Recovery Oriented Systems of Care: A Space to Integrate Abstinence Based Treatment and Harm Reduction Models
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The document discusses the integration of abstinence-based treatment and harm reduction strategies in addiction recovery, particularly in Philadelphia, highlighting the importance of a non-judgmental and supportive approach. It emphasizes the need for collaboration between various service providers, addressing social inequalities that affect drug use and recovery, while also recognizing the complex realities faced by individuals with addiction. Additionally, it calls for the empowerment of drug users in the creation of policies and programs that meet their needs.
Recovery Oriented Systems of Care: A Space to Integrate Abstinence Based Treatment and Harm Reduction Models
- 1. The Common Goals of Abstinence Based Treatment and Role of Harm Reduction: The Integrative Possibilities of Recovery-oriented Systems of Care: The Philadelphia Experience Marcella A. Maguire, Ph.D. Director for DBH Homeless Services City of Philadelphia
- 2. "Those who cannot remember the past are condemned to repeat it“.- George Santayana (1905) Reason in Common Sense, p. 284, volume 1 of The Life of Reason “
- 3. Abstinence Based Addiction Treatment: Goal of immediate and complete abstinence based lifestyle Harm Reduction: Minimizing injury to self, others and the community
- 4. Abstinence Based Harm Reduction Addiction Treatment (HR) (ABAT) -No Interaction with -Encouraging Supports till Completely Substance Use Clean
- 5. » Re-medicalization of severe and persistent alcohol and other drug problems. » Dramatic increase in Federal, State, and local investment in treatment » Rebirth of physician-directed treatment institutions.
- 6. » Professionalization of addiction medicine. » Growth in addiction treatment institutions and physicians working in addiction medicine. » Defense of medical approaches to treatment and reconceptualization of addiction as a chronic disease. » Transfer of the core technology of addiction medicine into mainstream medical practice. » Friday Nov 8th, 2013, Parity Rule Issued
- 7. »Born in the HIV/AIDS crisis of the 1980s »Views Drug use as a complex, multi- faceted phenomenon that encompasses a continuum of behaviors. »Establishes quality of life as criteria for successful interventions and policies. »Calls for the non-judgmental, non- coercive provision of services and resources »Ensures that drug users have a real voice in the creation of programs and policies.
- 8. »Seeks to empower users to share information and support each other in strategies which meet their actual conditions of use. »Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm. »Does not attempt to minimize or ignore the real and tragic harm and danger associated with licit and illicit drug use.
- 9. • Assist persons with multiple, severe, complex, and chronic challenges • Enhance Coping Mechanisms • Increase Social Supports • Reaching the same individuals at different stages of their AOD use, addiction, and recovery careers • Resistance and ambivalence are a natural—not pathological—response to internal and external pressure to change deeply engrained behaviors. • Resistance and ambivalence are reduced when people have real choices and are empowered to choose.
- 10. »Whose in Philadelphia? ◦ 1.5 million people ◦ Area Median Income = $36,957 ◦ Percentage below the poverty level = 25.6% ◦ Average Monthly enrollment in Medicaid in 2012 = 470,159 ◦ Unique individuals enrolled in Philadelphia Medicaid in 2012 = 569,236
- 11. »Both models of intervention must be publicly and professionally defended through the integration process. »Leadership and strategy at multiple levels are essential. »Ideas matter. ABAT/HR integration involves processes of conceptual stretching within both the AATR and HR communities. »Science helps, but stories and direct experience are essential. » Relationships matter. ABAT/HR integration involves relationship building and relationship maintenance across systems boundaries. » Money and public/professional recognition matter. ABAT/HR integration must address issues of personal/professional/institutional interests that inhibit collaboration.
- 12. »HR and ABAT collaborations can be a win/win process. »HR and ABAT are not either/or options. »Drug users may be viewed as “incompetent and pathological” and thus only “objects of intervention” or as “allies and participants in their own individual and collective health.” »Recovery initiation is about a synergy of pain and hope. »ABAT and HR are the products of heterogeneous social movements made up of constituency groups with widely varying philosophies and service practices, all of whom cannot be expected to approve of or participate in processes of collaboration. »HR and ABAT integration must be bi-directional.
- 13. »The role of the child welfare system in your community. »All services providers are “mandated reporters” and need training and policies that support this fact. »Liaisons and partnerships with your communities child welfare system and the agencies that work for them will be essential in any Housing First program for families. »These agencies have professional expertise in assessing safety issues.