Recovering students need support as they transition

Positive results in recovery support are reported among those serving two special populations: college students1 and licensed healthcare and other major professionals.2 But are the staff members working within collegiate recovery programs (CRPs) and professional monitoring organizations (PMOs) aware of each other? When they are, do they effectively collaborate when necessary?

Do these recovery support systems work together in an effective and integrated way? Or are recovering individuals on their own to discover, come to understand, and effectively engage and navigate between these unique systems of support over the course of their academic and professional career? These questions are of vital importance when considering the life trajectory of the individual being served. Consider the path of a student pictured in the hypothetical timeline below.

When viewed from this perspective, it is clearly in the interest of the individual student that addiction treatment professionals, staffs of various undergraduate and graduate wellness programs, and professional monitoring organizations network and collaborate effectively.

Commonalities and differences

Considered separately, CRPs and PMOs both support recovery from addiction with positive effects on remission rates for those they serve. Both CRPs and PMOs have existed for decades, and have developed and refined their respective and relatively unique models of recovery support. At first glance, one sees many aspects of recovery support3 that are shared between these two efforts. CRPs and PMOs both:

• Take a chronic disease/recovery management approach with long-term engagement, rather than acute intervention, as their basic model;

• Follow each individual in an ongoing way, over a period of years, with multiple indicators of progress and regress over time;

• Consider the family, cultural milieu, and person served as collectively central to the focus of service provision;

• Seek to maximize the long-term optimal outcome of the recovering individual, with disease management, recovery management, and overall health, wellness and life function of the person served in focus;

• Provide recovery supports both inside and outside clinical settings, with a special emphasis on service provision within the recovering individual's natural environment; and

• Evaluate service provision and effectiveness for each individual over a number of years.

The long-term recovery support outcomes of both CRPs and PMOs are in no small measure accounted for by these and other powerful structural and functional components.

A closer look, however, reveals key differences between CRPs and PMOs. These differences are important and necessary, given the particular distinctions between the populations they serve. These differences extend to both the philosophical and practical aspects of their work with recovering individuals.

Collegiate recovery communities protect individuals already in recovery from the generally pervasive and toxic threats against sustained addiction recovery found on college campuses. This is accomplished primarily through advocacy, and secondarily through accountability. CRPs excel in providing indigenous recovery support within the student’s milieu, in spite of the nature of the college campus. Their advocacy of and for recovering individuals extends to school administration, yielding positive impacts on academic entrance decisions, academic outcomes, and championing of real fellowship connections and related activities that support ongoing recovery.

The fact that their work takes place on college campuses and is highly effective at supporting recovery should be noticed by other recovery advocates, as their approaches could be extended in some version to other populations in other settings. Accountability may be found within CRPs. Examples may include a required minimum of six months of ongoing sobriety and active addiction recovery within a recovery fellowship for entrance to a collegiate recovery community, as well as ongoing adherence to a set of defined behavioral and academic standards.

Residency wellness programs4 offer a model of support for those in post-graduate training within their respective disciplines. Such efforts counter the significant problems found in that phase of training5 and promote overall wellness. As such, these programs extend recovery support beyond the reach of the undergraduate campus wellness program.

Professional monitoring organizations, by contrast, exist primarily to protect public safety through accountability and support, and secondarily to provide advocacy to their individual participant. PMOs regularly interact with those in the severely symptomatic phase of active and prolonged addiction, as well as those in both early and long-term recovery. They assist in identifying individuals with active addiction, placing them within systems of clinical care when necessary, and ensuring their participation in structures of accountability and support necessary to initiate and sustain recovery.

To achieve this, PMOs implement systems of accountability that promote behavioral compliance with formal treatment, compliance with recovery requirements, and long-term monitoring systems that include toxicology testing and perhaps workplace monitors. PMOs often encourage self-reporting of a need for help (vs. disciplinary action) as well as the participant’s ongoing compliance. Advocacy efforts can result, given the facts relevant to each participant and the policies and state laws that bear on each PMO. Advocacy may include helping to maintain the participant’s anonymity relative to his/her licensing board, encouraging access to legal assistance, and representing the participant before the relevant licensing board or other stakeholder organization (e.g., a hospital wellness committee chair, a human resources director, an employee assistance program, etc.).

Questions to ask

A person may choose a profession in healthcare or law. That person may one day enter systems of addiction treatment, undergraduate and graduate studies, and finally a professional monitoring organization. Caveats abound:

• Does the undergraduate campus wellness or CRP staff have knowledge of a graduate wellness program at the graduate learning institution of their participant’s choice, and is a handoff completed?

• Has the relevant PMO made itself and its policies and procedures known to CRP staff and graduate wellness staff within its state?

• Are formal addiction treatment programs aware of the phases of illness and recovery addressed by CRPs and PMOs, and are they effective at educating and promoting engagement with these advocacy and accountability systems for those they serve?

• Are the vested interests of treatment organizations, CRPs and PMOs narrowly adhered to by their respective staff members (given their policy differences), or do these organizations collaborate actively for the unified purpose of assisting people over the long term, in spite of differences in organizational focus and mission?

One may wonder about the potential positive impacts for the person served from developing understanding and collaboration among these systems of addiction treatment, recovery support and advocacy. Research opportunities present themselves in this context. For example, what helpful impacts are made by which mechanisms of support across these systems over time? Both quantitative and qualitative research examining the trajectory of these nascent professionals would be helpful to our field. Stages of recovery within their developmental contexts both personally and professionally may emerge from such inquiries. Such information might lead to improvements in our efforts to assist.

In the meantime, those of us serving in these various organizations should be informed as to the mission, philosophies and practices across these support systems, and should collaborate strongly and effectively for those we serve.

Brian Coon is Director of Clinical Programs at Pavillon in Mill Spring, N.C. He is a licensed clinical addictions specialist with more than 25 years of experience in addressing co-occurring substance use and mental health disorders in roles ranging from clinician to clinical supervisor and manager of multiple treatment programs. His e-mail address is brianc@pavillon.org.

References

1. Laudet A, Harris K, Kimball T, et al. Collegiate Recovery Communities Programs: What do we know and what do we need to know? J Soc Work Pract Addict 2014;14:84-100.

2. DuPont RL McLellan AT, White WL, et al. Setting the standard for recovery: Physicians’ Health Programs. J Subst Abuse Treat 2009;36:159-71.

3. White W, Boyle M, Loveland D. Addiction as chronic disease: From rhetoric to clinical application. Alcohol Treat Q 2003;3:107-30.

4. Lefebvre DC. Perspective: Resident physician wellness: a new hope. Acad Med 2012;87:598-602.

5. West CP, Shanafelt TD, Kolars JC. Quality of life, burnout, educational debt, and medical knowledge among internal medicine residents. JAMA 2011;306):952-60.