Day 4 People Movers

FACILITATOR 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 minutes

FACILITATOR 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 topics

Welcome & Review & ConnectionsSpectrum of AttitudesCultural AwarenessMC Affirmations & SummariesTrauma Sensitive Care Building Rapport – Sharing Your StoryBuilding Rapport – Boundary ManagementReview

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.

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 group

Agenda Day 4 – People Movers TIMEWelcome & Review & Connections 30Recovery Capital 60Pathways of Recovery 45Wicked Smart Goals 45Wants V Needs 30MC OEQs & Reflections 45Role Practice 45Understanding MAT 30Harm Reduction 45Review 15

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REcovery Capital – Building Muscle Page 1 Hour

STATE 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 relapse• providing 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 97

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

STATE: 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.

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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 Capital External Recovery Capital

Upon 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

SLIDE _____

"Increases in recovery capital can spark turning points that end addiction careers, trigger recovery initiation, elevate coping

(Cloud & Granfield, in press; Laudet,

SLIDE _____99

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) http://www.williamwhitepapers.com/pr/Recovery%20Capital%20Scale.pdf

SLIDE _____

Recovery Capital strengthens Muscular Spirit and restores the Muscular Hedonic Setpoint

Peer 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.Questions Scale Response NotesPURPOSE

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What 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?PHYSICAL 1-10Describe 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? 1-10EMOTIONAL 1-10How 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 security

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Debt 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?

1-10

QUALITY 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?

1-10

SOCIALDo you have anyone supporting you unconditionally?Do you have friends that don’t use substances?Describe your relationships with family.

PATHWAYS OF RECOVERY Page 45 minutes

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SLIDE _____

How do Recovery Coaches help build this resiliency muscle?

ONCLICK

Pathways Of Recovery Improved Well-being – whole health focusRecovery-Oriented System of CareBuilding Rapport - Roles of a Recovery Coach

ONCLICK- TRUE OR FALSE

Q. 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, http://www.williamwhitepapers.com/blog/2016/06/recovery-pathways-are-not-always-a-pathway.html)

Seven Recovery Wellness Domains (White) Recovery ConnectivityPhysicalEmotionalSpiritualLiving AccommodationsSchool/WorkDaily Living

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FACILITATOR 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?

ACTIVITY

FACILITATOR: 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.

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ONCLICK

Remember…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 RECOVERY

The 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.”

The 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 http://www.williamwhitepapers.com/blog/2016/06/recovery-pathways-are-not-always-a-pathway.html)

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Some Pathways Of Recovery include:

SLIDE _____

Levels of clinical care

o Pharmacology – MAT/MARo Alternative therapies – Acupuncture, Hypnosis, Meditation, Yoga, Guided

Imagery, Reflexologyo Creative Therapies – Art, Music, Dance & Movement, Dramao Animal Assisted – Equine, Canineo Specialized – Wilderness, Natureo Acceptance & Commitment Therapy (ACT) and Cognitive Behavioral Therapy

(CBT)o Intensive Outpatiento Traditional Counseling/Therapyo Oral Healtho Harm Reduction

SLIDE _____

Non-Clinical Pathwayso Recovery Residenceso Recovery Community Centerso Peer-based Recovery Supporto Education-based Recovery Supporto Employment-based Recovery Supporto Faith-based Recovery Supporto Mutual Aid Groups (AA, NA, HA, GA, EA, Celebrate Recovery, SMART Recovery,

All Recovery)o Reiki, Yoga, Acupuncture, Music Therapy, Art Therapy, Drum Therapy, Equine

Therapy, Pet Therapy, etc.o Phone Apps (SobrietySystems.com, SoberGrid.com, My Spiritual Toolkit, etc.)o Harm Reduction

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SLIDE _____

Self-Management Pathwayso Holistic – Spirituality, Prayer, Honesty, Understanding, Self-awareness, Healthy

Boundaries, Coping Skills, Problem Solving, Sleep-management, Nutrition, Exercise, Self-discipline, Integrity, Optimism, Gratitude, Mindfulness, Purpose

o External – Job, Housing, Transportation, Access to Health-care, Parenting, Family & Friends

o Harm 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 _____

SAMHSA

Recovery 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.

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Wicked Smart Goals Page 45 minutes

Facilitator 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 certificate

1. Get $20.00 for the fee

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~ 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.

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People Movers – Wants Versus Needs Page 30 minutes

SLIDE _____

STATE: Throughout this training, we've discussed the roles of a peer coach. We've discussed

Meeting them where they’re at – finding out where they’re at Forward movement and progress Building Trust and Rapport Autonomy, empowerment and support self- efficacy Help find/identify purpose and goals

How do we deliver all of that?

SLIDE _____

Staying Solution Focused - Wants Versus Needs

Want 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.

NEED WANT

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ACTION: 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: https://www.danmartell.com/hierarchy-of-entrepreneurial-needs/

Emphasize, 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.

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SLIDE _____

What is a recoveree doesn’t “want” to engage?

How do you engage? What is your role?

FACILITATOR Engage class discussion

SLIDE _____

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?

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MC OEQs and Reflections Page 1 Hour 112

FACILITATOR 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 MC

SLIDE _____REVIEW KEY CONCEPTS OF Motivational Collaboration or Motivational Conversation

Active Listening – already discussed OARS (Open-Ended Questions, Affirmations,

Reflections, Summaries) Develop Discrepancy Roll with Resistance Avoid the Expert Trap Change Talk DARN CAT

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FACILITATOR: Review Active Listening bullet points and provide examples or interactive discussion.

SLIDE _____

Tips for Effective Active Listening – A Skill

Shhhhhh. Listen more than you talk – 70/30 Avoid interrupting - finishing sentences Don’t’ try to solve the problem Learn to let go of the outcome BE Present – leave your stuff outside Intentional – an action performed awareness, done deliberately, consciously

and on purpose. Pause, count to 3 before responding DIG DEEP Be curious Listen generously Give space Empathy

SLIDE _____

Three forms of counseling style:

Directing - basically telling someone what their next step should be and what they should do.

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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?

1. Honors the person and where they’re at2. Builds trust3. Supports self-efficacy – choice & empowerment

FACILITATOR 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 OEQ

Affirm 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.

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SLIDE _____

“O”

Open-Ended Questions (OEQs)

Cannot be answered with yes or no or with one or two words Are not rhetorical Probe for information Avoid socially desirable response Draw people out Engage people Simple or complex (complex is more advanced) Help uncover the person’s priorities and values

Closed-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?

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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 _____

Reflections

One of the MOST important skills in MC

A 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 understanding

Stating it back to them with different words

Guessing what they mean, reaching, hypothesizing

Let’s the speaker hear their own words

****Rephrase or Mirror are alternative ways of thinking of Reflections

SLIDE _____

Two categories of reflections, Simple and Complex

Simple Reflections

Rephrase or simple repeat/mirror of what was said.

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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 Reflections

A 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 Choice

This 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 forward.

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Complex 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 rapport

REMINDERIntonation 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/Coaching

1. 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 encounter

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ACTIVITY 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 Reflections

Determine 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 – 70/30 Avoid interrupting - finishing sentences Don’t’ try to solve the problem Learn to let go of the outcome BE Present – leave your stuff outside Intentional – an action performed awareness, done deliberately, consciously

and on purpose. Pause, count to 3 before responding DIG DEEP Be curious Listen generously Give space Empathy

FACILITATOR 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?

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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.

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Understanding MAT Page 30 Minutes

SLIDE _____

TRUE OR FALSE

Q. 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 Recovery

Medication-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-SuboxoneMethadone

SLIDE _____

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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 care Allows opportunity for improved overall healthcare Further, develop recovery capital Reduce the negative consequences associated with substance use Increase the chances they’ll stay in treatment Decrease illicit substance use and criminal activity Assist individuals to secure employment

MAT allows people to live long enough to engage in treatment while they're alive.SLIDE _____Vivitrol

o Oral (daily) or injection (monthly)

o Full antagonist

o Treat alcohol dependence

o Prevent reuse of opioid dependence after detox

o Non-addictive-Non Narcotic

o Part of comprehensive care with psychological support

o Not used for pain management

Buprenorphineo Oral film or tablet, injection, or implant (6 months)

o Partial agonist

o Lower risk of physical dependency than opioids

o Can be used as a pain management

Methadoneo Daily oral concentration

o Agonist

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o Can be used for pain management

SLIDE _____

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 – MARhttps://youngpeopleinrecovery.org/2018/09/bridging-gap-many-pathways-recovery/

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“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 recovery

SLIDE _____

True or FalseMedication-Assisted Treatment is just substituting one drug for another.

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Harm Reduction Page 30 Minutes

SLIDE _____

Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.

-HarmReduction.org

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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. Legalization

SLIDE _____

Harm Reduction IS:

A Framework for Working with People Who Use Drugs (PWUD)o PWUD CAN make choices, changeso Client-driven. Not coercive o Supportive. Not punitive

A Framework for understanding drugs and drug useo Viewed through the lens of science, not morality o Acknowledges some drugs/use are safer than otherso Acknowledges & 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.

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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) naloxone• Access to evidence-based treatments• Housing-First• Criminal Justice Reform• Drug Policy Reform• On-site Drug Checking• Health Care Coverage• Syringe Services Programs• Supervised Use

SLIDE _____Traditional Treatment Approach

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FACILITATOR: 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 _____

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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.

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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, www.NHHRC.org

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.

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

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Areas for discussion about reducing negative consequences associated with substance use:

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Review and Debrief 15 minutes

SLIDE _____Review topics covered and ask for any questions

People Movers

Recovery CapitalPathways of RecoveryWicked Smart GoalsWants V Needs MC OEQs & ReflectionsRole PracticeUnderstanding MATHarm Reduction

Thank class and release.

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