**National Summit on Recovery**

**Conference Report**

Washington, D.C.

September 28-29, 2005

**Substance Abuse and Mental Health Services Administration**

**U.S. Department of Health and Human Services**

**Center for Substance Abuse Treatment**

**Acknowledgements**

This conference report was produced collaboratively by Health Systems
Research, Inc. and Abt Associates, Inc. under the Recovery Community
Services Program and the Partners for Recovery initiative contract
numbers 270-2003-00005 and 270-2003-00009 with the Substance Abuse and
Mental Health Services Administration (SAMHSA), U.S. Department of
Health and Human Services (DHHS). Catherine D. Nugent, Project Officer
for the Recovery Community Services Program within the Division of
Services Improvement, and Donna M. Cotter, Coordinator of the Partners
for Recovery (PFR) initiative within CSAT\'s Office of Program Analysis
and Coordination, provided leadership in developing the report. Dr. H.
Westley Clark, Director, CSAT, provided overall leadership for the
Recovery Summit, and George Gilbert, Director, CSAT\'s Office of Program
Analysis and Coordination, provided policy direction.

This report is based on discussions that occurred at the CSAT National
Summit on Recovery, held September 28-29, 2005 and at two adjunctive
meetings---a Summit Planning Meeting, held June 13-14, 2005 and a Summit
Follow-up Meeting, held December 14-15, 2005. The quality of the
discussions at the Summit and adjunctive meetings was due, in part, to
the expert facilitation of Susan Hailman and Paul Harris of Campaign
Consultation, Inc. and Tom Hill of Health Systems Research, Inc. A
diverse group of over 100 individuals representing the treatment and
recovery field participated in the Summit and adjunctive meetings.
SAMHSA/CSAT wishes to acknowledge their thoughtful observations and
creative suggestions, which shaped this report. Logistical planning and
support for the Summit meetings were provided by Westover Consultants,
Inc.

Major portions of this report were authored by Health Systems Research,
Inc. (HSR). The HSR team was led by June M. Gertig, Project Director,
with support from Tom Hill, Carolyn Davis, and Maria B. Martin. Abt
Associates Inc. also contributed significantly to the content and design
of the report. The Abt team consisted of Melanie R. Whitter, Project
Director, and G. Peter Gaumond, with graphical support from Edelman,
Inc. CSAT also wishes to acknowledge the efforts of the Summit Planning
Group members, who assisted in designing the agenda and framing key
discussion questions for the Summit and who also helped synthesize the
dialogue at the Summit.

**Disclaimer**

The opinions expressed herein are the views of the participants at
CSAT\'s National Summit on Recovery and adjunctive meetings and do not
necessarily reflect the official position of CSAT, SAMSHA, or DHHS. No
official support of or endorsement by CSAT, SAMHSA, or DHHS for these
opinions or for particular instruments, software, or resources described
in this document are intended or should be inferred. Nothing in this
document should be considered as a substitute for individualized client
care and treatment decisions.

**Public Domain Notice**

All materials appearing in this volume except those taken directly from
copyrighted sources are in the public domain and may be reproduced or
copied without permission from SAMHSA/CSAT or the authors. Do not
reproduce or distribute this publication for a fee without specific,
written authorization from SAMHSA\'s Office of Communications.

**Electronic Access and Copies of Publication**

Copies may be obtained free of charge from SAMHSA\'s National
Clearinghouse for Alcohol and Drug Information (NCADI), (800) 729-6636
or (301) 468-2600; TDD (for hearing impaired), (800) 487-4889, or
electronically through the following Internet World Wide Web site:
www.ncadi.samhsa.gov.

**Recommended Citation**

Center for Substance Abuse Treatment. National Summit on Recovery:
Conference Report. DHHS Publication No. (SMA) 07-4276. Rockville, MD:
Substance Abuse and Mental Health Services Administration 2007.

**A Note on the Graphic**

Members of the June 13-14, 2005 Planning Group were guided through a
process that resulted in a large pictorial representation of major
recovery issues and themes. Portions of this pictorial representation
are presented on the front cover and throughout the report.

**Table of Contents**

**Part I: Overview** 1

Summit Goals 1

Summit Participants 1

A Strategically Planned Summit 2

Guide to Conference Report 3

**Part II: Guiding Principles of Recovery**

**and Elements of Recovery-Oriented Systems of Care** 4

A Working Definition of Recovery 5

Guiding Principles 5

Systems of Care Elements 7

Visually Representing Recovery and Recovery-Oriented Systems of Care 9

**Part III: Recommendations for the Treatment and Recovery Field** 10

Recommended Next Steps for Consideration by CSAT 11

Recommended Next Steps for Consideration by Systems Professionals 12

Recommended Next Steps for Consideration by Treatment Providers 12

Recommended Next Steps for Consideration by Recovery Support Service
Providers 13

Recommended Next Steps for Consideration by Researchers and Evaluators
14

Recommended Next Steps for Consideration by Mutual Aid Organizations 14

Recommended Next Steps for Consideration by Recovery Advocates 15

**Appendices**

**Appendix 1: CSAT National Summit on Recovery Participant List 18**

**Appendix 2: Summit Agendas 32**

Appendix 2.1: CSAT National Summit on Recovery Planning Group Meeting
Agenda 33

Appendix 2.2: CSAT National Summit on Recovery Agenda 38

Appendix 2.3: CSAT Follow-Up Meeting Agenda 43

**Appendix 3: Background Paper: Recovery Themes 47**

**Appendix 4: SAMHSA National Outcomes Measures 77**

**Appendix 5: Voices from the Field: Panel Presentation Summaries 79**

Appendix 5.1: Phil Valentine: Recovery Community Services Program 80

Appendix 5.2: Pat Taylor: Faces & Voices of Recovery 83

Appendix 5.3: Randy Muck: SAMHSA/CSAT Adolescent Focus Groups Panel

and Paper 86

Appendix 5.4: William White: Comments Following Panel Discussion 102

**Appendix 6: Recovery Graphics 104**

Appendix 6.1: Individual and Environmental Components of Recovery 104

Appendix 6.2: Recovery and Wellness Model 105

Appendix 6.3: Service System Progression Model 106

Appendix 6.4: Building Resiliency, Wellness and Recovery---A Model for
the Prevention

and Management of Substance Use Disorders 107

**Part I: Overview**

Guiding principles of recovery and elements of recovery-oriented systems
of care for people with a substance use disorder[^1] (SUD) were
articulated by leaders of the treatment and recovery field at the 2005
National Summit on Recovery convened by the Substance Abuse and Mental
Health Services Administration's (SAMHSA's) Center for Substance Abuse
Treatment (CSAT). Transformative ideas and concrete recommendations for
advancing the development of such systems of care also emerged from the
Summit. This was the first time a broad-based consensus on guiding
principles of recovery and elements of recovery-oriented systems was
reached on a national level.

Support for the National Summit on Recovery was provided jointly by two
SAMHSA/CSAT initiatives, the Recovery Community Services Program and the
Partners for Recovery initiative.

**Summit Goals**

CSAT had three goals for the National Summit on Recovery:

 Develop new ideas to transform policy, services and systems toward a
recovery-oriented paradigm that is more responsive to the needs of
people in or seeking recovery, as well as their family members and
significant others.

 Articulate guiding principles and measures of recovery that can be
used across programs and services to promote and capture improvements in
systems of care, facilitate data sharing and enhance program
coordination.

 Generate ideas for advancing recovery-oriented systems of care in
various settings and systems (e.g., criminal justice, faith communities,
peer support programs, etc.) and for specific populations (e.g., racial,
ethnic and cultural groups; women; people in medication-assisted
recovery; people with co-occurring disorders, etc.).

**Summit Participants**

The Summit brought together a diverse group of over 100 stakeholders,
such as recovering individuals, family members, mutual aid
organizations, systems professionals and treatment providers. Over half
identified themselves as people in recovery. Participants also
represented many different stakeholder groups, defined by
characteristics such as:

 Race or ethnicity (African American, Asian American, Caucasian, Native
American, Hispanic/Latino)

 Co-occurring conditions (mental health disorders including trauma)

 HIV/AIDS and other infectious diseases

 Criminal justice involvement

 Stage in the life cycle (adolescents, adults and the elderly)

 Professional and/or community affiliation (systems professionals,
treatment providers, researchers, evaluators, recovery support service
providers, mutual aid groups and recovery advocates)

 Approaches to recovery, including secular, faith-based and
medication-assisted.

The Summit was designed to enable these diverse participants to interact
and engage in dialogue. Many schools of thought and unique perspectives
were represented, and participants did not always agree. However, they
demonstrated an exceptional willingness to find common ground on
recovery topics. Appendix 1 lists the participants.

**A Strategically Planned Summit**

The first National Summit on Recovery was a process, not an event. The
process included a stakeholders' planning meeting, CSAT planning
activities and materials development, the Summit itself and a follow-up
meeting. Appendix 2 contains agendas for each of the three Summit
meetings.

**Summit Planning Meeting, June 13--14, 2005**

Twenty stakeholders helped SAMHSA/CSAT frame questions and shape an
agenda for the Summit. Participants were instrumental in designing a
process that would maximize the contributions of attendees from diverse
groups and foster shared support for ideas and recommendations for
moving toward recovery-oriented systems of care.

The planning group reviewed and approved materials that had been sent to
them in advance to help frame the discussions including Appendix 3,
Background Paper: Recovery Themes, as well as preliminary research on
guiding principles of recovery and elements of recovery-oriented systems
of care. Appendix 4 contains National Outcome Measures identified by
SAMHSA.

Meeting planners and facilitators were encouraged to develop an
interactive agenda permitting all perspectives and stakeholder groups to
be heard and smaller structured discussions to take place.

The planning group identified the following types of breakout groups:
(1) participants viewing recovery and systems of care from a similar
perspective, designated as "lens groups" and (2) stakeholder groups in
the treatment and recovery field:

 Lens groups: Participants who were asked to view treatment and
recovery processes through one of six lenses: (1) cultural relevance,
(2) person-centeredness, (3) spirituality, (4) wellness, (5) treatment
and (6) measurement.

 Stakeholder groups: Stakeholders from the treatment and recovery field
who would be best positioned to effectuate change: (1) systems
professionals, (2) treatment providers, (3) researchers and evaluators,
(4) recovery support services providers, (5) mutual aid groups and (6)
recovery advocates.

In addition, the planning group decided that a breakout group would be
invited to develop various graphics that could capture, in a visual
fashion, the ideas being explored at the Summit.

**National Summit, September 28--29, 2005**

The agenda for the Summit included plenary presentations and a recovery
panel, and is included in Appendix 5; however, the majority of time was
devoted to interactive breakout activities in lens groups and
stakeholder groups in which participants engaged in structured
discussions of their ideas for moving toward recovery-oriented systems
of care. The two-day meeting concluded with the stakeholder groups
recommending steps to be taken to move toward

recovery-oriented systems of care.

**Follow-up Meeting, December 14--15, 2005**

The planning group reconvened to review and synthesize the ideas from
the Summit and develop recommendations for actions within each
stakeholder group and at CSAT. Participants were given draft briefs
summarizing the thinking of Summit participants on guiding principles of
recovery and elements of recovery-oriented systems of care and
recommendations for moving forward. The planning group's task was to
validate and/or modify the draft briefs to ensure that the final report
on the National Summit on Recovery fully and accurately reflected the
diverse perspectives of participants. In response to recommendations
from Summit participants, the planning group developed a working
definition of recovery that could be used across systems, programs and
stakeholder groups.

**Guide to Conference Report**

The synthesis of ideas and recommendations emerging from the Summit are
presented in Parts II and III:

 Part II: Guiding Principles of Recovery and Elements of
Recovery-Oriented Systems of Care

 Part III: Recommendations for the Treatment and Recovery Field

This synthesis represents the best thinking of the Summit participants.
It highlights principles that support recovery-oriented systems of care
and suggests steps that the treatment and recovery field can take in the
next year to move forward.

**Part II: Guiding Principles of Recovery and Elements of
Recovery-Oriented Systems of Care**

The concept of recovery lies at the core of SAMHSA's mission, and
fostering the development of recovery-oriented systems of care is a
SAMHSA priority. The working definition of recovery, guiding principles
of recovery and elements of recovery-oriented systems of care that were
developed through the Summit process provide a philosophical and
conceptual framework to guide SAMHSA and other stakeholder groups and
offer a shared language for dialogue among stakeholders. Although the
substance use disorder treatment and recovery field has discussed and
lived recovery for decades, this Summit represents the first broad-based
national effort to reach a common understanding of the guiding
principles of recovery and elements of systems of care and to define
recovery.

The development of guiding principles and elements emerged from a
multistage process, which began with a literature review, followed by a
first draft of guiding principles of recovery and elements of
recovery-oriented systems of care and review of the initial draft by the
Summit Planning group. The documents were revised to reflect planning
group input and mailed in advance of the Summit to those invited to
participate. Participants in the Summit were asked:

 What principles of recovery should guide the field in the future?

 What ideas could help make the field more recovery oriented?

Based on contributions from those attending the Summit, the guiding
principles and elements were further revised and a briefing report was
prepared for attendees at the Summit follow-up meeting. The guiding
principles and elements were reviewed and refined a third and final time
during the follow-up meeting. Responding to recommendations from the
Summit attendees, the participants at the follow-up meeting also
developed a working definition of recovery.

While there was consensus among participants at the follow-up meeting on
a working definition of recovery and among the Summit participants on
the guiding principles of recovery and systems of care elements, two
important points also were recognized by stakeholders:

 Individuals may choose to define recovery differently.

 Not all guiding principles apply to all people, and different guiding
principles may apply at different points in the recovery process.

Stakeholders agreed that recovery is a complex and dynamic process and
that race, ethnicity, gender, sexual orientation, family history,
life-cycle stage, environment, culture and other factors combine with an
individual's unique experiences, strengths, values, perspectives, needs
and desires to yield a recovery process unique to each person.

The working definition of recovery, guiding principles and systems of
care elements have a unique foundation in their grounding not only in a
review of relevant literature, but also in the experience of recovering
people, treatment and recovery support workers and many others. The
working definition, guiding principles and systems of care elements will
become part of CSAT's ongoing dialogue with the substance use disorder
treatment and recovery field, policymakers, Congress and the public, and
will be reflected in speeches, program announcements and other forms of
public communication. These defining elements will also be discussed in
publications, may be considered as standards or criteria against which
service models and products can be evaluated or developed and may also
be used for in-service training.

The working definition, guiding principles and system of care elements
provide States, treatment and recovery support providers, recovering
individuals, family members, researchers and other stakeholders with a
shared framework from which to begin dialogue.

The following sections detail the guiding principles and elements of
recovery-oriented systems of care that emerged from the Summit. These
sections are introduced by the working definition of recovery developed
at the follow-up meeting and are followed by a brief discussion of the
deliberations of the Summit participants who considered various ways of
representing these ideas visually.

"The Federal government can play a critical role by crafting messages
that treatment works, that recovery is real and that peers play a
critical role in fostering resilience and embodying a message of hope."

*--H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM*

*Director, Center for Substance Abuse Treatment*

**A. A Working Definition of Recovery**

A frequent recommendation from the Summit participants was that CSAT
take the initiative in asking the treatment and recovery field to
develop a shared definition of recovery that can be used across systems,
programs and stakeholder groups. CSAT, in turn, asked the participants
at the follow-up meeting to submit, for consideration by the field, a
working definition that reflected the tenor of the Summit deliberations.
Working from two sample definitions, the group developed the following:

> *Recovery from alcohol and drug problems is a process of change
> through which an individual achieves abstinence and improved health,
> wellness and quality of life.*

B.  **Guiding Principles**

The guiding principles that emerged from the Summit are broad and
overarching, intended to give general direction to SAMHSA and other
stakeholder groups as the treatment and recovery field moves toward
operationalizing recovery-oriented systems of care and developing core
measures and evidence-based practices. The principles also helped Summit
participants define the elements of recovery-oriented systems of care
that are identified in Part II-C of this report, and served as a
foundation for the recommendations to the field contained in Part III.

 **There are many pathways to recovery.** Individuals are unique with
specific needs, strengths, goals, health attitudes, behaviors and
expectations for recovery. Pathways to recovery are highly personal, and
generally involve a redefinition of identity in the face of crisis or a
process of progressive change. Furthermore, pathways are often social,
grounded in cultural beliefs or traditions and involve informal
community resources, which provide support for sobriety. The pathway to
recovery may include one or more episodes of psychosocial and/or
pharmacological treatment. For some, recovery involves neither treatment
nor involvement with mutual aid groups. Recovery is a process of change
that permits an individual to make healthy choices and improve the
quality of his or her life.

 **Recovery is self-directed and empowering**. While the pathway to
recovery may involve one or more periods of time when activities are
directed or guided to a substantial degree by others, recovery is
fundamentally a self-directed process. The person in recovery is the
"agent of recovery" and has the authority to exercise choices and make
decisions based on his or her recovery goals that have an impact on the
process. The process of recovery leads individuals toward the highest
level of autonomy of which they are capable. Through self-empowerment,
individuals become optimistic about life goals.

 **Recovery involves a personal recognition of the need for change and
transformation.** Individuals must accept that a problem exists and be
willing to take steps to address it; these steps usually involve seeking
help for a substance use disorder. The process of change can involve
physical, emotional, intellectual and spiritual aspects of the person's
life.

 **Recovery is holistic**. Recovery is a process through which one
gradually achieves greater balance of mind, body and spirit in relation
to other aspects of one's life, including family, work and community.

 **Recovery has cultural dimensions.** Each person's recovery process
is unique and impacted by cultural beliefs and traditions. A person's
cultural experience often shapes the recovery path that is right for him
or her.

 **Recovery exists on a continuum of improved health and wellness.**
Recovery is not a linear process. It is based on continual growth and
improved functioning. It may involve relapse and other setbacks, which
are a natural part of the continuum but not inevitable outcomes.
Wellness is the result of improved care and balance of mind, body and
spirit. It is a product of the recovery process.

 **Recovery emerges from hope and gratitude.** Individuals in or
seeking recovery often gain hope from those who share their search for
or experience of recovery. They see that people can and do overcome the
obstacles that confront them and they cultivate gratitude for the
opportunities that each day of recovery offers.

 **Recovery involves a process of healing and self-redefinition.**
Recovery is a holistic healing process in which one develops a positive
and meaningful sense of identity.

 **Recovery involves addressing discrimination and transcending shame
and stigma.** Recovery is a process by which people confront and strive
to overcome stigma.

 **Recovery is supported by peers and allies.** A common denominator in
the recovery process is the presence and involvement of people who
contribute hope and support and suggest strategies and resources for
change. Peers, as well as family members and other allies, form vital
support networks for people in recovery. Providing service to others and
experiencing mutual healing help create a community of support among
those in recovery.

 **Recovery involves (re)joining and (re)building a life in the
community.** Recovery involves a process of building or rebuilding what
a person has lost or never had due to his or her condition and its
consequences. Recovery involves creating a life within the limitation
imposed by that condition. Recovery is building or rebuilding healthy
family, social and personal relationships. Those in recovery often
achieve improvements in the quality of their life, such as obtaining
education, employment and housing. They also increasingly become
involved in constructive roles in the community through helping others,
productive acts and other contributions.

 **Recovery is a reality.** It can, will, and does happen.

C.  **Systems of Care Elements**

Participants at the National Summit on Recovery agreed that
recovery-oriented systems of care are as complex and dynamic as the
process of recovery itself. Recovery-oriented systems of care are
designed to support individuals seeking to overcome substance use
disorders across the lifespan. They are comprehensive, flexible,
outcomes-driven and uniquely individualized, offering a fully
coordinated menu of services and supports to maximize choice at every
point in the recovery process.

Participants at the Summit also declared, "There will be no wrong door
to recovery." The attendees recognized that some people recover
"naturally," without any apparent reliance on treatment, mutual aid, or
other formal supports, while many others enter recovery through mutual
aid groups and/or faith communities. Yet other individuals enter
recovery through substance use disorder treatment. The Summit
participants noted that a variety of factors, including the severity of
substance use disorders, age, culture and the presence of co-occurring
physical or mental health problems or involvement with the criminal
justice system can influence which of these paths an individual chooses.
Participants also recognized that recovery-oriented systems of care need
to provide "genuine, free and independent choice" (SAMHSA 2004) among an
array of treatment and recovery support options and that services should
optimally be provided in flexible, unbundled packages that evolve over
time to meet the changing needs of recovering individuals.

 **Person-centered.** Recovery-oriented systems of care will be
person-centered. Individuals will have a menu of stage-appropriate
choices that fit their needs throughout the recovery process. Choices
can include spiritual supports that fit with the individual's recovery
needs.

 **Family and other ally involvement.** Recovery-oriented systems of
care will acknowledge the important role that families and other allies
can play. Family and other allies will be incorporated, when
appropriate, in the recovery planning and support process. They can
constitute a source of support to assist individuals in entering and
maintaining recovery. Additionally, systems need to address the
treatment, recovery and other support needs of families and other
allies.

 **Individualized and comprehensive services across the lifespan.**
Recovery-oriented systems of care will be individualized, comprehensive,
stage-appropriate, and flexible. Systems will adapt to the needs of
individuals, rather than requiring individuals to adapt to them. They
will be designed to support recovery across the lifespan. The approach
to substance use disorders will change from an acute-based model to one
that manages chronic disorders over a lifetime.

 **Systems anchored in the community.** Recovery-oriented systems of
care will be nested in the community for the purpose of enhancing the
availability and support capacities of families, intimate social
networks, community-based institutions and other people in recovery.

 **Continuity of care.** Recovery-oriented systems of care will offer a
continuum of care, including pretreatment, treatment, continuing care
and support throughout recovery. Individuals will have a full range of
stage-appropriate services from which to choose at any point in the
recovery process.

 **Partnership-consultant relationships.** Recovery-oriented systems of
care will be patterned after a partnership-consultant model that focuses
more on collaboration and less on hierarchy. Systems will be designed so
that individuals feel empowered to direct their own recovery.

 **Strength-based.** Recovery-oriented systems of care will emphasize
individual strengths, assets and resiliencies.

 **Culturally responsive.** Recovery-oriented systems of care will be
culturally sensitive, competent and responsive. There will be
recognition that beliefs and customs are diverse and can impact the
outcomes of recovery efforts. In addition, the cultures of those who
support the recovering individual affect the recovery process.

 **Responsiveness to personal belief systems.** Recovery-oriented
systems of care will respect the spiritual, religious and/or secular
beliefs of those they serve and provide linkages to an array of recovery
options that are consistent with these beliefs.

 **Commitment to peer recovery support services.** Recovery-oriented
systems of care will include peer recovery support services. Individuals
with personal experience of recovery will provide these valuable
services.

 **Inclusion of the voices and experiences of recovering individuals
and their families.** The voices and experiences of people in recovery
and their family members will contribute to the design and
implementation of recovery-oriented systems of care. People in recovery
and their family members will be included among decision-makers and have
oversight responsibilities for service provision. Recovering individuals
and family members will be prominently and authentically represented on
advisory councils, boards, task forces and committees at the Federal,
State and local levels.

 **Integrated services.** Recovery-oriented systems of care will
coordinate and/or integrate efforts across service systems to achieve an
integrated process that responds effectively to the individual's unique
constellation of strengths, desires and needs.

 **Systemwide education and training.** Recovery-oriented systems of
care will ensure that concepts of recovery and wellness are foundational
elements of curricula, certification, licensure, accreditation and
testing mechanisms. The workforce also requires continual training, at
every level, to reinforce the tenets of recovery-oriented systems of
care.

 **Ongoing monitoring and outreach.** Recovery-oriented systems of care
will provide ongoing monitoring and feedback with assertive outreach
efforts to promote continual participation, re-motivation and
reengagement.

 **Outcomes driven.** Recovery-oriented systems of care will be guided
by recovery-based process and outcome measures. These measures will be
developed in collaboration with individuals in recovery. Outcome
measures will reflect the long-term global effects of the recovery
process on the individual, family and community, not just remission of
biomedical symptoms. Outcomes will be measurable and include benchmarks
of quality-of-life changes.

 **Research based.** Recovery-oriented systems of care will be informed
by research. Additional research on individuals in recovery, recovery
venues and the processes of recovery, including cultural and spiritual
aspects, is essential. Research will be supplemented by the experiences
of people in recovery.

 **Adequately and flexibly financed.** Recovery-oriented systems of
care will be adequately financed to permit access to a full continuum of
services, ranging from detoxification and treatment to continuing care
and recovery support. In addition, funding will be sufficiently flexible
to permit unbundling of services, enabling the establishment of a
customized array of services that can evolve over time in support of an
individual's recovery.

D.  **Visually Representing Recovery and Recovery-Oriented Systems of
    Care**

One breakout group convened to consider ways of visually representing
the complex and dynamic principles that guide recovery, and that drive
systems of care designed to help people achieve and sustain it. The
participants reviewed visual representations by a number of authors, and
four of these are presented in Appendix 6. While all the depictions were
seen as valuable, the consensus of the participants was that a
three-dimensional model was necessary to depict all the layers and
complexities of recovery.

Core criteria identified by the group included: Whose perspective does
the graphic reflect? Who is the target audience? What is its central
informational/emotional message? What effect is this message likely to
have on the target audience?

The group recommended that future efforts to develop a visual
representation of recovery and recovery-oriented systems of care
consider utilizing a series of overlays that captures recovery on at
least three levels: the individual, the individual within his or her
natural environment and the individual (located within his or her
environment) as the center of systems of care.

**Part III: Recommendations for the Treatment and Recovery Field**

The Summit planners and participants agreed that developing
recovery-oriented systems of care would require the commitment and
contributions of stakeholder groups, including:

 Systems professionals

 Treatment providers

 Recovery support service providers

 Researchers and evaluators

 Mutual aid groups

 Recovery advocates.

To generate concrete recommendations for the treatment and recovery
field, participants convened in stakeholder groups to consider key
questions:

 What does this stakeholder group currently contribute toward creating
recovery-oriented systems of care?

 What more could this stakeholder group do to advance recovery-oriented
systems of care?

 What are three strategies for advancing the goal of a change to
recovery-oriented systems of care?

They also convened in mixed stakeholder groups to consider other
questions:

 What would integrated recovery-oriented systems of care look like?

 Where are current examples of cross-group integration or cooperation?

 How could those efforts bridge to new kinds of collaboration?

 What are the major hurdles to achieving this vision?

 What ideas, if implemented, could move beyond those hurdles?

After the Summit, key recommendations were identified and listed for
each stakeholder group. A briefing report on recommendations, by
stakeholder group, was prepared for the follow-up meeting.

The planning group reviewed, consolidated, revised and prioritized the
recommendations that had been generated by the single and mixed
stakeholder groups at the Summit. In addition, the stakeholder group
recommendations were enriched by a "fishbowl" process where two
representatives of each stakeholder group shared their thinking about
which recommendations needed priority attention, and identified:

 Important partners whose support would be needed

 Places where discussions needed to occur

 Products that could be developed to support the process.

After each stakeholder group completed its presentation, the planning
group gave feedback.

The following sections outline recommended next steps for CSAT and each
of the stakeholder groups represented at the National Summit on
Recovery. These next steps were envisioned as part of an overall process
of operationalizing and developing core measures and evidence-based
practices for recovery-oriented systems of care.

**Recommended Next Steps for Consideration by CSAT**

 Inventory current programs and practices throughout CSAT to determine
strengths and gaps from a recovery-oriented perspective.

 Convene a full-day summit attended by researchers to discuss research
strategies and formulate an integrated research agenda. This summit
would be attended by researchers from the National Institute on Drug
Abuse (NIDA), the National Institute on Alcohol Abuse and Alcoholism
(NIAAA) and the National Institute of Mental Health (NIMH) and
community-based researchers, as well as by representatives of CSAT and
the Center for Mental Health Services (CMHS).

 Use the development of the "social connectedness" National Outcomes
Measures (NOMs) domain as an opportunity to further align NOMs with the
guiding principles of recovery and elements of recovery-oriented systems
of care identified at the Summit.

 Conduct outreach with other national organizations whose support for
recovery-oriented systems of care will be instrumental.

 Convene a series of regional meetings on recovery-oriented systems of
care to encourage their development within the States.

 Develop a working definition of recovery that can be used across
systems, programs and stakeholder groups.

 Provide education and technical assistance about recovery-oriented
approaches to care.

 Facilitate the development of an ethical framework for peer recovery
support services, building on current standards.

 Develop new financing models that will permit the treatment and
recovery field to support recovery-oriented systems of care.

 Continue to ensure that individuals and recovery organizations in
recovery are represented in CSAT initiatives. Representatives should be
diverse, reflecting a variety of recovery perspectives and personal
characteristics such as race, gender, ethnicity and age.

"CSAT is planning to infuse recovery principles and measures into our
policies, programs, and products. We will also inform and support
SAMHSA's larger efforts to promote recovery by offering substance use
disorder-related recovery ideas that can be incorporated into the larger
behavioral health picture."

*--George Gilbert, Director*

*Office of Program Analysis and Coordination/Center for Substance Abuse
Treatment*

**Recommended Next Steps for Consideration by Systems Professionals**

 Encourage National Association of State Alcohol/Drug Abuse Directors
(NASADAD) to convene, educate and support Single State Authorities
(SSAs) in the development of recovery-oriented systems of care.

 Utilize regional meetings as a venue for sharing information on the
challenges and opportunities for designing and implementing
recovery-oriented systems of care.

 Create opportunities at the State level for dialogue among key
stakeholders such as treatment and recovery support service providers.
Support stakeholders in promoting and disseminating a shared vision,
clear messages and a collaborative action plan.

 Inventory current programs and practices in the States to determine
strengths and gaps from a recovery-oriented perspective, including
experience, opportunities and challenges in working with nontraditional
providers of recovery support and with allies and partners from other
systems.

 Invest in building capacity where needed.

 Expand and strengthen collaborative and integrative work with other
systems---from mutual aid organizations to criminal justice
systems---that serve the needs of individuals, families and communities
seeking recovery.

"We need to function as change agents, convening key stakeholders at the
State level to promote dialogue. We need to replicate at the State level
what is happening here at the Summit -- engaging people from across the
treatment and recovery field and, where necessary, remediating perceived
differences and finding common ground where everybody can both
contribute and gain."

*--A Summit Participant*

**Recommended Next Steps for Consideration by Treatment Providers**

 Participate with other stakeholders in all aspects of design, planning
and implementation of recovery-oriented systems of care, starting with
the recommended regional summits on recovery-oriented systems of care to
be convened by CSAT.

 Engage and involve professional associations and public opinion
leaders in the effort to develop recovery-oriented systems of care.

 Work with recovery support service providers to clarify role
definition, with a vision to

create a seamless relationship on behalf of the person served.

 Further integrate the Guiding Principles of Recovery and Elements of
Recovery-Oriented Systems of Care into clinical frameworks.

 Survey treatment providers to identify strengths and gaps and
promising practices from a recovery perspective, including experience,
opportunities and challenges in working with nontraditional providers of
recovery support and with allies and partners from other systems.

 Explore innovative funding strategies to support recovery-oriented
systems of care.

 Offer a full range of recovery options that begin in treatment and
continue beyond the treatment episode.

 Provide outreach to engage individuals in treatment and continuing
recovery support as part of recovery-oriented systems of care.

"As clinicians, we need to think about the clinical implications of
broad recovery principles and how they apply to specific populations
such as women or people with co-occurring conditions. We also need to
consider the clinical implications of addressing recovery issues across
the life span, and within multigenerational contexts."

*--A Summit Participant*

**Recommended Next Steps for Consideration by Recovery Support Service
Providers**

 Clearly differentiate recovery support services from treatment and
mutual aid programs, seeking, in both cases, to expand and enhance
existing systems of care.

 Identify and disseminate promising trends and best practices in
recovery support services.

 Collaborate with evaluators and researchers to develop research
partnerships that integrate the perspectives and experiences of
recovering people to develop programs and services within recovery.

 Continue to build the capacity of recovery communities and recovery
community organizations to provide peer recovery support services.

 Improve internal capacities to provide accountability, including
financial management, corporate governance and data collection for
measuring results.

 Help to close gaps between systems and cultures, bringing the
authentic voice of diverse recovery communities to the tables where
decisions are made, and providing technical assistance to new recovery
support service providers.

 Develop diverse funding strategies that will sustain recovery support
services.

"Recovery support services are social vehicles for recovery. These
nonclinical services often operate to initiate or support recovery in
conjunction with the work of formal treatment or mutual aid groups."

*--A Summit Participant*

**Recommended Next Steps for Consideration by Researchers and
Evaluators**

 Form partnerships between members of the recovery community and
researchers to enrich and broaden the scope and content of research and
develop instruments specifically designed to measure recovery outcomes.

 Create and support a research agenda on recovery (e.g., studies on
multiple recovery processes, alternative methods of information
collection and recovery-oriented outcome measures).

 Convene a research summit on recovery to promote knowledge exchange
and increase awareness of projects under development within the research
community.

 Publish and disseminate recovery-based research.

 Assist the treatment and recovery field in translating research
findings into policy and practice.

"We need to conceptualize recovery research across all recovery stages
and pathways to form an integrated research agenda. Alternative methods
of information collection should include participatory action research.
Research questions and measures of recovery should be strength-based and
gender-specific and include expanded definitions of family. We need to
develop longitudinal models to determine predictors of sustained
recovery and long-term outcomes."

*--A Summit Participant*

**Recommended Next Steps for Consideration by Mutual Aid Organizations**

 Convene a meeting of mutual aid representatives to foster dialogue and
collaboration.

 Write a concept brief on mutual aid, covering its history, strengths
and limitations, including ideas for how this stakeholder group can best
contribute to recovery-oriented systems of care without compromising its
unique qualities and value.

 Develop a strategy for dissemination of information on mutual aid
groups and approaches.

 Create a self-assessment instrument to help people in or seeking
recovery choose from the full menu of available mutual aid programs and
other recovery support services.

 Create a comprehensive Web site that provides educational information
on mutual aid groups and links to their contact information.

 Using existing processes and structures, participate with other
stakeholder groups in the continuing development of recovery-oriented
systems of care.

> A mutual aid self-assessment tool would be valuable to people in early
> recovery who want to determine which system fits best with their needs
> and values. This is particularly important for people with histories
> of trauma, mental illness or incarceration who may need an alternative
> or adjunct to traditional 12-Step programs."
>
> *--A Summit Participant*

**Recommended Next Steps for Consideration by Recovery Advocates**

 Promote education, feedback and buy-in among recovery advocates on
recovery-oriented systems of care.

 Organize and build capacity within recovery communities and recovery
organizations to promote the strength of those in recovery as both an
advocacy strategy and a message of hope to those who need it.

 Ensure that individuals in recovery have authentic representation and
input into policy and systems development and before local, State and
Federal funding bodies. Actively recruit, develop and support leaders to
articulate concerns to policymakers.

 Ensure that people who are currently receiving or seeking access to
treatment have an authentic voice in policy and systems advocacy
efforts.

 Destigmatize individuals with substance use problems and people in
recovery through campaigns to raise public awareness, confront
discrimination and address barriers to recovery, especially for
ex-offenders.

 Continue to develop relationships with recovery communities, and
recovery community organizations, researchers, funders and local, State
and Federal policymakers.

 Strengthen the community web of support for recovery, including
engaging individuals with long-term recovery who can help anchor
recovery-oriented systems of care in the history of the field.

"It is important to ensure that organized recovery communities have
authentic representation and input in all recovery-oriented systems of
care. This will entail creating a ladder for leadership development and
support that begins at the grassroots level. Bringing these voices of
authentic recovery to the table will help guide the community in making
sound decisions."

*--A Summit Participant*

The National Summit on Recovery provided a forum through which expert
stakeholders including individuals in recovery, family members,
representatives of mutual aid groups, treatment providers and systems
professionals engaged in dialogue and consensus building. Through the
Summit they developed broad, generally applicable principles of recovery
and

identified elements of recovery-oriented systems of care. This report
represents the first comprehensive document on this topic that
incorporates the views of a diverse group of

stakeholders. It is intended as a starting point for future dialogue,
planning, and implementation on the national, State and local levels.

"When people from the treatment and recovery communities come together
to share their best thinking and their passion, real growth can come
from it. When the subject is recovery, that something has the potential
to be transformative."

*--George Gilbert, Director*

*Office of Program Analysis and Coordination*

*Center for Substance Abuse Treatment*

**References**

Boyle, M.G., White, W.L., Corrigan, P.W., & Loveland, D.L. Behavioral
Health Recovery

Management: A Statement of Guiding Principles. 2005. Accessed May 2005:

http://www.bhrm.org/papers/guiding principles/BHRMguidingprinciples.htm

Department of Mental Health and Addiction Services (DMHAS) & State of
Connecticut. Recovery TIPS: Key Guiding Principles and Practices of
Person-Centered Care. 2005a. Accessed May 2005:
http://www.dmhas.state.ct.us/recovery/pcc.pdf

Department of Mental Health and Addiction Services (DMHAS) & State of
Connecticut, People in Recovery. Recovery Core Values. 2005b. Accessed
May 2005: http://www.dmhas.state.ct.us/corevalues.htm

Department of Mental Health and Addiction Services (DMHAS) & State of
Connecticut. Supporting the Recovery System of Care. Presentation to the
Provider Advisory Council. 2003. Accessed May 2005:
http://www.dmhas.state.ct.us/recovery/2.4.03.pdf

Evans, A.C. Toward a Recovery System of Care. Presentation to the CCAR.
2003. Accessed May 2005:
http://www.dmhas.state.ct.us/recovery/5.13.03.pdf

McCrary, K.J. Guiding Principles of Recovery. 1998. Accessed May 2005:

http://www.state.sc.us/dmh/bryan/wbrecove.htm

Substance Abuse and Mental Health Services Administration (SAMHSA).
Report to the Congress on the Prevention and Treatment of Co-Occurring
Substance Use Disorders and Mental Disorders. 2002. Accessed May 2005:
http://alt.samhsa.gov/reports/congress2002/

Substance Abuse and Mental Health Services Administration (SAMHSA).
Access to Recovery (ATR) Grants (TI 04-009). Initial Announcement. 2004.
Accessed December 2005:
http://alt.samhsa.gov/grants/2004/nofa/atr/ti04009_ATR.doc

Support Systems Homes Inc. Treatment Philosophy. 2004. Accessed May
2005:

http://www.drug-rehabilitation.com/treatment_philosophy.htm

White, W.L., Boyle, M.G., & Loveland, D.L. (2005). A Model to Transcend
the Limitations of Addiction Treatment. Behavioral Health Management,
23, 38-44. Accessed May 2005:
<http://www.behavioral.net/Past_Issues.htm?ID=1637>

**Appendix 1: CSAT National Summit on Recovery Participant List**

**Substance Abuse and Mental Health Services Administration**

**Center for Substance Abuse Treatment**

**September 28 and 29, 2005**

**Washington, D.C.**

**Participant List**

\* Indicates planning committee member

\+ Indicates speaker and/or facilitator

**\*+Gregory K. Alex**

Matt Talbot Recovery Center

2313 Third Avenue

Seattle, WA 98122

Phone: 206-256-9865

Fax: 206-256-4065

Email: gregga@mtcenter.org

**Randy Atkins**

The Walsh Group

6701 Democracy Boulevard, Suite 300

Bethesda, MD 20817

Phone: 301-571-9494

Fax: 301-571-2417

Email: randy.atkins@walshgroup.org

**Ilene Baker**

Prevention Partnership

330 North Commerce Park Loop, Suite 160

Tucson, AZ 85745

Phone: 520-884-1300

Email: ibaker@pimaprevention.org

**Sonya Baker**

Community Recovery Network, Inc.

3730 State Street, #12, PO Box 2713

Santa Barbara, CA 93120

Phone: 805-451-1573

Email: sonya@communityrecovery.org

**Nancy Barmashi**

411 Colt Highway

Farmington, CT 06032

Phone: 860-678-9699

Email: nancy.barmashi@comcast.net

**Mark Beresky**

Opiate Dependence Resource Center

167 Main Street, Suite 304

Brattleboro, VT 05301

Phone: 802-251-0066

Fax: 802-246-1016

Email: mark.beresky@medication-assistedrecovery.org

**\*Anita Bertrand**

Northern Ohio Recovery Association (NORA)

3746 Prospect Avenue

Cleveland, OH 44115

Phone: 216-391-6672

Fax: 216-391-4633

Email: anitabertrand@yahoo.com

**Ed Blackburn**

Central City Concern

232 NW Sixth Avenue

Portland, OR 97209

Phone: 503-294-1681

Fax: 503-294-4321

Email: eblackburn@centralcityconcern.org

**Tracey Blaylock**

9704 Colony Place

Kansas City, MO 64131

Phone: 816-941-2155

Email: tblaylock1@kc.rr.com

**\*Frederic C. Blow**

Ann Arbor Veterans Administration Medical Center

University of Michigan

PO Box 130170

Ann Arbor, MI 48113-0170

Phone: 734-761-2210

Fax: 734-761-2617

Email: fredblow@umich.edu

**Angela Bowman**

IL Alcoholism and Drug Dependence Association

937 South Second Street

Springfield, IL 62704

Phone: 217-528-7335 ext 17

Fax: 217-528-7340

Email: abowman@iadda.org

**Arthur H. Boyd**

Group Ministries Inc.

1333 Jefferson Avenue

Buffalo, NY 14208

Phone: 716-833-4367 ext 18

Fax: 716-883-4449

Email: groupbuffalo@aol.com

**Michael Boyle**

Fayette Companies

600 Fayette Street

Peoria, IL 61603

Phone: 309-671-8025

Fax: 309-671-8010

Email: mboyle@fayettecompanies.org

**\*+Jacqueline Butler**

University of Cincinnati

College of Medicine

Substance Abuse Division

311 Martin Luther King Jr. Drive

Cincinnati, OH 45219

Phone: 513-475-5359

Fax: 513-281-1645

Email: jbutler4158@aol.com

**Deni Carise**

Treatment Research Institute

University of Pennsylvania

600 Public Ledger Building

150 South Independence Mall West

Philadelphia, PA 19106

Phone: 215-399-0980 ext 102

Fax: 215-399-0987

**Pearl Yellowman Caye**

4th World Consulting

Salish Kootenai College

Pablo, MT 59855

Phone: 406-212-3709

Email: pearl_yellowman@skc.edu

**Donald Clark**

Capitol City SDA Church

6701 Lemon Hill Avenue

Sacramento, CA 95824

Phone: 916-641-7933

Fax: 916-381-2701

Email: capitolcitysda@aol.com

**John Coppola**

Alcoholism and Substance Abuse Providers

of New York State

1 Columbia Place, Suite 400

Albany, NY 12207

Phone: 518-426-3122

Fax: 518-426-1046

Email: jcoppola@asapnys.org

**Stephanie Covington**

Center for Gender and Justice

The Institute for Relational Development

7946 Ivanhoe Avenue, Suite 201B

LaJolla, CA 92037

Phone: 858-454-8528

Fax: 858-454-8598

Email: sscird@aol.com

**Don Coyhis**

White Bison, Inc.

6145 Lehman Drive, Suite 200

Colorado Springs, CO 80918-3440

Phone: 719-548-1000

Fax: 719-548-9407

Email: don@whitebison.org

**Jackson Davis**

Center for Community Alternatives

115 East Jefferson Street, Suite 300

Syracuse, NY 13202

Phone: 315-422-5638 ext 222

Fax: 315-471-4924

Email: jdavis@communityalternatives.org

**Thomas Davis**

Turning Point Clinic

2401 East North Avenue

Baltimore, MD 21213

Phone: 410-675-2113

Fax: 410-675-2117

Email: tdavis@turnptc.org

**John de Miranda**

National Association on Alcohol,

Drugs and Disability

2165 Bunker Hill Drive

San Mateo, CA 94402-3801

Phone: 650-578-8047

Fax: 650-286-9205

Email: solanda@sbcglobal.net

**Herman Diesenhaus**

2230 Journet Drive

Dunn Loring, VA 22027-1164

Phone/Fax: 703-204-1817

Email: hdiesenhaus@cox.net

**Dona M. Dmitrovic**

Center for Education and Advocacy

Johnson Institute

613 2nd Street NE

Washington, D.C 20002

Phone: 202-662-7104

Fax: 202-662-7106

Email: donad@johnsoninstitute.org

**Martin Doot**

Advocate Addiction Treatment Program

701 Lee Street, Suite 100

Des Plaines, IL 60016

Phone: 847-795-2875

Fax: 847-795-2847

Email: martin.doot-md@advocatehealth.com

**Geno Dunnington**

Positive Effects

1526 East Capitol Street NE

Washington, DC 20003

Phone: 202-288-5477

Fax: 202-543-1354

Email: genodunn@verizon.net

**Christina Dye**

AZ Department of Health Services

150 North 18th Avenue, Suite 220

Phoenix, AZ 85007

Phone: 602-364-4594

Fax: 602-364-4763

Email: dyec@azdhs.gov

**Arthur Evans**

City of Philadelphia

Department of Behavioral Health/

Mental Retardation Services

1101 Market Street, Seventh Floor

Philadelphia, PA 19107

Phone: 215-685-4742

Email: arthur.c.evans@phila.gov

**Marlin Farley**

White Bison

3179 264th Avenue

Waubun, MN 56589

Phone: 218-473-2486

Email: marlin@paintedskymedia.com

**Andrew Finch**

Association of Recovery Schools

145 Thompson Lane

Nashville, TN 37211

Phone: 615-354-1525

Fax: 615-248-8762

Email: a.finch@creativerecovery.org

**David Fiorillo**

Signs of Sobriety

100 Scotch Road

Ewing, NJ 08628

Phone: 609-882-7677

Fax: 609-882-6808

**\*Michael T. Flaherty**

Institute for Research,

Education and Training in Addictions

Regional Enterprise Towers

425 Sixth Avenue, Suite 1790

Pittsburgh, PA 15219

Phone: 412-258-8565

Fax: 412-391-2528

Email: flahertym@ireta.org

**Cheryl Floyd**

Drug and Alcohol Service Providers

Organization of PA

3820 Club Drive

Harrisburg, PA 17110

Phone: 717-652-9128

Fax: 717-652-3857

**Deirdre Drohan Forbes**

Mt. Sinai Hospital

Madison East, Fifth Floor

1425 Madison Avenue

New York, NY 10029

Phone: 212-659-8714

Email: dforbes@tforbes.com

**Maryanne Frangules**

Massachusetts Organization for Addiction Recovery

c/o Boston ASAP

30 Winter Street, Third Floor

Boston, MA 02108

Phone: 617-423-6627

Fax: 617-423-6626

Email: moarfran@aol.com

**Larry Fricks**

Georgia Division of Mental Health

2 Peachtree Street, Suite 23-411

Atlanta, GA 30303

Phone: 404-657-2100

Fax: 404-657-4349

Email: lfricks@dhr.state.ga.us

**\*+Cheryl Gagne**

Center for Psychiatric Rehabilitation

Boston University

940 Commonwealth Avenue West

Brighton, MA 02135

Phone: 617-353-3549

Fax: 617-353-7700

Email: cgagne@bu.edu

**Roberto Garcia**

Department of Mental Health

and Addiction Services

410 Capitol Avenue, Fourth Floor

PO Box 341431, MS 14550

Hartford, CT 06134

Phone: 860-293-6349

Fax: 860-297-0930

Email: roberto.garcia@po.state.ct.us

**Walter Ginter**

National Alliance of Methadone Advocates

25 Vineyard Lane

Westport, CT 06880

Phone: 203-222-9416

Fax: 203-454-9675

Email: wpginter@covad.net

**Gloria Grijalva Gonzales**

San Joaquin County Behavior Health

SAS and House of Glory Inc.

223 East Canterbury Court

Stockton, CA 95207

Phone: 209-518-0670

Fax: 209-468-7032

Email: gloria6587@sbcglobal.net

**Marcia Colburn Green**

Baltimore City Health Department

Operation Safe Kids

1622 North Carey Street

Baltimore, MD 21217

Phone: 410-728-2566

Fax: 410-225-0546

Email: Marcia.green@baltimorecity.gov

**Dan Griffin**

4549 Park Avenue

Minneapolis, MN 55407

Phone: 651-825-1143

Email: dangriffin@msn.com

**Beverly J. Haberle**

Bucks County Council on Alcoholism and Drug Dependence, Inc.

252 West Swamp Road

Doylestown, PA 18901

Phone: 215-345-6644

Fax: 215-348-3377

Email: bhaberle@bccadd.org

**Nancy Hamilton**

Operations PAR, Inc.

6655 66th Street North

Pinellas Park, FL 33781

Phone: 727-545-7564

Fax: 727-545-7584

Email: nhamilton@operpar.org

Tim Hamilton

Dual Recovery Empowerment Foundation

PO Box 8708

Prairie Village, KS 66208

Phone: 615-504-9797

Fax: 913-262-6166

Email: rwth@kc.rr.com

**Yoon Joo Han**

Asian Counseling and Referral Service

720 Eighth Avenue South, Suite 200

Seattle, WA 98104

Phone: 206-695-7591

Fax: 206-695-7606

Email: yoonjooh@acrs.org

**\*Kitty Harris**

Center for the Study of Addiction and Recovery

Texas Tech University

Box 41162

Lubbock, TX 79409

Phone: 806-742-2891

Fax: 806-742-1070

Email: kitty.s.harris@ttu.edu

**Susan Harris**

Thresholds, Inc.

526-D North DuPont Highway

Georgetown, DE 19947

Phone: 302-856-1835

Fax: 302-856-1764

Email: smh39@aol.com

**Melody Heaps**

TASC, Inc.

1500 North Halsted Street

Chicago, IL 60622

Phone: 312-573-8203

Fax: 312-787-8214

Email: mheaps@tasc-il.org

**Holly A. Hills**

Department of Mental Health

Law and Policy

FL Mental Health Institute, USF

13301 Bruce B. Downs Boulevard

Tampa, FL 33612

Phone: 813-974-1923

Fax: 813-974-9327

Email: hills@fmhi.usf.edu

**Tom Horvath**

SMART Recovery

8950 Villa La Jolla Drive, #B214

La Jolla, CA 92037

Phone: 858-455-0042 ext 222

Fax: 858-455-0141

Email: tom.horvath@pyrysys.com

**\*Keith Humphreys**

Veterans Administration/Stanford Medical Center

115 Peter Courts Circle

Stanford, CA 94305-2518

Phone: 650-617-2746

Fax: 650-617-2736

Email: knh@stanford.edu

**\*Davis Y. Ja**

California School of Professional Psychology/

Alliant International University

362 Victoria Street

San Francisco, CA 94132

Phone: 415-585-2773

Fax: 415-239-4511

Email: davisyja@yahoo.com

**Marco E. Jacome**

Healthcare Alternative Systems, Inc. (HAS)

2755 West Armitage Avenue

Chicago, IL 60647

Phone: 773-252-3100 ext 118

Fax: 773-252-8945

Email: mjacome@hascares.org

**Jerome Jaffe**

5217 Beavertail Court

Columbia, MD 21044

Phone: 410-730-1957

Fax: 410-730-7735

Email: jhjaffemd@comcast.net

**Mary Beth Johnson**

Addiction Technology Transfer Center

UMKC, 5100 Rockhill Road

Kansas City, MO 64110

Phone: 816-482-1110

Fax: 816-482-1101

Email: johnsonmb@nattc.org

**Sherry L. Johnson**

Idaho Department of Health and Welfare

450 West State Street, Fifth Floor

Boise, ID 83720-0036

Phone: 208-334-5934

Fax: 208-334-0667

Email: johnsos2@idhw.state.id.us

**Linda Kaplan**

Global KL, LLC

8639 B 16th Street, #242

Silver Spring, MD 20910

Phone: 301-529-8220

Fax: 301-654-3357

Email: linda.kaplan2@verizon.net

**Charlotte Kasl**

Many Roads, One Journey

7725 Moe Road

Lolo, MT 59847

Phone: 406-273-6080

Fax: 406-273-0111

Email: charlotte@sophia.myrf.net

**Roxanne Kibben**

Synergy Enterprises, Inc.

8757 Georgia Avenue, Suite 450

Silver Spring, MD 20910

Phone: 240-485-1700

Fax: 240-485-1717

Email: rkibben@synergyentinc.com

**\*Thomas A. Kirk**

Connecticut Department of Mental Health

and Addiction Services

410 Capital Avenue

P.O. Box 341431

Hartford, CT 06106

Phone: 860-418-6969

Fax: 860-418-6691

Email: thomas.kirk@po.state.ct.us

**Irene Kontje**

Alcoholics Anonymous

475 Riverside Drive, 11th Floor

New York, NY 10115

Phone: 212-870-3400

Fax: 212-870-3003

Email: cpc@aa.org

**Jean LaCour**

NET Training Institute

PO Box 536875

Orlando, FL 32853-6875

Phone: 407-236-9400

Fax: 407-849-1120

Email: drjean@netinstitute.org

**Ting-Fun May Lai**

National Asian Pacific American Familes

Against Substance Abuse

235 South Street, Second Floor

New York, NY 10002

Phone: 212-720-4520

Fax: 212-732-9754

Email: may@hmh100.com

**Alexandre Laudet**

NDRI

71 West 23rd Street, Eighth Floor

New York, NY 10010

Phone: 212-845-4520

Fax: 917-438-0894

Email: laudet@ndri.org

**Henry C. Lozano**

Corporation for National

and Community Service

41118 Valley of the Falls Drive

PO Box 620

Forest Falls, CA 92314-0826

Phone: 909-794-3229

Fax: 909-794-1120

Email: abfab02@aol.com

**\*Chilo Madrid**

Aliviane NO-AD, Inc.

7722 North Loop Road

El Paso, TX 79915

Phone: 915-782-4000

Fax: 915-718-4040

Email: lwebb.aliviane@ionexmail.net

**Robyn Leary Mancini**

Recovery Network Foundation

51 Hudson Point Lane

PO Box 169

Scarborough, NY 10510

Phone: 914-941-2863

Fax: 914-941-2850

Email: robyn.leary@verizon.net

**Mary E. McCaul**

Johns Hopkins University

School of Medicine

JHH Comprehensive Women's Center

911 North Broadway

Baltimore, MD 21205

Phone: 410-955-5439

Fax: 410-955-4769

Email: betsymc@jhmi.edu

**Carol McDaid**

Capitol Decisions, Inc.

101 Constitution Avenue NW

Suite 675 East

Washington, DC 20001

Phone: 202-638-0326

Fax: 202-638-0353

Email: cmcdaid@capitoldecisions.com

**Trish Merill**

Faith Partners Against Substance Abuse

1406 Ethridge Avenue

Austin, TX 78703

Phone: 512-476-2896

**Jay Meyer**

OMNI Youth Services

1111 Lake Cook Road

Buffalo Grove, IL 60089

Phone: 847-353-1500

Fax: 847-541-0228

Email: jmeyer@omniyouth.org

**Lisa Mojer-Torres**

9 Whitemarsh Drive

Lawrenceville, NJ 08648

Phone: 609-671-1995

Fax: 609-671-1994

Email: rtorres605@aol.com

**Robert Morrison**

National Association of State Alcohol

and Drug Abuse Directors (NASADAD)

808 17th Street NW, Suite 410

Washington, DC 20006

Phone: 202-293-0090 ext 106

Fax: 202-293-1250

Email: rmorrison@nasadad.org

**+Stacia Murphy**

National Council on Alcoholism and

Drug Dependence, Inc.

22 Cortlandt Street, Suite 801

New York, NY 10007-3128

Phone: 212-269-7797 ext 19

Fax: 212-269-7510

Email: president@ncadd.org

**Tonja Myles**

Free Indeed Faith Based Intense Outpatient Clinic

PO Box 14322

Baton Rouge, LA 70898-4322

Phone: 225-924-1910

Email: tonja@setfreeindeedministry.com

**Michael Nelipovich**

Office for the Blind and Visually Impaired

State of Wisconsin

1 West Wilson #451

Madison, WI 53702

Phone: 608-266-3109

Fax: 608-266-3256

Email: nelipmi@dhfs.state.wi.us

**Theda New Breast**

PO Box 164

Babb, MN 59411

Phone: 406-732-9288

**\*Mark W. Parrino**

American Association for the Treatment of

Opioid Dependence

217 Broadway, Suite 304

New York, NY 10007

Phone: 212-566-5555

Fax: 212-349-2944

Email: mark.parrino@aatod.org

**Joseph Powell**

Association of Persons Affected by Addiction

2438 Butler Street, Suite 120

Dallas, TX 75235

Phone: 214-634-2722

Fax: 214-634-2721

Email: joep2722@aol.com

**Laura Prescott**

Sister Witness International, Inc.

315 Vermont Street, #2

West Roxbury, MA 02132

Phone: 617-469-3233

Fax: 309-414-9467

Email: lpleiades@aol.com

**John H. Robbins**

Welcome Home Ministries

1749 Sky Loft Lane

Encinitas, CA 92024

Phone: 760-436-7137

Fax: 760-632-1336

Email: jhnhrbbns@sbcglobal.net

**\*+Pamela Rodriguez**

TASC, Inc.

1500 North Halsted Street

Chicago, IL 60622

Phone: 312-573-8238

Fax: 312-787-8214

Email: prodriguez@tasc-il.org

**Gilberto Romero**

De Sol a Sol

PO Box 459

Santa Cruz, NM 87567

Phone: 505-412-2373

Email: gilbertoromero@cnsp.com

**Malika Saada Saar**

The Rebecca Project for Human Rights

1752 Columbia Road NW, Third Floor

Washington, DC 20009

Phone: 202-265-3907

**Kristin B. Schubert**

The Robert Wood Johnson Foundation

Route 1 and College Road East

Princeton, NJ 08543

Phone: 609-627-7563

Fax: 609-514-5452

**Howard Shapiro**

States Associations of Addiction Services

236 Massachusetts Avenue NE, Suite 505

Washington, DC 20002

Phone: 202-546-4600

Fax: 202-544-5712

Email: hshapiro@saasnet.org

**\*+Candace Shelton**

FASD Center for Excellence

2240 East Kleindale

Tucson, AZ 85719

Phone: 520-881-8182

Fax: 520-881-8183

Email: canshelton@aol.com

**Dick Spence**

Gulf Coast Addiction Technology Transfer Center, University of Texas

1717 West Sixth Street, Suite 335

Austin, TX 78703

Phone: 512-232-0616

Email: rtspence@mail.utexas.edu

**\*Flo Stein**

North Carolina Division of Mental Health/Developmental
Disabilities/Substance Abuse Services

3007 Mail Service Center

Raleigh, NC 27699-3007

Phone: 919-733-4670

Fax: 919-733-4556

Email: flo.stein@ncmail.net

**Gordon Storey**

Self Help Addiction Resource Centre Inc.

1242 Glenhuntly Road

Glen Huntly, Victoria, 3168 AUSTRALIA

Phone: 011-61-3-9573-1786

Fax: 011-61-3-9572-3498

Email: gstorey@sharc.org.au

**+Pat Taylor**

Faces and Voices of Recovery

1010 Vermont Avenue, NW, #708

Washington, D.C 20005

Phone: 202-737-0690

Fax: 202-737-0695

Email: pat.taylor@verizon.net

**Alice Terson**

Institute for Staged Recovery

85 Fifth Avenue, Ninth Floor

New York, NY 10003

Phone: 212-242-5052

Email: wilevine@aol.com

**Cynthia Moreno Tuohy**

NAADAC

The Association for Addiction Professionals

901 Washington Street, Suite 600

Alexandria, VA 22314

Phone: 703-741-7686

Fax: 703-741-7698

Email: cmoreno@naadac.org

**\*+Philip Valentine**

Connecticut Community for Addiction Recovery

530 Silas Deane Highway, Suite 220

Wethersfield, CT 06109

Phone: 860-571-2985

Fax: 860-571-2987

Email: phillip@ccar.us

**Cornelia Vaughn**

Chrysalis House, Inc.

916 The Curtilage

Lexington, KY 40502

Phone: 859-269-4738

Fax: 859-227-5281

**\*Bonita M. Veysey**

Rutgers University

School of Criminal Justice

123 Washington Street

Newark, NJ 07102

Phone: 973-353-1929

Fax: 973-353-5896

Email: veysey@andromeda.rutgers.edu

**Jeannie Villarreal**

821 York Street

Vallejo, CA 94590

Phone: 707-553-1064

Fax: 707-642-5508

Email: jeanniev@ix.netcom.com

**Howard Vogel**

Double Trouble in Recovery

PO Box 245055

Brooklyn, NY 11224

Phone: 718-373-2684

Email: hv613@aol.com

**R. Dale Walker**

One Sky National Resource Center

3181 SW Sam Jackson Park, RD GH 156

Portland, OR 97201-3098

Phone: 503-494-3703

Email: walkerrd@ohsu.edu

**Michael Walsh**

The Walsh Group

6701 Democracy Boulevard

Bethesda, Maryland 20817

Phone: 301-571-9494

Fax: 301-571-2417

Email: michael.walsh@walshgroup.org

**Carmen Warner-Robbins**

Welcome Home Ministries

104 South Barnes Street

Oceanside, CA 92054

Phone: 760-721-2117 ext 307

Fax: 760-632-1336

Email: jhrhrbbns@sbcgbbal.net

**Marsha Weissman**

Center for Community Alternatives

115 East Jefferson Street

Syracuse, NY 13202

Phone: 315-422-5638

Fax: 315-471-4924

Email: mweissman@communityalternatives.org

**Sis Wenger**

National Association for Children of Alcoholics

11426 Rockville Pike, Suite 100

Rockville, MD 20850

Phone: 301-468-0985

Fax: 301-468-0987

Email: swenger@nacoa.org

**+William White**

Chestnut Health Systems

3479 Shawn Street

Port Charlotte, FL 33980

Phone: 941-624-0210

Email: bwhite@chestnut.org

**Annette Williams**

Detroit Recovery Project

335 East Grand Boulevard

Detroit, MI 48207

Phone: 313-579-5462

**Ann Yabusaki**

Coalition for Drug-Free Hawaii

47-670 Halemanu Street

Kaneoke, HI 96744

Phone: 808-239-4114

Fax: 808-239-4114

Email: geckogroup@cs.com

**Federal Participants**

**Mady Chalk**

Director

Division of Services Improvement

Center for Substance Abuse Treatment

Substance Abuse and Mental Health

Services Administration

1 Choke Cherry Road, Room 5-1091

Rockville, MD 20857

Phone: 240-276-2942

Email: mady.chalk@samhsa.hhs.gov

**+H. Westley Clark**

Director

Center for Substance Abuse Treatment

Substance Abuse and Mental Health

Services Administration

1 Choke Cherry Road, Room 5-1091

Rockville, MD 20857

Phone: 240-276-1660

Fax: 240-276-1670

Email: westley.clark@samhsa.hhs.gov

**Donna M. Cotter**

Public Health Advisor

Office of Program Analysis and Coordination

Center for Substance Abuse Treatment

Substance Abuse and Mental Health Services Administration

1 Choke Cherry Road, Room 5-1035

Rockville, MD 20857

Phone: 240-276-1682

Email: donna.cotter@samhsa.hhs.gov

**Stephenie Colston**

Special Assistant to the Administrator

Substance Abuse and Mental Health

Services Administration

1 Choke Cherry Road, Room 12C-05

Rockville, MD 20857

Phone: 240-276-2004

Email: stephenie.colston@samhsa.hhs.gov

**Paolo Delvecchio**

Associate Director for Consumer Affairs

Center for Mental Health Services

Substance Abuse and Mental Health

Services Administration

1 Choke Cherry Road, Room 6-1069

Rockville, MD 20857

Phone: 240-276-1946

Email: paolo.delvecchio@samhsa.hhs.gov

**+George R. Gilbert**

Director

Office of Program Analysis and Coordination

Center for Substance Abuse Treatment

Substance Abuse and Mental Health

Services Administration

1 Choke Cherry Road, Room 5-1031

Rockville, MD 20857

Phone: 240-276-1681

Email: george.gilbert@samhsa.hhs.gov

**+Randolph D. Muck**

Lead Public Health Advisor/Team Leader

Adolescent Programs

Center for Substance Abuse Treatment

Substance Abuse and Mental Health

Services Administration

1 Choke Cherry Road

Rockville, MD 20857

Phone: 240-276-1576

Email: randy.muck@samhsa.hhs.gov

**Catherine D. Nugent**

Senior Public Health Advisor/Project Officer

Center for Substance Abuse Treatment

Substance Abuse and Mental Health

Services Administration

1 Choke Cherry Road, Room 5-1079

Rockville, MD 20857

Phone: 240-276-1577

Email: cathy.nugent@samhsa.hhs.gov

**Stephen Wing**

Associate Administrator for Alcohol Policy

Office of Policy and Program Coordination

Substance Abuse and Mental Health

Services Administration

1 Choke Cherry Road, Room 5-1031

Rockville, MD 20857

Phone: 240-276-2235

Email: stephen.wing@samhsa.hhs.gov

**Government Contractors**

**June Gertig**

Health Systems Research, Inc.

1200 18th Street NW, #700

Washington, DC 20036

Phone: 202-828-5100

Email: jgertig@hsrnet.com

**+Susan Hailman**

Campaign Consultation, Inc.

2819 Saint Paul Street

Baltimore, MD 21218

Phone: 410-243-7979

Fax: 410-243-1024

Email: hailman@campaignconsultation.com

**+Paul Harris**

Campaign Consultation, Inc.

2819 Saint Paul Street

Baltimore, MD 21218

Phone: 410-243-7979

Fax: 410-243-1024

Email: harris@campaignconsultation.com

**+Tom Hill**

Health Systems Research, Inc.

1200 18th Street NW, #700

Washington, DC 20036

Phone: 202-828-5100

Email: thill@hsrnet.com

**Sandra Thompson**

Westover Consultants, Inc.

8630 Fenton Street #724

Silver Spring, MD 20910

Phone: 301-495-7405

Email: sthompson@westover.com

**+Melanie Whitter**

Abt Associates Inc.

4550 Montgomery Avenue, Suite 800 North

Bethesda, MD 20814

Phone: 301-634-1744

Email: <melanie_whitter@abtassoc.com>

**Appendix 2: Summit Agendas**

**Appendix 2.1: CSAT National Summit on Recovery**

**Planning Group Meeting Agenda**

**Substance Abuse and Mental Health Services Administration**

**Center for Substance Abuse Treatment**

**June 13 and 14, 2005**

**Rockville, MD 20857**

**Agenda**

**Monday, June 13, 2005**

9:00 a.m. -- 9:15 a.m. Welcome and Introductions

Catherine D. Nugent, M.S., M.S., LGPC

Senior Public Health Advisor/Project Officer

Recovery Community Services Program

Center for Substance Abuse Treatment (CSAT)

> Substance Abuse and Mental Health Services Administration\
> (SAMHSA)

Rockville, Maryland

9:15 a.m. -- 9:30 a.m. The Charge

George R. Gilbert

Director

Office of Program Analysis and Coordination

CSAT/SAMHSA

Rockville, Maryland

9:30 a.m. -- 9:45 a.m. Meeting Outcomes and Processes

Susan Hailman

Director

Knowledge Transfer and Utilization

Campaign Consultation, Inc.

Baltimore, Maryland

Paul Harris

Project Specialist

Campaign Consultation, Inc.

Baltimore, Maryland

**Monday, June 13 (Continued)**

9:45 a.m. -- 10:10 a.m. Perspectives from the Field: Building on What We
Know

June Gertig

Senior Associate

Health Systems Research, Inc.

Washington, D.C.

Melanie Whitter

Senior Associate

Abt Associates, Inc.

Bethesda, Maryland

10:10 a.m. -- 10:30 a.m. BREAK

10:30 a.m. -- 12:30 p.m. Facilitated Discussion

Susan Hailman

Paul Harris

12:30 p.m. -- 1:45 p.m. Working Lunch

Panel: Related Recovery Initiatives

Moderator

Stephen Wing, M.S.W.

Associate Administrator for Alcohol Policy

Office of Policy and Program Coordination

SAMHSA

Rockville, Maryland

Panelists

Paolo DelVecchio

Associate Director for Consumers Affairs

Center for Mental Health Services

SAMHSA

Rockville, Maryland

Dona M. Dmitrovic

Director

Center for Education and Advocacy

Johnson Institute

Washington, D.C.

**Monday, June 13 (Continued)**

Stacia Murphy

Director

National Council on Alcoholism and Drug Dependence

New York, New York

Pat Taylor

Campaign Coordinator

Faces and Voices of Recovery (FAVOR)

Washington, D.C.

1:45 p.m. -- 2:10 p.m. Measuring Recovery -- SAMHSA's National Outcome
Measures

Mady Chalk, Ph.D.

Director

Division of Services Improvement

CSAT/SAMHSA

Rockville, Maryland

2:10 p.m -- 2:30 p.m. BREAK

2:30 p.m. -- 5:00 p.m. Themes and Issues: Highlighting Topics That
Resonate

5:00 p.m. CLOSING

7:30 p.m. Optional Evening Networking Session

**Tuesday, June 14, 2005**

8:30 a.m. -- 9:00 a.m. Opening/Framing the Day

9:00 a.m. -- 9:10 a.m. Logistics for the Summit

Donna M. Cotter, M.B.A.

Public Health Advisor

Office of Program Analysis and Coordination

CSAT/SAMHSA

Rockville, Maryland

9:10 a.m. -- 10:15 a.m. Framing the Questions for the Summit: Principles
and Measures

Susan Hailman

Paul Harris

10:15 a.m. -- 10:45 a.m. BREAK

10:45 a.m. -- 12:00 p.m. Framing the Questions for the Summit: System of
Care

12:00 p.m. -- 12:15 p.m. CLOSING

Catherine D. Nugent, M.S., M.S., LGPC

**Appendix 2.2: CSAT National Summit on Recovery Agenda**

**Substance Abuse and Mental Health Services Administration**

**Center for Substance Abuse Treatment**

**September 28 and 29, 2005**

**Washington, D.C.**

**Agenda**

**Anticipated Outcomes**

CSAT Summit participants will:

1.  Develop new ideas to help transform policy, services, and systems
    toward a recovery-oriented paradigm that is more responsive to the
    needs of people in or seeking recovery, as well as their family
    members/significant others.

2.  Articulate principles and measures of recovery that can be used
    across programs and services to\
    promote and capture improvements in systems of care, facilitate data
    sharing, and enhance\
    program coordination.

3.  Generate ideas for advancing recovery-oriented systems of care in
    various settings and systems\
    (e.g., criminal justice, faith communities, peer support programs,
    etc.), and for specific\
    populations (e.g., racial and cultural groups, women, persons in
    medication-assisted recovery\
    persons with co-occurring disorders, etc.)

**Wednesday, September 28, 2005**

**Part I: A View of Yesterday and Today**

9:00 a.m. -- 9:30 a.m. Welcome -- Washington Room, Roof Level

Charles G. Curie, M.A., ACSW

Administrator

Substance Abuse and Mental Health Services Administration

U.S. Department of Health and Human Services

Rockville, Maryland

9:30 a.m. -- 10:00 a.m. Introductions

Catherine D. Nugent, M.S., M.S., LGPC

Senior Public Health Advisor

Center for Substance Abuse Treatment (CSAT)

Substance Abuse and Mental Health Services Administration (SAMHSA)

Rockville, Maryland

10:00 a.m. -- 10:20 a.m. Vision and Purpose of Summit

H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM

Director

CSAT/SAMHSA

Rockville, Maryland

10:20 a.m. -- 10:45 a.m. Break

10:45 a.m. -- 12:00 p.m. Guided Tour through the History of Recovery

> *Activity to depict and honor the history of recovery. We will
> identify where our own histories intersect with the history of
> treatment and recovery, and explore the strengths and limitations of
> systems of care for people in recovery throughout the decades.*

Facilitators: Susan Hailman

Director

Knowledge Transfer and Utilization

Campaign Consultation, Inc.

Baltimore, Maryland

Paul Harris

Project Specialist

Campaign Consultation, Inc.

Baltimore, Maryland

Tom Hill

Technical Assistance Manager

Recovery Community Services Program

Technical Assistance Project

Health Systems Research, Inc.

Washington, D.C.

Special Guest Stacia Murphy

Moderator: Director

National Council on Alcoholism

and Drug Dependence (NCADD)

New York, New York

**Part II: Moving Forward**

1:30 p.m. -- 3:30 p.m. **Principles and Measures of Recovery** -- See
sheet entitled Break-Out Session Information for Room Locations

*Participants will meet in small groups to develop principles and*

> *measures of recovery from various perspectives.*

3:30 p.m. -- 4:00 p.m. Break

4:00 p.m. -- 5:15 p.m. **Plenary Session: Speakout --** Washington Room,
Roof Level

> *Participants will be invited to share insights and ideas generated
> from the discussion to inspire transformation of systems of care for
> people in recovery and their family members.*

5:15 p.m. -- 5:30 p.m. **Summary and Closure**

6:00 p.m. -- 7:00 p.m. **Optional Recovery Support Meetings**

AA -- Parkview, Lobby Level

NA -- Federal Room, Mezzanine Level

Al-Anon -- Caucus Room, Mezzanine Level

Smart Recovery -- Board Room, Mezzanine Level

8:00 p.m. **Optional Networking Event --** Washington Room, Roof Level

**Thursday, September 29, 2005**

**Part III: Integrating Change into Systems of Care**

8:30 a.m. -- 9:30 a.m. **Panel Presentation: Voices from the Field --**
Washington Room, Roof\
Level

Brief Report on Adolescent Focus Groups

Randolph Muck, M.Ed.

Team Leader, Adolescent Programs

CSAT/SAMHSA

Rockville, Maryland

Brief Report on RCSP Grantees' Discussion of

Peer Recovery Support Services

Philip Valentine

Executive Director

Connecticut Community for Addiction Recovery

Wethersfield, Connecticut

Brief Report on FAVOR Recovery Advocacy Summit

Pat Taylor

Campaign Coordinator

Faces and Voices of Recovery (FAVOR)

Washington, D.C.

Respondent:

William White

Senior Research Coordinator

Chestnut Health Systems

Bloomington, Illinois

Moderator: Susan Hailman

9:30 a.m. -- 10:30 a.m. **The Future Vision: What Could a
Recovery-Oriented System of\
Care Look Like**

> *Small group discussion among the various sectors represented at the\
> Summit.*

10:30 a.m. -- 11:00 a.m. Break

11:00 a.m. -- 12:00 p.m. **Weaving the Vision**

*Discussion of recovery-oriented system of care continues in mixed
sector*

*groups.*

12:00 p.m. -- 1:00 p.m. Lunch

1:00 p.m. -- 2:00 p.m. **Strategies for the Future --** See sheet
entitled Break-Out Session\
Information for Room Locations

> *Sector groups reconvene to develop strategies through which each
> sector\
> could stimulate the development of a recovery-centered system of
> care.*

**Appendix 2.3: CSAT Follow-up Meeting Agenda**

**Substance Abuse and Mental Health Services Administration**

**Center for Substance Abuse Treatment**

**December 14 and 15, 2005**

**Washington, D.C.**

**Agenda**

**Anticipated Outcomes**

CSAT Recovery Summit Follow-up Meeting participants will:

1.  Develop a working definition of recovery.

2.  Review and refine principles of recovery and elements of a
    recovery-oriented system of care.

3.  Identify other stakeholders who need to become supporters.

4.  Define actions to be taken by CSAT based on Summit results.

5.  Develop sector action plans based on Summit results.

**Thursday, December 14, 2005**

9:00 a.m. -- 9:20 a.m. Opening and Welcome

George R. Gilbert

Acting Deputy Director

CSAT/SAMHSA

9:20 a.m. -- 9:30 a.m. Agenda and Material Review

Facilitators:

Susan Hailman

Director

Knowledge Transfer and Utilization

Campaign Consultation, Inc.

Paul Harris

Project Specialist

Campaign Consultation, Inc.

9:30 a.m. -- 10:30 a.m. Defining Recovery (Part 1):

*The group will develop a working definition of recovery.*

10:30 a.m. -- 10: 45 a.m. Break

10:45 a.m. -- 12:15 p.m. Principles of Recovery and Elements of a
Recovery-Oriented System

> *The group will examine and refine the Summit's work on principles of
> recovery and elements of a recovery-oriented system.*

12:15 p.m. -- 1:30 p.m. Lunch (on your own)

1:30 p.m. -- 2:30 p.m. CSAT Recommendations and Actions

> *The group will hear a review of the recommendations for CSAT that
> emerged from the Summit.*

Donna M. Cotter, M.B.A.

Partners for Recovery Coordinator

CSAT/SAMHSA

2:30 p.m. -- 2:45 p.m. Break

2:45 p.m. -- 4:45 p.m. Sector Review

> *The group will break into sectors to review, consolidate, revise, and
> prioritize recommendations for their sector.*

4:45 p.m. -- 5:00 p.m. Wrap-Up of Day 1

5:00 p.m. Adjourn

**Friday, December 15, 2005**

9:00 a.m. -- 9:30 a.m. Day 2 Opening -- Reflections

9:30 a.m. -- 10:30 a.m. Sector Recommendations Review and Comments

*The group will review recommendations of all sectors.*

10:30 a.m. -- 10:45 a.m. Break

10:45 a.m. -- 12:00 p.m. Potential Partners and Venues for Dissemination

> *The group will identify potential partners and opportunities to
> persuade and educate the field regarding the preliminary findings from
> the Summit.*

12:00 p.m. -- 1:15 p.m. Lunch (on your own)

1:15 p.m. -- 2:30 p.m. Sector Response (Part 1)

> *The group will explore potential responses to existing opportunities
> by sector.*

2:30 p.m. -- 3:30 p.m. Sector Breakouts

> *Each sector will meet to create a basic action plan integrating the
> ideas developed in the above discussions to present back to the
> group.*

3:30 p.m. -- 4:45 p.m. Defining Recovery (Part 2):

> *The group will return to the definition of recovery to summarize what
> has been offered and make any recommendations of products,
> publications, or actions that could result.*

4:45 p.m. -- 5:00 p.m. Closing

Catherine D. Nugent, M.S., M.S., LGPC

Senior Public Health Advisor

CSAT/SAMHSA

> **Appendix 3: Background Paper---Recovery Themes**

**Background Paper---Recovery Themes**

**Introduction**

This paper has been prepared as part of the background material for the
Substance Abuse and Mental Health Services Administration's (SAMHSA)
Center for Substance Abuse Treatment (CSAT) planning group which will
meet on June 13--14, 2005, to prepare for a CSAT National Recovery
Summit scheduled for September 28--29, 2005. The Recovery Summit will
gather approximately 100 leaders from the addiction treatment and
recovery communities who will seek to:

1.  Reach a shared understanding of principles of recovery from
    addiction^1^ to alcohol and/or other drugs,

2.  Identify domains and associated markers that lend themselves to
    measuring recovery, and

3.  Recommend next steps for moving addiction treatment systems beyond a
    pathology-based focus on the remission of symptoms to a focus on
    wellness.

The purpose of this paper is to assist the planning group in its
considerations of how best to facilitate the National Recovery Summit's
achievement of the first goal---a shared understanding of principles of
recovery.^2^

A substantial body of clinical and research literature exists on
addiction, pretreatment and treatment activities, relapse prevention,
and early recovery (the stage most often measured in treatment outcome
studies). Considerably less can be found on middle-stage and ongoing
recovery. However, a large body of literature, prepared by individuals
in recovery and members of mutual aid groups, lays out experientially
derived processes and methods for achieving and sustaining recovery.

In addition, numerous perspectives on addiction recovery and treatment
models for medically assisted recovery have been advanced by leaders in
a wide array of professions---ranging from clinicians and social workers
to brain researchers and other scientists. Much information,
particularly about early recovery, has been generated by treatment
practitioners, evaluators, and systems professionals. Also, researchers
are beginning to accumulate information about successful recovery
strategies that involve neither formal treatment nor mutual aid support.

The perspectives and models of recovery presented in professional and
lay literature have emerged from a wide variety of social, cultural, and
life cycle contexts and represent many different voices. Multiple voices
and perspectives do not lend themselves easily to the development of
shared definitions or a unified theory. Yet, in practice, a pragmatic
streak of eclecticism exists, with peers, practitioners, researchers,
and theoreticians frequently drawing from what appear to be promising
practices and wisdom representing various doctrines, methods, and styles
of recovery.

The authors have also adopted an eclectic approach in preparing this
background paper on recovery. Such an approach is consistent with a
major theme that emerges from the literature: Like addiction, recovery
is a complex and dynamic process. Race, class, ethnicity, gender, sexual
orientation, family history, life cycle stage, environment, and culture
combine with the individual's unique experiences, strengths, values,
needs, and desires to form an ecological context within which recovery
takes place. This means invariably that recovery is experienced
differently by different people, depending on who they are and the
circumstances and environment in which they live.^3^

Although no universally accepted definition of recovery exists, recovery
can be understood to be a process of change that takes place between the
individual and his or her relationship to alcohol and/or other drugs,
which typically is experienced in many dimensions of life.^4^ This
understanding forms the basis for this paper, which is presented in
three sections. Section 1, The Architecture of Change, identifies a
number of themes that occur in the literature relating to the nature of
change during the recovery process. Section 2, Recovery Across Body,
Mind, Relationships, and Spirit, is an in-depth exploration of one
overarching theme that emerges from the literature---the holistic nature
of physical, mental, social, and spiritual changes experienced by an
individual throughout recovery. The paper concludes by highlighting some
of the tensions and unresolved issues that exist in any discussion of
themes on recovery in Section 3, Illustrative Questions for Discussion
and Dialogue.

Themes found in the literature are not principles of recovery
themselves, but they can inform the search for principles in several
ways. In some cases, a theme may point the way to a clear consensus on a
matter that likely will be widely accepted as a shared principle without
much discussion. In other cases, themes can reveal tensions between and
among differing viewpoints. In these cases, discussion and dialogue can
help to bridge the gap between views, honoring the truth of each in the
development of shared principles. Alternatively, discussion and dialogue
can shed new light on hard questions, moving the addiction and recovery
field forward in its thinking. This paper is presented in the spirit of
advancing such a discussion and dialogue.

**Section 1: The Architecture of Change**

This section is a distillation of a number of themes from the literature
relating to the nature of change in the recovery process. These themes
reflect many varieties of individual experience and at times display
seemingly contradictory qualities or phases. These contradictions are
often reconciled over time. Therefore, respect for differences and an
appreciation for paradox are needed in the search for shared principles
of recovery.

**Many Ecologies of Change.** Each individual lives within an ecological
system that is composed of personal, social, cultural, and environmental
factors and influences. The base of this constellation of factors lies
in one's origins (e.g., family, race, ethnicity, gender), upon which are
superimposed current realities of status (e.g., economic, educational,
health, criminal justice, mental health), quality of "place" (e.g.,
where one lives, works, and finds community), and belief and value
systems. These factors and influences can be major determinants of the
individual's threshold for change and, depending on their context, can
function as either bridges or barriers to recovery. One way to view the
ecology of change for a given individual is to look at his or her
recovery capital, a concept first introduced by Granfield and Cloud
which refers to the sum total of social, psychological, and human
capital that can be drawn upon for support.

**Many Pathways of Change.** The variety of recovery experience reflects
the complex dimensions of function affected as well as the unique
strengths, values, needs, and desires that each recovering person brings
to the process. As White notes, the expanding varieties of recovery
experience are reflected in the growing diversity of mutual aid groups,
the proliferation of religious and cultural frameworks for recovery, the
growth of medically assisted recovery, and increasing recognition of
natural recovery.

**Holistic Change.** People from many varieties of recovery experience
have a shared understanding that initiating and maintaining a changed
relationship with alcohol and/or other drugs is not a simple matter of
making a single change in behavior. Rather, it is a holistic process
involving many of life's domains---one's physical self (including the
brain); how one thinks and processes emotions and feelings; one's
relationships; and, for many, one's spiritual life. Each of these
domains is addressed more fully in Section 2 of this paper.

**Incremental/Transformative Change.** People experience and/or analyze
the recovery process in different ways. Some describe their recovery as
occurring in small, incremental steps while others experience it as
transformative, with major changes occurring suddenly. Often, it is
portrayed as both. In 12-Step programs, for example, the newcomer is
cautioned to take it "one day at a time" but also learns that "the
promises," with their vision of a transformed self, will come into being
over time. A strong subtheme is the concept of identity transformation,
with important variations thought to exist along gender, cultural, and
life cycle parameters. With respect to identity, debate exists about the
positives and negatives of accepting the label of alcoholic or addict.
Identity transformation often is linked closely to the power of shared
story, which is often a major strategy for recovery initiation and
maintenance.

**Nonlinear Change.** Like other changes in life, recovery is not a
linear process; it is often depicted graphically as a spiral, with
movement in both directions on the spiral. Although the field has no
shared definition of relapse, a number of models and strategies, such as
those put forth by Marlatt and Gorski, exist for preventing it and for
minimizing the consequences when relapse occurs. Relapse also has been
viewed as a learning opportunity in the context of managing a chronic
condition, as McLellan and others have pointed out. As a practical
matter, however, a person who relapses may find his or her access to
treatment and other recovery support services terminated and also may
feel shamed within his or her mutual aid community.

**Developmental Model of Change.** A person who is one day sober is not
in the same place as a person with 30 days, 1 year, or 10 years of
sobriety. This reflects the number and degree of changes that take place
over time in various aspects of the recovering person's life and
continued human development. A number of thinkers, including Larsen,
Brown, DiClemente, and Picucci, have developed various staged or
developmental models of recovery to describe this process. Among these
models, the stages of change model has been researched most thoroughly
and is well known in the treatment world, though less so in the recovery
community. These models reflect a sense that despite the multiple
pathways, dimensions, and zigzags that characterize the many types of
recovery experience, recovery generally follows predictable stages.
These stages are marked by common milestones and seen as opportunities
to build on changes that occurred in earlier stages in the process.
Moving to a new stage has inherent risks, especially when people are
asked to accomplish goals that they may not be ready for. The existence
of numerous models of human development across the life span should be
noted. Where any given person is in the life cycle---e.g., adolescence;
early, middle, or late adulthood; old age---will affect his or her
recovery process.

**Safety as a Foundation for Change.** The need to feel safe in the
recovery process underlies the various structures of confidentiality and
anonymity that pervade formal and informal treatment and recovery
support systems. In recent years, this theme has acquired broader
significance within the context of the early recovery needs of people
who are survivors of violence and/or trauma, homeless, or living in
unsafe environments.

**Motivation: Pain and Hope as Foundations for Change.** Most peer and
professional recovery support approaches agree that motivation plays a
central role in recovery. According to traditional 12-Step and treatment
thinking, the motivation to change emerges from the pain of "hitting
bottom." Pain often increases, and motivation may be enhanced, when
others stop enabling the individual or when one's family and associates
conduct an intervention. More recently, among increasingly disempowered
persons as well as those with co-occurring disorders, the opportunity to
take part in empowering activities has been identified as a necessary
precursor to the development of motivation. What is needed before some
persons can develop the motivation to initiate recovery is not more pain
but hope.

**Power and Powerlessness in the Change Process.** One of the many
paradoxes for persons in recovery is the need to strike a delicate
balance between, on the one hand, accepting that one is powerless over
alcohol and drugs and, on the other, developing the strength needed to
overcome addiction. In the context of Alcoholics Anonymous, its
offshoots, and many faith-based approaches to recovery, resolving this
paradox requires surrender to a Higher Power. There is a great body of
literature, most notably by Tiebout and Kurtz, on the psychological and
spiritual significance of surrender and admission of powerlessness.

As noted by Williams, Kasl, Covington, and Kirkpatrick, some groups of
people in recovery, including many women and Americans of color who see
themselves as oppressed and disempowered, perceive the admission of
powerlessness and surrender as a further undermining of their hope for
recovery. In order to achieve recovery, many of them---as well as others
who have resisted either the admission of powerlessness or the spiritual
aspects of surrender---have taken the opposite route: laying claim to
power. Thus, some people gain control over the use of substances, not by
accepting notions of their powerlessness but by devoting energies to
establishing their own internal power. Through this process, they
develop the resilience and self-esteem needed to implement and sustain
recovery. Countless millions of people in recovery around the world have
embraced one or the other of these notions, sometimes (but not always)
rejecting the other. Many have integrated both.

**Intentionality and Choice in the Change Process.** Intentionality
means choosing to undertake the hard work of recovery by taking personal
responsibility to safeguard and protect one's own recovery despite the
many perceived obstacles ahead. For most people, recovery is an
intentional process, with the individual playing an active role in
initiating and, eventually, sustaining recovery within a web of
self-selected supports that include a sense of place, community, and

relationships with others. Intentionality assumes that the individual is
ready, willing, and able to make these choices.

Paradoxically, the process of recovery often begins at a place where the
individual, in fact, may be faced with limited choices and limited
confidence in his or her ability to make those choices. The constriction
of choice can take many forms: external pressures that oppose continued
use of drugs and/or alcohol, such as the threat of imprisonment and
correctional sanctions or fears of job loss, child-welfare pressures,
family or community norms that may oppose or support continued use, lack
of meaningful or personally acceptable treatment or recovery support
options, and hopelessness, to name just a few.

**Section 2: Recovery Across Body, Mind, Relationships, and Spirit**

Both the literature and the practices of people seeking to achieve or
sustain recovery clearly demonstrate that recovery is a process of
change that involves the whole person, with all of his or her strengths,
weaknesses, desires, goals, and values. Physical changes in the body
(including the brain) are coupled, in the mind, with changes in thinking
patterns and acquiring new methods of dealing with emotions. Change also
commonly occurs in a person's relationships with other people and his or
her community. For many people, the process of change in recovery has a
strong spiritual component.

These four domains of holistic health---body, mind, relationships, and
spirit---parallel the biopsychosocial model of addiction. These domains
are interactive, and change in one can influence change in another. Each
is a place where recovery can begin and where recovery can be either
strengthened or stymied. Different recovering individuals assess and
balance the various changes differently, based on individual needs and
preferences and the personal ecology in which recovery occurs, all of
which change over time as recovery progresses.

A.  **Body**

**Brain and Central Nervous System.** Researchers for the National
Institute on Drug Abuse (NIDA) and in research centers around the world
increasingly see addiction as a complex and chronic brain disorder that
cannot be isolated from its behavioral and social components. Like
Alzheimer's, Parkinson's, schizophrenia, and depression, addiction has
behavioral and social dimensions. Research is yielding medical avenues
to help assist recovery for some individuals.

In early recovery, individuals often face a number of problems centered
in the brain, such as detoxification, cravings, the response to events
and environmental conditions that trigger cravings, and the
reestablishment of brain and central nervous system functions affected
by addiction. The confusion and befuddlement of very early recovery can
fade away, but some brain effects are thought to be long lasting and may
persist throughout recovery. Individuals with co-occurring mental and
addictive disorders may experience change related to each disorder.

**Physical Health.** Individuals in early recovery often become
concerned with their general health, which may have been neglected,
sometimes for many years. Common problems include liver disease, anemia,
and other nutritional deficiencies resulting from poor dietary habits,
neuropathy, HIV infection, hepatitis C, herpes, and sexually transmitted
and other infectious diseases, including tuberculosis. Dental problems
also are common. For those who have been living in the cramped and
crowded conditions of shelters, jails, or prisons,
multiple-drug-resistant tuberculosis and other infectious diseases can
be a major problem, not just for the individuals directly affected but
also for the communities to which they return.

Ideally, these conditions are identified early in recovery through a
physical examination. Feelings of shame and a desire to avoid
disapproval may prevent many from disclosing their addictive and
recovery status to the physician or other health care provider. This is
unfortunate, because full disclosure of past addiction history is
necessary in order for the health care provider to recommend appropriate
diagnostic tests and to help minimize the adverse health conditions that
often accompany addiction. Sometimes, medical problems emerge in later
stages of recovery. Hepatitis C, in particular, is often discovered only
after an individual is well along in recovery.

The presence of disorders that cause chronic or acute pain can present a
significant challenge to the person in recovery, because many
pain-killing medications contain mood-altering drugs. This may be a
particular challenge for individuals who have been addicted to opiates
such as heroin and who are now drug free. For example, practitioners
unfamiliar with the recovering person\'s history might provide opiates
or opioid medication for acute pain, unwittingly triggering relapse.

It is a good idea for a recovering person to work closely with a pain
management specialist who is knowledgeable about addiction and who can
consider nonpsychoactive medications and techniques for pain control. If
psychoactive medications become necessary, the pain management
specialist can establish baseline dosages, carefully titrate the
medication, and cautiously manage the patient\'s medication needs while
assisting with maintaining recovery.

Individuals who have been addicted to opiates and who utilize an
opioid-based form of recovery assistance, such as methadone, may also
have acute or chronic pain issues. Nonpsychoactive medications may be
effective for pain control, but opioid-based medication may become
necessary in some cases. One common myth about patients in
medication-assisted treatment is that these patients do not experience
pain or cannot benefit from opioid-based pain medication. It is a good
idea for these patients to work with both their opioid treatment
physicians and a pain management specialist to control pain while
maintaining gains made in recovery.

As recovery progresses, many people become involved in a proactive
health regimen that includes healthy eating, exercise, and rest. Many
recovering individuals find alternative health interventions, ranging
from brain wave biofeedback to yoga and acupuncture, helpful in
sustaining long-term recovery.

**B. The Mind**

At a minimum, the person in early recovery has to learn how to overcome
the strong cravings common in early recovery and how to identify and
avoid the triggers that can prompt relapse. He or she will need to
accomplish the challenging task of learning to identify the cycle of
environmental cues, thoughts, emotions, and behaviors that act as
triggers, and develop coping strategies. This task must be undertaken
during a period which is frequently emotionally turbulent. Painful
feelings associated with acknowledging the harm one may have done to
others or suffered at the hands of others can be particularly strong,
especially when powerful cravings are present, and the person in
recovery will need to develop new strategies to cope with these powerful
feelings as well.

Many people discover hidden strengths and resilience as they face these
challenges. Some discover problem-solving skills (including insight and
resourcefulness) or a sense of purpose and future (such as
goal-directedness and an innate optimism and persistence). Others may
have strong social competencies (such as good communication skills or a
sense of humor) that will make it easier for them to find allies to
support them. Many others may need support in building these skill sets.

The person in early recovery can be helped by many strategies and
techniques for learning new behaviors. Cognitive restructuring can be
achieved in numerous ways, including cognitive behavioral therapy (CBT),
social skills training, and participation in the rituals and processes
of mutual aid groups. Other key components in sustaining one's recovery
are learning to identify personal stressors; developing a personal
approach to stress management, self-care, and self-efficacy; and
practicing these skills each day.

Other common and important tasks during early stages of recovery are
addressing powerful feelings of grief, loss, shame, and guilt about the
past, and facing one's fears and apprehensions about the future. When
these feelings are not dealt with, they can linger, adversely affecting
relationships and self-esteem as well as hampering the ability to
accomplish the tasks of daily life and develop or regain a sense of
competence. A strong sense of competence helps to facilitate the
development of effective cognitive processes and increases performance
in a variety of areas of life.

Another important task of ongoing recovery is to develop a healthy sense
of autonomy in order to establish and maintain personal boundaries and
establish healthy relationships. Learning to resolve the tension between
the desire for closeness and the need to establish appropriate distance
is necessary for preserving personal relationships and establishing and
maintaining new ones. For some, this can include cultivating quality
nonsexual relationships with persons of the opposite gender, perhaps for
the first time in their lives.

As recovery continues to progress, priorities often shift to achieving
important but less urgent goals. This change in focus may come about
naturally, as confidence in one's ability to sustain recovery grows.
Educational or career development goals may emerge, as well as a desire
to address unresolved family issues.

**C. Intimate and Social Relationships**

The task of building a network of social support is perhaps the most
challenging part of recovery work. At the center of the web is a person
in early recovery whose own sense of self-worth may be fragile and who
may be overwhelmed by demands to reprocess and sometimes reconfigure the
internal dynamics related to his or her most important relationships. He
or she may have many or few social skills and healthy relationships to
fall back upon. As one moves out from the center to family and other
intimate relationships, peers, community, and culture, he or she will
find many resources that support recovery. At the same time, the
individual will encounter others that undermine recovery and will be put
to the task of distinguishing between them and deciding which fit
comfortably with his or her newly recovering self.

Reconnecting with and sometimes disconnecting from friends,
acquaintances, and colleagues are important goals. Decisions about
reconnecting and coming to terms with necessary separations constitute
challenges, because bonds of love and deep human needs are often
involved. For the same reasons, cultivating strong and healthy new
relationships is rewarding and contributes to a recovery that endures.
One mark of mature recovery is completion of these processes.

**Family and Other Intimate Relationships.** Some approaches to recovery
focus on the family as a resource either to help initiate or support the
individual's recovery process or to support the family's own needs for
healing. For some individuals, family or other intimate relationships
may have contributed to the development of addiction or may play a
subversive role in recovery. In many cases, individuals will work to
assess these relationships and will struggle at reestablishing or
severing these important ties.

Assessing the current status of relationships and one's role within them
can be emotionally charged. In the attempt to let go of relationships
that are harmful, powerful feelings of grief and loss can occur. When
attempting to reestablish former relationships, the individual often
faces anger and resentment from others because of disappointments and
hurts they experienced as a result of the individual's addictive
behaviors. Recovering persons also often are challenged to "prove" that
they are now responsible and trustworthy.

Sometimes work to heal the family as well as the recovering individual
is done in an addiction treatment setting. Healing also may occur later
in the recovery process, either with professional assistance (for those
who can afford it) or with the help of peer support and advocacy groups.
Sometimes it is done without any formal assistance.

**Peers.** Many people in early recovery shift from the self-imposed
isolation of addiction to a desire for connection with other people.
Assessing the current status of relationships with peers is often
necessary. This frequently results in a severing of relationships with
peers who are using substances. For many, mutual aid groups offer an
opportunity to share their experience with others who are also
restructuring relationships (or have already done so), observe social
role modeling, take on responsibilities that enable them to develop
skills, and learn from the sharing of stories with others. Mutual aid
groups offer affiliation with, and an ability to contribute to, a
community of peers who have shown demonstrable strength and even good
humor in the face of adversity. The support from others provided in
these groups can strengthen hope and a belief that recovery is
achievable. However, some people in recovery do not participate in these
groups, whether because they feel they do not need peer support; because
the mutual aid groups available to them seem inconsistent with their
values, life expectations, or worldview; or because they have poor
social skills and difficulties interacting within a group.

**Treatment Providers.** Professional treatment providers can help the
person in early recovery develop needed social and other life skills
that contribute to effective socialization. However, treatment episodes
are often brief and focus primarily on the task of stabilization.
Continuing care and emerging techniques (such as posttreatment brief
telephone "check-ins") can sometimes extend the ability of the treatment
provider to play this supportive role during early recovery. Of course,
many people cannot or do not avail themselves of treatment
opportunities.

**Community and Culture.** The recovering person and his or her network
of family, professional, and peer supports are nested within the larger
community. This community may provide supports that nurture recovery, as
well as conditions that foster relapse. At a minimum, the recovering
person is likely to encounter stigma and discrimination in the
community. Persons with co-occurring conditions (e.g., mental disorders)
or characteristics (e.g., ex-offender status) often struggle with
compounded stigma and discrimination.

Sometimes people look to the strengths of their culture as a source of
support for recovery. For example, for Native Americans, The Red Road to
Wellbriety: In the Native American Way integrates the wisdom of elders,
traditional values, healing practices as depicted on the Medicine Wheel,
and the insights of 12-Step fellowships within a community-based
recovery support system. Important political and cultural trends within
the larger community---such as the civil rights and racial pride
movements, feminism, and more recently the growth of Christian
evangelism---are often reflected in recovery thinking as well.
Typically, these cultural revitalization and social justice movements
are concerned with healing the individual, the community, and society as
a whole.

**Life Tasks and Roles.** Some persons in early recovery may need to
learn new skills to survive in the larger society. They may need help in
becoming employable, finding work, assuming the role of employee,
finding suitable housing, and even acquiring basic skills such as
learning how to prepare a meal. Many need to learn or relearn how to
socialize without alcohol or other drugs as a social lubricant. Some
will be challenged to develop a healthy sexual life that is not
intimately connected to alcohol and/or drug use.

Liberated from their addiction, some individuals feel propelled to
rediscover learning. Not only adolescents and young people but also
older people whose education may have been interrupted by their
substance use often return to school to complete their education and go
on to pursue more advanced education and other professional goals.
Others become interested in simply expanding their personal knowledge.
Many take up expected family roles---son or daughter, spouse or partner,
parent or grandparent---that they formerly ignored. Some do this within
their prerecovery family structures, while others do so within new
family arrangements or in other constructions of interpersonal
relationships.

Success at an expanding array of life tasks and the assumption of new or
enhanced roles in the community---as they are identified and defined by
the person in recovery over time---both derive from and contribute to
sustained recovery. Those without emotional and financial resources,
social supports, or skills to accomplish new or enhanced tasks and roles
may need a great deal of support from others to achieve their goals.

**D. Spirit**

Spirituality and spiritual development receive a great deal of attention
in both lay and professional recovery literature. Many recovering
persons, as well as researchers and clinicians, view spiritual
development as a catalyst that can drive and give meaning to the changes
in body, mind, and social relationships that characterize recovery. Many
other recovering people, however, cannot accept what they see as a
religious aspect of traditional approaches to recovery. In addition, the
topic is difficult to write about because it is personal in nature.
Everyone "knows" what spirituality means, but it means different things
to different people. Even so, one researcher, Ringwald, recently arrived
at a definition that seems to embrace many other definitions:
"\[Spirituality is\] an ongoing internal process of change that results
in a transformation of the recovering person's attitudes, values,
beliefs, and practices."

The traditional understanding about spirituality in addiction recovery,
which comes from 12-Step fellowships, suggests that spiritual change
begins when the person seeking recovery realizes that he or she is
imperfect, cannot achieve recovery alone, and seeks help from an outside
source. People taking the traditional spiritual route find that recovery
can flourish through a connection to others; an affiliation with
community; and a reliance on something greater than oneself, defined in
a variety of ways, including "higher power" and God. Spiritually based
programs give people in recovery a safe place to nurture the ongoing
processes of healing, self-reflection, character building, and
developing new attitudes and behaviors. A major component of
spirituality is the ability to forgive and be forgiven for the range of
things that went awry during addiction. The ethical principle of
mutuality, or a spirit of "giving back," also is associated with
spiritual recovery approaches and functions as a support for one's own
recovery as well as the recovery of others.

Faith-based programs have brought new dimensions of spirituality into
the recovery community. Increasing numbers of people are entering
recovery through faith-based programs that are shaping new approaches to
recovery by drawing directly from Judeo-Christian traditions in a way
that publicly funded programs (where the majority of treatment has been
provided in the United States) historically could not. These programs
meet the person seeking recovery with the message that every human being
is created in the image of God and is unconditionally loved by the
creator. People entering the recovery community from these programs
bring notions of God's love as the empowering force that enables them to
make the changes required to recover.

While 12-Step fellowships and faith-based organizations are the
best-known venues for spiritual approaches to recovery, spirituality and
cultural revitalization movements are often intertwined. For example, to
help those who are not well served by non-Native treatment and recovery
supports, the Native American community has embraced traditional
spiritual healing and ceremonial practices including drumming, sweat
lodges, talking circles, chanting, pipe ceremonies, smudging, and other
rituals. In this tradition, true healing takes place within the context
of the community, and the process of recovery is a quest for harmony and
wholeness within the context of the self, the family, and the tribe.

**Section 3: Illustrative Questions for Discussion and Dialogue**

As is apparent in the foregoing sections of this paper, the literature
on recovery reveals areas of both consensus and divergence. As the
planning group moves forward with its design of the National Recovery
Summit, it may want to look at some of the "hard questions" that are
raised by the themes of recovery recounted in this paper, and consider
how to address them in ways that promote agreement rather than discord.
The following examples are suggestive and meant to assist the planning
group by stimulating discussion related to the development of shared
principles about recovery:

 Some key concepts in recovery thinking are often expressed in ways
that appear to be polar opposites. For example, some say that the key to
recovery is admission of powerlessness; others say the key is
empowerment. The pain and fear of negative consequences, on the one
hand, are described as key motivators; on the other hand, hope and
empowerment are described as the essential elements. How do we develop
principles of recovery that recognize and reconcile such seemingly
dichotomous perspectives?

 In mental health recovery, as in many other areas of health, choice is
seen as a fundamental driver of recovery, conferring dignity on the
individual and underscoring his or her right to live a self-directed
life. The freedom to make meaningful choices is seen as essential to the
healing process. A person approaching recovery from addiction, on the
other hand, is often doing so in a context where his or her past choices
are seen as deeply flawed and his or her ability to make sound current
choices is viewed with suspicion. Moreover, the person may be facing an
enormous array of social and criminal sanctions if he or she doesn't
comply with other people's judgment about what constitutes good choices.
How do we develop a principle relating to choice that takes these
realities into account?

 Some Americans are attaining recovery via community- and culturally
specific routes that focus first on healing the community (and sometimes
the family). Does it represent fairly what we know about recovery---or
what we hope to achieve by moving to a recovery-based paradigm---to
develop recovery principles that are predominantly focused on the
individual? If not, how could we expand the scope of these principles to
include families and the community? How would these expanded parameters
play out in our current systems?

 Wellness-based models typically incorporate strength-based planning
and notions of resilience. How do these constructs fit within a recovery
paradigm?

 Recovery is ultimately defined by most individuals as having a
meaningful life that is consonant with their personal value system and
includes values that derive from their religious and spiritual beliefs
and their culture. How do we develop principles that acknowledge the
power of these values?

 It is commonly said that recovery is not a linear or one-step
process---that there is important "prerecovery" work preceding a
decision to initiate recovery and important continuing work after
recovery has been established, and that relapse is a normal part of the
process and can be a learning experience. What would a system look like
that offered meaningful support at all stages, including prerecovery,
continuing recovery, and relapse?

**Notes**

1.  As used in this paper, the term addiction includes alcoholism, and
    addict includes the alcoholic. These terms are widely used by people
    associated with different schools of thought, including those who
    reject disease-based concepts and terminology. The authors recognize
    and respect the preference of many to adopt less stigmatizing and
    more "person first" terminology, such as "persons with substance use
    disorders."

2.  Materials related to Goals 2 and 3 also will be provided to assist
    the planning group.

3.  A systematic exploration of the commonalities and differences in
    recovery thinking associated with the person (e.g., age, gender,
    sexual orientation, coexisting disorders and conditions) and his or
    her environment (e.g., culture, ethnicity, family, class, criminal
    justice involvement, housing status) is beyond the scope of this
    paper. Nevertheless, the importance of developing recovery
    principles that accommodate these differences cannot be overstated.

4.  This change in relationship is defined in abstinence-based models as
    stopping all use. For those who approach the question from a disease
    perspective, diagnostic criteria may play a role in defining the
    changed relationship. DSM-IV, for example, provides diagnostic
    criteria for levels of substance use disorders. Based on these
    criteria, "Recovery from DSM-IV Alcohol Dependence: United States,
    2001--2002," a study released by the National Institute on
    Alcoholism and Alcohol Abuse in January 2005 based on data from the
    2001--2002 National Epidemiologic Survey on Alcohol and Related
    Conditions, defined people as being in recovery if they were
    classified as being in partial remission, asymptomatic risk drinkers
    (who demonstrated a pattern of drinking that put them at risk of
    relapse), low-risk drinkers, or abstainers.

**Acknowledgments**

This document has been produced for the Substance Abuse and Mental
Health Services Administration/Center for Substance Abuse Treatment
(SAMHSA/CSAT) by Health Systems Research, Inc., under contract number
270-2003-00005, Recovery Community Services Program (RCSP II).

**Disclaimer**

The contents of this document do not necessarily reflect the views of
SAMHSA/CSAT, or the Department of Health and Human Services. The paper
has been prepared to stimulate discussion at the CSAT National Summit on
Recovery, September 28--29, Washington, D.C.

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**Appendix 4: SAMHSA National Outcome Measures**

**National Outcome Measures (NOMs)**

-   Abstinence from Drug / Alcohol Use

-   Employment / Education

-   Crime and Criminal Justice

-   Family and Living Conditions

-   Access / Capacity

-   Retention

-   Social Connectedness

-   Perception of Care

-   Cost Effectiveness

-   Use of Evidence-Based Practices

> **Appendix 5: Panel Presentation Summaries**

**Appendix 5.1: Phil Valentine: Recovery Community Services Program
(RCSP)**

**Summary of Grantee Perspectives on Recovery from**

**Discussion Groups at the August 2005 RCSP Annual Conference:**

**Recovery and the Whole Person**

**Principle 1**

-   Addiction can have its roots in any or all human aspects---physical,
    mental, social and\
    spiritual.

-   Successful recovery addresses and heals the physical, mental, social
    and spiritual aspects of\
    a person.

**Principle 2**

-   Addiction is a chronic disease and must be treated with the same
    integrity as other chronic\
    diseases.

-   Relapse is not an indication of noncompliance. It is a confirmation
    of the diagnosis.

**Principle 3**

-   The recovery process of addressing wholeness is challenging and
    lifelong.

**Principle 4**

-   Peer assistance is a natural bridge between leaving treatment and
    beginning a life of\
    recovery in the world.

-   Experienced peers are the best supports for those new in recovery.

-   The system must recognize long-term recovery as a competency along
    with traditional\
    clinical skills.

-   Systems of care would:

-   Address recovery as a healing process focusing on the whole
    person---physical, mental,\
    social and spiritual;

-   Require treatment facilities to elevate their "recovery-friendly"
    rating (as determined by the\
    recovery community) to receive Federal and State funding;

-   Recognize recovery as a competency.

**Recovery and Spirituality**

-   Spirituality is a key component in a high percentage of recoverees,
    but not all.

-   Spirituality must be honored within a recovery-oriented system of
    care.

-   Spirituality and religion should not be confused. Religion may be
    for some, but not for\
    everyone.

-   Spiritual journey transforms lives.

-   Spiritual transformation facilitates movement from woundedness
    toward health, wholeness\
    and ultimately wellness.

**Recovery and Wellness**

-   Wellness could be defined as having healthy attitudes and behaviors
    concerning physical,\
    mental, social and spiritual aspects.

-   Wellness incorporates health holistically on individual, family and
    community levels.

-   Wellness brings purpose and service.

-   Recovery-oriented systems would increase opportunities for wellness
    through integration and\
    networking.

**Appendix 5.2: Pat Taylor: Faces & Voices of Recovery (FAVOR)**

**Faces & Voices of Recovery (FAVOR)**

Faces & Voices of Recovery is working to mobilize, organize and rally
the families, friends and allies of the millions of Americans in
recovery from addiction in a campaign to:

-   End discrimination

-   Increase public understanding

-   Treat addiction as a public health crisis.

**Recovery Community**

-   People in recovery from alcohol and other drug addiction, their
    family members, friends and allies.

**Paths to Recovery**

There are many paths:

-   On your own

-   Nontraditional methods

-   Support groups

-   Professional treatment

-   Medical interventions

-   Faith

-   And more.

**Supporting Local Recovery Advocacy**

-   Increasing access to research, policy, organizing and technical
    support.

-   2001 Peter Hart survey of the recovery community found that half of
    the recovery community said that they would be likely to take part
    actively in a public campaign.

-   Improving access to policymakers and the media.

**National Survey**

-   Peter D. Hart Research and Robert M. Teeter's Coldwater Corporation
    2004 survey:

-   A majority of Americans (63%) have been affected by addiction to
    alcohol and other drugs.

-   A majority (67%) believe that there is a stigma toward people in
    recovery.

-   A majority (74%) says that attitudes and policies must change.

**Removing Barriers to Recovery: Public Knowledge & Attitudes**

Communicating to the public about recovery:

-   Describing recovery

-   Describing pathways

-   Messengers: people in recovery, family members.

**State & Federal Policies**

-   Employment

-   Housing

-   Enfranchisement/civic engagement

-   Education

-   Facilitating relationships among local and regional groups

-   Web site
    [www.facesandvoicesofrecovery.org](http://www.facesandvoicesofrecovery.org/)

**Be living proof that there are real solutions to addiction. Join us!**

[www.facesandvoicesofrecovery.org](http://www.facesandvoicesofrecovery.org/)

**Appendix 5.3: Randy Muck: SAMHSA/CSAT Adolescent Focus\
Groups Panel Presentation and Paper**

**THE VOICES OF YOUTH**

Substance Abuse & Mental Health Services Administration

Center for Substance Abuse Treatment

National Summit on Recovery

**Youth Focus Groups, September 19--21, 2005**

-   30 youth, ages 14 -- 23

-   4 focus groups -- approximately 1 hour each

-   Chosen from CSAT adolescent treatment listserv (nominated by
    programs) of over 100 facilities nationwide

-   One recovery home

-   Selected on basis on diversity (gender, race/ethnicity, levels of
    care, geographic distribution)

**Youth Focus Groups, September 19--21, 2005**

-   Early recovery -- 3 months to 2 years

-   All had been through more than one treatment episode, and previous
    mental health and behavioral health treatment were often mentioned

-   Current status (treatment, continuing care, recovery home, sober
    high school or college dorm)

-   Recovery home -- sample of 10 adolescent female volunteers

**Definition of Recovery**

-   Growing in every respect (physically, spiritually, and mentally)

-   A whole lifestyle change with everything revolving around and
    supporting recovery

-   A mental and physical healing process

-   Understanding that addiction is a disease and taking appropriate
    measures to address this health problem

**Barriers to Recovery**

-   Not enough coping skills gained in treatment to deal with triggers

-   Inadequate education about the nature of the disease

-   No access to professionals in addiction in schools where they return

-   Relationships with family and community for which they are
    inadequately prepared

-   Returning to face hardships and trauma that have not been dealt with
    in treatment

-   Abandoned by treatment programs after program completion

-   Lack of focus on trauma and sexuality

-   Eating disorders/self mutilation issues which programs did not
    address

-   Not held accountable for actions

-   Self worth is not enhanced

-   Staff that are poorly paid and overworked

-   Staff uninterested in listening to youth

-   Continuing care is optional or not offered

-   No opportunity to practice skills in real life settings

-   No linkages with mentors or sponsors before treatment ends.

**What is Needed for Youth to Succeed**

-   Appropriate transitional environment

-   Hope

-   Positive reinforcement

-   Sense of self worth

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-   Constructive and supportive environment

-   Individualized appropriate care

-   Relevant (coping) skills

-   Personal accountability framed with understanding and support

**Improvements Recommended**

-   More family involvement

-   Mentors/sponsors -- before leaving treatment

-   Better education about the disease of addiction

-   All practitioners licensed and trained

-   Treatment staff that are not overworked and underpaid

-   More (gradual) transition programs (e.g., sober schools, recovery
    homes)

-   Opportunities to practice skills in the real world while
    living/going to school in a recovery environment

**Questions to Measure Recovery for Youth**

-   What is recovery?

-   How are you doing with your recovery today?

-   List 10 internal motivations to stay clean. How have you followed up
    on them?

-   What have you done to improve your recovery?

-   What is different in your life today versus when you were using?

**Listening to Youth**

-   Have you listened?

-   How will you incorporate this information into your recovery
    framework?

-   How will youth continue to be involved?

-   What can you do in the programs and communities where you work to
    support the recovery of youth?

Thank you for this opportunity on behalf of all of the youth who
participated.

**Voices of Youth In Recovery**

**Substance Abuse and Mental Health Services Administration (SAMHSA)**

**Center for Substance Abuse Treatment (CSAT)**

**Acknowledgements**

This report was prepared under the auspices of the Substance Abuse and
Mental Health Services Administration (SAMHSA), Center for Substance
Abuse Treatment (CSAT), Division of Services Improvement and the
Partners for Recovery (PFR) initiative within CSAT's Office of Program
Analysis and Coordination.

Ms. Donna M. Cotter, PFR Coordinator, provided support to conduct the
adolescent focus groups. Mr. Randolph D. Muck, Public Health Advisor of
the Division of Services Improvement, structured the focus group
sessions and facilitated focus group discussions. Ms. Angela Bowman,
Executive Director of the Illinois Alcoholism and Drug Dependence
Association, facilitated a focus group for adolescent females.

**SAMHSA would like to express its gratitude to the adolescents who
participated in the focus groups. Each adolescent contributed to the
culmination of this report through his or her sincere responses,
thoughts and insights. This report would not be possible without their
participation and willingness to share their experiences on recovery.**

Abt Associates Inc., led by Melanie Whitter, PFR Project Director, with
support from Candy A. Magana, Peter Gaumond and Denise Young, documented
the focus group discussions and authored and produced this report.

**Table of Contents**

Introduction 93

Participant Criteria

and Demographics 94

Criteria 94

General Participant Profile 94

Geographic Distribution 94

Gender 94

Race/Ethnicity 94

Age 94

Definitions of Recovery 96

Barriers to Recovery 96

Lack of Individualized/Appropriate

Care During Treatment 96

Lack of Post-Treatment Follow-Up 97

Lack of Access to Resources 97

Returning to Non-supportive

Environments---Families and Schools 97

Failure to Address Trauma or

Sexual Histories 97

Maintenance of Past Peer Networks 97

Critical Factors for Success 98

Developing Coping Skills 98

Maintaining a Supportive

Treatment Environment 99

Developing Accountability and Self Worth 99

Providing a Transitional Environment 99

Assuring a Constructive School\
Environment 100

Including Family in the Recovery Process 100

Recommendations 100

Questions to Measure Recovery 100

Conclusion 101

References 102

**Introduction**

The Substance Abuse and Mental Health Services Administration (SAMHSA)
conducted a National Summit on Recovery on September 28 and 29, 2005, to
define principles and measures of recovery, as well as describe systems
of care that support recovery. SAMHSA sought the perspectives of youth
on these topics by holding focus groups to gather the information.

Addictions that begin during the teen years are often different than
addictions that originate during adulthood. For example, addictions that
are initiated during adolescence tend to progress more quickly than
addictions that develop during adulthood (Clark et al, 1998). In
addition, drinking patterns established during the teen years have been
found to be a predictor of alcohol dependence in adulthood (Bonomo,
2004). Alcohol Health and Research World found that persons who begin
drinking before the age of 15 are four times more likely to develop
alcohol dependence than those who begin drinking at 21 years of age
(Grant, 1998). Adolescence is a time when proper intervention can
prevent the progression of drug or alcohol use. Despite these factors,
the voices of youth are often not incorporated into treatment and
recovery policy and systems change efforts. For these reasons, SAMHSA
felt it was critical to solicit the views of adolescents to inform the
National Summit on Recovery.

This report represents the voices of youth in recovery by summarizing
their words and thoughts. Input was provided by 30 teens that
participated in four one-hour youth focus groups, held between September
19 and September 21, 2005. The first three focus groups took place on
September 19, 2005, in Oak Brook, Illinois. Participants came from
locations across the United States. One of the three groups held on
September 19th comprised eleven (11) males, a second consisted of nine
(9) females, and the third consisted of all twenty (20) participants
representing both genders. The fourth focus group, involving ten (10)
adolescent female residents of a recovery home, took place in Rockford,
Illinois.

The focus groups were a joint effort between the SAMHSA/CSAT Partners
for Recovery initiative, which resides in the Office of Program Analysis
and Coordination, and the Division of Services Improvement. The
discussions provided valuable information regarding the definitions of
recovery, barriers to recovery, critical factors for successful
recovery, recommendations for systems improvement and measures of
recovery. The results of the focus groups were presented at the National
Summit on Recovery, hosted by SAMHSA/CSAT on September 29, 2005, in
Washington, D.C., and will be incorporated into systems and services
development activities subsequent to the Summit.

**Participant Criteria and Demographics**

**Criteria**

Adolescents were asked to participate in the focus groups based on
criteria established by SAMHSA. Participation was voluntary.
Participants were requested to have a minimum of three months in
recovery and an ability and willingness to express their experiences and
views about treatment and recovery. Participants were selected to assure
a mix of gender and diversity in terms of race/ethnicity, geographic
distribution and recovery experiences.

**General Participant Profile**

All participants described themselves as being in recovery, ranging in
duration from three months to over two years. Substances of choice for
the participants included: marijuana, "pills," alcohol,
methamphetamines, cocaine, ecstasy, crack and heroin.

All focus group participants had undergone more than one episode of
treatment. Several individuals received mental health treatment.
Participants also described their current recovery status in numerous
ways. Many youth noted that they were currently involved in continuing
care, recovery homes, or sober high schools or living in sober college
dorms.

**Geographic Distribution**

Focus group participants came from a variety of areas within the United
States (i.e., Alaska, California, Connecticut, Hawaii, Illinois,
Michigan, Minnesota, North Carolina, New York, Ohio and Texas) and
Canada.

**Gender**

In total, 11 males and 19 females participated in the focus groups.

**Race/Ethnicity**

The adolescents were diverse representing a variety of races/ethnicities
(White, African American, Hispanic/Latino, Asian, biracial and
Athabascan \[Alaskan tribe\]).

**Age**

Focus group participants' ages ranged from fourteen (14) to twenty-three
(23) years. The majority of the participants were between sixteen (16)
and eighteen (18) years of age.

**Definitions of Recovery**

Focus group participants were informed that the National Summit on
Recovery would be convening in Washington, D.C., on September 28 and 29,
2005. A primary Summit objective would include developing agreement
around definitions of treatment and recovery principles. Participants
were asked to define recovery and were informed that their perspectives
would be shared with Summit participants. The adolescents responded with
a number of definitions, such as:

-   "Recovery is growing in every respect... physically, spiritually and
    mentally. I have grown so much in every single way ever since I have
    been in recovery."

-   "Recovery, to me, is the difference between life and death. It is
    something that you have to want and focus on."

-   "Recovery is a choice. It is an ongoing process that is like cancer
    in remission. At any point in time it can turn back to the way it
    was before."

-   "Recovery is a whole lifestyle change. Everything has to revolve
    around and support staying sober. It is an intense and hard process,
    but, at the same time, it is the only choice."

-   "Recovery is a healing process... like having physical therapy after
    a car accident. A person doesn't realize what strength they have
    until they work the program. It means healing mentally and
    physically."

-   "Recovery is learning how to live life free from the bondage of
    addiction."

-   "Recovery is the chance to grow into the woman that I have wanted to
    be. Before I was in a dead end. Now I can be happy and proud of
    myself."

-   "Recovery is different from being sober or abstinent. It is actively
    working some kind of program to maintain a state of sobriety."

-   "Recovery is not just staying off of drugs but changing your whole
    life...\[having\] new networks of people, a whole \[new\]
    environment and state of mind."

-   "Recovery is finding different coping skills and things to do."

-   "Recovery is when you actually believe in yourself. When you
    recover, you are staying sober for yourself and not your parents or
    the recovery system."

-   "Recovery is dealing with the feelings that caused you to use \[in
    the first place\]. It is learning how to deal with feelings and
    reactions."

-   "Recovery is understanding what the problem is. I didn't know I had
    a disease. It is about addressing this disease and finding out what
    \[you\] need to do to get better."

-   "Recovery is overcoming the mindset of wanting and needing to do
    drugs. It is actively taking an approach to live a different life. I
    needed to learn how to be myself again without the drugs."

**Barriers to Recovery**

The facilitators asked a variety of questions to determine what barriers
may impede recovery-oriented services for adolescents:

-   Now that you are in recovery, do you still hang out with the same
    people or have you found a new peer group?

-   How does a person create a new network of friends?

-   What are other means, besides new peers, that adolescents turn to
    during recovery?

-   What was your treatment like?

-   Did your treatment programs prepare you for recovery before leaving?

-   What can treatment programs do to address the problem of helping
    adolescents feel accepted by others?

-   What kinds of messages did you get regarding relapse during
    treatment?

-   Did your treatment programs talk about sexual orientation or trauma?

-   What did treatment professionals do that was the least helpful for
    your recovery?

The adolescents summarized barriers under the following categories:

-   Lack of individualized/appropriate care during treatment;

-   Lack of post-treatment follow-up;

-   Lack of access to resources;

-   Returning to non-supportive environments---families and schools;

-   Failure to address trauma or sexual histories; and

-   Maintenance of past peer networks.

Each of these categories is elaborated below and specific comments from
the youth participants are provided.

**Lack of Individualized/Appropriate Care During Treatment**

-   Recovering adolescents are frequently not treated as individuals
    with unique concerns and needs. Adolescents seek information on a
    variety of treatment options as well as an individualized approach
    to their care.

-   "Sometimes people need more time to recover...\[people\] can't just
    be put on a time frame."

-   Frequently, an expectation of failure is placed on individuals.
    Recovering adolescents are "taught what to do when they relapse
    rather than being instructed on how to prevent relapse."

-   Adolescents are not taught a sufficient range of coping skills to
    manage everyday triggers (e.g., stress, work, raising a child or
    boredom).

-   Treatment programs do not offer adequate education on the disease of
    alcohol and drug addictions.

-   Treatment programs do not address co-occurring eating or
    para-suicidal behavior, such as self-mutilation experienced in
    conjunction with alcohol and drug addictions.

-   Treatment programs provide minimal direction to youth struggling to
    understand and manage their emotions.

> "I needed people to show me how to deal with my emotions...all of
> those suppressed\
> emotions."

-   Adolescents do not receive effective treatment for alcohol and drug
    problems in psychiatric wards.

> "\[In psych wards\] I never talked about my drug dependency...\[I\]
> didn't relate to others. I couldn't even get my shoes. I got shots and
> was put into a quiet room. That was where I did not belong. Being here
> in the real world helped me more than anything."
>
> "Psych wards helped me escape out of reality. \[They\] just gave me a
> pill for depression to send me on my way."
>
> "\[The\] psych ward was my bottom... all they did was put me on meds
> and \[have me\] walk around with no shoes for eight days. I really
> needed to get out of my situation and be taken away to live in a
> facility. Everything that I had known was taken away from me."

**Lack of Post-Treatment Follow-Up**

-   Adolescents do not receive recovery support from their treatment
    agencies upon treatment completion.

"I didn't know what to do after I graduated."

"My first one (treatment program) just dumped me."

**Lack of Access to Resources**

-   Recovering adolescents will most likely not have access to a
    treatment professional within their school systems.

**Returning to Non-supportive Environments---Families and Schools**

-   Unhealthy family relationships can compromise recovery. Physical and
    emotional abuse, family substance use and lack of communication may
    put an adolescent at risk for relapse.

-   Unsupportive school environments create risky conditions for a
    recovering adolescent. After successful treatment, some adolescents
    struggle with not returning to old habits.

**Failure to Address Trauma or Sexual Histories**

-   Many treatment programs do not address trauma or sexuality. The
    attention given to trauma usually occurs only during initial
    individual screenings or assessments.

**Maintenance of Past Peer Networks**

-   Building new peer networks is one of the most difficult aspects of
    the recovery process. Socializing with previous peers can lead to
    relapse or complicate the recovery process.

> "Hanging out with old friends is the hardest thing to do... it is hard
> to stay sober and hang\
> out with the same people. It may be the reason that I am relapsing."
>
> "I can't be around with my old friends anymore. It is important to
> make new friends\
> especially when I get a craving. My old friends are struggling \[with
> addictions\] themselves."
>
> "I got arrested with five of my best friends and we all got into
> recovery together for the initial\
> six months. The only reason that my recovery is working out for me is
> because I made new friends. If I started hanging out with my old
> friends, it would be really hard not to use... falling back into old
> habits would be inevitable."

"It is hard to find sober people. I don't feel like I am accepted by
anyone... people judge."

**Critical Factors for Success**

The participants were asked several questions to determine what skills,
services and systems are critical factors to support adolescents'
recovery.

-   How important is it to have family included in the recovery process?

-   What can programs do to involve families more in an adolescent's
    recovery?

-   How are outpatient programs following up after people leave
    treatment?

-   What changes need to be made within the juvenile justice system to
    help adolescents who are using substances?

-   In your treatment programs, what have you been told about relapse?

-   How did your treatment programs prepare you to deal with trauma and
    post-traumatic stress?

-   How do you think your treatment program(s) have helped women deal
    with problems that are uniquely female based?

-   What are treatment programs doing to help you deal with your
    families once you have finished the program?

-   What did treatment professionals do that was the most helpful to
    your recovery?

Adolescents summarized critical factors for success under the following
categories:

-   Developing coping skills;

-   Maintaining a supportive treatment environment;

-   Developing accountability and self worth;

-   Providing a transitional environment;

-   Assuring a constructive school environment; and

-   Including family in the recovery process.

These success factors are discussed below.

**Developing Coping Skills**

-   Learning how to express emotions and deal with anger are critical
    coping skills for recovering adolescents.

**Maintaining a Supportive Treatment Environment**

-   Supportive treatment environments are key to achieving and
    maintaining recovery.

-   Building relationships of trust with mentors, sponsors and peers is
    very important.

> "My mentor kept visiting me. She would call my mother if she hadn't
> heard from me. She would come by and pick me up... she would always
> keep checking on me. It made me feel like I was her adopted
> daughter... that she had faith in me. It was key to motivating me
> through my sessions and even after I graduated."

-   Environments where individuals feel accepted and can share similar
    experiences are essential for successful recovery.

> "This is not the normal teen thing to be doing... \[I\] feel abnormal
> sometimes from the normal young girl... but then \[I\] come home to a
> house full of other girls \[in recovery\] that are like me. They
> understand and support and care about me and my well-being."
>
> "Knowing other people are like me \[is important\]...I want to see
> people who are sober that are my age. We need to know that other
> people who are young are out there."

-   Patience, honesty and sincerity are characteristics that are
    critical for treatment staff to exhibit in a recovery environment.
    Recovering adolescents can determine if "a person is just coming to
    work for a paycheck."

"The staff here really care about us... here the staff really love and
want the best for us."

-   An atmosphere of positive reinforcement, trust and hope, supported
    by treatment staff, is imperative to recovery.

**Developing Accountability and Self Worth**

-   Development of a sense of self worth is fundamental in the recovery
    process.

-   Enforcement of rules and regulations is necessary to a successful
    treatment environment.

-   Accountability within the treatment environment is crucial.
    Adolescents do not want to be "babied."

> "What helped me the most was \[staff\] holding me accountable. What I
> was living was not real."

"We need to know that our choices not only can hurt us, but others as
well."

**Providing a Transitional Environment**

-   Supportive transitional environments post-treatment, such as a
    recovery home, are important to maintaining recovery.

> "Here, I get to bring what I learn into the real world. I am not
> confined. Here I am able to go to school, get a job and learn how to
> live a sober life."

-   Continuing care and recovery support programs are essential supports
    post-treatment. Typically, these services are provided only on an
    optional basis post-treatment or not offered at all.

**Assuring a Constructive School Environment**

-   Supportive school environments are important to maintaining
    recovery. Counseling and weekly support group meetings located at
    school would assist those in recovery.

"Having options would be helpful, even if we did not attend all of the
sessions."

**Including Family in the Recovery Process**

-   Family involvement in the recovery process can be critical. It
    allows for the building or rebuilding of relationships.

> "My biggest problem was not having my family more involved. I wish
> they were more educated about what was happening to me."
>
> "\[Family group\] gave me the opportunity to communicate with my
> parents. I wasn't scared of them anymore. Building trust was the
> biggest aspect of my recovery. My parents are a resource to me."
>
> "My mom was the only one who was always there \[during recovery\]. She
> never left me. My friends weren't there \[for me\]. They never called.
> My mom was the only one who stuck around."

**Recommendations**

Recovering adolescents were asked for their recommendations for
improving treatment and for supporting the recovery process. They
responded with the following recommendations:

-   Include opportunities for more family involvement within the
    treatment process;

-   Allow parents/guardians to connect and share their experiences with
    other parents/guardians who are going through the same processes
    with their adolescent;

-   Assign mentors/sponsors to adolescents in recovery before they are
    discharged from treatment;

-   Provide comprehensive education on the disease of addictions;

-   Employ licensed and trained treatment counselors;

> "They have degrees in sociology or psychology but they need \[to
> hire\] people who have taken extra classes before they come in contact
> with patients. They bring their experiences into treatment, but it
> sometimes clashes with kids, because they talk to us like we are
> nothing."

-   Minimize overworked and underpaid treatment staff; and

-   Provide more (gradual) transitional programs.

**Questions to Measure Recovery**

Focus group participants were asked to provide specific measures for
determining the progress of an adolescent's recovery. Participants
responded in the following manner:

-   "How are you doing in your recovery today?"

-   "What is recovery? If a person cannot answer that, then more work
    needs to be done."

-   "List ten internal motivations to stay clean. Have you followed up
    on them?"

-   "What have you done to improve your addictions?"

-   "What is different in your life today versus when you continued to
    use? It really is all about change."

**Conclusion**

In conclusion, several major themes consistently emerged from the focus
groups, when adolescents were asked their views about treatment and
recovery. These important points include:

-   While the definition of recovery is expansive and differs from
    person to person, it often includes growing in several capacities
    (mentally, physically and spiritually) and embracing a complete
    lifestyle change.

-   Adolescents face a number of barriers in the recovery process:

-   Lack of individualized/appropriate care during treatment;

-   Lack of post treatment follow-up;

-   Lack of access to resources;

-   Returning to nonsupportive environments;

-   Failure to address trauma or sexual histories; and

-   Maintenance of past peer networks.

-   Several critical factors are necessary for success in the recovery
    process:

-   Developing coping skills;

-   Maintaining a supportive treatment environment;

-   Developing accountability and self worth;

-   Providing a transitional environment;

-   Providing a constructive school environment; and

-   Including family in the recovery process.

The information gathered from the adolescent focus groups provides a
valuable resource to service providers and policy makers examining
adolescent services and systems of care. As stated in the introduction,
the voices of youth are often not incorporated into treatment and
recovery policy and systems change efforts for adolescents. However, the
voices and experiences of adolescents in recovery can contribute greatly
to improving the quality of current and future services. Although
numerous barriers to recovery were identified, adolescents also provided
great insight into factors that are critical to an individual achieving
a successful recovery process and recommendations for improving
treatment and supporting recovery. This report should serve as a guide
for those in the substance use disorder field to develop
recovery-oriented systems for adolescents. Further efforts to engage the
perspectives of adolescents should be considered in system improvements.

**References**

Bonomo, Y.A., G. Bowes, C. Coffey, J.B. Carlin and G.C. Patton, "Teenage
Drinking and The\
Onset of Alcohol Dependence: A Cohort Study Over Seven Years," Addiction
99(12), 2004,\
pp. 1520-1528.

Grant, B.F., "The Impact of a Family History of Alcoholism on the
Relationship Between Age at\
Onset of Alcohol Use and DSM-IV Alcohol Dependence: Results From the
National\
Longitudinal Alcohol Epidemiologic Survey," Alcohol Health and Research
World, 22(2),\
1998, pp. 144-147.

Clark, D.B., L. Kirisci and R.E. Tarter, "Adolescent Versus Adult Onset
and the Development of\
Substance Use Disorders in Males" Drug and Alcohol Dependence, 49(2),
1998, pp.\
115-121.

**Appendix 5.4: William White: Comments Following Panel Discussion**

**William White: Comments Following Panel Discussion**

William White, noted author and historian of addictions treatment, is a
Senior Research Consultant at Chestnut Health Systems/Lighthouse
Institute in Bloomington, Illinois. Mr. White served as panel
discussant, commenting on various aspects of the panel presentations and
on other themes that were emerging at the Summit. Among his observations
and suggestions:

-   The emerging consensus at this Summit that recovery-oriented systems
    of care should be person-centered is an important development. It is
    important, however, that the crucial family- and community-centered
    aspects of recovery work are not forgotten.

-   The emphasis on making sure that the recovery community is
    authentically involved in the design and review of recovery-oriented
    systems of care is commendable. However, the phrase "recovery
    community" suggests something monolithic, while the phrase "recovery
    communities" more accurately reflects the great
    diversity---including adolescents, the elderly, people of color,
    varying roads to recovery---that characterizes those seeking and
    finding recovery, all of whom need to be at the table, stay at the
    table, and respect the right of others to be at the table.

-   The clear indication at this Summit of a growing interest in
    spirituality is to be celebrated. However, references to "spiritual"
    should be accompanied by references to "religious" (which is not the
    same thing) and also to "secular". Every time one of these
    constructs is mentioned, the legitimacy of all of them should be
    explicitly reaffirmed.

-   There is a clear consensus at this Summit of the overwhelming need
    for prerecovery and posttreatment services, and that peer recovery
    support services that seek to promote recovery initiation and
    prevent relapse have the potential to carry a message of hope into
    every community so powerful that it will penetrate denial.

-   There is a dialogue, now, as to where to locate peer recovery
    support services. Are they better housed within or as adjuncts to
    traditional treatment systems, or should they be located in
    free-standing recovery support and advocacy organizations? They need
    to be piloted in both settings, and subjected to evaluation.

-   There is always the risk of unintended consequences. If Federal
    funding for peer recovery support services erodes the service ethic
    of recovery communities, our communities will be harmed, not helped,
    by this initiative. Peer recovery support services need to be
    designed and implemented in such a way as to honor and engage the
    service ethic of recovery communities, not replace it.

-   A Code of Ethics for peer recovery support services, filtered
    through multiple communities of recovery, is a critical need.
    Without this, the field is vulnerable to perceived breaches of
    ethics, including business ethics.

-   The question has been raised here as to what is the appropriate role
    of the Federal government in supporting the trajectory of recovery.
    Perhaps most important is to pioneer financing models to shift from
    a sole focus on acute care to sustained support for recovery.
    Federal leadership is desperately needed to move beyond rhetoric to
    develop national funding models that are tied to stage-appropriate
    services.

**Appendix 6: Recovery Graphics**

**Appendix 6.1 Individual and Environmental Components of Recovery**

**Individual and environmental Components of Recovery**

For recovery to be successful, change is required of the individual and
in the environment. An interplay is necessary between the individual and
environmental changes that creates hope, purpose, potential, respect,
and meaning.

**Individual Components of Recovery**

Healing and Reconstruction

-   Internal and external

-   Sense of self

-   Developmental growth

-   Physical wellness

-   Emotional wellness

-   Mental wellness

-   Spiritual wellness

Personhood

-   Self reliance

-   Self esteem

-   Personal resourcefulness

-   Self determination

-   Self care

Environmental Components

Social relationships

-   Mutual support

> Family
>
> Friends
>
> Peers
>
> Neighbors
>
> Colleagues

-   Community affiliation

-   Full citizenship

-   Sense of home

Meaningful activities

-   Job and career

-   Education

-   Service and volunteer opportunities

-   Leadership development

-   Sports and exercise

-   Hobbies

Resources

-   Livable income

-   Safe and decent housing

-   Healthcare and social services

-   Transportation

-   Means of communication

-   Recovery supports

> **Appendix 6.2 Recovery and Wellness Model**

**Recovery and Wellness Model**

Treatment and abstinence lie at the center of this recovery and wellness
model, encircled by three layers depicting areas in which change occurs
during recovery: 1) life skills, 2) support systems, and 3) wellness,
wholeness, balance, and culture. The components of life skills and
support systems are listed below:

Life Skills

-   Coping mechanisms

-   Employment/treatment

-   Financial stability

-   Dealing with feelings

Support Systems

-   12 steps

-   Living conditions

-   Spirituality

-   Family of choice

-   Community

-   Criminal justice

-   Mental health

-   Family

**Appendix 6.3 Service System Progression Model**

**Service System Progression Model**

Three service systems paradigms are presented in model form, each are
provided showing the progression of an individual with substance use
disorder through systems of care to the achievement of a healthy life in
the community. The first views "effective treatment" to a healthy life
in the community; the second shows the individual progressing along a
circular continuum of care from detox through treatment episodes and
subsequently on to healthy living in the community.

The third shows a recovery-oriented system of care in which the
individual with substance use disorder is served by many systems within
the community---treatment, peer support, housing, family, budgeting,
social support, work or school, and faith communities. In the fourth,
the recovery-oriented system of care is depicted again, along with this
question: What connections are not yet in place for the person and what
needs to be done to establish or cultivate them? The answers to the
question can be any of the systems depicted---treatment peer support,
housing, family, budgeting, social support, work or school, and faith
communities.

**Appendix 6.4. Building Resiliency, Wellness and Recovery---A Model for
Prevention and Management of Substance Use Disorders**

**Building Resiliency, Wellness and Recovery---A Model for Prevention
and Management of Substance Use Disorders**

This model depicts the individual nested within the family and community
and receiving person-centered culturally appropriate care. Four types of
interventions surround the individual---prevention, intervention,
treatment, and recovery supports. These are nested within risk and
protective factors and recovery capital, and the outer layer of the
model comprises wellness and recovery.

[^1]: "Substance use disorder" is used here as a term of convenience,
    and is meant as a broad and encompassing term that includes alcohol
    and drug problems whether viewed as a disease or in another
    conceptual framework. CSAT recognizes that there are several
    terminologies---such as substance abuse, addiction, and
    others---that might be applied, and respects that some individuals
    and communities may choose to use different terminologies.