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Recovery Management: Presentation Guidelines


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Title: Recovery Management: Presentation Guidelines

Recovery Management Presentation Guidelines
  • Bill White

Presentation Goal
  • Enhance each participants abilities to prepare
    and deliver presentations on RM ROSC via
    conference keynotes workshops, inservice
    trainings, and meeting presentations with key
    individuals and groups.

Learning Objectives Participants will be able
  • Define distinguish recovery management (RM) and
    recovery-oriented systems of care (ROSC)
  • Identify and discuss 8 areas of RM-related
    changes in service practice
  • Discuss tasks and tools for each of the 3 stages
    of effective RM presentations

Personal Perspective
  • Work in addictions field since 1969
  • 1998-2003 Behavioral Health Recovery Management
  • 2002-2008 presentation consultations on RM
  • 2005-present ATTC/Philadelphia DBH/MRS monograph
  • Gratitude to leadership team members

Your Personal Perspective
  • Each of you who present on this subject will need
    to build your own credentials and reputations on
    this subject.
  • No substitute for preparation You must become a
    serious student of this subject to avoid flavor
    of the month perception
  • I will suggest resources as we proceed that will
    help with this process.

Topical Resources
  • RM/ROSC Monograph Series, particularly the
    science monograph (2008)
  • RM/ROSC Papers at
  • Book Kelly, J. White, W. (Late 2010)
    Addiction recovery management Theory, science
    and practice. New York Springer Science.
  • Video of presentations from Philadelphia
    Atlanta PowerPoint Slides

Resources to Enhance Presentation Skills
  • Training of Trainer opportunities
  • The Training Life Full text available at
  • Menu of presentation slides
  • Availability of email/phone consultation with
    resource team, White, Achara, Laudet, etc.

Conceptual Language Clarity
  • Recovery management (RM) is a philosophical
    framework for organizing addiction treatment and
    recovery support services across the stages of
    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.

Recovery Management Stages of Recovery
  1. Pre-recovery identification and engagement
    (recovery priming)
  2. Recovery initiation and stabilization
  3. Transition to successful recovery maintenance
  4. Enhancement of quality of personal/family life in
    long-term recovery

Conceptual Language Clarity
  • 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.

RM ROSC Focus Today
  • My focus will be on how you as individuals and as
    teams can serve as presenters within a variety of
    educational venues within your respective regions
    to introduce the concept and practices of RM.
  • Dr. Achara will focus on how you can serve as
    facilitators and resource brokers for groups
    interested or involved in ROSC-related systems
    transformation processes.

Stages of Effective RM/ROSC Presentations Are
Like other Effective Presentations
  • 1. Pre-presentation Planning (Its all about the
    detailssetting, audience, message refinement)
  • 2. Clear Presentation Stages
  • --Opening
  • --Middle
  • --End
  • 3. Post-presentation Follow-up (information TA)

Stage One Opening
  • Spans 30-60 minutes prior to presentation through
    first 10 of presentation time
  • Multiple tasks to be achieved in narrow window of
  • RM/ROSC-related material can be threatening to
    multiple parties Opening tasks essential to
    enhance receptiveness

Tasks and Tools for Presentation Opening
  • 1. Resolve problems with presentation environment
  • 2. Early audience contact, assessment welcoming
    (refine message diminish distance)
  • 3. Engage
  • Initial presentation of selfwarmth,
    humility, respect, curiosity, confidence
  • Speaker identification with audience

Tasks and Tools for Presentation Opening
  • 4. Equalize presenter-participant power
  • --evaluate degree of power discrepancy
  • --increase or decrease your power
  • --control the introduction
  • --gage formality based on
    organizational/cultural context
  • --early participant involvement

Tasks and Tools for Presentation Opening
  • 5. Reduce resistance by acknowledging
    achievements of modern addiction treatment (See
    forthcoming slides as sample)
  • --Given such achievements, why does treatment
    need to be transformed?
  • 6. Create clear expectations via goals and
    learning objectives Let audience know you will
    answer the why question using treatment systems
    performance data and their own experience (where
    time format allows the latter)

Tasks and Tools for Presentation Opening
  • 7. Honor the participants contributions and ideas
    via praise gifts (resources, e.g., handouts,
    monographs, links, etc.)
  • 8. Create sense of historical personal urgency
    via your own commitment energy

Achievements of Modern Treatment Include
Elimination of Below
Achievements of Modern Treatment Include (To name
a few)
  • Replicable, community-based treatment modalities
  • Federal, state, local, private partnership to
    fund addiction treatment and ancillary support
    industries, e.g., research, training, etc.
  • Accessibility From less than 50 to more than
    13,000 U.S. specialty treatment programs

Achievements of Modern Treatment Include
  • Professionalization of addiction medicine
    addiction counseling
  • Systems of early intervention, EAP, SAP, SBIRT
  • Screening/assessment/diagnostic tools
  • Continuum of care
  • Millions of lives touched and transformed
  • Background Source Slaying the Dragon

Core Presentation Tasks
  • Core of Presentation Must Answer 7 Questions
  • Why does addiction treatment need to be
  • What changes in frontline service practices
    occur in the shift to recovery management?
  • What changes in administrative, regulatory,
    funding practices can be anticipated as part of
    an RM/ROSC transformation process?

Core Presentation Tasks
  • 4. How will this process of systems
    transformation be achieved?
  • 5. Who will be involved in systems transformation
    (and how will it affect my role)?
  • 6. When will this process begin and how long will
    it take?
  • 7. What obstacles should we anticipate?

Core Presentation Tools
  • Craft a presentation using a mix of the following
    based on the audience characteristics and the
    time available
  • Findings from scientific research
  • Treatment systems performance data (localize
    where possible)
  • Video Internet Resources
  • Self-disclosure / Stories
  • Structured discussions and learning exercises

Critical Content Areas
  • I will focus in this first presentation on how
    you can best answer
  • Why does addiction treatment need to be
  • What changes in frontline service practices occur
    in the shift to RM?

Impetus for Change
  • 1. Cultural and political awakening of
    individuals/families in recovery
  • Growth/diversification of mutual aid
  • New recovery advocacy movement
  • New recovery support institutions
  • Tell this story in pictures
  • Resources Lets Go Make Some History

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Impetus for Change
  • 2. Frustration of frontline addiction
  • 3. Addiction science, particularly research on
    addiction/recovery careers, treatment outcome
    studies treatment systems performance data

Impetus for Change
  • 4. Addiction treatment payors
  • 5. Need to counter growing cultural pessimism
    about treatment, e.g., effects of celebrity rehab

RM ROSC Part of Shift in Emphasis within 3
overlapping Governing Constructs
  • Pathology Paradigm Knowledge drawn from study
    of the etiology and epidemiology of substance use
  • Intervention Paradigm Knowledge drawn from
    study of social and clinical interventions into
    severe AOD problems
  • Recovery Paradigm Knowledge drawn from the
    study of long-term addiction recovery

Limitations of Acute Care Approach to Addiction
  • Modern treatment has focused on an acute care
    model of addiction treatment
  • Define AC Model
  • Extol what the AC Model can achieve
    biopsychosocial stabilization more effectively,
    more safely for more people than has ever been
    achieved in history
  • Treatment Works, BUT Recovery initiation does
    not assure recovery maintenance for people with
    high problem severity / low recovery
    capitalantibiotics analogy

Limitations of Acute Care Approach to Addiction
  • Discovery that addiction shares many
    characteristics with other chronic medical
    disorders (McLellan, et al, 2000)
  • Growing interest in How would we treat
    addiction if we really believed that addiction
    was a chronic disorder?, e.g., how models of
    disease management in primary health care might
    be adapted to long-term management of addiction

AC. RM key recovery performance measures
  • Each of you will need to personalize and localize
    presentation of this material, but following 8
    elements are essential
  • Review current AC model performance limitations
  • Outline current future directions of RM-models
    of care

8 Key Performance Arenas Linked to Long-term
Recovery Outcomes
  • Attraction, access early engagement
  • Screening, assessment placement
  • Composition of the service team
  • Service relationship
  • Service dose, scope quality

Key Performance Arenas Linked to Long-term
Recovery Outcomes
  • Locus of service delivery
  • Assertive linkage to communities of recovery
  • Post-treatment monitoring, support and early
  • NOTE There are others but these 8 are most

1. Attraction, Access Early Engagement
  • AC Limitations
  • 10 25 data late stage and under coercion
    waiting list drop-out data attrition data (more
    than 50 will not complete)
  • RM Directions
  • Assertive community education outreach
  • Assertive waiting list management
  • Lowered threshold of engagement rethinking
    motivation institutional outreach
  • Changes in administrative discharge policies

2. Screening, Assessment Placement
  • AC assessment is categorical, pathology-focused,
    professionally-driven, an intake function
    focused on individual placement based on problem
  • RM assessment is global, strengths-based, client
    focused (rapid transition to recovery plans),
    continual and encompasses the individual, family
    and recovery environment recovery capital
    factored into placement decisions.

3. Composition of the Service Team
  • AC model uses disease rhetoric but few medical
    personnel recovery rhetoric but decreasing
    involvement of recovering people.
  • RM expands role of medical (including primary
    care physicians) and other allied professionals,
    recovering people (P-BRSS) and culturally
    indigenous healers. Also emphasizes reinvestment
    in volunteer and alumni programs.

4. Service relationship
  • Acute Care Dominator model emphasis on
    professional authority great power discrepancy
    role of client is one of compliance.
  • Recovery Management Sustained recovery
    partnership (long-term consultation) model
    emphasis on prolonged continuity of contact
    client as co-leader philosophy of choice
    greater use of personal/professional self
    contrasting ethical guidelines.

5. Service Dose, Scope Quality
  • AC model has become ever briefer, narrower via
    reimbursable services continues to incorporate
    methods lacking scientific support.
  • RM model emphasis on importance of dose (NIDA
    principles90 days), role of ancillary services
    and weeding out practices that are not linked to
    recovery outcomes or that may produce inadvertent

6. Locus of Service Delivery
  • AC model locus is the institution How do we get
    the individual into treatmentget them from their
    world to our world?
  • Problem of transfer of learning
  • RM model emphasizes the ecology of long-term
    recovery How do we nest recovery in the
    natural environment of this individual or create
    an alternative recovery-conducive environment?
  • Healing forest metaphor (Coyhis)
  • Concept of community recovery

7. Assertive linkage to communities of recovery
  • AC Model Passive linkage, low affiliation and
    high early attrition, single pathway model of
  • RM model Assertive linkage, multiple pathway
    model of recovery, linkage beyond recovery mutual
    aid groups active relationship with local
    service committees, involved in recovery
    community resource development

8. Post-treatment Monitoring, Support and, if
needed, Early Re-intervention
  • 50-80-90 rule More than 50 of clients
    discharged from Tx will return to some use in the
    next year80 of those will do so in first 90
    days after discharge.
  • 15-25 rule The stability point of recovery
    (risk of future lifetime relapse drops below 15)
    isnt reached until 4-5 years for alcohol
    dependence 25 of opioid dependent persons who
    achieve five years of abstinence will later
    resume narcotic addiction.

8. Post-treatment Monitoring, Support and, if
needed, Early Re-intervention
  • 25-35 of clients who complete addiction
    treatment will be re-admitted to treatment within
    one year, 50 within 2-5 years (Hubbard, et al,
    1989 Simpson, et al, 2002).
  • An Acute Revolving Door Of those admitted to
    the U.S. public treatment system in 2003, 64
    were re-entering treatment--23 accessing
    treatment the 2nd time, 22 for the 3rd or 4th,
    and 19 for 5 or more times (OAS/SAMHSA, 2005).

8. AC Model Aftercare as an Afterthought
  • Post-discharge continuing care can enhance
    recovery outcomes (Johnson Herringer, 1993
    Godley, et al, 2001 Dennis, et al, 2003).
  • But only 1 in 5 (McKay, 2001) to 1 in 10 (OAS,
    SAMHSA, 2005) adult clients receive such care
    (McKay, 2001) and only 36 of adolescents receive
    any continuing care (Godley,et al, 2001)

8. RM Model Assertive Approaches to Continuing
  • Post-treatment monitoring support (recovery
  • Stage-appropriate recovery education coaching
  • Assertive/continued linkage to recovery resources
  • Early re-intervention re-linkage to Tx and
    recovery support resources
  • Recovery community building

Closing of Presentation Summation
  • Outlined 5 sources of impetus for shift to a
    model of sustained recovery management
  • Outlined 8 areas of service practice that
    significantly change in the transition from AC to
    RM model
  • RM/ROSC do not eliminate AC model, but wrap the
    AC model in RM technologies for those with severe
    AOD problems and low recovery capital
  • Add ROSC points from Dr. Acharas presentation on
    RM/ROSC transformation process.

Closing of Presentation Express a Sense of
Historical Urgency
  • It will take years to transform addiction
    treatment from an exclusively AC model of
    intervention to a RM model of sustained recovery
  • The future of addiction treatment and recovery
    will hinge on well how we are able to achieve
    this task.

Closing of Presentation Make It Personal Open
It Up
  • The personal/professional destinies of some of
    you in this room are linked to leadership in this
    emerging movement. For some of you, your whole
    lives have prepared your for this unique moment
    in the fields history. (Extend invitation for
  • Again expression your gratitude for the
    invitation to present open for further
    questions, comments and personalization of

Concluding Note on Preparation and Presentation
  • Parallel Process What you want to convey to
    your audience is the very essence of the
    transformation experience, e.g., focus on
    engagement, tolerance, respect, personal and
    system strengths, partnership, honesty
    (transparency), and commitment to continuity of