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    t3 Threads: Changing the Conversation

    Making the Case for Peer Providers

    Once a person is assigned a stigmatizing label, they are often seen as “less than” and in need of fixing for the remainder of their lives. Members of the larger society often see individual recovery as only partially effective or non-existent. These erroneous conclusions do not go away--no matter how successful or how accomplished the individual may be. These views can be mitigated by the inclusion of peer providers in various key roles.

    Peer providers help employers, colleagues, other peers, and services users by example. They use their recovery experiences to make systems of care more focused on the needs of individuals. Peer providers increase the effectiveness of efforts to eliminate stigma in medical and behavioral health care settings.

    Calling for a Public Health Approach to Trauma Awareness

    Why a Public Health Approach? There are many reasons to learn about the impact of trauma and untreated trauma on individuals, families, and communities. Trauma and untreated trauma are common in all socioeconomic groups and are often misunderstood. For example, people experiencing opioid addiction, other substance use conditions, mental illness, and homelessness may shy away from treatment because of stigma in communities and treatment settings.

    The symptoms of trauma and its under-treatment are evident more and more everyday. Early childhood and adult trauma are implicated in the onset of addictions and the comorbidity of post-traumatic stress disorders and mood-related psychopathology.

    Recovery Housing: A Moment in Time

    I’ve listened to the words of my friends, family members, and colleagues long enough to know that without the stability of a safe and healthy place to live--and the support of people around you--long term recovery from a substance use disorder can be illusive. With what we know about the changes in brain chemistry in response to alcohol and other drugs, it’s not surprising that when people leave treatment and go back to the same environments where they were using substances, reoccurrence happens more often than not.

    Reflections from the Field: Motivational Interviewing Facilitates Change

    When I graduated with my Master’s of Social Work (MSW) in 2013, I felt ready to tackle the world. I knew all about social justice. I had learned all the theories. I had learned about trauma. About the importance of community. The impact of racism and oppression. The endless cycle of poverty. White privilege. Cultural humility. I soaked it all in, and I couldn’t wait to start applying this knowledge in the field of social work. Cut to three weeks later, walking into my first day of work at a homeless shelter - and the undeniable truth that I had no idea what I was doing.

    Supporting Parents in Recovery

    The number of parents in recovery from mental illness, trauma, homelessness, and substance use is unclear because there is no standardized national data collection.This lack of data leads to a huge gap in service delivery to a sector of the population who is raising children.

    This can be remedied by screening and assessing parents across our health care system to identify needs for specific education and support services--particularly in areas of mental illness, trauma, homelessness, and substance use. This would give families a good chance to receive critical support services to keep them intact and healthy. Children could escape the isolation and helplessness that comes with living with a parent who is ill, but without treatment. Interventions could occur before children are neglected or abused.

    Understanding Addiction as a Chronic Disease

    I recently spent my day writing final project reports. I wrote about how our project helped one state place peer recovery coaches in hospital emergency rooms to support people recovering from opioid overdoses. Another state expanded supported employment opportunities for transition-age youth. Several states created training and credentialing programs for peer recovery support specialists to help people enter and sustain recovery from mental health conditions and substance use disorders. Another state is re-examining and re-engineering their entire behavioral health crisis response system. We helped a U.S. Territory experiencing a substance use crisis take steps to establish their first-ever recovery community organization. We brought together adults in recovery with family members of adults with behavioral health disorders to discuss ways to improve supports for people in crisis.

    Role of Relationships in Substance Use Recovery

    Human connection is an integral part of social and emotional health and well-being. Think about the many connections, friendships, and relationships that shape your daily life. When you are in need of support, these relationships are key to providing guidance, happiness, and stability.

    Social supports act as a crucial determinant for shaping health outcomes. Research suggests relationships are a significant factor in determining substance use and recovery outcomes. Studies of adolescents suggest that family support and involvement acts as a protective factor against substance use. A study of women experiencing homeless found that those who had less social support were more likely to engage in illicit substance use. A common affirmation in the recovery community— people, places, things—points to how important people can be in impacting one’s journey to recovery. Social networks, including family, friends, community and kinship ties, can act as risk or protective factors in determining an individuals’ path toward recovery.

    Recovery Benchmark: Sustaining Relationships

    Recovery outcomes are valued goals of services throughout the nation. Relationships that empower and encourage choice and self-direction are hallmarks of all activities that support recovery. 

    It is a beautiful Sunday morning. A friendly visitor is coming to my house today. She is a young person studying at a university in Boston. I am looking forward to our meeting. She is just starting out in life. I am in the older stages of life. When we are having coffee, I realize we are speaking the same language. The generation gap is not evident in our communications. She reminds me to be energetic and hopeful. She makes me laugh. She is a bright spot in my day. I trail off in my thinking…I wish I had family and children in my life. I am alone most of the time. I actually like my company, but occasionally I lament that along the path to recovery I did not construct my own family. I realize the importance of relationships and quality of life in promoting recovery.

    Trauma Therapies Support Enduring Sense of Safety

    Trigger Warning: Trauma re-enactment

    I am 65 years old and a trauma survivor. When I entered therapy, I was labeled as having an adolescent adjustment reaction. Years later, the mental health label was changed repeatedly—from schizoaffective disorder to post-traumatic stress disorder (PTSD) and major depression and then later to dissociative identity disorder, paranoia, and bipolar disorder. It was clear to me that my trauma symptoms determined the diagnosis. I wanted a cure and a reduction of my symptoms, instead of a variety of methods to merely manage them.

    My commitment to making therapy work was matched by the efforts of my therapist. She is a learner spirit and as tenacious as I am. Even so, it has taken a lifetime to arrive at an enduring sense of safety and freedom from the daily derailing of my consciousness by the intrusion of trauma memory content. Therapy changed as new knowledge of the impact of trauma emerged. I wondered if there was a way to combine therapies to improve the quality of my life and speed recovery.

    Who Knew the Mailman Triggered My Trauma?

    More than two years ago I detoxed out of a medication assisted treatment program after 15 years on methadone. Methadone helped me stabilize my life after a 20 year run with street opioids and just about every other “recreational” drug that was available. Over the time I was in the program, I enjoyed a very robust recovery.

    When I withdrew from methadone, I experienced--and continue to experience--a recovery within a recovery. The last two years have provided me with some insight into trauma, recovery, and ways of learning to cope with the events in my past that would have triggered me back into substance use. (Read more about Steven's experiences with trauma and recovery.)

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