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Compassion in Action ReportsExpanding the Substance Abuse Treatment Paradigm: Faith-Based and Community Organizations and Recovery SystemsPreface In January 2007, the White House Office of Faith-Based and Community Initiatives launched a series of monthly Compassion in Action Roundtable meetings to highlight organizations, programs, and policies addressing critical social needs. The Roundtables convene and facilitate discussion among policymakers, government officials, philanthropists, and faith-based and community service providers around targeted issues. The events reveal the President’s Faith-Based and Community Initiative as a broad-based, community-centered reform agenda; showcase innovative projects and promising practices; and draw attention to government efforts to expand and support the work of faith-based and community organizations actively engaged in serving their neighbors and communities. The following report offers an overview of the September 20, 2007, Compassion in Action Roundtable, entitled Expanding the Substance Abuse Treatment Paradigm: Faith-Based and Community Organizations and Recovery Systems. Please note the statistical information presented throughout the report reflects data available up to the time of Roundtable, and excludes any data collected after September 2007. Introduction
In his 2003 State of the Union address, President Bush announced an innovative, choice-based substance abuse treatment initiative titled Access to Recovery (ATR). The ATR program is designed to increase the number and types of clinical treatment and recovery support service providers eligible for Federal funding, including faith-based and community organizations. ATR also expands the variety of available treatment and recovery support services (RSS), enabling clients to receive a continuum of care essential to sustainable recovery. These strategies are implemented within the context of a voucher system predicated on the belief that clients should choose which treatment programs best meet their individual needs, whether physical, mental, emotional, or spiritual. Launched in 2004, ATR is a 3-year competitive discretionary grant program funded by the U.S. Department of Health and Human Services (HHS) Substance Abuse and Mental Health Services Administration (SAMHSA), and administered through a State governor’s office or a recognized Tribal organization. The first 3-year ATR grants were awarded to 14 States and one Tribal organization, including: California, Connecticut, Florida, Idaho, Illinois, Louisiana, Missouri, New Jersey, New Mexico, Tennessee, Texas, Washington, Wisconsin, Wyoming, and the California Rural Indian Health Board. Grantees were selected among 66 applications submitted by 44 States and 22 Tribes and Territories. Since its inception, approximately $300 million in ATR funds have been awarded and more than 170,000 people with substance abuse problems have received treatment and/or recovery support services within the 3-year period, exceeding its initial goal of serving 125,000 clients within the 3-year period. Consistent with President Bush’s conviction that, “the measure of true compassion is results,” ATR grantees are asked to report meaningful outcome measures that are recovery-based. To date, ATR grantees have collected discharge data on 105,873 clients, including the following client outcomes:
The success of ATR can be attributed, in part, to increased participation among faith-based service providers. Nearly one-third, or 32 percent, of all vouchers redeemed for ATR services were by faith-based organizations. Additionally, faith-based organizations account for 23 percent of recovery support and 31 percent of clinical treatment providers. President Bush has requested an additional $98.2 million in the fiscal year 2007 budget to expand the ATR program.
Transforming and Expanding the Treatment System Through Access to Recovery In 2002, President Bush approached John Walters, Director of the White House Office of National Drug Control Policy (ONDCP), to get a sense of how many Americans seeking drug treatment actually receive the help they need. The estimate, as determined by the U.S. Department of Health and Human Services and ONDCP, was roughly 100,000. With this in mind, Walters said President Bush proposed the Access to Recovery program in order to "unilaterally close the [treatment] gap,” and, in doing so, eliminate the discriminatory barriers that keep faith-based organizations from providing treatment and recovery support services to those in need. Walters explained that the President wanted to “remove the bigotry” against people of faith, “many of whom represent the reason why many, many people are in recovery today.” Walters added, "I think that was the most controversial part of this proposal....We had a force built up in the publicly-funded programs that was not neutral. It was bigoted against faith." Faith-based organizations are able to provide crucial recovery support services, such as job counseling and case management, which integrate people into communities and provide a support structure that enables sustained recovery. Although the President initially asked for twice the funding Congress appropriated, ATR has established bonds that previously did not exist. Walters noted, "Many revolutions have started small, sometimes as small as 12 individuals, and they change the world." Walters attributes ATR's success to the prayers and hard work of faith-based and community organizations that are “helping others get up when they fall down.” Faith-based organizations now constitute 23 percent of the recovery support services and 31 percent of the clinical treatment providers in the program. Walters said the expanded base of service providers “gives those suffering, and their families, for the first time, real and genuine choice,” so that clients can determine which treatment programs optimize their chances of recovery. Through ATR’s strict adherence to clearly established Constitutional guidelines, Walters explained, “We have shown that we can provide funding and choice and community support and governmental partnership in a way that is fully consistent with the principles of government and the ability for government to carry out programs through your help." Future expansion of ATR will include capacity building measures that will enhance the ability of treatment providers to extend their outreach, giving more people in need of treatment access to comprehensive clinical and recovery service programs. Walters added, "We’d like to have better coordination between clinical treatment and recovery support. Obviously, one of the principles here was to take the part of substance abuse that is the life-long challenge; that is getting stable recovery, getting life-long recovery, and putting resources in that. We want to continue to empower individuals. Not only those who provided support, but those receiving it." Walters emphasized the importance of program evaluation, noting, "I think that the best programs do this because they know that they need to show people what’s working and they know they need to know what they need to do to improve themselves. They want to be doing the best job possible, and they know that credible and appropriate evaluation is the way to know that." In closing, Walters said faith-based and community organizations are at the forefront of a revolution whereby public/private partnerships are no longer deemed “suspect and dangerous.” He explained, “I think what we’re seeing is the re-acceptance that our country is strong because it is both faithful and tolerant and because it’s united on principles that do not involve bigotry when they involve faith. In fact, they make us more tolerant, caring, and more just.” Systems Transformation: Grantees’ Experiences with Access to Recovery Connecticut Access to Recovery In 2004, Connecticut was awarded a 3-year, $22.8 million Access to Recovery (ATR) grant administered through the Connecticut Department of Mental Health and Addiction Services (DMHAS). Connecticut’s program is unique in that 80 percent of ATR funding went toward recovery support services (RSS). William Halsey, Connecticut’s ATR project manager, told the Roundtable, “We felt we had a clinically rich environment in Connecticut, so we used this grant to really beef up our recovery support services.” Halsey noted that because housing is a “critical component to sustain recovery in the community,” the State invested most of its recovery support service funding on housing, covering up to 2 months of housing expenses for ATR participants. Other recovery support services included case management, transportation, vocational services, peer-based counseling, and faith-based counseling. Of the 86 recovery support service providers, 38 were faith-based. Through ATR, both service providers and the State made mutually beneficial gains while advancing innovative strategies that enhanced treatment and recovery support systems, creating what Halsey called “concurrent clinical and recovery services.” Faith-based and community service providers are able to reach into the community and find people who needed help, whom they could then refer to behavioral health providers. In fact, 40 percent of ATR recipients had no prior involvement in the DMHAS service system. Conversely, DMHAS could refer clients to faith-based and community service providers, 38 of which had no prior involvement with the State. Halsey explained, “We leveled the playing field. We brought these providers to the table, and through reimbursement we provided a lot of dollars to them to provide very important services.” According to Halsey, attitude is everything when meeting with faith and community service providers, and government’s role should be “as a partner and not a parent.” While faith-based and community service providers are natural entry points into the State system, many need technical assistance, guidance, and support to succeed in a fee-for-service reimbursement system. As a result of ATR, DMHAS, CSAT, and government consultants worked with faith-based and community service providers to develop more sophisticated systems, generate new revenue streams, and establish formal governance structures to further develop public/private partnerships. Halsey explained, “There is no turning back now. We have made huge strides forward with faith-based and community recovery support providers and so there is only one way to go, and that is forward.” The Louisiana Access to Recovery voucher program targeted women and adolescents to provide both treatment and recovery support services. The vouchers were not limited to this population in the wake of Hurricane Katrina, but they were the primary focus for expanded capacity and represented 54 percent of the total people served. Louisiana served over 200 percent of the targeted number of individuals required by the grant, reaching a total of 19,570 individuals. The voucher program resulted in a 32 percent increase in expanded capacity, with a total of 204 providers statewide. This included 141 providers new to the existing public sector treatment system, 76 percent of which were faith-based and community-based organizations (FBCOs). Fifty-six percent of the total funding reimbursements went to faith-based organizations that provided both clinical treatment and recovery support services. Michael Duffy, assistant secretary of the Office of Addictive Disorders, Louisiana Department of Health and Hospitals, told the Roundtable that ATR ushered in a systems transformation that “brought improved relationships between the State and our Federal partners, and between the State and our local partners.” This partnership created a statewide faith-based coalition and a nonprofit provider association that has led to enhanced and continuous treatment and recovery support services. Duffy said working with new providers created a systems challenge, necessitating training, outreach, and the development of an electronic vouchers system, which helped the State monitor for fraud and abuse. The new system also coordinated client services, making sure clients received the appropriate amount of treatment and recovery support services. Duffy noted, “true recovery is about more than just treatment; it is about safe housing…it is about a job…or about healthy relationships, but more importantly, those of us at the State level must understand that true recovery is about working a spiritual program.” Louisiana ATR client outcomes at the point of discharge include:
California Rural Indian Health Board For more than 37 years, the California Rural Indian Health Board, Inc. (CRIHB) has worked to improve health care services, enhance social conditions, and expand resources for 109 Federally recognized tribal groups. Since 2004, CRIHB has administered the statewide Access to Recovery (ATR) program, which was named the California American Indian Recovery (CAIR) program. The ATR CAIR program developed and maintained a voucher system that has funded culturally appropriate clinical treatment and recovery support services to 7,527 American Indian/Alaska Native (AI/AN) people with substance abuse disorders. Vicki Sanderford-O’Connor, CRIHB’s Social Wellness program manager and project director, said ATR CAIR was the beginning of a “revolutionary journey.” Sanderford-O’Connor explained, “The approach was revolutionary because, for the first time, we were able to develop an infrastructure, the center point of which is the voucher management system that addressed the needs of the whole person, however they defined it. ATR opened the door to a whole new way of conceptualizing, funding, and delivering clinical treatment and recovery support services through traditional, cultural interventionists and paving the way for new collaboration with faith-based and community organizations.” Since implementation in May 2005, ATR CAIR established 101 treatment and recovery support services providers, 43 of which are Tribal and urban Indian healthcare organizations that often operate as intermediaries for faith-based partners that lack the infrastructure to manage ATR funds. Through site visits, technical assistance training, on-call availability, and other outreach efforts, CRIHB has increased the number of FBCOs participating in ATR CAIR. Sanderford-O’Connor said “[this] allowed us to expand the continuum of care, moving us closer to our ultimate goal of sustained recovery by expanding the definition of acceptable services to include spiritual and cultural support.” Faith-based organizations that Sanderford-O’Connor said “were never offered a seat at the table,” were brought into the State’s network of providers, helping Indian communities address disproportionately high rates of intergenerational substance use and addiction. Nearly half of ATR CAIR providers now offer recovery support services previously unfunded by public dollars, and 88 percent have developed new, collaborative relationships with FBCOs. As a result, Sanderford-OConnor explained, “We were able to build a bridge between the sacred and the secular, we were able to build a bridge between Indian healthcare and health support services to support real choice for the American Indian/Alaskan Native population.” Recovery Support Services and Access to Recovery Recovery support services (RSS) play a large role throughout the service networks established by the ATR program. Within available data, over 63 percent of clients have received RSS, and approximately 50 percent of ATR dollars have provided RSS. Westley Clark, director of the Center for Substance Abuse Treatment (CSAT) at HHS, told the Roundtable, “It is not just professional treatment that helps people’s lives….What we need is a continuum of interventions. Treatment is a part of recovery and the end point of treatment is abstinence from the clinical disorder. But the end point of recovery is holistic health.” Traditional substance abuse treatment programs focus primarily on a client’s acute symptoms. According to Clark, this creates “a series of discontinuous interventions” that fall short of relapse prevention. A more effective approach is followed within a recovery-oriented system of care, which provides “a continuous treatment process with a professional delivery system…addressing symptoms and promoting self-care and rehabilitation,” Clark explained. Providing clients with a continuum of care “returns an individual to a more normalized existence,” and creates a “recovery zone” in which the client is less likely to relapse. Clark said ATR has provided the “comprehensive services that can greatly assist recovery,” including cost-effective peer-based services, such as mentoring and recovery coaching, as well as Federally-sponsored programs “that play an important role in understanding ways to design and implement recovery-oriented systems of care.” Clark said the CSAT Recovery Community Services Program (RCSP) program laid the foundation for ATR. RCSP grant projects work through FBCOs to design and deliver peer-to-peer recovery support services that initiate and sustain recovery and gain overall wellness. Peer support services are not treatment or post-treatment services provided by professionals, but rather support services from people who share the experiences of addiction and recovery. They are designed to promote a sense of self-worth, community connectedness, and quality of life—all important factors in sustaining recovery from alcohol and drug use disorders. RCSP grant projects focus on helping individuals and improving the quality of life in communities and are tailored to local needs identified by community members. Four types of social services are provided through RCSP grants:
Transforming Communities and Lives Through Faith-Based and Community Organizations The following organizations participate in ATR and the RCSP by providing comprehensive, recovery support services for drug and alcohol addiction. Set Free Indeed Ministry Tonja Miles is co-founder and chief executive officer of Set Free Indeed Ministry and Free Indeed Treatment Center, Louisiana’s first faith-based, licensed outpatient treatment clinic. Miles attended the 2003 State of the Union Address during which President Bush announced the Access to Recovery Program. As a guest of the President, Miles represented the longstanding contribution of faith-based organizations to the field of substance abuse treatment and recovery services. Miles told the Roundtable, “Twenty years ago, I was addicted to cocaine, and so I know first-hand how addiction can kill, steal, and destroy. Over 15 years, my husband and I have been blessed to serve people with addiction and destructive behavior.” Clients with ATR vouchers can participate in the programs and services of the Free Indeed Clinic, which provide structured and intense outpatient treatment services that emphasize total recovery from substance abuse and other related addictions and/or destructive behaviors. Services include treatment interventions, counseling, and intensive outpatient services, as well as case management, housing, transportation, vocational/educational, and other recovery support services, including peer- and faith-based services. To date, Free Indeed Clinic treats 508 outpatient clients weekly; assisted 800 family members of addicts, including children; and serves 75-100 adolescents through outpatient and support services like anger management, conflict resolution, character building, and life skills. Recovery Consultants of Atlanta Recovery Consultants of Atlanta, Inc. (RCA, Inc.), is a faith-based recovery community organization led by members of metro-Atlanta’s 12-step and faith-based addiction recovery community. Since October 2001, RCA Inc. has participated in RCSP and the Targeted Capacity Expansion for Substance Abuse Treatment and HIV/AIDS Services Program (TCE-HIV), both funded by CSAT. Through these programs, RCA Inc. provides street outreach, alcohol and drug treatment, peer-led recovery support services and rapid HIV testing to inner-city Atlanta homeless substance users. Between January 2004 and February 2007, their rapid HIV testing program tested more than 6,900 homeless substance users with more than 270 testing positive for HIV. Director David Whiters founded RCA Inc. with two other former drug abusers in 1999. Their mission was to help recovering addicts pursue educational degrees. Whiters told the Roundtable, “The first person we helped get into school, we helped him fill out his application on the hood of our car after an AA meeting. That was our office. But today, we’ve grown tremendously to an organization that has 11 full-time employees. We offer what we think to be some very wonderful programs—we like to make sure that we add the phrase ‘peer-led’ to the front of our recovery support services. We want to make sure that people know that the majority of these services should be offered by people who have suffered and identify with those in long-term recovery. They are not intended to replace treatment. We augment treatment, and treatment centers are one of our biggest referral services. We are very successful in getting treatment services to work with us and see how important it is to have the services that we provide.” Almost all of RCA Inc.’s peer-led recovery support services work in cooperation with churches throughout Atlanta. Whiters explained, “[We have successfully bridged] the gap between individuals who are in 12-step, long-term recovery and the church. We both have desires to provide the same type of services to the same population of people….We decided to create this support group that is faith-based in nature as an alternative to 12-step support, that was profanity-free and allowed us to openly and honestly talk about our relationship with God.” Churches provide transportation and child care for clients attending support groups and help find housing for clients coming out of clinical treatment centers. In addition, churches work with RCA Inc.’s Recovery at Work program, which employs more than 30 full-time employees. Members within the church and community network hire Recovery at Work employees to perform a variety of jobs, including roofing and restoration projects. “We signed a contract of more than $200,000 to tear down, rebuild and stain more than 440 fences at a condominium complex just south of Atlanta. We got that contract partly because of what we do, but also because of our faith-based affiliation. The woman who gave us that contract went to a church where she heard about what we did, and because of that contract, they contacted us and offered us that contract,” Whiters explained. A New Entry Founded in 2004, A New Entry, Inc. (ANE) provides recovery support services to individuals released from prison who may be chronically homeless and substance dependent. Executive Director Peter Daniels said that the population he serves is “a tough population to work with. It is tough for them to reenter the community and get back and involved with the mainstream and become citizens again…. Our mission is to work with those individuals and help them to understand that they have a calling on their lives, a God-given call on their lives. We can provide treatment and services, and we can provide a lot of outputs for individuals, but what we want to do is instill in them that there is an intrinsic motivation that can be grown within them. That is a big part of our vision, to see everyone that has been impacted by incarceration, by homelessness, [and] by substance abuse to understand what their true vision, passion, and calling is in their life.” ANE offers one-on-one and group counseling and education classes; access to affordable, recovery-supportive housing; goal-oriented case management services including the development of permanent housing, living-wage employment, and personal stability; employment access and retention support through training and practical resources; and development and placement of adult mentors and volunteers. With funds obtained through ATR and other government grants, ANE serves over 150 participants each month. “ATR has been a great benefit in terms of the expansion of service offerings, and in terms of multiplying the amount of housing we can provide.” The Next Door, Inc. The Next Door is a faith-based nonprofit agency that assists women in crisis, equipping them for lives of wholeness and hope. Through the provision of housing with supportive services, the program addresses the physical, mental, and spiritual needs of women suffering from the co-occurring disorders of addiction and mental illness. Founded in 2004, The Next Door participates in the ATR program, which Chief Executive Officer Linda Leathers described as “a catalyst for transformation in Nashville. Leathers explained, “From housing to case management to relapse prevention groups to drug testing, ATR provided the door for our women to get the hope and the healing that we’re striving for them to get.” At its downtown location, The Next Door accommodates up to 52 women in a six-month transitional residence. In the recently opened 20-unit Freedom Recovery Community, women and their children live in a permanent apartment setting located in a formerly drug-infested building. Leathers explained, “The history of that property which we bought and then transformed was so scary. The police knew it; they were there all the time…Interestingly enough, due to all the support we have received, that place is a transformation center for hope and wholeness. We are seeing families come together, children playing, tutoring happening, all because of the good things that have happened. It’s no longer crack infested, it is hope infested.” At both locations, the professional staff and volunteers of The Next Door provide counseling, mentoring, case management, workforce development, spiritual support and educational enhancement. Residents enter the program from incarceration, homelessness, transitional centers, and rehabilitation facilities. In 2006, according to the National Survey on Drug Use and Health (NSDUH), 23.6 million Americans required substance abuse services, yet only 2.5 million people actually received services from a specialty facility. Of the 21.1 million who did not receive help, only 940,000 felt they needed treatment, and 314,000 said they were unable to find the care they sought. Dr.Terry Cline, Administrator of SAMSHSA, described the gap in treatment services as “huge,” noting that the impact extents beyond the individuals in need of treatment. “We are talking about the impact on husbands, wives, children, fathers, aunts, teachers, [and] people in the community. The ripple effect in incredible. And when those needs are unaddressed, the impact on our country can be devastating. So the stakes are very, very high.” On September 20, 2007, HHS announced $98 million in new ATR grants, an increase of over 50 percent from the first grant round. The 24 new grants expanded treatment capacity and consumer choice in 18 States, five Tribal organizations, and the District of Columbia. The three-year grants were awarded to the States of Arizona, California, Colorado, Connecticut, Hawaii, Illinois, Indiana, Iowa, Louisiana, Missouri, New Mexico, Ohio, Oklahoma, Rhode Island, Tennessee, Texas, Washington and Wisconsin. The Alaska Southcentral Foundation, California Rural Indian Health Board, Inter-Tribal Council of Michigan, Inc., Montana-Wyoming Tribal Leaders Council, Cherokee Nation of Oklahoma and the District of Columbia also are receiving awards. Of the $98 million, approximately $2 million will be used to fund an independent evaluation of the program. Research Summaries Preliminary Outcomes of the Texas Access to Recovery Project The target population of the Texas Access to Recovery (ATR) project consists of individuals with substance use disorders who are involved in the criminal justice system. Individuals are referred to the ATR program through drug court, probation offices, or child protective services for independent assessment of needs and service planning. The current study examines outcomes for 825 clients who entered and were terminated from the ATR program during the period of June 2005 and September 2006. Clients who were rated by assessment providers as successful completers (n = 311) of the ATR program were compared to non-completers (n = 514) on client and voucher service characteristics. Results indicated that retention in the ATR program, higher amounts of care coordination, and the provision of treatment only or treatment with recovery support services were associated with positive outcomes. Providing recovery support services only, rather than in combination with treatment, was associated with negative program outcomes. Analyses of specific recovery support categories indicated that service types that are more closely associated with the process of recovery, such as recovery coaching, recovery support, and relapse prevention group, were most strongly associated with positive outcomes. Other recovery support services types that provide social supports, such as transitional housing, transportation, and employment coaching, were associated with negative outcomes, particularly in the absence of treatment. Results also indicated that clients under drug court supervision and individuals who are employed and have higher levels of education responded more positively to the ATR program. Building a Unified Vision for Recovery in America I am an addiction professional, relying on sound scientific methods to provide effective treatment. So, it may be shocking when I say that the personal and community experience of long-term recovery are necessary in truly understanding addiction. Historically, addiction care was rooted in the community with one alcoholic helping another. Our knowledge of effective treatment methods and the illness have evolved beyond this idea so that today we now know more scientifically than ever. But we also must remember not to stray too far from our roots—the experience of those who have “been there.” We are finally beginning to see scientific proof that supports what recovery communities have been sharing anecdotally for more than 100 years, i.e. people can and do recover and that support makes a significant difference. This nascent research is taking place in the streets of America, allowing us to document exactly when and how recovery occurs—and what it means to families and communities. This community-based research reports that addiction is an illness best treated through a continuum of care, over time and with strong linkages to recovery supports such as peer-support groups and sponsors. Often existing within an environment of discrimination and stigma, it is an illness that has strong physiological markers but that must also take into account the cultural belief systems of individuals if recovery is to be lasting. It is these beliefs and community ties that, when knocked down, allow addicts to dust themselves off, get back on their feet, and try again, one day, one hour, or one minute at a time. The research also reports that due to the chronic nature of addiction, a majority of individuals require several episodes of treatment or attempts over multiple years to achieve recovery. It is an illness, the recovery from which is greatly enhanced by rapid entry into treatment, long-term retention in treatment, and clear linkages between each level of care and recovery supports. Best of all, this science highlights outcomes that are as good or better than most other chronic conditions when appropriate care is provided. Not only does this care help individuals get well, but it also brings significant cost savings to society – more than $34 for every $1 spent when applying continuing care to the illness of addiction. Billions of dollars (and thousands of lives) can be saved if the appropriate care is provided. With this understanding, a unified and predictable vision of recovery becomes a reality. Despite all the scientific advances, an estimated 22.6 million American have yet to achieve recovery. While researchers, prevention and treatment professionals, and those in recovery alike have come to understand the complex and multi-faceted nature of addiction for all involved, many recovery-related questions remain e.g., What are the essential and defining ingredients of recovery? How does information on recovery tie into more traditional scientific knowledge about addiction? Can we now better prevent the illness? Minimize its progression? Intervene sooner? How can “being there” truly inform others about prevention, treatment and recovery? The IRETA blue books included in your packets answer some of the larger questions and provide an overview of recovery research. It becomes clear from these booklets and other related questions posed to me on a daily basis by stakeholders at all levels, that it is time a recovery research agenda is given the priority it deserves. If we do so, we will finally be able to integrate community knowledge about addiction and recovery, known for over a century, with the latest scientific research on a large scale. Ultimately, this is an illness that affects almost everyone in the US—either directly or indirectly. Knowing this, we must forge ahead to add the science of recovery to our science of addiction. Appendix A: Federal Efforts to Bridge the Achievement Gap U.S. Agency for International Development The U.S. Agency for International Development works around the world in a variety of ways to address the scourge of the world-wide drug and substance abuse problems. The approaches used by the USAID Missions vary from programs to eradicate opium production to support for programs treating those struggling with substance abuse, based on the location and population being served USAID established the Alternative Livelihood Program in Afghanistan, where the opium poppy production supplies over 90 percent of the world’s illegal opiates. This production makes up an estimated one-third of the country’s Gross Domestic Product (GDP). Through the Alternative Livelihood Program, USAID has reached more than 800,000 farmers across all of Afghanistan’s provinces with seed and fertilizer distributions. Many of these farmers may have been previously dependent upon poppy cultivation because it brought in more revenue than ordinary crops. USAID is supporting lawful economic growth by providing farmers with the assistance needed to grow sustainable alternative crops as well as working to open new markets in places like Dubai for Afghan agricultural goods. In Honduras, USAID donates equipment and materials to allow local drug rehabilitation programs to support themselves. Projecto Victoria, a residential center for drug and alcohol abuse rehabilitation, is the only hope for many Hondurans addicted to drugs and alcohol. The approximately 60 young men undergoing therapy at the Center work the land to grow crops used by its residents. All this work had been done by hand and with rustic tools by the residents. USAID was able to provide a new tractor and other agricultural equipment such as a plow to prepare the land and a planter for various crops. They are now using the new equipment in activities that are part of their rehabilitation and contribute to the sustainability of the project. Projecto Victoria is also able to rent the equipment out to local landholders, which also helps to maintain community support for the program. In other regions, USAID supports HIV/AIDS curriculum and education programs which draw on the connection between substance abuse and disease to strongly warn youth about the dangers of substance abuse and thus reduce the demand for drugs. USAID also supports drug demand reduction programs for vulnerable populations and programs for People Living with HIV/AIDS who are also struggling with substance abuse. U.S. Department of Agriculture The U.S. Department of Agriculture (USDA) recognizes that faith-based and community organizations play a vital role in the lives of many Americans who seek to recover from drug or alcohol addiction. In 2006, USDA removed a key barrier to the work of faith-based and community organizations that offer drug and alcohol rehabilitation programs. This action also supported individuals seeking help for their drug or alcohol addictions to make an important personal choice as to which recovery program they enter without fear of losing their food stamp benefits. USDA worked with the Department of Health and Human Services to develop policy to help ensure access to nutrition assistance for individuals choosing a faith-based or community-based drug and alcohol treatment center. This policy governing access to food stamps for individuals residing in faith-based and community drug and alcohol treatment centers underscored that a faith-based or community drug or alcohol treatment facility does not need to be licensed by the state in order for its residents to qualify for food stamps. As long as a facility is recognized by the State’s Title XIX agency as furthering the purpose of rehabilitating drug addicts and/or alcoholics, the residents of the facility may retain food stamp benefits and the facility itself may be an authorized food stamp retailer. USDA’s Food and Nutrition Service, which administers the Food Stamp Program, has conducted outreach and education activities to help ensure that all relevant parties understand and are implementing this policy guidance. To view a copy of this policy, please visit: http://www.fns.usda.gov/fsp/rules. The Food Stamp Program is the cornerstone of Federal nutrition assistance programs and provides crucial support to needy households. The program serves more than 26 million people. For more information on the Food Stamp Program, visit http://www.fns.usda.gov/fsp/. For more information on how faith-based and community organizations can partner on USDA programs, please visit http://www.usda.gov/fbci/. U.S. Department of Health and Human Services Drug Free Communities Support Program The grants support coalitions of youth; parents; media; law enforcement; school officials; faith-based organizations; fraternal organizations; State, local, and tribal government agencies; healthcare professionals; and other community representatives. The Drug-Free Communities Support Program enables the coalitions to strengthen their coordination and prevention efforts, encourage citizen participation in substance abuse reduction efforts, and disseminate information about effective programs. For more information, visit www.ondcp.gov/dfc/ Recovery Month Recovery Month provides a platform to celebrate people in recovery and those who serve them. Each September, thousands of treatment programs around the country celebrate their successes and share them with their neighbors, friends, and colleagues in an effort to educate the public about treatment, how it works, for whom, and why. Substance abuse treatment providers have made significant accomplishments, having transformed the lives of untold thousands of Americans. For more information, visit www.recoverymonth.gov Partners for Recovery U.S. Department of Housing and Urban Development The U. S. Department of Housing and Urban Development (HUD) is committed to the development and maintenance of safe, decent, affordable housing for all, in vibrant communities that are good places to live and good places for business and financial institutions to invest. Within that context, the Department is committed to addressing the challenges faced by the homeless. Homeless funding authorized by the Stewart B. McKinney Homeless Service Act provides for wraparound services that include substance abuse treatment. Continuum of Care
For more information on these and other HUD programs please visit www.hud.gov or www.hudhre.info. Federal Bureau of Prisons Residential Reentry Centers The Bureau and the National Institute on Drug Abuse combined funding and expertise to conduct a rigorous analysis of the Bureau’s residential drug treatment program. Research findings demonstrated that RDAP participants are significantly less likely to recidivate and less likely to relapse than non-participants. The studies also suggest that the Bureau’s RDAPs make a significant difference in the lives of inmates following their release from custody and return to the community. Further information: http://www.bop.gov/intmae_programs/substance.jsp Drug Court Discretionary Grant Program Indian Alcohol and Substance Abuse Program (IASAP) Further information: http://www.ojp.usdoj.gov/BJA/grant/indian.html Appendix B: Compassion in Action Roundtable Agenda September 20, 2007 9:30 – 9:35 am Snapshots of Compassion: Stories of Recovery 9:40 – 9:50 am Transforming and Expanding the Treatment System through the Access to Recovery Program (ATR) 9:50 – 9:55 am Transformed Lives through Recovery Support 9:55 – 10:45 am Panel I Systems Transformation: States’ Experiences with ATR William Halsey, Access to Recovery Project Manager, Connecticut Department of Mental Health and Addiction Services Michael Duffy, Assistant Secretary, Office of Addictive Disorders, Louisiana Department of Health and Hospitals Vicki Sanderford-O’Connor, Social Wellness Program Manager and Project Director, ATR California Rural Indian Health Board 10:45 – 11:10 am Panel II Realizing Outcomes: Success and Benefits of Recovery Oriented Systems of Care Laurel Mangrum, Ph.D., Research Scientist, University of Texas, Addiction Research Institute Michael Flaherty, Ph.D., Executive Director, Institute for Research, Education and Training in Addictions 11:10 – 11:45 am Panel III Transforming Communities and Lives through Faith-Based and Communities Organizations David Whiters, Director, Recovery Consultants of Atlanta, Inc. Linda Leathers, Chief Executive Officer ,The Next Door, Inc. Peter Daniels, Executive Director, A New Entry, Inc. H. Westley Clark, M.D., J.D., M.P.H., CAS, FASAM As director of the Center for Substance Abuse Treatment under the Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, Dr. H. Westley Clark leads the agency’s efforts to provide effective and accessible treatment to all Americans with addictive disorders. Dr. Clark’s areas of expertise include substance abuse treatment, methadone maintenance, pain management, dual diagnosis, psychopharmacology, anger management, and medical and legal issues. He is also a noted author, clinician, teacher and spokesperson in the field of addiction and forensic psychiatry. Dr. Clark has received numerous awards for his contribution to the field of substance abuse treatment, including the President of the United States of America, Rank of Meritorious Executive in the Senior Executive Service for his sustained superior accomplishments in management of programs of the United States Government and for noteworthy achievement of quality and efficiency in the public service in 2005. He received his medical degree from the University of Michigan and his law degree from Harvard University Law School. Dr. Clark received his board certification from the American Board of Psychiatry and Neurology in psychiatry and sub-specialty certifications in both addiction and forensic psychiatry. Dr. Clark is licensed to practice medicine in California, Maryland, Massachusetts and Michigan. He is also a member of the Washington, D.C., Bar Association. Terry Cline, Ph.D. Terry Cline, Ph.D., was nominated by President George W. Bush on November 13, 2006 and confirmed by the U.S. Senate on December 9, 2006 as Administrator for the Substance Abuse and Mental Health Services Administration (SAMHSA). As SAMHSA Administrator, Dr. Cline reports to Health and Human Services Secretary Michael O. Leavitt and leads the $3.3 billion agency responsible for improving the accountability, capacity and effectiveness of the nation’s substance abuse prevention, addictions treatment, and mental health service delivery systems. Throughout his career Dr. Cline has worked to ensure individual and family needs are the driving force for the prevention, treatment and recovery support services delivered. He has championed the principle that mental health and freedom from substance abuse are fundamental to overall health and well-being and that mental and substance use disorders should be treated with the same urgency as any other health condition. Prior to his appointment as SAMHSA Administrator, Dr. Cline put these core values to work as Oklahoma’s Secretary of Health, a position he was appointed to by Governor Brad Henry in 2004. At the same time, he served as Oklahoma’s Commissioner of the Department of Mental Health and Substance Abuse Services, a position he held since January 2001. He actively participated in and supported the creation of grassroots coalitions to improve the health status of local communities. During his tenure in Oklahoma, Dr. Cline built strong collaborative relationships among the multiple constituency groups and government agencies that touch the lives of people with substance abuse and mental health problems. As a result of these partnerships significant advances were made in transforming the State’s service delivery systems, including the creation of Oklahoma’s Integrated Services Initiative which creates a holistic approach to treatment needs, a wide expansion of drug courts throughout the State and the introduction of mental health courts into Oklahoma along with a Statewide focus on recovery and recovery support services. Dr. Cline has extensive experience in overseeing health and human services at the State level. He has also served as a provider through an earlier post as the Clinical Director of the Cambridge Youth Guidance Center in Cambridge, Massachusetts and as a Staff Psychologist at McLean Hospital in Belmont, Massachusetts. His professional history also includes a six-year appointment as a Clinical Instructor in the Department of Psychiatry at Harvard Medical School and Chairman of the governing board for a Harvard teaching hospital in Cambridge, Massachusetts. A native of Ardmore, Oklahoma, Dr. Cline attended the University of Oklahoma where he earned a bachelor’s degree in psychology in 1980. He then received both a master’s degree and a doctorate in clinical psychology from Oklahoma State University. Dr. Cline has involved himself in community service, including membership on a number of local, State and national committees and boards with a focus on improving the overall health of the community and the Nation. Peter F. Daniels, III LMSW Peter Daniels serves as founder and executive director of A New Entry, Inc., a faith inspired non-profit organized to serve the homeless, persons in recovery and ex-offenders. Mr. Daniels earned a masters degree in electrical engineering from the University of Missouri- Columbia in 1996 and worked for Bell Laboratories, before accepting his calling to directly impact the lives of men in recovery in 2001. In 2005, he earned his masters in social work from the University of Texas– Austin and is licensed to practice in the state of Texas. He has served in various leadership, counseling and coaching positions within Shoreline Christian Center and participates in several community roundtables and planning committees on re-entry and behavioral health issues. Mr. Daniels currently resides in an Austin suburb with Joyce, his wife of four years, son Xavier and daughter by marriage Danielle. Michael Duffy Michael Flaherty, Ph.D. Dr. Flaherty is a clinical psychologist (certified APA in addictions) with over 30 years of daily clinical and administrative experience in the addictions. He is the Executive Director of the Northeast Addiction Technology Transfer Center (NeATTC) serving NY, NJ and Pa. from its home bases in Pittsburgh, Pa. and Albany, NY and of its parent organization, the Institute for Research, Education and Training in the Addictions (IRETA). Prior to IRETA and the NeATTC, Dr. Flaherty was the Executive Director of the St. Francis Institute for Psychiatry and Addiction Services, Pennsylvania’s largest provider to individuals with addictions and mental illness. He has participated in many NIDA and NIAAA research initiatives and has published in depression and most notably in the addictions with special emphasis on systems of care, recovery models of care, pregnant and addicted women, the elderly, the nature of addiction, the alignment of science/service and health policy and the chronic nature of addiction and the implications of this understanding for prevention, intervention, treatment, research, financing and policy related to addictions. As the Executive Director of the NeATTC he helped lead a collaborative effort of leaders in NY, NJ and PA. in a “workforce summit” around which each state (SSA) developed or enhanced their state specific workforce plan—with National expertise/ advice—and continue to implement those plans today. He served as the Co-Chair for the Substance Use Expert Treatment Plan for the SAMHSA funded Annapolis Coalition and is on the Advisory Boards for the Robert Wood Johnson/NIATx Advancing Recovery Initiative and the Washing Circle for Quality Improvement. Dr. Flaherty continues also to practice daily as a clinical psychologist. He is a retired Captain from the United States Naval Reserve with service in Desert Storm and Desert Shield. He has three children: Daniel (State Department); Kathleen (U.S. Army—M.D.) and Connor (DEA). William L. Halsey, LCSW, LADC, MBA Mr. Halsey has over 13 years experience in behavioral health services. Prior to his employment for the State of Connecticut’s Department of Mental Health and Addiction Services, Mr. Halsey worked in the nonprofit sector. He has held numerous positions within non-profit agencies such as, outpatient substance abuse counselor, director of a regional behavioral health unit, director of special services, director of a regional case management program and director of quality management. Mr. Halsey has a master’s degree in Social Work from Columbia University and a master’s in Business Administration from the University of Hartford. He is a Licensed Clinical Social Worker and a Licensed Alcohol and Drug Counselor. He lives in Connecticut with his wife and 3 children. Ramie Judkins Ramie Judkins, a 2006 graduate of The Next Door residential transition program, serves as the residential case manager of the Freedom Recovery Community, the 20-unit apartment complex which The Next Door offers as permanent residences to women and their children. Immediately following her completion of The Next Door’s six-month curriculum, Ramie was chosen for the position of Resident Manager of the downtown Nashville transitional facility. Ramie’s compelling story is one of hope, courage and ongoing recovery. She is a graduate of the University of Tennessee with a degree in social work. Her 18-year-old daughter, Dawn, is a freshman at Vanderbilt University and has been a strong inspiration and motivator to Ramie to re-build her life and her relationships. Linda Leathers Linda serves as the chief executive officer of The Next Door, Inc., and in this position she is passionate about helping women re-entering society from crisis situations to find a life of purpose and abundance. A Management and Public Relations major from the University of North Alabama and a Master of Religious Education graduate from Southwestern Baptist Theological Seminary, Linda served for 10 years as minister to single adults in Southern Baptist churches in Texas, Florida, and Tennessee. In 2002, Linda led the “wild prayin’ women” to pray for direction and completion of a community needs assessment of 40 local agencies to determine the best use of an empty building in the heart of downtown Nashville. The overwhelming community need was for housing and supportive services for women re-entering society from incarceration, and this need led to the establishment of The Next Door in 2003. In May 2004 the organization began receiving women residents and has experienced phenomenal growth in three years. From its beginnings with only one staff person, Linda Leathers, and a host of volunteers, the agency now has 15 employees and serves up to 70 women and children at any given time. Linda is currently active in local and State efforts focused on corrections and re-entry. She serves on the Treatment and Recovery Support Advisory Committee and the Faith-Based Advisory Committee for the Tennessee Department of Mental Health and Developmental Disabilities. She was named the Tennessee Access to Recovery faith-based Transition Coordinator. In July 2007 she was honored with the Director’s Award from the National Office of Drug Control Policy. In 2006 she received the Hampton-Perry Award for her work with individuals struggling with co-occurring disorders. Laurel Mangrum, Ph.D. Laurel Mangrum has a doctorate in clinical psychology and is a research scientist at the Addiction Research Institute at the University of Texas at Austin. Her research interests include substance abuse and mental health treatment, co-occurring disorders, recovery support services, psychodiagnostics, tests and measurement, treatment outcome, and program evaluation. Dr. Mangrum has extensive experience working with State agencies providing substance abuse and mental health treatment, and has research and clinical experience in both systems. She is currently lead evaluator on the Access to Recovery and Co-Occurring State Incentive grants for the state of Texas, as well as lead evaluator for a Recovery Community Services Project grant in the state. Dr. Mangrum has also provided technical assistance to States outside of Texas in the areas of data analysis, clinical report design, and program evaluation through the Gulf Coast Addiction Technology Transfer Center. Tonja Miles Tonja and Darren are ordained ministers who are highly respected in both their community and church. They have been married for almost 12 years and been involved in their community for over 14 years. Their life mission is to assist those who are struggling with addiction to be set free through the power of God. They have established two very successful substance abuse and faith-based ministries, A Day of Celebration Ministry and Set Free Indeed. The Day of Celebration Ministry Team travels out into the community and schools to provide group and one-on-one counseling to those who struggle with addiction and truly want to recover. The second ministry, Set Free Indeed, is a Ministry designed to work with people who struggle with addiction, destructive behavior or any form of bondage that is holding them captive. Not only does this ministry offer counseling and encouragement to those who are struggling with addiction, it also offers help to those who have loved ones who are suffering. Tonja and Darren have a passion for helping men and women who are or were incarcerated in prison to regain, reestablish, and recover their lives and have established a support/recovery group for ex-offenders and family members of those incarcerated. Further, Tonja is the Co-Founder/CEO and Darren is the Co-Founder/COO of both Set Free Indeed Ministry and Free Indeed Faith-Based Intense Outpatient Clinic, the first of its kind in the nation. The clinic is licensed by the State of Louisiana. The Free Indeed program consists of structured and intense outpatient treatment services that emphasize total recovery from substance abuse and other related addiction(s) and/or destructive behavior(s). The clinic also offers treatment to ex-offenders who through the Access to Recovery grant are able to receive transportation, transitional housing, job placement and life skills. The clinic also works closely with city and State probation and parole offices as well as judges. Free Indeed has a staff of qualified professionals who aid in meeting the needs of those bound by addiction(s) and destructive behavior(s). Tonja is living proof that the power of God can set anyone free who is bound by addiction(s) and/or destructive disorder(s). Having been the victim of sexual molestation at the age of seven and later turning to drugs to relieve the pain, she eventually turned to selling drugs and prostitution as a means of supporting her addiction. As things went from bad to worse Tonja eventually tried to take her own life to escape the pain and hopelessness of her addicted lifestyle. It was God’s infinite grace and mercy that allowed her to be here today. That was 18 years ago when Tonja turned her life over to God and is now a living testimony to the power of the Word of God to change lives and set the captive free. On January 28, 2003, Tonja and Darren were in Washington, D.C. where Tonja had the privilege of attending the State of the Union address. She was the personal guest of President and Mrs. Bush. President Bush recognized her as an example of personal perseverance and belief that through the grace of God healing from addiction(s), destructive behavior(s) or any form of bondage can be achieved. Tonja and Darren have dedicated their lives to helping those who cannot help themselves. Their biggest joy is to see people set free from drugs, alcohol or any form of destructive behavior. They truly believe in the Power of Faith, Family, Prayer and the Word of God which states: “Whom the Son sets free is free indeed”. John 8:36 Vicki Sanderford-O’Connor, M.A. As ATR CAIR Program Manager since 2005, Vicki directs an Access to Recovery program with a $17.1 million budget. Vicki spent 16 years with the California Department of Corrections and Rehabilitation (CDCR) as the Community Correctional (reentry) Program Manager. During that time, she planned, implemented, and managed the $14 million Preventing Parolee Failure Program, the second program in CDCR history to successfully reduce recidivism and save tax dollars. Author of The Power of Compassion, a handbook for correctional officers, Vicki is a recognized international trainer and peace builder who has worked with indigenous peoples globally. She earned an M.A .in Conflict Transformation and Restorative Justice at Eastern Mennonite University and a B.A. in Health Services Administration at St. Mary’s College. John Walters John P. Walters is the director of National Drug Control Policy (ONDCP)— sworn in on December 7, 2001. As the Nation’s “Drug Czar,” Director Walters coordinates all aspects of Federal drug control programs and spending. Under Director Walters’ leadership, youth drug use has dropped to its lowest levels since the early 1990s. The latest Monitoring the Future Study, released in December, 2006, indicated that 840,000 fewer young people are using drugs today than in 2001—a 23 percent reduction. Teen marijuana use has dropped 25 percent, and teen methamphetamine, ecstasy, and LSD use have declined 50 percent or more over the past five years. Emphasizing the need for a balanced approach to reducing drug use, Director Walters has overseen the creation and implementation of several key prevention and treatment programs: The National Youth Anti-Drug Media Campaign has been restructured to improve its effectiveness. More than 1,000 schools across the country now use the preventive power of random student drug testing to help young people resist peer pressure to use drugs and alcohol. The number of community anti-drug coalitions supported by ONDCP has grown to over 700. The “Access to Recovery” treatment initiative is providing vouchers for thousands of Americans struggling with addiction. The Screening, Brief Intervention, and Referral and Treatment program is engaging the Nation’s health care system to diagnose and treat drug abuse, with the Medicaid system now offering reimbursement for such services. Director Walters has also worked with our international partners to make significant progress in reducing the supply of illegal drugs: The number of domestic methamphetamine labs have dropped 30 percent between 2005 and 2006, and continue downward. Colombian cultivation of coca and production of cocaine have declined steeply, as has cultivation of opium poppy and production of heroin. Working with U.S. authorities, Mexico has demonstrated unprecedented resolve to dismantle violent drug cartels. Working with the United Nations Commission on Narcotic Drugs, Director Walters has focused on securing international cooperation in the control of pseudoephedrine and other precursor chemicals used to produce synthetic drugs. Prior to returning to ONDCP, Mr. Walters served as president of the Philanthropy Roundtable. Previously he served at ONDCP as chief of staff and as deputy director for Supply Reduction and worked in the U.S. Department of Education and the National Endowment for the Humanities. David Whiters, MSW David has a master’s degree in Social Work from the University of Michigan and is currently a 5th year doctoral student at the University of Georgia’s School of Social Work. He is certified as an addictions counselor with NAADAC and as an HIV educator with the American Red Cross. He lectures extensively on the interrelationship between HIV, Hepatitis C, and substance use, particularly in the African-American community. While a graduate student at Michigan, David completed a 4 month internship in Durban, South Africa, developing addiction recovery support services for HIV-positive substance users. David began his career in the field of addiction treatment in 1989, as a counselor with Coalesce, a culturally specific alcohol and drug treatment program designed to provide services to African-American substance users in Atlanta. His professional experiences include serving as director of a residential program for men and counseling substance users from the offender population. David is the executive director of Recovery Consultants of Atlanta, Inc., a SAMHSA/CSAT funded faith-based, peer-led Addiction Recovery Community Services Program. This program offers support services that help sustain members of Atlanta’s addiction recovery community while helping them reduce behaviors considered high risk for HIV-infection.
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