FROM ABSOLUTES TO CONTEXT - North Dakota · 2019. 3. 4. · FROM ABSOLUTES TO CONTEXT: THE ROLE OF...
Transcript of FROM ABSOLUTES TO CONTEXT - North Dakota · 2019. 3. 4. · FROM ABSOLUTES TO CONTEXT: THE ROLE OF...
FROM ABSOLUTES TO CONTEXT:
THE ROLE OF PEERS IN THE CHANGING PHILOSOPHIES OF ADDICTION
AND RECOVERY
Patrick Roff MA, LCADC, CPRS, CPP
Center of Addiction Education Recovery and Success (CARES)
Morris County Prevention is Key
Rockaway, NJ
OUTLINE
1. The Emerging SUD Peer Workforce
2. The History of Peerness in Addiction & Recovery
3. Two Languages of Addiction and Recovery
4. Creating a Coherent Philosophy of Peerness for SUD
5. SUD Peer Work in Action: Theory and Practice
THE EMERGING SUD PEER WORKFORCE
Message From SAMHSA
The effectiveness of peer support
• Educating through shared Lived Experience
• Empowerment of Service Recipients
• Reduction in Self- Stigma
• Long-term Recovery Management
• Reduced Morbidity
THE EMERGING SUD PEER WORKFORCE
The Need for Training and Credentialing
International Credentialing & Reciprocity Consortium
(IC&RC)
The Peer Recovery Credential (PR)
• Ethical Guidelines
• Advocacy
• Mentoring and Education
• Wellness and Recovery
A HISTORY OF PEERNESS
The Field of Addiction & Recovery
• Origins
• The Peer = Experientially Credentialed
• Professionalization
• The Clinician = Academically Credentialed
• Danger of Losing “The Wounded Healer”
• Peer Recovery Specialists as New Wounded Healers
THE ROLE OF LANGUAGE
The Relationship Between Language & Reality
Two Paradoxes
Mirrors Creates
Reveals Obscures
TWO LANGUAGES OF ADDICTION & RECOVERY
Paradoxical Nature of Language Applied to Addiction & Recovery:
Two Languages Emerge
1. Traditional and Absolute
Singular/Exclusive/Objective
2. Contemporary and Contextual
Multiple/Inclusive/Subjective
TWO LANGUAGES OF ADDICTION & RECOVERY
When The Two Languages are Complimentary:
The Creation of a Holistic & Coherent
Philosophy of Peerness
Becomes Possible
THE LANGUAGE OF ABSOLUTES
When Something is Understood in Absolute, it is:
Given Assumed & Implied
Universal Comprehensive & Independent
Unequivocal Authoritative & Certain
Permanent Forever & Unchanging
ABSOLUTE ADDICTION
The Definition of Addiction is:
Given we all know what it is
Universal it is the same every time
Unequivocal without doubt
Permanent one way street
THE VALIDITY OF ABSOLUTE ADDICTION
DSM IV
• Abuse & Dependence
• Problems are uniform, discernable & treatable
• Authority & Objectivity of Science
• Certainty in Diagnosing of a Disease
• Matches Tradition of Alcoholics Anonymous
• Exclusivity of Unique “Spiritual Malady”
ABSOLUTE LANGUAGE OF DSM IV
THE PROBLEM OF ONE LANGUAGE OF ABSOLUTE ADDICTION
Singular -- The “Yes” and “No”
of a Diagnosis
Exclusive -- Absolute Uniformity of
the Disease
Objective -- Absolute Certainty in the
need for Recovery
False Hopes
&
Stigma
ABSOLUTE RECOVERY
The Definition of Recovery is:
Given we all know what it is
Universal it is the same every time
Unequivocal without doubt
Permanent one way street
ABSOLUTE RECOVERY
Yes NoAre you Clean And Sober?
THE VALIDITY OF ABSOLUTE RECOVERY
80 years of Enduring Success
• Simplicity of Abstinence
• Maintenance of Cognitive/Behavioral Changes
• Countless Millions Helped
THE LANGUAGE OF CONTEXT
When something is understood in Context, it is:
Diverse Unalike & Unfamiliar
Unique Specific & Personal
Fallible Human & Imperfect
Grounded Supported & Justified
CONTEXTUAL ADDICTION
The Definition of Addiction is:
Diverse Unalike & Unfamiliar
Unique Specific & Personal
Fallible Human & Imperfect
Grounded Supported & Justified
CONTEXTUAL ADDICTION
DSM 5
Substance Use Disorder
A Continuum Rather than a Dichotomy
Mild Severe
Moderate
DSM 5
Mild Moderate Severe
A Substance Use Disorder exists on a continuum over a lifespan
THE VALIDITY OF CONTEXTUAL ADDICTION
DSM 5
• Absolutes Alienate Mild and Moderate Users
• The Ending of Absolute Dichotomies
Innovative Treatment
• Motivational Interviewing
• Emphasis on Meet the Person Where They Are
• Rather than Confrontation
THE PROBLEM OF ONE LANGUAGE OF CONTEXTUAL ADDICTION
• Multiplicity – Problem of “not now”
or “depends”
• Inclusive – Loss of a tangible definition Inaction & Indecision
of the Disease
• Subjective – Obvious Need for Recovery
becomes relative
CONTEXTUAL RECOVERY
The Definition of Recovery is:
Diverse Unalike & Unfamiliar
Unique Specific & Personal
Fallible Human & Imperfect
Grounded Supported & Justified
THE VALIDITY OF CONTEXTUAL RECOVERY
SAMHSA
Four Domains of Recovery
1. Health
2. Home
3. Purpose
4. Community
Self -Defined
&
Person-Driven
THE VALIDITY OF CONTEXTUAL RECOVERY
SAMHSA - 10 Principles of Recovery
1. Hope 6. Relational
2. Person-Driven 7. Cultural
3. Many Pathways 8. Trauma-Informed
4. Holistic 9. Strengths-Based
5. Peer Supported 10. Respect
THE PROBLEM OF ONE LANGUAGE OF CONTEXTUAL RECOVERY
Excessive Diversity --- No Common Ground
Terminal Uniqueness --- Immunity from harms Rudderless &
Vague
Endlessly Fallible --- Indecision & Apathy
Unmovably Grounded --- Isolation & Rigidity
COMBINING THE TWO LANGUAGES:EMBRACING PARADOX
Addiction:
Given Universal Unequivocal Permanent
Diverse Unique Fallible Grounded
Recovery:
Given Universal Unequivocal Permanent
Diverse Unique Fallible Grounded
A COHERENT PHILOSOPHY OF PEERNESS
FOUNDATION OF ABSOLUTES & CONTEXT
BUILT ON THREE PILLARS
Mutuality ……………We identify and support – learn from our sameness
Reciprocity …………We give and take – learn from our differences
Pluralism ……………We respect different paths
SUBSTANCE USE DISORDERPEER WORK
Scope of Practice
Non-Clinical Assistance
Support & Support Services
Contextual Peer Identities
Abstinence Peers
Harm Reduction Peers
Family Peers
SUD PEER WORK
Contextual Peer Roles:
Confidant & Truth Teller
Coach & Cheerleader
Mentor
Case Manager
Navigator
SUD PEER WORK
Contextual Settings:
Peer Run Recovery Centers
Treatment Centers & Sober Living
Courts
Jails
Hospitals
Government Agencies
SUD PEER WORK
Contextual Services:
After-Care Planning
Re-Entry
Crisis Intervention
Recovery Management
Linkage to Outside Resources
Individual & Group Sessions
PEER WORK ACROSS A RECOVERY CONTINUUM
• Person Still Using
Peer
• Referral to TX
Peer• Early
Recovery
Peer
• Stabilization
Peer• Recovery
Maintenance
Peer
SUMMARY
The Paradox of Addiction & Recovery Language:
• Creation of Coherent Peer Philosophy
• Built on Theoretical Foundation of Absolutes & Context
• Operating From Three Pillars:
• Mutuality/Reciprocity/Pluralism
• Articulation of Contextual Peer Identities
• Identification of Contextual Peer Roles
• Operating Context-Based Environments
• Quality Peer Services Across a Recovery Continuum