The Substance Abuse and Mental Health Services Administration (SAMHSA) defines recovery as a “process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential.”1 While setbacks are expected, hope is the foundation of recovery. The four dimensions that support recovery include1:
- Health—the individual can manage the disease or its symptoms and makes healthy, informed choices.
- Home—the living environment is safe and stable.
- Purpose—the individual can participate in society in a meaningful, purposeful way.
- Community—social relationships provide support, friendship, love, and hope.
Recovery supports are community-based services that can improve patients’ quality of life and help sustain progress they have made in treatment.2 These support services take a holistic approach to recovery by providing emotional and practical support to help individuals with opioid use disorders manage their lives and their conditions.
The types of services that providers connect patients with should be determined by what is locally available and the individual patient’s needs and preferences. Providers should first focus on addressing the personal and practical problems of greatest concern to their patients.2 Recovery supports also need to be flexible, as recovery is very personal and needs and preferences may change over time.1
Providers identify and help link patients to community-based recovery supports based on patient needs and preferences.
How Do You Do It?
Recognize the Role of Social Determinants of Health
The social determinants of health are the social, physical, and economic conditions in which people live. Social determinants of health can play a critical role in patients’ short- and long-term health outcomes, including functioning, quality of life, and risk factors.3
Healthy People 2020 groups social determinants into five categories3:
- Economic stability (e.g., employment, food insecurity, housing instability, poverty);
- Education (e.g., early childhood education and development, enrollment in higher education, graduation from high school, literacy);
- Social and community context (e.g., social cohesion and support, discrimination, incarceration rates);
- Health and health care (e.g., access to health care, health literacy); and
- Neighborhood and built environment (e.g., prevalence of crime and violence, environmental quality, housing).
A true patient-centered, holistic approach to recovery will identify patients’ needs related to their social determinants of health and incorporate services that address those needs into the treatment plan. For example, if patients are unemployed and living in poverty, providers might consider connecting them with supported employment services to help them find a job.
Identify Recovery Supports and Develop Partnerships
The recovery supports available will vary based on the local community. Overall, these resources may be more limited in rural or poor areas. Medication-assisted treatment (MAT) programs should maintain a list of all potentially helpful community-based recovery support services and organizations that may help meet patients’ complex needs. Ideally, they might engage and develop partnerships with these community organizations. They can educate patients and their families about these available recovery supports. If patients need and are interested in these services, the treatment plan should reflect this interest and include strategies to actively connect them.
Mutual Aid or Self-Help Groups. These groups are often the most widely available type of recovery support, even in rural areas. They allow individuals in treatment or recovery to learn from the experiences of others and form connections for emotional support.4 Some of these groups, such as Alcoholics Anonymous, Narcotics Anonymous, and SMART Recovery, are based on a 12-step program. Some support groups are specifically designed for family members of those with substance use disorders.
It is worth noting that, historically, some of these groups did not welcome individuals taking medications to treat substance use disorders, as they did not consider this option to be true “abstinence.” While attitudes may be shifting and some MAT-specific 12-step groups are forming, providers should listen to patient feedback and experiences with these groups and encourage attendance at those that will offer patients the best support. In some cases, patients may not want to be extremely vocal about their MAT.
Recovery Coaches and Peer Support Workers. These are lay members of the recovery team. They may be paid or voluntary positions. A variety of titles are used, including recovery coaches and peer support workers. People in recovery often serve in these roles. They draw on their own lived experience with substance use disorders to help instill hope and offer emotional support to others.4 They also model positive behaviors and help individuals in recovery develop needed life skills, such as how to build social relationships and how to structure free time. They might also serve a navigation role, connecting individuals with substance use disorders to needed community services and addressing any barriers that might interfere with their recovery.4
Case Management. These services can help establish the stability in a patient’s life needed for recovery.2 Case management includes helping patients get access to food, housing, income support, legal aid, transportation, and employment. A safe, stable living environment may be key to recovery. Therefore, community-based organizations may help connect individuals with substance use disorders to affordable housing or offer substance-free housing options.
For example, a local community may have recovery housing or sober living homes.4 Living in recovery-supportive homes can help patients draw on mutual support from other residents in a substance-free environment. Learn more about the importance of finding and keeping housing.
Similarly, finding a job can help individuals with opioid use disorder by giving them meaning or purpose in life and financial stability. Organizations or agencies that provide supported employment or vocational rehabilitation services can help people find job training, apply for jobs, and obtain accommodations to help maintain employment. Learn more about the importance of meaningful work in recovery.
Mobile or Web-Based Applications. Providers in rural communities or other areas that lack available recovery supports should also consider the use of mobile or web-based applications. These apps can help provide support whenever and wherever patients need it. For example, in 2016, SAMHSA held a challenge to develop free, recovery-focused support apps for patients with opioid use disorder receiving outpatient MAT. The winners included apps called: FlexDek for MAT, rePear, and Recopia.
What Not To Do
- Don’t ignore the impact of social determinants of health on patient behaviors and outcomes.
- Don’t forget there are many paths to recovery. Everyone is unique, and what works for one person may not work for another.
Treatment Improvement Protocol (TIP) 60: Using Technology-Based Therapeutic Tools in Behavioral Health Services
- Substance Abuse and Mental Health Services Administration. Recovery and Recovery Support. Last updated May 2019. https://www.samhsa.gov/find-help/recovery. Accessed June 6, 2019.
- Substance Abuse and Mental Health Services Administration. Treatment Improvement Protocol 63: Medications for Opioid Use Disorder. Part 4: Partnering Addiction Treatment Counselors With Clients and Healthcare Professionals. Rockville, MD: Substance Abuse and Mental Health Services Administration; 2018. Publication No. SMA18-5063PT4. https://store.samhsa.gov/product/SMA18-5063PT4. Accessed June 6, 2019.
- Healthy People 2020. Social Determinants of Health. n.d. https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health. Accessed June 6, 2019.
- Office of the Surgeon General. Recovery: The many paths to wellness. In: Facing Addiction in America: The Surgeon General’s Spotlight on Opioids. Washington, DC: U.S. Department of Health and Human Services; 2016. Chapter 5. https://addiction.surgeongeneral.gov/sites/default/files/chapter-5-recovery.pdf. Accessed June 6, 2019.