SMART Policy Podcast
Podcast by the UT SMART Initiative. Host Jeremy Kourvelas speaks with experts from across the recovery ecosystem - representing healthcare, prevention, law enforcement and more - about local, state and federal drug policy to find out what is and isn't working to make this fight against addiction a little easier.
SMART Policy Podcast
Recovery Community Centers Are Changing Everything
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You're listening to the Smart Policy Podcast, a production of the University of Tennessee's Institute for Public Service. Access to treatment. Housing, employment, educational opportunities. We're used to hearing about the need for these aspects of recovery. But what about community? A place to gather with others, especially those with similar experiences. That's where recovery community centers play a role.
SPEAKER_01We want recovery support services to be free and accessible to everybody. So we are doing our best to remove any barriers.
SPEAKER_02That's Dottie Green. She's the executive director of the first recovery community center in the 8th County region of Northeast Tennessee. She's also a person in long-term recovery and has been providing recovery support since the 80s. And as you might expect, she has seen the field of recovery change significantly in that time.
SPEAKER_01Back when I first came into the field, there was no training. I mean, we were literally fluffed out of AA meetings and put into counseling roles.
SPEAKER_02Our second guest this month is Bettina Hebner, who has joined Dotte to talk about her academic research on recovery community centers, or RCC. Dr. Hebner is an experimental psychologist who focuses on substance use disorder, and she directs the Health Through Flourishing Research Program. Her work on RCCs highlights how their unique natures make studying them as complex as logical.
SPEAKER_00But would the RCC directors agree this is a good outcome for the people who walk for our door, or the clinicians saying this is an acceptable outcome versus the people who are funding the RCC saying this is what we want to fund and what we're striving for? So trying to build consensus.
SPEAKER_02In this episode, we discuss the ins and outs of recovery community centers and how they fill crucial gaps in the care continuum, as well as how attitudes towards recovery have changed dramatically over the last decade. I really enjoyed this conversation, and we touch on a lot of other issues, such as the need for community in general in modern America.
SPEAKER_00Oh, see, I was waiting for you, Dottie. All right. So my name is Bettina Hubner. I am an associate professor at Harvard Medical School, and my research takes place at the Massachusetts General Hospital. I'm the director of a health reforction program within the psychiatry department of MGH. And I came to recovery research really through the work I was doing with Dr. John Kelly at the Recovery Research Institute, where I learned a lot about mechanisms of change. And at the time we were looking at AA, in particular and how AA conveys benefit or confers benefit to people and really trying to understand that. And in doing this work, we then heard about recovery community centers. And Dr. John Kelly led a project on that, where we surveyed RCCs in the New England area. And from there, then we grew into our current interest in them. And through the current project that we have, that is funded by NIDA, I've had a chance to really interact with a lot of RCC directors, participants, people who advocate for them for multiple stakeholders around them. And every time I hear more and see more about recovery community centers, I'm very much inspired and uh impressed. So I'm very passionate about this research, and it's why I'm continuing to do this work.
SPEAKER_01I'm Dottie Green, and most importantly, I'm a person in long-term recovery. Uh began my recovery journey in 1983. So I've seen a lot of changes in our field. And uh I'm also an associate professor in the Department of Social Work at East Tennessee State University. And um, I've been working in addiction in the addiction field in some form or fashion for nearly 40 years. And um I've done clinical work, I've done, you know, worked in recovery houses, I've, you know, done a little bit of everything, worked in the prison, worked with Department of Children's Services with women, gender responsive treatment. And I started my journey in 1984 professionally. Uh back then, and Bettina, I'm sure that you've seen this in your research. Back then, the only requirement to be an addiction counselor was that you were a person in recovery. And uh, and that was the only training that I had. I did not have any education or training. I came into recovery with a ninth grade education. So it's been really interesting. And I feel like now that I've spent about 20 years in academia developing clinical addiction certificate programs for addiction counselors and um running those. But now I feel like I've come full circle in a lot of ways because now I have a pretty good scientific knowledge of recovery, and I have the practical knowledge. And I was getting ready to retire, a grant opportunity came about a little over, well, about a year and a half, almost two years now. Uh, and RCCs are, you know, developed and run by people in recovery. And I was like the only one in my in my university that could probably do this. And you know, I just felt like the universe was talking to me and just saying it's not quite time to retire. You got a little more work to do here. So hence the birth of Johnson City Recovery Center, and I am absolutely having a blast, and now I think I might not even retire. So that's kind of uh my story.
SPEAKER_02Dottie, uh, you know, it's interesting. You describe an interesting change in trends, the trajectory of recovery as the only real credential necessary at that time. And now these days, it seems that there is such a push to seek out people in recovery to take up more of these spaces. It's it it seems almost like at the policy level, an inverse of what was happening at the on the ground level. Now all the buzz is about, oh, we've got to get some peer recovery specialists and oh, we need some certified uh peer recovery uh uh specialists in this hospital and and and so on and so forth.
SPEAKER_01Back when I first came into the field, there was no training. I mean, we were literally plucked out of AA meetings and put into counseling roles. And I, you know, sometimes when I think about what we used to do, because back then the big the old therapeutic communities were in vogue, and it was really before, a little before the Minnesota model, you know, the 12-step model really came into being. And there were some pretty harmful practices back then. You know, there were some beautiful practices, you know, I think. And one of the cool, just kind of anecdotal things, there were like five uh me and four other of my friends in recovery, and we all went to, we just kind of followed each other when we changed jobs in the field, and all of us remained in sustained remission for all these years. So I'm talking, you know, 40 and 50 years of long-term recovery. You know, that kind of talks a little bit about the the power of the bond of recovery, too. But in my career also, I've seen lots of people in recovery not have that kind of success. You know, I had a a dear friend who I found overdosed who had been in the field for many years. So, you know, I've got a lot of stories like that. But what I'm, I guess, so excited about now in the field is the training. You know, we're training peer recovery support specialists, and they're getting some really good, solid training, and uh, I think really helps to equip them. And we've also moved away from that real punitive approach when an addiction professional had a return to use, you know, they would get fired. And you I I shouldn't speak generally, but I know that in my world, my research was around relapse among recovering addiction professionals, but we have moved to a much more supportive and compassionate approach to professionals when they do experience a return to use. And so it's not closeted the way that it was. Yeah, I'm sorry. I could talk about this stuff forever and ever.
SPEAKER_02So it's actually a really good segue. You mentioned uh how there is a change in culture and policy in response to return to use. Uh, for example, popped into mind how it is has been found repeatedly to be a violation of the Americans with Disabilities Act to take someone off their medication if they're uh receiving medications for opioid use disorder. Uh Bettina, some of the things Dottie was talking about, I was wondering in in your capacity as a researcher, how has this evolved? I I I understand a lot of your work is around the impact of these these changing recovery resources, uh, and and especially in terms of accessibility. I was wondering if you could uh provide a follow-up comment.
SPEAKER_00Yeah, so you didn't uh characterize my research correctly. You know, access to care is a huge uh interest of mine and and the main motivation behind my program of research, which includes recovery community centers. But in terms of the science about how this has evolved, there's very, very little science on recovery support services. And there is even less on the peer recovery support workforce. So we know nothing, very, very little about how people do when you know when they receive training, the places that they are uh then performing those duties in, and there's a wide variety of them, how that impacts them, how much support they are getting, um, how long they are able to stay in those jobs. We do know there's a lot of secondary trauma as they're being re-exposed to things that they know and that they've experienced themselves. Um, so we know, like from talking to people that all of these issues exist, but empirically, we know nothing about that at present. And that's something that we still desperately need to do, especially given this much larger investment and how much um peer recovery support workers have to offer and how much we're increasingly relying on them, understanding how they're actually experiencing that job and that career and how much support they have and how it impacts them is something that's critically important.
SPEAKER_02I've seen meta-analyses showing that broadly speaking, the more access you have to, the more resources possible, outcomes tend to be generally better. But that's an important point about the lack of uh let's say qualitative research, or at least research on variances in quality. If you don't mind, uh it's uh you've just had a paper accepted for publication. I was looking at that. It it some of the results that stuck out to me. For example, uh residents of areas with RCCs were more likely to be black, which uh that's an important gap in access right there, is engaging uh black Americans. I did see a less likely to be Asian or American Indian or Alaskan Native, as well as a reduction in chances of being rural, which struck me as interesting. There are some other really crucial findings here, but uh just broadly speaking, in terms of access there, I would like for you to talk about your paper a little bit.
SPEAKER_00Yeah, for sure. So for I mentioned that we started by doing research myth uh RCCs uh that were near us in New England. And for this one, our task for NIDA was to build infrastructure to really get multiple stakeholders involved in building the science on recovery community centers. And we wanted to involve not just scientists and clinicians, but we wanted to engage RCC directors, staff, members, um, people who are involved in the policy making about how to fund RCCs. We wanted to really bring everybody together to kind of understand what the issues are, the most important topics that we need answers to, and to also build consensus about how we should assess something like the outcomes. How do you measure the outcome, a positive outcome for RCCs? We talked about 12-step having being very abstinence-based, but the field in addiction is certainly moving away from a pure abstinence model and then agreeing on what would satisfy, what would be what would you know, RCC directors agree this is a good outcome for the people who walk through our door, versus clinicians saying this is an acceptable outcome versus the people who are funding the RCC saying this is what we want to fund and what we're striving for. So trying to build consensus. Um that was our that's our goal, and that's why we want to have these conversations with our multi-stakeholder groups. And we thought that an important step would be to actually reach out to all the RCCs that we can find in the nation, beyond just our part of the world, but really within the whole country. So that's how we conducted the survey. And we wanted to just really see what services do they provide, who are they engaging, who are they, where are they? And that was what was behind our survey. We also did ask about outcome measures and what they thought about those. Um, but one of the things that we've also wanted to really look at is where we're located, what communities are they serving? Because so oftentimes we see disparities, racial ethnic disparities about you mentioned Black Americans not being able to reach resources, not being reached by the treatment community. So we wanted to see how that look like for RCCs. And here we found that they successfully engage Black Americans. They also successfully engage young individuals in recovery. So folks who are traditionally underserved, RCCs have the ability, at least according to our survey, to be engaged. And that's an incredible message of hope. And it's inspiring that they're able to do that.
SPEAKER_02Dottie, I was wondering in your RCC, I mean, you serve a very rural area, and a lot of people don't realize how diverse Northeast Tennessee can be too. Uh, but I guess I was wondering if I could ask you a bit about how your RCC is doing specifically.
SPEAKER_01So we've been open officially since January 3rd, 2023. So we're brand new. We're located in Johnson City, and so far we've served about 7,000 people in our groups and events. But those those, yeah, I see your eyes. Um but that's not unique individuals. We've had about 7,000 attend all of our groups and events, and some of those, you know, are unique individuals that have come multiple times. So our best guess is that we've probably served about 900 to 1000 unique individuals since we've been open. Now, and I say our best guess because one of the fundamental principles for us is that we want recovery support services to be free and accessible to everybody. So we are doing our best to remove any barriers. And one of those barriers is that not everybody wants to sign in and give their information. And we allow them that option. Uh, we track our numbers if they're coming, you know, to the groups and all of that. That way we we do that, I'll get a good account. But if somebody doesn't want to sign in to RDP, they they don't have to. Although, you know, we we share that it's really helpful for us to have dumpers and be able to show this to our funders. But a lot of people actually choose not to because they've had experiences maybe in professional treatment or in the you know criminal justice system or in you know, all of that.
SPEAKER_02So I was gonna say uh fear of reprisal is just such a absolutely in the stigma.
SPEAKER_01I mean, we had somebody uh yesterday a great example, somebody who's been in long-term recovery for a number of years and chose, you know, really didn't want to sign in um because of his professional standing, you know. And uh and so, you know, it's across the board. And RCC, we serve people from you know that are currently using all the way to people with 40, 50 years in recovery. And, you know, we have about 20 mutual aid and support groups a week, anywhere from traditional 12-step A N A. We have Well Briety, Smart Recovery, Mindfulness for Recovery, ACOA, Al Anon. I mean, we do a little bit of everything, and uh we're actually doing really well for our first year. We have my projected outcomes, we're probably have, I would say, doubled that for our first year. And we've gotten a lot of support. The community, we do naloxone distribution. We have an outdoor naloxone box too, where folks can access naloxone um on the weekend or after hours, and we have a lot of folks that access it because of the stigma, they don't want to come in, you know. And we also have one social, one big social event a month, which is the that's probably the most popular thing we do, which is uh a loads of fun. We have a game night, we've got Super Bowl Sunday this this weekend, so uh three TVs, and so y'all come on down if you want to. But our community has been incredibly supportive. We got a startup grant from the uh Washington County, which is where we are, Washington County baby doe litigation funds. So that was um almost two years ago, and we were just blown away that the city council supported us. I mean, it it was really it was very impressive. It said a lot for our county government and city government. But yes, I mean, you know, we are I I'm tickled pink at how we're doing, you know, and uh we we don't quite know how we're gonna sustain everything just yet. We do offer some peer uh support specialists um continuing education that brings in a little bit of money and and some grants here and there, but we haven't we don't have enough yet to feel solid like we're gonna be sustained for the long haul. Although we've got some big grants in, but we we have a lot of work to do around sustainability.
SPEAKER_02You say only about 900 to uh or so uh uh individuals in your first year. I mean, that's that's really, really tremendous. So this not one size fits all, this uh any approach, all recovery type approach, seems to be exactly the kind of fit. And it's not just in terms of treatment modalities or or expected outcomes, it's also additional supports, like you mentioned, uh the social determinants of health, transportation, and I've seen other RCCs do clothing drives and food banks and and on and on and on. It is this panacea of options and the lowest barrier possible that seems to have the most uh impact. Uh Bettina, in your research, I see that discussions about medications or opioid use disorder were extremely common. Uh that uh support for that is extremely common, like well over three-fourths, uh if not four-fifths, of uh all RCCs uh reported engaging in those conversations and supporting those options. On the whole, it does seem like there is a a large uh support for medication uh as well as for 12-step modalities. This openness to treatment modality seems to be the key to Cisco. So would you say the same?
SPEAKER_00I think that's one of the most inspiring parts. Like I think there's been so much um so many different paths that are distinct from each other that didn't live happily and comfortably with each other in the addiction field before. And seeing how in an RCC, which is, you know, it's a community, people come there for the people, right? Um, that there is a setting that allows so many different diverse pathways to engage with. Some people come for the 12-step, some people come for the yoga, some people come for the mindfulness dimension, some people come for the navigation to resources, somebody comes to write a resume. It's all one place. And a variety of people are coming through the doors and are interacting with each other in a way that is welcoming, right? People wouldn't come back if I didn't feel like, even though this is me and this is my path, I feel welcome here, even if other people choose differently. I can choose this and feel welcome and feel happy to come back. I think that is a really inspiring part of RCCs. And the reason why we highlighted medications in particular in our paper and in our survey is because we wanted again to bring together the multiple stakeholder groups. And oftentimes there has been a pushback in 12-step organizations against medications, making it difficult for physicians to send their patients, you know, to say, this is, you know, I'm not telling you one thing and they will tell you another thing, and there is an inherent conflict there. So we wanted to see what is it like in RCCs? Do these boundaries exist there? We know that people have strong opinions one way or another, and having different opinions is great. Just to what degree does the RCC, like how does RCC handle that? And these are the comments we got back about having conversations, being open, um it being really a welcoming place. So people who are choosing to use medications for virtual disorder or other medication assisted recovery, they can feel welcome and they don't have to hide that. They can find resources, knowledge, other perspectives and experiences that can help them along that path. And that's why we really wanted to highlight that.
SPEAKER_01And that's exactly what's happening here. I mean, I love that you said that because really the medical Medical clinics that utilize medication to support recovery, we're like the go-to here because there is so much friction and controversy. And we have like a MARA group, we're getting ready to start two all recovery meetings in March. And uh, and one of the things we're known for in the community is that no matter what our meeting is, if it's traditional 12-step narcotics anonymous, everybody's welcome. So we're the we're getting a lot of our referrals from the medication-assisted recovery community, you know. But there's uh so much fear and stigma. I mean, oh my gosh, it just breaks my heart. I mean, these are folks that need recovery as much as anybody. I mean, their chances, the risk involved with opioid use disorder is enormous. And uh, so we've really worked hard to get that out in our community, that we welcome everybody. Nobody is turned away. And uh in the community, it's been such a need here because we still have that. Oh my gosh, that, you know, there's a lot of archaic thinking um around medication and just erroneous information that, you know, you know, still kind of that replacing one drug for another mentality is very strong in some of the 12-step corners. But we're opening up. I mean, you know, I've seen a lot of change. We got a lot more to do, but I am seeing some change in attitudes around that.
SPEAKER_00Seeing people, right? Like it's one thing to have an idea about something, and it's another thing to know a person and know that they're on a different path and how they're choosing that personal connection makes all the difference in understanding something more deeply and and feel differently about it. I think it goes beyond if you use and how much you use. So I think the idea of reducing substance use as a very important outcome has moved the field tremendously. And the studies that show that this is a uh an excellent marker for other improvements downstream has helped a lot. Uh, I think where it becomes interesting for defining the outcome for a recovery community center is that the recovery construct isn't just substance use. It is a multidimensional construct that has to do with your mental health, your uh social environment, that the degree to which your um determinants of health, your social terms of health are met, you know, your living circumstances. So an RCC supports you in all of these dimensions. So if you solely focus on how much they are using and you know, whether or not reduce, that's only a piece of that whole recovery journey. It's a journey to help folks in myth education and attainment, myth job placement, myth um uh, you know, well-being, myth uh social connectedness. It's like all of these other things that are the rich milieu that bring people to recover community centers. It's what they're striving for in recovery. Um, and that needs to be captured and that needs to be celebrated when those progresses are being made. Um, and that's what I think is really needed in terms of determining, you know, what is the the best outcome measure for an RCC, something that really embraces that and captures that and celebrates that.
SPEAKER_02I am pulling up some numbers here, uh, looking at the opioid abatement council and its funding for this first round of uh statewide grants. The number one category by far in terms of applications that applied was recovery support at 37%, uh, followed uh behind by treatment at 28%. I expected treatment to be 70, 80%. I was really, really surprised to see recovery support, which would include RCCs, housing, uh, a number of other things, be so strongly represented here in the applications.
SPEAKER_01I'll tell you a little even better, well, not better news, but really good news around that too. I was just in the OAC meeting yesterday. They restructured the funding pie chart, you know, who's getting how much of the funds. Recovery support services were number two. So they've uh designated 20% of the funding to go to recovery support service proposals, and then like 30% to treatment. So we were recovery support is really being recognized and valued.
SPEAKER_02Yeah, that is a massive shift. And it is good that that original uh percentage that the OAC had pinned on treatment was 40%. And the thinking was uh that because treatment is so expensive, it would need a significant uh amount of the money. And there's of course still truth to that, a treatment is expensive, but yeah, to shift away to to bolster the funding for recovery support services really does reflect not only phenomenal. Yeah, it's it's really a pleasant surprise. Uh I was wondering if you two could reflect on on how these attitudes are changing uh at these levels.
SPEAKER_00So I will say that you know, when we did our survey, we asked the question about how long has your RCC been open. And for more than half of uh our RCC directors, it's been less than five years that they have been operation. So there's like this tremendous growth in RCCs. And since our survey, you know, we conducted our study for a year trying to track on everybody, and I'm sure we didn't we missed many folks. Um, so there's more out there than we know. Um but you know, the the there's been many more that have been uh opening since then. So I can only speak for Massachusetts, where I know the numbers a little more concretely, that we went from like I believe it was eight RCCs in 2004 or 2008, and now we have 39 funded RCCs. Um that's a tremendous uh investment there. And it's not the only state, there's other states that have gone through similarly explosive growth phases in terms of supporting um in recovery community centers. And why I personally find that really exciting is because many people who might not go into treatment, who might not seek formal treatment, they will walk for the doors of an RCC and they will say, let me check it out. So we are now reaching through these recovery community centers, folks that haven't had help before, that haven't had support. It's a much wider net that is being cast, it's much more accessible.
SPEAKER_02It seems to me that really one of the biggest benefits is that engaging space, that that space and context wherein people can just have fun, frankly. Um I I know it sounds silly, but uh in today's day and age, it's really hard to have fun without some sort of substance being shoved in your face uh through advertising, or or really the only places like it's some some towns, really the only place you can go to have fun is going to be a bar. That can make it very difficult for people in recovery. I see you nodding your head. Young people are having this issue, reporting this issue a lot, that there's not enough ways to engage with their community and have fun in places that aren't extremely expensive or any or or don't involve uh exposure to some sort of substance. And we've seen at the user level that boredom, lack of uh loneliness, that lack of engagement with the community is a major reason for not only initiating but continuing use. I I mean is is this is this a model that not only for just recovery spaces, but for communities in general. You know, it it's beyond an addiction crisis. We're having a loneliness crisis. I mean is this is this something that uh we're rediscovering is is are are these community centers?
SPEAKER_00I I think so. I mean we we've had community centers for hours, you know. Certainly we have uh elder community centers and they serve that purpose of reducing uh loneliness and engaging people. So in that's a model that's worked and which is why we have more of them. And I think it's great. And you know, the fact that an RCC isn't just a you know a service place, it's also a place for information sharing. But then the social aspect, a social place to come together and be connected and to engage in rewarding experiences with others who get you and who respect you and who understand you, and then just doing things together is a is a huge component that I find uh incredibly helpful.
SPEAKER_01It's funny that you said that because when I describe RRCC to people that don't know anything about recovery community centers, I said, well, think about it as the senior center. That's who we are, but for people in recovery. And people get that. Right. You know, in the I think I might have said this earlier in our conversation, but you know, one of the I guess biggest things that we do is really provide that safe, welcoming um environment. We have people that come by, just come by after work, you know, to hang out, get a cup of coffee. And uh, you know, you walk in, and most days you're gonna hear some laughter when you come in because it's just, you know, it's really, we just have a blast. And uh, and people, you know, all the people that are coming through here, the 900 unique folks, the 7,000 people, for the most part, those are people that have not used drugs or alcohol that day and have stayed alive. So, I mean, that's kind of the bottom line is that that's a lot of people that, you know, have at least some hope that day, and most of them are coming back. But here's the here is the absolute coolest thing, I think, about what we've done so far is that by having that presence, we don't require appointments. People can make appointments if they want, but they can just show up anytime they want. The coolest thing is when we have folks that stop by and say, God, I had to come by because I really want to get huh. I was getting ready to, you know, go cop and I remembered y'all were here. You know, we had one guy not long ago say, you know, I was getting ready to go to the ATM and uh I just got paid and take out all my money, and and but I remembered y'all were here. And uh, you know, that for me is like, okay, you know, we're doing some good work.
SPEAKER_02So the biggest takeaways I think then probably sustainability has to be ascertained, that a sense of autonomy, that grassroots ground up, recovery-based, lived experience-based component has to be preserved. And that uh one-size tournament does not fit at all. Okay. Well, I think there's a good takeaway messages, though, uh, for folks. Donna Green, Bettina Hubner, I appreciate you both joining me here today on the Smart Policy Podcast.
SPEAKER_00Hey, thank you for having us, Jeremy.
SPEAKER_02For more episodes on in-depth discussions on Tennessee policies related to substance use disorder by a range of local experts. Please subscribe to us wherever you get podcasts and visit our website at smart.tennest.edu. I'm Jeremy Corvellis. Thank you for listening and see you next month.