“What should I say to my co-workers and friends who don’t know I went to treatment?”
“How can I fit my new meditation practice into my schedule when I’m back home?”
“What if I don’t like 12-Step meetings?”
“How do I rebuild my relationship with my spouse?”
“How can I make my work schedule more manageable?”
“How do I find a sponsor?”
“I’ve never had a hobby; how can I find one now?”
“Now that I’m clean and sober, what’s next?”
In 2007, when I started the alumni program at CeDAR, the Center for Dependency, Addiction and Rehabilitation, these are the kinds of questions patients were asking when they left our treatment program. I was fairly new in recovery and eager to learn how I might support our alumni. I knew all too well how tricky early recovery could be.
As the staff person who kept in touch with patients after they left treatment, I quickly discovered that whether patients returned home after their primary care experience or participated in a continuing care program, most described early recovery as a demanding and baffling time. Dealing with the choices and challenges of “real life” was daunting.
As I continued to connect with alumni, I noticed some common denominators among those who were experiencing the most success and satisfaction with their lives in recovery:
They were committed to a vision of recovery that included a better life than the one they had been living.
They identified and used assets (people, places and things) that supported their recovery efforts.
They used strategies for self-management and self-care that they had learned in treatment, and were open to learning more.
If these behaviors constituted markers of success, I began to wonder how they might be intentionally taught to patients to enhance their early recovery efforts.
Coinciding with these informal observations, several other developments in the addiction field were influencing my thinking:
William White’s book, Pathways from the Culture of Addiction to the Culture of Recovery, introduced me to the idea that recovery is indeed a journey—a trip from the culture of addiction where unhealthy rituals, activities and values support dysfunctional behavior to a culture of recovery where healthy rituals, activities and values support wellness and a positive way of engaging with others and in life. In his book, White suggests that treatment professionals can be the “welcome wagon to the culture of recovery” by teaching patients its rules, etiquette, language and values during their treatment episodes.1
At the 2005 National Summit on Recovery, professionals from all walks of the addiction field came together with policy-makers, people in recovery and other stakeholders to reach consensus about guiding principles of recovery and elements of recovery-oriented systems of care (ROSC). Based upon the discussions at this summit, recommendations were posed for the treatment and recovery field. Suggestions to treatment providers included a call to “offer a full range of recovery options that begin in treatment and continue beyond the treatment episode,” states the Substance Abuse and Mental Health Services Administration's (SAMHSA's) summit report.
The organizing principle for providing care to persons with addiction started to shift from a pathology-based acute care model to a long-term recovery paradigm. Treatment providers were considering recovery management models of care that enhance individuals' and families' quality of life by providing services that sustain long-term recovery.
The notion of “recovery capital” started to appear in the addiction literature. Cloud and Granfield defined recovery capital as the “breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from alcohol and other drug problems.”2 They added that “both the quality and quantity of recovery capital play a major role in predicting recovery success” and that individuals could in fact actively work on increasing their recovery capital.
Research in the area of peer support services indicated that this type of support can be valuable to those overcoming substance abuse challenges.3 It is a flexible approach in which people with common experiences learn and grow. SAMHSA has supported this type of programming by funding more than 30 peer recovery support centers across the United States.
Taken together, I believed that a blend of these ideas offered an opportunity for the Alumni Services department at CeDAR to create an innovative program that could empower our patients in their long-term recovery efforts. This type of program could be implemented in concert with the clinical, medical and educational components already in place.
As I was considering all of these events and trends, Steve Millette was hired as CeDAR's new executive director in 2010. Millette is a strong proponent of ROSC, and his strategic plans for CeDAR included integration of a recovery management model of care. As he and I began to formulate how we could operationalize ROSC principles, recovery management and peer coaching at CeDAR, we decided that the Alumni Services department would be a logical place from which to spearhead the project.
At many treatment centers, alumni activities kick into gear after patients leave treatment. Our intention was that patients would get connected to CeDAR’s alumni program by starting the recovery planning and coaching program as soon as they entered treatment.