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eNewsletter - January 8, 2008
Medication Assisted Recovery
Maine's Recovery Community Involvement in Advancing Recovery Project
Maine’s Office of Substance Abuse was one of a number of states to receive funding from the Robert Wood Johnson Foundation’s Advancing Recovery project. One of the state’s goals was to advance the use of medication-assisted treatment (MAT) in the state. Under the project, the state wanted to: a) evaluate barriers to MAT recovery b) develop educational strategies to reduce barriers and c) engage providers and encourage them to add medications to their treatment offerings.
Debbie Dettor, Coordinator of the Maine Alliance for Addiction Recovery (MAAR), was part of the state’s “grant team.” Below she’s described what MAAR did as part of the project to add a recovery focus to the project. She is interested in working with recovery advocates around the country to encourage treatment providers to meaningfully engage with the recovery community.
The state’s “grant team” talked about attitudinal barriers faced by people in MAT recovery, from treatment providers and the recovery community, notably within mutual support and other recovering groups. To give the project a recovery focus, they decided to engage people in treatment and recovery to get their thoughts and feedback about using medication. They were looking for more information about the overall barriers that people using medication face in their recovery; find out what peer recovery supports would be most useful; and get ideas about how to educate the general public and people in recovery about MAT supported recovery.
There were a number of questions that came up that they wanted the recovery community to answer. MAAR was charged with coordinating this work. The issues/questions were:
- Beliefs about the use of medications to assist recovery
- Experiences with medications and views on their effectiveness
- Reactions from providers with regard to MAT
- Whether or not they had been able to get what they needed within the treatment system
- Finding out what they want community members to understand about MAT
- Finding out what they want people on other recovery pathways to know about MAT
- Identifying the types of peer supports would be most beneficial to them
They decided to do a survey of the recovery community as well as to conduct focus groups.
1) A general survey was developed and distributed throughout recovery communities using traditional recovery-based methods like hand-delivery and asking for circulation assistance; posting on-line through Survey Monkey and emailing about this; asking treatment providers to get them to clients. Responses were anonymous. 128 responses were received and complied and at the MAAR (Maine Alliance for Addiction Recovery) website
2) Nine focus groups were held within the agencies represented in the Advancing Recovery grant process. A total of 81 participants offered their feedback, which was compiled. Providers were given the questionnaire ahead of time and informed that they would receive the completed report about the focus group done at their agency. Groups were identified only by number and participants remained anonymous. Compilation reports of all data were posted on-line at the MAAR website.
3) Five more focus groups were held within Methadone Clinics with a total of 24 people. Click here for a report about this group . A report was generated about their experience and it was posted online at the MAAR website.
Recovery Elements of the Focus Groups
The MAAR Coordinator facilitated each group. She identified herself as a person in long-term recovery for 22 years
- The Advancing Recovery grant process and the state’s goals were reviewed with participants
- The participants were informed that their responses would be anonymous and that the group would be identified by a number only and compilation reports would be posted on-line. The facilitator handed out her cards and MAAR website information where reports would be posted.
- The participants were informed that the facilitator viewed them as the experts about treatment and the support needs of those in recovery. She told them that the direct input of the recovery community was vital for the state to be able to develop a system that could support recovery
- The facilitator made a personal commitment to use the reports from the focus groups to make sure that the 'recovery voice' was heard within the state’s treatment delivery system and described MAAR as a recovery advocacy organization, as well as describing Faces & Voices of Recovery and the Robert Wood Johnson Foundation.
- The facilitator acknowledged that people in recovery use a variety of pathways to begin and maintain recovery journey and gave a brief overview about recovery advocacy movement.
1). About Maine's treatment system and the lack of community recovery support resources
We knew that access barriers abound in Maine’s formal treatment system due to chronic funding and resource gaps. Participants commented about their great difficulty locating treatment, being placed on long waiting lists, as well as problems with insurance coverage, especially for Suboxone. The NIATx rapid cycle improvement process is working to change business practices to improve access and engagement; and this RWJ AR grant seeks to expand access to MAT and case management.
However, recovery speaks to the larger life process. While recovery may be facilitated by the short term treatment models that treat addiction as an acute episode, long-term structured support is required by people to be successful with recovery efforts.
Participants remarked about the pervasive stigma that plagues those using MAT to assist recovery. For these individuals, there is virtually no community support in Maine. Many stated that family members don't understand benefits of MAT and that no education exists for family members leading to a lack of their support. Participants report that 12 step members speak disparagingly about MAT and these meetings are not beneficial to the majority of these participants. There are no other community-based support models in Maine. It was noted that medical providers lack knowledge about addiction and MAT recovery which presents healthcare barriers for people. MAT poses unique challenges to employment and to individuals being viewed as productive community members by law enforcement and judges.
Given the feedback from women and men in treatment, it is clear that the current MAT treatment structure is not enough to support long-term recovery success. Other barriers to methadone recovery include the challenge of maintaining recovery commitment when the perception is that so many other methadone clients are abusing the system. Respondents talked about how discouraging it is when providers don't intervene and 'cut offenders loose' to offer slots to those who truly want to get better. They expressed anger that the general public and police view them with the same negative lens.
When asked, most of the individuals engaged in MAT recovery stated that positive role models are not visible leading to a lack of MAT recovery success stories. This combined with cultural stigma makes many feel hopeless about their own potential. There are no structured support forums where they can go and meet individuals who are doing well over time.
2). About the benefits of offering recovery-based focus groups in treatment settings
The focus group discussions were clearly empowering for participants, who noted that no one had ever asked for their opinions in these ways. Many were also inspired to learn that recovering people work publicly using their recovery stories to benefit others and to educate policy makers and state leaders about recovery experiences and needs. Discussions about stigma & discrimination allowed for shared experiences to be explored, and ideas were generated about the ways stigma can be addressed within ourselves and the community.
The majority of participants left these groups expressing positive comments about being able to talk in these ways and many stated a need for more groups like this. These experiences indicate that people in long-term recovery can facilitate empowering discussions with people in treatment. The active addiction experience is already one of disempowerment and at many times, the treatment delivery system amplifies this in a number of ways. Personal empowerment is crucial, along with hope, in supporting steps to long-term recovery. Group discussions like these focus groups can offer some hopeful and empowering recovery opportunities while in the treatment process, giving participants models to aspire toward.
Participants provided important feedback about the kinds of peer support networks they would like to have available. I presented a number of peer models being used in other states and asked whether they thought these would be beneficial in Maine and recorded this information. In addition, they also expressed clear needs above and beyond these specific models.
The Maine Advancing Recovery team will be looking at how this information can be used to address the recovery barriers that were identified within the state. MAAR also held discussions with people in long-term MAT recovery about the ways their positive recovery stories could help lower attitudinal barriers. They are interested in developing a speakers' bureau of MAT recovering individuals who can assist with strategic education and are seeking interested women and men.
For further information, contact Debbie Dettor, M.S., MAAR Coordinator, MAAR c/o MASAP 8 Mulliken Court Augusta, Maine 04330 or by phone at (207)458-4366.