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COLLEGIATE RECOVERY PRIMER: REDUCING STIGMA AND ENHANCING ACCESS FOR STUDENTS IN ADDICTION AND RECOVERY DR. REBECCA CALDWELL, UNIVERSITY OF SOUTH CAROLINA AIMEE HOURIGAN, UNIVERSITY OF NORTH CAROLINA WILMINGTON OBJECTIVES The participant should be able to: Describe the key elements of collegiate recovery programs, including the current literature base. Engage students who are in addition and recovery through enhanced skills and a stronger working knowledge of relevant issues. WHAT IS A COLLEGIATE RECOVERY PROGRAM? An innovate and growing model of peer-driven recovery support delivered on college campuses. (Laudet, 2014) CRP s strive to create a campus-based recovery-friendly space and supportive social community to enhance educational opportunities while supporting students continued recovery and emotional growth. (Harris et al., 2008). Recovery-support infrastructure WHAT IS A COLLEGIATE RECOVERY PROGRAM? Reflects the national movement in addiction treatment from an acute care to continuum care model. SAMHSA promotes a recovery-oriented chronic care approach to SUDs. Recovery support systems (RSS), including peer-based support are a key component of a continuum of care model. Peer-based RSS are a key component of the ONDCP National Drug Strategy. U.S. Dept. of Ed. goal of ensuring a continuum of care from high school to college to post-graduation (Dickard et al., 2011) OVERVIEW OF COLLEGIATE RECOVERY PROGRAMS AND MOVEMENT There were 4 C.R.P.s in 2003, 29 programs in 2008, and over 100 at this time. Early full-service programs: Texas Tech, Rutgers, & Augsburg Explosion of start-up programs since 2012 Many received start-up funds from Transforming Youth Recovery What does the future hold? Recovery high schools Informed consumers WHAT CAN COLLEGIATE RECOVERY PROGRAMS INCLUDE: Identified space on campus Identified resource person on campus Opportunities for formal and informal peer support Seminar class or program series to address recovery-related issues Access for mutual support, such as 12-step meetings, on campus Support groups and individual counseling services Formal application process and parameters of membership Scholarships and other financial support On-campus housing or roommate matching services WHAT MOST COLLEGIATE RECOVERY PROGRAMS DO NOT DO: Accept mandated referrals from the college, the criminal justice system, or families Drug test. Core belief that the students and the community will reveal relapse. End membership or service access when relapse occurs Relapse is addressing rapidly with a treatment plan including re-entry into the community in appropriate manner. ARE COLLEGIATE RECOVERY PROGRAMS EFFECTIVE? Larger scale studies are underway. Site-level outcomes include: Low relapse rate: CRPs report a 0-25% relapse rate, with a 8% average. In comparison, over 60-79% of people attending treatment relapse within 1 year of treatment. Strong academic achievement: CRP s often boast a higher average G.P.A. and a higher graduate rate than the campus average. WHAT DO WE KNOW ABOUT STUDENTS WHO PARTICIPATE IN COLLEGIATE RECOVERY PROGRAMS? First national study published in 2015 (Laudet et al., 2015) 486 of 600 possible students from 29 CRPs responded (81% response rate) Participants: Most were male (57%), over 91% were Caucasian Mean age was 26. Most were full-time students who lived off-campus. Of those with roommates, half live with someone in recovery, although a quarter lives with someone actively using. Mean days without a drink: 952 Mean days since last drug use: 1053 WHAT DO WE KNOW ABOUT STUDENTS WHO PARTICIPATE IN COLLEGIATE RECOVERY PROGRAMS? Average lifetime severity of addiction was high. 75% had been diagnosed with a mental health disorder. Top three conditions: depression (74%), anxiety disorders (48%), and bipolar (23%). 76.5% were currently taking medications for mental health disorders. Most considered themselves in recovery from more than one substance, including behavioral addiction: disordered eating (15.6%), self-harm (10.5%), and sex and/or love addiction (9.5%). Up to 1 in 6 participants considered themselves in recovery from a behavioral addiction. A similar percentage were actively engaged in a behavioral addiction at this time of study. PROGRAM EXAMPLE: UNCW CRC HAWKS UNIVERSITY OF NORTH CAROLINA WILMINGTON Public 4-Year Institution in southeastern North Carolina 5 miles from Atlantic Ocean Enrollment: 13,000 undergrad, 1,600 graduate 65% female, 35% male 85% white, 5 % African- American 3rd most competitive state institution for admissions after flagships (Chapel Hill & NC State) UNCW CROSSROADS 25 year-old substance abuse prevention & education program Campus-based prevention efforts based on harm reduction & environmental management principles. Adolescent substance abuse prevention programs to prevent & delay initiation of substance use Evidence-based interventions for student experiencing consequences, including campus citations Collegiate recovery program Mission: Offer opportunities for students in recovery to connect with each other and UNCW Provide individual consultations and case management Reduce stigma associated with addiction, recovery, and seeking help Facebook: UNCW Collegiate Recovery Community Currently On Campus: The Ripple Effect, SMART Recovery, AA meeting Seahawk Strength & Hope Weekly seminar series Open Hours & Social events (usually connected to campus programs) Case Management Source: 2012 UNCW Alcohol & Drug Survey, n = 429 students UNCW Addiction & Recovery Data Have you ever been to treatment for alcohol and drug abuse or addiction? 5.5% Yes 94.5% No Do you consider yourself addicted to alcohol and/or other drugs? 3.5% Yes 3.7% Unsure right now 92.8% No Do you consider yourself in recovery from alcohol and drug abuse or addiction? 2.6% Yes 2.4%I have quit drinking or using, but don t use the phrase in recovery for myself 95% No UNCW Addiction & Recovery Data The following list include resources that some colleges have made available to students in recovery. Please indicate if any of these would help you now or would have helped you, in your opinion: 80% A dedicated space for students in recovery to hang out 50% Sober recovery housing off-campus (in partnership with campus resources) 50% 12-Step meetings on campus 50% Sober activities for students in recovery 40% Alcohol-free activities on campus (open to all students) 20% Sober recovery living on campus 20% Group counseling with professional counselor VIDEO: What the CRC has done for me? CRC HAWKS UNCW CRC Adaption of dedicated space Weekly dinner Monthly Seahawk Strength & Hope recovery celebration Peer education Social & educational events Support campus AA and NA meetings Support group for affected students I SUPPORT RECOVERY campaign Faces & Voices training ISSUES FACING STUDENTS IN RECOVERY Studying and living in an abstinence-hostile environment Internal pressure to succeed/prove oneself worthy Transparency of recovery identity; choosing whether to be out Developing belonging and connection to peers Life skills development Facing stigma Possibly moving away from an established support system KEY ASSET: RECOVERY CAPITAL Amassing and Retaining Recovery Capital The resources (social, physical, human and cultural), which are necessary to begin and maintain recovery from substance use, abuse, and dependence. Theorized relationship between recovery capital and addiction remission (Kelly & Hoeppner, 2014) MANY PATHWAYS TO RECOVERY Professional treatment Mutual support, including 12-step programs Faith-based/religious Medication-assisted Criminal justice/drug court Natural recovery RESEARCH INSIGHT: MUTUAL SUPPORT GROUPS AND YOUNG PEOPLE John Kelly, MGH and Harvard Medical School (2014): 12-step participants appears to help young people across time. Young people-specific meeting can engage new people, but a mix of ages and lengths of recovery is therapeutically optimal. There is an observed relationships between 3x per week attendance and complete abstinence early post recovery. Weekly or twice weekly meetings may be effective until five years when the relapse rate falls below 15% EFFECTIVE COMMUNICATION STRATEGIES START WITH ADDRESSING STIGMA Substance use disorder remains #1 stigmatized health condition Americans generally believe that recovering alcoholics or drug addicts are still trying to achieve sobriety. Language conveys knowledge and reduces stigma Person with a substance abuse disorder vs. addict Person living in recovery vs. recovering addict LANGUAGE OF RECOVERY Current Terminology Substance Abuse Addict Drug of choice Relapse is part of addiction Clean / sober Dirty test / dirty urine Self help group Suggestions Substance Use Disorder A person with substance use disorder A person who is addicted to ( ) Drug of use Recurrence is common in a chronic, progressive disease Drug Free Positive drug test Mutual aid group EFFECTIVE COMMUNICATION STRATEGIES: Be curious Use non-stigmatizing language Affirm strengths and commitment Ask about associated issues: recovery from multiple SUDs, active or recovering from behavioral addictions, mental health concerns and treatment Use motivational interviewing techniques MOTIVATIONAL INTERVIEWING TECHNIQUES A collaborative conversation to strengthen a person s own motivation for and commitment to change. Spirit of M.I. is based on 3 key elements: Collaboration between the clinician and the client/patient Evoking or drawing out the client s own ideas about change Emphasizing the autonomy of the client ROLE PLAY RECOVERY ADVOCACY There is a national recovery movement of people in recovery, their friends, family members and allies telling the story of the millions of people who live in recovery. Over 20 million Americans are living in long-term recovery today! Recovery Message Training: Learn how to tell your recovery story to your friends and family and in public settings of your choosing. Get more information at: Change your language and confront stigma when you encounter it. Become aware of and promote the public policy agenda of the recovery movement. Support your campus and community recovery community organizations. RESOURCES Recovery Research Institute: Massachusetts General Hospital and Harvard Medical School: Transforming Youth Recovery: Association of Recovery in Higher Education: Center for Collegiate Recovery Communities, Texas Tech University, including access to their replication manuals Collegiate Recovery Communities Curriculum : Faces and Voices of Recovery, including Recovery Messaging Training: REFERENCES: Best, D. & Laudet, A.B. (2010). The potential of recovery capital. Retrieved from: v5.pdf Cloud, W. & Granville, R. (2008). Conceptualizing recovery capita: Expansion of a theoretical construct. Substance Abuse & Misuse, 43(12-13), Dickard, N., Downs, T., Cavanaugh, D. (2011). Recovery/relapse prevention in educational settings for youth with substance use and co-occurring mental health disorders: 2010 Consultative sessions report. Washington, DC: U.S. Department of Education, Office of Safe & Drug-Free Schools. Harris, K.S., Bakers, A.K., Kimball, T.G., & Sumway, S.. (2008). Achieving systems-based sustained recovery: A comprehensive model for collegiate recovery communities. Journal of Groups in Addiction & Recovery, 2, Kelly, J.F. (2013). Building recovery capital: Addiction, recovery, and recovery support services among young adults. Presented at the 4 th National Collegiate Recovery Conference, Texas Tech University, Lubbock, TX. Kelly, J.F. & Hoeppner, B. (2015). A biaxial formulation of the recovery construct. Addiction Research & Theory, 23(1), 5-9. REFERENCES: Laudet, A.B., Harris, K., Kimball, T., Winters, K.C., & Moburg, D.P. (2015). Characteristics of students participating in collegiate recovery programs: A national study. Journal of Substance Abuse Treatment, 51, Laudet, A.B., Harris, K., Kimball, T., Winters, K.C., & Moburg, D.P. (2014). Collegiate recovery communities programs: What do we know and what do we need to know? Journal of Social Work Practice in the Addictions, 14, Laudet, A.B., Harris, K., Kimball, T., Winters, K.C., & Moburg, D.P. (2014). Nationwide survey of collegiate recovery programs: Is there a single model? Journal of Drug and Alcohol Dependence, 140, e117. Miller, W.R., & Rollnick, S. (2002). Motivational Interviewing: Preparing People for Change. 2nd Edition. New York: Guilford Press. CONTACT INFORMATION UNCW CRC Hawks: Aimee Hourigan, Assistant Director, UNCW CROSSROADS, , Dr. Rebecca Caldwell, Director of Strategic Health Initiatives, University of South Carolina, ,
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