Recovery Support: An Iowa Perspective

1. Recovery Support:An Iowa Perspective Presented by Eric M. Preuss, IAADC, CCS Iowa Gambling Treatment Program Manager Iowa Department of Public Health September 16, 2016

2. Overview What is Recovery? Key Dimensions and Guiding Principles Recovery Support Services in Iowa Recovery Support Services: Utilization and Impact

3. What is Recovery?

4. What is Recovery? “Recovery is the process in which people are able to live, work, learn, and participate fully in their communities.” “For some, this is the ability to live a fulfilling and productive life despite a disability.”  “For others, recovery implies the reduction or complete remission of symptoms.” - President’s New Freedom Commission on Mental Health, 2003 “Recovery is the journey of navigating truth without losing the way.” - Mark Lundholm

5. What is Recovery? I’m (my family and I are) in long term recovery which means I’ve not used alcohol and other drugs for . . . I’ve not been hospitalized since . . . I’ve got new hope and stability I’ve been able to create a better life for myself, my family and my community. I’m speaking out so that others have the opportunity to achieve long term recovery. We have found new ways to cope with our family member’s addiction and/or mental illness We’ve become healthier together, enjoying family life in our home

6. What is Recovery? http://www.reneweveryday.com/resources/addiction-recovery-facts/ In any given day, over 700,000 Americans seek treatment for alcohol or drug addiction. At least one-third of individuals with alcoholism fully recover. Using prescription drugs to combat alcohol dependency, in combination with treatment, boost the recovery success rate to 50 percent. There are an estimated 1.25 million Alcoholics Anonymous members in the U.S. There are more than 25,000 Narcotics Anonymous groups in the world. A majority of Americans (80 percent) have positive feelings about prevention and recovery from substance use disorders

7. What is Recovery? http://www.facesandvoicesofrecovery.org/resources/public_opinion.php 88% of recovery community members believe it is important for the American public to see that thousands get well each year. 63% of Americans have been affected by addiction 67% of Americans believe that there is a stigma towards people in recovery 74% of Americans say that attitudes and policies must change

8. Working Definition of Recovery and Guiding Principles (SAMHSA) http://store.samhsa.gov/shin/content/PEP12-RECDEF/PEP12-RECDEF.pdf

9. SAMHSA’s Working Definition of Recovery “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” SAMHSA –December 2011

10. Recovery:Four Key Dimensions

11. Recovery:Four Key Dimensions • Health:  Overcoming or managing one’s disease(s) or symptoms. • For example: • Abstaining from use of alcohol, illicit drugs, and non-prescribed medications if one has an addiction problem • Making informed, healthy choices that support physical and emotional wellbeing if in recovery • Home: Having a stable and safe place to live • Purpose: Meaningful daily activities • Job, school, volunteerism, family caretaking, or creative endeavors • Independence, income and resources to participate in society • Community:  relationships and social networks that provide support, friendship, love, and hope.

12. Recovery: Guiding PrinciplesRecovery . . . • Emerges From Hope • Is Person-Driven • Occurs Via Many Pathways  • Is Holistic • Is Supported by Peers and Allies • Is Supported Through Relationships and Social Networks • Is Culturally-based and Influenced • Is Supported by Addressing Trauma • Involves Individual, Family, and Community Strengths and Responsibility • Is Based on Respect

13. Recovery SupportsSubstance Abuse Treatment Facilities in the United States http://www.samhsa.gov/data/sites/default/files/NSSATS-SR175-RecoverySvcs-2014/NSSATS-SR175-RecoverySvcs-2014.htm

14. Recovery SupportsSubstance Abuse Treatment Facilities in the United States http://www.samhsa.gov/data/sites/default/files/NSSATS-SR175-RecoverySvcs-2014/NSSATS-SR175-RecoverySvcs-2014.htm

15. Recovery Supports12-Step based Recovery • Alcoholics Anonymous (www.aa.org) • Narcotics Anonymous (www.na.org) • Gamblers Anonymous (www.gamblersanonymous.org) • Overeaters Anonymous (www.oa.org) • Sex and Love Addicts Anonymous (www.slaafws.org) • For Families • Al-Anon (www.al-anon.alateen.org) • Nar-Anon (www.nar-anon.org) • Gam-Anon (http://www.gam-anon.org)

16. Recovery SupportsOther . . . • Celebrate Recovery (www.celebraterecovery.com) • Faces and Voices of Recovery (www.facesandvoicesofrecovery.org) • Harm Reduction (http://harmreduction.org) • Moderation Management (www.moderation.org) • Natural Recovery (http://www.addictioninfo.org/articles/2978/1/Natural-Recovery-From-Addiction-Beyond-the-12-Steps/Page1.html) • Medication Assisted Treatment (http://www.integration.samhsa.gov/clinical-practice/medication-assisted-treatment) SAMHSA -TIP 43 • Rational Recovery (www.rational.org) • Red Road to Well-briety(http://www.whitebison.org/wellbriety_movement/index.html) • SMART Recovery (http://www.smartrecovery.org/) • More . . . check out (http://www.reneweveryday.com/resources/addiction-recovery-facts/)

17. Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS) • Launched in 2011 by to promote the widespread adoption of recovery-oriented supports, services, and systems for people in recovery from substance use and/or mental health conditions. • BRSS TACS serves individuals and communities that are vital for moving the field towards a recovery orientation • http://www.samhsa.gov/brss-tacs • FAQ’s http://www.samhsa.gov/sites/default/files/faq.pdf • For information on technical assistance, send an email to brsstacs@center4si.com

18. Recovery Supports - Iowa

19. Recovery Supports - IowaRecovery Support Services (RSS)Vision and Principles • Individuals with behavioral health (gambling/SUD) related problems and their families have the right to choose recovery and the recovery-related services, supports, and providers that best meet their needs. • Client choice is enhanced by a recovery-oriented system of care that honors each client’s familial, cultural, spiritual, economic, and logistical needs. • Individualized choice enhances client retention in treatment and strengthens client commitment to and success in recovery. • Participation in Recovery Support Services (RSS) is voluntary and the client can choose to no longer utilize RSS at any time, without repercussion to the client or family member.

20. Recovery Supports - IowaRSS Provider Requirements • RSS Providers must comply with the following: • RSS Eligibility Requirements • Clients have the right to culturally competent services • Volunteers who work with RSS clients must comply with Grant/Program RSS Provider Manual • RSS Funded Provider shall establish safeguard to prevent conflict of interest • IDPH Monitoring and Evaluation • Eligibility (Provider/Client), facilities, policies, service documentation • Fraud, Abuse and Waste Monitoring

21. Recovery Supports - IowaAccess To Recovery IV(ATR – Grant) • Care Coordination • Child Care • Pharmacological Interventions • Recovery Calls • Sober Living Activities • Housing Assistance • Integrated Therapy • Life Skills Coaching • Co-Pays • Drug Testing • Recovery Peer Coaching • Spiritual Counseling • Supplemental Needs • Transportation

22. Recovery Supports - IowaPregnant and Post Partum Women (PPW-Grant) • Care Coordination • Child Care • Education/Vocational Training • Pharmacological Interventions • Sober Living Activities • Supplemental Needs • Clothing/Personal/Children • Gas Cards • Wellness • Utility Assistance/Cell Phone Service • Bus/Cab

23. Recovery Supports - IowaMedication Assisted Treatment (MAT-Grant) Care Coordination Medications (Buprenorphine, Naltrexone, Disulfiram) Medical Evaluation Services (doctor visits, lab and UA tests, etc.) Clients without insurance or other coverage of these services may qualify for the MAT grant.

24. Recovery Supports - IowaState Youth Treatment – Implementation (SYT-I Grant) • Behavioral Health Assessment • Celebrating/Strengthening Families • Child Care • Crisis Respite • Drug Testing and Incentive Card • Educational/Vocational Training • In Home Services • Electronic Recovery Support Messaging • Life Skills Coaching • Pharmacological Interventions • Sober Living Activities • Gas Cards • Transportation

25. Recovery Supports - IowaIGTP Recovery Support Services • Life Skills Coaching • Short Term Supportive Housing • Recover Peer Coaching • Electronic Recovery Support Messaging • Supplemental Needs • Utility Assistance • Clothing/Hygiene • Education • Gas Cards • Wellness • Housing – Rental Assistance • Bus/Cab

26. Recovery Supports - IowaIDPH and MCO’s • IDPH funded treatment provider can fund recovery support services for IDPH-funded patients not participating in discretionary grant programs. • All MCO’s are required to cover peer support/peer counseling services • Additionally for SUD clients: • Develop substance use disorder peer support or peer counseling services. • Such services may give recovering persons volunteer or employment opportunities through which they support their own recovery by supporting others in their recovery efforts. • Develop a service description for substance use disorder peer support/counseling coaching that includes practitioner qualifications.

27. Recovery Support Services: Utilization and Impact

28. Recovery Support ServicesUtilization and Impact • Iowa Gambling Treatment Program • 409 Iowans received RSS since inception in July 2011 • 25.3% of Admissions • 3,801 services • $241,000 expended ($590 per client) • Highest Utilization • Transportation: Bus/Cab/Gas Cards (381 clients) • Clothing/Hygiene (193 clients) • Wellness (145 clients) • Rental Assistance (137 clients)

30. Education House rental Bus-cab Utility Ind-living Gas cards

31. RSS and average length of services (LOS)

32. Recovery Support ServicesUtilization and Impact • Access to Recovery (ATR) • 4,059 Iowans enrolled in ATR 4 (since October 2014) • Abstinence = 81.7% • No Arrests past 30 days = 94.9% • Currently Employed/in School = 57.5% • No Health Consequences = 93.3% • Social Connectedness = 96.8% • Stable Housing = 53.1%

33. Recovery Support ServicesUtilization and Impact • Access to Recovery (ATR) – Client Outcomes • Alcohol Use • 46% stopped Alcohol use • 74% reduction in Frequent of Alcohol use • 50% reduction in Binge drinking

34. Recovery Support ServicesUtilization and Impact • Access to Recovery (ATR) – Client Outcomes • Illicit Drug Use • 57% stopped using Methamphetamine • 76 % reduced frequent use of Methamphetamine

35. Recovery Support ServicesUtilization and Impact • Access to Recovery (ATR) – Client Outcomes • Housing • 35% increase in stable housing • Legal • 70% decrease in criminal activity • Hospital • 52% decrease in Emergency Room Utilization for Substance Abuse

36. Recovery Support ServicesUtilization and Impact • Access to Recovery (ATR) – Client Outcomes • Mental Health • 20% reduction in anxiety symptoms • 19% reduction in depressive symptoms • Self-Help Participation • Some improvement in regular, continuing participation compared to the frequency of attendance reported by clients at intake.

37. Recovery Support ServicesUtilization and Impact • SYT-I • 47 clients (10/1/15 – 7/1/31/16) • $5,338 expended to date • $114 per client • The sustainability of Recovery Support Services is a key factor that SYT-I is exploring. • Most RSS are not covered by medical insurance for substance use treatment clients. • Through collaboration with insurers and other State Departments, SYT-I seeks to identify alternative ways to fund RSS.

38. Recovery Support:An Iowa Perspective • A couple things to remember . . . • How we talk and the language we use when talking about Recovery is important • Recovery is a Choice • Client gets to choose • Matching Client to Recovery Supports • Assess for “Recovery Capital” (Health, Home, Purpose, Community) • Be educated on best practices • Provide appropriate information and referral • Client makes an informed choice of recovery supports

39. Recovery Support:An Iowa Perspective Questions?

40. Thank you! Eric M. Preuss, MA, IAADC, CCS Iowa Gambling Treatment Program Manager Iowa Department of Public Health Eric.Preuss@idph.iowa.gov 515.281.8802 www.1800BETSOFF.org http://www.idph.iowa.gov/igtp