As late summer sun slanted through the many windows of Barbara’s elegant seaside condo, Richard cued up another Shubert CD. The afternoon stretched ahead. We were content. “This is what I sobered up for,” he said. A decade later, Richard still plays honky-tonk piano and Barbara’s mezzo voice is yet coaxing our tears in lieder and show tunes. And I, on days both good and bad, enjoy what Phil Valentine calls fulfillment in recovery. “I’m living my right life,” I recently told a friend. Turns out there’s life after addiction. A life for me. My life. Who knew?
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These reflections inform my peer recovery practice. I’m a coach and an educator, and I see fellow professionals for mentoring. In adult learning classrooms, I prepare peer recovery students for public health careers in treatment centers and hospital emergency rooms. It’s a privilege to work with such a highly motivated cohort, and very rewarding to run into these professionals in the field. Elsewhere, I enjoy the challenge of bringing peer recovery concepts and principles to professional coaches in a variety of disciplines.
Increasingly, I’ve come to believe that we must put “recovery” at the heart of the “addiction” conversation. In the middle of an unprecedented health emergency, there is a natural impulse to triage. If we could only stop “the addict” from using, we could breathe again. That’s certainly how my family and friends thought when I was in the throes of late-stage alcoholism. Can’t we just get “the plug in the jug?”
Sure we can. Sometimes. But what’s to keep it there?
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Phil Valentine is Executive Director of the Connecticut Community for Addiction Recovery (CCAR) and a pioneer in peer recovery. With several veteran colleagues, he developed a model of Stages of Recovery. You read that right. Stages of Recovery, not the celebrated Stages of Change model introduced into addiction treatment in the 1980s and still workable, whatever the change being contemplated or completed.
The more recent Stages of Recovery provide a similar roadmap to life after successful treatment. In my view, it’s the single most exciting innovation in decades. The model answers the question every addict is too scared to ask, “If I stop using, then what?”
For those of us in recovery, I know that we’ll be “improving our health and wellness, living a self-directed life, and striving to reach our full potential” (SAMSHA-Substance Abuse & Mental Health Services Administration recovery definition from 2011). More specifically, I’ll be working tasks set out in the five Stages of Recovery – Stabilization; Deepening; Connectedness; Integration; Fulfillment. As a goal to aim for, I like the sound of all of these stages. (With deepest respect to clinicians who swear by Stages of Change, trading a drink for the prospect of living in a place called “maintenance” doesn’t do it for me.) Fulfillment? Now you have my attention.
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How do we introduce clients to recovery?
No counselor, however talented and dedicated, can prepare for that moment at discharge when the (challenging) cocoon of previous weeks is over. Yes, I’ve got a terrific treatment plan, but where’s the bus into town? Whose sofa am I surfing tonight? Is there a job to go back to? How am I going to pay my bills while I rebuild my bridges?
Enter the peer recovery professional. We’re the ones who meet clients as the treatment center door closes. It’s that crucial time when people with a substance use disorder have cycled through just enough change to think about a future in recovery. That’s when we can help.
This logistical support is based on leveraging the particular expertise peers bring to the coach role: “I know what sleeping under the railway track is like, but I also know how, in recovery, I’m paying off my first mortgage.” For real? For real.
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Peer recovery as a profession that emerged out of those grassroots organizations, such as Valentine’s CCAR providing coach services in the community for some 15 years (much of it on a voluntary basis). These recovery centers offer what Tom Hill, formerly of SAMSHA, calls “a recovery nurturing setting.” The question visitors are greeted with is a simple, “How can I help you with your recovery today?”
The immediate success of this “non clinical, non-professional” peer support model has been welcomed and valued beyond the recovery community by public officials such as Arthur Evans Jr. of Philadelphia’s Department of Behavioral Health. Evans supports taxpayer funding of services “that result in recovering lives which are personally meaningful and socially productive.” Geographically diverse peer service providers, such as Michael Askew from the Bridgeport Community Center and Andre Johnson of the Detroit Recovery Project, agree that the success of a nationwide network of recovery community centers, originally funded via SAMSHA, demonstrates the efficacy of the peer model. It’s an argument that’s finding traction in state capitals.
Meanwhile, the CCAR-Recovery Coach Academy is a widely adopted curriculum built out of the grassroots experience of these first centers. Students focus on gaining a deeper understanding of recovery, including the Stages of Recovery, as they develop their communications skills. Around the country, successful graduation from this curriculum can lead to a peer career in publicly funded behavioral health, in addiction treatment centers and, more recently, in hospital emergency rooms where peers serve as a front line opioid crisis response.
Finally, health care reform mandating parity payments for substance use disorder has resulted in increasing deployment of recovery coaches in the private sector.
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Of these developments, Harvard emeritus William L. White observes approvingly that, “We are on the brink of moving from a pathology paradigm and a treatment paradigm as the center of the field to a paradigm of recovery.” Perhaps. White’s recovery advocacy is legendary. But is he broadcasting from a far galaxy?
In hospitals, on sidewalks and subway platforms, do narcan administrators have any scope for promoting recovery? Or is the very idea of recovery an ambiguous luxury, even an unkind joke, when whole communities are being wiped out by the disease of addiction?
Further, do therapists and counselors really see a role for the (theoretical) value peers bring to the continuum of care? Visiting one reputable treatment agency recently, I overhead a clinical supervisor say unapologetically, “those peers don’t know what they’re doing – they’re only waiting to relapse; I have to work twice as hard to keep them in line.” Where do I begin to deconstruct her hostility? Her comment perpetuates stigma around substance use disorder (“once an addict, always an addict”), and the speaker doesn’t seem to have any faith that her peers are building recovery lives for themselves. It’s a short jump from there to worrying if this therapist even believes that her clients can live productive and fulfilling lives. And if she doesn’t . . .
Clinicians understandably bemoan the “revolving door of treatment.” While definitive studies are still sparse, evidence is beginning to emerge quantifying the degree to which the engagement of peers is having a positive impact on post-treatment outcomes. Speaking to statewide stakeholders at the ASAP-Peer Workforce Initiative summit in June, Gayle Farman set out a list of no fewer than five challenges facing researchers. These include the range, duration and environments of peer engagements through the complex needs and challenges of the population served. (Farman is Director of Peer Certifications at ASAP’s New York Certification Board.) Notwithstanding, she quoted a preliminary conclusion that “Most [valid] studies reported statistically significant findings indicating that participants receiving the peer intervention showed improvements in substance use, a range of recovery outcomes, or both.” That is, decreased use leading to lower hospitalizations leading to improved post-discharge adherence. “We have a real opportunity to educate leadership and clinical staff about the roles and efficacy of the peer workforce,” Farman told the summit.
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Over twenty years ago, William L. White’s colleague Thomasina Borkman, then at George Mason University, defined qualifications appropriate to the special responsibilities of the non-clinical model. Borkman writes that people serving as recovery peers “rather than being legitimized through traditionally acquired education credentials, draw their legitimacy from experiential knowledge and experiential expertise.” Experiential knowledge is defined as information acquired about addiction recovery through the process of one’s own recovery or being with others through the recovery process; experiential expertise requires the additional ability to transform this knowledge into the skill of helping others achieve and sustain recovery, she writes.
Thanks to the work of these trailblazers, we now have not only a map of recovery and the tasks of its five stages, but a workforce, in both public health and private practice, inspiring and supporting clients in living fulfilled lives beyond treatment.
And we’re looking to partner with you in our shared mission.
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President & CEO of Sobriety Together™ Recovery Education & Coaching Services, Ruth Riddick is a Certified Addiction Recovery Coach and 2015 Irish America Healthcare & Life Sciences honoree. Contact her at firstname.lastname@example.org.