going through there was one of the most single influential events of my entire life. it was an opportunity that presented itself at a time when i was ready to change my life. it provided me with the tools, the social support, in order to move forward in a more positive way with my life. everything that i have i really do believe, to the bottom of my soul, is because i was accepted into this program. somebody knew that i was going to need this before i knew i was going to need it, and had it set up and it was in place. and when i got here, the phoenix house was ready for me to come in. i had been through a few programs before and i had always failed to create a social support system for myself. through this new start program at [inaudible] i developed a core group of men that have, to this day, become my close friends, and supporters. i do have that sense of security for myself. i always know i have a place to go. at my worst moment i can come up here and just sit and

hang out if i need to. what i do to help people that are still in the program is i like to come back to this place, the phoenix house, i like to offer up support, i like to be a guiding light, someone who has gone ahead of where they are at now, because people did that for me, and that is what gave me hope and encouragement and helped me along the road of sobriety. i think what keeps adults coming to phoenix house is the modality of treatment that we have, which is peer driven. they get a lot of support from their peers and they begin to have a sense of family, and i think that community feeling and having a function while they are in the house, a job while they are in the house, really does help them respond to the structure that we provide, and then they begin to understand that they deserve their lives to be different than being back incarcerated or out on the street. i think it is an individual thing, but i think that is very helpful. people should understand that the phoenix house really has the power to change lives, and i would like to see it

around for years to come. keith, we've been talking about healthcare reform and how some of the programs that are going to help folks in recovery are going to be integrated into the whole healthcare system. talk a little bit about that. yeah, i'd be glad to. this is a very exciting time for this field due to some real changes in public policy. the first one is parity, which was a law passed at the very end of the bush administration and then the regulations were written during the obama administration. and what parity rules say is that if you're an insurance company and you offer benefits for substance use disorder treatment, you can't make those benefits lesser than you could for any other condition. and you used to be allowed to do that. you used to be able to say outpatient co pay is $10 unless it's for mental health or substance use in which case it's $20. that's illegal now. so that should help people who have private insurance be able to access care. then in terms of public insurance, the affordable care

act or healthcare reform as people called it, also is really going to make quite an impact on this field. medicaid is going to be expanded up to people who make 133 percent of poverty, which it historically hasn't covered. you're going to have health exchanges that people will compete to offer insurance in and both of those new programs are mandated that substance use care is an essential healthcare benefit. so it's quite an achievement for the field. if you want to offer health insurance through health exchange, you have to cover substance use treatment. these new medicaid dollars have to cover substance use treatment. and that was an achievement in part, i have to say, of the recovering community. a lot of recovering people helped advocate for those changes around town and made that happen. and not just advocacy where they talk to politicians but i think kitchen table advocacy where people talk to each other and they understand this is an illness, it should be treated. and that made a constituency in the country because these changes were popular. and both bev and joe, how do we make the new systems be

a recovery-oriented system of care? my first off the cuff response to you is that i think we need to make sure that recovering people are at the table and that they have an informed voice and that they are supported in sharing that voice. i think that's really important to make sure that people who are speaking for the recovery community really have ways to make sure that they're speaking not just for themselves but for a larger recovery community. i see. one of the, i guess, exciting things about the healthcare reform is that recovery support services is in there also and primary care along with behavioral health. in other words, now that the recovery organizations and, of course, you have health navigators and recovery coaches and peer specialists are able to help a person in recovery not only with mental health or substance use,

addiction problems, but also to link them to some primary care because we know that recovery support, you know, if i have cancer or diabetes or hurt in any kind of way and especially that can also cause stress and cause me to relapse or go back to addiction and also seek medications as far as they're drug related, and i don't need that, but healthcare reform has a lot of this recovery supports in it that also access the community. on a local level, we're doing a lot of that right now as from the primary care, criminal justice, all of the providers are involved only because of the healthcare reform, they have initiatives and same thing at the state level. so integration and also with primary care and behavior health is important right now. yes, thomasina? on the federal level in mental health the feds are experimenting, there are at least eight states that have been given grants, 5-year grants, to transform their

public health system, mental health system, into the recovery oriented. that is a huge thing. to look at the whole public health system of mental health and that's going to affect the substance abuse, too. i'm so glad thomasina brought that up because there's another point to this that's really key that is recovery is not just a service that we're supposed to attach to treatment for 3 years while we have a grant and then it goes away. it's supposed to transform the entire treatment system. we have to change the way of doing business throughout it, so it truly is recovering support system. and the systems that are thriving, like, for example, in philadelphia, i'll cite where bev is from as an example, or the work that joe is doing, the ones that are taking that on, this is a philosophical, cultural transformation not just flavor of the month, a grant, we'll do this for a year and then we'll forget about it. yeah, and describe that for us, bev.

well, it really is a transformation process and it's not only bringing people to the table but really looking at all of the different aspects and components of this system- and that's why it's called recovery oriented. recovery oriented. but what's really, for me, pretty exciting about it is the nontraditional community support services that have been out there for a long time. such as? such as some of the faith based organizations, some of the recovery support services that are peer-to-peer are all now sort of a part of the mix and so there's a concerted effort to do linkages and to do warm handoffs for people. we're not just sending somebody there. but also to really walk with people in their recovery journey and having support for doing that has been incredibly important. it's not just you go here, then you go here, you go here. there's a concerted effort to make sure that everybody is walking along the same path or the same kind of

a response to somebody. you know, we talk about no wrong door and that if you land somewhere you're going to get an opportunity to be able to access services for recovery. so let's say i'm in recovery and i go to pro-act for example, someone greets me, do they do an assessment? do they do an orientation? what happens? we say how can we help you with your recovery? and for some people, it's kind of like, what? and it's how can we help you with your recovery and then we give them a tour and say here are all the kinds of things that are available. which is transportation-? transportation, things like learning how to get an email address because for many people who have been out of circulation for awhile, that's like a huge opportunity to get an opportunity, we don't realize how important technology is now. but how about do you need help with getting employment? how about writing a resume? you know, all of those kinds of things and then we say,

"now we have a survey that we'd like you to take and what do you have to give us?" what is it you would like to get but what would you like to offer, too, and most people say i've got nothing and then we say well take a look at this and they say, "oh, well, gee i do know how to cook," or "i do know how to do this." well, maybe you'd like to share that with somebody else. so we're trying to help people to understand the value of giving back at the very earliest opportunity that they come into the process. and it's so exciting. sometimes it's those giving back things are what in the long term keep people really committed to their recovery. it's a changing perspective. and just to add to that because that is a key element in the recovery-oriented system of care is strength base because not only does the community have so many resources and supports that they haven't tapped into and that's when we pull together then we can see that there's many strengths in the community.

the same thing goes with the peer that comes into our place; we also let them know we do a strength based. we're not assessment, but a strength-based model where we talk to them and see well did you have a high school diploma? you mean you have a car? oh you have family even in town. some folks are homeless and broke and busted and disgusted but there are many that do have little things that can help them to maintain recovery and also to guide them. so the travelling companion, which is another peer, to help them with their strengths and also to give them more capital, recovery capital. there's four supports that we offer that most recovery organizations don't, and that's information support, instrumental support, which health and wellness gets into when you're talking about jobs, employment, and also housing. but also social supports, okay, which is companionship support, teaching them again how to socialize now, know what i mean, in the community and how to navigate them in the community. jmn recovery and recovery at the movies. and then the last one is emotional support to help

them with their emotions and becoming emotionally mature in my recovery. excellent. many of these places become communities and people feel involved, there's purpose in their life, they have meaning again and they have friends so it's not just individual services but it's a holistic support system that becomes a community. and keith, you know we've just talked about a recovery-oriented system of care but there's also the screening and brief intervention which really is at the front end as well, so this is sort of the back end when folks get finished with their treatment or if they've done a spontaneous recovery through a mutual support network, etc. but when we come back, i'd like you to start us off and talk about the screening and brief intervention and how relevant that is with the new health reform.

we'll be right back. for more information on national recovery month, to find out how to get involved, or to locate an event near you, visit the recovery month web site at recoverymonth.gov. when you have a drug or alcohol problem, your whole world stops making sense. you can get help for yourself or a loved one and make sense of life again. for information, treatment referral and most importantly help, call 1-800-662-help. brought to you by the u.s. department of health and human services.

when i lacked courage in myself, i was lent courage. when i didn't believe in myself, somebody believed in me. when i was hopeless, folks had hope for me. when you first get into recovery, you're looking back and you're thinking all you can see is that wreckage. and what we are, we understand that wreckage, but we're that light. we're that hope. we had that wreckage, too, and this is where we're at today. i've been there. i've done this. i know what you are going through. i can help you if you will allow me to help you. the recovery mentor program, the group of staff that have been there done that. when you say you are going to call me, then you need to call me. because a mentor can speak to somebody far differently than i can speak to somebody about motivating them for help and also seeing through all the filters. is this an opportunity you really want? comes with supportive housing, folks get people tied into the recovery community. they take them to 12-step meetings. they take them to other community support meetings and

make sure they're making doctor appointments and they get their food stamp cards so they can get on their feet. pots and pans, all of that. it's a tremendous program and it has a huge success rate. in the past, i would walk out of detox and i take those first breaths of air after a week or 10 days or 2 weeks and immediately just not knowing what to do next. i was given some really basic things, you know, a bed, shelter. a recovery community that goes from people that are in my same position to the mentors to janitors on the floor that went through the program in recovery. i've got this rocking little sro, it's an 8x10 room and i get to be safe for a minute. you have shelter, you have food, you have safety. i can focus on other things now. it gave me a very simple task to do; go to a meeting, check with them in the morning. it's like, ok, that's manageable, i can do that.

first, you have to do meetings. it's a must. make all your appointment groups, acupuncture, and check in with your mentor every day. and you get held accountable for your actions. we can help folks transitions safely, and when i say safely, with some prognosis that they are going to be successful. now i'm engaged in an employment access part of this program and the person i'm talking to is a recovering addict herself. so it's like, that feeling of needing to explain, why i have gaps in my employment history, i don't need to explain that. they showed me that i could be a better man. that i don't have to use to handle my problems or face everyday life. my belief system has changed, like i don't believe i'm a victim. i believe i have choices.

i can let go of resentments. and it's like an emotional and spiritual freedom that i've never experienced in my whole life. i can actually do some good and actually affect people positively in this world. and that's a responsibility that i feel and that i'm excited to live up to. and keith, let's talk a little bit about screening and brief interventions, which really are at the front end of what our last panel conversation. talk to us, i know that samhsa was one of the proponents of screening and brief interventions and then when the ondcp began to really promote it. yeah, so screening brief intervention and referral treatment or sbirt as it goes by its acronym, started as a very strange idea. no one thought that you could possibly reach the addicted population in the primary care setting or in the emergency room, but it turns out that from a lot of research, in fact, you can. these are great opportunities that are often missed.

so the idea behind sbirt is to take advantage of those opportunities and hopefully stop people from having to go so far into a really terrible addiction career before they get help. so this might be your primary care doctor when they ask you all the questions about do you exercise, asking also can you tell me something about your drinking? or have you ever used a prescription medicine in a nonprescription way and that gives a chance for somebody, an authority figure in a white coat to say, hey, that's unhealthy. and if it's at a low level, maybe i can handle here in primary care, but if this is really serious, i need to talk to you about some of the options out there because there are treatments that work, you could overcome this problem and i'd really like to see that happen. and that's almost a preventive measure? right, right. in public health, they talk about primary prevention when you stop a condition entirely, so sbirt is secondary prevention. so the person has the problem, but you try to catch it as early as you can and all the evidence is that

it's so much easier to change when you haven't blown out your marriage and your job and your housing and all that kind of thing. so you catch people early. and in policy weight, samhsa has been very proactive in providing grants to states to do sbirt. a lot of private insurers are now covering it because work through a number of administrations to put it into health insurance and a billing code and in health care you don't exist until you have a billing code. so, i think, it's one of the more exciting things that's happening in health care at the moment. which truly brings up a challenge talking about billing codes in terms of recovery services. have they achieved the-in some states, i believe they do have a billing code, correct joe? right and we're just fortunate that these are those great times that managed care has jumped on board and we are fortunate to have two billing codes to do peer services. in fact, to do peer recovery coaching and to do peer support groups. the other thing to how it connects to the sbirt is that

sbirt is the screening piece and right now we are actually in training to see how can we do that early intervention and screening in the emergency rooms in the hospital for folks that's coming in with drug and alcohol-addicted related incidences, so it's very important. back on what joe was saying, our experience with sbirt has been not only to encourage and train physicians and physician's assistants and all to do that, but then also to provide the support so that if somebody does screen that they've got, that they're at higher risk to be able to make it easy for them to access services and so our recovery coaches are able to connect right with the person at that point. they may need just some education and so we've got packets of information for them and things like that, but also to make actual transition into some level of care if they need to because right then they're motivated. and they're willing to do it. so it is a great kind of much more consistent process then

just here, go do something and so that's been very successful. and we spoke about-thomasina said that it's a peer-to-peer, we've talked about recovery coaches where there's a little bit of training to let people know what are the primary elements that they must know about in order to help someone else. in the context of family however, what are some of the issues the family need to be aware of in order to support someone in recovery and i'll start with you, bev. they need to understand the illness they're dealing with, so we have an ongoing education program for families that deals with what is the illness and understanding addiction. then what's my role? what are the kinds of things that are helpful and constructive and what are the things that aren't so helpful and constructive? and then what are the resources out there and how can i access them? some of the others is just a family understanding their

rights and that some of the confidentiality laws don't apply to the family. you know, i can tell you what is happening in my family's life. the counselor or the treatment provider may not be able to tell me what's happening, but as a family member i can do that and really help, really support in a very constructive way the person's recovery. and why is it important, joe, for families to get engaged? well, one, of course, is like bev said is that we're dealing with a disease, one that it really hurts the whole family. it affects the whole family. one of the things we say is that risk factors are not predictor factors, they're protector factors. and the one thing is that we do protect the community with the recovery support services and there's many, of course, paths to the family not only al-anon and narc-anon, but also, of course, culturally when you talk about latinos or african americans, you know african americans they'll go to the church first and they'll see the pastor

before they'll see a professional, and, of course, they'll take the whole family and the pastor is not skilled in the course of addiction and disease so it's very important also that the families get all the resources in the community and know about not only addiction but also mental health and how do i tap into those resources? well we are training- nacoa is going around the country training. it's called a nondenominational training program. we have some clergy guidelines as to what clergy can do. so there are resources, at least we're beginning to pay a little closer attention to the role of faith and everyone has faith initiatives that they're working on as well. but i want to get back to the whole experience of relapsing. in spite of all of this, there will be some individuals right, keith, that will relapse? absolutely. and what should the family do and what should the individual

do in the event that there is a relapse? i'm so glad you brought that up because i think the one element about recovery oriented systems of care we probably haven't talked about it's the recognition that these problems are chronic and not acute. so a lot of times the way we set up treatment in the united states, we treat it like a broken bone or something. you go to the hospital, i set your bone, then you're done and you're going to heal naturally. but the truth is that most people will relapse. take a very common experience, quitting smoking. most people who have succeeded quitting smoking failed six or seven times. those are people that have succeeded. you see that in alcohol, you see that with the other drugs. so what that means is that you should not feel dispirited, shamed that you had a relapse. it's a very, it's highly likely you'll have a relapse. that's the nature of the condition. and by the way, people that have heart problems have relapses. people that have back pain have relapses. that's what chronic medical disorders are like. they wax and they wane depending on how life is going. so for the family not to get dispirited and not to feel hostile that the person has done this but just try to

accept that this is a chronic illness and it doesn't mean, by the way, that you can't get mad. it's natural. if your spouse is addicted and treats you badly or treats your kids badly, of course, you're going to get mad, it's not to take away those feelings. but just to give you a way to understand this is what is going on. this is what millions of people have gone through. they've had relapses and many of those people go on and recover. so it's not-it's tough, but it's not the end of the world. in terms of the family, let's be honest, the family suffers, too. it's not just the person in recovery. many family members, all family members with the children, etc. suffer a great deal and i think the recovery supports need to include the family and i know like the 12-step al-anon and nar-anon are for family members. and for the children, ala-teen. right, ala-teen for the children and there was-during

the 1980s in california during the social model movement, alcohol recovery movement, back in the 1980s there was a wise man in the same county that leon panetta is that argued that if the whole country adopted al-anon principles, we all would be a lot better off in terms of actually helping people in recovery. that they're very constructive ways of helping, not capitulating but standing firm and helping, so i think the family needs to be seen as a group that suffers and needs their own recovery in and of themselves. i think that's accurate, but i think also sometimes they retreat and all of the shame comes back in-and they've done something wrong and i think that's where

it's so important to understand the nature of this illness. but also not to hide it. that a relapse can be a learning, very constructive experience for people to look at what they have maybe done wasn't helpful and both the individual and the family can look at how they can get back on track and i've had many people who have said "gee i really learned and it really expanded my recovery by going through that relapse." that doesn't mean, though, that it's necessary. and the family, sometimes they just don't know how to let go and it's time for treatment for my family member and we got a lot of family members that are very angry because they're tired of relapsing over and over and over again and i've been taking care of this person. and so now it's time for me to let a professional help. and a person will come back to the family because we know that culturally, even latinos, i mean, they love their family.

they're not going to let go of that family. they're going to go through the whole process with the family, but it's very important that they learn how to let go. and bev, getting back to all of this, i mean all of what we said is actually very on target in terms of helping individuals in recovery in the various programs. but you were speaking at one point about the broader community and the recovery month event that was held in pennsylvania. what is significant about that and why should other communities adopt that kind of effort? one, it's a validation that recovery is possible. so i think it really reframes for people what the possibility of recovery. i think it is an incredible opportunity for families to really celebrate recovery together and to validate the opportunity that they as a group have really made progress and

can support in a very tangible way recovery just like you do with other diseases and i think that it's so important for people to feel normal that here they are being part of something that is similar to what other diseases experience. i mean, there are other marches and walks and kinds of things and now their disease has that, too, so it's a wonderful experience. it's a very emotional experience for many people to get that kind of recognition. this year, for the first time, we had people lining the streets cheering the walkers and that was like a significant change from-our first walk had 100 people in it. you know, this was 11,000 people. and we frankly walked to ourselves and now having people on the curbs going down a main street in philadelphia proud of their recovery just is a huge reframe. and unless the public policy individuals- absolutely. --elected officials, civic leaders know that there is

a movement, there is a force. and it's really important that they are there. you know that public policy officials, people from samhsa, people from the governor's office, you know, are there, kind of recognizing the progress that people have made. very, very important. and i want to remind our audience that september is national recovery month and every individual in recovery, their families, their friends, and all the individuals in the community can get together, host events and activities to help celebrate those in recovery. thank you for being here. it was a great show. for a copy of this program or other programs in the road to recovery series, call samhsa at 1-800-662-help, or order online at recoverymonth.gov and click multimedia.