Peer-Based Recovery Support Services for Substance Abuse P-BRSSNebraska Division of Behavioral Health Office of Consumer AffairsBy: Cody Manthei, B.S,PLADC,CPWS

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Introduction to Presentation

What is addiction specific peer support History of addiction related peer support Recovery and the dimensions' as defined by

SAMSHA Characteristics of addiction specific peer support Difference between peer support and professional

help Social Supports and the importance of community

connections in substance abuse recovery Possible Titles and Functions of addiction related

peer supporter DRAFT

Peer Support History in Substance Abuse

“The history of addiction treatment and recovery in the United States contains a rich “wounded healer” tradition”.

For many years individuals and families have provided recovery support to others seeking recovery.

Formal peer-based recovery support services (P-BRSS) are now being delivered through diverse organizations and diverse roles

The wounded healer tradition is embedded within the history of medicine and psychiatry.

“One must first deeply understand his own wounds in order to help others heal effectively” William White

William L. White, MA http://www.facesandvoicesofrecovery.org/pdf/White/Peer-Based_Recovery_Support_Services_June_08_0

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Peer-based recovery support is the process of giving and receiving non-professional, non-clinical assistance to achieve long-term recovery from severe alcohol and/or other drug-related problems.

This support is provided by people who are experientially credentialed to assist others in initiating recovery, maintaining recovery, and enhancing the quality of personal and family life in long-term recovery

Experientially credentialed refers to persons with lived experience; who have successfully achieved addiction recovery and shares other characteristics e.g. age gender, ethnicity. Those who have walked the same or similar journey. Having lived experience does no imply that peer support persons do not need training or supervision, but that lived experience is a needed foundationWilliam L. White, MA http://www.facesandvoicesofrecovery.org/pdf/White/Peer-Based_Recovery_Support_Services_June_08_0

Substance Abuse Specific Peer Support defined byWilliam M White M.A

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History of Peer SupportIt is suggested that ANY and ALL peer support services have emerged and flourished due to human services systems proving to be ineffective and harmful to the person receiving services “Harm done in the name of Help” Persons receiving services took responsibility for their own recovery and peer support bloomed.

Substance Abuse Peer Support widely took hold in a 12 step help environments and fit well into the consumer movement. However due to the anonymity involved in 12 step help groups Substance abuse peer support remained localized to these groups for a long time.

William L. White, MA http://www.facesandvoicesofrecovery.org/pdf/White/Peer-Based_Recovery_Support_Services_June_08_0DRAFT

History of ContinuedHistorical research has placed the beginning of Substance Abuse P-BRSS within the mid-eighteenth century in Native American Tribes. Since then building momentum and contributing to the well-known spiritual traditions found in12 step help groups around the world.

Peer support has since been noted to be alive and well in family-focused, age, gender specific, criminal justice, LGBT and occupational based recovery support systems. It is noted that mutual-aid and advocacy truly has been grown in communities of color where poverty and addictions are engrained within communities and family systems.

William L. White, MA http://www.facesandvoicesofrecovery.org/pdf/White/Peer-Based_Recovery_Support_Services_June_08_0DRAFT

What is recoveryA process of change through which individuals improve their health and wellness, live a self-directed lives, and strive to reach their full potential.

Substance Abuse and Mental Health Administration (SAMSHA)has been diligent in providing information and support to individuals and families seeking recovery and to organizations that promote recovery

http://www.samhsa.gov/newsroom/advisories/1112223420.aspx DRAFT

Guiding Principles

Recovery emerges from hope Recovery is person-driven Recovery occurs via many

pathways Recovery is holistic Recovery is supported by

peers and allies: Recovery is supported

through relationship and social networks

Recovery is culturally-based and influenced

Recovery is supported by addressing trauma

Recovery involves individual, family, and community strengths and responsibility

Recovery is based on respect

SAMSHA’S Recovery Guiding Principles

Recovery Oriented systems are important for organizations who serve persons with substance abuse challenges. SAMSHA suggest incorporating these principles fosters recovery at a larger level.

http://www.samhsa.gov/newsroom/advisories/1112223420.aspx

4 Major Dimensions of Recovery 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—and for everyone in recovery, making informed, healthy choices that support physical and emotional wellbeing.

Home: a stable and safe place to live; Purpose: meaningful daily activities,

such as a job, school, volunteerism, family caretaking, or creative endeavors, and the independence, income and resources to participate in society; and

Community: relationships and social networks that provide support, friendship, love, and hope.

Recovery is a person centered process; each person must decide what recovery looks like for themselves, how they can best create change in their lives and move into recovery. These are guidelines for self discovery.

http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated

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The Recovery Process

Process implies that recovery is not a single event or an activity.Recovery is relational; rather the mechanical, and that the continuity of support happens over time this central to the desired outcome of long-term recovery.

Addiction specific peer support differs from professional help as they are able to lend support throughout the recovery process; allowing the individual to be in this process continuously. P-BRSS is not a liner process, it is a circular process allowing for growth to occur in natural time . DRAFTWilliam L. White, MA http://www.facesandvoicesofrecovery.org/pdf/White/Peer-Based_Recovery_Support_Services_June_08_0

Substance Abuse Related Peer Support“Focuses on the reduction of the overwhelming urge to use a substance or other harmful behaviors as a problem-solving tool” Cody Manthei 2013 Recovering Addict

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Awareness and Early

Acknowledgment

Active Recovery and Maintenance

Consideration and

Incubation

Early Recovery and

Rehabituation

Sub

stan

ce A

buse

Rec

over

y

This process is continuous, non-linear moving in and out of stages throughout recovery, continuing to practice acceptance of things and situations that are beyond personal control. P-BRSS encourage the individual to move toward a self-directed solution.

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Exploring Recovery and Early Activities

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Peer Support vs. Professional ServicesPeer Models

Experiential knowledge drawn from personal experience

Knowledge freely available and widely shared

Helper and Helpee roles are mutual, emphasis on connection and personal involvement

Professional Model

Scientific knowledge theories and analysis

Knowledge carefully controlled

Relationships extremely separated and distance kept

These differences are vary apparent to persons who provide peer support; that the power of the one on one relationships promotes personal growth and recovery in a safe non-judgmental environment. The value of these two models working together can only enhance a persons ability to recover !

William L. White, MA http://www.facesandvoicesofrecovery.org/pdf/White/Peer-Based_Recovery_Support_Services_June_08_0DRAFT

Possible Titles Sponsors Peer Specialist Peer Helpers Peer Educators Recovery Coaches Recovery Support

Specialist Recovery Mentors

Some program may want to use terms such as peer counselor, counselor’s aid…. These terms can lead to confusion on the role of a peer supporter and the person receiving the support. Mixing professional treatment with peer support takes away the mutuality of the peer support relationship; by minimizing the lived experience and placing formal education as more important.

William L. White, MA http://www.facesandvoicesofrecovery.org/pdf/White/Peer-Based_Recovery_Support_Services_June_08_0

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Building Support Systems A key to long lasting substance Abuse recovery lies within creating positive social supports. Research completed on this suggest there is 4 types of support.

Emotional – Demonstrate empathy and caring or concern bolsters a persons self-esteem

Informational- Share knowledge and information provides life and vocational skills training

Instrumental- Provides concrete assistance to help others accomplish task

Affiliation- Facilitates contacts with others people to promote learning of social and recreational skills, creates community and a sense of belonging.

4 types of supportThat peer support services facilitate

http://store.samhsa.gov/shin/content/SMA09-4454/SMA09-4454.pdf

Peer Recovery Support Services can:• Precede formal treatment, strengthen a peer’s

motivation for change• Accompany treatment, providing a community

connection during treatment• Follow treatment, supporting relapse prevention• Be delivered apart from treatment to someone who

cannot enter the formal treatment system or choose not do so.

• http://store.samhsa.gov/shin/content/SMA09-4454/SMA09-4454.pdf

It is imperative for persons seeking recovery from substance abuse to build strong supports in a like minded recovery community, as this will help them to learn positive coping skills for situations that creates urges to use. The benefits of peer support in this area is of high importance as peer support follows individuals into the community.

Recovery Based Peer Support focuses on

Strengths of an individual, things they do well, encouraging them to take healthy risks through a mutual relationship. This approach builds resiliency in individuals .

Provides them with self-confidence and stays away from the correction of deficits but instead the acceptance of who they are and embracing their character defects.

Substance Abuse Recovery is all about being self-directed, empowering and having choices.

Shared Values

Keeping recovery first—Placing recovery at the center of the effort, grounding peer services in the strengths and inherent resiliency of recovery rather than in the pathology of substance use disorders. ■ Cultural diversity and inclusion—Developing a recovery community peer support services program that honors different routes to recovery and has leaders and members from many groups at all levels within the organization. ■ Participatory process—Making sure the recovery community directs or is actively involved in project design and implementation, so that recovery community members can identify their own strengths and needs, and design and deliver peer services that address them. Authenticity of peers helping peers—Drawing on the power of example, as well as the hope and motivation, that one person in recovery can offer to another; providing opportunities to give back to the community; and embracing the notion that both people in a relationship based on mutuality can be helped and empowered in the process. ■ Leadership development—Building leadership abilities among members of the recovery community so that they are able to guide and direct the service program and deliver support services to their peers.

“My deepest fear is not that I’m inadequate , but that I ‘am powerful beyond measure”

1. Peer recovery support services are clearly defined in ways that differentiate them from professional treatment services and from sponsorship in 12-Step or other mutual-aid groups.2. The programs and peer recovery support services are authentically peer based (participatory, peer led, and peer driven) in design and operation.3. The peer recovery support program has well delineated processes for engaging and retaining a pool of peer leaders who reflect the diversity of the community and of people seeking recovery support.4. The peer recovery support program has an intentional focus on leadership development.5. The peer recovery support program operates within an ethical framework that reflects peer and recovery values.6. The peer recovery support program incorporates principles of self-care, which are modeled by staff and peer leaders, and has a well considered process for handling relapse.7. The peer program and peer recovery support services are non-stigmatizing, inclusive, and strengths-based.8. The peer recovery support program honors the cultural practices of all participants and incorporates cultural strengths into the recovery process.9. The peer recovery support program connects peers with other community resources irrespective of types of services offered.10. The peer recovery support program has well established, mutually supportive relationships with key stakeholders.11. The peer recovery support program has a plan to sustain itself.12. The peer recovery support program has well documented governance, fiscal, and risk management practices to support its efforts

12 Quality Indicators

Assertive outreach for persons seeking recovery

Minimization of harm to self or others by engagement in peer support

SA Recovery needs assessments that are strength based

SA Recovery education and resource development involvement

Community level resource development

Developing and linking services within the community y for person served

Liaison bridge building for persons navigating a system of care

SA Recovery focused skill building Companionship and role modeling of

recovery lifestyles Problem-solving to eliminate

obstacles Recovery advocacy for person

recovering and their families Recovery leadership roles in the

community Continuous self –inventory for

quality assurance of personal recovery and services provided

Possible Core FunctionsThese functions are suggested; however depending on the characteristics of the organization such as geographical location and population served, these functions may change or vary in degree needed. The core functions of P-BRSS span the stages of recovery.The key is to remember that keeping peer support duties separate from clinical duties, allows for the genuineness of the peer support relationship to occur without retribution or judgment. This will allow for the “recovery process” to take hold and flourish

William L. White, MA http://www.facesandvoicesofrecovery.org/pdf/White/Peer-Based_Recovery_Support_Services_June_08_0 DRAFT

White, William L. "Peer-Based Addiction Recovery Support." History, Theory, Practice, and Scientific Evaluation (n.d.): n. pag. Web. <www.attcnetwork.org/greatlakes>.

"The Stages of Recovery." Recovering from Addiction. N.p., 2008. Web. 1 Jan. 2014.

"Working Definition of Recovery Updated." SAMSHA Substance Abuse and Mental Health Administration. N.p., 23 Mar. 2012. Web. 1 Jan. 2014.

Center for Substance Abuse Treatment, What are Peer Recovery Support Services?, HHS Publication No.(SMA) 09-4454. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S Department of Health and Human Services,2009

References