Create Recovery-Ready Communities

Introductory Paragraph

Substance use disorders (SUDs) continue to be a leading cause of death, a leading correlate in violent crime, and a major cause of lost productivity in the workplace. SUD recovery happens in communities, and community-based resources have been shown to positively affect SUD impact. Recovery is not just a matter of individual treatment or individual approaches combined with peer group support. The whole community plays a role in supporting successful recovery. A community response to SUDs provides social and economic support and impacts health at a community level. Recovery efforts have been improved for individuals who live within the community, by educating communities and creating continuity among support services, community-based services, and new innovations, such as recovery community organizations and other recovery support services. `

Recovery-Oriented Systems of Care (ROSC) provide coordinated community-based services that are person-centered and build strength and resilience of individuals, families, and communities. Community recovery is a voluntary process through which a community uses the assertive resolution of alcohol and other drug-related problems as a vehicle for collective healing, community renewal, and enhanced intergenerational resilience.

Key Information

Recovery support can look like many different things for individuals on their pathway to recovery. This is a crucial component of viewing SUD as a chronic disorder requiring long-term care. Individuals entering recovery through treatment, the criminal justice system, or on their own often face many challenges in early recovery. It is important that communities identify needs, examine what supports are available, and ensure those with the greatest need have access to these supports. Individuals who do not have these needs met are more likely to relapse. Communities that fund these supports help those in early recovery re-engage with the community, increase self-esteem, and become highly productive members of their communities. Providing effective recovery supports prevents relapse, the need to engage additional treatment and other services, and reduces the numbers of overdose. Communities that have invested in recovery supports have seen a substantial return on their investment both in financial and human terms.

Most recovery support services fall under the ROSC model. ROSC is based on the idea that severe substance use disorders are treated most effectively through chronic care management which involves outpatient care, recovery housing, recovery coaching, and management checkups. These are meant to be culturally sensitive and easy to navigate. ROSC follows recovery-related values and beliefs which include the following concepts:

• People who suffer from substance use disorder have essential worth and dignity.
• Stigma prevents many people from seeking help, and this must be combatted.
• There are many paths to recovery.
• Access to treatment is a human right, even though recovery might mean something more
• People who are in recovery, as well as their families, have valuable experiences and support to offer to those who are still struggling with substance use.

The recovery journey does not start in one place. Recovery is a critical asset in which communities need to invest. This includes removing barriers, so recovery can be sustained. Recovery-oriented approaches involve a multi-system, person-centered continuum of care where a comprehensive menu of coordinated services and supports is tailored to individuals' recovery stage, needs, and chosen recovery pathway. The goal is to promote abstinence and a better quality of life.

There are four primary domains in which recovery can be improved:

• Connections. Many recovery strategies come under the broad umbrella of improving connections. Isolation is the enemy of recovery. Connection includes regular contact with others in recovery across a number of peer-led support organizations. Connection includes access to direct support from peer recovery specialists and recovery coaches. Connections within the family are vital to help the family recover and to be able to support family members in recovery. Other connections include those made in the wider community and even regional/national organizations that can help foster connection to others who provide support for individuals in recovery.

• Recovery Housing. Perhaps the most basic support needed is housing and food. Without this there can be no security or the ability for focus on health and recovery. In many cases going home is not a safe option for those new to recovery. A stable housing situation is foundational and allows growth and progress in other areas to take place. There is a need to be able to find safe, affordable, and supportive recovery housing options in communities across the country.

• Education and Job Training. Finding meaning and purpose in one's life is important to all, but is especially critical to a person who has not found, or has lost, that purpose. The ability to get and hold a job, get a promotion, improve one's education, and become independent are all important needs for people in early recovery. Safe Solutions includes resources and information designed to help people in recovery develop the tools they need to find that purpose and achieve their goals.

• Collegiate and High School Recovery Support. Many in early recovery find recovery while still in high school or college. Many others enter high school or college after beginning their recovery journey. Building an infrastructure of recovery support within these specific communities is another area of focus, where it is possible to learn both where programs currently exist and the tools used by others to create these supports at colleges and high schools.

Here is a summary of specific recovery supports that communities can provide:

• Sober Living - Helps individuals transfer from treatment to independent living. For some individuals, returning to their previous living environment can be unsafe or not conducive to their recovery. Sober living offers individuals a safe, peer-to-peer recovery-oriented home with structure, accountability, and support. Typically, there are household duties in sober living that need to be fulfilled including rent, chores, curfew, etc. For more information about strategies for improving recovery housing, please see the Your Safe Solutions -- "Recovery Housing" page as well.

• Vocational Training - Substance use disorders could result in loss of job, job abandonment, or legal issues that may add additional barriers to obtaining employment. Vocational training can provide on-the-job training, remedial training, college training, and resume building. For more information about improving education, job training, and employment for people in recovery, please visit Your Safe Solutions -- "Improve Education, Job Training, and Employment for People in Recovery."

• Collegiate Recovery Programs - Helps students balance recovery and higher education. Provides support to students such as therapy, sober housing, and substance-free events. For more information on strategies to expand recovery schools and collegiate recovery programs, please see Your Safe Solutions page -- "Expand Recovery Schools and Collegiate Recovery Programs."

• Recovery Coaches - are people who have lived experience of substance use disorder and/or mental health conditions who provide non-clinical recovery support to their peers. They are not sponsors or alcohol and drug counselors. Recovery coaches can also be called Peer Recovery Specialists. There is a certification process that solidifies the Recovery Coach/Peer Recovery Specialist workforce.

• Peer-Based Recovery Support - Giving and receiving nonprofessional, nonclinical, peer-to-peer assistance to achieve long-term recovery from substance use disorders. Alcoholics Anonymous (AA) is the most common support group and is based on the 12 steps. All Recovery brings people together from multiple pathways of recovery. SMART Recovery or Self Management and Recovery Training, is guided by the 4-point program. The clients find and develop the power within themselves to change and lead fulfilling lives. For more information about how to strengthen peer recovery support services and programs, please see Your Safe Solutions -- "Peer Recovery Support Services & Programs."

• Harm Reduction - Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in and respect for, the rights of people who use drugs. For more information about strategies to expand harm reduction practices, please also see Your Safe Solutions -- "Expand Harm Reduction Practices."

• Medicated Assisted Treatment/Therapy (MAT) - uses medication and counseling to provide a whole-patient approach to recovery. Medications are FDA approved. MAT can help sustain recovery and prevent or reduce opioid overdose. Primarily, MAT is used for addiction to opioids, such as prescription pain killers and heroin. For more information on expanding access to MAT, please see Your Safe Solutions -- "Expand Access to Medication-Assisted Treatment."

• Criminal Justice - Substance use disorder and the justice system have a complex history. It is estimated that about one-half of state and federal prisoners misuse drugs or are addicted to drugs, but few typically receive treatment while incarcerated. For more information about strategies to support people who are criminal justice involved, please visit Your Safe Solutions -- "Recovery Supports for People in the Criminal Justice System."

Recovery-ready communities include internal and external resources that support and sustain recovery from SUD. Recovery capital is a term identified and linked to recovery-ready communities.

Recovery-ready communities also encompass individual, community, institutional and policy level Involvement and collaboration. A community that is recovery ready provides a continuum of care and support to those in recovery or seeking recovery support. Key components of a recovery-ready community are adequate detox and treatment facilities, the ability to address all pathways to recovery, harm reduction, youth recovery, recovery housing, prevention, recovery community organizations, family support, criminal justice involvement (police, court systems), and inclusion of special interest populations (faith-based, LGBTQ).

Examples of Recovery Support Services:

• Alternative Peer Groups: A comprehensive adolescent recovery support model that integrates recovering peers and prosocial activities into evidence-based clinical practice. These are community-based peer support programs that act as a liaison between residential treatment programs and mental health professionals. The purpose is positive peer support to maintain sobriety.

• Collegiate Recovery Support provides a supportive environment on campus to reduce the addiction cycle. Includes educational resources and recovery support.

• Jail & Prison-based Recovery Support programs and resources assist incarcerated individuals or those involved in the criminal justice system.

• Peer Recovery Coaching: Non-clinical peer recovery coaches who appropriately bring their own experience to the table while helping others on their recovery journey.

• Medication-Assisted Recovery: Recovery support programs that include medication-assisted treatment (MAT).

• Recovery Community Centers: A recovery-oriented hub in the community that offers recovery and family support services. It is peer-operated and may include coaching, education, peer-support, medication-assisted treatment, and employment resources.

• Recovery High Schools focus on academics and recovery and positive peer pressure.

• Recovery Housing: Substance-free living environments that support individuals in recovery from addiction.

• Community Task Force: SAMHSA provides 10 concrete steps that leaders can take for recovery-ready communities.
  • Bring people in recovery to the table early and often to create a shared vision of recovery.
  • Identify leaders in the recovery community
  • Identify recovery champions to support the effort and to be ambassadors for the cause.
  • Launch community visioning.
  • Assess community strengths. Where is recovery thriving?
  • Conduct a community recovery capital assessment to identify areas where recovery support and recovery-friendly policies are most prevalent.
  • Get creative and innovative.
  • Encourage friends, family, and colleagues to share their personal stories.
  • Create recovery community centers that make recovery visible on Main Street.
  • Celebrate recovery from addiction!

Community resources are vast and can include:

• • Recovery activism and advocacy aimed at reducing stigma
  • A full range of addiction treatment resources
  • Peer-led support, such as mutual-aid meetings, which seek to meet the diverse needs of the community
  • Recovery Community Organizations
  • Recovery support institutions, educational-based recovery support such as recovery high schools, colleges, recovery housing, and recovery ministries and churches
  • Visible and diverse local recovery role models
  • Resources to sustain recovery and early intervention programs, like employee assistance programs, and drug courts
  • Cultural capital. These resources resonate with individuals cultural and faith-based beliefs

Relevant Research

SAFE Solutions is an ever-growing platform. Currently no information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Impactful Federal, State, and Local Policies

SAFE Solutions is an ever-growing platform. Currently no information is readily available for this section. SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration. Please check back soon.

Available Tools and Resources

Community Listening Forum Toolkit. Provides guidance to taking action with building a recovery-ready community.

The Recovery Café Model allows those in recovery to have a safe place that "meets people where they are on the recovery continuum, engages them for a lifetime of managing their disease, focuses holistically on a person’s needs, and empowers them to build a life that realizes their full potential." The organization supports successfully replicating the model in additional communities.

Recovery-Ready Communities is a guide to recovery support services.

The SAFE Project Community Playbook serves as a blueprint and framework for rural, suburban, and urban communities to navigate an effective, collaborative response using a six-step approach.

• • Integrated-Forensic Peer Recovery Specialist (I-FPRS). This Training of Trainers equips participants to train Certified Peer Recovery Specialists and Supervisors to navigate the complexities associated with providing support to individuals who are justice-involved.

• • Treatment and Family Support Locator assists individuals and their loved ones in finding the best treatment for their needs, as well as programs, supports, and other services for friends and family of people caring for individuals with substance use disorder and/or mental health challenges. The locator is a collaboration between SAFE Project and the Partnership to End Addiction.

Recovery Oriented Systems of Care (ROSC) is a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resiliencies of individuals, families, and communities to achieve abstinence and improved health, wellness, and quality of life for those with or at risk of alcohol and drug problems. It is an approach advocated by SAMHSA, which has published a guidebook on ROSC. According to Ijeoma Achara, CEO of Achara Consulting, a ROSC is NOT:

• A Model
• Primarily focused on the integration of recovery support services
• Dependent on new dollars for development
• A new initiative
• A group of providers that increase their collaboration to improve coordination
• An infusion of evidence-based practices
• An organizational entity, group of people, or committee
• A closed network of services and supports

Dr. Achara continues to explain that a ROSC is:

• Value-driven APPROACH to structuring behavioral health systems and a network of clinical and non-clinical services and supports
• Framework to guide systems transformation

Promising Practices

No single program or innovation makes a community the ideal place to support recovery, but communities can add things and then integrate them with treatment and recovery services to create a community that provides more support and better options for people in recovery. Some examples follow:

• Community Gardening. Participation with a community gardening program can bring many benefits to people in recovery. It provides positive social interaction, skill building, improved access to healthy foods, and more. Ideally, involvement with community gardening could be integrated with peer-to-peer recovery groups, recovery coaches, tools like rTribe or Triggr, or a comprehensive success plan managed in a community care coordination platform like XCare Community.

• Fitness & Recreation-based Recovery. Programs like Phoenix Multisport in Colorado have demonstrated the power of having a recovery community that emphasizes active living and recreation.

• Men's Sheds. This concept originated in Australia in the late 1990s, and there are now more than 1,000 Men's Sheds in Australia with thriving movements in a growing number of other countries. Available buildings (such as vacant warehouses, foreclosed houses that have been possessed by the city or county, or vacant space in a retail center) can be donated, rented, or purchased to create a space for men to gather (it would not need to be limited to men, but that has been the roots). The space is then filled with tools, workbenches, and materials that can be used for the men to tinker, build, fix, and putter--all while building new social relationships.

• Operation New Hope is a model program that provides support and life-skills and job-skills training for citizens returning to the community after incarceration in the state of Florida.