Today’s column is written by Jason Padgett, Program Director with the Phoenix Paramedics Quick Response Team and Recovery Community Advocate. He shares his view of recovery and how communities can support this process. Jason’s vision of recovery is not only focused on helping an individual maintain sobriety, but also creating a community level of support that incorporates a wholistic view of recovery which includes all aspects of life. SAMSHA website https://www.samhsa.gov/find-help/recovery lists the four pillars of recovery as:
We soon realized that successful recovery systems were more than a checklist. Meaningful change requires learning from those who have gone before you, continuing dialogue with those in the field, and listening to the voices of those in recovery.
What we took away from those early conversations was the need for a philosophical change that is often articulated as ‘bringing recovery to practice’ or RTP. While there are several key components interwoven in the RTP ideology, the central theme revolves around all parties maintaining a focus on the optimal outcome for each individual: long term recovery. When we begin to see people as individuals, when we begin to believe that recovery is possible and work with those individuals toward reaching their full potential, allowing each person to choose their recovery path, we embrace the best practices to facilitate the goal of long term recovery.
We began to realize that Bill White is correct when he touts “there are multiple pathways to long term recovery and all are a cause for celebration.” There is no one correct way to recover. Some find success in 12-step programs, others prefer cognitive based therapies that focus on changing thinking and addressing triggers. Some embrace spiritually-based programs, while others find secular programs more helpful. Whatever path the individual chooses, we find that respect, peer support, addressing underlying trauma, and taking a wholistic approach are essential. People in the beginning stages of recovery are very fragile and easily discouraged. They need support and a “warm-handoff” to navigate the resources and services they need to be successful. More and more service providers have begun to embrace this idea and help their clients connect face-to-face with other services and resources.
If the above paragraph describes what a person seeking help for a substance use disorder experiences in your System of CARE, then you have likely brought Recovery to Practice; if not, it’s never too late for an overhaul.
Recovery Community Advocate
People involved in substance use find themselves facing some unexpected dangers during the corona virus pandemic. The first is their increased physical vulnerability to disease. People involved in substance use often have health conditions exacerbated by poor nutrition, COPD, cirrhosis, cardiovascular disease, HIV, Hep C and compromised immune systems which make them more vulnerable to severe illness and especially CoVid. Some people in recovery reside in communal living situations which increase their risk for exposure to the Coronavirus.
Nationally, the quarantine has seen a 50 to 70% increase in alcohol sales. Whether people are hoarding alcohol or actually using it to self-medicate remains to be seen. Mental health and substance use treatment providers express concern about the isolation during a pandemic and the ease of hiding a relapse or an increase in use.
According to Mike Thibideau, with Indiana Workplace Recovery, during the CoVid quarantine the Indiana Addiction hotlines went from 20 calls per week to 20 calls per day. The 211 resource helpline, which typically has 1000 mental health calls per day, is currently receiving 25,000.
As we have discussed in previous columns, the opposite of addiction is connection. During the social distancing and sheltering in place, many folks in recovery and treatment for substance use find themselves isolated and alone. There is the increased financial stress of unemployment or working from home. With recovery meetings cancelled, many find themselves without accountability, bored, fearful and stressed. Any of these may become a trigger for the recurrence of substance use. In addition, isolation increases risk for overdose, experiencing dangerous withdrawal symptoms, reusing drug paraphernalia, and buying from unfamiliar dealers.
Many recovery groups have quickly turned to online platforms such as Zoom, Go to Meeting, Google Meet, and a variety of apps. Although virtual meetings have dramatically increased, there are some unexpected obstacles in accessing them. Many involved in substance use do not have access to the internet or previously accessed it in public spaces such as libraries, which may be closed. Those who live in rural areas may have limited internet access. People may have limited data minutes on their phones. Older people in recovery may not be comfortable or familiar with online platforms.
There have been some benefits from the increased online services. Some people prefer the online services because they can meet in the familiar environment of their home. Those who travel to services outside their community, find that online services reduce the transportation barrier. Phoenix Paramedic Solutions’ White County Quick Response Team has been surprised that some clients are much more receptive to virtual meetings and are more open when meeting online or by phone.
There are concerns about online confidentiality and security. Some of the HIPPA restrictions have been relaxed by the State of Indiana to allow mental health and substance use treatment professionals to continue to meet with clients online and over the phone. Some virtual participants have expressed concern about sharing personal stories when you don’t know who else is in the online room.
As we face our new normal post quarantine, we need to consider how recovery and treatment services for those involved in substance use will need to change and adapt. Will virtual and online services develop into an alternate way to support those in need of mental health and substance use services? How will communities address increased levels of mental health/substance use needs once the CoVid crisis is over? The future may be uncertain, but recovery is possible.
We live in a world full of stress, anxiety and worry. We develop coping strategies or habits to deal with everyday pressures. Some people become workaholics, using success to protect themselves. Others strive for control, spend hours in the gym, binge media, gamble, overeat, or view pornography to feel good. Some self-medicate with caffeine, nicotine, alcohol or other substances to get through the day.
We all use coping strategies to help us in our day-to-day life and to fulfill some basic longing or need within us or to rebound from difficulty, trauma, fears or anxiety. Some improve our health and help us lead productive, successful lives. These are often valued and encouraged as “self-care.” Other habits or coping strategies can be harmful, leading to negative consequences like isolation, debt, incarceration, or even death.
Some of us are able to keep these in balance, living productive lives. Others find themselves consumed with the thing intended to bring happiness and fulfilled desires. In reality, they find themselves led farther and farther from where they wanted to be. At the beginning, it may seem pleasant and harmless, without a hint of the long-term consequences, negative effects, or, in the case of substance use, the ongoing physical changes that make controlling a habit more difficult by the day.
But sometimes, repeating these habits over time can be less satisfying and more compulsive or obsessive. Without addressing underlying issues, challenges, and trauma, the innocent ways to cope become unconscious habits that can undermine our well-being. We repeat them over and over, attempting to fill what is missing, increasing the amounts and frequency without bringing satisfaction, always wanting more. We can create a dependency on an action, a person, or a substance.
But there are ways to intervene when habits grow to unhealthy levels. A variety of simple options can help avoid dangerous routines. Outdoor spaces that promote interaction, for example, provide a community alternative to excessive solitary distractions. Peer support groups, like the AA meetings we have addressed in recent articles allow people to share their concerns and find like-minded support. Our partners at NAMI (National Alliance on Mental Illness) are working to bring even more peer supports to our area.
Finding balance in coping with stress can be as simple as adding variety, human interaction, and service to others to our routines. Understanding that balance is important to a full life, and that everyone we meet is creating their own balance can help us be more empathetic to those who sometimes struggle to find the right mix. Most important, if we know that coping can create habits, habits can create ruts, and ruts can create obsessions, we can be sources of strength to those in our lives who may need help along the way. Before a person loses the ability to control their coping strategies, we can make a difference, helping to strike a balance.
The past few articles have looked at local faith-based recovery organizations. Today the focus is on SMART recovery.
While AA and Living Free are spiritually-based recovery organizations, SMART recovery is secular and scientific in its philosophy and orientation. SMART recovery, like AA and Living Free, is an abstinence-based recovery system. AA and SMART recovery originally focused on alcoholism, but like Living Free, SMART recovery now includes any self-destructive habit or coping strategy such as substance use (prescription or illicit drugs), gambling or sexual addiction, or other problematic behaviors.
SMART Recovery stands for Self-Management and Recovery Training focusing on evidence-based, scientifically validated methods to empower individuals to change from self-destructive, unhappy coping skills/ habits to ones that are constructive and satisfying.
SMART recovery is a mental health and educational program based on cognitive behavioral therapy, motivational interviewing and mindfulness. SMART recovery holds that your mindset creates your feelings and influences your actions. By keeping your thoughts, emotions, and beliefs in check, individuals can be empowered to take responsibility for their own change.
SMART recovery does not apply labels to its members such as “alcoholic” or “addict”. SMART recovery does not believe you are powerless over addiction but the power to change lies within each individual.
Where AA has an emphasis on healing past experiences, SMART recovery focuses on the present and how to change your current thinking, emotions and behavior. They focus on changing present thinking and actions.
Instead of 12 steps, SMART recovery incorporates a four-point program:
(1) All people are motivated to survive, avoid pain and seek happiness. Habits or coping strategies are ways to pursue these goals. Some habits may seem helpful in the short-term but can cause long term damages and consequences to the person as well as those around him.
(2) SMART recovery offers specific strategies to overcome cravings and desires to fall back into ineffective ways of life.
(3). SMART recovery focuses on changing damaging belief systems (I’ve tried to quit before and it didn’t work. I need _____ to cope with life.), dealing with anger, guilt, anxiety and low self-esteem, and then developing behavioral patterns to overcome them.
(4) SMART recovery encourages participants to become involved in enjoyable, healthy, productive activities that replace their problematic coping strategies, and have the commitment and perseverance to continue.
SMART recovery has many online resources. There are online group meetings for those struggling with addiction, as well as their friends and family members. There are short 4 to 6-minute videos explaining the process, tool kits that teach specific strategies to overcome destructive habits, 24/7 chat rooms, and online message boards. There are currently no SMART recovery meetings in White County, but SMART recovery resources can be accessed from a computer or smart phone.
SMART recovery does not prescribe a path of recovery but encourages each individual to find their own way. They support the use of Medically Assisted Treatment as well as other support groups such as AA.
After taking a several week break to discuss coping strategies related to sheltering in place, we return to our discussion of local recovery groups to help those involved in substance misuse.
Every person in recovery has a different situation, background and belief system. Just as there is no one-size-fits-all treatment plan for substance use disorder, there are a variety of recovery support groups to meet the varying needs of those in recovery.
Another support group that is meeting in White and Carroll counties is Lifeline Connection, a Living Free Community. Living Free is a national organization providing the curriculum for every Living Free Community, but each Living Free Community is run under local direction to meet their individual community’s needs.
According the Carroll County Lifeline Connection Website (cclifeline.org). “Our society is full of people who choose to live self-destructive lifestyles and endure every day the painful consequences of their choices. Everyone faces these situations at some time in life. Living Free small groups confront our mistaken thinking that keeps us involved in coping strategies that are not helpful or healing.”
The Living Free website lists the following components of recovery from any self-destructive habit:
Living Free has a much more Christian focus than AA’s focus on “a higher power as you understand him.” But religious belief is not required or expected of the participants. Eleanor Estes, who was instrumental in bringing Living Free to White County, indicated that she has had atheists and agnostics attend and benefit from the classes.
Where AA focuses on recovery from alcoholism, Living Free looks on a broader scale, addressing many forms of unhealthy coping strategies. Their goal is to guide individuals in discovering how to overcome harmful or destructive patterns. Their weekly classes include dealing with depression, anger, grief, PTSD, fear and finding peace. Living Free also supports families with classes on parenting, caring for aging parents, and restoring family relationships.
In addition to weekly classes, Living Free offers a thirteen-week recovery program called Stepping into Freedom, providing twice weekly classes to inmates of the county jail and can be a part of Carroll County court ordered treatment plans. Living Free is an evidence-based program claiming an 89% success rate.
Currently, in White County there are Living Free at two locations on Monday evenings. The classes run from eight to twelve weeks.
Dian and Ed Davis, directors of Carroll County Lifeline Connection and state leaders for Living Free, emphasize that “we want to meet people at their point of need. You don’t have to be at a certain level of maturity to benefit. You can come as you are. Our goal is to help people become the best version of themselves they can possibly be.” Living Free membership is open to anyone.
The Davis’ also mentioned that they are always looking for new facilitators. They need people who are stable, like-minded and have a heart for this volunteer ministry. Training is provided.
For more information on Living Free in White or Carroll County, please contact Ed or Dian Davis firstname.lastname@example.org or call them at 765-426-2062.
Lynn Saylor is the AmeriCorps member working with the United Against Opioid Abuse Initiative alongside the White County United Way. She is a major facilitator of the United Council on Opioids serving White County and a regular contributor to local media.