Detroit Recovery Oriented Systems of Care

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Detroit Recovery Oriented Systems of Care

• Implications for Prevention
• Calvin R. Trent Ph.D.
• General Manager
• City of Detroit
• Department of Health and Wellness Promotion
• Division of Special Population Health Services

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Brief Profile City of Detroit (A County
Within a County)

• Population 951,270 (largest city in the State
  of Michigan)
• Racial/Ethnic Composition 82 African-American,
  10 White, 5 Hispanic, 1 Asian, lt1 American
  Indian
• Estimated Number of People Addicted 10-12 (or
  90,000-108,000)

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Detroit Drug Abuse Patterns and Trends

• Cocaine is the foremost primary illicit drug of
  abuse among admissions to treatment programs.
• Users tend to be over 30, African- American or
  White, and of low socioeconomic status.
• Cocaine (including crack) was involved as either
  primary, secondary, or tertiary drug in 52 of
  all treatment admissions in Detroit/Wayne County
  in FY2002, and 50 in FY2003.

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Detroit Drug Abuse Patterns and Trends (contd)

• Heroin is the second foremost primary illicit
  drug of abuse among admissions to treatment
  programs.
• Users are typically male, over the age of 30,
  African-American and of low socioeconomic status.
• Heroin was involved as the primary drug in 29 of
  all treatment admissions in Detroit/Wayne County
  in both FY2002 and FY2003

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Detroit Drug Abuse Patterns and Trends (contd)

• Marijuana also accounts for admissions to
  treatment programs in the city of Detroit.
• Users are typically adolescents or young
• adults, and predominantly male.
• Marijuana was involved as primary, secondary,
  tertiary drug in 29 of all treatment admissions
  in Detroit/Wayne County in FY2003.

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Detroit Coordinating Agency (CA)

• Coordinates substance abuse treatment and
  prevention services through the current network
  of 45 treatment and 33 prevention providers.
• One of 15 specialized local public or
  quasi-public entities called Coordinating
  Agencies.
• The Detroit CA (that is, the Bureau of Substance
  Abuse Prevention, Treatment and Recovery) is
  organizationally placed within the Detroit
  Department of Health

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Detroit Coordinating Agency (CA) (continued)

• and Wellness Promotion (DHWP).
• The Michigan Medicaid behavioral health
  carve-out model has been in existence since
  10/1/98.

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The Old Paradigm Treatment As Usual

• The target of service in the Acute Care Model of
  substance abuse interventions is the individual.
• The interventions associated with this model are
  designed to
• Alter the beliefs and behaviors thought to
  sustain addiction, and
• Lower the biological vulnerability to addiction.

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Recovery-oriented Systems of Care

• Recovery-oriented systems of care (ROSC) are
  networks of formal and informal services
  developed and mobilized to sustain long-term
  recovery for individuals and families impacted by
  severe substance use disorders. The system in
  ROSC is not a treatment agency but a macro level
  organization of a community, a state or a nation.
  

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Recovery Management

• Recovery management (RM) is a philosophical
  framework for organizing addiction treatment
  services to provide pre-recovery identification
  and engagement, recovery initiation and
  stabilization, long-term recovery maintenance,
  and quality of life enhancement for individuals
  and families affected by severe substance use
  disorders.

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Looking Forward Recovery Management Model of
Care

• Individuals with Alcohol and other Drug problems
  are nested within complex relationships between
• Family
• Culture
• Society

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Recovery Management

• Each level of this social ecosystem can
  contribute to the development of, help resolve,
  or sabotage resolution of AOD problems.
• Recovery Management interventions target the
  whole ecosystem rather than the individual.

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Recovery Management

• Recovery Management moves beyond the clinical
  skills of assessment, diagnosis, and treatment of
  individuals to encompass
• Family reconstruction
• Community resource development
• Nation building

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RM with Communities of Color

• Premised on the belief that the community
• Is experienced through group solidarity with a
  historical and geographical community
• Is an essential dimension of personal healing and
  prevention of negative behaviors

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RM with Communities of Color

• From a Recovery Management perspective,
  Prevention efforts with communities of color must
  not segregate the threat of addiction from the
  multiple risks associated with the lives of
  individuals.

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RM with Families of Color

• Addiction is but one wound families of color have
  suffered via the intergenerational transmission
  of historical trauma
• The forced breakup of family units in slavery
• Indian boarding schools and their aftermath
• The family unit itself needs a sustained process
  of recovery from these wounds.

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RM with Families of Color

• The addiction-related transformation of family
  roles, relationships, rules, and rituals is
  deeply imbedded within family members and
  habitual patterns of family interaction and will
  not spontaneously remit with recovery initiation

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RM with Families of Color

• Developmental stages of family recovery (over
  first 3 to 5 years)
• Personal healing
• Realignment of family subsystems
• adult intimate
• parent-child
• sibling
• Familys relationship with the outside
  environment

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RM with Families of Color

• Sustained recovery monitoring and support for
  family members (particularly the youth) is as
  crucial as it is for the individual recovering
  from severe AOD problems.
• Families that do not have sufficient supports to
  make these difficult transitions risk
• Continuing the intergenerational cycle of
  addictive behaviors in the children
• Disintegration

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Resources for Recovery Management

• Individuals must have resources to initiate and
  sustain the recovery process.
• Ultimate goal of RM is to expand each communitys
  natural prevention and recovery support
  resources
• Physical
• Psychological
• Social

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Resources for Recovery Management

• We call these resources Recovery Capital, defined
  as
• The quantity and quality of internal and external
  resources that one can bring to bear in the
  initiation and maintenance of recovery.

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Resources for Recovery Management

• Successful Prevention strategies must include the
  development of resources to sustain the
  motivation to reject AOD as a lifestyle choice.
• We call these resources Prevention Capital,
  defined as
• The quantity and quality of internal and external
  resources that one can bring to bear in support
  of rejecting AOD use as a lifestyle option.

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RM, Resources, and Youth

• Building a community that is replete with natural
  recovery support resources will also be one that
  naturally promotes the development of Prevention
  Capital in its youth.

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Strategies to Improve Recovery Resources

• Introducing youth and families to local
  communities of recovery
• Conducting recovery-focused family and community
  education
• Seeding local communities with visible recovery
  role models
• Advocating pro-recovery social policies at all
  levels of government
• Normalizing conversation about AOD in cultural
  institutions (Churches, School, etc.)

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• For more information, please visit our website at
• www.drugfreedetroit.org