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Day 4 People MoversFACILITATOR Before you begin the session remember to ALWAYS BE MINDFUL OF TIME and ALWAYS BE WATCHING THE ROOM.PREPARATION – Tables are set, Day 2 Welcome Slide displayed on the screen, all video has been checked, sign-in sheet out and manuals available. Preparation from Day 1 – ask participants if anyone has an index card they want to hand in for boundary issues or recovery coach scenarios.Connections, Review, Seat Change & Agenda 30 minutesFACILITATOR Invite individuals to partner with someone they’ve not spoken with and speak about anything they want for 4 minutes. Set timer. People may guffaw – use your professional skills to get them up out of their seats and moving. Emphasize this is the last day of networking and partnership building.Que up previous day topic When timer sounds instruct group to gather in larger groups. Provide one specific topic from prior days topics (ON SLIDE) for group discussion for 4 minutes. Set timer.Upon completion of this group activity invite participants to line up using your own method for seat change. Or, instruct to change seats as you deem appropriate.Instruct participants to move to new tables, grab all of their things. When seated invite them to say hello to their new neighbors. Begin review of previous day materials.SLIDE_____Previous day topicsWelcome & Review & ConnectionsSpectrum of AttitudesCultural AwarenessMC Affirmations & SummariesTrauma Sensitive Care Building Rapport – Sharing Your StoryBuilding Rapport – Boundary ManagementReviewWhen timer sounds instruct group to gather in larger groups. Provide one specific topic from prior days topics (ON SLIDE) for group discussion for 4 minutes. Set timer.When the timer sounds thank the group for the active offer instructions to change seating (optional). When participants move to their seats for the day invite them to say hello to their new group members.Regroup and review day’s agenda as a groupAgenda Day 4 – People MoversTIMEWelcome & Review & Connections30Recovery Capital60Pathways of Recovery45Wicked Smart Goals45Wants V Needs 30MC OEQs & Reflections45Role Practice45Understanding MAT30Harm Reduction 45Review15------------------------------------------------End Module---------------------------------------------REcovery Capital – Building MusclePage1 HourSTATE Robert Granfield and William Cloud introduced and elaborated on the concept of “recovery capital” in a series of articles and a 1999 book, Coming Clean: Overcoming Addiction without Treatment.SLIDE _____Granfield and Cloud define recovery capital as the volume of internal and external assets that can be brought to bear to initiate and sustain recovery from alcohol and other drug problems.Recovery is not just about abstinence but about improvements in all areas of an individual’s life.Resolving AOD problems is not just a matter of abstinence or symptom reduction. Recovery involves improvements in functioning, psychological well-being and quality of life.SLIDE _____Much of the current SUD research demonstrates that professionals understand how to initially stop substance use, meaning that these professionals know how to medically detox someone from opioids, alcohol, and other sedative-hypnotics, and ensure that the patient is clinically stable.We have been less successful in:preventing the fire from restarting— preventing relapseproviding the architectural planning for reconstructing that person’s life once the fire is out—providing access to the building materials— recovery capital— necessary to reconstruct their lives.granting the “rebuilding permits” needed to allow the recovery process to begin. E.g., If someone has a criminal record, for example—often directly related to their substance use—they often cannot get a job, housing, or a loan for college or job training. FACILITATOR - CIRCLE BACK TO THE PIE and THE ROLE OF A RC TO HELP MAKE THE LIST OF INGREDIENTS TO Fill the pie.Recovery coaches begin to help individuals build the foundation of the ruins from the ground up with empathy, understanding, and empowerment.SLIDE _____Recovery coaches advocate for systems change to increase and support recovery capital, thus improved outcomes for recovery = improved outcomes for families and society.Recovery capital, or recovery capacity, differs from individual to individual and differs within the same individual at multiple points in time. William White 306070016446500STATE: Reference back to SAMHSA's 4 Dimension of the Recovery Process and as we discussed earlier, many addiction behaviors lead to the destruction of one having a relationship with the world. Loss of family, jobs, housing, health are all possible outcomes from SUD. With these losses being of high significance in anyone having a purpose, or a relationship with the world, how then do we help people find recovery?SLIDE _____By building the muscle of resilience through building recovery capital sustained recovery can be achieved.Recovery is a lifelong process.FACILITATOR asks the class for one or two examples of internal recovery. Then, ask for examples of external recovery. ACTIVITY Instruct participants to work as groups to create a list of internal and external recovery capital. Provide some examples if necessary. Offer 7-10 minutes and set timer. When timer sounds draw group to the center of the room and create one master list by going around the room and asking for two ideas from each group. Start with Internal, when exhausted, move to the external list.Internal Recovery CapitalExternal Recovery CapitalUpon completion of extensive lists Emphasize with conviction – this is the job of a recovery coach! This is how sustainable recovery is achieved. STATE – all of these examples of recovery capital are healthy behaviors. Emphasize, by introducing and emphasizing patterns of healthy behaviors to replace the patterns of unhealthy behaviors a person’s Hedonic set point will be rehabilitated.This is how we become people movers. Every engagement we have with a recoveree can be discretely geared towards building resiliency muscle or recovery capital.SLIDE _____ "Increases in recovery capital can spark turning points that end addiction careers, trigger recovery initiation, elevate coping abilities, and enhance the quality of life in long-term recovery" (Cloud & Granfield, in press; Laudet, Morgan, & White, 2006). 31178501270000SLIDE _____It is important to recognize that clients may come to you with high problem severity and high recovery capital. These individuals might require a different approach to achieve sustainable recovery management than someone with high problem severity and low recovery capital.Group Discussion:What might a person with HPS and HRC look like?What might a person with HPS and LRC present?SLIDE _____How do you measure someone’s Recovery Capital? Ask for group responses to the above question? Some may say QOL survey, BHI survey, etc. Endorse there are many ways to measure someone's RC.See Recovery Capital Index Scale by William White (in additional materials) _____Recovery Capital strengthens Muscular Spirit and restores the Muscular Hedonic SetpointPeer support specialists, through the use of MI, use SMART goal setting as a primary tool for building recovery capital and forward movement.FACILITATOR: Review the next 2 pages, Choices Recovery Capital Blueprint ?. If time permits, invite participants to fill out the form individually. Or, set up partners for a role practice. This tool was created by Choices as a map to improved health and well-being. STATE: Every agency will have their own Recovery Capital Plan.Choices Recovery Capital Blueprint?Life, it’s one thing to have one, it’s the participation in it that helps one meet their dreams.Mapping out your build your resiliency muscle.Scale of 1 – 10, 1 being the worst and 10 being the best.Questions without a scale can be answered by yes or no, or define.QuestionsScale ResponseNotesPURPOSEWhat positive changes would you like to make?What brought you in here today?How willing are you to do whatever it takes?Do you have or have you ever had any goals?How hopeful are you about your future?1-10DRUG USE GOALSAre you having thoughts/obsessions?1-10How’s your medication Management?Are you consuming any other drugs?What are your drug use goals?PHYSICAL1-10Describe your eating patterns.What type of liquids do you drink?1-10Do you take vitamins?What type of exercise do you like?How are you sleeping?How would you rate your hygiene?Are you able to shower and cleanse regularly?Are you able to provide clean clothes?1-10EMOTIONAL1-10How would you rate your anxiety?What is your self-talk like?What are your thoughts about counseling?How do you reduce stress?1-10LIVING ACCOMMODATIONSHow would you rate your living situation?Do you feel safe in your housing?Are you looking for housing/need help?Are you able to pay your monthly bills?1-10Are you able to pay for food?Are you in need of any furniture or essentials?DAILY LIVINGHow would you rate your transportation?Do you have a license?Do you need help getting one?Do you have an ID?1-10Rate your involvement with CJDo you have any warrants for arrest?Do you have any open court cases?Do you have any outstanding fines?1-10Are you on probation or parole?FINANCIALRate your financial securityDebt collections/outstanding debts?Outstanding income tax returns?Outstanding child support or alimony?1-10What do you know about credit scores?Do you have a bank account/need help?Need assistance budgeting and planning/bills?SCHOOL/WORKHow would you rate your job satisfaction?Is going to school or Voc Tech a goal? Are you able to get to work daily?Are you able to dress for work daily?1-10Do you need support with daycare?Do they seem attainable? Would you like tomake some?1-10QUALITY OF LIFEHow satisfied are you with your quality of life?What would you like to see happen to improvethis score?How hopeful are you about your future?1-10SPIRITUALITY – RECOVERY CONNECTIVITYWhat does spirituality mean to you?1-10How would you rate your spirituality?What recovery programs have you tried?If you had everything you wanted, what would your life look like to you today, in 3 years, in 10 years?1-10SOCIALDo you have anyone supporting you unconditionally?Do you have friends that don’t use substances?Describe your relationships with family.PATHWAYS OF RECOVERYPage45 minutesSLIDE _____How do Recovery Coaches help build this resiliency muscle?ONCLICKPathways Of Recovery Improved Well-being – whole health focusRecovery-Oriented System of CareBuilding Rapport - Roles of a Recovery CoachONCLICK- TRUE OR FALSEQ. Anyone who wants to stop using drugs or alcohol must attend one of the mutual aid groups like AA or NA or they won’t be successful.SLIDE _____“Long-term recovery involves a rebirthing and assertive reconstruction of one’s life across multiple zones: physical, cognitive, emotional, relational, and spiritual health—all unfolding and evolving across the stages of life and within one’s unique personal responsibilities and aspirations. “William White(Source, )3303270647319000Seven Recovery Wellness Domains (White) Recovery ConnectivityPhysicalEmotionalSpiritualLiving AccommodationsSchool/WorkDaily LivingFACILITATOR Refer back to the list of internal and external recovery capital and make a correlation between those lists and the seven recovery wellness domains.SLIDE _____Why can’t people just stop?ACTIVITYFACILITATOR: Place as many sheets as necessary of flip chart paper on a wall horizontally. Maybe 4 to make a box shape, or 2 if the class is small.OPTIONAL ACTIVITY If time permits (If time-restricted generate a brief conversation only): Draw a circle and label it in the center “HERE.” Ask participants how they got “here?” Give yourself as an example. I got here by way of joining the Army, meandering around for a few years to find my purpose, working for Marriott, starting a magazine, becoming an alcoholic and now I’m HERE. Draw a dot or stick person to represent you outside of the HERE circle and then draw a curvy line from the stick person to here to represent your pathway. Proceed around the room and ask others to do this quickly.These represent pathways. Draw stumbling blocks and doorways around the map. POINT: No one got here the same way. We all have different circumstances, even today, as we all sit HERE in this space and time, we are all different. Recovery, just like the disease, is a personal journey. STATE: People with stage 4 lung cancer did not acquire that all in the same way. Diabetes, heart disease, on and on. It was their journey to that disease (remember the pathways To recovery activity we did earlier) that will dictate the way out. This is a hard concept for people to embrace. ONCLICKRemember…The chemical has hijacked the brain, the cerebral cortex is damaged.Substances trick the brain's rewards system.A Person must work to replace old behaviors with new behaviors.PROCEED WITH PATHWAYS OF RECOVERYThe addiction recovery experience has been sliced and diced in all manner of categories: secular, spiritual, and religious; natural recovery, peer-assisted, and treatment-assisted; and abstinence-based, moderation-based, and medication-assisted, to name just a few.? Recovery achieved through any of these frameworks is often referred to as a pathway of recovery.? The growing consensus that there are multiple pathways of long-term addiction recovery marks an important public and professional milestone within the alcohol and drug problems arena.Progress has been made by recovery-focused research scientists on mapping recovery pathways and noting their distinctive and shared qualities. This classification work is important as long as one does not lose sight of the fact that reality is often far messier than such pristine categories would suggest.? Or put another way, “the recovery map does not always accurately depict the territory.”?063500The image of pathways suggests a crossroads with distinct options?that call for clear decision-making or voiced guidance from some GPS of addiction recovery.Long-term recovery involves a rebirthing and assertive reconstruction of one’s life across multiple zones: physical, cognitive, emotional, relational, and spiritual health—all unfolding and evolving across the stages of life and within one’s unique personal responsibilities and aspirations. (Source )Some Pathways Of Recovery include:SLIDE _____Levels of clinical carePharmacology – MAT/MARAlternative therapies – Acupuncture, Hypnosis, Meditation, Yoga, Guided Imagery, ReflexologyCreative Therapies – Art, Music, Dance & Movement, DramaAnimal Assisted – Equine, CanineSpecialized – Wilderness, NatureAcceptance & Commitment Therapy (ACT) and Cognitive Behavioral Therapy (CBT)Intensive OutpatientTraditional Counseling/TherapyOral HealthHarm ReductionSLIDE _____Non-Clinical PathwaysRecovery ResidencesRecovery Community CentersPeer-based Recovery SupportEducation-based Recovery SupportEmployment-based Recovery SupportFaith-based Recovery SupportMutual Aid Groups (AA, NA, HA, GA, EA, Celebrate Recovery, SMART Recovery, All Recovery)Reiki, Yoga, Acupuncture, Music Therapy, Art Therapy, Drum Therapy, Equine Therapy, Pet Therapy, etc.Phone Apps (, , My Spiritual Toolkit, etc.)Harm ReductionSLIDE _____Self-Management PathwaysHolistic – Spirituality, Prayer, Honesty, Understanding, Self-awareness, Healthy Boundaries, Coping Skills, Problem Solving, Sleep-management, Nutrition, Exercise, Self-discipline, Integrity, Optimism, Gratitude, Mindfulness, PurposeExternal – Job, Housing, Transportation, Access to Health-care, Parenting, Family & FriendsHarm Reduction“Recovery by any means necessary under any circumstances.”William White? These are only some options for people. The person defines. Sometimes quickly, sometimes slowly. Let go of the outcome.STATE: These are only some options for people. Not knowing what will work for each person is what makes the job of a peer coach even more challenging.ASK for other pathways not listed and write on a flip chart. There is space in manuals for participants to write down additional pathways. Invite participants to take pictures of the master flip chart. SLIDE _____SAMHSARecovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.ONCLICKThe GOAL: Improved Health & Well Being – whatever that means to you.NOTE: IN ADDITIONAL MATERIALS IS A LIST OF DESCRIPTIONS OF SOME OF THESE PATHWAYS THAT CAN BE HANDED OUT TO RECOVEREES TO EXPLORE OR DISCUSS IN PERSON.------------------------------------------------End Module---------------------------------------------Wicked Smart GoalsPage45 minutesFacilitator instruct participants to turn to their Choices Wicked SMART Goal worksheets in the manuals.Review the slide that corresponds with defining the smart goals.Invite participants to process through the worksheet individually. Provide 7 minutes to do this. When timer sounds, invite participants back to the center of the room and share any outcomes.IMPORTANT: Inform participants that they can use a real-life goal or a made up one because they will be sharing this goal with a partner later on in the activity.ASK:Did anyone have any a different goal at the end than when they started? Does anyone want to share any experience?Allow 5-7 minutes for participants to share.NEXT: Refer to slide that outlines “back-staging.”SLIDE _____Example of back-staging:GOAL: Get a driver's license or ID.What might be some preparation steps need to achieve this goal?3. Get a ride to the center 2. Get a birth certificate1. Get $20.00 for the fee~ Have group discussion to ensure clarity on back-staging and small goal setting.SLIDE _____Goal setting is an important skill in peer coaching.It can set a person up for success or failure.Lofty goals can overwhelm a person and they may NEVER come back – HIGH RISK.Supporting peers in setting their own goals allows Recovery Coaches to Let Go of Outcomes.See Wicked Smart Goal Worksheet on next page.---------------------------------------------------End Module------------------------------------------------People Movers – Wants Versus NeedsPage30 minutesSLIDE _____STATE: Throughout this training, we've discussed the roles of a peer coach. We've discussedMeeting them where they’re at – finding out where they’re atForward movement and progressBuilding Trust and RapportAutonomy, empowerment and support self- efficacyHelp find/identify purpose and goalsHow do we deliver all of that?SLIDE _____Staying Solution Focused - Wants Versus NeedsWant a desire for something; to possess something; "I want an apple"Need: circumstances in which something is necessary, or that require some course of action; "the basic human need for food"Review Maslow's Theory on the slide.FACILITATOR Instruct participants to take 5 – 7 minutes to fill out the section below with 5 wants and 5 needs at this time. Set timer for 5 minutes. If the group seems finished proceed. If not, offer 2 more minutes. Set timer if necessary. NEEDWANTACTION: When the group is done, create a discussion around what participants wrote and discovered. ASK for examples of what a person new in recovery might come in and indicate their needs are?Make a list on the flip chart. Review Maslow’s Hierarchy of Needs again and discuss basic needs versus wants.Maslow’s Hierarchy of Needs Source: , research tells us recovery is made more difficult without basic physiological and safety needs met. These are the first steps for a recovery coach.How do you, as a recovery coach, engage with a person to help them to understand that their identified needs are wants (goals – to work towards) and foundation recovery principles require basic needs met.This is a tough conversation and takes skill and practice. It can be made easier through the use of tools.E.G., Recoveree presents with needing the court off his back; that the court insists he remains abstinent.SLIDE _____What is a recoveree doesn’t “want” to engage? How do you engage? What is your role?FACILITATOR Engage class discussionSLIDE _____What can we do today to move you towards what you want?How can I help you in your path today?What does your drug use look like in 1 year? 3 years?What are you willing to do?----------------------------------------------------End Module--------------------------------------------------MC OEQs and Reflections Page1 HourFACILITATOR Introduce the next section of MC learning, Open-Ended Questions, and Reflections. Begin by reviewing the definition of MI – enforce Empowerment and Managing our Stuff. Explain that using MI, allows the user to place the outcome on the recipient which results in improved boundary management and self-care.SLIDE _____REVIEW: Motivational Conversation is Motivational Interview for peer coaches; a conversation designed to strengthen an individual's motivation for and movement toward a specific goal (which requires a change of behavior) by eliciting and exploring the person's reasons for change within an atmosphere of empathy and curiosity. SLIDE _____Motivational Conversation (MC) is used with Intention – deliberate and on purpose. As you engage with a client, the goal is to MOVE towards a change. Not get stuck in conversations about the past. FACILITATOR review the key concepts of MCSLIDE _____REVIEW KEY CONCEPTS OF Motivational Collaboration or Motivational Conversation3840480-15864900Active Listening – already discussedOARS (Open-Ended Questions, Affirmations, Reflections, Summaries)Develop Discrepancy Roll with ResistanceAvoid the Expert TrapChange TalkDARN CATFACILITATOR: Review Active Listening bullet points and provide examples or interactive discussion.SLIDE _____Tips for Effective Active Listening – A SkillShhhhhh. Listen more than you talk – 70/30Avoid interrupting - finishing sentencesDon’t’ try to solve the problemLearn to let go of the outcomeBE Present – leave your stuff outsideIntentional – an action performed awareness, done deliberately, consciously and on purpose.Pause, count to 3 before respondingDIG DEEPBe curiousListen generously Give spaceEmpathySLIDE _____Three forms of counseling style:Directing - basically telling someone what their next step should be and what they should do.Following - no agenda, structure, or input, openly listening and following where the client wants to go.Guiding – soliciting the individual's ideas and willingness; helping them take ownership through Open-Ended Questions and Reflections.ASK Which style prompts the best outcomes?SLIDE _____FOLLOWING. Why?Honors the person and where they’re atBuilds trustSupports self-efficacy – choice & empowermentFACILITATOR STATE In addition to active listening, a key MC skill is OARS:SLIDE _____O.A.R.S.Open-ended questions rather than yes/no questions. 3 to 1 R to OEQAffirm strengths, validates, and movement in a positive direction.Reflect what the patient says to convey that you are listening and confirm understanding.Summarize the interaction to bring closure, confirm mutual steps understanding and next steps. Beginning & end.SLIDE _____ “O”Open-Ended Questions (OEQs)Cannot be answered with yes or no or with one or two wordsAre not rhetoricalProbe for informationAvoid socially desirable responseDraw people outEngage peopleSimple or complex (complex is more advanced)Help uncover the person’s priorities and valuesClosed-Ended Questions (CEQ)Are one, or two-word answers such as Yes or no; numbers or data mining (e.g., when was the last time you used? Where did you work last?)SLIDE ___Exercise – Check off the Closed-Ended Questions:What brought you here today?Do you think of yourself as depressed?Do you have on average 3 or more drinks a day?How do you feel about being in this program?Did you graduate from high school?How old are your children?Do you like your job?What are the most important reasons for you to do this?Did you ever do something difficult like this before?If you decide to do this, how will you go about it?Tip: Change almost any closed-ended question to an open-ended question by replacing or eliminating the first one or two words. FACILITATOR EMPHASIZE THAT QUESTIONS CAN SOUND LIKE STATEMENTS AND THAT IS A GOOD THING. Example: You have an average of 3 or more drinks a day, or you drink each day. Could be a statement or a question.SLIDE _____ReflectionsOne of the MOST important skills in MCA response to a speaker's statement is a clear assertive statement, reflecting what the speaker said or meant.It is a process of Hearing what the speaker said & Checking our understandingStating it back to them with different wordsGuessing what they mean, reaching, hypothesizingLet’s the speaker hear their own words****Rephrase or Mirror are alternative ways of thinking of ReflectionsSLIDE _____Two categories of reflections, Simple and ComplexSimple ReflectionsRephrase or simple repeat/mirror of what was said.You’re feeling…You’re wondering if…You’re not happy with…In other words, you’re saying…You’re struggling with…Let me see if I heard you correctly…You’re afraid that…You’re saying…SLIDE _____Complex ReflectionsA Complex Reflection takes a simple reflection AND ADDS significant new meaning.Amplified-the person’s statement is taken to the extreme.This (behavior) doesn’t cause you any problems.Affective (feelings) – reflect the feeling or emotion being expressed.You feel…This is scary…Double-sided – reflects back the ambivalence or pros and cons.One the one hand…and on the other…Continuing the paragraph – the listener finishes the statement.You’re not sure which direction to go.This is important…Guessing the unexpressed – guess at what is underlying the statement (what do they value, label the feeling).Metaphor – uses a metaphor to restate the person’s statement.You’re on the fence.Emphasizing Personal ChoiceThis is your choice.It is up to you.Siding with the Negative (relationship dependent-must have a good one)You would rather stay in the same place and not move plex reflections are covered more in advance MI trainings.SLIDE _____TIP:Avoid ‘Sounds like…or What I hear you saying is'…as it can be interpreted as a CANNED conversation. Initially, you may default to these statements and that's ok. Be mindful and correct/adjust as you practice and improve.SLIDE _____The tone is essential for positive outcomes and building rapportREMINDERIntonation is variation of spoken pitch that is not used to distinguish words; instead it is used for a range of functions such as indicating the attitudes and emotions of the speaker, signaling the difference between statements and questions, and between different types of questions, focusing attention on important elements of the spoken message and also helping to regulate conversational interaction. PAY ATTENTION TO WHAT YOU ARE SAYING AND HOW YOU ARE SAYING IT. IS IT CANNED OR GENUINE?SLIDE _____Process of an Intentional Motivational Conversation/Coaching1. Affirmation2. Summary3. OEQ4. Reflections – 2 or 3 to 1 OEQ5. Affirmations in sprinkled throughout6. OEQ gets you unstuck – moves the conversation forward7. Summary gets you unstuck – moves the conversation forward8. Summary closes the encounterACTIVITY Part 1 Instruct participants to find a partner, someone they’ve not yet worked with. Once partners have been secured proceed with further instructions. SLIDE _____OEQs and ReflectionsDetermine who will go first as the speaker (recoveree)7 Minutes to discuss one challenge in your life right now (a relationship at work or personal, budgeting, balancing life/work, self-care, etc).SLIDE _____ACTIVITY Part 2 BEFORE BEGINNING, REMIND PARTICIPANTS OF ACTIVE LISTENING SKILLS:Shhhhhh. Listen more than you talk – 70/30Avoid interrupting - finishing sentencesDon’t’ try to solve the problemLearn to let go of the outcomeBE Present – leave your stuff outsideIntentional – an action performed awareness, done deliberately, consciously and on purpose.Pause, count to 3 before respondingDIG DEEPBe curiousListen generously Give spaceEmpathyFACILITATOR Set timer for 7 minutes. When timer sounds, offer 1 minute to summarize and close encounter. Set timer. When timer sounds bring attention back to the center of the room for feedback. ASK How was that for the listener? How was it for the speaker?Speakers, were you a problem solver? Did you interrupt? Were you present?Allow 3 minutes for debriefing and instruct participants to switch roles. The 2nd partner shares what they discovered about their results. Set timer for 7 minutes, then 1 minute and repeat debriefing process.FACILITATOR Close module by asking for final questions, thoughts.------------------------------------------------End Module---------------------------------------------Understanding MATPage30 MinutesSLIDE _____TRUE OR FALSEQ. People who stop using substances on their own aren’t successful.Q. Moderation is not an option as a pathway to recovery.SLIDE _____MAT and Medicated Assisted RecoveryMedication-assisted treatment (MAT), also referred to as MAR, is the use of medications in combination with counseling and behavioral therapies for the treatment of substance use disorders. A combination of medication and behavioral therapies is effective in the treatment of substance use disorders and can help some people to sustain recovery.VivitrolBuprenorphine-SuboxoneMethadoneSLIDE _____Not intended as a replacement drug. Intended to stabilize until other problems are resolved, or hedonic set point (natural dopamine levels) levels out to their biological level.Provides a safety net for medical careAllows opportunity for improved overall healthcareFurther, develop recovery capitalReduce the negative consequences associated with substance useIncrease the chances they’ll stay in treatmentDecrease illicit substance use and criminal activityAssist individuals to secure employmentMAT allows people to live long enough to engage in treatment while they're alive.SLIDE _____VivitrolOral (daily) or injection (monthly)Full antagonistTreat alcohol dependencePrevent reuse of opioid dependence after detoxNon-addictive-Non NarcoticPart of comprehensive care with psychological supportNot used for pain managementBuprenorphineOral film or tablet, injection, or implant (6 months)Partial agonistLower risk of physical dependency than opioidsCan be used as a pain managementMethadoneDaily oral concentrationAgonistCan be used for pain managementSLIDE _____ As a result of prejudices (stigma and social attitudes) held by both the potential MAT recoveree and the community, many individuals are hesitant to utilize medications, even when necessary to limit harm. When they do, they are shunned from some mutual aid group meetings as not being in recovery.SLIDE _____Across the continuum of care, the messaging must be clear; MAT was never designed to be a stand-alone tool. The recovery journey may require the use of medications alongside treatment and recovery-oriented activities. MAT is an effective tool that helps individuals' brains stabilize and heal so they can more fully engage in treatment, recovery, and functional wellness.Facilitators notes: Source for Harm Reduction/MAT – MAR _____“The historical stigma attached to methadone and the broader arena of medication-assisted treatment has denied MAT patients the status of recovery and left them isolated from mainstream community life and existing in limbo between cultures of addiction and cultures of recovery.”“At the very core of this stigma is the deeply embedded idea that recovery from opioid addiction does not begin until the day the use of medications like methadone and buprenorphine ends. Recovery from no other chronic health condition rests on such a proposition. “Source White, W. (2012) Medication-assisted recovery from opioid addiction: Historical and contemporary perspectives Journal of Addictive Diseases,.31(3), 199-206. Segway – Harm Reduction is listed as a pathway to recoverySLIDE _____True or FalseMedication-Assisted Treatment is just substituting one drug for another.----------------------------------------------End Module--------------------------------------------------Harm ReductionPage30 MinutesSLIDE _____Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.-STATE: Harm Reduction is a concept of reducing use and safe use as a pathway to recovery.SLIDE _____Harm Reduction is NOT“Whatever happens, happens.”“Anything goes.”Only “meeting people where they’re at.” (it’s supporting folks to change behavior)“Helping a person who has stopped using drugs to start using again.”Condoning, endorsing, or encouraging drug use.LegalizationSLIDE _____Harm Reduction IS:A Framework for Working with People Who Use Drugs (PWUD) PWUD CAN make choices, changesClient-driven. Not coercive Supportive. Not punitiveA Framework for understanding drugs and drug use Viewed through the lens of science, not morality Acknowledges some drugs/use are safer than othersAcknowledges & addresses the context of use (drug, set, setting)SLIDE _____Goals of Harm Reduction:To improve the health and well-being of individuals, their partners, families, associates, and communities.Bring dignity to IDU (injection drug users) to improve their lives.Reduce Mortality.To highlight and address: The roles of discrimination due to poverty, racism, classism, sexism, social isolation, trauma, and other inequalities in drug-related harm.The roles of dignity, respect, and empowerment in reducing harm.Prevent Disease (HIV/HCV/Soft tissue infection & Endocarditis).SLIDE _____Strategies:Access to (free) naloxoneAccess to evidence-based treatmentsHousing-FirstCriminal Justice ReformDrug Policy ReformOn-site Drug CheckingHealth Care CoverageSyringe Services ProgramsSupervised UseSLIDE _____Traditional Treatment ApproachFACILITATOR: Explain that this model represents recovery “should” be achieved by going to treatment and upon release of treatment a person “should” be able to return to a productive life. This model does not take into account the Whole Person recovery or address the destruction that resulted from the disease.SLIDE _____FACILITATOR: Society position is that an individual with SUD, through the treatment model, ought to be able to go from Chaotic to Abstinence without moving through any of these other phases.SLIDE _____FACILITATOR: A better, proven way to address chaotic or dangerous drug use is to “meet people where they’re at” and take incremental change steps. Whether changing use or changing conditions around use, harm reduction aims for client-centered improvements. SLIDE _____FACILITATOR: Addressing basic needs is essential in achieving sustained recovery management. We must support the whole person. Peer coaches do this.Harm Reduction is a social movement designed around PWIDU but it is not just for PWIDU. Harm reduction conversations are a part of a recovery coach's role in discussing all aspects of health and well-being.Source for Harm Reduction, SLIDE _____Thinking about reducing negative consequences and whole health, what other ways can peer coaches take a harm reduction approach in working with peers, not specific to moderation or MAT/MAR?FACILITATOR: Offer participants 7 minutes to discuss this at their tables. Process as a group; write ideas on flip charts and stimulate conversation around Reducing Negative Consequences and Whole Health Approach.13525583185Areas for discussion about reducing negative consequences associated with substance use:00Areas for discussion about reducing negative consequences associated with substance use:Harm reduction conversations are about reducing negative consequences despite continued use.Unwanted pregnanciesTrauma to children by witnessing use (alcohol or drug)Possible Child Welfare reportingOperating under the influenceJob losses – work performance Social relationships – domestic violence, continuous arguing with a partner Criminal involvement-----------------------------------------End Module-----------------------------------------------Review and Debrief15 minutesSLIDE _____Review topics covered and ask for any questionsPeople MoversRecovery CapitalPathways of RecoveryWicked Smart GoalsWants V Needs MC OEQs & ReflectionsRole PracticeUnderstanding MATHarm Reduction Thank class and release. ................
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