatment &
Work or rehab

school
Community
Life Peer
Social support
support
Phys. Health Housing
Family

28. Stages of Recovery
• Pre-recovery
• Initial Stabilization
• Recovery Maintenance
• Quality of Life Enhancements
– Build individual & community recovery capital.
These are informal connections as well as
Recovery Support Services.

29. Exercise
• Think about a recent or significant change
in your life.
– How were you feeling?
– What coping skills did you use?
– Did you seek out support? Where?
– Who helped you most?
• Now think of one word to fill in the blank:
– I ___________________ change

30. Now, What Can You Do?

31. Everyone can …
• Remove personal and environmental
barriers to recovery.
• Facilitate participation in the recovery
community.
• Enhance the quality of life of the
person in recovery.

34. Recovery Partners Montgomery
• Partners • Strategic Plan
– Wells/Robertson House – ADAA Learning
– Maryland Treatment Collaborative
centers, Inc. – Change Leadership Team
– Alcohol and Drug Abuse – Stigma reduction (stories)
Administration – Recovery Community
– Avery House for Women Center Activities
– Journey to Self • The Front Porch
Understanding • Peer-led groups
– Adult Behavioral Health • Peer-led education
– Outpatient Addiction and • Book Clubs/Story-telling
Mental Health Services – Youth Drop-in Center
– On Our Own of Maryland – Peer Leadership Institute
• Recovery Coach Academy
• PLI Manual & Training

35. International Consortium of
Reciprocal Certification (ICRC)

36. Connecticut Community for
Addiction Recovery (CCAR)
• Recovery Coach Academy
• Recovery Community Centers
• Telephone Outreach
• Employment Curriculum
• Recovery Walk & Other Events (Stigma)
• How to start a recovery House
• http://www.ccar.us/

37. PRO-ACT
http://www.councilsepa.org/programs/pro-act/
• PRO-ACT is a grassroots advocacy and recovery support initiative of The
Council covering Southeastern Pennsylvania. PRO-ACT works to reduce
the stigma of addiction, ensure the availability of adequate treatment and
recovery support services, and to influence public opinion and policy
regarding the value of recovery.
• PRO-ACT is developing, educating and mobilizing a constituency of
Ambassadors for Recovery – those in recovery, their family members and
friends, professionals working in the field, and others with a special interest
in and knowledge of recovery. We have over 400 volunteers in the five
county area.
• Our one-to-one recovery support services and trainings occur primarily in
our Recovery Community Centers. Our special programs and events are
driven by Volunteer Committees.
• PRO-ACT supports all pathways to recovery and embraces the Recovery-
Oriented System of Care. Recovery-oriented systems support person-
centered and self-directed approaches to care that build on the strengths
and resilience of individuals, families, and communities to take responsibility
for their sustained health, wellness and recovery from alcohol and drug
problems.

38. Change Leadership Begins
Here
• Treatment is often
focused on the individual.
• Treatment outcomes
improve with use of
evidence based-practice.
• The #1 practice?
Rapport, relationship.
• ROSC is systemic and
focused on the whole.

39. Resources
• www.nrepp.samhsa.gov National Registry of Evidence-based Programs/ Practices
– National Clearinghouse on Alcohol and Drug Information
• ADAA http://adaa.dhmh.maryland.gov/SitePages/Home.aspx for information on ROSC in Maryland & ATR Grant
• http://www.niatx.net for improving business practices
• www.glattc.org click on Recovery Management Resources. The Great Lakes ATTC Network has many ROSC and training
resources, including articles & mongraphs.
• www.ibr.tcu.edu/resources/rc-trtprocess.html Institute for Behavioral Research
• http://partnersforrecovery.samhsa.gov/docs/Summit-Report.pdf Summit Report
• http://www.williamwhitepapers.com/papers/ William White is a prolific writer on this subject.
• www.facesandvoicesofrecovery.com
• http://pfr.samhsa.gov click on Recovery, then Resources. Information about the national movement
• http://rcsp.samhsa.gov Recovery Community Services Program on CSAT'S website
• www.ct.gov/dmhas/site.default.asp Connecticut's Practice Guidelines for Recovery-Oriented Behavioral Health Care booklet can be
accessed on this site
• www.bhrm.org Behavioral Health Recovery Management