Recovery-oriented Systems Of Care Research Articles

Linkage facilitation for opioid use disorder in criminal legal system contexts: a primer for researchers, clinicians, and legal practitioners

At the intersection of drug policy, the opioid crisis, and fragmented care systems, persons with opioid use disorder (OUD) in the United States are significantly vulnerable to contact with the criminal legal system (CLS). In CLS settings, provision of evidence-based treatment for OUD is variable and often secondary to punitive approaches. Linkage facilitation at every touch point along the CLS Sequential Intercept Model has potential to redirect persons with OUD into recovery-oriented systems of care, increase evidence-based OUD treatment connections, and therefore reduce CLS re-exposure risk. Research in this area is still nascent. Thus, this narrative review explores the state of the science on linkage facilitation across the varied CLS contexts, including general barriers, facilitators, and opportunities for using linkage facilitation for OUD treatment and related services. Following the CLS Sequential Intercept Model, the specific CLS contexts examined include community services, police encounters, the courts (pre- and post-disposition), incarceration (pre-trial detention, jail, and prison), reentry (from jails, prisons, and unified systems), and community supervision (probation and parole). Examples of innovative linkage facilitation interventions are drawn from the Justice Community Opioid Innovation Network (JCOIN). Areas for future research and policy change are highlighted to advance the science of linkage facilitation for OUD services in the CLS.

Negative Implications of Drug and Substance use on Mental Health

Mental health refers to a person's emotional, psychological, and social well-being, which encompasses aspects such as thoughts, feelings, behaviors, and the ability to cope with life's challenges. Several factors including drug abuse have been recognized to cause mental health disorders; hence, the urgent need to globally address these factors. Drug abuse emerges as a complex public health issue, involving the misuse of legal and illegal drugs, with consequences extending beyond individual health. The relationship between mental health and drug abuse intensifies challenges, as drug misuse contributes to the development or worsening of mental health disorders. This review examined biological, psychological, and social determinants, and advocate for a standardized approach to address the complex issue of drug abuse. Various electronic databases, such as PubMed, Scopus, Web of Science, Medline, and others, were used to access resources, in which thirty-three (33) literatures were reviewed. Results of the reviewed literatures revealed that the impact of drug abuse on mental health involves neurobiological alterations affecting neurotransmitter levels and structural changes in the brain. This does not only affect individuals, but also results in societal burdens, such as increased healthcare costs and criminal justice involvement, compounded by the stigma surrounding mental health and substance abuse. The classification of drugs into legal and illegal categories highlights the diversity of substances and emphasizes the need to understand their effects on mental well-being. Categories include legal drugs, prescription medications, socially accepted substances, and illegal drugs with varying dependency potentials. Addressing mental health disorders induced by drug abuse requires a comprehensive approach, involving strategies like Integrated Dual Diagnosis Treatment (IDDT), Medication-Assisted Treatment (MAT), Cognitive-Behavioral Therapy (CBT), Motivational Interviewing (MI), Dialectical Behavior Therapy (DBT), Peer Support, 12-Step Programs, and Recovery-Oriented Systems of Care (ROSC). These methods guarantee a care continuum that centers on the individual and emphasizes recovery, acknowledging the relationship between mental health and drug abuse disorders. Nevertheless, the review highlights a research gap in that, in-depth research is needed to evaluate the effectiveness of the aforementioned interventions. Additionally, exploring innovative strategies to address challenges such as stigma, limited treatment accessibility, and the cyclical nature of addiction would enhance intervention effectiveness.

Utility of the Global Appraisal of Individual Needs Recommendation and Referral Report for Substance Use Diagnosis, Treatment Planning, and Placement.

This study aims to evaluate the utility of the Global Appraisal of Individual Needs Recommendation and Referral Report (GRRS) as guided by American Psychiatric Association diagnosis criteria and American Society of Addiction Medicine guidelines for treatment planning and placement. Global Appraisal of Individual Needs data were gathered between March 2018 and June 2020 from a total of 82 agencies and 245 clinicians as part of a program evaluation of agencies receiving public funding through the Mid-State Health Network under contract with the Michigan Department of Health and Human Services and the Office of Recovery Oriented Systems of Care. Of the 1395 patients 18 years or older, 1027 GRRS reports were produced by clinical staff. κ And ρ analyses were used to measure rates of clinician agreement with the recommendations produced by the GRRS report based on patient interviews. Clinicians agreed with the GRRS preliminary diagnostic recommendations 88% to 100% of the time, with κ scores indicating excellent agreement by ranging from 0.6 to 0.9. For an average patient, 41 of 46 treatment planning statements generated by the GRRS were used by clinicians, with moderate to high correlation indicated by ρ scores ranging from 0.62 to 0.82. The percent agreement for all American Society of Addiction Medicine dimension ratings was greater than 99%, with κ scores of 0.98 and higher. This study demonstrates the utility and efficiency of the GRRS as a clinical decision support system to support diagnosis, treatment, and placement in routine practice.

Recovery-Oriented Systems of Care: A Perspective on the Past, Present, and Future.

This paper provides a perspective on the recent concept of recovery-oriented systems of care with respect to its origins in the past and its status in the present, prior to considering directions in which such systems might move in the future. Although influential in practice, this concept has yet to be evaluated empirically and has not been the object of a review. Recovery-oriented systems of care emerged from the efforts of persons with mental health and/or substance use disorders who advocated for services to go beyond the reduction of symptoms and substance use to promote a life in the community. Subsequent efforts were made to delineate the nature and principles of such services and those required of a system of such care. Coincident with the U.S. Substance Abuse and Mental Health Services Administration dropping reference to behavioral health in its revised definition of recovery, confusions and limitations began to emerge. Recovery appeared to refer more to a process of self-actualization for which an individual is responsible than to a process of healing from the effects of a behavioral health condition and associated stigma. In response, some systems are aiming to address social determinants of behavioral health conditions that transcend the scope of the individual and to develop a citizenship-oriented approach to promote community inclusion.

The Role of the Family in Alcohol Use Disorder Recovery for Adults.

Alcohol use disorder (AUD) and family functioning are inextricably bound, and families are impacted negatively by AUD, but families show substantial improvements with AUD recovery. Family members can successfully motivate a person with AUD to initiate changes in drinking or to seek AUD treatment. During recovery, family members can provide active support for recovery. Several couple- or family-involved treatments for AUD have been developed and tested in rigorous efficacy trials. Efficacious treatments based in family systems theory or cognitive behavioral approaches focus on the concerned family member alone, or they engage the couple or family as a unit in the treatment. However, most treatments have been studied in fairly homogeneous, heterosexual, White, non-Hispanic populations, limiting the potential generalizability of these treatments. Substantial gaps remain in our understanding of family processes associated with the initiation and maintenance of AUD recovery among adults. This review outlines the existing literature and describes opportunities for future research to address knowledge gaps in understanding the mechanisms by which these treatments are efficacious, use of family-based treatments with diverse populations, integration of pharmacotherapies with family-involved treatment, role of families in recovery-oriented systems of care, and how to improve treatment development and dissemination.

Are We Acute-Care or Recovery-Oriented? Exploring Ideals and Practices Expressed Within the Substance Use Treatment and Correctional Systems

Aim The aim of this study was to explore whether treatment and probation professionals describe ideals and practices more aligned with the recovery-oriented systems of care (ROSC) model or the acute-care model. Methods: Semi-structured individual interviews were used to gather qualitative data on the ideals and practices of nine probation professionals and nine treatment professionals. Results: Directed content analysis revealed that all treatment professionals interviewed and eight out of nine probation professionals described more ideals and practices in line with the ROSC model than those in line with the acute-care model. Of all the meaning units coded for model alignment, 81.7% aligned with ROSC and 18.3% with acute care. Of the meaning units coded as ROSC, 51.4% were from treatment professionals and 48.6% from probation professionals. Of the meaning units coded as acute care, 30.2% came from treatment professionals and 69.8% from probation professionals. In building a ROSC, it seems the concern is less about buy in for recovery-oriented characteristics and more about shedding characteristics of the acute-care model. Although professionals have many ideals and practices in line with the ROSC model, some acute-care characteristics linger and could continue to exist without intervention.

A Community College approach to the Collegiate Recovery Movement

The history of collegiate recovery programs in the United States attempts to connect two competing yet related activities. The First Movement is a treatment renewal movement whose goals are to reconnect treatment to the process of long-term recovery and rebuild relationships between treatment organizations, local communities and local recovery support groups. The Second Movement, the recovery advocacy movement, rose in reaction to the re-stigmatization, de-medicalization and re-criminalization of alcohol and other drug (AOD) problems in the 1980s and 1990s. The goals of this second movement included reaffirming the reality of long-term addiction recovery, by celebrating the legitimacy of multiple pathways of recovery, enhancing the variety, availability and quality of local/ regional treatment and recovery support services, and transforming existing human services into recovery-oriented systems of care. The goal of the above approaches is to integrate a comprehensive social support network both on campus and in the community geared toward: (1) the elimination of stress on college campuses; (2) being attentive regarding environmental factors such as, stigma and discrimination; and (3) increasing employment opportunities (workforce Initiatives).

Recovery and Youth: An Integrative Review.

Although rates of alcohol and other substance use disorders in adolescents have been estimated for decades, little is known about the prevalence, pathways, and predictors of remission and long-term recovery among adolescents. This article provides an integrative review of the literature on youth recovery. A final selection of 39 relevant articles was grouped into five sections: treatment outcomes, special emphasis populations, recovery-oriented systems of care, families, and non–abstinence-based approaches. The review recommends more adolescent research in three basic areas: more research about medication-assisted treatment and recovery as well as harm reduction approaches for adolescents; expansion of research on recovery practices for youth who do not receive treatment due to personal choice or societal disparities; and more life course research, which may begin with adolescent participants and extend across the life span. Additionally, the authors suggest the recovery capital model for adolescents and the neuroscience of addiction may provide additional precision and direction for the study of youth recovery.

63 EDUCATIONAL ATTAINMENT CAUSALLY IMPACTS DRINKING BEHAVIORS AND RISK FOR ALCOHOL DEPENDENCE: RESULTS FROM A TWO-SAMPLE MENDELIAN RANDOMIZATION STUDY WITH ∼ 780,000 PARTICIPANTS

'New recovery' can be conceptualised as both a social movement and a broader policy agenda to restructure treatment service systems towards 'recovery-oriented systems of care'. Emerging initially out of the United States, new recovery has gained currency as a policy agenda in other jurisdictions - perhaps most distinctly in the United Kingdom. In 2012, the ideas behind 'new recovery' were debated in the Australian alcohol and other drug field as the Victorian government sought to incorporate recovery principles into policy and service design. This paper uses the policy transfer and policy translation literature to understand how international policy ideas about 'new recovery' were negotiated in the Australian context, focusing specifically on the role of non-government actors in the process.This paper draws on an analysis of policy documents, organisational documents and interviews with representatives from the Australian non-government alcohol and other drug sector to consider how new recovery was translated into Victorian drug policy.The interactions between organisations and actors — including bureaucrats, governmental agencies and policy entrepreneurs — facilitated the circulation and translation of policy ideas in the Victorian context. Despite this, the analysis suggests that policy transfer was largely a symbolic exercise: overall, some of the key features of new recovery policy from the United States and the United Kingdom, such as encouraging peer-led recovery and mutual aid, were not incorporated in the Victorian policy. NGOs resisted what they considered to be some of the more problematic elements of 'new recovery', and informed the local translation of the policy.The results have implications for understandings of the relationship between social movements, non-government organisations and the state, as well as the dynamics of knowledge transfer in drug policy.

The movement and translation of drug policy ideas: The case of ‘new recovery’

Introduction'New recovery' can be conceptualised as both a social movement and a broader policy agenda to restructure treatment service systems towards 'recovery-oriented systems of care'. Emerging initially out of the United States, new recovery has gained currency as a policy agenda in other jurisdictions - perhaps most distinctly in the United Kingdom. In 2012, the ideas behind 'new recovery' were debated in the Australian alcohol and other drug field as the Victorian government sought to incorporate recovery principles into policy and service design. This paper uses the policy transfer and policy translation literature to understand how international policy ideas about 'new recovery' were negotiated in the Australian context, focusing specifically on the role of non-government actors in the process. MethodsThis paper draws on an analysis of policy documents, organisational documents and interviews with representatives from the Australian non-government alcohol and other drug sector to consider how new recovery was translated into Victorian drug policy. ResultsThe interactions between organisations and actors — including bureaucrats, governmental agencies and policy entrepreneurs — facilitated the circulation and translation of policy ideas in the Victorian context. Despite this, the analysis suggests that policy transfer was largely a symbolic exercise: overall, some of the key features of new recovery policy from the United States and the United Kingdom, such as encouraging peer-led recovery and mutual aid, were not incorporated in the Victorian policy. NGOs resisted what they considered to be some of the more problematic elements of 'new recovery', and informed the local translation of the policy. DiscussionThe results have implications for understandings of the relationship between social movements, non-government organisations and the state, as well as the dynamics of knowledge transfer in drug policy.

Building recovery ready communities: the recovery ready ecosystem model and community framework

Background: Public and private systems in the United States and around the World are impacted by substance use disorders (SUD). Despite recent attempts at bringing top down solutions, SUDs continue to be a leading cause of death, a leading correlate in violent crime, and a leading cause of lost productivity in the workplace. Community-based resources have been shown to positively affect SUD impact and SUD recovery, by orienting stakeholders towards the problem and creating continuity among support services. Community-based innovations, such as recovery community organizations and other recovery support services, have provided evidence of successfully scaling recovery efforts and improving the chance of sustained recovery for individuals that live within the community.Methods: A theoretical model and framework, grounded in the recovery-oriented systems of care (ROSC) theorems, is proposed to identify components and connections that support a community’s ability to support individual and group recovery from SUD.Results: The Recovery Ready Ecosystem Model (RREM) and Recovery Ready Community Framework builds upon the early work of the ROSC, highlighting recently emboldened support structures such as harm reduction, educational recovery programs, and other traditional support structures in communities.Conclusions: Enhanced community needs assessment can be informed by the RREM and Recovery Ready Community framework to identify gaps in their current community infrastructure. Further testing of the recovery readiness equation should be performed as a potential measure of efficacy of community ability to support long-term recovery from SUD. Exploration of potential application of the model and framework to international settings is also needed.

Recovery-informed Theory: Situating the Subjective in the Science of Substance Use Disorder Recovery

As recovery from substance use disorder becomes more than a mere quantifiable outcome, there exists a need to discuss and propose the underlying theoretical constructs that ultimately describe and identify the science of recovery. In this abstract undertaking, we propose an initial formulation of a grand theory of recovery science, built upon the seminal theories of recovery capital, recovery-oriented systems of care, and socioecological theory. This grand theory - labeled recovery-informed theory (RIT) - states that successful long-term recovery is self-evident and is a fundamentally emancipatory set of processes. This paper will discuss, analyze, and explore this theory as it is situated within the larger substance use, misuse, and disorder contexts. The uses, implications, and benefits of RIT as an organizing point of inquiry for recovery science are also discussed. By promoting the role of subjective recovery experience in the formulation of the study of recovery, it may be possible to summon new ideas, metrics, and strategies that can directly address substance use disorders in society. Adopting a recovery-informed understanding as follows from this grand theory may allow individual recovery and wellness trajectories to be explored, adapted, and modified to exemplify person-centered and individualized recovery strategies.

Evidence- and practice-informed approach to implementing peer grief support after suicide systematically in the USA

ABSTRACTThe landmark report, Responding to Grief, Trauma, and Distress After a Suicide: U.S. National Guidelines, identifies the suicide bereaved as an underserved population and recommends systematic development of peer grief support to help meet the needs of survivors of suicide loss. A widespread array of peer grief support after suicide (PGSS) services exists nationally, but only as a decentralized network of autonomous programs. Some research indicates that peer support is generally helpful to the suicide bereaved, a finding that is reinforced by a large body of emerging research showing that peer support is effective in mental illness and substance abuse recovery. The practice, study, growth, and refinement of peer support in those fields have generated viable ideas about the elements and principles of effective peer support—for individual practitioners and for programs and organizations—that could be used to guide the systematic implementation of PGSS. In addition, a comprehensive PGSS program (Tragedy Assistance Program for Survivors) that currently serves a large population—survivors of suicide in the military—could be a model for national PGSS systems development. Finally, there are several frameworks for systems development—zero suicide, consumer-operated services, recovery-oriented systems of care, and the consumer action research model—that could guide the expansion and increased effectiveness of PGSS in keeping with the Guidelines’ recommendation.

Developing an Experiential Definition of Recovery: Participatory Research With Recovering Substance Abusers From Multiple Pathways

ABSTRACTBackground: The What is Recovery? (WIR) study identified specific elements of a recovery definition that people in substance abuse recovery from multiple pathways would endorse. Objectives: To explain how participatory research contributed to the development of a comprehensive pool of items defining recovery; and to identify the commonality between the specific items endorsed by participants as defining recovery and the abstract components of recovery found in four important broad recovery definitions. Methods: A four-step, mixed-methods, iterative process was used to develop and pretest items (August 2010 to February 2012). Online survey recruitment (n = 238) was done via email lists of individuals in recovery and electronic advertisements; 54 were selected for in-depth telephone interviews. Analyses using experientially-based and survey research criteria resulted in a revised item pool of 47 refined and specific items. The WIR items were matched with the components of four important definitions. Results: Recovering participants (1) proposed and validated new items; (2) developed an alternative response category to the Likert; (3) suggested criteria for eliminating items irrelevant to recovery. The matching of WIR items with the components of important abstract definitions revealed extensive commonality. Conclusions/Importance: The WIR items define recovery as ways of being, as a growth and learning process involving internal values and self-awareness with moral dimensions. This is the first wide-scale research identifying specific items defining recovery, which can be used to guide service provision in Recovery-Oriented Systems of Care.

Bringing Recovery Housing to Scale in Ohio: Lessons Learned

ABSTRACTObjective: States across the country are recognizing recovery housing, an abstinence-based living environment promoting recovery from alcohol and other drugs, as an important yet underrepresented choice within their housing and treatment continuums. However, strategies for bringing recovery housing to scale are not well known. Building upon broader quality improvement efforts in Ohio, this paper aims to identify barriers and facilitators to expanding recovery housing in Ohio by understanding the perspectives of relevant stakeholders. Methods: We conducted 6 recovery housing program site visits; 24 semi-structured key informant interviews with state and national researchers, policy makers, and stakeholder groups; and 16 focus groups with administrators and staff, residents, and local stakeholders including housing developers, advocates, and county and city policy makers (n = 113). Focus groups were disaggregated by stakeholder membership and guided by separate interview protocols. Transcripts were coded and analyzed to identify primary themes. Results: Most participants across stakeholder groups expressed a need to increase recovery housing supports within the state. Two facilitators and three barriers emerged as primary themes from the qualitative analysis. Facilitators included (1) the ability of recovery housing programs to identify, connect, and collaborate with other recovery housing programs and service systems, an approach that increased a program's ability to refer, accept new clients, learn about programmatic and financial supports, and advocate for a space within the services continuum, and (2) support from legislators and other local stakeholders to include recovery housing as a viable and necessary option. Barriers included (1) variations in recovery housing definitions, language, and understanding that limited recovery housing providers’ ability to connect with one another and be eligible for different streams of support, (2) availability of funds and ability to access them, and (3) restrictions in federal, state, and local regulations and codes. Conclusions: Although recovery housing is limited and has not been integrated into many housing and treatment continuums, there is growing consensus about its importance for various subpopulations. Developing consistent definitions, program models, funding streams, networks of recovery housing providers, and collaborations among recovery-oriented systems of care will reduce misperceptions and enhance the likelihood that recovery housing will be expanded.

Recovery Oriented Systems of Care (ROSC) and Recovery Management.

Recovery Oriented Systems of Care (ROSC) and Recovery Management.

Recovery Management and Recovery-Oriented Systems of Care

Recovery Management and Recovery-Oriented Systems of Care

Recovery and Recovery-Oriented Systems of Care: Integrating Treatment for Substance Use, Primary Care, and Psychiatric-Mental Health Disorders.

The need for integrated treatment of substance use disorders (SUDs) and psychiatric–mental health disorders (PMHDs) is at an all-time high. According to the Substance Abuse and Mental Health Services Administration (SAMHSA)2014 National Survey on Drug Use and Health, an estimated 43.6 million (18.1%

Community pharmacy-based opiate substitution treatment and related health services: a study of 508 patients and 111 pharmacies

Community pharmacies have a central role in the provision of opiate substitution therapy (OST) for drug misusers, offering accessible, additional health services within recovery-oriented systems of care. However, little is known about the patients receiving OST, availability and uptake of related services and associated pharmacy characteristics. We aimed to describe OST in terms of patients, pharmacies and services within the UK’s largest health authority, NHS Greater Glasgow and Clyde, Scotland. Patients completed semi-structured questionnaires and pharmacists provided summary statistics relating to OST provision. Responses from 508 patients receiving OST from 111 participating pharmacies revealed an established patient population, with 89 % (449/507) aged 30 years or above and 80 % (387/484) attending the same pharmacy for 1 year or more. Methadone was the main form of OST (96 % (487/508), with 97 % (491/504) receiving supervision. Within pharmacies, OST consumption was supervised in one of four main areas: consultation room, dispensing hatch, quiet/private area or over the counter. Location of supervision was considered suitably private by 96 % of patients. Positive staff attitudes, privacy and the provision of additional health services were key factors influencing choice of pharmacy. Additional health services were offered to 75 % of patients and included information provision (43 %), signposting to other health care providers (72 %) and a Scottish service offering free advice and medicines for minor ailments (74 %). Patients and pharmacists have developed working relationships, enabling access to multiple services associated with health gain and harm reduction. Further development of enhanced services in community pharmacies is merited.

Recovery definitions: Do they change?

BackgroundThe term “recovery” is widely used in the substance abuse literature and clinical settings, but data have not been available to empirically validate how recovery is defined by individuals who are themselves in recovery. The “What Is Recovery?” project developed a 39-item definition of recovery based on a large nationwide online survey of individuals in recovery. The objective of this paper is to report on the stability of those definitions one to two years later. MethodsTo obtain a sample for studying recovery definitions that reflected the different pathways to recovery, the parent study involved intensive outreach. Follow-up interviews (n=1237) were conducted online and by telephone among respondents who consented to participate in follow-up studies. Descriptive analyses considered endorsement of individual recovery items at both surveys, and t-tests of summary scores studied significant change in the sample overall and among key subgroups. To assess item reliability, Cronbach's alpha was estimated. ResultsRates of endorsement of individual items at both interviews was above 90% for a majority of the recovery elements, and there was about as much transition into endorsement as out of endorsement. Statistically significant t-test scores were of modest magnitude, and reliability statistics were high (ranging from .782 to .899). ConclusionsLongitudinal analyses found little evidence of meaningful change in recovery definitions at follow-up. Results thus suggest that the recovery definitions developed in the parent “What Is Recovery?” survey represent stable definitions of recovery that can be used to guide service provision in Recovery-Oriented Systems of Care.