Recovery and the Eye of History
I received two emails this week, each posing the question: Are recovery management (RM) and recovery-oriented systems of care (ROSC) dead as organizing frameworks for addiction treatment and recovery support? For 15 years, these conceptual rubrics ascended as promising alternatives to ever-briefer, acute care models of addiction treatment. RM and ROSC were among the most important progeny of efforts to extend the organizing center of the addictions field from its historically dual focus on problems (etiological roots and resulting clinical pathologies) and interventions (competing methods of treatment) to a focus on lived solutions (i.e., lessons drawn from the collective experience of long-term personal and family recovery). Questions regarding the future of RM and ROSC are quite legitimate concerns.
RM pilots (see HERE and HERE) generated promising new approaches to treatment and recovery support spanning the arenas of early identification, engagement, and motivational enhancement; comprehensive and continual assessment protocol; partnership models of recovery planning; assertive linkage to indigenous recovery support institutions; the integration of professional and peer-based recovery support services; and post-treatment personal/family recovery check-ups. Most importantly, RM implementation efforts addressed support needs across the stages of recovery: 1) precovery, 2) recovery initiation and stabilization, 3) transition to recovery maintenance, 4) enhanced quality of personal and family life in long-term recovery, and 5) efforts to break intergenerational cycles of addiction and related problems.
The concept of ROSC provided a rationale and a framework for expanding recovery support resources beyond the treatment setting into the very fabric of local communities. ROSC promoted forging the physical, psychological, and social space (recovery landscapes) within which personal and family recovery could flourish. Adopted and adapted at the federal level under the leadership of Dr. Westley Clark at SAMHSA and drawing inspiration from early ROSC efforts in Connecticut and Philadelphia, significant resources were extended to seed ROSC-focused transformations in addiction treatment in the U.S.
The question at present is whether RM/ROSC-related innovations mark a sustainable shift in addiction treatment and recovery support, or if they are one more flavor of the month to be cast into the waste bin of a field known for such fleeting infatuations. The recovery orientation within national drug policy (at ONDCP, SAMHSA, and to the extent that it existed at NIDA and NIAAA) has rapidly dissipated under a new presidential administration whose drug policy efforts to date are marked by delayed promises, at best, and, at worst, a return to failed drug policies of the distant past. Also of concern is the disengagement of the first wave of RM/ROSC champions (e.g., McLellan, Lewis, Boyle, White, Kirk, Evans, Clark, Nugent, Botticelli, and Murthy) due to the assumption of new roles or retirement. The lost visibility of RM/ROSC initiatives at the federal level and the decreased visibility of RM/ROSC champions at a national level spark fears that these concepts will be relegated to a brief footnote within the field’s history.
But there is another side to the RM/ROSC story. The RM/ROSC initiatives launched at the federal level exerted a potentially enduring influence on the field. Addiction professionals from across the U.S. and around the world visited early RM/ROSC pilots in Connecticut and Philadelphia. The Center for Substance Abuse Treatment’s network of Addiction Technology Transfer Centers embraced RM/ROSC and the resulting RM/ROSC monograph series and related training events stirred innumerable state and local RM/ROSC initiatives. The results of these and related efforts are evident in the following:
- Key elements of the RM/ROSC model are being positively evaluated by research scientists, e.g., the positive effects of post-treatment recovery checkups.
- A second generation of RM/ROSC leaders is providing training and consultation services focused on RM/ROSC implementation across diverse clinical, cultural, and geographical settings.
- New strength-based assessment instruments are being developed, e.g., the Assessment of Recovery Capital.
- Peer-based recovery support services are being integrated into addiction treatment and allied health and human service organizations.
- Traditional abstinence-based addiction treatment organization and harm reduction organizations are evolving from a state of stale rhetorical warfare to efforts of collaboration and integration—aided by staged models of addiction recovery.
- Efforts are increasing to integrate addiction treatment and recovery support services within primary health care, the criminal justice system, and the child welfare system.
- New financing models are being piloted that support the transition from acute care interventions to RM/ROSC.
- Recovery community building efforts are progressing via the growth and diversification of recovery mutual aid organizations, the rise of new recovery support institutions, and the maturing of a new addiction recovery advocacy movement.
No matter what happens at the federal level, the essence of RM/ROSC will prevail, or if lost, be rediscovered in the future. Historically, when addiction-related systems of care collapse, people in recovery and their families and visionary professionals rise up and forge new systems of care and support.
Recovery is more than a personal and family experience; it is a catalytic idea that can transform addiction treatment, allied service organizations, and the communities in which such professional support is nested. The future of RM/ROSC is being written by heroes who are carrying forward this movement at a grassroots level. And change at the grassroots level is ultimately what RM and ROSC are all about. The stakes are enormously high, and the eye of history is watching.