SAFE Solutions - User contributions [en]

Strengthen Collegiate Recovery Programs

2024-04-02T14:18:49Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''All-Recovery Meeting/”Self-Healers Book Club” curriculum - Collegiate Recovery Program at Florida State University''' This curriculum comes from the book How To Do The Work by Dr. Nicole LePera, a clinical psychologist. The text offers readers the support and tools that will allow them to break free from destructive behaviors to reclaim and recreate their lives. Nothing short of a paradigm shift, this is a celebration of empowerment that will forever change the way we approach mental wellness and self-care. <ref>https://drive.google.com/file/d/1uGHfCUm0Lgn6MW-N4H83AGZr6Mf3_I88/view</ref>

*'''American College Health Assocation (ACHA): National College Health Assessment 2022''' We often cite the statistic that 2.2% of all college students identify in recovery. Find that datapoint on page 36 of this document alongside a breadth and depth of additional student health data. If your campus participates in this survey, please use your data instead. <ref>https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_REFERENCE_GROUP_DATA_REPORT.pdf</ref>

*'''Best Practices Guide - ARHE''' This document is intended to help you get started in your planning process. Since every campus has its own unique culture, this document is not intended to be a step-by-step how-to guide, but rather it is something every school can adapt in its own way in order to meet the needs of students in recovery on that campus. <ref>https://collegiaterecovery.org/wp-content/uploads/2021/08/Collegiate-Recovery-Best-Practice-Guide.pdf</ref>

*'''Collegiate Recovery Community Replication Model - Mississippi State University''' Collegiate recovery programs are incredibly diverse (and increasingly so). These resources, and the next one, provide some context for how large southern campuses have established their programs. “The Collegiate Recovery Community offers comprehensive support services for recovering students by embracing a wellness approach. Choosing to focus on recovery enhancement as the best way to prevent recurrence of use allows the CRC to provide the programs and initiatives needed to enhance a student's recovery program. The following information is intended to assist partners in this recovery work.<ref>https://drive.google.com/file/d/1ifTnN6Ffd0ZkXaCpvMwP3I4TPpN44mT2/view</ref>

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''Recovery Bingo - Florida State University Center for Health Advocacy & Wellness''' This is a great activity that could be used to build community in the CRC/P or as an outreach activity with student orgs across campus. The team at FSU presented this activity at the annual SCHA meeting. APA citation: Cryderman, Jacob. J, Thompson, Zabe., Shore, C.D., Gundrum, G., Gomez, M., (2023, March 8th – 10th). Alcohol and Other Drugs Bingo: Gamifying Health Education [Presentation – Breakout Session]. 2023 Southern College Health Association Annual Meeting in Greenville, North Carolina, United States of America. <ref>https://drive.google.com/file/d/1srLJKBqlshPADuOHBu2Rw1WLDmFKlmEx/view</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Making the Case: Fostering buy-in for recovery support. A slideshow from 2022 Summer Series that summarizes approaches to collegiate recovery advocacy among professionals and potential partners. This serves a similar role as the week 3 worksheet in the 2023 Summer Series. <ref>https://www.canva.com/design/DAFCUnEqJUA/2coDbLD5LNwF-SngErzuew/view?utm_content=DAFCUnEqJUA&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Support Not Stigma.This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources/strategy. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Where are the students: Students, Outreach & Recruitment. A slideshow from summer of 2022 that summarizes the tensions, barriers, and approaches related to student engagement with collegiate recovery initiatives. <ref>https://www.canva.com/design/DAFCUn0slNE/SEiSodRZ-kJJRXiqWk7zhw/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''Substance Use Disorder, Collegiate Recovery, & Student Accommodations - SAFE Project + AHEAD''' This slideshow, presented as part of the 2021 Association on Higher Education and Disability’s Fall Webinar Series, overviewed the relationship between disability law, substance use disorder, recovery, and student accommodations. <ref>https://www.canva.com/design/DAEsFbVT9sk/-l7kCdukKVWPrXr2fXq4PA/view?utm_content=DAEsFbVT9sk&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink#1</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-04-02T14:12:31Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''All-Recovery Meeting/”Self-Healers Book Club” curriculum - Collegiate Recovery Program at Florida State University''' This curriculum comes from the book How To Do The Work by Dr. Nicole LePera, a clinical psychologist. The text offers readers the support and tools that will allow them to break free from destructive behaviors to reclaim and recreate their lives. Nothing short of a paradigm shift, this is a celebration of empowerment that will forever change the way we approach mental wellness and self-care. <ref>https://drive.google.com/file/d/1uGHfCUm0Lgn6MW-N4H83AGZr6Mf3_I88/view</ref>

*'''American College Health Assocation (ACHA): National College Health Assessment 2022''' We often cite the statistic that 2.2% of all college students identify in recovery. Find that datapoint on page 36 of this document alongside a breadth and depth of additional student health data. If your campus participates in this survey, please use your data instead. <ref>https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_REFERENCE_GROUP_DATA_REPORT.pdf</ref>

*'''Best Practices Guide - ARHE''' This document is intended to help you get started in your planning process. Since every campus has its own unique culture, this document is not intended to be a step-by-step how-to guide, but rather it is something every school can adapt in its own way in order to meet the needs of students in recovery on that campus. <ref>https://collegiaterecovery.org/wp-content/uploads/2021/08/Collegiate-Recovery-Best-Practice-Guide.pdf</ref>

*'''Collegiate Recovery Community Replication Model - Mississippi State University''' Collegiate recovery programs are incredibly diverse (and increasingly so). These resources, and the next one, provide some context for how large southern campuses have established their programs. “The Collegiate Recovery Community offers comprehensive support services for recovering students by embracing a wellness approach. Choosing to focus on recovery enhancement as the best way to prevent recurrence of use allows the CRC to provide the programs and initiatives needed to enhance a student's recovery program. The following information is intended to assist partners in this recovery work.<ref>https://drive.google.com/file/d/1ifTnN6Ffd0ZkXaCpvMwP3I4TPpN44mT2/view</ref>

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Making the Case: Fostering buy-in for recovery support. A slideshow from 2022 Summer Series that summarizes approaches to collegiate recovery advocacy among professionals and potential partners. This serves a similar role as the week 3 worksheet in the 2023 Summer Series. <ref>https://www.canva.com/design/DAFCUnEqJUA/2coDbLD5LNwF-SngErzuew/view?utm_content=DAFCUnEqJUA&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Support Not Stigma.This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources/strategy. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Where are the students: Students, Outreach & Recruitment. A slideshow from summer of 2022 that summarizes the tensions, barriers, and approaches related to student engagement with collegiate recovery initiatives. <ref>https://www.canva.com/design/DAFCUn0slNE/SEiSodRZ-kJJRXiqWk7zhw/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''Substance Use Disorder, Collegiate Recovery, & Student Accommodations - SAFE Project + AHEAD''' This slideshow, presented as part of the 2021 Association on Higher Education and Disability’s Fall Webinar Series, overviewed the relationship between disability law, substance use disorder, recovery, and student accommodations. <ref>https://www.canva.com/design/DAEsFbVT9sk/-l7kCdukKVWPrXr2fXq4PA/view?utm_content=DAEsFbVT9sk&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink#1</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-04-02T14:08:56Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''All-Recovery Meeting/”Self-Healers Book Club” curriculum - Collegiate Recovery Program at Florida State University''' This curriculum comes from the book How To Do The Work by Dr. Nicole LePera, a clinical psychologist. The text offers readers the support and tools that will allow them to break free from destructive behaviors to reclaim and recreate their lives. Nothing short of a paradigm shift, this is a celebration of empowerment that will forever change the way we approach mental wellness and self-care. <ref>https://drive.google.com/file/d/1uGHfCUm0Lgn6MW-N4H83AGZr6Mf3_I88/view</ref>

*'''American College Health Assocation (ACHA): National College Health Assessment 2022''' We often cite the statistic that 2.2% of all college students identify in recovery. Find that datapoint on page 36 of this document alongside a breadth and depth of additional student health data. If your campus participates in this survey, please use your data instead. <ref>https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_REFERENCE_GROUP_DATA_REPORT.pdf</ref>

*'''Collegiate Recovery Community Replication Model - Mississippi State University''' Collegiate recovery programs are incredibly diverse (and increasingly so). These resources, and the next one, provide some context for how large southern campuses have established their programs. “The Collegiate Recovery Community offers comprehensive support services for recovering students by embracing a wellness approach. Choosing to focus on recovery enhancement as the best way to prevent recurrence of use allows the CRC to provide the programs and initiatives needed to enhance a student's recovery program. The following information is intended to assist partners in this recovery work.<ref>https://drive.google.com/file/d/1ifTnN6Ffd0ZkXaCpvMwP3I4TPpN44mT2/view</ref>

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Making the Case: Fostering buy-in for recovery support. A slideshow from 2022 Summer Series that summarizes approaches to collegiate recovery advocacy among professionals and potential partners. This serves a similar role as the week 3 worksheet in the 2023 Summer Series. <ref>https://www.canva.com/design/DAFCUnEqJUA/2coDbLD5LNwF-SngErzuew/view?utm_content=DAFCUnEqJUA&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Support Not Stigma.This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources/strategy. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Where are the students: Students, Outreach & Recruitment. A slideshow from summer of 2022 that summarizes the tensions, barriers, and approaches related to student engagement with collegiate recovery initiatives. <ref>https://www.canva.com/design/DAFCUn0slNE/SEiSodRZ-kJJRXiqWk7zhw/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''Substance Use Disorder, Collegiate Recovery, & Student Accommodations - SAFE Project + AHEAD''' This slideshow, presented as part of the 2021 Association on Higher Education and Disability’s Fall Webinar Series, overviewed the relationship between disability law, substance use disorder, recovery, and student accommodations. <ref>https://www.canva.com/design/DAEsFbVT9sk/-l7kCdukKVWPrXr2fXq4PA/view?utm_content=DAEsFbVT9sk&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink#1</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-04-02T14:04:09Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''American College Health Assocation (ACHA): National College Health Assessment 2022''' We often cite the statistic that 2.2% of all college students identify in recovery. Find that datapoint on page 36 of this document alongside a breadth and depth of additional student health data. If your campus participates in this survey, please use your data instead. <ref>https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_REFERENCE_GROUP_DATA_REPORT.pdf</ref>

*'''Collegiate Recovery Community Replication Model - Mississippi State University''' Collegiate recovery programs are incredibly diverse (and increasingly so). These resources, and the next one, provide some context for how large southern campuses have established their programs. “The Collegiate Recovery Community offers comprehensive support services for recovering students by embracing a wellness approach. Choosing to focus on recovery enhancement as the best way to prevent recurrence of use allows the CRC to provide the programs and initiatives needed to enhance a student's recovery program. The following information is intended to assist partners in this recovery work.<ref>https://drive.google.com/file/d/1ifTnN6Ffd0ZkXaCpvMwP3I4TPpN44mT2/view</ref>

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Making the Case: Fostering buy-in for recovery support. A slideshow from 2022 Summer Series that summarizes approaches to collegiate recovery advocacy among professionals and potential partners. This serves a similar role as the week 3 worksheet in the 2023 Summer Series. <ref>https://www.canva.com/design/DAFCUnEqJUA/2coDbLD5LNwF-SngErzuew/view?utm_content=DAFCUnEqJUA&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Support Not Stigma.This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources/strategy. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Where are the students: Students, Outreach & Recruitment. A slideshow from summer of 2022 that summarizes the tensions, barriers, and approaches related to student engagement with collegiate recovery initiatives. <ref>https://www.canva.com/design/DAFCUn0slNE/SEiSodRZ-kJJRXiqWk7zhw/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''Substance Use Disorder, Collegiate Recovery, & Student Accommodations - SAFE Project + AHEAD''' This slideshow, presented as part of the 2021 Association on Higher Education and Disability’s Fall Webinar Series, overviewed the relationship between disability law, substance use disorder, recovery, and student accommodations. <ref>https://www.canva.com/design/DAEsFbVT9sk/-l7kCdukKVWPrXr2fXq4PA/view?utm_content=DAEsFbVT9sk&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink#1</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-04-02T13:59:15Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''American College Health Assocation (ACHA): National College Health Assessment 2022''' We often cite the statistic that 2.2% of all college students identify in recovery. Find that datapoint on page 36 of this document alongside a breadth and depth of additional student health data. If your campus participates in this survey, please use your data instead. <ref>https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_REFERENCE_GROUP_DATA_REPORT.pdf</ref>

*'''Collegiate Recovery Community Replication Model - Mississippi State University''' Collegiate recovery programs are incredibly diverse (and increasingly so). These resources, and the next one, provide some context for how large southern campuses have established their programs. “The Collegiate Recovery Community offers comprehensive support services for recovering students by embracing a wellness approach. Choosing to focus on recovery enhancement as the best way to prevent recurrence of use allows the CRC to provide the programs and initiatives needed to enhance a student's recovery program. The following information is intended to assist partners in this recovery work.<ref>https://drive.google.com/file/d/1ifTnN6Ffd0ZkXaCpvMwP3I4TPpN44mT2/view</ref>

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Making the Case: Fostering buy-in for recovery support. A slideshow from 2022 Summer Series that summarizes approaches to collegiate recovery advocacy among professionals and potential partners. This serves a similar role as the week 3 worksheet in the 2023 Summer Series. <ref>https://www.canva.com/design/DAFCUnEqJUA/2coDbLD5LNwF-SngErzuew/view?utm_content=DAFCUnEqJUA&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Support Not Stigma.This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources/strategy. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Where are the students: Students, Outreach & Recruitment. A slideshow from summer of 2022 that summarizes the tensions, barriers, and approaches related to student engagement with collegiate recovery initiatives. <ref>https://www.canva.com/design/DAFCUn0slNE/SEiSodRZ-kJJRXiqWk7zhw/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-04-02T13:55:28Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''American College Health Assocation (ACHA): National College Health Assessment 2022''' We often cite the statistic that 2.2% of all college students identify in recovery. Find that datapoint on page 36 of this document alongside a breadth and depth of additional student health data. If your campus participates in this survey, please use your data instead. <ref>https://www.acha.org/documents/ncha/NCHA-III_FALL_2022_REFERENCE_GROUP_DATA_REPORT.pdf</ref>

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Making the Case: Fostering buy-in for recovery support. A slideshow from 2022 Summer Series that summarizes approaches to collegiate recovery advocacy among professionals and potential partners. This serves a similar role as the week 3 worksheet in the 2023 Summer Series. <ref>https://www.canva.com/design/DAFCUnEqJUA/2coDbLD5LNwF-SngErzuew/view?utm_content=DAFCUnEqJUA&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Support Not Stigma.This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources/strategy. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Where are the students: Students, Outreach & Recruitment. A slideshow from summer of 2022 that summarizes the tensions, barriers, and approaches related to student engagement with collegiate recovery initiatives. <ref>https://www.canva.com/design/DAFCUn0slNE/SEiSodRZ-kJJRXiqWk7zhw/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-04-02T13:31:16Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Making the Case: Fostering buy-in for recovery support. A slideshow from 2022 Summer Series that summarizes approaches to collegiate recovery advocacy among professionals and potential partners. This serves a similar role as the week 3 worksheet in the 2023 Summer Series. <ref>https://www.canva.com/design/DAFCUnEqJUA/2coDbLD5LNwF-SngErzuew/view?utm_content=DAFCUnEqJUA&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Support Not Stigma.This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources/strategy. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Where are the students: Students, Outreach & Recruitment. A slideshow from summer of 2022 that summarizes the tensions, barriers, and approaches related to student engagement with collegiate recovery initiatives. <ref>https://www.canva.com/design/DAFCUn0slNE/SEiSodRZ-kJJRXiqWk7zhw/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-04-02T13:24:26Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAFE Project.''' Support Not Stigma.This slideshow was presented by the SAFE Campuses team at the 2023 NASPA Annual Meeting. The session covered the history of recovery ally trainings around the country, provided a content preview, shared the impact of these sessions, and gave implementation resources/strategy. <ref>https://www.canva.com/design/DAFdMYgYX1I/cWIHQhyaXJqdFbyk8oSBVQ/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-03-29T15:19:53Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page.<ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAFE Project.''' Recovery Allyship Training Slides. This slide deck has been developed at SAFE Project since 2019 with a strong focus on stigma reduction and understanding recovery inclusion. This training can be implemented on any campus, and our team is willing to collaborate on “Training of Trainers” and co-branding these resources. <ref>https://www.canva.com/design/DAFQ0qNAhto/QpTNSLfudJs5rXOf-A-kOg/view?utm_content=DAFQ0qNAhto&utm_campaign=designshare&utm_medium=link&utm_source=publishsharelink</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Expand Harm Reduction Practices

2024-03-29T15:07:33Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Axios: Why more states are decriminalizing fentanyl test strips''' This quick overview provides insight into the rapidly shifting landscape around fentanyl testing strips around the nation. A large amount of additional resources are linked. <ref>https://www.axios.com/2023/04/20/red-states-drug-use-fentanyl-test-strips</ref>
* '''Dance Safe''' Introducing a new and improved Fentanyl Test Strip for the Harm Reduction Community. <ref>https://dancesafe.org/fentanyl/</ref>
* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''International Journal of Drug Policy: Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: Evidence from 44 US states''' “Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.” <ref>https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''Next Distro''' An online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.<ref>https://nextdistro.org/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities''' This online training models an approach to educating folks about fentanyl. The content of this training is available for reproduction and localized implementation. Contact Dylan for more information. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''SAMHSA: Harm Reduction Framework''' This is the first document to comprehensively outline harm reduction and its role within the Department of Health and Human Services (HHS). The Framework was developed and written in partnership with the Harm Reduction Steering Committee, composed of harm reduction leaders from around the country. This group represents a broad array of backgrounds and experience, with most having lived experience of drug use. This document includes a definition of harm reduction, pillars and principles supporting that definition, and core practices that SAMHSA can support. <ref>https://www.samhsa.gov/sites/default/files/harm-reduction-framework.pdf</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides a vulnerable account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. These experiences aren’t often explored in our on-campus work.<ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>
* '''WTFentanyl''' Physician experts in poisoning and emergency care created this site to correct fentanyl misinformation online. We are tired of seeing lies and misinformation spread like wildfire. <ref>https://wtfentanyl.com/#about</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-03-29T15:02:23Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Axios: Why more states are decriminalizing fentanyl test strips''' This quick overview provides insight into the rapidly shifting landscape around fentanyl testing strips around the nation. A large amount of additional resources are linked. <ref>https://www.axios.com/2023/04/20/red-states-drug-use-fentanyl-test-strips</ref>
* '''Dance Safe''' Introducing a new and improved Fentanyl Test Strip for the Harm Reduction Community. <ref>https://dancesafe.org/fentanyl/</ref>
* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''International Journal of Drug Policy: Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: Evidence from 44 US states''' “Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.” <ref>https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''Next Distro''' An online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.<ref>https://nextdistro.org/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities''' This online training models an approach to educating folks about fentanyl. The content of this training is available for reproduction and localized implementation. Contact Dylan for more information. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides a vulnerable account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. These experiences aren’t often explored in our on-campus work.<ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>
* '''WTFentanyl''' Physician experts in poisoning and emergency care created this site to correct fentanyl misinformation online. We are tired of seeing lies and misinformation spread like wildfire. <ref>https://wtfentanyl.com/#about</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Strengthen Collegiate Recovery Programs

2024-03-29T14:42:31Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page. <ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''UC Davis Health: Can fentanyl be absorbed through your skin?.''' “UC Davis Health toxicology expert dispels myths around fentanyl exposure” <ref>https://health.ucdavis.edu/news/headlines/can-fentanyl-be-absorbed-through-your-skin/2022/10</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Expand Harm Reduction Practices

2024-03-29T14:39:22Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Axios: Why more states are decriminalizing fentanyl test strips''' This quick overview provides insight into the rapidly shifting landscape around fentanyl testing strips around the nation. A large amount of additional resources are linked. <ref>https://www.axios.com/2023/04/20/red-states-drug-use-fentanyl-test-strips</ref>
* '''Dance Safe''' Introducing a new and improved Fentanyl Test Strip for the Harm Reduction Community. <ref>https://dancesafe.org/fentanyl/</ref>
* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''International Journal of Drug Policy: Naloxone expansion is not associated with increases in adolescent heroin use and injection drug use: Evidence from 44 US states''' “Naloxone access laws and pharmacy naloxone distribution were more consistently associated with decreases rather than increases in lifetime heroin and IDU among adolescents. Our findings therefore do not support concerns that naloxone access promotes high-risk adolescent substance use behaviors. As of 2019, all US states have adopted legislation to improve naloxone access and facilitate use. However, further removal of adolescent naloxone access barriers is an important priority given that the opioid epidemic continues to affect people of all ages.” <ref>https://www.sciencedirect.com/science/article/abs/pii/S0955395923000294</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''Next Distro''' An online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.<ref>https://nextdistro.org/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities''' This online training models an approach to educating folks about fentanyl. The content of this training is available for reproduction and localized implementation. Contact Dylan for more information. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides a vulnerable account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. These experiences aren’t often explored in our on-campus work.<ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Strengthen Collegiate Recovery Programs

2024-03-29T14:26:42Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''Inside Higher Ed (IHE): Students Are Learning to Stop Opioid Overdoses''' “As concerns grow over the presence of fentanyl and other opiates on campus, more colleges and universities are making the overdose-reversal drug naloxone widely available.” This article shares a number of perspectives from folks doing this work on campus <ref>https://www.insidehighered.com/news/2022/08/15/narcan-increasingly-common-college-campuses</ref>

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page. <ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Advocate for Policy Change

2024-03-29T14:21:51Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Educating policymakers and the general public about the legislative or policy changes necessary to create change in your community is an important step to addressing substance misuse and substance use disorder (SUD). Policies help states and local communities in several important ways:

1. By providing direct funding to communities for treatment and other services. 2. By improving access and/or affordability of care to individuals in need of assistance. 3. By removing barriers that prevent or limit the use of best practices across government agencies.

Policy change can take place at all levels of government. This page will provide information about how policy changes typically take place, as well as some examples of federal, state, and local laws that have helped local communities.

= Key Information =

'''Initial Steps for Policy Advocacy''' In order to bring about policy changes through laws or ordinances, any group of citizens must be able to become a "constituency of consequence" to those with the ability to create and change policy. This can be accomplished with a number of different advocacy approaches, as highlighted below. A few key principles to change policy at any level of government include:

*Have clear policy objectives. The more specific and narrow the objective the better. If the policy goals are too broad or general, it is easy for legislators to object on that basis.
*Support your position. Have research and data to support why the policy change you are seeking would be beneficial. For example, if seeking to improve harm reduction through the creation of a needle exchange program, provide data on expected lives that will be saved, reduced medical costs, improved linkages to care, and other benefits.
*Build a coalition. It is important to build a coalition to increase political clout. Think about other groups within the state or local community whose goals align with yours that would support your policy objectives and who would be willing to take action in order to achieve them. For example, if you were advocating for a needle exchange program, you might seek support from harm reduction organizations including hospitals, community health organizations and professionals, the recovery community, families in support of recovery, the treatment community, and potentially many others.
*Know your opposition. If a policy change hasn't happened, it is likely opposition exists. It is important to learn why policymakers may be hesitant to make a certain change, including what groups oppose the policy and why. Learning about the other side is critical to developing an effective advocacy strategy. Overcoming opposition may require education, effective counterarguments, financial resources, and increased public awareness.
*Identify champions. The most successful efforts resulting in desired policy changes are led by individuals who are passionate about the issue. Identifying and working with champions in the state or local government is a big key to success. It is important to have people "on the inside" that can hold hearings, develop legislation, utilize input and information from stakeholders, and provide insight on the process.
*Your voice matters. Many times, individuals or groups with minimal advocacy experience can be intimidated by the process. Remember that those "in power" are there because they were elected to serve. Lawmakers across all levels of government represent the people of their states, districts, cities, towns, and so forth. It is your constitutional right to petition the government and be heard. Those representing the people need to hear the concerns of all those they represent.

'''Converting Policy Into Action''' After taking the initial steps delineated above, the next step is to identify and implement a set of strategies that will grow public and political support for those policies. While approaches and specific strategies are almost innumerable, taking action involves communication and messaging intended to educate and influence.

'''Grassroots Advocacy''' Grassroots Advocacy generally refers to engaging the public to actively educate and lobby on behalf of a desired policy objective. Communication occurs through letters, emails, calls to legislators, rallies, social media campaigns, letters to the editor, and other forms of messaging campaigns designed to put political pressure on policymakers to enact desired changes.

'''Direct Lobbying''' Direct lobbying refers to direct communication and meetings with policy makers at all levels of government, including governors, mayors, county executives, and the legislative branch. This key activity provides the opportunity to meet with decision makers and their staff to gauge the receptiveness of the policymakers and to discuss the desired policy goals, benefits, support, and potential points of opposition. Opportunities for direct lobbying often take place during the legislative session, which varies from jurisdiction to jurisdiction. Some advocates and interest groups will organize a "lobby day" where members converge in Washington, state capitols, or with local legislative bodies to advocate for desired policy objectives. When the legislative body is not in session, advocates can meet with their representatives at their local offices.

'''Lobbying Rules and Restrictions''' Lobbying rules vary widely between levels of government and across all states. Therefore, it is important to know how lobbying is defined and what the restrictions are in the jurisdiction you are involved with. Some fundamentals include:

* 501(c)3 organizations (tax-exempt nonprofits) have some restrictions on lobbying in the government.

* The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with: Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation" and as "Referring to specific legislation and reflects a view on such legislation."

* The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof."

* Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation."

'''The Legislative Process''' The legislative process varies between different levels of governments and in jurisdictions across the country. There are typically several steps in the process that provide opportunities to influence policymakers, such as when they are in session. Some states and localities have relatively short time frames to consider and pass new laws or ordinances, while other states and the federal government are in session for many more weeks throughout the year. It is important to know when the actual work of policy development and consideration takes place in the legislative body where you want the change to happen.

'''Sponsors and Early Support''' In any legislative body, a successful policy enactment starts with one or more members of the legislative body drafting legislation that would bring about the desired change. Members can do this individually or as a group. A group of members that introduce a legislative proposal are typically referred to as sponsors or "original" sponsors of the proposal. Other members can then sign on in support of the bill as co-sponsors.

Effective advocacy can help build momentum for a bill during this process. The more sponsors and cosponsors, the better. It is also extremely beneficial to have early supporters from both political parties - especially at the state and federal level. Bipartisan support, and support among a broad base of members at the local level, can show other members that the bill is not likely to be controversial. It is also especially helpful to have support for the proposed legislation from key leaders of the committees with jurisdiction.

Advocates can provide their champions within the legislature with all of the supporting information and research to help their champions in the legislative body attract as many co-sponsors as possible and to respond to questions or objections as they arise.

'''Committee Process''' Typically, legislative proposals are taken up by the committee (or committees) of jurisdiction. Actual consideration of a proposal often takes place after one or more committee hearings on the proposal. This often involves hearing from witnesses in support of, and potentially in opposition to, a given proposal. Written testimony is also included in the public record to provide additional information to both the public and the legislators. The hearing process provides another opportunity for advocates to testify as witnesses and/or provide information to be included in the record. Hearing can take place in front of the full committee or by a sub-committee which oversees the specific policy area impacted.

After the hearing process, the bill may be taken up by the full committee for consideration. Although the bill can be altered by the manager of the bill at any time, consideration by the committee is the first time lawmakers have an opportunity to propose amendments to the proposal. These amendments are voted and adopted, or not adopted, by a majority vote. Following the amendment process the committee chair can call for a final vote on the legislation. If passed, the bill can move to the full legislative body for consideration.

Advocacy efforts can move quickly during the committee process, as unexpected challenges may surface due to an unfriendly amendment that might weaken the bill and the policy impact desired. It is important to work with allies to carefully track this process and respond to any negative developments.

'''Consideration by the Full Body''' At the local level, there is a single body that approves local legislative proposals. This is typically a Board of Commissioners or other duly elected body. At the state and federal levels, there are two legislative chambers, with delegates and senators at the state level, and the House and Senate at the federal level.

The process is usually relatively simple at the local level. Legislation (or ordinance) proposals are taken up at regularly scheduled meetings where a debate occurs, amendments are offered, and the proposals are voted on. Often, the chief executive at the local level has a vote along with the other members.

At the state and federal level, the process is more complex. A bill has to pass both chambers before it can be reconciled, voted on again by both bodies, and sent to the Governor or President for signature. While on the floor, members can again offer amendments that can be voted on individually or "en bloc" as two amendments in one. Typically, more controversial amendments will be voted on by individual basis. Assuming the bill passes, it is sent to the other body for consideration. A similar or identical bill may be in process in that other chamber already, or it may be that no companion legislation exists. In the latter case the chamber that did not originate the bill will take up the version that was passed in the other chamber.

When a bill does pass both chambers, there are almost always differences that must be worked out. The committee chairs will select a reconciliation committee with a bi-partisan group of legislators from both chambers to accomplish this. Assuming any differences can be worked out, the bill then goes back to the floor of each chamber for a final vote. If passed, the bill is finally referred to the Governor or President.

As with the Committee process, advocacy must continue throughout the time in which a bill is considered by the full legislative body. At the state and federal levels, this can be a challenge with many steps involved and a larger number of legislators to contend with - some of whom may not be supportive. Again, it is critical to stay in constant contact with supporters within the legislative body to keep track of potential harmful amendments and keep count of likely supporters within the full body. At times advocacy efforts need to be focused on a handful of legislators who have reservations or are undecided.

'''Potential Veto and Override''' Although rare, Governors and the President may veto a bill passed by the state and federal legislators. If the vote on final passage was close, it is unlikely that the bill will be taken up again, as a two-thirds majority is needed to override a veto. If the original vote approached the two-thirds number, there is a better chance to find the supporters needed for a successful override.

'''Continued Funding (Budget and Appropriations)''' Even when a law or ordinance is passed and signed by the chief executive, advocacy efforts often do not end. This is due to the fact that legislation containing funding to implement programs is authorized (usually for a period of years), but there is still a budget and appropriations process that must be monitored over the authorization period. Typically, the executive branch of government produces an annual budget that reflects their policy and spending priorities. The budget may or may not be approved by the legislative body. After this point the legislative body will take up annual appropriations bills, which set spending levels for all agencies and their programs. These bills often work through the regular order of other legislation, but sometimes will have a different, often expedited process.
It is important for community coalitions and advocates to understand that funding for the agencies and programs they support can change through each step of the budget and appropriations process. There is a need to stay vigilant to ensure that full funding is achieved. Advocates must stay in touch with their champions in the executive branch and legislature to keep informed of any changes and be ready to advocate just as vigorously in order to restore any proposed cuts in funding.

= Impactful Federal, State, and Local Policies =

Governments at all levels will frequently create their own set of policy goals to address a particular issue. This has been true for several public health issues including the current opioid epidemic. This process typically involves bringing numerous stakeholders together to provide education and input in coordination with government representatives who initiate the process and finalize the set of policy objectives.

States and localities vary widely on what types of laws are implemented across multiple policy areas. <ref>https://www.fda.gov/media/147152/download</ref> Below are a few examples that can provide your community coalition with some ideas on what has been successful in a variety of policy initiatives. This policy inventory begins with two major federal actions, then provides a variety of initiatives that are organized by specific topic, and closes with an example of a successful advocacy process in Illinois.

'''Biden-Harris Drug Policy Priorities''' <ref>https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84&utm_source=Faces+%26+Voices+of+Recovery&utm_campaign=1c12da631e-november-2020-advocacy-policy_COPY_01&utm_medium=email&utm_term=0_3410cda480-1c12da631e-382685157</ref> - On April 1, 2021, President Biden and Vice President Harris released their administration's Drug Policy Priorities for the upcoming year. President Biden made clear that addressing the overdose and addiction epidemic was an urgent priority for his administration.

Priorities include:

*Expanding access to evidence-based treatment
*Advancing racial equity issues in our approach to drug policy
*Enhancing evidence-based harm reduction efforts
*Supporting evidence-based prevention efforts to reduce youth substance use
*Reducing the supply of illicit substances
*Advancing recovery-ready workplaces and expanding the addiction workforce
*Expanding access to recovery support services

'''Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis'''

*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Mandate Prescriber Education
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions;
*Equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses versus physical health diagnoses.

'''Prevention and Reduced Access to Prescription Medications'''

*New Jersey - New Jersey's Prescription Monitoring Program <ref>https://www.njconsumeraffairs.gov/pmp/</ref>
*California (Alameda County) - Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<ref>https://library.municode.com/ca/alameda_county/codes/code_of_ordinances?nodeId=TIT6HESA_CH6.53ALCOSADRDIOR</ref>
*Connecticut - Statute <ref>https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm</ref>enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.
*Illinois - Statute enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<ref>https://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf</ref>

'''Harm Reduction'''

*AmfAR Opioid & Health indicators Database - Syringe Access Locations <ref>https://opioid.amfar.org/indicator/num_SSPs</ref>
*National Harm Reduction Coalition - Resources for Syringe Access and Policy<ref>https://harmreduction.org/issues/syringe-access/landscape-report/</ref>
*Rhode Island - Fentanyl Testing Strip Program<ref>https://preventoverdoseri.org/fentanyl-test-strips/</ref>

'''Access to Treatment and Protecting Treatment Services'''

California legislation has a process for reducing treatment fraud and waste.<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries</ref>

'''Federal Government - Affordable Care Act (2010)'''

Support to get mental health and substance abuse treatment through the 2010 ACA.

'''Criminal Justice Reform and De-criminalization.'''

* Good Samaritan Laws provide immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose. The Policy Surveillance Program provides an interactive database of current Good Samaritan Laws in the U.S. All 50 states and Washington D.C. have Good Samaritan Laws in place.<ref>https://www.ncbi.nlm.nih.gov/books/NBK542176/</ref>

*Oregon - State Initiative to De-criminalize almost all narcotics: Measure 110, passed by a majority of statewide voters in November 2020, decriminalizes the possession of marijuana and small amounts of "harder" drugs including cocaine and methamphetamine and reduces criminal penalties for larger amounts.

*Washington State - Law Enforcement Assisted Diversion <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx#:~:text=The%20Law%20Enforcement%20Assisted%20Diversion,behavioral%20health%20needs%20or%20poverty.</ref>

'''Recovery Support Services'''

* Federal SUPPORT Act: Section 7151. Building Communities of Recovery. This section amends the Building Communities of Recovery (BCOR) program that was first authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016 by redefining “recovery community organization” as an organization that mobilizes resources within and outside of the recovery community, including through a peer support network. This section authorizes $5 million for each of FY 2019-2023.

* Federal SUPPORT Act: Section 7031. National Recovery Housing Best Practices. This section amends part D of title V of the Public Health Service Act to authorize the Secretary of HHS to identify or facilitate the development of best practices for operating recovery housing. The Secretary is directed to bring together a wide variety of stakeholders to develop best practices for Recovery Housing.

'''State Policy Plans to Address the Opioid Epidemic'''

* Rhode Island's Strategic Plan on Addiction and Overdose<ref>https://health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf</ref>
*Massachusetts’s Recommendations of the Governor's Opioid Working Group<ref>https://www.mass.gov/lists/governors-opioid-addiction-working-group</ref>

'''Example of Successful Illinois Advocacy Strategy''' The following illustrates some of the partnerships and strategies used to pass an important piece of legislation in the state of Illinois:

Illinois SB2928<ref>https://ilga.gov/legislation/billstatus.asp?DocNum=2928&GAID=12&GA=98&DocTypeID=SB&LegID=79014&SessionID=85</ref> is a current law with the common name "Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. The lead Project Coordinator Bill Gentes, has as a result, been awarded CADCA's Advocate of the Year.

The following steps were used in the creation, adoption, and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

*Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one reviews current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
*Partnering with Local Law Enforcement - As stated by Gentes at an interview "“circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you what that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process. "In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more.
*Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference.
*Securing Public-Private Partnerships - Walgreens was approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be an issue with a need to review current laws regarding drug disposal. This increased the capacity of the project and accompanying police force in collection efforts.
*Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support.
*Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments.

= Available Tools and Resources =

*FedUp! - A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids. FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies.<ref>https://feduprally.org/</ref>
*Department of Health & Human Services Guidebook for State by State Opioid Prescribing Guidelines-<ref>https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf</ref>
*National Council For Behavioral Health. Advocates for mental health and substance use policies.<ref>https://www.thenationalcouncil.org/policy-agenda/</ref>
*National Harm Reduction Coalition. Advocates for numerous harm reduction approaches.<ref>https://harmreduction.org/</ref>
* Grassroots Unwired provides a good overview of grassroots advocacy. <ref>https://www.grassrootsunwired.com/grassroots-advocacy/</ref>
* Model Law Virtual Knowledge Labs. The Model Law Virtual Knowledge Labs are a virtual learning series that provides state and county leaders with an opportunity to deepen their awareness and understanding of how model laws can assist jurisdictions in addressing substance use disorders and concomitant issues . <ref>https://legislativeanalysis.org/model-law-virtual-knowledge-labs/</ref>
* Legislative Analysis and Public Policy Association. LAPPA is excited to announce the release of State of the States: Legislative Roadmap for Reducing Overdose Deaths and Increasing Access to Treatment (the Roadmap), a guide for state leaders on the most effective approaches to addressing the current drug epidemic. <ref>https://files.constantcontact.com/9b9edb2e701/6fe81aeb-e7b3-49f9-8b98-e5060d133156.pdf</ref>
* Legislative Analysis and Public Policy Association. Drug Checking Equipment, Needles/Syringes, and Drug Paraphernalia: Summary of State Laws. <ref>https://legislativeanalysis.org/wp-content/uploads/2024/01/Drug-Checking-Equip-Needles-Syr-and-Drug-Paraphernalia-Summary-of-State-Laws.pdf</ref>
* Legislative Analysis and Public Policy Association. Naloxone: Summary of State Laws. <ref>https://legislativeanalysis.org/wp-content/uploads/2022/09/Naloxone-Access-Summary-of-State-Laws.pdf</ref>
* O'Neill Institute for National and Global Health Law: The Context: Racial and other Disparities in the Opioid Crisis.<ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>
* Reasons Foundation: Drug Legalization Handbook.<ref>https://reason.org/wp-content/uploads/drug-legalization-handbook.pdf</ref>
* SAMHSA: Evidence-Based Practices Resource Center. SAMHSA is committed to improving prevention, treatment, and recovery support services for mental and substance use disorders. The Evidence-Based Practices Resource Center provides communities, clinicians, policy-makers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings.<ref>https://www.samhsa.gov/resource-search/ebp?utm_source=SAMHSA&utm_campaign=d562f4d6eb-EMAIL_CAMPAIGN_2024_03_14_04_39&utm_medium=email&utm_term=0_-d562f4d6eb-%5BLIST_EMAIL_ID%5D</ref>
* South Southwest PTTC: The Ins and Outs of Advocating for Policy Change & The Ten Do’s and Don’ts of Successful Legislative Advocacy <ref>https://pttcnetwork.org/the-ins-and-outs-of-advocating-for-policy-change/</ref> <ref>https://pttcnetwork.org/news/the-ten-dos-and-donts-of-successful-legislative-advocacy/</ref>

= Promising Practices =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Sources =

Expand Harm Reduction Practices

2024-03-29T14:19:37Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Axios: Why more states are decriminalizing fentanyl test strips''' This quick overview provides insight into the rapidly shifting landscape around fentanyl testing strips around the nation. A large amount of additional resources are linked. <ref>https://www.axios.com/2023/04/20/red-states-drug-use-fentanyl-test-strips</ref>
* '''Dance Safe''' Introducing a new and improved Fentanyl Test Strip for the Harm Reduction Community. <ref>https://dancesafe.org/fentanyl/</ref>
* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''Next Distro''' An online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.<ref>https://nextdistro.org/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities''' This online training models an approach to educating folks about fentanyl. The content of this training is available for reproduction and localized implementation. Contact Dylan for more information. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides a vulnerable account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. These experiences aren’t often explored in our on-campus work.<ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-03-28T19:51:00Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Dance Safe''' Introducing a new and improved Fentanyl Test Strip for the Harm Reduction Community. <ref>https://dancesafe.org/fentanyl/</ref>
* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''Next Distro''' An online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.<ref>https://nextdistro.org/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities''' This online training models an approach to educating folks about fentanyl. The content of this training is available for reproduction and localized implementation. Contact Dylan for more information. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>
*'''TIME: What Harm Reduction Taught Me About My Ex's Addiction—And Myself.''' This article provides a vulnerable account of the experience of folks whose loved ones struggle with substance use, recovery, and who utilize harm reduction services. These experiences aren’t often explored in our on-campus work.<ref>https://docs.google.com/document/d/19uUqV2xRCD8aqmMGbwUcGppca56813oASXa6vATYovU/edit</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Strengthen Collegiate Recovery Programs

2024-03-28T19:32:14Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page. <ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. In this webinar, as part of the SAFE Project Collegiate Recovery Leadership Academy Webinar Series, community harm reduction experts share their experiences and perspectives on the value and use of harm reduction as an approach and set of tools <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAFE Project.''' Tools Over Fear”: Lessons Learned from Campuses Navigating the Fentanyl & Overdose Crisis. In this slideshow delivered at the 2023 NASPA Annual Meeting, the SAFE Campuses team summarized themes and outcomes from providing technical assistance to students and staff seeking to implement harm reduction measures across the country. <ref>https://www.canva.com/design/DAFd3JKSgYU/-3pnegV7b2kQ4w-PIBYcLA/view</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''University Health Services (UHS) at UC Berkeley Health Promotion Department: The Party Safe Toolkit.''' Summary: “PartySafe@Cal is dedicated to creating an alcohol and other drugs (AOD) culture at UC Berkeley that supports the well-being of all who live, study, work and play in the campus area. We strive to engage, educate and motivate stakeholders (that’s you!) to: Put well-being, safety, harm reduction, and equity at the center of alcohol and other drug choices, Recognize and respect that many chose not to use alcohol and other drugs, Ask all users and social/retail providers to do so in mindful and low-risk ways and situations, Support noticing problematic behaviors and situations and addressing them in timely, effective, and compassionate ways. We hope this Toolkit assists you play your unique role in our community.” <ref>https://uhs.berkeley.edu/sites/default/files/partysafe_toolkit.pdf</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Strengthen Collegiate Recovery Programs

2024-03-28T19:17:17Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

'''Recovery High Schools''' are secondary schools created specifically for students who are in recovery from a substance use disorder or co-occurring disorders. The purpose of recovery high schools is to offer students who are in recovery a safe place to earn their diploma while also focusing on their recovery. Just like other secondary schools, recovery high schools are staffed with teachers, counselors, support staff, administrators, and mental health professionals. The main difference between recovery high schools is that they provide students in recovery with the opportunity to separate themselves from situations and peers who might have impacted their prior use. Recovery high schools also provide opportunities for group therapy, meetings with addiction counselors, and an environment where they are encouraged to be open about their struggles.

'''Collegiate Recovery''' is a young, emerging, and quickly growing field. Yet, it is also more than a field - collegiate recovery is a profession, and it is a community. Collegiate recovery involves thousands of students across the country, their supporting staff mentors and allies, researchers learning more about recovery every day, and their collective experiences. Although the first collegiate recovery program started in the 1970s, the field as a whole is one that is young and blossoming. Collegiate recovery is anchored to the personal development of students in recovery and their communities, the prevention of substance use disorders and their related impacts, and the healing of the wounds that may have led to or resulted from maladaptive behaviors. All of this leads to ensuring that students impacted by addiction can access the full benefits of higher education without having to put their recovery at risk.

= Key Information =

'''Recovery High Schools'''

The first recovery high school was opened in the 1970s. However, recovery high schools did not gain a lot of traction or notoriety until roughly 2008. Today, there are approximately 45 recovery high schools across the nation, with this number increasing each year. Given the smaller nature and more involved education that recovery high schools offer, they tend to be more costly than traditional public high schools. Funding often comes from private donors, partnerships with other nonprofit organizations/agencies, and insurance. In some cases, state funding is available. Effectiveness statistics for recovery high schools are positive. Students who attend a recovery high school are much less likely to return to use compared to their peers who are either out of school or return back to a traditional high school. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

The first collegiate recovery program emerged in 1977 at Brown University when a professor who was in recovery saw the need to help students find recovery as well. His title soon switched to “Dean of Chemical Dependency”, and he spent over 25 years serving students by helping them find counseling, meetings, offering non-clinical support, and academic advising. The next school to recognize the need for recovery support services was Rutgers, which in 1983, hired the school’s first ever Alcohol and Drug Counselor. This ultimately led to the opening of the first recovery house on a college campus in the world in 1988. In 1986 the Center for Collegiate Recovery Communities (CCRC) opened at Texas Tech. Their primary focus was conducting research, offering students' academic support, and providing a space for meetings. Texas Tech remains one of the strongest programs in the country. Later, in 1997, Augsburg University launched their StepUp program, which remains one of the largest collegiate recovery programs in the country. In the 2010's, Transforming Youth Recovery offered a grant program, and many new programs began to emerge. Today, there are over 250 communities and programs across the country. This reflects increasing traction in the collegiate recovery movement, but the unmet needs remain far greater: <ref>https://www.yoursafesolutions.us/backups/Collegiate-Recovery-Census-2017.pdf</ref>
* Less than 1% of community colleges and trade schools offer true recovery support for students.
* Less than 5% of four-year institutions offer collegiate recovery programs.
* Less than 1% of the 5% of universities with collegiate recovery, offer transitional living, recovery housing education programs, young adult IOPs, or treatment and education programs.

There is significant diversity in recovery support initiatives because of the unique culture, structure, and needs of each university. However, there are three major types of levels of collegiate recovery initiatives. These include collegiate recovery programs (CRP), collegiate recovery communities (CRC), recovery residency programs, and recovery support referral. Almost all collegiate recovery supports focus on peer support and sober social activities. Approximately one third of them include counseling or clinical support. The primary difference between a CRP and a CRC is that CRCs are often student-led and not always recognized or supported by the institution. These four types of recovery initiatives are described below.

'''''CRP's''''' are institutionally supported programs that provide safe, supportive learning environments for students in recovery from substance misuse or dependency, and often behavioral addictions and mental illness. Approximately 40% of university recovery support initiatives are CRPs. The primary components of CRPs include:

*Mutual aid support groups
*Physical space for students to gather
*Institutional acceptance and support of the CRP
*Staff, counselors, and/or student leaders
*Peers, recovery coaches, and/or counselors
*Social events and programming

'''''CRC''''' efforts are energized by students to create recovery-supportive learning environments at an institution of higher education. Approximately 60% of university recovery support initiatives identified as being a CRC. The key components of collegiate recovery communities are:

*Mutual aid support groups
*Students and/or other committed individuals who gather socially
*Peer recovery support

'''''Collegiate Recovery Residency Programs''''' offer recovery housing options for students in recovery enrolled at an institution of higher education. Recovery housing options differ from campus to campus. Some options include a building dedicated strictly to students in recovery and often have commitment requirements while others involve a sober living floor in a dorm building or a Living Learning Community framework.
Approximately 10% of collegiate recovery initiatives also have a collegiate recovery residency program. Examples of these programs include:

*Rutgers
*Augsburg University
*Virginia Commonwealth University
*University of Houston

'''''Recovery Support Referral.''''' Colleges and universities that offer some level of substance misuse prevention services and referral-based recovery support resources for enrolled students. Approximately 30% of collegiate recovery initiatives include recovery support referrals. Although this level of support can differ widely from campus to campus, the key components of recovery support referrals are:

*Dedicated Alcohol and Other Drug (AOD) professional on staff
*Referrals to local treatment centers
*Continuum of care built into student conduct protocols

'''Best Practices and Common Practices'''

Each institution is unique, so best practices should be adapted to fit the needs of students. Generally speaking, the field of collegiate recovery recommends the following:

*Dedicated space on campus
*Dedicated staff
*Institutional financial support

Additionally, the following are common practices in many different types of programs and communities:

*Sober social activities
*Advocacy efforts for student needs
*Awareness events
*Mutual aid meetings (of any kind)
*Conference attendance
*Peer mentoring
*Registered student organizations
*Academic advisement and/or early registration
*Educational and training opportunities
*Service opportunities
*Recovery ally training
*Counseling
*Career readiness

= Relevant Research =

'''Recovery High Schools'''
* Data from Monitoring the Future indicates that teen drug and alcohol use continues to decline, but that the statistics are still alarming. <ref>https://monitoringthefuture.org/</ref>

* A study titled "Recovery High Schools: A Descriptive Study of School Programs and Students" documents the higher effectiveness of recovery schools in preventing return to use than traditional schools. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2629137/</ref>

'''Collegiate Recovery'''

* This article summarizes a research survey of almost 500 college students at 29 CRPs. One third of the students reported they would not be in college were it not for a CRP, and 20% would not be at their current institution. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4852860/</ref>

* This article documents research findings that indicate that students in recovery-ready universities who are engaged in recovery initiatives have had better outcomes than the average of their student body regarding GPA, retention, and graduation rates. Additionally, students who feel accepted enough to be open about their recovery often take leadership positions in student government and student wellness organizations, and that they have increased employment opportunities. Further, collegiate recovery initiatives effective model peer-led recovery support for communities that are served by the campus, and these collegiate recovery promotes continued residence by students in recovery to stay in those communities as active citizens. <ref>https://www.tandfonline.com/doi/abs/10.1080/15560350802080951</ref>

* This article reviews the literature supporting the need for the expansion of CRPs, presents information on the diversity of CRP services, and outline key areas where research is needed. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3952555/</ref>

= Impactful Federal, State, and Local Policies =

'''Comprehensive Addiction and Recovery Act of 2016 (CARA 2.0)''' <ref>https://www.congress.gov/bill/114th-congress/senate-bill/524/text</ref>

This is the first major federal addiction legislation in 40 years and the most comprehensive effort undertaken to address the opioid epidemic. It encompasses all six pillars necessary for such a coordinated response – prevention, treatment, recovery, law enforcement, criminal justice reform, and overdose reversal. While it authorizes over $181 million each year in new funding to fight the opioid epidemic, monies must be appropriated every year through the regular appropriations process in order for it to be distributed in accordance with the law.

'''State Policies on Recovery High Schools'''

* New Jersey -- Senate Bill No. 2058 (216th Legislature, 2014) authorizes establishment of three pilot recovery alternative high schools that provide high school education and a substance dependency plan of recovery to test the effectiveness of this model.

* Rhode Island -- The Recovery High Schools Act (2013 General Laws, Title 16 - Education, Chapter 16-95) authorizes the creation of a pilot recovery high school for the purposes of demonstrating the effectiveness of this model in Rhode Island.

'''State Policies on Collegiate Recovery'''

* New Jersey -- In 2015, a bill was passed that required campuses to implement a sober living option within four years if at least 25 percent of the student body lives on campus.

= Available Tools and Resources =

*'''The Association of Recovery in Higher Education (ARHE)''' represents CRPs and CRCs, the students involved, and the faculty and staff who support them. ARHE provides the education, resources, and community connection needed to help change the trajectory of the lives of college students in recovery. <ref>https://collegiaterecovery.org/</ref>

*'''The Association of Recovery Schools (ARS)''' is the only association exclusively representing recovery high schools. ARS supports and inspires recovery high schools to achieve optimum performance. It empowers every student in recovery, providing hope and access to services. ARS offers technical assistance, accreditation, and support to members. <ref>https://recoveryschools.org/</ref>

* '''The National Center on Safe and Supportive Learning Environments.''' This is a useful transcript of a Q&A session following a webinar titled "Supporting Recovery and Building Resilience on Campus: The Role of Collegiate Recovery Programs <ref>https://safesupportivelearning.ed.gov/sites/default/files/FINAL%20IHE%20Webinar_QA%20Doc_3.28.19%20(1).pdf</ref>

*'''SAFE Project Campuses Initiative.''' SAFE Campuses is one of the six lines of operation at SAFE Project. The SAFE Campuses initiative aims to normalize recovery on every campus in the country. SAFE Campuses offers a variety of programs. It advocates for recovery support services, provides educational opportunities for collegiate staff and administrators, and collects data to strengthen the field of collegiate recovery. SAFE Campuses also promotes leadership opportunities for students in recovery. SAFE Campuses collects meaningful metrics that contribute to the knowledge base through the '''''Collegiate Recovery Census Project.''''' To learn more about collegiate recovery as a field or to contribute information about your university, please visit the SAFE Project Census page. <ref>https://www.safeproject.us/census/</ref>

*'''SAFE Project.''' Webinar: Supporting Harm Reduction: MJ Jorgensen and Brandi Drtina. <ref>https://www.youtube.com/watch?v=cub0vd0dU7Y</ref>

*'''SAMHSA's Directory of Single State Agencies for Substance Abuse Services.''' SAMHSA is the agency within the U.S. Department of Health and Human Services that leads public health efforts to advance the behavioral health of the nation. SAMHSA's mission is to reduce the impact of substance abuse and mental illness on America's communities. Every state has a designated Single State Agency (SSA) that oversees federal grant applications for programs that aim to prevent, treat, and rehabilitate those with substance use disorders. The state-by-state directory of agencies provides essential contact information. <ref>https://www.samhsa.gov/sites/default/files/ssa_directory_12-03-2018_final_508.pdf</ref>

*'''The Texas Tech Guide.''' As one of the pioneers in the collegiate recovery field, Texas Tech is a model for what many CRCs and CRPs can look like. Texas Tech created a Collegiate Recovery Communities Curriculum for campuses who are interested in replicating their model. <ref>https://www.depts.ttu.edu/hs/csa/replication.php</ref>

*'''Young People in Recovery (YPR)''' envisions a world where all young people have the resources they need to thrive in recovery from addiction to drugs and alcohol. YPR’s mission is to provide the life skills and peer support to help people recover from substance use disorder and reach their full potential. <ref>https://youngpeopleinrecovery.org/</ref>

= Promising Practices =

*'''North Carolina''' In 2015, The NC Department of Health and Human Service’s Division of Mental Health, Developmental Disabilities and Substance Abuse Services (DMH) initially began using $750,000 in annual Substance Abuse Prevention and Treatment Block Grant funds to offer support to six campuses: University of North Carolina at Charlotte, Chapel Hill, Wilmington, and Greensboro, North Carolina A&T University and East Carolina University. Each campus initially received $125,000 annually to aid education, prevention and recovery efforts. As the pilot programs became more self-sustainable, funds were reallocated to add Appalachian State University, North Carolina State University and North Carolina Central University to the program. <ref>https://www.ncdhhs.gov/blog/2019-09-23/dhhs-supports-students-recovery-substance-misuse</ref>

* '''West Virginia:''' In 2019, the Alliance for Economic Development of Southern West Virginia was awarded roughly $321,000 by the West Virginia Department of Health and Human Services to establish a Southern West Virginia Collegiate Peer Recovery Network, offering peer recovery support services on seven higher education campuses (Bridge Valley Community and Technology College, Bluefield State College, Concord University, Marshall University, Southern West Virginia Community and Technical College, the West Virginia School of Osteopathic Medicine, and West Virginia State University).

* '''Virginia.''' In 2019, the Virginia Department of Behavioral Health and Developmental Services (DBHDS) awarded $675,000 of federal State Opioid Response (SOR) grant funding to Virginia Commonwealth University (VCU) to help expand substance use recovery programs at eight universities across the state.

Every campus is unique with differing needs, resources, and student desires. It is important to keep this in mind when developing recovery programming because there is no “one size fits all” when it comes to supporting students in recovery. While there is no template that fits the needs of every campus, below is a diverse list of campuses who have each approached collegiate recovery from a different lens and have found success in distinguishing ways.

*'''Auraria Recovery Community''' is a coalition serving students at three different institutions in the Denver area (University of Colorado Denver, Metropolitan State University of Denver, and Community College of Denver). <ref>https://www.aurariarecoverycommunity.com/</ref>

*'''Baylor and Saint Joseph's University''' are examples of faith-based, private institutions serving students in recovery. <ref>https://www.baylor.edu/barc/</ref>

*'''North Carolina A&T State University''' is the largest HBCU. <ref>https://www.ncat.edu/campus-life/student-affairs/departments/counseling-services/collegiate-recovery-community.php</ref>

*'''Northampton Community College''' is a community college serving students in recovery. <ref>https://www.northampton.edu/ncc-crp.htm</ref>

*'''The Ohio State University and University of Michigan ''' are examples of very large public institutions serving students in recovery. <ref>https://swc.osu.edu/services/collegiate-recovery-community/</ref> <ref>https://uhs.umich.edu/recovery</ref>

= Sources =

Expand Harm Reduction Practices

2024-03-28T19:06:20Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Dance Safe''' Introducing a new and improved Fentanyl Test Strip for the Harm Reduction Community. <ref>https://dancesafe.org/fentanyl/</ref>
* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''Next Distro''' An online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.<ref>https://nextdistro.org/</ref>
* '''SAFER-U: Strategies, Awareness, and Fentanyl Education Resources for Universities''' This online training models an approach to educating folks about fentanyl. The content of this training is available for reproduction and localized implementation. Contact Dylan for more information. <ref>https://wvdii.thinkific.com/courses/saferU</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-03-28T18:58:53Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Dance Safe''' Introducing a new and improved Fentanyl Test Strip for the Harm Reduction Community. <ref>https://dancesafe.org/fentanyl/</ref>
* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''Next Distro''' An online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.<ref>https://nextdistro.org/</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-03-28T18:50:27Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''Next Distro''' An online and mail-based harm reduction service designed to reduce opioid overdose death, prevent injection-related disease transmission, and improve the lives of people who use drugs.<ref>https://nextdistro.org/</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-03-28T16:57:38Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>
* '''Never Use Alone (NUA)''' NUA is peer-lead nonprofit. Their staff and volunteers have lived experience with substance use and impacted by the drug overdose crisis. Whether personal use or a loved one’s, they understand what you are going through. When you call them, they are the people who will support and love you.<ref>https://neverusealone.com/</ref>
* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Expand Harm Reduction Practices

2024-03-28T16:49:23Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>

* '''Harm Reduction International''' We use data and advocacy to promote harm reduction and drug policy reform. We show how rights-based, evidence-informed responses to drugs contribute to healthier, safer societies, and why investing in harm reduction makes sense. <ref>https://hri.global/what-is-harm-reduction/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Build Education and Raise Awareness

2024-03-27T14:34:03Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Many public establishments, such as schools and places of work, maintain a zero tolerance for substance use. While this high standard ensures safety, it can sometimes leave individuals with nowhere to turn if they find themselves with a substance use problem. In addition to having high standards, school systems and places of employment can assist their stakeholders by motivating them to maintain a drug-free lifestyle through fostering connection to available resources and by building more effective education. This process can begin by raising awareness of the extent of substance use in society and carefully selecting the right tools to inform and assist individuals to maintain a drug-free lifestyle in and outside of work or school. <ref>https://www.samhsa.gov/workplace/employer-resources/prepare-workplace</ref>

= Key Information =

Drug education programs in public schools have changed over the years, from prioritizing an abstinence-only approach to incorporating mental health, social skills, family bonding, and behavior management. The National Institute on Drug Abuse website has a comprehensive list of drug education programs reflective of this progress. <ref>https://archives.nida.nih.gov/publications/preventing-drug-use-among-children-adolescents</ref> See the SAFE wiki, "Prevent First Time Use Through Education" for more information. <ref>https://www.yoursafesolutions.us/wiki/Prevent_First_Time_Use_Through_Education</ref> This prevention work for children and adolescents has crafted a good foundation for extending the same type of advances in workplace education.

Drugs in the workplace have detrimental effects on all individuals due to impaired decision making. There is an increased risk of damage to property and increased chance of physical harm due to accidents. Drug use also costs employers money because of increased turnover and increased time off. By implementing support for individuals with SUD and integrating effective education, employers may save thousands of dollars. Many businesses have realized the importance of drug education and prevention in the workplace. More businesses, especially smaller businesses, could benefit from implementing drug education. This type of education can be costly, and many times businesses feel they can not afford to add it to the budget. However, research shows that by implementing a drug education and drug testing program, employers and employees both experience positive outcomes. In order to incentivize corporate investment in people, some proven benefits of drug education programs in the workplace are listed below: <ref>https://drugabuse.com/addiction/workplace-drug-abuse/</ref>

*Increased morale
*Decreased workplace accidents
*Reduced employee theft
*Increased productivity
*Reduced employee turnover
*Decreased cost of insurance, such as workers’ compensation

The American Addiction Center recommends that drug education programs include the following: <ref>https://americanaddictioncenters.org/</ref>

*Rules and expectations with terms clearly defined
*Prevention methods and education
*Testing
*Quality employee assistance programs

One possible way to raise awareness in the workplace is to distribute materials, in writing and through visual presentations, that pertain to drug use and its impacts on the work environment and employees. Adding in a Drug Awareness day and presenting information and resources that are available to employees can increase understanding of best actions to take when an individual is struggling with substance use.

'''Common Signs of Substance Use'''

By providing education to employees about common signs that indicate someone is struggling with addiction, a workplace may be able to intervene and provide assistance before the problem escalates. Some signs of substance use may be overlooked as common ailments and other signs are more noticeable. Below are some examples <ref>https://drugabuse.com/addiction/workplace-drug-abuse/</ref>.

*Frequent Accidents
*Erratic Behavior
*Dilated Pupils
*Slurred Speech
*Extreme Mood Swings
*Paranoia
*Glassy Eyes
*Noticeable Exhaustion
*Frequent Absenteeism

= Relevant Research =

'''Rates of Drug Use in the Workforce'''

According to SAMHSA, almost 70% of drug users are actively employed in the workplace. <ref>https://www.nsc.org/forms/substance-use-employer-calculator</ref> The Tennessee Department of Labor and Workforce Development reported that one third of employees are aware of the presence and the illegal sales of drugs at their place of employment. <ref>https://www.nsc.org/forms/substance-use-employer-calculator</ref>

'''Adults Survey on Drug Education'''

A study conducted by the American Addiction Centers surveyed 500 men and women. Thirty-seven percent of the participants reported that the most effective way they learned about drug education was by learning about the possible dangers of substance use. In the next highest category, at 20%, participants reported that the most effective drug prevention education approach was listening to the powerful testimonials of recovered adults. This information could be helpful in building an effective drug education program. Surprisingly, 41.2% of respondents reported that they did not receive any education about the science of addiction. Many of the respondents reported that they were not educated on some of the most commonly abused drugs. About half of the 500 adults surveyed had not received formal education about meth, ecstasy, heroin, or other opioids. These statistics support the need for building more educational resources and programs to address all of these gaps. <ref>https://americanaddictioncenters.org/learn/drug-education-survey/</ref>.

= Impactful Federal, State, and Local Policies =

SAMHSA’s Division of Workplace Programs (DWP) performs regulatory, knowledge development, and technical assistance for federally regulated workplace programs in efforts to eliminate illicit drug use in the workplace. The DWP is also responsible for evaluating evidenced-based drug-free programs in non-federal workplaces <ref>https://www.samhsa.gov/workplace/about</ref>.

= Available Tools and Resources =

'''International Drug Policy Consortium (IDPC)''' Confronting the drug war: Roundtable series. <ref>https://idpc.net/news/2023/08/confronting-the-drug-war-roundtable-series</ref>

'''Opioid Response Network (ORN)''' provides free training and education that is evidence-based and designed to meet the needs of a community or organization. <ref>https://opioidresponsenetwork.org/</ref>

'''SAMHSA'''
The Substance Abuse and Mental Health Services (SAMHSA), Office of Behavioral Health Equity held the Behavioral Health Equity Best Practices for African Americans event on Monday, February 5 at 1:30-3:00 pm EST. This dynamic webinar was a collaboration with SAMHSA’s Division of Children and School Mental, Mental Health Promotion Branch, Suicide Prevention Branch, and the 988 & Behavioral Health Crisis Coordinating Office. <ref>https://share.nned.net/2024/01/behavioral-health-equity-best-practices-for-african-americans/</ref>

'''Substance Use Employer Cost Calculator'''
This resource provides information about the real costs of substance use on employers and businesses. By answering questions, employers can determine how substance use in their workplace can negatively impact their budget. <ref>https://www.nsc.org/forms/substance-use-employer-calculator</ref>

= Promising Practices =

= Sources =

Increase Access to Naloxone

2024-03-27T14:28:48Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph=

Naloxone (Narcan) has the potential to be very beneficial in communities with a high opioid problem. Increasing community awareness about the power of Narcan to reverse overdose is a benefit unlike any other. Narcan is a prescription medicine that can reverse an opioid overdose or prevent it long enough for the person to receive adequate medical care. It blocks the opioid receptors in the brain to prevent breathing and heart rates from slowing to fatal levels. It has been effective in saving lives, giving people with addiction a chance to realize the depth of their problem and a chance to ask for help. <ref>Hazelden Betty Ford Foundation. Heroin and Prescription Painkillers: A Toolkit for Community Action. 2016.</ref> Narcan will allow victims of substance abuse to be more likely to survive an overdose when first responders are rightly prepared. Many states are working to pass laws that give police, first responders, and concerned family members the ability to carry and administer Narcan when called to a possible overdose situation.

Narcan can either be injected or be administered in a nasal spray. In 2023, The US Food and Drug Administration made Narcan available to the general public as an over-the-counter drug to use as a nasal spray. <ref>https://www.fda.gov/news-events/press-announcements/fda-approves-first-over-counter-naloxone-nasal-spray</ref> It can be easily administered with little or no formal training. Although the drug could potentially save more lives if it were more widely distributed, bystanders often do not summon medical assistance due to fear of possible prosecution against them. Narcan only works on opioids, and does not harm an individual in the case of a non-opioid overdose. So, if there is any question as to what a person took, use Narcan.

= Key Information =

Opioid overdose education and Naloxone distribution programs increase knowledge on how to effectively respond when someone is experiencing an overdose. Participation in the Naloxone distribution programs is linked to a reduction in overdose deaths and an increase in confidence when responding to overdose. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref> Research documents that communities that have programs aimed at training bystanders to respond to opioid overdoses have experienced a more rapid reduction in opioid overdose death rates than communities without these programs. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

Those who are close to opioid users have greater knowledge about overdose and how to respond appropriately after they have completed training in naloxone administration compared to peers who learn via an information booklet. Current and former opioid users who complete overdose response training are as adept as medical experts in the identification of an overdose and are equally able to tell when Naloxone is appropriate. Opioid users who participate in only a brief 5-minute training or who have learned about Naloxone administration through social networks are able to respond appropriately to an overdose.

Training first responders to administer Naloxone may reduce time to overdose rescue, possibly decreasing overdose-related injury and death. Law enforcement officers who participate in Naloxone administration and overdose training report having increased knowledge and confidence in dealing with opioid overdose emergencies after the program is finished. <ref>https://www.countyhealthrankings.org/take-action-to-improve-health/what-works-for-health/strategies/naloxone-education-distribution-programs</ref>

'''The Dangers of Dual Use'''

The extent of fatalities associated with opioid is well-documented. However, it is less understood that opioid overdoses are seldom due to opioid use alone. The majority of overdoses are a result of mixing an opioid with some other drug. The best way to avoid an opioid overdose is not taking opioids. It is also critical to increase awareness of the need to avoid knowingly mixing opioids with other drugs. Some safety precautions are listed below:

*Don't use alone
*Limit the amount of drugs you have available
*Stick to less lethal combinations of drugs
*Use smaller amounts of each drug
*Use the least impairing drug first
*When injecting drugs of unknown strength and purity (street heroin), start with a small "tester" shot to gauge the strength of the drug before injecting a full dose
*When using a drug or drug combination for the first time, start with a small dose to gauge your innate tolerance
*Make sure your friends (or at least someone) knows what drug combinations you have taken
*Have a plan in place in case something goes wrong
*Have Narcan on hand

= Relevant Research =

* A study in Massachusetts found that cities that have Naloxone distribution programs have lower overdose death rates than those without a program. <ref>http://www.bmj.com/content/346/bmj.f174</ref>

*A University of Washington study evaluating the initial results of Washington state’s Good Samaritan policy found in a survey that drug users who were aware of the law were 88 percent more likely to call 911 in the event of an overdose than before.<ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> <ref>http://adai.uw.edu/pubs/infobriefs/ADAI-IB-2011-05.pdf</ref>

*This article was published in the Annals of Emergency Medicine and is directed to physicians in Emergency Departments. It highlights successes that have been achieved in recent years and calls for specific patient-centered action by emergency physicians. <ref>https://www.annemergmed.com/article/S0196-0644(19)30606-7/fulltext</ref>

= Impactful Federal, State, and Local Policies =

In 2015, the White House announced a treatment-based initiative. The $2.5 million budget was allocated to a program that engaged law enforcement officers and public health professionals to collect data on the movement of heroin along the East coast and to train first responders on when it is adequate to administer Naloxone. <ref>http://www.slate.com/articles/news_and_politics/crime/2015/08/good_samaritan_drug_laws_they_save_lives_and_more_states_should_pass_them.html</ref> Various federal organizations have come together to encourage good faith prescription of Naloxone to ordinary citizens. They also encourage bystanders to become "Good Samaritans" by summoning emergency responders without fear of negative legal consequences.

State laws make it difficult for citizens to obtain prescriptions for injection Narcan, due to policies on third-party prescriptions and on prescriptions via standing orders. The third party-prescription law prohibits the prescription of drugs to someone other than the person who will receive them, while the standing order law prohibits the prescription of drugs to a person not personally examined by the prescribing physician. There are a variety of cases in which the complexity of Naloxone policies are advancing:

*The California State Board of Pharmacy passed a policy that allows pharmacists to give out Naloxone without a prescription in case of emergencies. <ref>https://nabp.pharmacy/news/news-releases/california-pharmacists-may-now-dispense-naloxone-without-prescription/</ref>

* In 2006, New Mexico passed a Good Samaritan Law that granted limited immunity from prosecution on simple possession charges for people who dialed 911 to report a drug overdose. Within ten years, 28 states in addition to the District of Columbia had passed similar laws to overcome hesitation to seek treatment or to call medical assistance, as a result of fear of incarceration or other forms of punishment

* In 2023, in Minnesota, a Good Samaritan law was passed to assure that people who call the police or emergency responders to help with an overdose situation will not face legal consequences for their involvement, use of, or possession of legal or illegal opioids. This removed a potential barrier --fear of arrest -- that sometimes leads to help not being called and lives being lost to overdose. <ref>https://www.revisor.mn.gov/statutes/cite/604A.01</ref>

*The National Conference of State Legislatures has many examples of policy efforts that have been attempted or passed, including Drug Overdose Immunity and Good Samaritan Laws. <ref>http://www.ncsl.org/research/civil-and-criminal-justice/drug-overdose-immunity-good-samaritan-laws.aspx</ref> <ref>http://www.ncsl.org/research/health/prevention-of-prescription-drug-overdose-and-abuse.aspx</ref>

= Available Tools and Resources =

*'''CDC''' provides a website titled "Reverse Overdose to Prevent Death." This has information on Naloxone and Good Samaritan laws. <ref>https://www.cdc.gov/opioids/overdoseprevention/reverse-od.html</ref>

* '''SAMHSA''' Overdose Prevention and Response: Toolkit. <ref>https://store.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf</ref>

*'''The Bureau of Justice Assistance (BJA)''' maintains an online toolkit featuring resources and information on Naloxone, including a section on liability and risk for law enforcement officers and their employers. <ref>https://bjatta.bja.ojp.gov/tools/naloxone/Liability-and-Risk</ref>

*'''The National Association of Drug Diversion Investigators, Inc. (NADDI)''' provides a resource titled "Overdose and Prevention Strategies that has every state's strategy in an online resource hub. This gives users a free resource to see what is being enacted in other states and lets people compare and contrast. This allows communities to identify the most effective strategies for them to implement. <ref>https://www.overdosepreventionstrategies.org/</ref>

= Promising Practices =

*'''Aetna.''' Many people who are prescribed Narcan (nearly 35%) don’t pick it up because they can’t afford the co-pay.<ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref> Having insurers eliminate the co-pay is one strategy to help address that. Aetna was the first national payer to waive copays for Narcan for its fully insured commercial members. This improved access by eliminating potential financial barriers to the lifesaving drug. <ref>https://www.healthcaredive.com/news/aetna-launches-new-policies-to-combat-opioid-crisis/512866/</ref>

*'''Connecticut.''' Several communities have made it mandatory for first responders to receive overdose training. <ref>https://www.newstimes.com/local/article/More-responders-using-wonder-drug-Narcan-to-5925616.php</ref>

*'''New York.''' The Drug Policy Alliance printed 1 million cards and posters that explained the Good Samaritan Law and offered basic instructions on how to initially respond to an overdose and worked with various agencies to help distribute these materials to vulnerable populations.

*'''North Carolina.''' The NC Harm Reduction Coalition has given out 52,000 naloxone kits since 2013 through their statewide grassroots network that includes syringe exchange and Naloxone distribution, with more than 8,700 overdose reversals reported. <ref>https://www.usatoday.com/story/opinion/2017/12/01/opioid-commission-almost-got-right-their-naloxone-recommendation-megan-mclemore-corey-davis-column/899812001/</ref>

*'''The Police Executive Research Forum''' provides case examples of law enforcement Naloxone programs instituted in Fayetteville (NC), Lummi Nation (WA), Virginia Beach (VA), Staten Island (NY), and Camden County, Montgomery County, and Hagerstown (MD). They include descriptions of training, funding, administration, and support. <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>

= Sources =
</div>
[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Treatment and Recovery]]

Expand Harm Reduction Practices

2024-03-27T14:28:27Z

AlexFigueroa: /* Available Tools and Resources */

Expand Harm Reduction Practices

2024-03-27T14:27:29Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term harm reduction involves addressing all types of harm:
* Preventing death through reversing overdose
* Preventing infection and disease transmission through needle exchange programs
* Preventing overdose through the use of testing strips, and
* Supporting public awareness campaigns

Harm reduction supports interventions that are aimed at reducing the negative effects of health behaviors without necessarily completely extinguishing potentially harmful behaviors. In a substance use disorder setting, harm reduction seeks to keep individuals and communities alive while minimizing negative health impacts that can result from active substance use. It is not the primary goal of harm reduction strategies to get someone into treatment and recovery. Harm reduction is rooted in the view that we need to meet people where they are - and many are not ready to accept or able to access treatment or recovery. That being said, those involved in harm reduction work are nearly always ready to assist someone in getting connected to services if they express a desire to get additional support. As many in the harm reduction community will say, a dead person cannot recover. Harm reduction has been defined as "policies and programs which aim to reduce the health, social, and economic costs of legal and illegal psychoactive drug use ''without necessarily reducing'' drug consumption." <ref>https://harmreductionjournal.biomedcentral.com</ref> The principles of harm reduction set out by the National Harm Reduction Coalition include: <ref>https://harmreduction.org</ref>

*Accepts, for better or worse, that licit and illicit drug use is part of our world and chooses to work to minimize its harmful effects rather than simply ignore or condemn them

*Ensures that people who use drugs and those with a history of drug use routinely have a real voice in the creation of programs and policies designed to serve them

*Affirms people who use drugs (PWUD) themselves as the primary agents of reducing the harms of their drug use and seeks to empower PWUD to share information and support each other in strategies that meet their actual conditions of use

*Calls for the non-judgmental, non-coercive provision of services and resources to people who use drugs and the communities in which they live in order to assist them in reducing attendant harm

*Recognizes that the realities of poverty, class, racism, social isolation, past trauma, sex-based discrimination, and other social inequalities affect both people’s vulnerability to and capacity for effectively dealing with drug-related harm

*Does not attempt to minimize or ignore the real and tragic harm and danger that can be associated with illicit drug use

*Understands drug use as a complex, multi-faceted phenomenon that encompasses a continuum of behaviors from severe use to total abstinence, and acknowledges that some ways of using drugs are clearly safer than others

*Establishes quality of individual and community life and well-being — not necessarily cessation of all drug use — as the criteria for successful interventions and policies

=Key Information=

The cluster of SAFE wiki articles on harm reduction explore, in greater detail, many strategies used in communities across the country to achieve the outcomes sought by harm reduction advocates and practitioners. While the list below is not a complete inventory of research-based strategies, it includes approaches that challenge the stigma that is targeted at people who use drugs. Three of the most widely adopted strategies include:

* '''Naloxone Training and Distribution.''' Naloxone HCl is a life-saving medication specifically useful in the reversal of an opioid overdose. Also known by its name brand, Narcan, this medication is used via a syringe or a nasal spray by a bystander who intervenes in a suspected overdose. Naloxone does not have the potential for misuse. Naloxone is available to most Americans without a prescription from pharmacies. Saving a life provides the opportunity to find recovery. A wide variety of stakeholders are engaged in this strategy because there is no such thing as too many opportunities to get a use overdose reversal medication. Efforts are often accompanied with public awareness campaigns that inform the public about where to get Naloxone and encourage active users not to use alone.

*'''Expansion of Needle Exchange Programs.''' The use of non-sanitized needles or the re-use and sharing of syringes can lead to infection, the spread of disease, and create a tremendous increase in healthcare-related costs. The investment of a few cents in a single clean needle that can be accessed by users can save thousands of dollars. Having people participate in needle exchange programs provides another opportunity to connect with others and to services. As with most harm reduction strategies, there is an element of stigma which needs to be overcome, both with the user and the public. Many people in the public see these programs as enabling harmful or immoral behaviors.

*'''Harm Reduction in Special Settings.''' The focus here is on how to help those in specific situations, including those in the criminal justice system and women who are pregnant or who have recently given birth. In both cases, numerous strategies have been developed to improve harm reduction for all affected.

=Relevant Research=

*'''Science/Research-Based Education.''' The role of developmentally appropriate substance use education is similar to the movement away from abstinence-only sex education. This maturation of the field is critical to preventing the harms associated with risky substance use behaviors. Many of the unwanted or undesirable outcomes of substance use can be prevented by appropriate sharing of available knowledge regarding substance use. In terms of harm reduction, this allows people who use drugs to more accurately anticipate and manage their own risk. Equipping individuals with an understanding of how substances interact with one another, how the route of administration impacts risk and effects of use, and how to indicate an overdose is an important tenet of harm reduction.

*'''The Harm Reduction Journal''' is an open access, peer-reviewed journal that publishes research and commentary on approaches diminishing the harm of stigmatization, marginalization and criminalization of public health, human rights and social justice issues. <ref>https://harmreductionjournal.biomedcentral.com/ https://harmreductionjournal.biomedcentral.com</ref>

*'''Stanford University, School of Medicine.''' This article documents research that has been done on the implementation of the Safety First <ref>https://drugpolicy.org/resources/drug-education-resources</ref> curriculum developed at Stanford for school-based harm reduction with adolescents. <ref>https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-022-00502-1</ref>

=Impactful Federal, State, and Local Policies=

Progress is being made in harm reduction policy in the following areas:

*Bystander interventions

*Naloxone standing orders and bulk funds

*Safe injection site and syringe access

*Paraphernalia laws

*Lift on purchase of fentanyl testing strips

= Available Tools and Resources =

* '''SAMHSA''' Overdose Prevention and Response: Toolkit. <ref>https://store.samhsa.gov/sites/default/files/overdose-prevention-response-kit-pep23-03-00-001.pdf</ref>

* '''The National Harm Reduction Coalition''' works to create spaces for dialogue and action focused on harm reduction strategies. It hosts an annual conference and an online resource center. <ref>https://harmreduction.org/</ref> One example of the type of information available through the resource center is on fentanyl test strips and safer use supplies. <ref>https://harmreduction.org/issues/fentanyl/</ref>

= Promising Practices =

* '''Syringe Services Programs (SSPs),''' also known as needle exchanges, are proven to have incredible impacts on preventing large-scale outbreaks of diseases such as HIV and hepatitis. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2021/03/syringe-distribution-programs-can-improve-public-health-during-the-opioid-overdose-crisis</ref>

* '''Overdose Prevention Sites.''' These go by different names, but are basically supervised injection sites. <ref>https://www.nytimes.com/2021/11/30/nyregion/supervised-injection-sites-nyc.html</ref>

* '''Technology-Assisted Awareness and Safety.''' Hotlines are emerging that advocate to "never use alone." There is also a growing use of technological tools to generate “hot batch” alerts in areas where drugs are identified to be excessively potent. Likewise, there is a growing database generated from overdose response reporting.

= Sources =

[[Category:SAFE-Full Spectrum Prevention]] [[Category:SAFE-Law Enforcement and Criminal Justice]]

Advocate for Policy Change

2024-03-27T14:23:20Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Educating policymakers and the general public about the legislative or policy changes necessary to create change in your community is an important step to addressing substance misuse and substance use disorder (SUD). Policies help states and local communities in several important ways:

1. By providing direct funding to communities for treatment and other services. 2. By improving access and/or affordability of care to individuals in need of assistance. 3. By removing barriers that prevent or limit the use of best practices across government agencies.

Policy change can take place at all levels of government. This page will provide information about how policy changes typically take place, as well as some examples of federal, state, and local laws that have helped local communities.

= Key Information =

'''Initial Steps for Policy Advocacy''' In order to bring about policy changes through laws or ordinances, any group of citizens must be able to become a "constituency of consequence" to those with the ability to create and change policy. This can be accomplished with a number of different advocacy approaches, as highlighted below. A few key principles to change policy at any level of government include:

*Have clear policy objectives. The more specific and narrow the objective the better. If the policy goals are too broad or general, it is easy for legislators to object on that basis.
*Support your position. Have research and data to support why the policy change you are seeking would be beneficial. For example, if seeking to improve harm reduction through the creation of a needle exchange program, provide data on expected lives that will be saved, reduced medical costs, improved linkages to care, and other benefits.
*Build a coalition. It is important to build a coalition to increase political clout. Think about other groups within the state or local community whose goals align with yours that would support your policy objectives and who would be willing to take action in order to achieve them. For example, if you were advocating for a needle exchange program, you might seek support from harm reduction organizations including hospitals, community health organizations and professionals, the recovery community, families in support of recovery, the treatment community, and potentially many others.
*Know your opposition. If a policy change hasn't happened, it is likely opposition exists. It is important to learn why policymakers may be hesitant to make a certain change, including what groups oppose the policy and why. Learning about the other side is critical to developing an effective advocacy strategy. Overcoming opposition may require education, effective counterarguments, financial resources, and increased public awareness.
*Identify champions. The most successful efforts resulting in desired policy changes are led by individuals who are passionate about the issue. Identifying and working with champions in the state or local government is a big key to success. It is important to have people "on the inside" that can hold hearings, develop legislation, utilize input and information from stakeholders, and provide insight on the process.
*Your voice matters. Many times, individuals or groups with minimal advocacy experience can be intimidated by the process. Remember that those "in power" are there because they were elected to serve. Lawmakers across all levels of government represent the people of their states, districts, cities, towns, and so forth. It is your constitutional right to petition the government and be heard. Those representing the people need to hear the concerns of all those they represent.

'''Converting Policy Into Action''' After taking the initial steps delineated above, the next step is to identify and implement a set of strategies that will grow public and political support for those policies. While approaches and specific strategies are almost innumerable, taking action involves communication and messaging intended to educate and influence.

'''Grassroots Advocacy''' Grassroots Advocacy generally refers to engaging the public to actively educate and lobby on behalf of a desired policy objective. Communication occurs through letters, emails, calls to legislators, rallies, social media campaigns, letters to the editor, and other forms of messaging campaigns designed to put political pressure on policymakers to enact desired changes.

'''Direct Lobbying''' Direct lobbying refers to direct communication and meetings with policy makers at all levels of government, including governors, mayors, county executives, and the legislative branch. This key activity provides the opportunity to meet with decision makers and their staff to gauge the receptiveness of the policymakers and to discuss the desired policy goals, benefits, support, and potential points of opposition. Opportunities for direct lobbying often take place during the legislative session, which varies from jurisdiction to jurisdiction. Some advocates and interest groups will organize a "lobby day" where members converge in Washington, state capitols, or with local legislative bodies to advocate for desired policy objectives. When the legislative body is not in session, advocates can meet with their representatives at their local offices.

'''Lobbying Rules and Restrictions''' Lobbying rules vary widely between levels of government and across all states. Therefore, it is important to know how lobbying is defined and what the restrictions are in the jurisdiction you are involved with. Some fundamentals include:

* 501(c)3 organizations (tax-exempt nonprofits) have some restrictions on lobbying in the government.

* The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with: Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation" and as "Referring to specific legislation and reflects a view on such legislation."

* The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof."

* Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation."

'''The Legislative Process''' The legislative process varies between different levels of governments and in jurisdictions across the country. There are typically several steps in the process that provide opportunities to influence policymakers, such as when they are in session. Some states and localities have relatively short time frames to consider and pass new laws or ordinances, while other states and the federal government are in session for many more weeks throughout the year. It is important to know when the actual work of policy development and consideration takes place in the legislative body where you want the change to happen.

'''Sponsors and Early Support''' In any legislative body, a successful policy enactment starts with one or more members of the legislative body drafting legislation that would bring about the desired change. Members can do this individually or as a group. A group of members that introduce a legislative proposal are typically referred to as sponsors or "original" sponsors of the proposal. Other members can then sign on in support of the bill as co-sponsors.

Effective advocacy can help build momentum for a bill during this process. The more sponsors and cosponsors, the better. It is also extremely beneficial to have early supporters from both political parties - especially at the state and federal level. Bipartisan support, and support among a broad base of members at the local level, can show other members that the bill is not likely to be controversial. It is also especially helpful to have support for the proposed legislation from key leaders of the committees with jurisdiction.

Advocates can provide their champions within the legislature with all of the supporting information and research to help their champions in the legislative body attract as many co-sponsors as possible and to respond to questions or objections as they arise.

'''Committee Process''' Typically, legislative proposals are taken up by the committee (or committees) of jurisdiction. Actual consideration of a proposal often takes place after one or more committee hearings on the proposal. This often involves hearing from witnesses in support of, and potentially in opposition to, a given proposal. Written testimony is also included in the public record to provide additional information to both the public and the legislators. The hearing process provides another opportunity for advocates to testify as witnesses and/or provide information to be included in the record. Hearing can take place in front of the full committee or by a sub-committee which oversees the specific policy area impacted.

After the hearing process, the bill may be taken up by the full committee for consideration. Although the bill can be altered by the manager of the bill at any time, consideration by the committee is the first time lawmakers have an opportunity to propose amendments to the proposal. These amendments are voted and adopted, or not adopted, by a majority vote. Following the amendment process the committee chair can call for a final vote on the legislation. If passed, the bill can move to the full legislative body for consideration.

Advocacy efforts can move quickly during the committee process, as unexpected challenges may surface due to an unfriendly amendment that might weaken the bill and the policy impact desired. It is important to work with allies to carefully track this process and respond to any negative developments.

'''Consideration by the Full Body''' At the local level, there is a single body that approves local legislative proposals. This is typically a Board of Commissioners or other duly elected body. At the state and federal levels, there are two legislative chambers, with delegates and senators at the state level, and the House and Senate at the federal level.

The process is usually relatively simple at the local level. Legislation (or ordinance) proposals are taken up at regularly scheduled meetings where a debate occurs, amendments are offered, and the proposals are voted on. Often, the chief executive at the local level has a vote along with the other members.

At the state and federal level, the process is more complex. A bill has to pass both chambers before it can be reconciled, voted on again by both bodies, and sent to the Governor or President for signature. While on the floor, members can again offer amendments that can be voted on individually or "en bloc" as two amendments in one. Typically, more controversial amendments will be voted on by individual basis. Assuming the bill passes, it is sent to the other body for consideration. A similar or identical bill may be in process in that other chamber already, or it may be that no companion legislation exists. In the latter case the chamber that did not originate the bill will take up the version that was passed in the other chamber.

When a bill does pass both chambers, there are almost always differences that must be worked out. The committee chairs will select a reconciliation committee with a bi-partisan group of legislators from both chambers to accomplish this. Assuming any differences can be worked out, the bill then goes back to the floor of each chamber for a final vote. If passed, the bill is finally referred to the Governor or President.

As with the Committee process, advocacy must continue throughout the time in which a bill is considered by the full legislative body. At the state and federal levels, this can be a challenge with many steps involved and a larger number of legislators to contend with - some of whom may not be supportive. Again, it is critical to stay in constant contact with supporters within the legislative body to keep track of potential harmful amendments and keep count of likely supporters within the full body. At times advocacy efforts need to be focused on a handful of legislators who have reservations or are undecided.

'''Potential Veto and Override''' Although rare, Governors and the President may veto a bill passed by the state and federal legislators. If the vote on final passage was close, it is unlikely that the bill will be taken up again, as a two-thirds majority is needed to override a veto. If the original vote approached the two-thirds number, there is a better chance to find the supporters needed for a successful override.

'''Continued Funding (Budget and Appropriations)''' Even when a law or ordinance is passed and signed by the chief executive, advocacy efforts often do not end. This is due to the fact that legislation containing funding to implement programs is authorized (usually for a period of years), but there is still a budget and appropriations process that must be monitored over the authorization period. Typically, the executive branch of government produces an annual budget that reflects their policy and spending priorities. The budget may or may not be approved by the legislative body. After this point the legislative body will take up annual appropriations bills, which set spending levels for all agencies and their programs. These bills often work through the regular order of other legislation, but sometimes will have a different, often expedited process.
It is important for community coalitions and advocates to understand that funding for the agencies and programs they support can change through each step of the budget and appropriations process. There is a need to stay vigilant to ensure that full funding is achieved. Advocates must stay in touch with their champions in the executive branch and legislature to keep informed of any changes and be ready to advocate just as vigorously in order to restore any proposed cuts in funding.

= Impactful Federal, State, and Local Policies =

Governments at all levels will frequently create their own set of policy goals to address a particular issue. This has been true for several public health issues including the current opioid epidemic. This process typically involves bringing numerous stakeholders together to provide education and input in coordination with government representatives who initiate the process and finalize the set of policy objectives.

States and localities vary widely on what types of laws are implemented across multiple policy areas. <ref>https://www.fda.gov/media/147152/download</ref> Below are a few examples that can provide your community coalition with some ideas on what has been successful in a variety of policy initiatives. This policy inventory begins with two major federal actions, then provides a variety of initiatives that are organized by specific topic, and closes with an example of a successful advocacy process in Illinois.

'''Biden-Harris Drug Policy Priorities''' <ref>https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84&utm_source=Faces+%26+Voices+of+Recovery&utm_campaign=1c12da631e-november-2020-advocacy-policy_COPY_01&utm_medium=email&utm_term=0_3410cda480-1c12da631e-382685157</ref> - On April 1, 2021, President Biden and Vice President Harris released their administration's Drug Policy Priorities for the upcoming year. President Biden made clear that addressing the overdose and addiction epidemic was an urgent priority for his administration.

Priorities include:

*Expanding access to evidence-based treatment
*Advancing racial equity issues in our approach to drug policy
*Enhancing evidence-based harm reduction efforts
*Supporting evidence-based prevention efforts to reduce youth substance use
*Reducing the supply of illicit substances
*Advancing recovery-ready workplaces and expanding the addiction workforce
*Expanding access to recovery support services

'''Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis'''

*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Mandate Prescriber Education
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions;
*Equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses versus physical health diagnoses.

'''Prevention and Reduced Access to Prescription Medications'''

*New Jersey - New Jersey's Prescription Monitoring Program <ref>https://www.njconsumeraffairs.gov/pmp/</ref>
*California (Alameda County) - Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<ref>https://library.municode.com/ca/alameda_county/codes/code_of_ordinances?nodeId=TIT6HESA_CH6.53ALCOSADRDIOR</ref>
*Connecticut - Statute <ref>https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm</ref>enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.
*Illinois - Statute enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<ref>https://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf</ref>

'''Harm Reduction'''

*AmfAR Opioid & Health indicators Database - Syringe Access Locations <ref>https://opioid.amfar.org/indicator/num_SSPs</ref>
*National Harm Reduction Coalition - Resources for Syringe Access and Policy<ref>https://harmreduction.org/issues/syringe-access/landscape-report/</ref>
*Rhode Island - Fentanyl Testing Strip Program<ref>https://preventoverdoseri.org/fentanyl-test-strips/</ref>

'''Access to Treatment and Protecting Treatment Services'''

California legislation has a process for reducing treatment fraud and waste.<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries</ref>

'''Federal Government - Affordable Care Act (2010)'''

Support to get mental health and substance abuse treatment through the 2010 ACA.

'''Criminal Justice Reform and De-criminalization.'''

* Good Samaritan Laws provide immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose. The Policy Surveillance Program provides an interactive database of current Good Samaritan Laws in the U.S. All 50 states and Washington D.C. have Good Samaritan Laws in place.<ref>https://www.ncbi.nlm.nih.gov/books/NBK542176/</ref>

*Oregon - State Initiative to De-criminalize almost all narcotics: Measure 110, passed by a majority of statewide voters in November 2020, decriminalizes the possession of marijuana and small amounts of "harder" drugs including cocaine and methamphetamine and reduces criminal penalties for larger amounts.

*Washington State - Law Enforcement Assisted Diversion <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx#:~:text=The%20Law%20Enforcement%20Assisted%20Diversion,behavioral%20health%20needs%20or%20poverty.</ref>

'''Recovery Support Services'''

* Federal SUPPORT Act: Section 7151. Building Communities of Recovery. This section amends the Building Communities of Recovery (BCOR) program that was first authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016 by redefining “recovery community organization” as an organization that mobilizes resources within and outside of the recovery community, including through a peer support network. This section authorizes $5 million for each of FY 2019-2023.

* Federal SUPPORT Act: Section 7031. National Recovery Housing Best Practices. This section amends part D of title V of the Public Health Service Act to authorize the Secretary of HHS to identify or facilitate the development of best practices for operating recovery housing. The Secretary is directed to bring together a wide variety of stakeholders to develop best practices for Recovery Housing.

'''State Policy Plans to Address the Opioid Epidemic'''

* Rhode Island's Strategic Plan on Addiction and Overdose<ref>https://health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf</ref>
*Massachusetts’s Recommendations of the Governor's Opioid Working Group<ref>https://www.mass.gov/lists/governors-opioid-addiction-working-group</ref>

'''Example of Successful Illinois Advocacy Strategy''' The following illustrates some of the partnerships and strategies used to pass an important piece of legislation in the state of Illinois:

Illinois SB2928<ref>https://ilga.gov/legislation/billstatus.asp?DocNum=2928&GAID=12&GA=98&DocTypeID=SB&LegID=79014&SessionID=85</ref> is a current law with the common name "Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. The lead Project Coordinator Bill Gentes, has as a result, been awarded CADCA's Advocate of the Year.

The following steps were used in the creation, adoption, and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

*Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one reviews current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
*Partnering with Local Law Enforcement - As stated by Gentes at an interview "“circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you what that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process. "In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more.
*Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference.
*Securing Public-Private Partnerships - Walgreens was approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be an issue with a need to review current laws regarding drug disposal. This increased the capacity of the project and accompanying police force in collection efforts.
*Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support.
*Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments.

= Available Tools and Resources =

*FedUp! - A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids. FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies.<ref>https://feduprally.org/</ref>
*Department of Health & Human Services Guidebook for State by State Opioid Prescribing Guidelines-<ref>https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf</ref>
*National Council For Behavioral Health. Advocates for mental health and substance use policies.<ref>https://www.thenationalcouncil.org/policy-agenda/</ref>
*National Harm Reduction Coalition. Advocates for numerous harm reduction approaches.<ref>https://harmreduction.org/</ref>
* Grassroots Unwired provides a good overview of grassroots advocacy. <ref>https://www.grassrootsunwired.com/grassroots-advocacy/</ref>
* Model Law Virtual Knowledge Labs. The Model Law Virtual Knowledge Labs are a virtual learning series that provides state and county leaders with an opportunity to deepen their awareness and understanding of how model laws can assist jurisdictions in addressing substance use disorders and concomitant issues . <ref>https://legislativeanalysis.org/model-law-virtual-knowledge-labs/</ref>
* Legislative Analysis and Public Policy Association. LAPPA is excited to announce the release of State of the States: Legislative Roadmap for Reducing Overdose Deaths and Increasing Access to Treatment (the Roadmap), a guide for state leaders on the most effective approaches to addressing the current drug epidemic. <ref>https://files.constantcontact.com/9b9edb2e701/6fe81aeb-e7b3-49f9-8b98-e5060d133156.pdf</ref>
* Legislative Analysis and Public Policy Association. Drug Checking Equipment, Needles/Syringes, and Drug Paraphernalia: Summary of State Laws. <ref>https://legislativeanalysis.org/wp-content/uploads/2024/01/Drug-Checking-Equip-Needles-Syr-and-Drug-Paraphernalia-Summary-of-State-Laws.pdf</ref>
* O'Neill Institute for National and Global Health Law: The Context: Racial and other Disparities in the Opioid Crisis.<ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>
* Reasons Foundation: Drug Legalization Handbook.<ref>https://reason.org/wp-content/uploads/drug-legalization-handbook.pdf</ref>
* SAMHSA: Evidence-Based Practices Resource Center. SAMHSA is committed to improving prevention, treatment, and recovery support services for mental and substance use disorders. The Evidence-Based Practices Resource Center provides communities, clinicians, policy-makers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings.<ref>https://www.samhsa.gov/resource-search/ebp?utm_source=SAMHSA&utm_campaign=d562f4d6eb-EMAIL_CAMPAIGN_2024_03_14_04_39&utm_medium=email&utm_term=0_-d562f4d6eb-%5BLIST_EMAIL_ID%5D</ref>
* South Southwest PTTC: The Ins and Outs of Advocating for Policy Change & The Ten Do’s and Don’ts of Successful Legislative Advocacy <ref>https://pttcnetwork.org/the-ins-and-outs-of-advocating-for-policy-change/</ref> <ref>https://pttcnetwork.org/news/the-ten-dos-and-donts-of-successful-legislative-advocacy/</ref>

= Promising Practices =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Sources =

Improve Recovery Support for People in the Criminal Justice System

2024-03-27T14:17:42Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Substance use is common among justice-involved individuals. More than half of those in US prisons and jails meet the criteria for substance use disorders (SUDs). As the opioid epidemic unfolds, correctional institutions are looking for best practices that they can use to help handle the increased demand for substance abuse and addiction treatment, including diversion, treatment/drug courts, treatment while incarcerated, and re-entry services and resources. Ongoing research has suggested that substance use can be associated with poorer outcomes among individuals who have been incarcerated, including those under supervision in the community. A study by Pew Trusts study shows that more imprisonment does not reduce drug related issues. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/03/more-imprisonment-does-not-reduce-state-drug-problems?hd&utm_campaign=2018-03-14+PNN&utm_medium=email&utm_source=Pew</ref> This study reinforces a large body of prior research that cast doubt on the theory that tough prison terms deter drug misuse, distribution, and other drug-law violations. The evidence strongly suggests that policymakers should pursue alternative strategies - that research shows work better. Many states are revising their drug penalties and focusing on prevention, treatment, and recovery to integrate evidenced-based practices for treatment and recovery. Implementation of evidenced-based practices allows criminal justice agencies and communities to work together to save lives and decrease costs associated with criminal justice system and healthcare system involvement. Many individuals return to communities, social networks and families and require mental and/or physical healthcare services. Community-based behavioral health systems have an essential role in serving individuals with mental and substance use disorders who are currently or formerly involved with the criminal justice system. These individuals are a part of every community and providing resources to a person with a SUD can help lead to a life in recovery as opposed to a life in long-term incarceration.

= Key Information =

Community-based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery and that they live productively with dignity and respect. People who simply need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors related to their untreated mental illness or when a law enforcement officer believes that a person could benefit from healthcare services that are provided in the jail. Arrest and even brief incarceration can destabilize an individual’s life in many ways, including housing, health care, employment, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services that they need, and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration. Programs to improve outcomes of those in recovery within the criminal justice system includes community-based diversion programs, drug/treatment courts, treatment while incarcerated, and re-entry resources and services. For more detailed information on re-entry, please see the SAFE wiki titled "Improve Reentry After Incarceration." <ref>https://www.yoursafesolutions.us/wiki/Improve_Reentry_After_Incarceration</ref>

'''SAMHSA's 8 Principles'''

The Substance Abuse and Mental Health Services Administration (SAMHSA) identified eight principles to assist community-based behavioral health providers and criminal justice professionals to collaborate most effectively. <ref>https://store.samhsa.gov/product/Principles-of-Community-based-Behavioral-Health-Services-for-Justice-involved-Individuals-A-Research-based-Guide/SMA19-5097</ref> These principles provide a strong foundation for understanding re-entry programs, evidence-based practices, the risk of recidivism, pre-arrest and diversion programs, and medication assisted therapy:

* Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.
* Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.
* Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.
* Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.
* Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.
* Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.
* Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism .
* Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system.

'''Drug Treatment & Specialty Courts'''

In the late 1980s, justice-system professionals began to recognize the importance of treating substance use and mental health to prevent relapse and recidivism. Innovative approaches, such as drug courts, began to emerge. Drug courts aim to reduce drug use relapse and criminal recidivism through a variety of services. These services include risk and needs assessment, judicial interaction, monitoring and supervision, graduated sanctions and incentives, treatment, and various rehabilitation services. As of today, there are more than 3,000 drug courts across the United States. <ref>https://www.ojp.gov/pdffiles1/nij/238527.pdf</ref> Drug courts consist of juvenile, adult, and family treatment (aimed at family parenting and reunification of families). Overall, the drug court approach intends to reduce time in the criminal just system and provide treatment to individuals instead of punishment.<ref>https://www.nadcp.org/treatment-courts-work/</ref>

There are also Veteran Treatment Courts that are specifically aimed at working with veterans. These are served by judges who understand veteran behavioral health challenges and are familiar with the Veterans Health Administration. <ref>https://justiceforvets.org/what-is-a-veterans-treatment-court/</ref> Veteran Treatment Courts are one type of what is referred to as a specialty court. These include Family Drug Treatment Courts, DUI/DWI, Mental Health, Juvenile, Tribal, Opioid and Re-entry Courts. Additional information on specialty courts may be found at the SAFE wiki titled "Expand and Enhance Specialty Courts." <ref>http://ifi-wikis.com/IFI-OpioidCrisis/Expand_and_Enhance_Speciality_Courts</ref>

'''Pre-Arrest Diversion & Deflection Programs'''

These two types of program are related, but distinct. Deflection is the practice by which law enforcement ''or other first responders,'' such as fire and EMS, connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted. This is done in lieu of inaction when issues of addiction, mental health, and/or other needs are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested. Pre-arrest diversion is the practice by which ''law enforcement officers'' connect individuals who otherwise would have been eligible for criminal charges to community-based treatment and/or services, ''in lieu of arrest.'' This diverts them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs), clients are diverted to community-based services. Pre-arrest diversion programs should not be confused with ''prosecutorial diversion'', which occurs after individuals have already been arrested and become involved in the justice system. In contrast, pre-arrest diversion occurs before the filing of charges.

Pre-arrest diversion programs are designed to reduce the number of persons who are arrested and placed in jail because of a mental health problem, these programs shift responsibility for rehabilitation from the criminal justice system to the mental health system.<ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> Early diversion programs provide an alternative to arrest for individuals with substance use and/or mental health disorders, as well as for low-risk offenders. They allow these individuals to avoid the collateral consequences that result from arrest and contact with the criminal justice system. The movement for early diversion is data-driven and is grounded in the belief that public safety and public health approaches must work in tandem to support vulnerable individuals with substance use disorder and/or mental illness. Instead of shifting responsibility or cost from one system actor to another, this collaborative approach creates additional tools and supports for those on the front line. It provides appropriate treatment for eligible individuals. It opens up community opportunities for systemic change by leadership looking for creative solutions to complicated problems. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> Thus, these programs serve the best interest of the individuals involved, the community, and taxpayers. A variety of case studies provide documentation of the following beneficial outcomes of pre-arrest diversion and deflection programs: <ref name="SAFE Pre-Arrest Diversion Guide">https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

*Break the costly cycle of justice system involvement for eligible individuals.
*Increase cross-sector collaboration to create new pathways to community-based behavioral health services.
*Enhance relations between community members and law enforcement.
*Decrease crime, incarceration, and recidivism rates.
*Lessen the burden on justice systems.
*Improve public health and safety.
*Reduce the burden on individuals who commit non-violent, low-level offenses.
*Ensure equal access to pre-arrest diversion regardless of race, income, or geography; and
*Save taxpayer dollars

Additional information on early diversion can be found at the SAFE wiki titled "Expand Law Enforcement Assisted Diversion and Deflection Programs." <ref>https://www.yoursafesolutions.us/wiki/Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs</ref>

'''The Sequential Intercept Model (SIM) <ref>https://www.samhsa.gov/criminal-juvenile-justice/sim-overview</ref>'''

SIM helps communities identify resources and gaps in services at each of six "interception points." The SIM mapping process brings together leaders and different agencies and systems to work together to identify local strategies and action plans to divert people with mental and substance use disorders away from the justice system into treatment. The six SIM intercepts are described below:

*'''Community Services.''' This involves opportunities to divert people into local crisis care services. Resources are available without requiring people in crisis to call 911, but sometimes 911 and law enforcement are the only resources available. The emphasis is on connecting people with treatment or services instead of arresting or charging them with a crime.
*'''Law Enforcement.''' At this point diversion performed by law enforcement and other emergency service providers who respond to people with mental and substance use disorders. It allows people to be diverted to treatment instead of being arrested or booked into jail.
*'''Initial Court Hearings/Initial Detention.''' This involves diversion to community-based treatment by jail clinicians, social workers, or court officials during jail intake, booking, or initial hearing.
*'''Jails/Courts.''' This interception involves diversion to community-based services through jail or court processes and programs after a person has been booked into jail. It includes services that prevent the worsening of a person’s illness during their stay in jail or prison.
*'''Reentry''' supports reentry back into the community after jail or prison to reduce further justice involvement of people with mental and substance use disorders. It includes reentry coordinators, peer support staff, or community in-reach to link people with proper mental health and substance use treatment services.
*'''Community Corrections.''' This involves community-based criminal justice supervision with added supports for people with mental and substance use disorders to prevent violations or offenses that may result in another jail or prison stay.

'''Medication-Assisted Treatment (MAT)'''

MAT can be utilized for drug-dependent individuals within the criminal justice populations. Currently, within the criminal justice system, MAT is used primarily for pregnant women to detoxify and is minimally used for reentry. There are ongoing studies surrounding MAT, as well as efforts to expand the use of MAT within the current correctional infrastructure. Efforts to expand MAT include training, education, reducing stigma, and increasing funding. Expansion of MAT within community correctional settings will also require increased collaboration with community providers in order to enhance the appropriate pharmacotherapy for individuals under community correction supervision. Concerns of correctional facilities surrounding MAT have included liability, staffing, regulation, and funding. More information can be found at the SAFE wiki article titled, "Expand the Use of MAT/MAR in Correctional Facilities." <ref>https://www.yoursafesolutions.us/wiki/Expand_the_Use_of_MAT/MAR_in_Correctional_Facilities</ref>

= Relevant Research =

*'''Impact of Mature Drug Court over 10 Years of Operation: Recidivism and Costs''' -- This study examined the impact and costs of a primarily pre-plea drug court on the total population of drug court-eligible offenders over a 10-year period in Portland, Oregon. Results included reduced recidivism for drug court participants up to 14 years after drug court entry compared to eligible offenders that did not participate. Drug court judges that worked longer with the drug court had better participant outcomes. Judges that rotated through the drug court twice had better participant outcomes the second time than the first. Compared to traditional criminal justice system costs, there was an average of $1,392 lower cost per drug court participant. Reduced recidivism and other long-term program outcomes resulted in public savings of $79 million over 10 years. <ref>https://nij.ojp.gov/library/publications/impact-mature-drug-court-over-10-years-operation-recidivism-and-costs</ref>

*'''Evaluating Treatment Drug Courts in Kansas City, Missouri and Pensacola, Florida: Final Reports for Phase I and Phase II''' Using retrospective data, researchers found that drug courts reduced recidivism among program participants in contrast to comparable probationers. This study found that within a two-year follow-up period, the felony re-arrest rate decreased from 40 percent before the drug court to 12 percent after the drug court started in one county, and the felony re-arrest rate decreased from 50 percent to 35 percent in another county. <ref>https://nij.ojp.gov/library/publications/evaluating-treatment-drug-courts-kansas-city-missouri-and-pensacola-florida</ref>

*'''Criminal Justice Drug Abuse Treatment Studies (CJ-DATS).''' This study surveyed criminal justice agencies affiliated with the CJ-DATS to assess the use of MAT. It summarizes factors influencing use of MAT by survey responses according to availability, barriers & intentions. <ref> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295578/</ref>

= Impactful Federal, State, and Local Policies =

SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration and will add additional resources.

= Available Tools and Resources =

*'''American Acadamy of Addiction Psychiatry.''' Cultivating Law and Medicine Partnerships to Support Justice-Involved Individuals With Substance Use Disorders – Digital Guide. <ref>https://www.aaap.org/law-and-medicine/guide/</ref>

*'''Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP).''' The website offers profiles of COSSUP sites across the nation, information on COSSUP demonstration projects, and access to technical assistance and peer-to-peer learning opportunities. <ref>https://www.cossapresources.org/</ref>

*'''National Drug Court Resource Center''' provides evidence-based practice standards set forth by subject matter experts, researchers, and policy makers. Their website also includes resources associated with a variety of different types of courts. <ref>https://ndcrc.org/best-practice-resources/</ref>

*'''Opioid Response Network''' Community Supervision and MOUD Toolkit: A free online learning series to help probation officers and treatment providers enhance client recovery during supervision. <ref>https://resources.opioidresponsenetwork.org/Education/CommunitySupervisionandMOUDToolkit.aspx</ref>

*'''Police, Treatment and Community Collaborative (PTACC)''' provides a webinar titled "Starting Your Pre-Arrest Diversion (PAD) Effort: Law Enforcement, Behavioral Health, and Community Together." This provides information on pre-arrest diversion models. <ref>https://ptaccollaborative.org/webinars/</ref>

*'''SAFE Project''' through collaboration with PTACC has published "Law Enforcement Pre-Arrest Diversion Guide." This guide contains coverage of a variety of diversion pathways and several case studies. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

*'''SAMHSA''' has published "After Incarceration: A Guide to Helping Women Reenter the Community." This guide was created for individuals who provide or coordinate reentry services for women involved in the criminal justice system, including corrections staff, reentry organizations, substance use disorder and mental health treatment providers, reentry specialists, and peer specialists. <ref>https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-01-001_508.pdf</ref>

= Promising Practices =

'''A Way Out (Lake County, IL)''' <ref>https://awayoutlc.org/</ref> “A Way Out” is a Lake County, Illinois Law Enforcement Assisted Diversion (LEAD) pilot program, designed to fast-track users to substance abuse programs and services. This program is available 24 hours a day, 7 days a week, at participating police departments across Lake County. It ensures that no criminal charges will be sought for those who may be in possession of narcotics or paraphernalia, if assistance is sought out by the prospective program participant. “A Way Out” is a program developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, re-frame the role law enforcement plays in community safety, and unite the community. For too long, substance use has been stigmatized and dealt with as a criminal issue. Substance use is a public health problem that needs to be addressed as such. Lake County Opioid Initiative is committed to developing innovative ways to create positive change regarding substance use and mental health.

'''The Hope Initiative (Nashville, NC)''' <ref> https://www.townofnashville.com/home/showpublisheddocument/129/636527353948700000</ref> The HOPE Initiative was the first pre-arrest diversion program in North Carolina. Its purpose is to assist those individuals with substance use disorder find treatment options, get into treatment, and begin recovery. While other programs were centered on opioids, the HOPE Initiative was willing to accept any substance use disorder. Partnerships were established with the local district attorney’s office, the Eastpointe Local Management Entity, UNC Nash Hospital, Coastal Plain Hospital (Detox facility), Police Assisted Addiction and Recovery Initiative (PAARI), and many others. The program allows individuals to come to the Nashville Police Department to start their recovery process by turning over any drugs and/or paraphernalia without fear of charges. The first organization in the HOPE Initiative served 320 clients in 2 years. The program is funded through donations, grants, and fundraisers.

'''Plymouth County Outreach (Plymouth County, MA) <ref>https://otf.plymouthda.com/project-outreach/</ref>''' Plymouth County Outreach (PCO) was developed through the Public Safety, Community Coalition, and the Faith Based Subcommittees of the Plymouth County Drug Abuse Task Force. Since its inception, PCO has fostered an innovative law enforcement/non law enforcement collaboration which includes faith-based coalitions, the District Attorney’s Office, The Sheriff’s Department, all 27 police departments, 5 major hospitals, the Division of Children and Families, recovery coaches, District Court Probation, and the Police Assisted Addiction and Recovery Initiative (PAARI). The two main aspects of the program are overdose follow-up and community drop-in centers. Within 12-24 hours of an overdose, an outreach team consisting of plainclothes officers, a licensed clinician, and/or a recovery coach will conduct a home visit of the overdose survivor. The intent of the outreach effort is to provide resources and support to those with substance use disorders and/or their families with the hope of getting people into treatment and connecting family/friends with existing resources in the county. Drop-in center are held each week in various sites across Plymouth County. These centers host a growing number of health care providers who help with treatment options and train and distribute Narcan for free.

'''Arlington Opiate Outreach Initiative (Arlington, MA) <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>''' This community-based strategy has two major components. First is the proactive outreach to known substance users. This involves the police department clinician reaching out to the known population of persons with substance use disorders to support them in developing a plan to ensure their survival, to provide access to services, and to facilitate the long-term process of recovery. The second component is the Arlington Community Training & Support (Arlington ACTS) which involves a series of community-based meetings. These are co-facilitated by the police department’s clinician and a community substance abuse intervention expert and are aimed at creating a supportive non-judgmental environment for substance users and their families.

'''Drug Abuse Response Team (Toledo, OH)''' <ref>https://www.cossapresources.org/Content/Documents/Diversion_Library/Lucas_County_DART_Presentation_2019_508.pdf</ref> The Lucas County Sheriff’s Office developed the Drug Abuse Response Team (DART) model. Lucas County credits it with diverting more than a thousand people from the criminal-justice system and into treatment during its first 4 years. 70% of participants successfully entered detox and treatment programs. The Ohio legislature has since approved a pilot grant program to assist other Ohio counties in implementing a DART program. 39 programs received grant funding for 21-month-long pilots. The Lucas County DART program has over 20 officers from several area law enforcement agencies, including Toledo PD, the Sheriff’s Department, and the Division of Children and Families. Each officer works with parents with substance use disorder whose children have been put in foster care, in order for parents to get access to treatment so that the family can be reunited.

'''Quick Response Team (Hamilton County, OH)''' <ref>https://www.cossapresources.org/Content/Documents/Diversion_Library/HCTF_Hamilton_County_OH_Program_Policy_508.pdf</ref> The Hamilton County Heroin Task Force partnered with law enforcement, fire departments and social workers to create a team that follows up with overdose victims and offers them addiction treatment. The goal is to have a first responder follow up with overdose victims within the “recovery window” (72 hours after an overdose reversal) and to provide a warm hand off to treatment options. Teams work to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data-collecting agency. Teams also use “predictive analysis” to track drug activity to target potential overdoses with the help of University of Cincinnati’s Institute of Crime Science. QRT has since been launched as a national model.

'''Law Enforcement Assisted Diversion (King County, WA) <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx</ref>''' Law Enforcement Assisted Diversion (LEAD) is a pre-booking diversion program developed in King County, Washington to address low-level drug and prostitution crimes in Seattle and King County. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution. By diverting eligible individuals to services, LEAD is committed to improving public safety and public order and reducing the criminal behavior of people who participate in the program. The King County LEAD program has evolved to a national model with a national support organization, the LEAD National Support Bureau, which assists departments in establishing LEAD programs.

'''Stop, Triage, Engage, Educate and Rehabilitate (Montgomery County, MD) <ref>https://opioid-resource-connector.org/index.php/program-model/stop-triage-engage-educate-and-rehabilitate-steer</ref>''' The STEER Program in Montgomery County, MD, is a pre-booking law enforcement and drug treatment and recovery linkage program that aims to provide rapid identification, deflection, and access to treatment for drug-involved individuals as an alternative to conventional arrest. Individuals are assigned a care-coordinator who focuses on rapid treatment access, retention, motivation, engagement, and completion and conducts a full clinical assessment and referral. Police officers use a screening tool to decide whether a person is a candidate for this deflection. The risk assessment may be used by a police officer who is responding to a call for service or in an on-view situation. Charges can be held in abeyance while the person is seeking services. STEER operates around the core value proposition of deflection, namely ensuring the “correct” movement of citizens either into the criminal justice system or away from it. As a result of moving people towards the human services system, STEER exemplifies the following outcomes:

* reducing crime
* (re) building community relations
* reducing drug use
* restoring the lives of citizens

'''Pre-Arrest Diversion/Adult Civil Citation (Leon County/Tallahassee, FL) <ref>https://university.pretrial.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=514d95d4-413d-7a4f-f2e2-7fa588a297c2&forceDialog=0</ref>''' As a model pre-arrest diversion program, the Leon County/Tallahassee PAD/ACC program holds offenders accountable for their crime; but, instead of being arrested and prosecuted by the traditional criminal justice system, the person receives civil sanctions, e.g., community service, and behavioral health intervention services. Following referral by law enforcement, one essential elements of the program is the use of evidence-based behavioral health intervention services to reduce the likelihood of future criminal activity. The PAD/ACC program also works to avoid an arrest record for those who successfully complete the program. The decision to arrest or refer for behavioral health assessment and intervention services is best made by the law enforcement officer who is on the scene and understands the nature of the offense at the time it occurred. Since its inception, the Leon County/Tallahassee PAD/ACC program has had over 1300 participants. The Civil Citation model has grown throughout the State of Florida. Today the Civil Citation Network (CCN) assists communities in implementation of the Civil Citation model.

''' Crisis Intervention Teams (Memphis, TN) <ref>https://www.memphistn.gov/government/police-department/crisis-intervention-team/</ref>''' The Crisis Intervention Team (CIT) program is a community partnership working with mental health consumers and family members. Officers are part of a specialized team which can respond to a crisis at any time, and they will work with the community to resolve each situation in a manner that shows concern for the citizen’s well-being. The CIT is made up of volunteer officers from each Uniform Patrol Precinct. CIT officers are called upon to respond to crisis calls that present those officers, face-to-face, with complex issues relating to mental illness. CIT officers also perform their regular duty assignment as patrol officers. The Memphis Police Department has 268 CIT officers who participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. Due to the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24/7 coverage.

''' Virginia Recovery and Re-Entry Project.''' <ref>https://mcshin.org/wp-content/uploads/2020/06/1-VRR-Info-Sheet1.pdf</ref> The VRR Project serves individuals with SUDs during incarceration and through the re-entry process, with a peer-to-peer approach to recovery. The McShin Foundation and SAMHSA’s Building Communities of Recovery Initiative funded two new recovery jail programs in Riverside Regional Jail and Rappahannock Shenandoah Warrenton (RSW) Regional Jail. Recovery support services are provided five days a week in RSW and three days a week in Riverside. In follow-up to participation in these VRR programs, residential recovery program scholarships were offered to twenty individuals. VRR uses a wide variety of resources to promote long-term recovery support networks and services.

= Sources =

Improve Recovery Support for People in the Criminal Justice System

2024-03-27T14:06:52Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Substance use is common among justice-involved individuals. More than half of those in US prisons and jails meet the criteria for substance use disorders (SUDs). As the opioid epidemic unfolds, correctional institutions are looking for best practices that they can use to help handle the increased demand for substance abuse and addiction treatment, including diversion, treatment/drug courts, treatment while incarcerated, and re-entry services and resources. Ongoing research has suggested that substance use can be associated with poorer outcomes among individuals who have been incarcerated, including those under supervision in the community. A study by Pew Trusts study shows that more imprisonment does not reduce drug related issues. <ref>https://www.pewtrusts.org/en/research-and-analysis/issue-briefs/2018/03/more-imprisonment-does-not-reduce-state-drug-problems?hd&utm_campaign=2018-03-14+PNN&utm_medium=email&utm_source=Pew</ref> This study reinforces a large body of prior research that cast doubt on the theory that tough prison terms deter drug misuse, distribution, and other drug-law violations. The evidence strongly suggests that policymakers should pursue alternative strategies - that research shows work better. Many states are revising their drug penalties and focusing on prevention, treatment, and recovery to integrate evidenced-based practices for treatment and recovery. Implementation of evidenced-based practices allows criminal justice agencies and communities to work together to save lives and decrease costs associated with criminal justice system and healthcare system involvement. Many individuals return to communities, social networks and families and require mental and/or physical healthcare services. Community-based behavioral health systems have an essential role in serving individuals with mental and substance use disorders who are currently or formerly involved with the criminal justice system. These individuals are a part of every community and providing resources to a person with a SUD can help lead to a life in recovery as opposed to a life in long-term incarceration.

= Key Information =

Community-based behavioral health providers play a key role in ensuring that every individual they serve has the treatment, support, skills, and opportunity for recovery and that they live productively with dignity and respect. People who simply need access to quality community-based care may be arrested instead. In many communities, people with behavioral health disorders cannot access adequate community-based services and find themselves channeled into the justice system. This may happen when a person is arrested for behaviors related to their untreated mental illness or when a law enforcement officer believes that a person could benefit from healthcare services that are provided in the jail. Arrest and even brief incarceration can destabilize an individual’s life in many ways, including housing, health care, employment, and disruptions in family life and social connections. Once in the criminal justice system, individuals with mental and substance use disorders stay in jails longer, have an increased risk for self-harm, and receive more frequent punitive responses to infractions. Due to funding and staffing limitations, many people with mental illnesses do not receive the services that they need, and their conditions often worsen inside jail settings. For individuals already receiving medications and treatment in the community, these services may be interrupted during incarceration, creating lapses in treatment and difficulties in resuming treatment upon reentry to the community. Without continuous coordinated care throughout and following incarceration, these individuals are at risk for re-incarceration. Programs to improve outcomes of those in recovery within the criminal justice system includes community-based diversion programs, drug/treatment courts, treatment while incarcerated, and re-entry resources and services. For more detailed information on re-entry, please see the SAFE wiki titled "Improve Reentry After Incarceration." <ref>https://www.yoursafesolutions.us/wiki/Improve_Reentry_After_Incarceration</ref>

'''SAMHSA's 8 Principles'''

The Substance Abuse and Mental Health Services Administration (SAMHSA) identified eight principles to assist community-based behavioral health providers and criminal justice professionals to collaborate most effectively. <ref>https://store.samhsa.gov/product/Principles-of-Community-based-Behavioral-Health-Services-for-Justice-involved-Individuals-A-Research-based-Guide/SMA19-5097</ref> These principles provide a strong foundation for understanding re-entry programs, evidence-based practices, the risk of recidivism, pre-arrest and diversion programs, and medication assisted therapy:

* Community providers are knowledgeable about the criminal justice system. This includes the sequence of events, terminology, and processes of the criminal justice system, as well as the practices of criminal justice professionals.
* Community providers collaborate with criminal justice professionals to improve public health, public safety, and individual behavioral health outcomes.
* Evidence-based and promising programs and practices in behavioral health treatment services are used to provide high quality clinical care for justice-involved individuals.
* Community providers understand and address criminogenic risk and need factors as part of a comprehensive treatment plan for justice-involved individuals.
* Integrated physical and behavioral health care is part of a comprehensive treatment plan for justice-involved individuals.
* Services and workplaces are trauma-informed to support the health and safety of both justice-involved individuals and community providers.
* Case management for justice-involved individuals incorporates treatment, social services, and social supports that address prior and current involvement with the criminal justice system and reduce the likelihood of recidivism .
* Community providers recognize and address issues that may contribute to disparities in both behavioral health care and the criminal justice system.

'''Drug Treatment & Specialty Courts'''

In the late 1980s, justice-system professionals began to recognize the importance of treating substance use and mental health to prevent relapse and recidivism. Innovative approaches, such as drug courts, began to emerge. Drug courts aim to reduce drug use relapse and criminal recidivism through a variety of services. These services include risk and needs assessment, judicial interaction, monitoring and supervision, graduated sanctions and incentives, treatment, and various rehabilitation services. As of today, there are more than 3,000 drug courts across the United States. <ref>https://www.ojp.gov/pdffiles1/nij/238527.pdf</ref> Drug courts consist of juvenile, adult, and family treatment (aimed at family parenting and reunification of families). Overall, the drug court approach intends to reduce time in the criminal just system and provide treatment to individuals instead of punishment.<ref>https://www.nadcp.org/treatment-courts-work/</ref>

There are also Veteran Treatment Courts that are specifically aimed at working with veterans. These are served by judges who understand veteran behavioral health challenges and are familiar with the Veterans Health Administration. <ref>https://justiceforvets.org/what-is-a-veterans-treatment-court/</ref> Veteran Treatment Courts are one type of what is referred to as a specialty court. These include Family Drug Treatment Courts, DUI/DWI, Mental Health, Juvenile, Tribal, Opioid and Re-entry Courts. Additional information on specialty courts may be found at the SAFE wiki titled "Expand and Enhance Specialty Courts." <ref>http://ifi-wikis.com/IFI-OpioidCrisis/Expand_and_Enhance_Speciality_Courts</ref>

'''Pre-Arrest Diversion & Deflection Programs'''

These two types of program are related, but distinct. Deflection is the practice by which law enforcement ''or other first responders,'' such as fire and EMS, connect individuals to community-based treatment and/or services when arrest would not have been necessary or permitted. This is done in lieu of inaction when issues of addiction, mental health, and/or other needs are present. Deflection is performed without fear by the individual that if they do not “accept the deflection” they will subsequently be arrested. Pre-arrest diversion is the practice by which ''law enforcement officers'' connect individuals who otherwise would have been eligible for criminal charges to community-based treatment and/or services, ''in lieu of arrest.'' This diverts them from the justice system into the community. Some pre-arrest diversion programs have policies that mandate holding charges in abeyance until treatment or other requirements, such as restitution or community service, are completed, at which time the charges are dropped. Although pre-arrest diversion is facilitated by justice system stakeholders (usually police and sheriffs), clients are diverted to community-based services. Pre-arrest diversion programs should not be confused with ''prosecutorial diversion'', which occurs after individuals have already been arrested and become involved in the justice system. In contrast, pre-arrest diversion occurs before the filing of charges.

Pre-arrest diversion programs are designed to reduce the number of persons who are arrested and placed in jail because of a mental health problem, these programs shift responsibility for rehabilitation from the criminal justice system to the mental health system.<ref>http://www.centerforhealthandjustice.org/chjweb/tertiary_page.aspx?id=73&title=The-Police,-Treatment-and-Community-Collaborative-(PTACC)</ref> Early diversion programs provide an alternative to arrest for individuals with substance use and/or mental health disorders, as well as for low-risk offenders. They allow these individuals to avoid the collateral consequences that result from arrest and contact with the criminal justice system. The movement for early diversion is data-driven and is grounded in the belief that public safety and public health approaches must work in tandem to support vulnerable individuals with substance use disorder and/or mental illness. Instead of shifting responsibility or cost from one system actor to another, this collaborative approach creates additional tools and supports for those on the front line. It provides appropriate treatment for eligible individuals. It opens up community opportunities for systemic change by leadership looking for creative solutions to complicated problems. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2018/07/PTACC_visual.pdf</ref> Thus, these programs serve the best interest of the individuals involved, the community, and taxpayers. A variety of case studies provide documentation of the following beneficial outcomes of pre-arrest diversion and deflection programs: <ref name="SAFE Pre-Arrest Diversion Guide">https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

*Break the costly cycle of justice system involvement for eligible individuals.
*Increase cross-sector collaboration to create new pathways to community-based behavioral health services.
*Enhance relations between community members and law enforcement.
*Decrease crime, incarceration, and recidivism rates.
*Lessen the burden on justice systems.
*Improve public health and safety.
*Reduce the burden on individuals who commit non-violent, low-level offenses.
*Ensure equal access to pre-arrest diversion regardless of race, income, or geography; and
*Save taxpayer dollars

Additional information on early diversion can be found at the SAFE wiki titled "Expand Law Enforcement Assisted Diversion and Deflection Programs." <ref>https://www.yoursafesolutions.us/wiki/Expand_Law_Enforcement_Assisted_Diversion_and_Deflection_Programs</ref>

'''The Sequential Intercept Model (SIM) <ref>https://www.samhsa.gov/criminal-juvenile-justice/sim-overview</ref>'''

SIM helps communities identify resources and gaps in services at each of six "interception points." The SIM mapping process brings together leaders and different agencies and systems to work together to identify local strategies and action plans to divert people with mental and substance use disorders away from the justice system into treatment. The six SIM intercepts are described below:

*'''Community Services.''' This involves opportunities to divert people into local crisis care services. Resources are available without requiring people in crisis to call 911, but sometimes 911 and law enforcement are the only resources available. The emphasis is on connecting people with treatment or services instead of arresting or charging them with a crime.
*'''Law Enforcement.''' At this point diversion performed by law enforcement and other emergency service providers who respond to people with mental and substance use disorders. It allows people to be diverted to treatment instead of being arrested or booked into jail.
*'''Initial Court Hearings/Initial Detention.''' This involves diversion to community-based treatment by jail clinicians, social workers, or court officials during jail intake, booking, or initial hearing.
*'''Jails/Courts.''' This interception involves diversion to community-based services through jail or court processes and programs after a person has been booked into jail. It includes services that prevent the worsening of a person’s illness during their stay in jail or prison.
*'''Reentry''' supports reentry back into the community after jail or prison to reduce further justice involvement of people with mental and substance use disorders. It includes reentry coordinators, peer support staff, or community in-reach to link people with proper mental health and substance use treatment services.
*'''Community Corrections.''' This involves community-based criminal justice supervision with added supports for people with mental and substance use disorders to prevent violations or offenses that may result in another jail or prison stay.

'''Medication-Assisted Treatment (MAT)'''

MAT can be utilized for drug-dependent individuals within the criminal justice populations. Currently, within the criminal justice system, MAT is used primarily for pregnant women to detoxify and is minimally used for reentry. There are ongoing studies surrounding MAT, as well as efforts to expand the use of MAT within the current correctional infrastructure. Efforts to expand MAT include training, education, reducing stigma, and increasing funding. Expansion of MAT within community correctional settings will also require increased collaboration with community providers in order to enhance the appropriate pharmacotherapy for individuals under community correction supervision. Concerns of correctional facilities surrounding MAT have included liability, staffing, regulation, and funding. More information can be found at the SAFE wiki article titled, "Expand the Use of MAT/MAR in Correctional Facilities." <ref>https://www.yoursafesolutions.us/wiki/Expand_the_Use_of_MAT/MAR_in_Correctional_Facilities</ref>

= Relevant Research =

*'''Impact of Mature Drug Court over 10 Years of Operation: Recidivism and Costs''' -- This study examined the impact and costs of a primarily pre-plea drug court on the total population of drug court-eligible offenders over a 10-year period in Portland, Oregon. Results included reduced recidivism for drug court participants up to 14 years after drug court entry compared to eligible offenders that did not participate. Drug court judges that worked longer with the drug court had better participant outcomes. Judges that rotated through the drug court twice had better participant outcomes the second time than the first. Compared to traditional criminal justice system costs, there was an average of $1,392 lower cost per drug court participant. Reduced recidivism and other long-term program outcomes resulted in public savings of $79 million over 10 years. <ref>https://nij.ojp.gov/library/publications/impact-mature-drug-court-over-10-years-operation-recidivism-and-costs</ref>

*'''Evaluating Treatment Drug Courts in Kansas City, Missouri and Pensacola, Florida: Final Reports for Phase I and Phase II''' Using retrospective data, researchers found that drug courts reduced recidivism among program participants in contrast to comparable probationers. This study found that within a two-year follow-up period, the felony re-arrest rate decreased from 40 percent before the drug court to 12 percent after the drug court started in one county, and the felony re-arrest rate decreased from 50 percent to 35 percent in another county. <ref>https://nij.ojp.gov/library/publications/evaluating-treatment-drug-courts-kansas-city-missouri-and-pensacola-florida</ref>

*'''Criminal Justice Drug Abuse Treatment Studies (CJ-DATS).''' This study surveyed criminal justice agencies affiliated with the CJ-DATS to assess the use of MAT. It summarizes factors influencing use of MAT by survey responses according to availability, barriers & intentions. <ref> https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295578/</ref>

= Impactful Federal, State, and Local Policies =

SAFE Project is dedicated to providing communities with the most relevant and innovative materials. We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration and will add additional resources.

= Available Tools and Resources =

*'''American Acadamy of Addiction Psychiatry.''' Cultivating Law and Medicine Partnerships to Support Justice-Involved Individuals With Substance Use Disorders – Digital Guide. <ref>https://www.aaap.org/law-and-medicine/guide/</ref>

*'''Comprehensive Opioid, Stimulant, and Substance Use Program (COSSUP).''' The website offers profiles of COSSUP sites across the nation, information on COSSUP demonstration projects, and access to technical assistance and peer-to-peer learning opportunities. <ref>https://www.cossapresources.org/</ref>

*'''National Drug Court Resource Center''' provides evidence-based practice standards set forth by subject matter experts, researchers, and policy makers. Their website also includes resources associated with a variety of different types of courts. <ref>https://ndcrc.org/best-practice-resources/</ref>

*'''Police, Treatment and Community Collaborative (PTACC)''' provides a webinar titled "Starting Your Pre-Arrest Diversion (PAD) Effort: Law Enforcement, Behavioral Health, and Community Together." This provides information on pre-arrest diversion models. <ref>https://ptaccollaborative.org/webinars/</ref>

*'''SAFE Project''' through collaboration with PTACC has published "Law Enforcement Pre-Arrest Diversion Guide." This guide contains coverage of a variety of diversion pathways and several case studies. <ref>https://secureservercdn.net/198.71.233.33/lpo.969.myftpupload.com/wp-content/uploads/2019/06/SAFE-Pre-Arrest-Guide_Final-.pdf</ref>

*'''SAMHSA''' has published "After Incarceration: A Guide to Helping Women Reenter the Community." This guide was created for individuals who provide or coordinate reentry services for women involved in the criminal justice system, including corrections staff, reentry organizations, substance use disorder and mental health treatment providers, reentry specialists, and peer specialists. <ref>https://store.samhsa.gov/sites/default/files/SAMHSA_Digital_Download/PEP20-05-01-001_508.pdf</ref>

= Promising Practices =

'''A Way Out (Lake County, IL)''' <ref>https://awayoutlc.org/</ref> “A Way Out” is a Lake County, Illinois Law Enforcement Assisted Diversion (LEAD) pilot program, designed to fast-track users to substance abuse programs and services. This program is available 24 hours a day, 7 days a week, at participating police departments across Lake County. It ensures that no criminal charges will be sought for those who may be in possession of narcotics or paraphernalia, if assistance is sought out by the prospective program participant. “A Way Out” is a program developed by the Lake County Opioid Initiative to create additional treatment access points, reduce crime, reduce substance-related harms, re-frame the role law enforcement plays in community safety, and unite the community. For too long, substance use has been stigmatized and dealt with as a criminal issue. Substance use is a public health problem that needs to be addressed as such. Lake County Opioid Initiative is committed to developing innovative ways to create positive change regarding substance use and mental health.

'''The Hope Initiative (Nashville, NC)''' <ref> https://www.townofnashville.com/home/showpublisheddocument/129/636527353948700000</ref> The HOPE Initiative was the first pre-arrest diversion program in North Carolina. Its purpose is to assist those individuals with substance use disorder find treatment options, get into treatment, and begin recovery. While other programs were centered on opioids, the HOPE Initiative was willing to accept any substance use disorder. Partnerships were established with the local district attorney’s office, the Eastpointe Local Management Entity, UNC Nash Hospital, Coastal Plain Hospital (Detox facility), Police Assisted Addiction and Recovery Initiative (PAARI), and many others. The program allows individuals to come to the Nashville Police Department to start their recovery process by turning over any drugs and/or paraphernalia without fear of charges. The first organization in the HOPE Initiative served 320 clients in 2 years. The program is funded through donations, grants, and fundraisers.

'''Plymouth County Outreach (Plymouth County, MA) <ref>https://otf.plymouthda.com/project-outreach/</ref>''' Plymouth County Outreach (PCO) was developed through the Public Safety, Community Coalition, and the Faith Based Subcommittees of the Plymouth County Drug Abuse Task Force. Since its inception, PCO has fostered an innovative law enforcement/non law enforcement collaboration which includes faith-based coalitions, the District Attorney’s Office, The Sheriff’s Department, all 27 police departments, 5 major hospitals, the Division of Children and Families, recovery coaches, District Court Probation, and the Police Assisted Addiction and Recovery Initiative (PAARI). The two main aspects of the program are overdose follow-up and community drop-in centers. Within 12-24 hours of an overdose, an outreach team consisting of plainclothes officers, a licensed clinician, and/or a recovery coach will conduct a home visit of the overdose survivor. The intent of the outreach effort is to provide resources and support to those with substance use disorders and/or their families with the hope of getting people into treatment and connecting family/friends with existing resources in the county. Drop-in center are held each week in various sites across Plymouth County. These centers host a growing number of health care providers who help with treatment options and train and distribute Narcan for free.

'''Arlington Opiate Outreach Initiative (Arlington, MA) <ref>https://cops.usdoj.gov/RIC/Publications/cops-p356-pub.pdf</ref>''' This community-based strategy has two major components. First is the proactive outreach to known substance users. This involves the police department clinician reaching out to the known population of persons with substance use disorders to support them in developing a plan to ensure their survival, to provide access to services, and to facilitate the long-term process of recovery. The second component is the Arlington Community Training & Support (Arlington ACTS) which involves a series of community-based meetings. These are co-facilitated by the police department’s clinician and a community substance abuse intervention expert and are aimed at creating a supportive non-judgmental environment for substance users and their families.

'''Drug Abuse Response Team (Toledo, OH)''' <ref>https://www.cossapresources.org/Content/Documents/Diversion_Library/Lucas_County_DART_Presentation_2019_508.pdf</ref> The Lucas County Sheriff’s Office developed the Drug Abuse Response Team (DART) model. Lucas County credits it with diverting more than a thousand people from the criminal-justice system and into treatment during its first 4 years. 70% of participants successfully entered detox and treatment programs. The Ohio legislature has since approved a pilot grant program to assist other Ohio counties in implementing a DART program. 39 programs received grant funding for 21-month-long pilots. The Lucas County DART program has over 20 officers from several area law enforcement agencies, including Toledo PD, the Sheriff’s Department, and the Division of Children and Families. Each officer works with parents with substance use disorder whose children have been put in foster care, in order for parents to get access to treatment so that the family can be reunited.

'''Quick Response Team (Hamilton County, OH)''' <ref>https://www.cossapresources.org/Content/Documents/Diversion_Library/HCTF_Hamilton_County_OH_Program_Policy_508.pdf</ref> The Hamilton County Heroin Task Force partnered with law enforcement, fire departments and social workers to create a team that follows up with overdose victims and offers them addiction treatment. The goal is to have a first responder follow up with overdose victims within the “recovery window” (72 hours after an overdose reversal) and to provide a warm hand off to treatment options. Teams work to find overdose survivors using a database maintained by the Greater Cincinnati Fusion Center, a public safety data-collecting agency. Teams also use “predictive analysis” to track drug activity to target potential overdoses with the help of University of Cincinnati’s Institute of Crime Science. QRT has since been launched as a national model.

'''Law Enforcement Assisted Diversion (King County, WA) <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx</ref>''' Law Enforcement Assisted Diversion (LEAD) is a pre-booking diversion program developed in King County, Washington to address low-level drug and prostitution crimes in Seattle and King County. The program allows law enforcement officers to redirect low-level offenders engaged in drug or prostitution activity to community-based services, instead of jail and prosecution. By diverting eligible individuals to services, LEAD is committed to improving public safety and public order and reducing the criminal behavior of people who participate in the program. The King County LEAD program has evolved to a national model with a national support organization, the LEAD National Support Bureau, which assists departments in establishing LEAD programs.

'''Stop, Triage, Engage, Educate and Rehabilitate (Montgomery County, MD) <ref>https://opioid-resource-connector.org/index.php/program-model/stop-triage-engage-educate-and-rehabilitate-steer</ref>''' The STEER Program in Montgomery County, MD, is a pre-booking law enforcement and drug treatment and recovery linkage program that aims to provide rapid identification, deflection, and access to treatment for drug-involved individuals as an alternative to conventional arrest. Individuals are assigned a care-coordinator who focuses on rapid treatment access, retention, motivation, engagement, and completion and conducts a full clinical assessment and referral. Police officers use a screening tool to decide whether a person is a candidate for this deflection. The risk assessment may be used by a police officer who is responding to a call for service or in an on-view situation. Charges can be held in abeyance while the person is seeking services. STEER operates around the core value proposition of deflection, namely ensuring the “correct” movement of citizens either into the criminal justice system or away from it. As a result of moving people towards the human services system, STEER exemplifies the following outcomes:

* reducing crime
* (re) building community relations
* reducing drug use
* restoring the lives of citizens

'''Pre-Arrest Diversion/Adult Civil Citation (Leon County/Tallahassee, FL) <ref>https://university.pretrial.org/HigherLogic/System/DownloadDocumentFile.ashx?DocumentFileKey=514d95d4-413d-7a4f-f2e2-7fa588a297c2&forceDialog=0</ref>''' As a model pre-arrest diversion program, the Leon County/Tallahassee PAD/ACC program holds offenders accountable for their crime; but, instead of being arrested and prosecuted by the traditional criminal justice system, the person receives civil sanctions, e.g., community service, and behavioral health intervention services. Following referral by law enforcement, one essential elements of the program is the use of evidence-based behavioral health intervention services to reduce the likelihood of future criminal activity. The PAD/ACC program also works to avoid an arrest record for those who successfully complete the program. The decision to arrest or refer for behavioral health assessment and intervention services is best made by the law enforcement officer who is on the scene and understands the nature of the offense at the time it occurred. Since its inception, the Leon County/Tallahassee PAD/ACC program has had over 1300 participants. The Civil Citation model has grown throughout the State of Florida. Today the Civil Citation Network (CCN) assists communities in implementation of the Civil Citation model.

''' Crisis Intervention Teams (Memphis, TN) <ref>https://www.memphistn.gov/government/police-department/crisis-intervention-team/</ref>''' The Crisis Intervention Team (CIT) program is a community partnership working with mental health consumers and family members. Officers are part of a specialized team which can respond to a crisis at any time, and they will work with the community to resolve each situation in a manner that shows concern for the citizen’s well-being. The CIT is made up of volunteer officers from each Uniform Patrol Precinct. CIT officers are called upon to respond to crisis calls that present those officers, face-to-face, with complex issues relating to mental illness. CIT officers also perform their regular duty assignment as patrol officers. The Memphis Police Department has 268 CIT officers who participate in specialized training under the instructional supervision of mental health providers, family advocates, and mental health consumer groups. Due to the training, CIT officers can, with confidence, offer a more humane and calm approach. These officers maintain a 24/7 coverage.

''' Virginia Recovery and Re-Entry Project.''' <ref>https://mcshin.org/wp-content/uploads/2020/06/1-VRR-Info-Sheet1.pdf</ref> The VRR Project serves individuals with SUDs during incarceration and through the re-entry process, with a peer-to-peer approach to recovery. The McShin Foundation and SAMHSA’s Building Communities of Recovery Initiative funded two new recovery jail programs in Riverside Regional Jail and Rappahannock Shenandoah Warrenton (RSW) Regional Jail. Recovery support services are provided five days a week in RSW and three days a week in Riverside. In follow-up to participation in these VRR programs, residential recovery program scholarships were offered to twenty individuals. VRR uses a wide variety of resources to promote long-term recovery support networks and services.

= Sources =

Advocate for Policy Change

2024-03-27T13:16:08Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Educating policymakers and the general public about the legislative or policy changes necessary to create change in your community is an important step to addressing substance misuse and substance use disorder (SUD). Policies help states and local communities in several important ways:

1. By providing direct funding to communities for treatment and other services. 2. By improving access and/or affordability of care to individuals in need of assistance. 3. By removing barriers that prevent or limit the use of best practices across government agencies.

Policy change can take place at all levels of government. This page will provide information about how policy changes typically take place, as well as some examples of federal, state, and local laws that have helped local communities.

= Key Information =

'''Initial Steps for Policy Advocacy''' In order to bring about policy changes through laws or ordinances, any group of citizens must be able to become a "constituency of consequence" to those with the ability to create and change policy. This can be accomplished with a number of different advocacy approaches, as highlighted below. A few key principles to change policy at any level of government include:

*Have clear policy objectives. The more specific and narrow the objective the better. If the policy goals are too broad or general, it is easy for legislators to object on that basis.
*Support your position. Have research and data to support why the policy change you are seeking would be beneficial. For example, if seeking to improve harm reduction through the creation of a needle exchange program, provide data on expected lives that will be saved, reduced medical costs, improved linkages to care, and other benefits.
*Build a coalition. It is important to build a coalition to increase political clout. Think about other groups within the state or local community whose goals align with yours that would support your policy objectives and who would be willing to take action in order to achieve them. For example, if you were advocating for a needle exchange program, you might seek support from harm reduction organizations including hospitals, community health organizations and professionals, the recovery community, families in support of recovery, the treatment community, and potentially many others.
*Know your opposition. If a policy change hasn't happened, it is likely opposition exists. It is important to learn why policymakers may be hesitant to make a certain change, including what groups oppose the policy and why. Learning about the other side is critical to developing an effective advocacy strategy. Overcoming opposition may require education, effective counterarguments, financial resources, and increased public awareness.
*Identify champions. The most successful efforts resulting in desired policy changes are led by individuals who are passionate about the issue. Identifying and working with champions in the state or local government is a big key to success. It is important to have people "on the inside" that can hold hearings, develop legislation, utilize input and information from stakeholders, and provide insight on the process.
*Your voice matters. Many times, individuals or groups with minimal advocacy experience can be intimidated by the process. Remember that those "in power" are there because they were elected to serve. Lawmakers across all levels of government represent the people of their states, districts, cities, towns, and so forth. It is your constitutional right to petition the government and be heard. Those representing the people need to hear the concerns of all those they represent.

'''Converting Policy Into Action''' After taking the initial steps delineated above, the next step is to identify and implement a set of strategies that will grow public and political support for those policies. While approaches and specific strategies are almost innumerable, taking action involves communication and messaging intended to educate and influence.

'''Grassroots Advocacy''' Grassroots Advocacy generally refers to engaging the public to actively educate and lobby on behalf of a desired policy objective. Communication occurs through letters, emails, calls to legislators, rallies, social media campaigns, letters to the editor, and other forms of messaging campaigns designed to put political pressure on policymakers to enact desired changes.

'''Direct Lobbying''' Direct lobbying refers to direct communication and meetings with policy makers at all levels of government, including governors, mayors, county executives, and the legislative branch. This key activity provides the opportunity to meet with decision makers and their staff to gauge the receptiveness of the policymakers and to discuss the desired policy goals, benefits, support, and potential points of opposition. Opportunities for direct lobbying often take place during the legislative session, which varies from jurisdiction to jurisdiction. Some advocates and interest groups will organize a "lobby day" where members converge in Washington, state capitols, or with local legislative bodies to advocate for desired policy objectives. When the legislative body is not in session, advocates can meet with their representatives at their local offices.

'''Lobbying Rules and Restrictions''' Lobbying rules vary widely between levels of government and across all states. Therefore, it is important to know how lobbying is defined and what the restrictions are in the jurisdiction you are involved with. Some fundamentals include:

* 501(c)3 organizations (tax-exempt nonprofits) have some restrictions on lobbying in the government.

* The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with: Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation" and as "Referring to specific legislation and reflects a view on such legislation."

* The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof."

* Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation."

'''The Legislative Process''' The legislative process varies between different levels of governments and in jurisdictions across the country. There are typically several steps in the process that provide opportunities to influence policymakers, such as when they are in session. Some states and localities have relatively short time frames to consider and pass new laws or ordinances, while other states and the federal government are in session for many more weeks throughout the year. It is important to know when the actual work of policy development and consideration takes place in the legislative body where you want the change to happen.

'''Sponsors and Early Support''' In any legislative body, a successful policy enactment starts with one or more members of the legislative body drafting legislation that would bring about the desired change. Members can do this individually or as a group. A group of members that introduce a legislative proposal are typically referred to as sponsors or "original" sponsors of the proposal. Other members can then sign on in support of the bill as co-sponsors.

Effective advocacy can help build momentum for a bill during this process. The more sponsors and cosponsors, the better. It is also extremely beneficial to have early supporters from both political parties - especially at the state and federal level. Bipartisan support, and support among a broad base of members at the local level, can show other members that the bill is not likely to be controversial. It is also especially helpful to have support for the proposed legislation from key leaders of the committees with jurisdiction.

Advocates can provide their champions within the legislature with all of the supporting information and research to help their champions in the legislative body attract as many co-sponsors as possible and to respond to questions or objections as they arise.

'''Committee Process''' Typically, legislative proposals are taken up by the committee (or committees) of jurisdiction. Actual consideration of a proposal often takes place after one or more committee hearings on the proposal. This often involves hearing from witnesses in support of, and potentially in opposition to, a given proposal. Written testimony is also included in the public record to provide additional information to both the public and the legislators. The hearing process provides another opportunity for advocates to testify as witnesses and/or provide information to be included in the record. Hearing can take place in front of the full committee or by a sub-committee which oversees the specific policy area impacted.

After the hearing process, the bill may be taken up by the full committee for consideration. Although the bill can be altered by the manager of the bill at any time, consideration by the committee is the first time lawmakers have an opportunity to propose amendments to the proposal. These amendments are voted and adopted, or not adopted, by a majority vote. Following the amendment process the committee chair can call for a final vote on the legislation. If passed, the bill can move to the full legislative body for consideration.

Advocacy efforts can move quickly during the committee process, as unexpected challenges may surface due to an unfriendly amendment that might weaken the bill and the policy impact desired. It is important to work with allies to carefully track this process and respond to any negative developments.

'''Consideration by the Full Body''' At the local level, there is a single body that approves local legislative proposals. This is typically a Board of Commissioners or other duly elected body. At the state and federal levels, there are two legislative chambers, with delegates and senators at the state level, and the House and Senate at the federal level.

The process is usually relatively simple at the local level. Legislation (or ordinance) proposals are taken up at regularly scheduled meetings where a debate occurs, amendments are offered, and the proposals are voted on. Often, the chief executive at the local level has a vote along with the other members.

At the state and federal level, the process is more complex. A bill has to pass both chambers before it can be reconciled, voted on again by both bodies, and sent to the Governor or President for signature. While on the floor, members can again offer amendments that can be voted on individually or "en bloc" as two amendments in one. Typically, more controversial amendments will be voted on by individual basis. Assuming the bill passes, it is sent to the other body for consideration. A similar or identical bill may be in process in that other chamber already, or it may be that no companion legislation exists. In the latter case the chamber that did not originate the bill will take up the version that was passed in the other chamber.

When a bill does pass both chambers, there are almost always differences that must be worked out. The committee chairs will select a reconciliation committee with a bi-partisan group of legislators from both chambers to accomplish this. Assuming any differences can be worked out, the bill then goes back to the floor of each chamber for a final vote. If passed, the bill is finally referred to the Governor or President.

As with the Committee process, advocacy must continue throughout the time in which a bill is considered by the full legislative body. At the state and federal levels, this can be a challenge with many steps involved and a larger number of legislators to contend with - some of whom may not be supportive. Again, it is critical to stay in constant contact with supporters within the legislative body to keep track of potential harmful amendments and keep count of likely supporters within the full body. At times advocacy efforts need to be focused on a handful of legislators who have reservations or are undecided.

'''Potential Veto and Override''' Although rare, Governors and the President may veto a bill passed by the state and federal legislators. If the vote on final passage was close, it is unlikely that the bill will be taken up again, as a two-thirds majority is needed to override a veto. If the original vote approached the two-thirds number, there is a better chance to find the supporters needed for a successful override.

'''Continued Funding (Budget and Appropriations)''' Even when a law or ordinance is passed and signed by the chief executive, advocacy efforts often do not end. This is due to the fact that legislation containing funding to implement programs is authorized (usually for a period of years), but there is still a budget and appropriations process that must be monitored over the authorization period. Typically, the executive branch of government produces an annual budget that reflects their policy and spending priorities. The budget may or may not be approved by the legislative body. After this point the legislative body will take up annual appropriations bills, which set spending levels for all agencies and their programs. These bills often work through the regular order of other legislation, but sometimes will have a different, often expedited process.
It is important for community coalitions and advocates to understand that funding for the agencies and programs they support can change through each step of the budget and appropriations process. There is a need to stay vigilant to ensure that full funding is achieved. Advocates must stay in touch with their champions in the executive branch and legislature to keep informed of any changes and be ready to advocate just as vigorously in order to restore any proposed cuts in funding.

= Impactful Federal, State, and Local Policies =

Governments at all levels will frequently create their own set of policy goals to address a particular issue. This has been true for several public health issues including the current opioid epidemic. This process typically involves bringing numerous stakeholders together to provide education and input in coordination with government representatives who initiate the process and finalize the set of policy objectives.

States and localities vary widely on what types of laws are implemented across multiple policy areas. <ref>https://www.fda.gov/media/147152/download</ref> Below are a few examples that can provide your community coalition with some ideas on what has been successful in a variety of policy initiatives. This policy inventory begins with two major federal actions, then provides a variety of initiatives that are organized by specific topic, and closes with an example of a successful advocacy process in Illinois.

'''Biden-Harris Drug Policy Priorities''' <ref>https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84&utm_source=Faces+%26+Voices+of+Recovery&utm_campaign=1c12da631e-november-2020-advocacy-policy_COPY_01&utm_medium=email&utm_term=0_3410cda480-1c12da631e-382685157</ref> - On April 1, 2021, President Biden and Vice President Harris released their administration's Drug Policy Priorities for the upcoming year. President Biden made clear that addressing the overdose and addiction epidemic was an urgent priority for his administration.

Priorities include:

*Expanding access to evidence-based treatment
*Advancing racial equity issues in our approach to drug policy
*Enhancing evidence-based harm reduction efforts
*Supporting evidence-based prevention efforts to reduce youth substance use
*Reducing the supply of illicit substances
*Advancing recovery-ready workplaces and expanding the addiction workforce
*Expanding access to recovery support services

'''Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis'''

*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Mandate Prescriber Education
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions;
*Equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses versus physical health diagnoses.

'''Prevention and Reduced Access to Prescription Medications'''

*New Jersey - New Jersey's Prescription Monitoring Program <ref>https://www.njconsumeraffairs.gov/pmp/</ref>
*California (Alameda County) - Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<ref>https://library.municode.com/ca/alameda_county/codes/code_of_ordinances?nodeId=TIT6HESA_CH6.53ALCOSADRDIOR</ref>
*Connecticut - Statute <ref>https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm</ref>enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.
*Illinois - Statute enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<ref>https://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf</ref>

'''Harm Reduction'''

*AmfAR Opioid & Health indicators Database - Syringe Access Locations <ref>https://opioid.amfar.org/indicator/num_SSPs</ref>
*National Harm Reduction Coalition - Resources for Syringe Access and Policy<ref>https://harmreduction.org/issues/syringe-access/landscape-report/</ref>
*Rhode Island - Fentanyl Testing Strip Program<ref>https://preventoverdoseri.org/fentanyl-test-strips/</ref>

'''Access to Treatment and Protecting Treatment Services'''

California legislation has a process for reducing treatment fraud and waste.<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries</ref>

'''Federal Government - Affordable Care Act (2010)'''

Support to get mental health and substance abuse treatment through the 2010 ACA.

'''Criminal Justice Reform and De-criminalization.'''

* Good Samaritan Laws provide immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose. The Policy Surveillance Program provides an interactive database of current Good Samaritan Laws in the U.S. All 50 states and Washington D.C. have Good Samaritan Laws in place.<ref>https://www.ncbi.nlm.nih.gov/books/NBK542176/</ref>

*Oregon - State Initiative to De-criminalize almost all narcotics: Measure 110, passed by a majority of statewide voters in November 2020, decriminalizes the possession of marijuana and small amounts of "harder" drugs including cocaine and methamphetamine and reduces criminal penalties for larger amounts.

*Washington State - Law Enforcement Assisted Diversion <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx#:~:text=The%20Law%20Enforcement%20Assisted%20Diversion,behavioral%20health%20needs%20or%20poverty.</ref>

'''Recovery Support Services'''

* Federal SUPPORT Act: Section 7151. Building Communities of Recovery. This section amends the Building Communities of Recovery (BCOR) program that was first authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016 by redefining “recovery community organization” as an organization that mobilizes resources within and outside of the recovery community, including through a peer support network. This section authorizes $5 million for each of FY 2019-2023.

* Federal SUPPORT Act: Section 7031. National Recovery Housing Best Practices. This section amends part D of title V of the Public Health Service Act to authorize the Secretary of HHS to identify or facilitate the development of best practices for operating recovery housing. The Secretary is directed to bring together a wide variety of stakeholders to develop best practices for Recovery Housing.

'''State Policy Plans to Address the Opioid Epidemic'''

* Rhode Island's Strategic Plan on Addiction and Overdose<ref>https://health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf</ref>
*Massachusetts’s Recommendations of the Governor's Opioid Working Group<ref>https://www.mass.gov/lists/governors-opioid-addiction-working-group</ref>

'''Example of Successful Illinois Advocacy Strategy''' The following illustrates some of the partnerships and strategies used to pass an important piece of legislation in the state of Illinois:

Illinois SB2928<ref>https://ilga.gov/legislation/billstatus.asp?DocNum=2928&GAID=12&GA=98&DocTypeID=SB&LegID=79014&SessionID=85</ref> is a current law with the common name "Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. The lead Project Coordinator Bill Gentes, has as a result, been awarded CADCA's Advocate of the Year.

The following steps were used in the creation, adoption, and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

*Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one reviews current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
*Partnering with Local Law Enforcement - As stated by Gentes at an interview "“circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you what that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process. "In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more.
*Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference.
*Securing Public-Private Partnerships - Walgreens was approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be an issue with a need to review current laws regarding drug disposal. This increased the capacity of the project and accompanying police force in collection efforts.
*Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support.
*Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments.

= Available Tools and Resources =

*FedUp! - A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids. FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies.<ref>https://feduprally.org/</ref>
*Department of Health & Human Services Guidebook for State by State Opioid Prescribing Guidelines-<ref>https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf</ref>
*National Council For Behavioral Health. Advocates for mental health and substance use policies.<ref>https://www.thenationalcouncil.org/policy-agenda/</ref>
*National Harm Reduction Coalition. Advocates for numerous harm reduction approaches.<ref>https://harmreduction.org/</ref>
* Grassroots Unwired provides a good overview of grassroots advocacy. <ref>https://www.grassrootsunwired.com/grassroots-advocacy/</ref>
* Model Law Virtual Knowledge Labs. The Model Law Virtual Knowledge Labs are a virtual learning series that provides state and county leaders with an opportunity to deepen their awareness and understanding of how model laws can assist jurisdictions in addressing substance use disorders and concomitant issues . <ref>https://legislativeanalysis.org/model-law-virtual-knowledge-labs/</ref>
* Legislative Analysis and Public Policy Association. LAPPA is excited to announce the release of State of the States: Legislative Roadmap for Reducing Overdose Deaths and Increasing Access to Treatment (the Roadmap), a guide for state leaders on the most effective approaches to addressing the current drug epidemic. <ref>https://files.constantcontact.com/9b9edb2e701/6fe81aeb-e7b3-49f9-8b98-e5060d133156.pdf</ref>
* Legislative Analysis and Public Policy Association. Drug Checking Equipment, Needles/Syringes, and Drug Paraphernalia: Summary of State Laws. <ref>https://legislativeanalysis.org/wp-content/uploads/2024/01/Drug-Checking-Equip-Needles-Syr-and-Drug-Paraphernalia-Summary-of-State-Laws.pdf</ref>
* O'Neill Institute for National and Global Health Law: The Context: Racial and other Disparities in the Opioid Crisis.<ref>https://oneill.law.georgetown.edu/wp-content/uploads/2024/03/240308-APP-Policy-Scholar-Lauren-N-WEB.pdf</ref>
* SAMHSA: Evidence-Based Practices Resource Center. SAMHSA is committed to improving prevention, treatment, and recovery support services for mental and substance use disorders. The Evidence-Based Practices Resource Center provides communities, clinicians, policy-makers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings.<ref>https://www.samhsa.gov/resource-search/ebp?utm_source=SAMHSA&utm_campaign=d562f4d6eb-EMAIL_CAMPAIGN_2024_03_14_04_39&utm_medium=email&utm_term=0_-d562f4d6eb-%5BLIST_EMAIL_ID%5D</ref>
* South Southwest PTTC: The Ins and Outs of Advocating for Policy Change & The Ten Do’s and Don’ts of Successful Legislative Advocacy <ref>https://pttcnetwork.org/the-ins-and-outs-of-advocating-for-policy-change/</ref> <ref>https://pttcnetwork.org/news/the-ten-dos-and-donts-of-successful-legislative-advocacy/</ref>

= Promising Practices =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Sources =

Advocate for Policy Change

2024-03-27T13:08:52Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Educating policymakers and the general public about the legislative or policy changes necessary to create change in your community is an important step to addressing substance misuse and substance use disorder (SUD). Policies help states and local communities in several important ways:

1. By providing direct funding to communities for treatment and other services. 2. By improving access and/or affordability of care to individuals in need of assistance. 3. By removing barriers that prevent or limit the use of best practices across government agencies.

Policy change can take place at all levels of government. This page will provide information about how policy changes typically take place, as well as some examples of federal, state, and local laws that have helped local communities.

= Key Information =

'''Initial Steps for Policy Advocacy''' In order to bring about policy changes through laws or ordinances, any group of citizens must be able to become a "constituency of consequence" to those with the ability to create and change policy. This can be accomplished with a number of different advocacy approaches, as highlighted below. A few key principles to change policy at any level of government include:

*Have clear policy objectives. The more specific and narrow the objective the better. If the policy goals are too broad or general, it is easy for legislators to object on that basis.
*Support your position. Have research and data to support why the policy change you are seeking would be beneficial. For example, if seeking to improve harm reduction through the creation of a needle exchange program, provide data on expected lives that will be saved, reduced medical costs, improved linkages to care, and other benefits.
*Build a coalition. It is important to build a coalition to increase political clout. Think about other groups within the state or local community whose goals align with yours that would support your policy objectives and who would be willing to take action in order to achieve them. For example, if you were advocating for a needle exchange program, you might seek support from harm reduction organizations including hospitals, community health organizations and professionals, the recovery community, families in support of recovery, the treatment community, and potentially many others.
*Know your opposition. If a policy change hasn't happened, it is likely opposition exists. It is important to learn why policymakers may be hesitant to make a certain change, including what groups oppose the policy and why. Learning about the other side is critical to developing an effective advocacy strategy. Overcoming opposition may require education, effective counterarguments, financial resources, and increased public awareness.
*Identify champions. The most successful efforts resulting in desired policy changes are led by individuals who are passionate about the issue. Identifying and working with champions in the state or local government is a big key to success. It is important to have people "on the inside" that can hold hearings, develop legislation, utilize input and information from stakeholders, and provide insight on the process.
*Your voice matters. Many times, individuals or groups with minimal advocacy experience can be intimidated by the process. Remember that those "in power" are there because they were elected to serve. Lawmakers across all levels of government represent the people of their states, districts, cities, towns, and so forth. It is your constitutional right to petition the government and be heard. Those representing the people need to hear the concerns of all those they represent.

'''Converting Policy Into Action''' After taking the initial steps delineated above, the next step is to identify and implement a set of strategies that will grow public and political support for those policies. While approaches and specific strategies are almost innumerable, taking action involves communication and messaging intended to educate and influence.

'''Grassroots Advocacy''' Grassroots Advocacy generally refers to engaging the public to actively educate and lobby on behalf of a desired policy objective. Communication occurs through letters, emails, calls to legislators, rallies, social media campaigns, letters to the editor, and other forms of messaging campaigns designed to put political pressure on policymakers to enact desired changes.

'''Direct Lobbying''' Direct lobbying refers to direct communication and meetings with policy makers at all levels of government, including governors, mayors, county executives, and the legislative branch. This key activity provides the opportunity to meet with decision makers and their staff to gauge the receptiveness of the policymakers and to discuss the desired policy goals, benefits, support, and potential points of opposition. Opportunities for direct lobbying often take place during the legislative session, which varies from jurisdiction to jurisdiction. Some advocates and interest groups will organize a "lobby day" where members converge in Washington, state capitols, or with local legislative bodies to advocate for desired policy objectives. When the legislative body is not in session, advocates can meet with their representatives at their local offices.

'''Lobbying Rules and Restrictions''' Lobbying rules vary widely between levels of government and across all states. Therefore, it is important to know how lobbying is defined and what the restrictions are in the jurisdiction you are involved with. Some fundamentals include:

* 501(c)3 organizations (tax-exempt nonprofits) have some restrictions on lobbying in the government.

* The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with: Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation" and as "Referring to specific legislation and reflects a view on such legislation."

* The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof."

* Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation."

'''The Legislative Process''' The legislative process varies between different levels of governments and in jurisdictions across the country. There are typically several steps in the process that provide opportunities to influence policymakers, such as when they are in session. Some states and localities have relatively short time frames to consider and pass new laws or ordinances, while other states and the federal government are in session for many more weeks throughout the year. It is important to know when the actual work of policy development and consideration takes place in the legislative body where you want the change to happen.

'''Sponsors and Early Support''' In any legislative body, a successful policy enactment starts with one or more members of the legislative body drafting legislation that would bring about the desired change. Members can do this individually or as a group. A group of members that introduce a legislative proposal are typically referred to as sponsors or "original" sponsors of the proposal. Other members can then sign on in support of the bill as co-sponsors.

Effective advocacy can help build momentum for a bill during this process. The more sponsors and cosponsors, the better. It is also extremely beneficial to have early supporters from both political parties - especially at the state and federal level. Bipartisan support, and support among a broad base of members at the local level, can show other members that the bill is not likely to be controversial. It is also especially helpful to have support for the proposed legislation from key leaders of the committees with jurisdiction.

Advocates can provide their champions within the legislature with all of the supporting information and research to help their champions in the legislative body attract as many co-sponsors as possible and to respond to questions or objections as they arise.

'''Committee Process''' Typically, legislative proposals are taken up by the committee (or committees) of jurisdiction. Actual consideration of a proposal often takes place after one or more committee hearings on the proposal. This often involves hearing from witnesses in support of, and potentially in opposition to, a given proposal. Written testimony is also included in the public record to provide additional information to both the public and the legislators. The hearing process provides another opportunity for advocates to testify as witnesses and/or provide information to be included in the record. Hearing can take place in front of the full committee or by a sub-committee which oversees the specific policy area impacted.

After the hearing process, the bill may be taken up by the full committee for consideration. Although the bill can be altered by the manager of the bill at any time, consideration by the committee is the first time lawmakers have an opportunity to propose amendments to the proposal. These amendments are voted and adopted, or not adopted, by a majority vote. Following the amendment process the committee chair can call for a final vote on the legislation. If passed, the bill can move to the full legislative body for consideration.

Advocacy efforts can move quickly during the committee process, as unexpected challenges may surface due to an unfriendly amendment that might weaken the bill and the policy impact desired. It is important to work with allies to carefully track this process and respond to any negative developments.

'''Consideration by the Full Body''' At the local level, there is a single body that approves local legislative proposals. This is typically a Board of Commissioners or other duly elected body. At the state and federal levels, there are two legislative chambers, with delegates and senators at the state level, and the House and Senate at the federal level.

The process is usually relatively simple at the local level. Legislation (or ordinance) proposals are taken up at regularly scheduled meetings where a debate occurs, amendments are offered, and the proposals are voted on. Often, the chief executive at the local level has a vote along with the other members.

At the state and federal level, the process is more complex. A bill has to pass both chambers before it can be reconciled, voted on again by both bodies, and sent to the Governor or President for signature. While on the floor, members can again offer amendments that can be voted on individually or "en bloc" as two amendments in one. Typically, more controversial amendments will be voted on by individual basis. Assuming the bill passes, it is sent to the other body for consideration. A similar or identical bill may be in process in that other chamber already, or it may be that no companion legislation exists. In the latter case the chamber that did not originate the bill will take up the version that was passed in the other chamber.

When a bill does pass both chambers, there are almost always differences that must be worked out. The committee chairs will select a reconciliation committee with a bi-partisan group of legislators from both chambers to accomplish this. Assuming any differences can be worked out, the bill then goes back to the floor of each chamber for a final vote. If passed, the bill is finally referred to the Governor or President.

As with the Committee process, advocacy must continue throughout the time in which a bill is considered by the full legislative body. At the state and federal levels, this can be a challenge with many steps involved and a larger number of legislators to contend with - some of whom may not be supportive. Again, it is critical to stay in constant contact with supporters within the legislative body to keep track of potential harmful amendments and keep count of likely supporters within the full body. At times advocacy efforts need to be focused on a handful of legislators who have reservations or are undecided.

'''Potential Veto and Override''' Although rare, Governors and the President may veto a bill passed by the state and federal legislators. If the vote on final passage was close, it is unlikely that the bill will be taken up again, as a two-thirds majority is needed to override a veto. If the original vote approached the two-thirds number, there is a better chance to find the supporters needed for a successful override.

'''Continued Funding (Budget and Appropriations)''' Even when a law or ordinance is passed and signed by the chief executive, advocacy efforts often do not end. This is due to the fact that legislation containing funding to implement programs is authorized (usually for a period of years), but there is still a budget and appropriations process that must be monitored over the authorization period. Typically, the executive branch of government produces an annual budget that reflects their policy and spending priorities. The budget may or may not be approved by the legislative body. After this point the legislative body will take up annual appropriations bills, which set spending levels for all agencies and their programs. These bills often work through the regular order of other legislation, but sometimes will have a different, often expedited process.
It is important for community coalitions and advocates to understand that funding for the agencies and programs they support can change through each step of the budget and appropriations process. There is a need to stay vigilant to ensure that full funding is achieved. Advocates must stay in touch with their champions in the executive branch and legislature to keep informed of any changes and be ready to advocate just as vigorously in order to restore any proposed cuts in funding.

= Impactful Federal, State, and Local Policies =

Governments at all levels will frequently create their own set of policy goals to address a particular issue. This has been true for several public health issues including the current opioid epidemic. This process typically involves bringing numerous stakeholders together to provide education and input in coordination with government representatives who initiate the process and finalize the set of policy objectives.

States and localities vary widely on what types of laws are implemented across multiple policy areas. <ref>https://www.fda.gov/media/147152/download</ref> Below are a few examples that can provide your community coalition with some ideas on what has been successful in a variety of policy initiatives. This policy inventory begins with two major federal actions, then provides a variety of initiatives that are organized by specific topic, and closes with an example of a successful advocacy process in Illinois.

'''Biden-Harris Drug Policy Priorities''' <ref>https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84&utm_source=Faces+%26+Voices+of+Recovery&utm_campaign=1c12da631e-november-2020-advocacy-policy_COPY_01&utm_medium=email&utm_term=0_3410cda480-1c12da631e-382685157</ref> - On April 1, 2021, President Biden and Vice President Harris released their administration's Drug Policy Priorities for the upcoming year. President Biden made clear that addressing the overdose and addiction epidemic was an urgent priority for his administration.

Priorities include:

*Expanding access to evidence-based treatment
*Advancing racial equity issues in our approach to drug policy
*Enhancing evidence-based harm reduction efforts
*Supporting evidence-based prevention efforts to reduce youth substance use
*Reducing the supply of illicit substances
*Advancing recovery-ready workplaces and expanding the addiction workforce
*Expanding access to recovery support services

'''Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis'''

*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Mandate Prescriber Education
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions;
*Equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses versus physical health diagnoses.

'''Prevention and Reduced Access to Prescription Medications'''

*New Jersey - New Jersey's Prescription Monitoring Program <ref>https://www.njconsumeraffairs.gov/pmp/</ref>
*California (Alameda County) - Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<ref>https://library.municode.com/ca/alameda_county/codes/code_of_ordinances?nodeId=TIT6HESA_CH6.53ALCOSADRDIOR</ref>
*Connecticut - Statute <ref>https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm</ref>enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.
*Illinois - Statute enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<ref>https://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf</ref>

'''Harm Reduction'''

*AmfAR Opioid & Health indicators Database - Syringe Access Locations <ref>https://opioid.amfar.org/indicator/num_SSPs</ref>
*National Harm Reduction Coalition - Resources for Syringe Access and Policy<ref>https://harmreduction.org/issues/syringe-access/landscape-report/</ref>
*Rhode Island - Fentanyl Testing Strip Program<ref>https://preventoverdoseri.org/fentanyl-test-strips/</ref>

'''Access to Treatment and Protecting Treatment Services'''

California legislation has a process for reducing treatment fraud and waste.<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries</ref>

'''Federal Government - Affordable Care Act (2010)'''

Support to get mental health and substance abuse treatment through the 2010 ACA.

'''Criminal Justice Reform and De-criminalization.'''

* Good Samaritan Laws provide immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose. The Policy Surveillance Program provides an interactive database of current Good Samaritan Laws in the U.S. All 50 states and Washington D.C. have Good Samaritan Laws in place.<ref>https://www.ncbi.nlm.nih.gov/books/NBK542176/</ref>

*Oregon - State Initiative to De-criminalize almost all narcotics: Measure 110, passed by a majority of statewide voters in November 2020, decriminalizes the possession of marijuana and small amounts of "harder" drugs including cocaine and methamphetamine and reduces criminal penalties for larger amounts.

*Washington State - Law Enforcement Assisted Diversion <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx#:~:text=The%20Law%20Enforcement%20Assisted%20Diversion,behavioral%20health%20needs%20or%20poverty.</ref>

'''Recovery Support Services'''

* Federal SUPPORT Act: Section 7151. Building Communities of Recovery. This section amends the Building Communities of Recovery (BCOR) program that was first authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016 by redefining “recovery community organization” as an organization that mobilizes resources within and outside of the recovery community, including through a peer support network. This section authorizes $5 million for each of FY 2019-2023.

* Federal SUPPORT Act: Section 7031. National Recovery Housing Best Practices. This section amends part D of title V of the Public Health Service Act to authorize the Secretary of HHS to identify or facilitate the development of best practices for operating recovery housing. The Secretary is directed to bring together a wide variety of stakeholders to develop best practices for Recovery Housing.

'''State Policy Plans to Address the Opioid Epidemic'''

* Rhode Island's Strategic Plan on Addiction and Overdose<ref>https://health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf</ref>
*Massachusetts’s Recommendations of the Governor's Opioid Working Group<ref>https://www.mass.gov/lists/governors-opioid-addiction-working-group</ref>

'''Example of Successful Illinois Advocacy Strategy''' The following illustrates some of the partnerships and strategies used to pass an important piece of legislation in the state of Illinois:

Illinois SB2928<ref>https://ilga.gov/legislation/billstatus.asp?DocNum=2928&GAID=12&GA=98&DocTypeID=SB&LegID=79014&SessionID=85</ref> is a current law with the common name "Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. The lead Project Coordinator Bill Gentes, has as a result, been awarded CADCA's Advocate of the Year.

The following steps were used in the creation, adoption, and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

*Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one reviews current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
*Partnering with Local Law Enforcement - As stated by Gentes at an interview "“circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you what that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process. "In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more.
*Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference.
*Securing Public-Private Partnerships - Walgreens was approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be an issue with a need to review current laws regarding drug disposal. This increased the capacity of the project and accompanying police force in collection efforts.
*Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support.
*Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments.

= Available Tools and Resources =

*FedUp! - A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids. FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies.<ref>https://feduprally.org/</ref>
*Department of Health & Human Services Guidebook for State by State Opioid Prescribing Guidelines-<ref>https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf</ref>
*National Council For Behavioral Health. Advocates for mental health and substance use policies.<ref>https://www.thenationalcouncil.org/policy-agenda/</ref>
*National Harm Reduction Coalition. Advocates for numerous harm reduction approaches.<ref>https://harmreduction.org/</ref>
* Grassroots Unwired provides a good overview of grassroots advocacy. <ref>https://www.grassrootsunwired.com/grassroots-advocacy/</ref>
* Model Law Virtual Knowledge Labs. The Model Law Virtual Knowledge Labs are a virtual learning series that provides state and county leaders with an opportunity to deepen their awareness and understanding of how model laws can assist jurisdictions in addressing substance use disorders and concomitant issues . <ref>https://legislativeanalysis.org/model-law-virtual-knowledge-labs/</ref>
* Legislative Analysis and Public Policy Association. LAPPA is excited to announce the release of State of the States: Legislative Roadmap for Reducing Overdose Deaths and Increasing Access to Treatment (the Roadmap), a guide for state leaders on the most effective approaches to addressing the current drug epidemic. <ref>https://files.constantcontact.com/9b9edb2e701/6fe81aeb-e7b3-49f9-8b98-e5060d133156.pdf</ref>
* Legislative Analysis and Public Policy Association. Drug Checking Equipment, Needles/Syringes, and Drug Paraphernalia: Summary of State Laws. <ref>https://legislativeanalysis.org/wp-content/uploads/2024/01/Drug-Checking-Equip-Needles-Syr-and-Drug-Paraphernalia-Summary-of-State-Laws.pdf</ref>
* SAMHSA: Evidence-Based Practices Resource Center. SAMHSA is committed to improving prevention, treatment, and recovery support services for mental and substance use disorders. The Evidence-Based Practices Resource Center provides communities, clinicians, policy-makers and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings.<ref>https://www.samhsa.gov/resource-search/ebp?utm_source=SAMHSA&utm_campaign=d562f4d6eb-EMAIL_CAMPAIGN_2024_03_14_04_39&utm_medium=email&utm_term=0_-d562f4d6eb-%5BLIST_EMAIL_ID%5D</ref>
* South Southwest PTTC: The Ins and Outs of Advocating for Policy Change & The Ten Do’s and Don’ts of Successful Legislative Advocacy <ref>https://pttcnetwork.org/the-ins-and-outs-of-advocating-for-policy-change/</ref> <ref>https://pttcnetwork.org/news/the-ten-dos-and-donts-of-successful-legislative-advocacy/</ref>

= Promising Practices =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Sources =

Advocate for Policy Change

2024-03-27T13:00:33Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Educating policymakers and the general public about the legislative or policy changes necessary to create change in your community is an important step to addressing substance misuse and substance use disorder (SUD). Policies help states and local communities in several important ways:

1. By providing direct funding to communities for treatment and other services. 2. By improving access and/or affordability of care to individuals in need of assistance. 3. By removing barriers that prevent or limit the use of best practices across government agencies.

Policy change can take place at all levels of government. This page will provide information about how policy changes typically take place, as well as some examples of federal, state, and local laws that have helped local communities.

= Key Information =

'''Initial Steps for Policy Advocacy''' In order to bring about policy changes through laws or ordinances, any group of citizens must be able to become a "constituency of consequence" to those with the ability to create and change policy. This can be accomplished with a number of different advocacy approaches, as highlighted below. A few key principles to change policy at any level of government include:

*Have clear policy objectives. The more specific and narrow the objective the better. If the policy goals are too broad or general, it is easy for legislators to object on that basis.
*Support your position. Have research and data to support why the policy change you are seeking would be beneficial. For example, if seeking to improve harm reduction through the creation of a needle exchange program, provide data on expected lives that will be saved, reduced medical costs, improved linkages to care, and other benefits.
*Build a coalition. It is important to build a coalition to increase political clout. Think about other groups within the state or local community whose goals align with yours that would support your policy objectives and who would be willing to take action in order to achieve them. For example, if you were advocating for a needle exchange program, you might seek support from harm reduction organizations including hospitals, community health organizations and professionals, the recovery community, families in support of recovery, the treatment community, and potentially many others.
*Know your opposition. If a policy change hasn't happened, it is likely opposition exists. It is important to learn why policymakers may be hesitant to make a certain change, including what groups oppose the policy and why. Learning about the other side is critical to developing an effective advocacy strategy. Overcoming opposition may require education, effective counterarguments, financial resources, and increased public awareness.
*Identify champions. The most successful efforts resulting in desired policy changes are led by individuals who are passionate about the issue. Identifying and working with champions in the state or local government is a big key to success. It is important to have people "on the inside" that can hold hearings, develop legislation, utilize input and information from stakeholders, and provide insight on the process.
*Your voice matters. Many times, individuals or groups with minimal advocacy experience can be intimidated by the process. Remember that those "in power" are there because they were elected to serve. Lawmakers across all levels of government represent the people of their states, districts, cities, towns, and so forth. It is your constitutional right to petition the government and be heard. Those representing the people need to hear the concerns of all those they represent.

'''Converting Policy Into Action''' After taking the initial steps delineated above, the next step is to identify and implement a set of strategies that will grow public and political support for those policies. While approaches and specific strategies are almost innumerable, taking action involves communication and messaging intended to educate and influence.

'''Grassroots Advocacy''' Grassroots Advocacy generally refers to engaging the public to actively educate and lobby on behalf of a desired policy objective. Communication occurs through letters, emails, calls to legislators, rallies, social media campaigns, letters to the editor, and other forms of messaging campaigns designed to put political pressure on policymakers to enact desired changes.

'''Direct Lobbying''' Direct lobbying refers to direct communication and meetings with policy makers at all levels of government, including governors, mayors, county executives, and the legislative branch. This key activity provides the opportunity to meet with decision makers and their staff to gauge the receptiveness of the policymakers and to discuss the desired policy goals, benefits, support, and potential points of opposition. Opportunities for direct lobbying often take place during the legislative session, which varies from jurisdiction to jurisdiction. Some advocates and interest groups will organize a "lobby day" where members converge in Washington, state capitols, or with local legislative bodies to advocate for desired policy objectives. When the legislative body is not in session, advocates can meet with their representatives at their local offices.

'''Lobbying Rules and Restrictions''' Lobbying rules vary widely between levels of government and across all states. Therefore, it is important to know how lobbying is defined and what the restrictions are in the jurisdiction you are involved with. Some fundamentals include:

* 501(c)3 organizations (tax-exempt nonprofits) have some restrictions on lobbying in the government.

* The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with: Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation" and as "Referring to specific legislation and reflects a view on such legislation."

* The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof."

* Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation."

'''The Legislative Process''' The legislative process varies between different levels of governments and in jurisdictions across the country. There are typically several steps in the process that provide opportunities to influence policymakers, such as when they are in session. Some states and localities have relatively short time frames to consider and pass new laws or ordinances, while other states and the federal government are in session for many more weeks throughout the year. It is important to know when the actual work of policy development and consideration takes place in the legislative body where you want the change to happen.

'''Sponsors and Early Support''' In any legislative body, a successful policy enactment starts with one or more members of the legislative body drafting legislation that would bring about the desired change. Members can do this individually or as a group. A group of members that introduce a legislative proposal are typically referred to as sponsors or "original" sponsors of the proposal. Other members can then sign on in support of the bill as co-sponsors.

Effective advocacy can help build momentum for a bill during this process. The more sponsors and cosponsors, the better. It is also extremely beneficial to have early supporters from both political parties - especially at the state and federal level. Bipartisan support, and support among a broad base of members at the local level, can show other members that the bill is not likely to be controversial. It is also especially helpful to have support for the proposed legislation from key leaders of the committees with jurisdiction.

Advocates can provide their champions within the legislature with all of the supporting information and research to help their champions in the legislative body attract as many co-sponsors as possible and to respond to questions or objections as they arise.

'''Committee Process''' Typically, legislative proposals are taken up by the committee (or committees) of jurisdiction. Actual consideration of a proposal often takes place after one or more committee hearings on the proposal. This often involves hearing from witnesses in support of, and potentially in opposition to, a given proposal. Written testimony is also included in the public record to provide additional information to both the public and the legislators. The hearing process provides another opportunity for advocates to testify as witnesses and/or provide information to be included in the record. Hearing can take place in front of the full committee or by a sub-committee which oversees the specific policy area impacted.

After the hearing process, the bill may be taken up by the full committee for consideration. Although the bill can be altered by the manager of the bill at any time, consideration by the committee is the first time lawmakers have an opportunity to propose amendments to the proposal. These amendments are voted and adopted, or not adopted, by a majority vote. Following the amendment process the committee chair can call for a final vote on the legislation. If passed, the bill can move to the full legislative body for consideration.

Advocacy efforts can move quickly during the committee process, as unexpected challenges may surface due to an unfriendly amendment that might weaken the bill and the policy impact desired. It is important to work with allies to carefully track this process and respond to any negative developments.

'''Consideration by the Full Body''' At the local level, there is a single body that approves local legislative proposals. This is typically a Board of Commissioners or other duly elected body. At the state and federal levels, there are two legislative chambers, with delegates and senators at the state level, and the House and Senate at the federal level.

The process is usually relatively simple at the local level. Legislation (or ordinance) proposals are taken up at regularly scheduled meetings where a debate occurs, amendments are offered, and the proposals are voted on. Often, the chief executive at the local level has a vote along with the other members.

At the state and federal level, the process is more complex. A bill has to pass both chambers before it can be reconciled, voted on again by both bodies, and sent to the Governor or President for signature. While on the floor, members can again offer amendments that can be voted on individually or "en bloc" as two amendments in one. Typically, more controversial amendments will be voted on by individual basis. Assuming the bill passes, it is sent to the other body for consideration. A similar or identical bill may be in process in that other chamber already, or it may be that no companion legislation exists. In the latter case the chamber that did not originate the bill will take up the version that was passed in the other chamber.

When a bill does pass both chambers, there are almost always differences that must be worked out. The committee chairs will select a reconciliation committee with a bi-partisan group of legislators from both chambers to accomplish this. Assuming any differences can be worked out, the bill then goes back to the floor of each chamber for a final vote. If passed, the bill is finally referred to the Governor or President.

As with the Committee process, advocacy must continue throughout the time in which a bill is considered by the full legislative body. At the state and federal levels, this can be a challenge with many steps involved and a larger number of legislators to contend with - some of whom may not be supportive. Again, it is critical to stay in constant contact with supporters within the legislative body to keep track of potential harmful amendments and keep count of likely supporters within the full body. At times advocacy efforts need to be focused on a handful of legislators who have reservations or are undecided.

'''Potential Veto and Override''' Although rare, Governors and the President may veto a bill passed by the state and federal legislators. If the vote on final passage was close, it is unlikely that the bill will be taken up again, as a two-thirds majority is needed to override a veto. If the original vote approached the two-thirds number, there is a better chance to find the supporters needed for a successful override.

'''Continued Funding (Budget and Appropriations)''' Even when a law or ordinance is passed and signed by the chief executive, advocacy efforts often do not end. This is due to the fact that legislation containing funding to implement programs is authorized (usually for a period of years), but there is still a budget and appropriations process that must be monitored over the authorization period. Typically, the executive branch of government produces an annual budget that reflects their policy and spending priorities. The budget may or may not be approved by the legislative body. After this point the legislative body will take up annual appropriations bills, which set spending levels for all agencies and their programs. These bills often work through the regular order of other legislation, but sometimes will have a different, often expedited process.
It is important for community coalitions and advocates to understand that funding for the agencies and programs they support can change through each step of the budget and appropriations process. There is a need to stay vigilant to ensure that full funding is achieved. Advocates must stay in touch with their champions in the executive branch and legislature to keep informed of any changes and be ready to advocate just as vigorously in order to restore any proposed cuts in funding.

= Impactful Federal, State, and Local Policies =

Governments at all levels will frequently create their own set of policy goals to address a particular issue. This has been true for several public health issues including the current opioid epidemic. This process typically involves bringing numerous stakeholders together to provide education and input in coordination with government representatives who initiate the process and finalize the set of policy objectives.

States and localities vary widely on what types of laws are implemented across multiple policy areas. <ref>https://www.fda.gov/media/147152/download</ref> Below are a few examples that can provide your community coalition with some ideas on what has been successful in a variety of policy initiatives. This policy inventory begins with two major federal actions, then provides a variety of initiatives that are organized by specific topic, and closes with an example of a successful advocacy process in Illinois.

'''Biden-Harris Drug Policy Priorities''' <ref>https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84&utm_source=Faces+%26+Voices+of+Recovery&utm_campaign=1c12da631e-november-2020-advocacy-policy_COPY_01&utm_medium=email&utm_term=0_3410cda480-1c12da631e-382685157</ref> - On April 1, 2021, President Biden and Vice President Harris released their administration's Drug Policy Priorities for the upcoming year. President Biden made clear that addressing the overdose and addiction epidemic was an urgent priority for his administration.

Priorities include:

*Expanding access to evidence-based treatment
*Advancing racial equity issues in our approach to drug policy
*Enhancing evidence-based harm reduction efforts
*Supporting evidence-based prevention efforts to reduce youth substance use
*Reducing the supply of illicit substances
*Advancing recovery-ready workplaces and expanding the addiction workforce
*Expanding access to recovery support services

'''Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis'''

*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Mandate Prescriber Education
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions;
*Equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses versus physical health diagnoses.

'''Prevention and Reduced Access to Prescription Medications'''

*New Jersey - New Jersey's Prescription Monitoring Program <ref>https://www.njconsumeraffairs.gov/pmp/</ref>
*California (Alameda County) - Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<ref>https://library.municode.com/ca/alameda_county/codes/code_of_ordinances?nodeId=TIT6HESA_CH6.53ALCOSADRDIOR</ref>
*Connecticut - Statute <ref>https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm</ref>enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.
*Illinois - Statute enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<ref>https://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf</ref>

'''Harm Reduction'''

*AmfAR Opioid & Health indicators Database - Syringe Access Locations <ref>https://opioid.amfar.org/indicator/num_SSPs</ref>
*National Harm Reduction Coalition - Resources for Syringe Access and Policy<ref>https://harmreduction.org/issues/syringe-access/landscape-report/</ref>
*Rhode Island - Fentanyl Testing Strip Program<ref>https://preventoverdoseri.org/fentanyl-test-strips/</ref>

'''Access to Treatment and Protecting Treatment Services'''

California legislation has a process for reducing treatment fraud and waste.<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries</ref>

'''Federal Government - Affordable Care Act (2010)'''

Support to get mental health and substance abuse treatment through the 2010 ACA.

'''Criminal Justice Reform and De-criminalization.'''

* Good Samaritan Laws provide immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose. The Policy Surveillance Program provides an interactive database of current Good Samaritan Laws in the U.S. All 50 states and Washington D.C. have Good Samaritan Laws in place.<ref>https://www.ncbi.nlm.nih.gov/books/NBK542176/</ref>

*Oregon - State Initiative to De-criminalize almost all narcotics: Measure 110, passed by a majority of statewide voters in November 2020, decriminalizes the possession of marijuana and small amounts of "harder" drugs including cocaine and methamphetamine and reduces criminal penalties for larger amounts.

*Washington State - Law Enforcement Assisted Diversion <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx#:~:text=The%20Law%20Enforcement%20Assisted%20Diversion,behavioral%20health%20needs%20or%20poverty.</ref>

'''Recovery Support Services'''

* Federal SUPPORT Act: Section 7151. Building Communities of Recovery. This section amends the Building Communities of Recovery (BCOR) program that was first authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016 by redefining “recovery community organization” as an organization that mobilizes resources within and outside of the recovery community, including through a peer support network. This section authorizes $5 million for each of FY 2019-2023.

* Federal SUPPORT Act: Section 7031. National Recovery Housing Best Practices. This section amends part D of title V of the Public Health Service Act to authorize the Secretary of HHS to identify or facilitate the development of best practices for operating recovery housing. The Secretary is directed to bring together a wide variety of stakeholders to develop best practices for Recovery Housing.

'''State Policy Plans to Address the Opioid Epidemic'''

* Rhode Island's Strategic Plan on Addiction and Overdose<ref>https://health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf</ref>
*Massachusetts’s Recommendations of the Governor's Opioid Working Group<ref>https://www.mass.gov/lists/governors-opioid-addiction-working-group</ref>

'''Example of Successful Illinois Advocacy Strategy''' The following illustrates some of the partnerships and strategies used to pass an important piece of legislation in the state of Illinois:

Illinois SB2928<ref>https://ilga.gov/legislation/billstatus.asp?DocNum=2928&GAID=12&GA=98&DocTypeID=SB&LegID=79014&SessionID=85</ref> is a current law with the common name "Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. The lead Project Coordinator Bill Gentes, has as a result, been awarded CADCA's Advocate of the Year.

The following steps were used in the creation, adoption, and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

*Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one reviews current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
*Partnering with Local Law Enforcement - As stated by Gentes at an interview "“circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you what that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process. "In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more.
*Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference.
*Securing Public-Private Partnerships - Walgreens was approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be an issue with a need to review current laws regarding drug disposal. This increased the capacity of the project and accompanying police force in collection efforts.
*Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support.
*Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments.

= Available Tools and Resources =

*FedUp! - A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids. FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies.<ref>https://feduprally.org/</ref>
*Department of Health & Human Services Guidebook for State by State Opioid Prescribing Guidelines-<ref>https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf</ref>
*National Council For Behavioral Health. Advocates for mental health and substance use policies.<ref>https://www.thenationalcouncil.org/policy-agenda/</ref>
*National Harm Reduction Coalition. Advocates for numerous harm reduction approaches.<ref>https://harmreduction.org/</ref>
* Grassroots Unwired provides a good overview of grassroots advocacy. <ref>https://www.grassrootsunwired.com/grassroots-advocacy/</ref>
* Model Law Virtual Knowledge Labs. The Model Law Virtual Knowledge Labs are a virtual learning series that provides state and county leaders with an opportunity to deepen their awareness and understanding of how model laws can assist jurisdictions in addressing substance use disorders and concomitant issues . <ref>https://legislativeanalysis.org/model-law-virtual-knowledge-labs/</ref>
* Legislative Analysis and Public Policy Association. LAPPA is excited to announce the release of State of the States: Legislative Roadmap for Reducing Overdose Deaths and Increasing Access to Treatment (the Roadmap), a guide for state leaders on the most effective approaches to addressing the current drug epidemic. <ref>https://files.constantcontact.com/9b9edb2e701/6fe81aeb-e7b3-49f9-8b98-e5060d133156.pdf</ref>
* Legislative Analysis and Public Policy Association. Drug Checking Equipment, Needles/Syringes, and Drug Paraphernalia: Summary of State Laws. <ref>https://legislativeanalysis.org/wp-content/uploads/2024/01/Drug-Checking-Equip-Needles-Syr-and-Drug-Paraphernalia-Summary-of-State-Laws.pdf</ref>
* South Southwest PTTC: The Ins and Outs of Advocating for Policy Change & The Ten Do’s and Don’ts of Successful Legislative Advocacy <ref>https://pttcnetwork.org/the-ins-and-outs-of-advocating-for-policy-change/</ref> <ref>https://pttcnetwork.org/news/the-ten-dos-and-donts-of-successful-legislative-advocacy/</ref>

= Promising Practices =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Sources =

The Recovery Ecosystem

2024-03-18T13:58:45Z

AlexFigueroa: /* Available Tools and Resources */

=Introductory Paragraph =

Recovery support can look like many different things for individuals on their pathway to recovery. This is a crucial component of viewing SUD as a chronic disorder requiring long-term care. Individuals entering recovery through treatment, the criminal justice system, or on there own often face many challenges in early recovery. It is important that communities identify needs, examine what supports are available, and ensure those with the greatest need have access to these supports. Individuals who do not have these needs met are more likely to relapse. Communities that fund these supports help those in early recovery re-engage with the community, increase self-esteem, and become highly productive members of their communities. Providing effective recovery supports prevents relapse, the need to engage additional treatment and other services, and reduces the numbers of overdose. Communities that have invested in recovery supports have seen a substantial return on their investment both in financial and human terms.

SAMHSA defines recovery as "a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential." <ref>https://www.samhsa.gov/find-help/recovery</ref> SAMHSA also identifies four major dimensions that support recovery:

*Health — overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being.
*Home — having a stable and safe place to live.
*Purpose — conducting meaningful daily activities and having the independence, income, and resources to participate in society.
*Community — having relationships and social networks that provide support, friendship, love, and hope.

= Key Information =

The recovery journey does not start in one place. Recovery is a critical asset that communities need to invest in, including removing barriers so recovery can be sustained. Recovery-oriented approaches involve a multi-system, person-centered continuum of care where a comprehensive menu of coordinated services and supports is tailored to individuals' recovery stage, needs, and chosen recovery pathway; the goal is to promote abstinence and a better quality of life. <ref>Clark, H. W. (2007) Recovery as an organizing concept. In W. L. White (Ed.), Perspectives
on systems transformation: How visionary leaders are shifting addiction treatment toward a recovery-oriented system of care (pp. 7–21). Chicago, IL: Great Lakes Addiction Technology Transfer Center</ref>

There are four primary domains in which recovery can be improved:

* '''Connections.''' Many recovery strategies come under the broad umbrella of improving connections. Isolation is the enemy of recovery. Connection includes regular contact with others in recovery across a number of peer-led support organizations. Connection includes access to direct support from peer recovery specialists and recovery coaches. Connections within the family are vital to help the family recover and to be able to support family members in recovery. Other connections include those made in the wider community and even regional/national organizations that can help foster connection to others who provide support for individuals in recovery.

* '''Recovery Housing.''' Perhaps the most basic support needed is housing and food. Without this there can be no security or the ability for focus on health and recovery. In many cases going home is not a safe option for those new to recovery. A stable housing situation is foundational and allows growth and progress in other areas to take place. There is a need to be able to find safe, affordable, and supportive recovery housing options in communities across the country.

* '''Education and Job Training.''' Finding meaning and purpose in one's life is important to all, but is especially critical to a person who has not found, or has lost, that purpose. The ability to get and hold a job, get a promotion, improve one's education, and become independent are all important needs for people in early recovery. Safe Solutions includes resources and information designed to help people in recovery develop the tools they need to find that purpose and achieve their goals.

* '''Collegiate and High School Recovery Support.''' Many in early recovery find recovery while still in high school or college. Many others enter high school or college after beginning their recovery journey. Building an infrastructure of recovery support within these specific communities is another area of focus, where it is possible to learn both where programs currently exist and the tools used by others to create these supports at colleges and high schools.

Here is a summary of specific recovery supports that communities can provide:

* Sober Living - Helps individuals transfer from treatment to independent living. For some individuals, returning to their previous living environment can be unsafe or not conducive to their recovery. Sober living offers individuals a safe, peer-to-peer recovery-oriented home with structure, accountability, and support. Typically, there are household duties in sober living that need to be fulfilled including rent, chores, curfew, etc. For more information about strategies for improving recovery housing, please see the Your Safe Solutions -- "Recovery Housing" page as well. <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Housing</ref>

* Vocational Training - Substance use disorders could result in loss of job, job abandonment, or legal issues that may add additional barriers to obtaining employment. Vocational training can provide on-the-job training, remedial training, college training, and resume building. For more information about improving education, job training, and employment for people in recovery, please visit Your Safe Solutions -- "Improve Education, Job Training, and Employment for People in Recovery." <ref>https://www.yoursafesolutions.us/wiki/Improve_Education,_Job_Training,_and_Employment_for_People_in_Recovery</ref>

* Collegiate Recovery Programs - Helps students balance recovery and higher education. Provides support to students such as therapy, sober housing, and substance-free events. For more information on strategies to expand recovery schools and collegiate recovery programs, please see Your Safe Solutions page -- "Expand Recovery Schools and Collegiate Recovery Programs." <ref>https://www.yoursafesolutions.us/wiki/Expand_Recovery_Schools_and_Collegiate_Recovery_Programs</ref>

* Recovery Coaches - are people who have lived experience of substance use disorder and/or mental health conditions who provide non-clinical recovery support to their peers. They are not sponsors or alcohol and drug counselors. Recovery coaches can also be called Peer Recovery Specialists. There is a certification process that solidifies the Recovery Coach/Peer Recovery Specialist workforce.

* Peer-Based Recovery Support - Giving and receiving nonprofessional, nonclinical, peer-to-peer assistance to achieve long-term recovery from substance use disorders. '''Alcoholics Anonymous (AA)''' is the most common support group and is based on the 12 steps. '''All Recovery''' brings people together from multiple pathways of recovery. '''SMART Recovery''' or Self Management and Recovery Training, is guided by the 4-point program. The clients find and develop the power within themselves to change and lead fulfilling lives. For more information about how to strengthen peer recovery support services and programs, please see Your Safe Solutions -- "Peer Recovery Support Services & Programs." <ref>https://www.yoursafesolutions.us/wiki/Strengthen_Peer_Recovery_Support_Services_and_Programs</ref>

* Harm Reduction - Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in and respect for, the rights of people who use drugs. <ref>https://harmreduction.org/about-us/principles-of-harm-reduction/</ref> For more information about strategies to expand harm reduction practices, please also see Your Safe Solutions -- "Expand Harm Reduction Practices." <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>

* Medicated Assisted Treatment/Therapy (MAT) - uses medication and counseling to provide a whole-patient approach to recovery. Medications are FDA approved. MAT can help sustain recovery and prevent or reduce opioid overdose. Primarily, MAT is used for addiction to opioids, such as prescription pain killers and heroin. For more information on expanding access to MAT, please see Your Safe Solutions -- "Expand Access to Medication-Assisted Treatment." <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)</ref>

* Criminal Justice - Substance use disorder and the justice system have a complex history. It is estimated that about one-half of state and federal prisoners misuse drugs or are addicted to drugs, but few typically receive treatment while incarcerated.<ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system</ref> For more information about strategies to support people who are criminal justice involved, please visit Your Safe Solutions -- "Recovery Supports for People in the Criminal Justice System." <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>

=Relevant Research=

* '''Nora's Blog''' on the Director's page of NIDA highlights recent advances in the science of drug use and addiction. For example, in evaluating the relationship between abstinence and relapse, it is noted that setbacks are regarded as a failure, leading to the perception that the client is starting all over, when in fact, a return to use may strengthen someone’s resolve to recover. <ref>https://nida.nih.gov/about-nida/noras-blog/2022/01/making-addiction-treatment-more-realistic-pragmatic-perfect-should-not-be-enemy-good</ref>

* This article provides a systematic review of nine different studies that examined peer-delivered recovery support services. <ref>https://addictionrecoverytraining.org/wp-content/uploads/2016/08/PeerRecoveryEffectiveness.pdf</ref>

* Although AA is the most well-known peer recovery support program, there are other pathways that provide support. This article gives alternatives to the 12-steps. <ref>https://americanaddictioncenters.org/therapy-treatment/12-step-alternatives</ref>

= Impactful Federal, State, and Local Policies =

* The Mainstreaming Addiction Treatment Act of 2021 removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., buprenorphine) for maintenance or detoxification treatment (i.e., substance use disorder treatment).<ref>https://www.congress.gov/bill/117th-congress/senate-bill/445</ref>

* Oregon passed a Drug and Addiction Treatment Act whose purpose is to make screening health assessment, treatment and recovery services for drug addiction available to all those who need and want access to those services; and to adopt a health approach to drug addiction by removing criminal penalties for low-level drug possession.<ref>https://www.oregon.gov/oha/hsd/amh/pages/measure110.aspx</ref>

=Available Tools and Resources=

* '''Faces & Voices of Recovery (Faces & Voices)''' conducted the first nationwide survey of persons in recovery from alcohol and other drug problems. The purpose of this survey was to document the benefits of recovery. <ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/22Life-in-Recovery22-Report-on-the-Survey-Findings.pdf</ref>

* '''SAMHSA''' Recovery from Substance Use and Mental Health Problems Among Adults in the United States. This brief report presents self-reports of recovery among adults aged 18 and older in the United States who thought they ever had a problem with their use of drugs or alcohol and/or mental health. These findings provide a clearer characterization of the factors associated with recovery among adults and how future efforts can foster a whole-health approach to sustain recovery from mental health and substance use conditions. <ref>https://store.samhsa.gov/product/recovery-substance-use-and-mental-health-problems-among-adults-united-states/pep23-10-00?utm_source=SAMHSA&utm_campaign=3315782ffc-EMAIL_CAMPAIGN_2023_09_20_06_25&utm_medium=email&utm_term=0_-3315782ffc-%5BLIST_EMAIL_ID%5D</ref>

* '''SAMHSA''' provides a treatment finder that connects people with licensed treatment providers who specialize in substance use, addiction, and mental health. <ref>https://findtreatment.gov/</ref> SAMHSA also provides video trainings that promote recovery-oriented services and supports by highlighting new knowledge areas, hot topics, and cutting-edge programs. <ref>https://www.samhsa.gov/brss-tacs/video-trainings</ref>

* '''SAMHSA''' Recovery Resources for American Indian and Alaska Natives. Get the latest news and resources on SAMHSA’s efforts to address recovery support within American Indian and Alaska Native (AIAN) communities. <ref>https://www.samhsa.gov/tribal-affairs/recovery-resources-american-indian-alaska-natives?utm_source=SAMHSA&utm_campaign=24c288fca9-EMAIL_CAMPAIGN_2024_03_13_03_56&utm_medium=email&utm_term=0_-24c288fca9-%5BLIST_EMAIL_ID%5D</ref>

* '''SAFE Project''' provides a variety of resources for recovery:
**'''Bridging Prevention and Recovery Program''' is a new evidence-based program model designed to provide substance use disorder professionals with a step-by-step process to facilitate sustainable integration of these two approaches in communities that have traditionally been siloed.<ref>https://www.safeproject.us/bridging-prevention-recovery/ </ref>
**'''Integrated-Forensic Peer Recovery Specialist (I-FPRS).''' This Training of Trainers equips participants to train Certified Peer Recovery Specialists and Supervisors to navigate the complexities associated with providing support to individuals who are justice-involved. <ref>https://www.safeproject.us/ifprs-training/</ref>
**'''Treatment and Family Support Locator''' assists individuals and their loved ones in finding the best treatment for their needs, as well as programs, supports, and other services for friends and family of people caring for individuals with substance use disorder and/or mental health challenges. The locator is a collaboration between SAFE Project and the Partnership to End Addiction. <ref>https://safelocator.org/en/search</ref>

=Promising Practices=

* '''Connecticut Community for Addiction Recovery (CCAR)''' supports all things recovery -- no matter what stage of recovery. The CCAR website helps people navigate the recovery community by providing support services and connections to people in recovery. They offer telephone recovery support, virtual support meetings on different recovery topics, peer recovery training, and a coffee lounge. They also have five recovery community centers throughout the state. <ref>https://ccar.us/</ref>
* '''The Hazelden Betty Ford Foundation''' has a series of virtual services. On-line outpatient addiction programs encompass addiction treatment, family services, community solutions, prevention and early intervention, recovery support, and mental health services. <ref>https://www.hazeldenbettyford.org/locations/online-care-support-services</ref>
*'''Recovery Texas.''' This state-wide movement provides recovery support specialists, screenings for substance use and mental health, and digital recovery support such as meetings, meditation, and yoga. <ref>https://recoverytexas.org/</ref>

=Sources=

Advocate for Policy Change

2024-03-14T14:18:50Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Educating policymakers and the general public about the legislative or policy changes necessary to create change in your community is an important step to addressing substance misuse and substance use disorder (SUD). Policies help states and local communities in several important ways:

1. By providing direct funding to communities for treatment and other services. 2. By improving access and/or affordability of care to individuals in need of assistance. 3. By removing barriers that prevent or limit the use of best practices across government agencies.

Policy change can take place at all levels of government. This page will provide information about how policy changes typically take place, as well as some examples of federal, state, and local laws that have helped local communities.

= Key Information =

'''Initial Steps for Policy Advocacy''' In order to bring about policy changes through laws or ordinances, any group of citizens must be able to become a "constituency of consequence" to those with the ability to create and change policy. This can be accomplished with a number of different advocacy approaches, as highlighted below. A few key principles to change policy at any level of government include:

*Have clear policy objectives. The more specific and narrow the objective the better. If the policy goals are too broad or general, it is easy for legislators to object on that basis.
*Support your position. Have research and data to support why the policy change you are seeking would be beneficial. For example, if seeking to improve harm reduction through the creation of a needle exchange program, provide data on expected lives that will be saved, reduced medical costs, improved linkages to care, and other benefits.
*Build a coalition. It is important to build a coalition to increase political clout. Think about other groups within the state or local community whose goals align with yours that would support your policy objectives and who would be willing to take action in order to achieve them. For example, if you were advocating for a needle exchange program, you might seek support from harm reduction organizations including hospitals, community health organizations and professionals, the recovery community, families in support of recovery, the treatment community, and potentially many others.
*Know your opposition. If a policy change hasn't happened, it is likely opposition exists. It is important to learn why policymakers may be hesitant to make a certain change, including what groups oppose the policy and why. Learning about the other side is critical to developing an effective advocacy strategy. Overcoming opposition may require education, effective counterarguments, financial resources, and increased public awareness.
*Identify champions. The most successful efforts resulting in desired policy changes are led by individuals who are passionate about the issue. Identifying and working with champions in the state or local government is a big key to success. It is important to have people "on the inside" that can hold hearings, develop legislation, utilize input and information from stakeholders, and provide insight on the process.
*Your voice matters. Many times, individuals or groups with minimal advocacy experience can be intimidated by the process. Remember that those "in power" are there because they were elected to serve. Lawmakers across all levels of government represent the people of their states, districts, cities, towns, and so forth. It is your constitutional right to petition the government and be heard. Those representing the people need to hear the concerns of all those they represent.

'''Converting Policy Into Action''' After taking the initial steps delineated above, the next step is to identify and implement a set of strategies that will grow public and political support for those policies. While approaches and specific strategies are almost innumerable, taking action involves communication and messaging intended to educate and influence.

'''Grassroots Advocacy''' Grassroots Advocacy generally refers to engaging the public to actively educate and lobby on behalf of a desired policy objective. Communication occurs through letters, emails, calls to legislators, rallies, social media campaigns, letters to the editor, and other forms of messaging campaigns designed to put political pressure on policymakers to enact desired changes.

'''Direct Lobbying''' Direct lobbying refers to direct communication and meetings with policy makers at all levels of government, including governors, mayors, county executives, and the legislative branch. This key activity provides the opportunity to meet with decision makers and their staff to gauge the receptiveness of the policymakers and to discuss the desired policy goals, benefits, support, and potential points of opposition. Opportunities for direct lobbying often take place during the legislative session, which varies from jurisdiction to jurisdiction. Some advocates and interest groups will organize a "lobby day" where members converge in Washington, state capitols, or with local legislative bodies to advocate for desired policy objectives. When the legislative body is not in session, advocates can meet with their representatives at their local offices.

'''Lobbying Rules and Restrictions''' Lobbying rules vary widely between levels of government and across all states. Therefore, it is important to know how lobbying is defined and what the restrictions are in the jurisdiction you are involved with. Some fundamentals include:

* 501(c)3 organizations (tax-exempt nonprofits) have some restrictions on lobbying in the government.

* The IRS defines direct lobbying as: "A direct lobbying communication is any attempt to influence any legislation through communication with: Any member or employee of a legislative body; or Any government official or employee (other than a member or employee of a legislative body) who may participate in the formulation of the legislation, but only if the principal purpose of the communication is to influence legislation" and as "Referring to specific legislation and reflects a view on such legislation."

* The IRS defines grassroots lobbying as: "any attempt to influence any legislation through an attempt to affect the opinions of the general public or any segment thereof."

* Grassroots Lobbying Communication is defined as: "Referring to specific legislation; reflecting a view on such legislation; and encouraging the recipient of the communication action with respect to such legislation."

'''The Legislative Process''' The legislative process varies between different levels of governments and in jurisdictions across the country. There are typically several steps in the process that provide opportunities to influence policymakers, such as when they are in session. Some states and localities have relatively short time frames to consider and pass new laws or ordinances, while other states and the federal government are in session for many more weeks throughout the year. It is important to know when the actual work of policy development and consideration takes place in the legislative body where you want the change to happen.

'''Sponsors and Early Support''' In any legislative body, a successful policy enactment starts with one or more members of the legislative body drafting legislation that would bring about the desired change. Members can do this individually or as a group. A group of members that introduce a legislative proposal are typically referred to as sponsors or "original" sponsors of the proposal. Other members can then sign on in support of the bill as co-sponsors.

Effective advocacy can help build momentum for a bill during this process. The more sponsors and cosponsors, the better. It is also extremely beneficial to have early supporters from both political parties - especially at the state and federal level. Bipartisan support, and support among a broad base of members at the local level, can show other members that the bill is not likely to be controversial. It is also especially helpful to have support for the proposed legislation from key leaders of the committees with jurisdiction.

Advocates can provide their champions within the legislature with all of the supporting information and research to help their champions in the legislative body attract as many co-sponsors as possible and to respond to questions or objections as they arise.

'''Committee Process''' Typically, legislative proposals are taken up by the committee (or committees) of jurisdiction. Actual consideration of a proposal often takes place after one or more committee hearings on the proposal. This often involves hearing from witnesses in support of, and potentially in opposition to, a given proposal. Written testimony is also included in the public record to provide additional information to both the public and the legislators. The hearing process provides another opportunity for advocates to testify as witnesses and/or provide information to be included in the record. Hearing can take place in front of the full committee or by a sub-committee which oversees the specific policy area impacted.

After the hearing process, the bill may be taken up by the full committee for consideration. Although the bill can be altered by the manager of the bill at any time, consideration by the committee is the first time lawmakers have an opportunity to propose amendments to the proposal. These amendments are voted and adopted, or not adopted, by a majority vote. Following the amendment process the committee chair can call for a final vote on the legislation. If passed, the bill can move to the full legislative body for consideration.

Advocacy efforts can move quickly during the committee process, as unexpected challenges may surface due to an unfriendly amendment that might weaken the bill and the policy impact desired. It is important to work with allies to carefully track this process and respond to any negative developments.

'''Consideration by the Full Body''' At the local level, there is a single body that approves local legislative proposals. This is typically a Board of Commissioners or other duly elected body. At the state and federal levels, there are two legislative chambers, with delegates and senators at the state level, and the House and Senate at the federal level.

The process is usually relatively simple at the local level. Legislation (or ordinance) proposals are taken up at regularly scheduled meetings where a debate occurs, amendments are offered, and the proposals are voted on. Often, the chief executive at the local level has a vote along with the other members.

At the state and federal level, the process is more complex. A bill has to pass both chambers before it can be reconciled, voted on again by both bodies, and sent to the Governor or President for signature. While on the floor, members can again offer amendments that can be voted on individually or "en bloc" as two amendments in one. Typically, more controversial amendments will be voted on by individual basis. Assuming the bill passes, it is sent to the other body for consideration. A similar or identical bill may be in process in that other chamber already, or it may be that no companion legislation exists. In the latter case the chamber that did not originate the bill will take up the version that was passed in the other chamber.

When a bill does pass both chambers, there are almost always differences that must be worked out. The committee chairs will select a reconciliation committee with a bi-partisan group of legislators from both chambers to accomplish this. Assuming any differences can be worked out, the bill then goes back to the floor of each chamber for a final vote. If passed, the bill is finally referred to the Governor or President.

As with the Committee process, advocacy must continue throughout the time in which a bill is considered by the full legislative body. At the state and federal levels, this can be a challenge with many steps involved and a larger number of legislators to contend with - some of whom may not be supportive. Again, it is critical to stay in constant contact with supporters within the legislative body to keep track of potential harmful amendments and keep count of likely supporters within the full body. At times advocacy efforts need to be focused on a handful of legislators who have reservations or are undecided.

'''Potential Veto and Override''' Although rare, Governors and the President may veto a bill passed by the state and federal legislators. If the vote on final passage was close, it is unlikely that the bill will be taken up again, as a two-thirds majority is needed to override a veto. If the original vote approached the two-thirds number, there is a better chance to find the supporters needed for a successful override.

'''Continued Funding (Budget and Appropriations)''' Even when a law or ordinance is passed and signed by the chief executive, advocacy efforts often do not end. This is due to the fact that legislation containing funding to implement programs is authorized (usually for a period of years), but there is still a budget and appropriations process that must be monitored over the authorization period. Typically, the executive branch of government produces an annual budget that reflects their policy and spending priorities. The budget may or may not be approved by the legislative body. After this point the legislative body will take up annual appropriations bills, which set spending levels for all agencies and their programs. These bills often work through the regular order of other legislation, but sometimes will have a different, often expedited process.
It is important for community coalitions and advocates to understand that funding for the agencies and programs they support can change through each step of the budget and appropriations process. There is a need to stay vigilant to ensure that full funding is achieved. Advocates must stay in touch with their champions in the executive branch and legislature to keep informed of any changes and be ready to advocate just as vigorously in order to restore any proposed cuts in funding.

= Impactful Federal, State, and Local Policies =

Governments at all levels will frequently create their own set of policy goals to address a particular issue. This has been true for several public health issues including the current opioid epidemic. This process typically involves bringing numerous stakeholders together to provide education and input in coordination with government representatives who initiate the process and finalize the set of policy objectives.

States and localities vary widely on what types of laws are implemented across multiple policy areas. <ref>https://www.fda.gov/media/147152/download</ref> Below are a few examples that can provide your community coalition with some ideas on what has been successful in a variety of policy initiatives. This policy inventory begins with two major federal actions, then provides a variety of initiatives that are organized by specific topic, and closes with an example of a successful advocacy process in Illinois.

'''Biden-Harris Drug Policy Priorities''' <ref>https://www.whitehouse.gov/wp-content/uploads/2021/03/BidenHarris-Statement-of-Drug-Policy-Priorities-April-1.pdf?fbclid=IwAR2TBk34U_XRqlqK_pAYnUd_9f7zY3IbCQI9KxI6S5eYeRJdFzl9B09hZ84&utm_source=Faces+%26+Voices+of+Recovery&utm_campaign=1c12da631e-november-2020-advocacy-policy_COPY_01&utm_medium=email&utm_term=0_3410cda480-1c12da631e-382685157</ref> - On April 1, 2021, President Biden and Vice President Harris released their administration's Drug Policy Priorities for the upcoming year. President Biden made clear that addressing the overdose and addiction epidemic was an urgent priority for his administration.

Priorities include:

*Expanding access to evidence-based treatment
*Advancing racial equity issues in our approach to drug policy
*Enhancing evidence-based harm reduction efforts
*Supporting evidence-based prevention efforts to reduce youth substance use
*Reducing the supply of illicit substances
*Advancing recovery-ready workplaces and expanding the addiction workforce
*Expanding access to recovery support services

'''Recommendations from the 2017 President's Commission on Combating Drug Addiction and the Opioid Crisis'''

*Establish and fund a federal incentive to enhance access to Medication-Assisted Treatment (MAT)
*Mandate Prescriber Education
*Require that all modes of MAT are offered at every licensed MAT facility and that those decisions are based on what is best for the patient.
*Partner with the National Institutes of Health (NIH) and the industry to facilitate testing and development of new MAT treatments.
*Provide model legislation for states to allow naloxone dispensing via standing orders, as well as requiring the prescribing of naloxone with high-risk opioid prescriptions;
*Equip all law enforcement in the United States with naloxone to save lives
*Develop and disseminate Fentanyl detection sensors
*Support and fund interstate sharing of PDMP data
*Better align, through regulation, patient privacy laws specific to addiction with the Health Insurance Portability and Accountability Act (HIPAA) to ensure that information about SUDs be made available to medical professionals treating and prescribing medication to a patient. This could be done through the bipartisan Overdose Prevention and Patient Safety Act/Jessie’s Law
*Enforce the Mental Health Parity and Addiction Equity Act (MHPAEA) with a standardized parity compliance tool to ensure health plans cannot impose less favorable benefits for mental health and substance use diagnoses versus physical health diagnoses.

'''Prevention and Reduced Access to Prescription Medications'''

*New Jersey - New Jersey's Prescription Monitoring Program <ref>https://www.njconsumeraffairs.gov/pmp/</ref>
*California (Alameda County) - Local ordinances that require drug manufacturers to establish and fund a drug disposal program.<ref>https://library.municode.com/ca/alameda_county/codes/code_of_ordinances?nodeId=TIT6HESA_CH6.53ALCOSADRDIOR</ref>
*Connecticut - Statute <ref>https://www.cga.ct.gov/2016/ACT/pa/2016PA-00043-R00HB-05053-PA.htm</ref>enacted May 2016: Seven-day limit for new opioid prescriptions for adults and all opioid prescriptions for kids. Exceptions for chronic and cancer pain, palliative care, and clinical judgement.
*Illinois - Statute enacted September 2015: Schedule II prescriptions limited to a 30-day supply (with exceptions). Allows multiple prescriptions up to a 90-day supply if the prescriber meets specified conditions.<ref>https://www.ilga.gov/legislation/publicacts/99/PDF/099-0480.pdf</ref>

'''Harm Reduction'''

*AmfAR Opioid & Health indicators Database - Syringe Access Locations <ref>https://opioid.amfar.org/indicator/num_SSPs</ref>
*National Harm Reduction Coalition - Resources for Syringe Access and Policy<ref>https://harmreduction.org/issues/syringe-access/landscape-report/</ref>
*Rhode Island - Fentanyl Testing Strip Program<ref>https://preventoverdoseri.org/fentanyl-test-strips/</ref>

'''Access to Treatment and Protecting Treatment Services'''

California legislation has a process for reducing treatment fraud and waste.<ref>https://www.hmpgloballearningnetwork.com/site/behavioral/news-item/policy/calif-bill-targets-profiteering-addiction-treatment-dialysis-industries</ref>

'''Federal Government - Affordable Care Act (2010)'''

Support to get mental health and substance abuse treatment through the 2010 ACA.

'''Criminal Justice Reform and De-criminalization.'''

* Good Samaritan Laws provide immunity from criminal prosecution for drug crimes to those who use drugs and those who act in good faith and call emergency services during an overdose. The Policy Surveillance Program provides an interactive database of current Good Samaritan Laws in the U.S. All 50 states and Washington D.C. have Good Samaritan Laws in place.<ref>https://www.ncbi.nlm.nih.gov/books/NBK542176/</ref>

*Oregon - State Initiative to De-criminalize almost all narcotics: Measure 110, passed by a majority of statewide voters in November 2020, decriminalizes the possession of marijuana and small amounts of "harder" drugs including cocaine and methamphetamine and reduces criminal penalties for larger amounts.

*Washington State - Law Enforcement Assisted Diversion <ref>https://kingcounty.gov/depts/community-human-services/mental-health-substance-abuse/diversion-reentry-services/lead.aspx#:~:text=The%20Law%20Enforcement%20Assisted%20Diversion,behavioral%20health%20needs%20or%20poverty.</ref>

'''Recovery Support Services'''

* Federal SUPPORT Act: Section 7151. Building Communities of Recovery. This section amends the Building Communities of Recovery (BCOR) program that was first authorized in the Comprehensive Addiction and Recovery Act (CARA) of 2016 by redefining “recovery community organization” as an organization that mobilizes resources within and outside of the recovery community, including through a peer support network. This section authorizes $5 million for each of FY 2019-2023.

* Federal SUPPORT Act: Section 7031. National Recovery Housing Best Practices. This section amends part D of title V of the Public Health Service Act to authorize the Secretary of HHS to identify or facilitate the development of best practices for operating recovery housing. The Secretary is directed to bring together a wide variety of stakeholders to develop best practices for Recovery Housing.

'''State Policy Plans to Address the Opioid Epidemic'''

* Rhode Island's Strategic Plan on Addiction and Overdose<ref>https://health.ri.gov/news/temp/RhodeIslandsStrategicPlanOnAddictionAndOverdose.pdf</ref>
*Massachusetts’s Recommendations of the Governor's Opioid Working Group<ref>https://www.mass.gov/lists/governors-opioid-addiction-working-group</ref>

'''Example of Successful Illinois Advocacy Strategy''' The following illustrates some of the partnerships and strategies used to pass an important piece of legislation in the state of Illinois:

Illinois SB2928<ref>https://ilga.gov/legislation/billstatus.asp?DocNum=2928&GAID=12&GA=98&DocTypeID=SB&LegID=79014&SessionID=85</ref> is a current law with the common name "Lake County Prescription Drug Disposal Pilot Program" which had been adopted in 2014 and is currently still functioning, losing its Pilot portion of title in 2015. It has been shown to be a model by which many organizations and local governments can partner with one another to improve outcomes in drug recovery and disposal efforts. The lead Project Coordinator Bill Gentes, has as a result, been awarded CADCA's Advocate of the Year.

The following steps were used in the creation, adoption, and advocacy for this bill that allowed successful passing of it within the 98th general assembly:

*Investigation of Previous Regulation and Legislation - As is shown in the Securing Public-Private Partnerships section, it is required that one reviews current legal standings to determine if advocacy for amendment is required to allow for a more proactive approach to drug prevention to exist.
*Partnering with Local Law Enforcement - As stated by Gentes at an interview "“circling back to law enforcement and telling them, ‘look, you guys dropped off 500 pounds and I want to tell you what that means,” makes it easy for those police departments to then get their mayors, and their village boards invested in the process. "In many jurisdictions, it is regulated that only police forces may collect excess pharmaceutical products, which increases the need to partner with Local Law Enforcement even more.
*Gaining support of Local and Community Leaders - Primarily through the method discussed in Partnering with Local Law Enforcement and through advocacy and education efforts, to have a bill passed one must show support at the local level as well as demonstrable results of local programs to garner such support. As Stated in the Route 50 Article: "Another goal for Gentes was to uncover and take advantage of the data coming out of the collection boxes. When scheduled substances are found within the boxes, the contents and amount is noted. This isn’t merely a measure to satisfy curiosity. Rather, Gentes uses the data collected as a tool to recruit new police departments to the program, and to remind participating police departments that their efforts are making a difference.
*Securing Public-Private Partnerships - Walgreens was approached by Gentes and worked to create Prescription Drop Off and Secure Sites with partnership with local police forces and legislature. Currently expanding their drop off points to several states, there appears to be an issue with a need to review current laws regarding drug disposal. This increased the capacity of the project and accompanying police force in collection efforts.
*Advocating for Adoption from State Officials - Through previous methods listed, especially community advocacy efforts, the proposal was adopted as a bill partly through the efforts of sponsor Senator Terry Link, and went on to receive unanimous support.
*Securing Funding For A Statewide Program - In the Example of SB2928, funding would be secured in law through the Illinois EPA with the rationale that disposal of such materials would prevent drugs from tainting local water supplies, though it should be noted that labor and supplies were primarily used from local Law Enforcement Departments.

= Available Tools and Resources =

*FedUp! - A grassroots coalition formed in 2012 that seeks action from the federal government to end the public health epidemic created by opioids. FedUp accepts no money from pharmaceutical corporations and 100% of the donations they receive are directly applied to managing the costs of hosting their FedUp! rallies.<ref>https://feduprally.org/</ref>
*Department of Health & Human Services Guidebook for State by State Opioid Prescribing Guidelines-<ref>https://www.azdhs.gov/documents/prevention/womens-childrens-health/injury-prevention/opioid-prevention/appendix-b-state-by-state-summary.pdf</ref>
*National Council For Behavioral Health. Advocates for mental health and substance use policies.<ref>https://www.thenationalcouncil.org/policy-agenda/</ref>
*National Harm Reduction Coalition. Advocates for numerous harm reduction approaches.<ref>https://harmreduction.org/</ref>
* Grassroots Unwired provides a good overview of grassroots advocacy. <ref>https://www.grassrootsunwired.com/grassroots-advocacy/</ref>
* Model Law Virtual Knowledge Labs. The Model Law Virtual Knowledge Labs are a virtual learning series that provides state and county leaders with an opportunity to deepen their awareness and understanding of how model laws can assist jurisdictions in addressing substance use disorders and concomitant issues . <ref>https://legislativeanalysis.org/model-law-virtual-knowledge-labs/</ref>
* Legislative Analysis and Public Policy Association. LAPPA is excited to announce the release of State of the States: Legislative Roadmap for Reducing Overdose Deaths and Increasing Access to Treatment (the Roadmap), a guide for state leaders on the most effective approaches to addressing the current drug epidemic. <ref>https://files.constantcontact.com/9b9edb2e701/6fe81aeb-e7b3-49f9-8b98-e5060d133156.pdf</ref>
* South Southwest PTTC: The Ins and Outs of Advocating for Policy Change & The Ten Do’s and Don’ts of Successful Legislative Advocacy <ref>https://pttcnetwork.org/the-ins-and-outs-of-advocating-for-policy-change/</ref> <ref>https://pttcnetwork.org/news/the-ten-dos-and-donts-of-successful-legislative-advocacy/</ref>

= Promising Practices =

SAFE Solutions is an ever-growing platform.  Currently no information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Sources =

Build Education and Raise Awareness

2024-03-14T13:42:01Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Many public establishments, such as schools and places of work, maintain a zero tolerance for substance use. While this high standard ensures safety, it can sometimes leave individuals with nowhere to turn if they find themselves with a substance use problem. In addition to having high standards, school systems and places of employment can assist their stakeholders by motivating them to maintain a drug-free lifestyle through fostering connection to available resources and by building more effective education. This process can begin by raising awareness of the extent of substance use in society and carefully selecting the right tools to inform and assist individuals to maintain a drug-free lifestyle in and outside of work or school. <ref>https://www.samhsa.gov/workplace/employer-resources/prepare-workplace</ref>

= Key Information =

Drug education programs in public schools have changed over the years, from prioritizing an abstinence-only approach to incorporating mental health, social skills, family bonding, and behavior management. The National Institute on Drug Abuse website has a comprehensive list of drug education programs reflective of this progress. <ref>https://archives.nida.nih.gov/publications/preventing-drug-use-among-children-adolescents</ref> See the SAFE wiki, "Prevent First Time Use Through Education" for more information. <ref>https://www.yoursafesolutions.us/wiki/Prevent_First_Time_Use_Through_Education</ref> This prevention work for children and adolescents has crafted a good foundation for extending the same type of advances in workplace education.

Drugs in the workplace have detrimental effects on all individuals due to impaired decision making. There is an increased risk of damage to property and increased chance of physical harm due to accidents. Drug use also costs employers money because of increased turnover and increased time off. By implementing support for individuals with SUD and integrating effective education, employers may save thousands of dollars. Many businesses have realized the importance of drug education and prevention in the workplace. More businesses, especially smaller businesses, could benefit from implementing drug education. This type of education can be costly, and many times businesses feel they can not afford to add it to the budget. However, research shows that by implementing a drug education and drug testing program, employers and employees both experience positive outcomes. In order to incentivize corporate investment in people, some proven benefits of drug education programs in the workplace are listed below: <ref>https://drugabuse.com/addiction/workplace-drug-abuse/</ref>

*Increased morale
*Decreased workplace accidents
*Reduced employee theft
*Increased productivity
*Reduced employee turnover
*Decreased cost of insurance, such as workers’ compensation

The American Addiction Center recommends that drug education programs include the following: <ref>https://americanaddictioncenters.org/</ref>

*Rules and expectations with terms clearly defined
*Prevention methods and education
*Testing
*Quality employee assistance programs

One possible way to raise awareness in the workplace is to distribute materials, in writing and through visual presentations, that pertain to drug use and its impacts on the work environment and employees. Adding in a Drug Awareness day and presenting information and resources that are available to employees can increase understanding of best actions to take when an individual is struggling with substance use.

'''Common Signs of Substance Use'''

By providing education to employees about common signs that indicate someone is struggling with addiction, a workplace may be able to intervene and provide assistance before the problem escalates. Some signs of substance use may be overlooked as common ailments and other signs are more noticeable. Below are some examples <ref>https://drugabuse.com/addiction/workplace-drug-abuse/</ref>.

*Frequent Accidents
*Erratic Behavior
*Dilated Pupils
*Slurred Speech
*Extreme Mood Swings
*Paranoia
*Glassy Eyes
*Noticeable Exhaustion
*Frequent Absenteeism

= Relevant Research =

'''Rates of Drug Use in the Workforce'''

According to SAMHSA, almost 70% of drug users are actively employed in the workplace. <ref>https://www.nsc.org/forms/substance-use-employer-calculator</ref> The Tennessee Department of Labor and Workforce Development reported that one third of employees are aware of the presence and the illegal sales of drugs at their place of employment. <ref>https://www.nsc.org/forms/substance-use-employer-calculator</ref>

'''Adults Survey on Drug Education'''

A study conducted by the American Addiction Centers surveyed 500 men and women. Thirty-seven percent of the participants reported that the most effective way they learned about drug education was by learning about the possible dangers of substance use. In the next highest category, at 20%, participants reported that the most effective drug prevention education approach was listening to the powerful testimonials of recovered adults. This information could be helpful in building an effective drug education program. Surprisingly, 41.2% of respondents reported that they did not receive any education about the science of addiction. Many of the respondents reported that they were not educated on some of the most commonly abused drugs. About half of the 500 adults surveyed had not received formal education about meth, ecstasy, heroin, or other opioids. These statistics support the need for building more educational resources and programs to address all of these gaps. <ref>https://americanaddictioncenters.org/learn/drug-education-survey/</ref>.

= Impactful Federal, State, and Local Policies =

SAMHSA’s Division of Workplace Programs (DWP) performs regulatory, knowledge development, and technical assistance for federally regulated workplace programs in efforts to eliminate illicit drug use in the workplace. The DWP is also responsible for evaluating evidenced-based drug-free programs in non-federal workplaces <ref>https://www.samhsa.gov/workplace/about</ref>.

= Available Tools and Resources =
'''Opioid Response Network (ORN)''' provides free training and education that is evidence-based and designed to meet the needs of a community or organization. <ref>https://opioidresponsenetwork.org/</ref>

'''SAMHSA'''
The Substance Abuse and Mental Health Services (SAMHSA), Office of Behavioral Health Equity held the Behavioral Health Equity Best Practices for African Americans event on Monday, February 5 at 1:30-3:00 pm EST. This dynamic webinar was a collaboration with SAMHSA’s Division of Children and School Mental, Mental Health Promotion Branch, Suicide Prevention Branch, and the 988 & Behavioral Health Crisis Coordinating Office. <ref>https://share.nned.net/2024/01/behavioral-health-equity-best-practices-for-african-americans/</ref>

'''Substance Use Employer Cost Calculator'''
This resource provides information about the real costs of substance use on employers and businesses. By answering questions, employers can determine how substance use in their workplace can negatively impact their budget. <ref>https://www.nsc.org/forms/substance-use-employer-calculator</ref>

= Promising Practices =

= Sources =

Expand and Enhance Speciality Courts

2024-03-14T13:35:14Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The drug court approach intends to reduce time in the criminal just system and provide treatment to individuals instead of punishment. As of 2023, there were more than 3,800 drug courts across the United States. The innovation of drug courts emerged in the late 1980s, when professionals recognized the importance of treating substance use and mental health in prevention of relapse and recidivism. Drug courts aim to reduce drug use relapse and criminal recidivism through a variety of services. These services include risk and needs assessment, judicial interaction, monitoring and supervision, graduated sanctions and incentives, treatment, and various rehabilitation services. <ref>https://www.ojp.gov/pdffiles1/nij/238527.pdf</ref>

= Key Information =

Drug courts are specialized courts targeting those charged with or convicted of a crime. Although drug courts vary in target populations and resources, programs are generally managed by a multidisciplinary team including judges, prosecutors, defense attorneys, community corrections officers, social workers, and treatment service professionals. Support from those representing law enforcement, the family, and the community is encouraged through participation in hearings, programming, and events such as graduation. <ref> https://www.ojp.gov/pdffiles1/nij/238527.pdf</ref>

There are several types of treatment courts including:

'''DWI/DUI.'''Specialized and comprehensive court programs that provide individual treatment, supervision and accountability for repeat DWI offenders. These specialty courts follow the well-established drug court model and are based on the premise that impaired driving can be prevented if the underlying causes, such as substance use and mental health disorders, are identified and addressed. <ref name="National Center for DWI Courts">https://www.dwicourts.org/whatsatstake/</ref>

'''Mental Health Treatment Courts''' for adults and juveniles work with people with mental illnesses who are involved in the justice system. These courts connect people to effective treatment and support after they undergo screening and assessments. <ref>https://www.samhsa.gov/gains-center/treatment-court-locators</ref>

'''Juvenile''' drug treatment courts are designed for youth with substance use disorders who come into contact with the juvenile justice system. Juvenile mental health courts focus on treatment and rehabilitation, and help divert youth from detention facilities to common-based services. Juvenile mental health courts also address issues such as involving families and schools in treatment. <ref>https://ojjdp.ojp.gov/programs/juvenile-drug-treatment-court-guidelines</ref>

'''Family Drug Treatment Courts''' also known as dependency drug courts or family drug courts, use a multidisciplinary, collaborative approach to serve families who require substance use disorder treatment and who are involved with the child welfare system. <ref>https://ncsacw.acf.hhs.gov/topics/family-treatment-courts/</ref>

'''Tribal.''' A ''Tribal Healing to Wellness Court'', like a state drug court, integrates substance abuse treatment with the criminal justice system to provide substance-abusing offenders judicially supervised treatment and transitional services using sanctions and incentives, and drug testing in a non-punitive setting, and intensive supervision. <ref>https://nicic.gov/tribal-healing-wellness-courts-policies-and-procedures-guide</ref>

'''Opioid Intervention Courts''' are an in-depth intervention for people at risk of overdose. They are designed to address the treatment needs for people with an opiate abuse history and to prevent them from using while their case proceeds through the criminal courts. <ref>https://www.courtinnovation.org/sites/default/files/media/documents/2019-07/report_the10essentialelements_07092019.pdf</ref>

'''Re-entry''' drug courts begin when a person enters a jail-based treatment program. The program involves regular judicial monitoring and support through recovery. Ultimately, it prepares individuals for reentry into the community. <ref>http://www.reentrycourtsolutions.com/wp-content/uploads/2009/10/Reentrypdf1.pdf</ref>

Participants who successfully complete the drug court program can have their underlying criminal offenses dismissed or expunged. If a participant fails to complete the program, their case will be processed as it normally would in the traditional criminal justice system. <ref name="National Drug Court Resource Center- What Are Drug Courts?">https://ndcrc.org/what-are-drug-courts/</ref> Drug court programs often include:

*Participation over a series of months or years to establish and maintain long-term recovery strategies
*Frequent and random drug tests
*Clinical treatment for substance use disorders
*Individualized case management services, connecting participants to employment opportunities, community service, pro-social activities, and education
*Mandatory appearances in court
*Rewards for maintaining treatment plans and sanctions for failure to meet obligations
*Support and encouragement from the drug court team

Additional information can be found at the SAFE Project wiki titled "Improving Recovery Support for People in the Criminal Justice System." <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>

= Relevant Research =

'''SAMHSA''' published a research brief titled "Adult Drug Courts and Medication-Assisted Treatment for Opioid Dependence." <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma14-4852.pdf</ref>

'''BJA''' published a research report titled "Tribal Healing to Wellness Courts - The Key Components." <ref>https://www.ojp.gov/pdffiles1/bja/188154.pdf</ref>

'''The National Institute of Justice (NIJ)''' in the US Department of Justice summarized early research on drug courts. In a 10-year longitudinal study on recidivism and cost analysis of drug court cohorts, NIJ researchers found that drug courts may lower recidivism rates and significantly lower costs. <ref>https://nij.ojp.gov/topics/articles/do-drug-courts-work-findings-drug-court-research</ref>

'''The Urban Institute Justice Policy Center''' conducted a five-year longitudinal study for NIJ. It examined twenty-three drug courts and six comparison groups in eight states: Florida, Georgia, Illinois, New York, Pennsylvania, North Carolina, South Carolina and Washington. The study titled, "Multisite Adult Drug Court Evaluation (MADCE)" went beyond simply measuring recidivism and examined multiple outcomes (crime, drug use, socioeconomic outcomes, family functioning, and mental health). It found that drug courts produce significant reductions in drug relapse and criminal behavior and that drug court participants experience select psychosocial benefits in other areas of their lives. <ref>https://www.ojp.gov/pdffiles1/nij/grants/237108.pdf</ref>

'''Re-Entry Drug Court Research.''' This was a collaborative study performed by NPC Research, The Center for Court Innovation, and RTI International. It was based upon an analysis of eight reentry courts. Results were mixed and primarily associated with level of supervision, the consistency and intensity of substance abuse treatment, the presence of wraparound services for multiple needs, and the degree of use of praise from the judge. It also suggested that eligibility factors associated with risk levels of substance use disorder Moderate versus high) may have also been a factor in the results. <ref>https://ndcrc.org/wp-content/uploads/2020/06/Reentry_Court_Multisite_Evaluation_2017.pdf</ref>

'''Minnesota''' conducted a detailed process evaluation and outcome evaluation in all nine of its DWI court programs. It also performed a cost-benefit evaluation in seven of these programs. The results for Beltrami County are detailed in this report. <ref>https://npcresearch.com/wp-content/uploads/Beltrami-Co-DWI-Court-Process-Outcome-and-Cost-Evaluation-FINAL-FOR-OTS.pdf</ref>

= Impactful Federal, State, and Local Policies =

*'''Adult Drug Treatment Court Grants.''' The Violent Crime Control and Law Enforcement Act of 1994 authorized the US Department of Justice to make grants to establish treatment courts. These courts integrate evidence-based substance use disorder treatment, random drug testing, equitable sanctions and incentives, and recovery support services in judicially supervised court settings. They are designed to prevent overdoses, reduce recidivism, and incorporate cultural elements and approaches. <ref>https://bja.ojp.gov/program/adult-drug-court-grant-program/overview</ref>

*'''The Veterans Treatment Court Coordination Act of 2019''' mandated continued funding for the types of projects that had been implemented by the Bureau of Justice Assistance in the preceding seven years. It directed the Attorney General to establish and carry out the Veterans Treatment Court Grant Program, which supports efforts to plan, implement, and enhance the operations of veterans treatment courts (VTCs). These courts operate in judicially supervised court settings that have jurisdiction over veterans involved in the justice system who have substance use disorders, including a history of violence and post-traumatic stress disorder as a result of their military service. Funding can also support efforts at the state level to assess, collect data, evaluate, training and build or enhance local or tribal VTCs, or to increase the identification and access to services for those underserved. <ref>https://bja.ojp.gov/program/veterans-treatment-court-grant-program/overview</ref>

= Available Tools and Resources =

'''SAMHSA''' maintains a locator for Mental Health Treatment Courts. <ref>https://www.samhsa.gov/gains-center/treatment-court-locators</ref> It also published a YouTube titled, "Drug Treatment Court - Opioid Overdose Prevention Framework." <ref>https://www.youtube.com/watch?v=__zaI4LULJU</ref>

'''The National Treatment Court Resources Center''' provides a wealth of useful information including:
*A set of webpages with extensive information on each of nine specific court types. <ref>https://ndcrc.org/resources-by-court-type/</ref>
*A set of webpages on best and evidence-based practice standards for all treatment court types, as set forth by subject matter experts, researchers, and policy makers. <ref>https://ndcrc.org/best-practice-resources/</ref>
*A peer-reviewed journal titled "Drug Court Review" <ref>https://ndcrc.org/drug-court-review/</ref>
*A website on current grants that are available through federal agencies such as BJA and SAMHSA. <ref>https://ndcrc.org/solicitations/</ref>
*A map of all operational treatment court programs by state and county

'''AllRise''' formerly known as National Association of Drug Court Professionals host the Treatment Court Institute which leads training, technical assistance, and research dissemination for more than 4,000 treatment court programs in the United States. <ref>https://www.ndci.org/resource/training/ta/</ref> It also hosts Justice for Vets <ref>https://justiceforvets.org/wp-content/uploads/2017/02/The-Ten-Key-Components-of-Veterans-Treatment-Courts.pdf</ref> AllRise has published "Family Treatment Court Best Practices" which provides shared elements required in quality practice. <ref>https://www.nadcp.org/standards/family-treatment-court-best-practice-standards/</ref>

'''Office of Juvenile Justice and Delinquency Prevention''' Juvenile Drug Treatment Court Guidelines." <ref>https://ojjdp.ojp.gov/programs/juvenile-drug-treatment-court-guidelines</ref>

'''The Center for Court Innovation''' has published two documents of particular interest: "Ten Essential Elements of Opioid Intervention Courts" <ref>https://www.courtinnovation.org/sites/default/files/media/documents/2019-07/report_the10essentialelements_07092019.pdf</ref> and "Re-entry Courts Looking Ahead: A Conversation about Strategies for Offender Reintegration." <ref>https://www.courtinnovation.org/sites/default/files/documents/Reentry_Courts.pdf</ref>

'''The National Institute of Justice''' published "Seven Program Design Features: Adult Drug Court Principles, Research, and Practice." <ref>https://www.ojp.gov/pdffiles1/nij/248701.pdf</ref> It also provides a website titled "Adult Drug Court Research to Practice Initiative" which indexes a variety of links to webinars and other materials produced by drug court experts at the National Center for State Courts and American University. These resources were designed to promote timely dissemination of research on addiction, substance abuse treatment, and drug court programming. <ref>https://nij.ojp.gov/topics/articles/adult-drug-court-research-practice-r2p-initiative</ref>

'''The National Institute of Corrections''' has a report titled "Tribal Healing to Wellness Court - Policies & Procedures." <ref>https://nicic.gov/tribal-healing-wellness-courts-policies-and-procedures-guide</ref>

= Promising Practices =

'''Nebraska''' The Nebraska Supreme Court, in response to legislation broadening the definitions of problem-solving courts, established the ''Nebraska Reentry Courts Best Practice Standards.'' <ref>https://ndcrc.org/wp-content/uploads/2020/06/Nebraska_Re-Entry_Court_Best_Practice_Standards.pdf</ref>

'''New York.''' In 2016, the Unified Court System launched an opioid intervention court in Buffalo, the first of its kind in the country. The opioid court provides immediate intervention, treatment, and supervision for defendants who are at risk of an opioid overdose. <ref>https://www.nycourts.gov/LegacyPDFS/courts/problem_solving/oc-OpioidReport-CCI.pdf</ref>

'''Pennsylvania.''' Cumberland County's Opioid Intervention Court was the second opioid court in the US. It is a voluntary program that consists of 30 court appearances as well as daily attendance at either drug counseling or NA/AA type meetings. Unlike other specialty courts, this program is a pre-trial program and not tied to a particular plea. The program is intended to engage participants with treatment resources and provide accountability for persons in the early stages of recovery. <ref>https://www.ccpa.net/4698/Opioid-Intervention-Court</ref>

= Sources =

Prevent First Time Use Through Education

2024-03-14T13:11:30Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Prevention is defined as the action of stopping something from happening or arising. Prevention through education can be an effective way to prevent drug use and substance use disorders, which may reduce the number of overdoses and drug-related fatalities within a community <ref>https://pubmed.ncbi.nlm.nih.gov/28252892/</ref>. These are often long-term strategies within the context of educating young people about the dangers and realities of using substances. Educational prevention programs can - and should - start at an early age. Society often promotes and glamorizes substance use. Young people are often exposed to substance use within their families and often feel peer pressure from friends who are already using substances. These are powerful forces in a young person's life that can be counteracted with effective education programs.
Education and prevention are an important part of helping individuals understand the consequences of drugs and alcohol. The main focus of drug education and prevention is teaching individuals about substance abuse and the harmful impacts it has on people's lives. For this reason, hearing stories from those with lived experiences is a powerful prevention tool. These and other types of programs can help a person learn how to avoid, stop, or get help for addiction.
Efforts also include those that target parents and provide them with the tools needed to educate their children about the dangers of drug use. Parents are also educated on warning signs that may indicate their child may already be using substances. This can lead to an early intervention that often prevents the progression into a substance use disorder <ref>https://www.ncbi.nlm.nih.gov/books/NBK424850/</ref>.

= Key Information =

There are multiple types of substance use education programs. Many successful approaches have been developed to target all types of populations. Programs have been developed to focus on different age groups, different racial and ethnic backgrounds, schools, families, faith-based organizations, doctors, pharmacists, and the wider community. While many programs focus on the impacts of drug use (including different drugs like prescription medications), others focus on building up the individual and helping them address risk factors like anxiety and trauma that often lead to drug use. Other prevention programs take the form of public awareness campaigns that seek to educate and warn large numbers of people <ref>https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf</ref>.

One area of focus involves knowing the dangers of prescription medications, especially opioids and other pain medications. The "first wave" of the current epidemic started when powerful pain medications were developed, heavily marketed, and often over-prescribed. The addictive nature of these medications was largely unknown, and millions of people developed substance use disorder as a result. Education strategies target both patients who are prescribed these medications and parents of children who may be prescribed - or given the option to be prescribed - pain medication <ref>https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/rise-prescription-drug-misuse-abuse-impacting-teens</ref>.

Young people are perhaps the most critical population to target with prevention education programs. Effective strategies include targeting where young people are located and the unseen risk factors that often lead to drug use and substance use disorder. School-based prevention programs are geared towards educating youth and creating resistance to peer pressure. At the core of many effective prevention strategies is an exploration of underlying trauma and other mental health challenges impacting today’s youth <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7064285/</ref>. Even without major trauma, an increasing number of young people are feeling stress and anxiety at high levels that lead them to seek relief by using substances. Educating youth about this reality and encouraging them to express these feelings and seek help can achieve tremendous benefits for the individual. <ref>https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf</ref>.

Schools have been used to disseminate information about drug use because of their easy access to large populations of students. Many initial attempts at school-based drug education programs were unsuccessful due to the fact that they primarily focused on the dangers of substance use and used fear tactics to detour children. These initial attempts were not based on theory and failed to include information about developmental factors, social impacts, and biological or medical risk factors that may put individuals at a higher risk for using substances.

= Relevant Research =

The American Addiction Centers conducted a study on the most effective methods of prevention education in schools according to the students who experienced the drug education programs. This study highlighted the strengths, weaknesses, and gaps in students’ perception and knowledge, and it provided insight on how to adjust future programs in order to ensure the right information is delivered in the most effective way <ref>https://americanaddictioncenters.org/learn/drug-education-survey/</ref>. Participants in school drug education programs reported that learning about the possible dangers of substance abuse was the most impactful. Many respondents of the study reported that they did not receive any education about the dangers of commonly used substances such as meth and ecstasy. However, a larger percentage of individuals, over 84%, reported having received education on alcohol use in school. Over 64% of respondents reported that using substances in high school was socially acceptable and considered “cool”. Having an open and honest conversation about the dangerous consequences of using substances, even recreationally, is extremely important to young vulnerable children.

= Impactful Federal, State, and Local Policies =

The Substance Abuse Prevention and Treatment Block Grant (SABG) is authorized under Title XIX, Section 1921 of the Public Health Service Act to help plan, implement, and evaluate activities that prevent and treat substance abuse. The SABG program provides funds to all 50 states, the District of Columbia, and various territories and tribal entities. It is administered by SAMHSA's Center for Substance Abuse Treatment’s (CSAT) Performance Partnership Branch, in collaboration with the Center for Substance Abuse Prevention’s (CSAP) Division of State Programs. SAMHSA requires that grantees spend no less than 20% of their SABG allotment on substance abuse primary prevention strategies. These strategies are directed at individuals not identified to be in need of treatment. One of the six primary prevention strategies is prevention education, which typically includes a large portion of block grant allocations at local levels.

= Available Tools and Resources =

'''The Hanley Foundation'''
It’s mission is to provide substance abuse prevention and education programs for parents, caregivers and school-age children. In addition, the foundation provides financial aid scholarships for patients who could not otherwise afford addiction treatment.

'''“Talk. They Hear You.”'''
This is a mobile app designed to support parents and caregivers. It prepares them for discussions with their children about alcohol and drug use. It provides information to assist parents to communicate effectively with their children. The app equips them with the necessary skills, confidence, and knowledge around the potential dangers of substances. The app also helps communities become proactive in supporting the needs of children and parents who may already be experiencing substance use or are at risk <ref>https://www.samhsa.gov/talk-they-hear-you</ref>.

'''Tobacco Education Resource Library'''
FDA Launches Spanish-Language Vaping Prevention and Education Resource Center. To help advance health equity and facilitate the reduction of tobacco-related health disparities for all people, FDA recently launched a Spanish-language version of the Vaping Prevention and Education Resource Center. This resource center is an online hub with free science-based, standards-mapped lesson plans and materials teachers can use to help students understand the dangers associated with e-cigarette use and nicotine addiction. <ref>https://digitalmedia.hhs.gov/tobacco/educator_hub/about?locale=es</ref>

'''Tobacco Education Resource Library'''
Find content focused on public health education, smoking cessation, tobacco research, retailer information, tobacco regulations, and compliance — all in one place.
<ref>https://digitalmedia.hhs.gov/tobacco/?utm_campaign=ctp-outreach&utm_content=landingpage&utm_medium=email&utm_source=govdelivery&utm_term=stratout
</ref>

= Promising Practices =

'''Creating Lasting Family Connections Program (CLFC)'''

This promising program was given a 3.7 out of 4 from the National Registry of Evidence-based Programs and Practices for the readiness of dissemination. CLFC was designed for high-risk families in an attempt to prevent substance use and violence. The program provides education on the importance of family bonding, enhances communication skills, and promotes health beliefs and attitudes in order to combat the onset of violence and drug use. Compared to the control groups, the families who participated in CLFC experienced less frequent alcohol use, decreased family pathology, increased use of community services, and increased parent knowledge on substance use <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916744/</ref>.

'''Life Skills Training (LST)'''

The Like Skills Training program is an evidence-based prevention program that has proven to reduce the risk of alcohol, tobacco, drug abuse, and violence by targeting social and psychological risk factors in youth that may lead to substance use and other risky behaviors. The U.S. Department of Education and the Center for Substance Abuse Prevention have recognized LST as an exemplary prevention program that is backed by over 30 studies to date. LST is comprised of three domains that provide education in efforts to prevent a wide range of high-risk behaviors including substance use. Drug resistance skills, personal self-management skills, and general social skills are explored and taught to participants in elementary, middle, and high school students. Rather than solely focusing on the dangers of drug abuse, the LST program highlights healthy alternatives to risky behavior. It provides guidance on how to implement necessary skills to resist peer pressure, develop self-esteem and confidence, effectively cope with anxiety, increase understanding of immediate consequences of substance use, and enhance cognitive and behavioral competency in order to reduce a variety of risky behaviors. The program has shown to be effective in diverse populations such as white middle-class students, minority students, urban, suburban, and rural populations. The curriculum is effective when implemented in a classroom, within the community, faith-based centers, and in summer or after-school settings <ref> https://www.lifeskillstraining.com/lst-overview/</ref>.

'''Project ALERT'''

This is a two year program for middle school students that aids in reducing the onset of drug use among youth. Project Alert Plus is a similar program that is geared towards high school students. <ref>https://www.projectalert.com/</ref>

'''Project Towards No Drug Use (Project TND)'''

Studies exploring the effectiveness of Project TND showed a 25% rate of reduction of hard drug use and between 7 and 12% alcohol use reduction in experimental high school groups. Results also showed a 27% reduction in cigarette use and a 22% reduction in marijuana use at one-year follow-up. This program is comprised of group discussions, games, role plays, and worksheets that focus on motivational activities, skills training, and decision making. Topics covered include attitudes, beliefs, and expectations regarding substance use, social skills, self-control, and how to make health-promoting decisions. The underlying theory of how and why Project TND works are based on the idea that students will not use drugs if they are aware of misconceptions around drug use, have adequate coping and social skills, know the negative consequences that may follow substance use, have an awareness of strategies for smoking and other drug cessation, and have adequate decision-making skills. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2916744/</ref>

'''Promoting Alternative Thinking Strategies (PATHS)'''

This program focuses on reducing behavioral problems in elementary school students while enhancing their education within the classroom. Both of these approaches help to prevent future substance use. <ref>https://www.pathstraining.com/main/</ref>

= Sources =

Strengthen Peer Recovery Support Services and Programs

2024-03-13T13:54:58Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Peer recovery support services and programs are designed to provide social support via peers throughout the recovery process. These services are provided by those who have experienced substance use disorder and recovery themselves. There has been proven success in peer support and recovery programs, primarily because these services are designed and delivered by peers who have been successful in the recovery process. A peer holds a vast amount of personal experience and knowledge, often referred to as “lived experience.” They are equipped to support a peer along the recovery path with a true understanding of the journey via shared life experiences. Peer Recovery Support Specialists also provide lived experience with mental health and with co-occurring disorders.

= Key Information =

The Substance Abuse and Mental Health Services Administration (SAMHSA) published a guidebook titled "What are Peer Recovery Services?" The guidebook is an all-encompassing coverage of recovery programs. It defines the use of the term peer "to refer to all individuals who share the experiences of addiction and recovery, either directly or as family members or significant others. In a peer-helping-peer service alliance, a peer leader in stable recovery provides social support." <ref>https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers</ref> Peers provide hope and inspire change by walking together with an individual on their recovery path and providing practical and emotional support. There are four types of social support that peers bring to their work: emotional, informational, instrumental, and affiliational support. These are types of support vs. delivery models and have been found useful with assisting with community-based peer-to-peer services: <ref>https://store.samhsa.gov/sites/default/files/d7/priv/sma09-4454.pdf</ref>

* '''Emotional - '''Demonstrate empathy, caring, or concern to bolster person’s self-esteem and confidence. This Includes peer-led support groups and peer mentoring.
* '''Informational - '''Share knowledge and information and/or provide life or vocational skills training. This includes parenting classes, job preparedness, and wellness seminars.
* '''Instrumental - '''Provide concrete assistance to help others accomplish tasks. This includes transportation, childcare, and assistance with accessing community health and social services. Social support peers are often referred to as “walking resources." It is a peer's ethical responsibility to become familiar with and educated about resources offered in their community and to provide linkage to those resources. Peer support is a person-centered, mentoring approach rather than "doing for" the recoveree. The peer builds self-efficacy within in the recoveree as to maintain their recovery.
* '''Affiliational - '''Facilitate contacts with other people to promote learning of social and recreational skills, create community, and acquire a sense of belonging. This includes opportunities within the community and participation in sports and in alcohol and drug-free social events.

Peer support may also be referred to as coaching, peer leadership, or peer mentoring. Delivery of peer support adapts to meet individuals at their current stage in the recovery process. It works throughout all of the different stages of change in the recovery process. Peers work in many settings, such as health departments, social services, child welfare systems, veteran services, youth & family centers, treatment programs, recovery Centers, emergency departments, and jails and prison systems. Peers often work on a clinical or programmatic team and, in ideal settings, have well-defined roles. However, one of the challenges to the efficacy of this field is to enhance workplace definition of roles and scope of work of Peer Support Specialists. This is especially true when peers work in a non-recovery-oriented environment. It is critical for them to have adequate support and an understanding from their supervisors regarding their roles. Whether working in a peer-run recovery organization (PRO) or recovery community organization (RCO) and whether they are delivering services in a recovery and wellness center or are contracting with a drug court, peers face a myriad of hiring options, operational standards, and supervisory concerns. SAMSHA has developed a set of peer core competencies to help guide service delivery of peer support programs and best practices for service delivery. These core competencies were developed by a diverse swath of national experts and peer constituencies. The values and principles are recovery-oriented, person-centered, relationship-focused, and trauma-informed. Guidance is also directed to promote success for behavioral health peer support. <ref>https://www.samhsa.gov/peer-recovery-center-of-excellence</ref>

= Relevant Research =

Ongoing research has shown the value of peers in the recovery process. A summary of this research on the effectiveness of peer support programs is provided by SAMHSA. <ref>https://www.opioidlibrary.org/wp-content/uploads/2021/01/value-of-peers-2017.pdf</ref>

= Impactful Federal, State, and Local Policies =

Peer and recovery specialist programs can be financed through a variety of policy-based funding streams. Communities may use existing state and county funds via state Departments of Alcohol and Drug Programs, Mental Health Services, Child Welfare Services, and County Boards of Supervisors’ funds.

* Substance Abuse Prevention and Treatment Block Grant (SABG) provides funds and technical assistance to all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, 6 Pacific jurisdictions, and 1 tribal entity. Grantees use the funds to plan, implement, and evaluate activities that prevent and treat substance abuse and promote public health. SABG funds are increasingly being used to hire peers through county health departments (who receive state funding). Likewise, other entities, such as SUD treatment programs contract with the single state agency (SSA) that manages the block grant. <ref>https://www.samhsa.gov/grants/block-grants</ref>

* Child Welfare and Recovery Support Specialist programs have utilized federal funding under Title IV-E Foster Care and Adoption Assistance Program. Waivers were implemented by the Administration for Children and Families (ACF), which allowed states to use funds more flexibly to test innovative approaches for child welfare service delivery and financing. <ref>https://www.acf.hhs.gov/cb/programs/child-welfare-waivers</ref> Other examples of on-going federal funding which were used by these programs include ACF’s Regional Partnership Grants, Temporary Assistance for Needy Families (TANF) and Office of Justice Programs’ Victims of Crime Act. <ref>https://www.acf.hhs.gov/ofa/programs/temporary-assistance-needy-families-tanf</ref>

* The Center for Medicare & Medicaid Services has guidelines and requirements for Medicaid funding for Recovery Peer Support Programs. <ref>https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/smd081507a.pdf</ref> The guidance and requirements include the following:
** States must identify the Medicaid authority to be used for coverage and payment, as well as describe the service, the provider of the service and their qualifications, and all applicable utilization review and reimbursement methodologies.
** Peer providers must complete a training and certification program as defined by the state.
** Peer providers must receive supervision from a “competent mental health professional.” Such supervision may be provided through direct oversight or periodic care consultation.
** Reimbursement must be based on an identified unit of service and be provided by a single peer provider, based on an approved plan of care. <ref> https://www.gao.gov/assets/gao-20-616.pdf</ref>

= Available Tools and Resources =

* '''The Veterans Health Administration''' generated a toolkit for VA Peer Support Specialists, in responses to an executive order to employ 800 peer support specialists. <ref>https://www.mirecc.va.gov/visn4/docs/Peer_Specialist_Toolkit_FINAL.pdf</ref>

* '''National Center of Substance Abuse and Child Welfare''' provides resources and information for peer support and recovery within the child welfare systems including program models and funding resources. <ref>https://ncsacw.samhsa.gov/</ref>

* '''Mental Health America''' provides a certification career roadmap. <ref>https://www.mhanational.org/sites/default/files/NCPS%20Roadmap%20Final_0.pdf</ref> They also offer an online directory of training and certification requirements. <ref>https://www.mhanational.org/how-become-peer-support-specialist</ref>

* '''The Southern Plains Tribal Health Board''' provides a toolkit to assist tribal programs in determining how peer specialists can best serve their tribal organizations and communities. <ref>https://issuu.com/spthb/docs/peer_support_toolkit_booklet</ref>

* '''The New York State Office of Alcoholism and Substance Abuse Services''' provides the New York State Peer Integration Toolkit to assist the integration peer services into service delivery system. <ref>https://oasas.ny.gov/system/files/documents/2019/08/PeerIntegrationToolKit-DigitalFinal.pdf</ref>

* '''The City of Philadelphia''' has an interactive toolkit to support behavioral health treatment agencies with the process of integrating peer providers into their service settings. <ref>https://dbhids.org/peer-support-toolkit/</ref>

* ''''The Unity Recovery Organization of Philadelphia''' provides a technology-based program that sncludes a tele-recovery guide for peer support. <ref>https://www.opioidlibrary.org/wp-content/uploads/2020/04/Unity-Recovery-Telerecovery-RSS-Guide-03-26-2020.pdf</ref>

* '''The College for Behavioral Health Leadership''' in collaboration with Optum Health provides a peer support toolkit that includes peer support job definitions. <ref>https://mhanational.org/sites/default/files/Peer_Services_Toolkit%204-2015.pdf</ref>

* '''Recovery Live''' is on Youtube and includes a variety of virtual events, including this one on strategies to provide supervision of Peer Support Recovery Specialists. <ref>https://www.youtube.com/watch?v=v49QD-UaQK4&list=PLBXgZMI_zqfSRZVtxRBWg7cDja_qy2e-M&index=6</ref>

* '''SAMHSA''' National Model Standards for Peer Support Certification <ref>https://www.samhsa.gov/about-us/who-we-are/offices-centers/or/model-standards</ref>

* '''SMI Advisor''' Building New Horizons: Opening Career pathways for peers with criminal justice backgrounds <ref>https://smiadviser.org/wp-content/uploads/2023/07/Building-New-Horizons-Peer-Hiring-Guide-FINAL.pdf</ref>

* '''Youth Move National''' published a report titled "Operationalizing and Funding for Youth Based Peer Support Programs." It includes an overview on the delivery of youth-based services via state-based Medicaid. <ref>https://youthmovenational.org/wp-content/uploads/2020/07/Operationalizing-Peer-Support-FINAL-electronic.pdf</ref>

= Promising Practices =

This report highlights four programs that have demonstrated positive child welfare and recovery outcomes for families. <ref>https://ncsacw.samhsa.gov/files/peer19_brief.pdf</ref>

= Sources =

The Recovery Ecosystem

2024-03-13T13:52:33Z

AlexFigueroa: /* Available Tools and Resources */

=Introductory Paragraph =

Recovery support can look like many different things for individuals on their pathway to recovery. This is a crucial component of viewing SUD as a chronic disorder requiring long-term care. Individuals entering recovery through treatment, the criminal justice system, or on there own often face many challenges in early recovery. It is important that communities identify needs, examine what supports are available, and ensure those with the greatest need have access to these supports. Individuals who do not have these needs met are more likely to relapse. Communities that fund these supports help those in early recovery re-engage with the community, increase self-esteem, and become highly productive members of their communities. Providing effective recovery supports prevents relapse, the need to engage additional treatment and other services, and reduces the numbers of overdose. Communities that have invested in recovery supports have seen a substantial return on their investment both in financial and human terms.

SAMHSA defines recovery as "a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential." <ref>https://www.samhsa.gov/find-help/recovery</ref> SAMHSA also identifies four major dimensions that support recovery:

*Health — overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being.
*Home — having a stable and safe place to live.
*Purpose — conducting meaningful daily activities and having the independence, income, and resources to participate in society.
*Community — having relationships and social networks that provide support, friendship, love, and hope.

= Key Information =

The recovery journey does not start in one place. Recovery is a critical asset that communities need to invest in, including removing barriers so recovery can be sustained. Recovery-oriented approaches involve a multi-system, person-centered continuum of care where a comprehensive menu of coordinated services and supports is tailored to individuals' recovery stage, needs, and chosen recovery pathway; the goal is to promote abstinence and a better quality of life. <ref>Clark, H. W. (2007) Recovery as an organizing concept. In W. L. White (Ed.), Perspectives
on systems transformation: How visionary leaders are shifting addiction treatment toward a recovery-oriented system of care (pp. 7–21). Chicago, IL: Great Lakes Addiction Technology Transfer Center</ref>

There are four primary domains in which recovery can be improved:

* '''Connections.''' Many recovery strategies come under the broad umbrella of improving connections. Isolation is the enemy of recovery. Connection includes regular contact with others in recovery across a number of peer-led support organizations. Connection includes access to direct support from peer recovery specialists and recovery coaches. Connections within the family are vital to help the family recover and to be able to support family members in recovery. Other connections include those made in the wider community and even regional/national organizations that can help foster connection to others who provide support for individuals in recovery.

* '''Recovery Housing.''' Perhaps the most basic support needed is housing and food. Without this there can be no security or the ability for focus on health and recovery. In many cases going home is not a safe option for those new to recovery. A stable housing situation is foundational and allows growth and progress in other areas to take place. There is a need to be able to find safe, affordable, and supportive recovery housing options in communities across the country.

* '''Education and Job Training.''' Finding meaning and purpose in one's life is important to all, but is especially critical to a person who has not found, or has lost, that purpose. The ability to get and hold a job, get a promotion, improve one's education, and become independent are all important needs for people in early recovery. Safe Solutions includes resources and information designed to help people in recovery develop the tools they need to find that purpose and achieve their goals.

* '''Collegiate and High School Recovery Support.''' Many in early recovery find recovery while still in high school or college. Many others enter high school or college after beginning their recovery journey. Building an infrastructure of recovery support within these specific communities is another area of focus, where it is possible to learn both where programs currently exist and the tools used by others to create these supports at colleges and high schools.

Here is a summary of specific recovery supports that communities can provide:

* Sober Living - Helps individuals transfer from treatment to independent living. For some individuals, returning to their previous living environment can be unsafe or not conducive to their recovery. Sober living offers individuals a safe, peer-to-peer recovery-oriented home with structure, accountability, and support. Typically, there are household duties in sober living that need to be fulfilled including rent, chores, curfew, etc. For more information about strategies for improving recovery housing, please see the Your Safe Solutions -- "Recovery Housing" page as well. <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Housing</ref>

* Vocational Training - Substance use disorders could result in loss of job, job abandonment, or legal issues that may add additional barriers to obtaining employment. Vocational training can provide on-the-job training, remedial training, college training, and resume building. For more information about improving education, job training, and employment for people in recovery, please visit Your Safe Solutions -- "Improve Education, Job Training, and Employment for People in Recovery." <ref>https://www.yoursafesolutions.us/wiki/Improve_Education,_Job_Training,_and_Employment_for_People_in_Recovery</ref>

* Collegiate Recovery Programs - Helps students balance recovery and higher education. Provides support to students such as therapy, sober housing, and substance-free events. For more information on strategies to expand recovery schools and collegiate recovery programs, please see Your Safe Solutions page -- "Expand Recovery Schools and Collegiate Recovery Programs." <ref>https://www.yoursafesolutions.us/wiki/Expand_Recovery_Schools_and_Collegiate_Recovery_Programs</ref>

* Recovery Coaches - are people who have lived experience of substance use disorder and/or mental health conditions who provide non-clinical recovery support to their peers. They are not sponsors or alcohol and drug counselors. Recovery coaches can also be called Peer Recovery Specialists. There is a certification process that solidifies the Recovery Coach/Peer Recovery Specialist workforce.

* Peer-Based Recovery Support - Giving and receiving nonprofessional, nonclinical, peer-to-peer assistance to achieve long-term recovery from substance use disorders. '''Alcoholics Anonymous (AA)''' is the most common support group and is based on the 12 steps. '''All Recovery''' brings people together from multiple pathways of recovery. '''SMART Recovery''' or Self Management and Recovery Training, is guided by the 4-point program. The clients find and develop the power within themselves to change and lead fulfilling lives. For more information about how to strengthen peer recovery support services and programs, please see Your Safe Solutions -- "Peer Recovery Support Services & Programs." <ref>https://www.yoursafesolutions.us/wiki/Strengthen_Peer_Recovery_Support_Services_and_Programs</ref>

* Harm Reduction - Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in and respect for, the rights of people who use drugs. <ref>https://harmreduction.org/about-us/principles-of-harm-reduction/</ref> For more information about strategies to expand harm reduction practices, please also see Your Safe Solutions -- "Expand Harm Reduction Practices." <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>

* Medicated Assisted Treatment/Therapy (MAT) - uses medication and counseling to provide a whole-patient approach to recovery. Medications are FDA approved. MAT can help sustain recovery and prevent or reduce opioid overdose. Primarily, MAT is used for addiction to opioids, such as prescription pain killers and heroin. For more information on expanding access to MAT, please see Your Safe Solutions -- "Expand Access to Medication-Assisted Treatment." <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)</ref>

* Criminal Justice - Substance use disorder and the justice system have a complex history. It is estimated that about one-half of state and federal prisoners misuse drugs or are addicted to drugs, but few typically receive treatment while incarcerated.<ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system</ref> For more information about strategies to support people who are criminal justice involved, please visit Your Safe Solutions -- "Recovery Supports for People in the Criminal Justice System." <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>

=Relevant Research=

* '''Nora's Blog''' on the Director's page of NIDA highlights recent advances in the science of drug use and addiction. For example, in evaluating the relationship between abstinence and relapse, it is noted that setbacks are regarded as a failure, leading to the perception that the client is starting all over, when in fact, a return to use may strengthen someone’s resolve to recover. <ref>https://nida.nih.gov/about-nida/noras-blog/2022/01/making-addiction-treatment-more-realistic-pragmatic-perfect-should-not-be-enemy-good</ref>

* This article provides a systematic review of nine different studies that examined peer-delivered recovery support services. <ref>https://addictionrecoverytraining.org/wp-content/uploads/2016/08/PeerRecoveryEffectiveness.pdf</ref>

* Although AA is the most well-known peer recovery support program, there are other pathways that provide support. This article gives alternatives to the 12-steps. <ref>https://americanaddictioncenters.org/therapy-treatment/12-step-alternatives</ref>

= Impactful Federal, State, and Local Policies =

* The Mainstreaming Addiction Treatment Act of 2021 removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., buprenorphine) for maintenance or detoxification treatment (i.e., substance use disorder treatment).<ref>https://www.congress.gov/bill/117th-congress/senate-bill/445</ref>

* Oregon passed a Drug and Addiction Treatment Act whose purpose is to make screening health assessment, treatment and recovery services for drug addiction available to all those who need and want access to those services; and to adopt a health approach to drug addiction by removing criminal penalties for low-level drug possession.<ref>https://www.oregon.gov/oha/hsd/amh/pages/measure110.aspx</ref>

=Available Tools and Resources=

* '''Faces & Voices of Recovery (Faces & Voices)''' conducted the first nationwide survey of persons in recovery from alcohol and other drug problems. The purpose of this survey was to document the benefits of recovery. <ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/22Life-in-Recovery22-Report-on-the-Survey-Findings.pdf</ref>

* '''SAMHSA''' Recovery from Substance Use and Mental Health Problems Among Adults in the United States. This brief report presents self-reports of recovery among adults aged 18 and older in the United States who thought they ever had a problem with their use of drugs or alcohol and/or mental health. These findings provide a clearer characterization of the factors associated with recovery among adults and how future efforts can foster a whole-health approach to sustain recovery from mental health and substance use conditions. <ref>https://store.samhsa.gov/product/recovery-substance-use-and-mental-health-problems-among-adults-united-states/pep23-10-00?utm_source=SAMHSA&utm_campaign=3315782ffc-EMAIL_CAMPAIGN_2023_09_20_06_25&utm_medium=email&utm_term=0_-3315782ffc-%5BLIST_EMAIL_ID%5D</ref>

* '''SAMHSA''' provides a treatment finder that connects people with licensed treatment providers who specialize in substance use, addiction, and mental health. <ref>https://findtreatment.gov/</ref> SAMHSA also provides video trainings that promote recovery-oriented services and supports by highlighting new knowledge areas, hot topics, and cutting-edge programs. <ref>https://www.samhsa.gov/brss-tacs/video-trainings</ref>

* '''SAFE Project''' provides a variety of resources for recovery:
**'''Bridging Prevention and Recovery Program''' is a new evidence-based program model designed to provide substance use disorder professionals with a step-by-step process to facilitate sustainable integration of these two approaches in communities that have traditionally been siloed.<ref>https://www.safeproject.us/bridging-prevention-recovery/ </ref>
**'''Integrated-Forensic Peer Recovery Specialist (I-FPRS).''' This Training of Trainers equips participants to train Certified Peer Recovery Specialists and Supervisors to navigate the complexities associated with providing support to individuals who are justice-involved. <ref>https://www.safeproject.us/ifprs-training/</ref>
**'''Treatment and Family Support Locator''' assists individuals and their loved ones in finding the best treatment for their needs, as well as programs, supports, and other services for friends and family of people caring for individuals with substance use disorder and/or mental health challenges. The locator is a collaboration between SAFE Project and the Partnership to End Addiction. <ref>https://safelocator.org/en/search</ref>

=Promising Practices=

* '''Connecticut Community for Addiction Recovery (CCAR)''' supports all things recovery -- no matter what stage of recovery. The CCAR website helps people navigate the recovery community by providing support services and connections to people in recovery. They offer telephone recovery support, virtual support meetings on different recovery topics, peer recovery training, and a coffee lounge. They also have five recovery community centers throughout the state. <ref>https://ccar.us/</ref>
* '''The Hazelden Betty Ford Foundation''' has a series of virtual services. On-line outpatient addiction programs encompass addiction treatment, family services, community solutions, prevention and early intervention, recovery support, and mental health services. <ref>https://www.hazeldenbettyford.org/locations/online-care-support-services</ref>
*'''Recovery Texas.''' This state-wide movement provides recovery support specialists, screenings for substance use and mental health, and digital recovery support such as meetings, meditation, and yoga. <ref>https://recoverytexas.org/</ref>

=Sources=

The Recovery Ecosystem

2024-03-13T13:47:38Z

AlexFigueroa: /* Available Tools and Resources */

=Introductory Paragraph =

Recovery support can look like many different things for individuals on their pathway to recovery. This is a crucial component of viewing SUD as a chronic disorder requiring long-term care. Individuals entering recovery through treatment, the criminal justice system, or on there own often face many challenges in early recovery. It is important that communities identify needs, examine what supports are available, and ensure those with the greatest need have access to these supports. Individuals who do not have these needs met are more likely to relapse. Communities that fund these supports help those in early recovery re-engage with the community, increase self-esteem, and become highly productive members of their communities. Providing effective recovery supports prevents relapse, the need to engage additional treatment and other services, and reduces the numbers of overdose. Communities that have invested in recovery supports have seen a substantial return on their investment both in financial and human terms.

SAMHSA defines recovery as "a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential." <ref>https://www.samhsa.gov/find-help/recovery</ref> SAMHSA also identifies four major dimensions that support recovery:

*Health — overcoming or managing one’s disease(s) or symptoms and making informed, healthy choices that support physical and emotional well-being.
*Home — having a stable and safe place to live.
*Purpose — conducting meaningful daily activities and having the independence, income, and resources to participate in society.
*Community — having relationships and social networks that provide support, friendship, love, and hope.

= Key Information =

The recovery journey does not start in one place. Recovery is a critical asset that communities need to invest in, including removing barriers so recovery can be sustained. Recovery-oriented approaches involve a multi-system, person-centered continuum of care where a comprehensive menu of coordinated services and supports is tailored to individuals' recovery stage, needs, and chosen recovery pathway; the goal is to promote abstinence and a better quality of life. <ref>Clark, H. W. (2007) Recovery as an organizing concept. In W. L. White (Ed.), Perspectives
on systems transformation: How visionary leaders are shifting addiction treatment toward a recovery-oriented system of care (pp. 7–21). Chicago, IL: Great Lakes Addiction Technology Transfer Center</ref>

There are four primary domains in which recovery can be improved:

* '''Connections.''' Many recovery strategies come under the broad umbrella of improving connections. Isolation is the enemy of recovery. Connection includes regular contact with others in recovery across a number of peer-led support organizations. Connection includes access to direct support from peer recovery specialists and recovery coaches. Connections within the family are vital to help the family recover and to be able to support family members in recovery. Other connections include those made in the wider community and even regional/national organizations that can help foster connection to others who provide support for individuals in recovery.

* '''Recovery Housing.''' Perhaps the most basic support needed is housing and food. Without this there can be no security or the ability for focus on health and recovery. In many cases going home is not a safe option for those new to recovery. A stable housing situation is foundational and allows growth and progress in other areas to take place. There is a need to be able to find safe, affordable, and supportive recovery housing options in communities across the country.

* '''Education and Job Training.''' Finding meaning and purpose in one's life is important to all, but is especially critical to a person who has not found, or has lost, that purpose. The ability to get and hold a job, get a promotion, improve one's education, and become independent are all important needs for people in early recovery. Safe Solutions includes resources and information designed to help people in recovery develop the tools they need to find that purpose and achieve their goals.

* '''Collegiate and High School Recovery Support.''' Many in early recovery find recovery while still in high school or college. Many others enter high school or college after beginning their recovery journey. Building an infrastructure of recovery support within these specific communities is another area of focus, where it is possible to learn both where programs currently exist and the tools used by others to create these supports at colleges and high schools.

Here is a summary of specific recovery supports that communities can provide:

* Sober Living - Helps individuals transfer from treatment to independent living. For some individuals, returning to their previous living environment can be unsafe or not conducive to their recovery. Sober living offers individuals a safe, peer-to-peer recovery-oriented home with structure, accountability, and support. Typically, there are household duties in sober living that need to be fulfilled including rent, chores, curfew, etc. For more information about strategies for improving recovery housing, please see the Your Safe Solutions -- "Recovery Housing" page as well. <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Housing</ref>

* Vocational Training - Substance use disorders could result in loss of job, job abandonment, or legal issues that may add additional barriers to obtaining employment. Vocational training can provide on-the-job training, remedial training, college training, and resume building. For more information about improving education, job training, and employment for people in recovery, please visit Your Safe Solutions -- "Improve Education, Job Training, and Employment for People in Recovery." <ref>https://www.yoursafesolutions.us/wiki/Improve_Education,_Job_Training,_and_Employment_for_People_in_Recovery</ref>

* Collegiate Recovery Programs - Helps students balance recovery and higher education. Provides support to students such as therapy, sober housing, and substance-free events. For more information on strategies to expand recovery schools and collegiate recovery programs, please see Your Safe Solutions page -- "Expand Recovery Schools and Collegiate Recovery Programs." <ref>https://www.yoursafesolutions.us/wiki/Expand_Recovery_Schools_and_Collegiate_Recovery_Programs</ref>

* Recovery Coaches - are people who have lived experience of substance use disorder and/or mental health conditions who provide non-clinical recovery support to their peers. They are not sponsors or alcohol and drug counselors. Recovery coaches can also be called Peer Recovery Specialists. There is a certification process that solidifies the Recovery Coach/Peer Recovery Specialist workforce.

* Peer-Based Recovery Support - Giving and receiving nonprofessional, nonclinical, peer-to-peer assistance to achieve long-term recovery from substance use disorders. '''Alcoholics Anonymous (AA)''' is the most common support group and is based on the 12 steps. '''All Recovery''' brings people together from multiple pathways of recovery. '''SMART Recovery''' or Self Management and Recovery Training, is guided by the 4-point program. The clients find and develop the power within themselves to change and lead fulfilling lives. For more information about how to strengthen peer recovery support services and programs, please see Your Safe Solutions -- "Peer Recovery Support Services & Programs." <ref>https://www.yoursafesolutions.us/wiki/Strengthen_Peer_Recovery_Support_Services_and_Programs</ref>

* Harm Reduction - Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in and respect for, the rights of people who use drugs. <ref>https://harmreduction.org/about-us/principles-of-harm-reduction/</ref> For more information about strategies to expand harm reduction practices, please also see Your Safe Solutions -- "Expand Harm Reduction Practices." <ref>https://www.yoursafesolutions.us/wiki/Expand_Harm_Reduction_Practices</ref>

* Medicated Assisted Treatment/Therapy (MAT) - uses medication and counseling to provide a whole-patient approach to recovery. Medications are FDA approved. MAT can help sustain recovery and prevent or reduce opioid overdose. Primarily, MAT is used for addiction to opioids, such as prescription pain killers and heroin. For more information on expanding access to MAT, please see Your Safe Solutions -- "Expand Access to Medication-Assisted Treatment." <ref>https://www.yoursafesolutions.us/wiki/Expand_Access_to_Medication-Assisted_Treatment_(MAT)</ref>

* Criminal Justice - Substance use disorder and the justice system have a complex history. It is estimated that about one-half of state and federal prisoners misuse drugs or are addicted to drugs, but few typically receive treatment while incarcerated.<ref>https://nida.nih.gov/publications/research-reports/medications-to-treat-opioid-addiction/how-opioid-use-disorder-treated-in-criminal-justice-system</ref> For more information about strategies to support people who are criminal justice involved, please visit Your Safe Solutions -- "Recovery Supports for People in the Criminal Justice System." <ref>https://www.yoursafesolutions.us/wiki/Improve_Recovery_Support_for_People_in_the_Criminal_Justice_System</ref>

=Relevant Research=

* '''Nora's Blog''' on the Director's page of NIDA highlights recent advances in the science of drug use and addiction. For example, in evaluating the relationship between abstinence and relapse, it is noted that setbacks are regarded as a failure, leading to the perception that the client is starting all over, when in fact, a return to use may strengthen someone’s resolve to recover. <ref>https://nida.nih.gov/about-nida/noras-blog/2022/01/making-addiction-treatment-more-realistic-pragmatic-perfect-should-not-be-enemy-good</ref>

* This article provides a systematic review of nine different studies that examined peer-delivered recovery support services. <ref>https://addictionrecoverytraining.org/wp-content/uploads/2016/08/PeerRecoveryEffectiveness.pdf</ref>

* Although AA is the most well-known peer recovery support program, there are other pathways that provide support. This article gives alternatives to the 12-steps. <ref>https://americanaddictioncenters.org/therapy-treatment/12-step-alternatives</ref>

= Impactful Federal, State, and Local Policies =

* The Mainstreaming Addiction Treatment Act of 2021 removes the requirement that a health care practitioner apply for a separate waiver through the Drug Enforcement Administration (DEA) to dispense certain narcotic drugs (e.g., buprenorphine) for maintenance or detoxification treatment (i.e., substance use disorder treatment).<ref>https://www.congress.gov/bill/117th-congress/senate-bill/445</ref>

* Oregon passed a Drug and Addiction Treatment Act whose purpose is to make screening health assessment, treatment and recovery services for drug addiction available to all those who need and want access to those services; and to adopt a health approach to drug addiction by removing criminal penalties for low-level drug possession.<ref>https://www.oregon.gov/oha/hsd/amh/pages/measure110.aspx</ref>

=Available Tools and Resources=

* '''Faces & Voices of Recovery (Faces & Voices)''' conducted the first nationwide survey of persons in recovery from alcohol and other drug problems. The purpose of this survey was to document the benefits of recovery. <ref>https://facesandvoicesofrecovery.org/wp-content/uploads/2019/06/22Life-in-Recovery22-Report-on-the-Survey-Findings.pdf</ref>

* '''SAMHSA''' Recovery from Substance Use and Mental Health Problems Among Adults in the United States. This brief report presents self-reports of recovery among adults aged 18 and older in the United States who thought they ever had a problem with their use of drugs or alcohol and/or mental health. These findings provide a clearer characterization of the factors associated with recovery among adults and how future efforts can foster a whole-health approach to sustain recovery from mental health and substance use conditions. <ref>https://store.samhsa.gov/product/recovery-substance-use-and-mental-health-problems-among-adults-united-states/pep23-10-00?utm_source=SAMHSA&utm_campaign=3315782ffc-EMAIL_CAMPAIGN_2023_09_20_06_25&utm_medium=email&utm_term=0_-3315782ffc-%5BLIST_EMAIL_ID%5D</ref>

* '''SAMHSA''' National Model Standards for Peer Support Certification <ref>https://www.samhsa.gov/about-us/who-we-are/offices-centers/or/model-standards</ref>

* '''SAMHSA''' provides a treatment finder that connects people with licensed treatment providers who specialize in substance use, addiction, and mental health. <ref>https://findtreatment.gov/</ref> SAMHSA also provides video trainings that promote recovery-oriented services and supports by highlighting new knowledge areas, hot topics, and cutting-edge programs. <ref>https://www.samhsa.gov/brss-tacs/video-trainings</ref>

* '''SAFE Project''' provides a variety of resources for recovery:
**'''Bridging Prevention and Recovery Program''' is a new evidence-based program model designed to provide substance use disorder professionals with a step-by-step process to facilitate sustainable integration of these two approaches in communities that have traditionally been siloed.<ref>https://www.safeproject.us/bridging-prevention-recovery/ </ref>
**'''Integrated-Forensic Peer Recovery Specialist (I-FPRS).''' This Training of Trainers equips participants to train Certified Peer Recovery Specialists and Supervisors to navigate the complexities associated with providing support to individuals who are justice-involved. <ref>https://www.safeproject.us/ifprs-training/</ref>
**'''Treatment and Family Support Locator''' assists individuals and their loved ones in finding the best treatment for their needs, as well as programs, supports, and other services for friends and family of people caring for individuals with substance use disorder and/or mental health challenges. The locator is a collaboration between SAFE Project and the Partnership to End Addiction. <ref>https://safelocator.org/en/search</ref>

=Promising Practices=

* '''Connecticut Community for Addiction Recovery (CCAR)''' supports all things recovery -- no matter what stage of recovery. The CCAR website helps people navigate the recovery community by providing support services and connections to people in recovery. They offer telephone recovery support, virtual support meetings on different recovery topics, peer recovery training, and a coffee lounge. They also have five recovery community centers throughout the state. <ref>https://ccar.us/</ref>
* '''The Hazelden Betty Ford Foundation''' has a series of virtual services. On-line outpatient addiction programs encompass addiction treatment, family services, community solutions, prevention and early intervention, recovery support, and mental health services. <ref>https://www.hazeldenbettyford.org/locations/online-care-support-services</ref>
*'''Recovery Texas.''' This state-wide movement provides recovery support specialists, screenings for substance use and mental health, and digital recovery support such as meetings, meditation, and yoga. <ref>https://recoverytexas.org/</ref>

=Sources=

Apply a Multi-Sectoral Approach

2024-03-13T13:42:46Z

AlexFigueroa: /* Promising Practices */

= Introductory Paragraph =

Systems-building is a complex task. Extensive work has been done in systems research in the physical and biological sciences, but less in the social sciences, especially focused on social systems associated with SUD. The classic introduction to the field is provided by Peter Senge. <ref>Senge, P. (1990). The fifth discipline. New York: Doubleday. </ref> A summary of work in changing social systems can be found in the work of David Stroh. <ref>Stroh, D. (2015). Systems thinking for social change. White River Junction: Chelsea Green Publishing.</ref> Creating a community coalition is one of the most effective ways to solve complex systems-level problems and is at the core of creating a local movement. A coalition is simply a group of individuals and organizations with a common interest, who agree to see the problem through each other’s eyes and work together toward a common goal.  A coalition concentrates a community’s focus on a particular problem, creates alliances among those who might not normally work together, and keeps the community’s approach consistent. This page provides an overview of what it takes to build and strengthen an effective coalition based on the experiences of communities across the country.

= Key Information =

'''Why Start A Coalition?''' The substance use disorder epidemic (SUD) is a complex problem requiring a highly coordinated and cooperative response from communities. The increase in non-fatal and fatal overdoses in recent years has caused many communities to realize that individual organizations cannot afford to work in silos. Without a unified strategy and a focus on broader common community goals (rather than singular programmatic goals), communities addressing a crisis as large as the addiction epidemic will not be poised for success. There is clear understanding that partners across sectors must align and work together to develop and implement effective strategies to improve their collective response to the SUD epidemic. By bringing together and working with a broad range of stakeholders, communities, both large and small, can develop solutions that work for all of those touched by the opioid and addiction crisis. Many local communities have assembled coalitions to improve their response to the SUD epidemic. There is no one-size-fits-all set of practices for creating an effective coalition. The suggestions that follow are based on the experiences of many communities and are meant to serve as a guide for those looking to form a new coalition or expand and improve upon one that already exists.

'''Who Can Start A Coalition?'''
Anyone can. Coalitions and task forces are often started by locally elected leaders, public health departments, public safety agencies, community organizations, or even passionate individuals engaged in the fight to save lives and reduce harm created by drug misuse and SUD. Typically, coalitions are formed as a response to increased rates of overdose and overdose deaths. Regardless of who takes the initiative, it is important to be inclusive and identify stakeholders whose ultimate goals align. Get started by looking around the community and determining if there are similar existing efforts in which to get involved or add value. It’s important not to duplicate efforts. Is there a mechanism or coalition body already taking a comprehensive approach to addiction that can be leveraged?

'''Potential Partners and Their Roles.'''
There are many potential partners that can be invited to join the coalition and improve the community response to SUD. The following list is not intended to be all-inclusive, and it is not a requirement to have all of these individuals at the table - these are suggestions based on the types of partners that are most often brought together. Keep in mind, it’s important to establish a team of optimal size and with sufficient authority to plan and implement ideas and strategies effectively and efficiently. Does the team include leaders with the perceived power and authority in the community to make decisions and drive the implementation of new strategies? Does it equally include individuals who are trusted in the community and have connections to people and neighborhoods who can support grassroots efforts? If you do not include all of these partners in the coalition, consider engaging them to build momentum and activate your community.<ref>https://www.yoursafesolutions.us/wiki/Activating_Your_Community</ref>

'''Government/Public Sector:'''

*Locally elected officials
*State/local drug prevention office
*Public safety officers/officials
*First responders to include EMS and Fire
*Health department
*School administration or school board
*Criminal judges and court professionals

'''Law Enforcement:'''

*Police and/or sheriff
*High Intensity Drug Trafficking Area (HIDTA) office
*Drug Enforcement Agency (agency in charge)
*School resource Officers (SRO's)
*Criminal judges, court professionals, and correction officers

'''Education Leaders:'''

*School district leadership
*School principals
*Teachers
*Parent Teacher Associations (PTA) and other youth serving organizations
*Colleges, universities, institutions of higher education, community colleges, and trade or technical schools

'''Community Leaders:'''

*Lions Club, Rotary, Elks, veteran’s groups
*YMCA, 4H, Boys & Girls Clubs
*Family support groups and recovery allies
*Youth and young adults including youth sports programs
*Faith community
*Housing providers

'''Business Leaders:'''

*Chamber of Commerce
*Employers
*Union leaders
*Local philanthropic organizations

'''Medical Community:'''

*Primary care physicians
*Nurse practitioners
*Emergency room doctors and staff administration
*Dental professionals
*Community behavioral healthcare providers
*Pharmacists
*Health plans and insurance providers

'''Treatment and Recovery:'''

*Treatment professionals
*Substance use disorder counselors
*Harm reduction organizations
*Recovery support organizations

'''Community Members with Lived Experience:'''

*Persons in recovery and active substance users
*Family and friends of those in active use or recovery
*Families of those lost to overdose

As your coalition progresses, you will likely find that the needs of the coalition will change over time. Most often, the composition of the coalition will change as well. There are many examples where organizations may need to expand services or take on new roles to address the SUD epidemic - especially in underserved areas of the community. This might include:

*Police working with peer recovery specialists/coaches in cases of overdose
*Community organizations taking on prevention/education/training roles; or,
*Hospitals coordinating with area treatment providers to help overdose patients.

Do new roles need to be taken on by government agencies and/or community groups? If so, who and what new roles would be helpful? Who should the coalition include to create new or expanded partnerships in the region? Ideally, what role(s) would they take on?

'''Initial Outreach.''' Getting your desired partners to the table is not always easy. Keep in mind that while there are a number of ways to contact these groups, in-person and direct contact is always preferable. You may have to overcome several types of resistance. Some organizations are not naturally inclined to work with others. For example, the harm reduction and law enforcement communities are not always natural allies in some communities. However, when these two groups come together and see the problem through each other’s lenses, some very powerful work can be done. Some organizations might not want to get involved because of their own perception of capacity (this is more work for me) or stigma (this is not my problem). You may have to expend considerable effort to convince these groups that reversing the epidemic is in the entire community’s interest and that everyone has a contribution to make.

It is important to build trust from the outset. Some common advice heard from those who have been through the process of bringing together a coalition includes:

*'''Honoring the Work that has Been Done.''' Everyone fighting this epidemic is doing their best and should always be recognized for their efforts.
*'''No Judgement.''' The rise of the current epidemic has been created by a series of events outside of any local jurisdiction. It is not the fault of local governments and community leaders fighting the epidemic.
*'''Common Goals'''. As part of initial discussions, it is important to talk about what all partners typically have in common - the desire to save lives and reduce suffering. While partners will vary in the approaches they use, and which they may feel are more effective, all involved want to see the same end result. It is important to focus on what the partners share in terms of outcomes they want to see and discuss how greater collaboration will benefit the efforts of all involved.

'''Organization, Structure, and Coalition Meetings.''' Each coalition will determine for itself what works best for them; however, some initial guidelines based on experience of what has worked in your community in the past may be helpful. Questions of leadership, frequency of meetings, who else should be included, the need for some type of by-laws or governance document, and the roles of participants are just some of the questions that typically arise during planning. As a coalition leader, it might also be helpful to track lessons learned over time to help maintain institutional knowledge as staffing changes over time. It is not unlikely that a standing coalition might experience "mission creep" - a tendency to slowly drift away from the organizing purpose of the group. Consistent evaluation of the coalition members, structure, and goals is an important function of any coalition leader.

'''Initial Actions of the Coalition.''' Hold your first meeting. Don’t worry if you have as few as five community leaders or as many as twenty. The important thing is that you have found people who are willing to work together to thoughtfully and comprehensively address the particular problem in your community. Although the topic that brings all of the stakeholders together is difficult, it is the coalition leader’s job to bring energy and optimism to the movement. Because solutions might look different to each of your stakeholders, focus on defining the common problem you are looking to solve. A goal of your first meeting should be to establish a meeting rhythm in which the coalition frequently gathers to review progress, update your plan, and share success stories.

'''Evaluate the State of Your Community.'''
For your community coalition to be successful, it will need to understand how the community perceives a number of elements of addiction, as well as what resources are already at work across the many stakeholders sets within your community. One way to evaluate perception and resources is through the SAFE Community Pulse Survey and SAFE Community Resources Exercise. These tools are designed specifically to provide you with the insight your coalition needs to focus and prioritize your work. These tools can be found in SAFE Project’s Community Playbook<ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref> – a framework for communities to organize, evaluate, and create change in their community to impact the addiction epidemic. Once you have completed both evaluations, it’s time to take a step back and look at what the data and research are telling you. Is there a correlation between what the community survey tells you and the gaps that you have identified in your resource exercise? Data is a critical foundation to action. The improved collection, distribution, and rapid analysis of data is critically important to the development of a strategy to address areas within a community that are being severely impacted by SUD. This typically goes far beyond just tracking overdose deaths and non-fatal overdoses. It is important to know where they are occurring in order to know where more resources need to be deployed. What data sources are currently available? How are they being used? Does the coalition have the partners to provide the necessary data? How can the coalition expand the data set to help focus resources where they are most needed, and when they are most needed? What can be done in a short amount of time, at reasonable expense, to better collect, analyze, and make use of data related to the SUD epidemic in the region? Use local data disaggregated by population characteristics like race, ethnicity, immigration status, language, and household levels of income to identify disparities in outcomes and inform policies and practices for specific populations, neighborhoods, and zip codes. Stronger data collection efforts and centering efforts around healthy equity can help to more effectively direct appropriate services to targeted areas within the community where they are most needed. This will also help community partners in better addressing the crisis in their neighborhoods. How can the coalition better serve areas of the community that have been underserved? What partnerships can help make this happen effectively? Both qualitative and quantitative data can help your community coalition to narrow down a set of goals to tackle. Ultimately, the approaches should address broad systemic and policy changes. Strategies should increase awareness, build education, enhance skills, build capacity, and improve access or fill gaps. For more information about setting S.M.A.R.T. goals, please refer back to SAFE Project's Community Playbook. <ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref>

= Impactful Federal, State, and Local Policies =

To our knowledge, there are no existing regulations or policies on coalitions, but as you consider who to reach out to in order to create or expand a coalition, below are some key lessons learned by communities that have gone through - and continue to go through - this process:

 '''The Contribution of Peer Support Networks.''' Peer Support Specialists and Recovery Coaches can play a vital role across numerous initiatives. Working together with police, health services, treatment providers, and recovery support networks, Peer Support Specialists and Recovery Coaches often provide an initial link to care for someone seeking help after an overdose or just wanting help. In many instances, they continue to work with people for longer periods of time - helping them find and get through treatment, as well as to provide support in meeting needs to maintain recovery. How are peers being utilized in the area? Is there room to expand current efforts and add more peer support through additional training and funding? If more peer specialists/coaches could be added in the region, who is needed to help make that a reality?

'''Harm Reduction Saves Lives and Provides a Linkage to Care.''' The distribution and training of how to use naloxone continues to be an effective way to reverse opioid overdose and save lives. Other programs, like needle/syringe exchanges, reduce the risk of infection and prevent the spread of other diseases. Resistance to these programs is reduced when they are paired with providing information about treatment options and other available support in the community. What training on naloxone administration is available in the area? How is this service being marketed to ensure organizations across the health system know it is available? What are the most effective ways to expand distribution of naloxone and add other harm reduction measures? Are there ways to improve linkages to care? What can the coalition do to reach more people, especially in areas with the highest rates of overdose, to expand harm reduction efforts?

'''The Criminal Justice System Plays a Key Role.''' It is generally recognized that a person suffering from SUD can be helped to a far greater degree through various diversion and treatment programs that can lead to a life in recovery, as opposed to long-term incarceration. Socially and economically, this is tremendously beneficial to society. What options are there for those in the criminal justice system in terms of diversion, drug court, treatment while incarcerated, and treatment/support services for those leaving incarceration? Are there areas that need to be added or improved? Given what programs currently exist, what improvements could be made within the state and local criminal justice systems in terms of additional or expanded programs to help those with SUD find treatment - either through diversion programs or treatment for those incarcerated? Are key figures who are part of the system willing to participate in a coalition?

'''Increasing Recovery Supports are Critical to Long-term Success.''' Housing, education, childcare, job training, and job placement assistance are just some of the recovery support services needed to help people in early recovery. Without these supports, many with limited means and/or a criminal record can become frustrated and hopeless - increasing their chances of relapse. Communities with strong supports for people newer to recovery have seen positive results. What types of recovery support services exist in the region? Who are the key organizations working on one or more recovery supports? Are area employers engaged? What about area workforce development entities? Who can help expand these efforts as part of the coalition?

= Available Tools and Resources =

Leaders of faith communities can support strategies to address substance misuse and support recovery in their community. Please see the Opioid Epidemic Practical Toolkit: Helping Faith and Community Leaders Bring Hope and Healing to Our Communities.<ref>https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref> Programs like One Body Collaboratives <ref>http://www.onebodycollaboratives.org/</ref>and software like Meet the Need<ref>https://meettheneed.org/</ref> can help engage and equip churches to participate in their communities. Churches, synagogues, mosques, and other faith groups can be a valuable bridge to the community. The U.S. Department of Health and Human Services has a dedicated Center for Faith and Opportunity Initiatives,<ref>https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref> with an accessible online toolkit containing ideas to help engage your spiritual community, educate and build community capacity, and respond to the opioid health crisis.

Harm-reduction organizations are nonprofit groups that advocate for public access to naloxone, Good Samaritan laws protecting users from arrest if they call 911 to save a friend, needle exchanges, and in some cases safe-use zones. In many communities, harm-reduction and law enforcement seem to be polar opposites. Law enforcement personnel are perceived as thinking only about arresting and jailing people for the illegal possession of drugs, while harm reduction organizations are perceived as focused on the complete legalization of all drugs. While each group certainly applies a different approach, both of these perceptions are false. Ensuring that law enforcement and harm-reduction organizations in your community are coordinating and collaborating is absolutely essential in the fight to end the opioid fatality epidemic. Harm-reduction coalitions have been essential in convincing law enforcement agencies to enact pre-arrest diversion programs. These programs provide low-level users the opportunity to seek treatment in lieu of facing charges or arrest. Law enforcement also must be at the table when harm-reduction organizations are planning new initiatives or programs. The Law Enforcement Action Partnership has compiled harm-reduction strategies supported by law enforcement professionals. Its list is a great way to start the conversation between these two communities, both focused on saving lives.<ref>https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png</ref>

= Promising Practices =

'''National Efforts.''' There are many national coalitions and organizations that can provide useful information and resources for local coalitions. These national groups are widely varied and numerous; therefore, it is important to research these organizations so local coalitions can verify that their goals and priorities are aligned with any national organization they choose to become involved with. A few examples follow, but there are many more at the national and even regional level.

* '''SAMHSA''' Implementation of a systems approach can be seen in the advancement of recovery-oriented systems of care (ROSC). <ref>Substance Abuse and Mental Health Services Administration. (2010). Recovery-oriented system of care (ROSC) resource guide. Rockville, MD: U.S. Department of Health and Human Services. </ref>

* '''SAMHSA''' Engaging community coalitions to decrease opioid overdose deaths: Practice Guide 2023. <ref>https://www.samhsa.gov/resource/ebp/engaging-community-coalitions-decrease-opioid-overdose-deaths-practice-guide-2023</ref>

* '''Community Anti-Drug Coalitions of America (CADCA)''' CADCA is the premier membership-based non-profit organization representing adult and youth coalition leaders throughout the United States and internationally - all working to make their communities safe, healthy, and drug-free. CADCA's model for community change represents a comprehensive, evidence-based, multi-sector approach to reduce underage and binge drinking, tobacco, illicit drugs, and the abuse of medicines.

* '''Coalition to Optimize the Management of Pain Associated with Surgery (COMPAS)''' Mission: To educate all those involved in pain management decisions about acute pain management strategies that minimize the need for opioids. COMPAS also provides education on how to implement multimodal analgesic strategies and how to measure success for patients and hospitals alike.

* '''Fed Up! Coalition to End the Opioid Epidemic''' A grassroots coalition seeking action from the federal government to bring this public health crisis to an end. Fed Up’s mission is to use united voices in a call for immediate, comprehensive and sustained federal action to end the opioid addiction epidemic. <ref>https://feduprally.org/</ref>

'''An Exemplary Local Effort:'''

* '''Dayton, Maryland -- Community Overdose Action Team (COAT)''' Dayton provides an example of a highly structured coalition. Their organizational chart details this structure and summarizes the role of each component within the COAT. <ref>https://cdn.americanprogress.org/content/uploads/2019/01/10055812/DaytonOpioids-fig9-693.png</ref> Other local coalitions might not be as complex or highly structured, but this example helps to provide ideas of what could be considered.

= Sources =

Expand Community Support for Impacted Families

2024-03-13T13:33:47Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The entire family feels the effects of substance use disorder. There are many ways a community can expand current supports for family members who are coping with a loved one’s substance use disorder, whether they are in treatment, transition, or recovery. In many cases, families can be part of the foundation for recovery, and their needs must be taken into consideration when a loved one is affected. In short: when the whole family is supported, the outcomes improve for each person in the family. Families recover too.

= Key Information =

'''Types of Programs That Support Families'''

Community support can be a powerful wellness tool. Communities may not be the builders of these support systems, but can provide support to those systems and ensure that families know what’s available for them in the community. Whether it’s a state, local, or federal government resource or a nonprofit organization, family support covers a wide spectrum of assistance for substance use, recovery, mental health, and harm reduction. Special programs are designed for all age groups, as offerings are specifically focused on issues affecting LGBTQI+, active-duty military, military families, non-denominational groups, parent only, spouse or partner only, as well as a cultural focus for a wide variety of ethnic and/or racial groups. The following programs are examples of family support. (NOTE: any references to a particular type of program or support group does not imply an endorsement or a referral.)

*'''12-Step Programs''' may be a family member’s first introduction to getting support when coping with a family member’s substance use disorder. These meetings are essentially fellowship programs that work on a peer-to-peer basis. Members help each other by practicing the Twelve Steps of Alcoholics Anonymous (or Narcotics Anonymous), welcoming and giving comfort to family members, as well as encouragement and support to the person with substance use disorder. The assurance of anonymity is essential to 12-Step programs to help more families and friends. There are an estimated 14,000 Al-Anon Family Groups meetings every week throughout the US and Canada.

*'''In-Person Support Groups (not 12-Step).''' Not everyone feels comfortable with a Twelve-Step framework, so families may want to be supported in other ways. There are many peer-to-peer alternatives that may appeal to those who would prefer a more secular, cognitive-behavioral (i.e., scientifically informed) strategy instead of a spiritual model. Other options for support meetings include ''Smart Recovery, Secular Organizations for Sobriety (SOS Sobriety), Because I Love You (BILY), Learn2Cope, Parents of Addicted Loved Ones, GRASP (Grief Recovery After a Substance Passing)'', and many others.

*'''Grief Support.''' Because of stigma about substance use disorder, families often deal with shame in addition to their grief. From 1999 to 2017, more than 702,000 people died from a drug overdose. <ref> https://www.cdc.gov/drugoverdose/index.html</ref> When the existing addiction epidemic intersected with the onset of the Covid pandemic in 2020, the results were tragic – as both fatal and nonfatal overdoses surged in the early months of the pandemic and continued. From April 2020 to April 2021, over 100,000 Americans lost their lives to overdoses. <ref>https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm</ref> Opioids continue to be the driving cause of those deaths. Synthetic opioids, primarily fentanyl, caused nearly two-thirds (64%) of all drug overdose deaths in the 12-month period ending April 2021, up 49% from the prior year. The ripple effect of those losses continues to affect families, friends, and caregivers.

* '''Collegiate Recovery Programs (CRPs)''' offer a connection to other students in recovery, as well as access to a supportive and confidential community. There are approximately 200 CRPs throughout the country that provide college students with the tools and support they need to succeed in the lifelong journey of recovery, such as substance-free housing and/or events, counseling, and drop-in safe spaces. CRPs also provide collegiate ''institutions'' with the knowledge and solutions necessary to effectively support students who are in or seeking recovery from substance use disorder.<ref>https://www.safeproject.us/</ref>

*'''Faith-Based Support.''' Churches, synagogues, mosques, and other faith groups can be a valuable bridge to the community when discussing the opioid epidemic. Faith-based organizations have a vested interest in their congregations and communities, and they can often reach people who may be reluctant to share information with anyone but their religious leaders. Houses of worship are generally open to sharing their spaces, whether it’s hosting a recovery group or a 12-step program. For example, the Alcohol, Drug Addiction and Mental Health Services Board of Cuyahoga County, Ohio, created a Faith-based Outreach Committee. Officials contracted with five faith-based programs to participate in the initiative. <ref>https://www.adamhscc.org/about-us/current-initiatives/faith-based-initiative</ref> By incorporating spirituality in the recovery process, congregations can increase awareness and education with their congregations. Additionally, State Opioid Response (SOR) grant funds can be used to the provision of substance use disorder services by faith-based organizations. <ref>https://www.hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref> Community leaders may find faith-based communities open to hosting a town hall to help educate their own members on the science of addiction, medication-assisted treatment, or naloxone training. Faith-based leaders also have a weekly audience where they can grow compassion within the community, while also supporting families in recovery. <ref>http://hhs.gov/about/agencies/iea/partnerships/opioid-toolkit/index.html</ref>

*'''Grand Families/Kinship.''' One tragic consequence of the opioid epidemic is the marked increase in children living with their grandparents. Grand families have unique challenges that may not fit neatly into family programs in a given community. Those who have taken in grandchildren after losing their sons or daughters to overdoses may struggle with shame and grief. Those same grandparents may be retired, on a fixed income, or living below the poverty line. A 2018 study from Generations United reported that "grand families are often not given access to the same supports and services that traditional unrelated foster families receive." <ref>https://www.gu.org/resources/the-state-of-grandfamilies-in-america-2016/</ref> Communities can offer updated parenting skills classes, provide specialized support groups, and help to navigate the school system and other community resources. West Virginia State University created an initiative, Healthy Grand families, to support grandparents now raising a family for the second time. <ref>http://healthygrandfamilies.com/</ref> The program provides everything a “new” parent needs to learn again: nutrition, social media and teens, stress management, and the new “normal” for their family. After completing the series, a licensed clinical social worker consults with them for three months to navigate community and advocacy services.

*'''Family Coaching Programs & Peer Navigators''' Many parents feel lost when navigating their child’s substance use issues. By speaking with someone who has been there, parents can learn how to stay connected to their loved one and get the support and encouragement they need and deserve. Communities can directly help parents by creating peer-to-peer programs such as the Partnership to End Addiction Parent Coaching program. This model pairs parents seeking help with a specially trained parent volunteer who has traveled the same path, dealing with a child’s substance use. Parent Coaching includes the benefits of shared experience and evidence-based techniques centered on motivating change. Consider building a community parent coaching program for families in crisis<ref> https://drugfree.org/article/parent-coaching/</ref>.

*'''Peer Navigators (Kinship or Family).''' Navigators provide critical information and referral services to grandparents and other relatives raising children who are outside the child welfare system. <ref>https://www.casey.org/what-are-kinship-navigators/</ref>Without these family members, many of the children would likely wind up in the foster care system. Kinship navigators can help families navigate their loved ones into treatment. One example is Arizona Kinship Support Services which provides help in a variety of ways, from completing guardianship packets and benefit applications to assisting families who wish to become guardians or adoptive parents. <ref>http://arizonaschildren.org/kinship/</ref> Their family testimonials offer compelling reasons for why this is critical support. New York state funds regional Family Support Navigators to provide help throughout the recovery process and connect families to vital resources. <ref>https://www.nyconnects.ny.gov/services/family-support-navigator-oasas-6346</ref>

'''Inform, Educate, and Create'''

It’s not enough to simply have various types of family support available in your community: families have to know it’s available.

*'''Inform Your Community about Available Family Support.''' Whether it’s an online directory, distributing flyers, social media, community events, or an email blast, community leaders are often the best positioned to get information directly to families of those with substance use disorder. There’s another benefit to openly promoting all that your community has available to help families: it will help families by reducing the stigma surrounding substance use disorder, treatment, and recovery. That helps both families and their loved ones in treatment and recovery.

*'''Educate Your Community about the Impact on Children.''' The opioid crisis has significant and multifaceted impacts on child and family health and well-being. As more families that affected by parental substance use around the country face child welfare involvement, it is more important than ever to support family-centered treatment-focused approaches, from supporting children in foster care to aiding children with Neonatal Abstinence Syndrome. Your community can engage clinics, pediatricians, schools, and child care providers with the help of the American Academy of Pediatrics’ fact sheets. Each sheet includes a state-by-state breakdown of the opioid epidemic, child welfare systems, and child health. They also recommend policy solutions that can support vulnerable children and families at the state and federal levels. <ref>https://www.thedoorway.nh.gov/</ref>

*'''Create a Family-Friendly Guide from Treatment to Recovery.''' Families affected by addiction need help navigating the disease and the systems set up to assist those looking for help. Many states and local communities have set up robust websites with links to multiple forms of support and service. As an example, the state of New Hampshire created a robust website to assist and support families to help them navigate everything from active addiction to recovery. It is an easy-to-follow guide that provides an extensive array of content, walking families through every step of the recovery process. The family-friendly format includes a variety of topics, as well as links to New Hampshire’s “Doorways” -- assistance with accessing every level of treatment and 211 support <ref>https://www.thedoorway.nh.gov/</ref>.

= Relevant Research =

*'''National Academy for State Health Policy (NASHP).''' With the increase in overdoses, alcohol use, and substance use during the pandemic, measuring and sharing data became more critical than ever. A study by NASHP reported that “Comprehensive data – often gathered from across the state, local, and federal resources – enables state and local leaders to tailor their prevention, treatment, and recovery responses and make the most of scarce resources.” <ref>https://www.nashp.org/how-states-access-and-deploy-data-to-improve-sud-prevention-treatment-and-recovery/#toggle-id-8-closed</ref>

*'''SAMHSA''' has updated Treatment Improvement Protocol (TIP) 39, titled "Substance Abuse Treatment and Family Therapy." <ref>https://store.samhsa.gov/product/treatment-improvement-protocol-tip-39-substance-use-disorder-treatment-and-family-therapy/PEP20-02-02-012?referer=from_search_result</ref> This TIP, first published in 2004, has been revised to reflect new research. It helps providers and administrators better understand how to include families in the complex and often difficult treatment of substance use disorder. This research report documents how involving family members or significant others in treatment and/or therapy can enhance patient outcomes ''and'' helps the family recover. Substance use disorder in a family of any size affects family dynamics, communications, healthy coping skills, as well as increases a child’s risk of developing SUD and/or mental health challenges.

= Impactful Federal, State, and Local Policies =

* To date, 47 states and the District of Columbia have enacted both Good Samaritan and Naloxone Access laws as part of an effort to reduce overdose deaths, while encouraging individuals to respond to opioid overdoses. These laws protect people from certain criminal penalties if they call 911 to save an overdose victim. The Government Accountability Office (GAO) reviewed 17 studies on Samaritan and Naloxone laws and found a pattern of lower rates of opioid-related overdose deaths among states that have enacted Good Samaritan laws, as well as an increased likelihood of individuals calling 911 if they are aware of the laws <ref>https://www.gao.gov/products/gao-21-248</ref>.

* SAMHSA's Center for Substance Abuse Treatment (CSAT), Building Communities of Recovery (BCOR) may be a source of funding for Family Recovery Programs. The purpose of this program is to mobilize resources within and outside of the recovery community to increase the prevalence and quality of long-term recovery support from substance abuse and addiction. These grants are intended to support the development, enhancement, expansion, and delivery of recovery support services (RSS) as well as the promotion and education of recovery. Programs will be principally governed by people in recovery from substance abuse and addiction who reflect the community being served. <ref>https://www.samhsa.gov/grants/grant-announcements/TI-21-004</ref>

= Available Tools and Resources =

*'''Celebrating Families!''' is a successful, evidence-based 16-week curriculum that addresses the needs of children and parents in families that have serious problems with alcohol and other drugs. The curriculum engages every member of the family, ages three through adult, to foster the development of healthy and addiction-free individuals. A typical cycle was designed to serve 6 to 15 families depending on the site's physical facilities, referral process, and intake of eligible families. <ref>https://celebratingfamilies.net/CFmodel.htm</ref>

*'''CRAFT (Community Reinforcement and Family Training)''' teaches families and friends how to positively interact with a loved one struggling with their substance use. With an evidence-based approach, participants can learn behavioral and motivational strategies. Training is also available for parents of teenagers with substance use disorder. <ref>https://www.apa.org/monitor/2017/12/underappreciated-intervention</ref>

*'''National Association for Children of Addiction''' provides a variety of resources for families in recovery. <ref>https://nacoa.org/</ref>

*'''National Center on Substance Abuse and Child Welfare''' Webinar Building Hope for Family Healing and Recovery. <ref>https://ncsacw.acf.hhs.gov/training/videos-and-webinars/building-hope-recovery/</ref>

*'''Research Recovery Institute Guide for Family Members''' offers supportive resources for families. <ref>https://www.recoveryanswers.org/resource/guide-family-members/</ref>

*'''SAMHSA''' provides a dedicated website titled "Resources for Families Coping with Mental and Substance Use Disorders." <ref>https://www.samhsa.gov/families</ref>

*'''The Sobriety Treatment & Recovery Teams (START)''' is a model for working with families affected by substance use disorder and child welfare involvement. <ref>https://www.opioidlibrary.org/wp-content/uploads/2021/01/START_Chapter_1.pdf</ref>

= Promising Practices =

*'''Baltimore’s Family Recovery Program''' works with families where substance use is a major factor in the removal of their child/children. <ref>https://frp-inc.org/</ref>

*'''Family Treatment Courts (FTC)''' – Casey Family Programs studied services provided by Family Treatment Courts across the country, especially their family services that are not exclusive to the court system. FTCs offer strategies including early identification of substance use disorder, access and referral to treatment, recovery coaches, intensive case management, one-on-one engagement, and family-centered treatment. They found each strategy can and should be implemented in any child and family well-being system and in all family courts, in collaboration with community partners. <ref>https://frp-inc.org/</ref>

*'''Maryland Department of Human Services''' has developed a fact sheet detailing five different promising practices for family engagement, including Adult Focused Family Behavior Therapy, Multisystemic Therapy – Building Stronger Families, Screening and Assessment for Family Engagement, Retention, and Recovery (SAFERR), and Sobriety Treatment and Recovery Coaches (START). <ref>https://theinstitute.umaryland.edu/media/ssw/institute/md-center-documents/Substance-Use-Disorder-EBPs-Promising-Practices-for-Adults-(April-2017).pdf</ref>

*'''National Judicial Opioid Task Force''' evaluated the Parent Partner Programs in a document titled "Promising Practice to Keep Families Struggling with Substance Use Disorder Together." Parent Partners (aka parent mentors, peer specialists, allies) have previous direct experience in the child welfare system. Parent Partners assist parents currently involved or at risk of becoming involved with the child welfare system. Whether the services are based in courts, welfare agencies, or independent, they provide peer support to new parents entering the system. This study shows how these programs have increased trust and confidence in the child welfare and juvenile court systems in several cities. <ref>https://www.ncsc.org/__data/assets/pdf_file/0017/17900/parent-partner-programs-final.pdf</ref>

= Sources =

Reduce Stigma

2024-03-13T13:28:13Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

The term “stigma” is used to represent the complex of attitudes, beliefs, behaviors, and structures that interact at different levels of society (i.e., individuals, groups, organizations, systems) and manifest in prejudicial attitudes about and discriminatory practices against people with mental and substance use disorders. Attention to stigmatizing structures of society, such as laws and regulations, enables examination of prejudice and discrimination against people with mental and substance use disorders. Discriminatory policies and practices can appear to endorse negative social norms and deepen self-stigma. <ref name="Ending Discrimination Against People with Mental and Substance use Disorders: The Evidence for Stigma Change.">https://www.ncbi.nlm.nih.gov/books/NBK384923/</ref>

Stigma often creates barriers for those who need treatment and other critical services from reaching out for assistance. This lack of understanding impacts many people in society. It can be most harmful to those who suffering from SUD and to those who are in early recovery. Reducing stigma and increasing understanding of substance use disorder improves the chance that people with SUD will find the assistance and support that they need. Addressing stigma requires education and breaking down barriers. This is performed by changing attitudes, perceptions, and even language that is used around SUD. Recent research showed that substance use is more stigmatized than obesity and smoking tobacco. <ref name="Substance use more stigmatized than smoking and obesity: Journal of Substance Use: Vol 18, No 4. (n.d.). Retrieved December 5, 2019,">from https://www.tandfonline.com/doi/abs/10.3109/14659891.2012.661516</ref> To break down the barrier of stigma we need to educate that SUD is a chronic Illness and that the approach for treatment should be the same as heart disease, diabetes, asthma, cancer or other illnesses.

= Key Information =

SAMHSA’s working definition of recovery states that recovery is “A process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” <ref>https://www.samhsa.gov/sites/default/files/programs_campaigns/02._webcast_3_resources.pdf</ref> SAMHSA lists health, home, purpose, and community as essential dimensions of support for a life in recovery. Stigma is a barrier in recovery. When a person with substance use disorder finally reaches out for help, he or she is often met with judgment or unhelpful responses. This is often the result of stigma. Many examples of stigma are not overt, but are more subtle. Stigma comes in the form of language used, pity, disdain, silence, or rejection. Persons with mental health and substance use problems are exposed to an array of stigma components that interact to endanger their mental health. These components include stereotypes, prejudice, and discrimination <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref>

Studies have shown that people with substance use disorder experience labeling, shame, and rejection from family members, friends, teachers, co-workers, supervisors, and health care professionals. This stigma can get in the way of the support that people in recovery need -- especially those in early recovery. Outside stigma can become internalized, leading people in recovery to embody and adopt inaccurate beliefs about themselves due to their exposure to external stigmatizing forces.

Individual factors, such as beliefs, play a large role in an individual’s decision about whether to seek treatment. According to ''Facing Addiction in America: The Surgeon General’s Report on Alcohol, Drugs and Health'' “stigma has created an added burden of shame that has made people with SUDs less likely to come forward and seek help.” <ref>https://addiction.surgeongeneral.gov/sites/default/files/surgeon-generals-report.pdf (Facing Addiction in America)</ref> Research shows that the vast majority of people do not seek treatment because of attitudinal or belief barriers (e.g., lack of perceived need, concerns about stigma, doubts about efficacy).

'''Types of Stigma.''' There are five different types of stigma, and each has an impact at both personal and social levels. Understanding and having awareness of the following types of stigma can help to break down barriers and reinvent the road to recovery.

* '''Self-Stigma.''' Shame, evaluative thoughts, and fear of enacted stigma -- prevents users from seeking prevention services, testing, and treatment. Stigma also limits employment, school enrollment, housing, and access to social and safety net services.<ref>Luoma, J. B., Kohlenberg, B. S., Hayes, S. C., Bunting, K., & Rye, A. K. (2008). Reducing self-stigma in substance abuse through acceptance and commitment therapy: Model, manual development, and pilot outcomes. Addiction Research & Theory, 16(2), 149–165. https://doi.org/10.1080/16066350701850295</ref>

* '''Courtesy stigma.''' This is “stigma by association” and involves public disapproval evoked as a consequence of people associating with a stigmatized group. This may have a negative impact as people may distance themselves to avoid stigma. One example is society blaming the family for an individual's substance use disorder or mental health condition.

* '''Public stigma''' is the collective public’s prejudice and discrimination toward a specific group of individuals — in this case, individual's with substance use problems. These negative perceptions cause emotional and behavioral reactivity.

* '''Structural stigma.''' These are policies or institutional actions that intentionally or unintentionally restrict the opportunities of those with substance use disorder and mental health conditions. This could include discriminatory behaviors or negative perceptions held by institutional representatives, such as those in criminal justice systems or healthcare settings. This includes both public and private sector polices that restrict opportunities of those with drug dependence. <ref>Corrigan P. W. “How stigma interferes with mental health care,” American Psychologist. 2004;59(7):614–625.</ref>

* '''Multiple stigma''' – Also may be referred to as “double stigma” and is prevalent among those who have co-occurring challenges such as mental illness, substance use disorder, homelessness and poverty.

'''Stigma Around Addiction Treatment.''' A large number of treatment centers are more focused on unscrupulous levels of profit, rather than on patients. This has led to a degree of stigma associated with even the seeking of treatment. It has become necessary to increase the quality of information about treatment centers for users seeking treatment as well as people who do patient referrals. Education about the following will help in the identification of the most positive treatment centers.

*Lack of Outcomes Data. The measure of substance use disorder treatment effectiveness may be more nuanced than presented by the treatment center's website. For example, if a center says it has a 90% success rate, that most likely refers to the following conditions:
**A reduction in the frequency of substance use during drug rehab treatment
**A reduction in the amount of the substance being used during drug rehab treatment
**Successful sobriety for a relative period of time (i.e. self-reported sobriety among patients between 3 and 6 months after treatment)
*Unbranded Drug Rehab Websites. Some facilities have created unbranded websites to attract additional web traffic. These websites often try to appear like an independent source verifying that one rehab center may be better than another, when in reality that website was created by a rehab center.
*Drug Rehab Centers: Some Claim to Be Experts at Everything
*Patient Brokering. This illegal practice occurs when "body brokers" make money by recruiting addicts for unethical and unscrupulous treatment facilities
*Rampant Urinalysis Testing and Lab Abuse. Some sober homes around the country make money by recruiting people for the intensive outpatient programs (IOPs) that take place at drug rehab centers. These centers charge millions of dollars in fees to insurance companies for drug urinalysis performed on patients in IOPs.

'''Reducing Stigma'''

Those speaking and writing about mental health and addiction should strongly consider the language they use when describing those struggling with those issues. People-first language or person-centric language can influence whether the material produced is further stigmatizing to people. The new edition of the Associated Press style book recommends people first phrasing with the goal of separating the person from the disease. The Addiction Technology Transfer Center (ATTC) has specific suggestions for stigma-reducing language: <ref>https://attcnetwork.org/centers/central-east-attc/product/anti-stigma-toolkit-guide-reducing-addiction-related-stigma</ref>

* Call it what it is: substance use disorder (or alcohol use disorder, cocaine use disorder, etc.) or substance dependence (or alcohol dependence, drug dependence, etc.). In a non-clinical environment, addiction is also acceptable.

* Use "people first" language and refer to people with substance use disorder, people with drug dependence, people with addiction.

* Avoid negative terms like addict, junkie, wino, boozer, drug fiend, and bum.

Regarding stigma specifically associated with MAT, the National Alliance for Medication Assisted Recovery recommends the following: <ref>https://namarecovery.org/</ref>

⦁ Speak publicly about the productive lives led by MAT patients

⦁ Establish contact with elected and appointed officials

⦁ Attend community meetings

⦁ Prepare and distribute educational material

⦁ Participate in media interviews

⦁ Create a unified voice to reach the public on all issues of concern to MAT patients

= Relevant Research =

* The National Academies of Sciences, Engineering, and Medicine published a text titled "Ending Discrimination Against People with Mental and Substance Use Disorders: The Evidence for Stigma Change." <ref>https://www.nap.edu/read/23442/chapter/1</ref>

* This article provides a systematic review of existing research that has evaluated interventions designed to reduce stigma related to substance use disorders. <ref> "The effectiveness of interventions for reducing stigma related to substance use disorders: a systematic review." retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3272222/</ref>

* One literature review of programs for reducing stigma found that online education programs and face-to-face education programs were equally effective in reducing personal stigma (an individual's own attitude towards people with mental illness), but neither was effective in reducing self-stigma.<ref>Griffiths, K. M., Carron-Arthur, B., Parsons, A., & Reid, R. (2014). Effectiveness of programs for reducing the stigma associated with mental disorders. A meta-analysis of randomized controlled trials. World Psychiatry, 13(2), 161–175. https://doi.org/10.1002/wps.20129</ref>

* Other research has shown that therapeutic interventions such as group-based Acceptance and Commitment Therapy (ACT) and vocational counseling produce positive outcomes for substance users suffering from self-stigma.<ref>Livingston, J. D., Milne, T., Fang, M. L., & Amari, E. (2012). The effectiveness of interventions for reducing stigma related to substance use disorders: A systematic review. Addiction (Abingdon, England), 107(1), 39–50. https://doi.org/10.1111/j.1360-0443.2011.03601.x</ref>

= Impactful Federal, State, and Local Policies =

SAFE Solutions is an ever-growing platform.  Currently limited information is readily available for this section.  SAFE Project is dedicated to providing communities with the most relevant and innovative materials.  We will continue to regularly monitor and make updates accordingly with community input and subject matter expert collaboration.  Please check back soon.

= Available Tools and Resources =

The following organizations, associations, and agencies provide information on stigma, stigma prevention, or developing prevention campaigns. Some of the organizations that provide information on stigma may focus on mental health but also address substance abuse. Similarly, some of the resources on conducting prevention campaigns focus on substance abuse prevention rather than stigma prevention. However, the principles and processes employed by substance abuse prevention campaigns are applicable to stigma prevention campaigns.

''' Addiction Technology Transfer Center (ATTC) Network''' is funded by SAMHSA. It is a nationwide, multidisciplinary resource for professionals in the addictions treatment and recovery services field. The ATTC Network raises awareness of evidence-based and promising treatment and recovery practices, builds skill to prepare the workforce to deliver state-of the-art addictions treatment and recovery services, and changes practice by incorporating these new skills into every use for the purpose of improving addictions treatment and recovery outcomes. ATTC provides a resource titled "Anti-Stigma Toolkit: Guide to Reducing Addiction-Related Stigma." <ref>https://attcnetwork.org/centers/central-east-attc/product/anti-stigma-toolkit-guide-reducing-addiction-related-stigma</ref>

'''The Advertising Council''' <ref>https://www.adcouncil.org</ref> The Ad Council produces, distributes, promotes, and evaluates public service communications programs. It provides information, resources, and assistance to community groups about public service campaigns.

'''The Anti-Stigma Project''' <ref>https://www.onourownmd.org</ref> fights stigma by raising consciousness, facilitating ongoing dialogues, searching for creative solutions, and educating the behavioral health community, including consumers, family members, providers, educators, and administrators. They offer online trainings regarding stigma reduction. ''The Distorted Perception's Initiative'' is a public education campaign that was created by the Anti-Stigma Project to provide facts and resources to help our community understand the stigma related to mental illness and addictions. <ref>https://www.distortedperceptions.org/</ref>

'''The Centre for Addiction and Mental Health (CAMH) Addictions Program.''' <ref>https://www.camh.ca/en/driving-change/addressing-stigma</ref> CAMH is Canada’s largest mental health and addiction teaching hospital. CAMH combines clinical care, research, education, policy development and health promotion to help transform the lives of people affected by mental health and addiction issues.

'''Community Anti-Drug Coalitions Of America (CADCA).''' <ref>https://www.cadca.org </ref> Since 1992, CADCA has been training local grassroots groups, known as community anti-drug coalitions, in effective community problem-solving strategies, teaching them how to assess their local substance abuse related problems and to develop a comprehensive plan to address them.

'''The Higher Education Center For Alcohol, Drug Abuse, And Violence Prevention Education Development Center, Inc''' is funded by the U.S. Department of Education, the Higher Education Center provides support to all institutions of higher education in their efforts to address the problems related to alcohol and other drug abuse and violence. <ref>https://www.higheredcenter.org</ref>

'''Life Unites Us''' You can make a difference in reducing stigma around addiction. Sharing content from Life Unites Us and having conversations online helps promote positive messaging and reduce stigma. <ref>https://www.facebook.com/reel/1342224413132500</ref>

'''Mental Health America''' <ref>https://mhanational.org/</ref> Mental Health America (formerly known as the National Mental Health Association) is the country’s leading nonprofit dedicated to helping ALL people live mentally healthier lives. MHA represents a growing movement of Americans who promote mental wellness for the health and wellbeing of the nation – every day and in times of crisis.

'''National Alliance For The Mentally Ill (NAMI)''' <ref>https://www.nami.org</ref> The National Alliance for the Mentally Ill is a nonprofit, grassroots, self-help, support, and advocacy organization of consumers, families, and friends of people with mental health problems. It provides education, supports increased research funding, and advocates for adequate health insurance, housing, rehabilitation, and jobs.

'''National Institute on Drug Abuse (NIDA)''' has provided “Words Matter - Preferred Language When Talking about Addiction." It provides a table of stigma-reducing language to act as a guide when talking about those with SUD and in recovery. <ref>https://nida.nih.gov/nidamed-medical-health-professionals/health-professions-education/words-matter-terms-to-use-avoid-when-talking-about-addiction</ref>

'''National Mental Health Consumers’ Self-Help Clearinghouse''' <ref>https://www.mhselfhelp.org</ref> The Clearinghouse was the first national technical assistance center founded and run by individual's diagnosed with mental health conditions. It is peer-run national technical assistance and resource center that fosters recovery, self-determination, and community inclusion. The Clearinghouse serves individuals with lived experience of a mental health condition, peer-run service and advocacy organizations, family members, mental health professionals and service providers, policy makers, and the public.

'''SAFE Project No Shame Pledge''' Join the no shame movement. <ref>https://www.safeproject.us/noshame-mental-health-addiction/?gad_source=1&gclid=Cj0KCQjwncWvBhD_ARIsAEb2HW81jVzdiu98jXEgsohnb6NwGV5qdffXSAIcfSDEbPIOmU8-HjSZeMoaAvKpEALw_wcB</ref>

'''Stop Stigma Now ''' is a campaign to counteract stigma and prejudice directed at both patients and treatment centers. <ref>http://www.stopstigmanow.org/resources/</ref> They provide a resource for preferred vs. non-preferred language in their guide to using person-centric language. <ref>http://www.stopstigmanow.org/resource-library/</ref>

'''Substance Abuse And Mental Health Administration''' <ref>https://www.samhsa.gov/</ref> SAMHSA is a federal government agency that seeks to provide substance abuse and mental health services to the people most in need and to translate research in these areas more effectively and more rapidly into the general health care system.

= Promising Practices =

'''The U.S. Department of Health and Human Services''' has published a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." <ref>-https://aspe.hhs.gov/sites/default/files/private/pdf/260791/BestSUD.pdf </ref> This guide provides stigma reducing best practices such as co-location of SUD counseling and other services with primary care. This reduces the stigma of accessing a facility identified as treating SUDs. It catches members in locations where they are more comfortable and permits improved coordination between physical and behavioral health care.

'''SAFE Project.'''<ref>https://www.safeproject.us/noshame-mental-health-addiction/</ref> SAFE Project believes there’s '''''No Shame''''' in getting help or in talking about mental health and addiction. The '''''No Shame Pledge''''' supports the ability to get help without judgement and acknowledge commitment to saving lives by fighting the stigma.

'''State Without Stigma''' <ref>https://www.opioidlibrary.org/video/2245/</ref> This video provides a public service announcement on reducing stigma.

= Sources =

Improve Recovery Housing

2024-03-13T13:16:46Z

AlexFigueroa: /* Available Tools and Resource */

=Introductory Paragraph=

Recovery housing is a highly individualized choice based on a variety of needs. For those seeking recovery housing, finding safe, affordable, and supportive housing options can be difficult. There are many types of housing in different settings and different levels of care. Supportive housing for people in recovery can range from peer-run homes to licensed treatment programs. It is important for individuals and communities to ensure recovery housing options are reputable and have the best interests of their residents in mind.

=Key Information=

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), “recovery houses are safe, healthy, family-like substance-free living environments that support individuals in recovery from addiction. While recovery residences vary widely in structure, all are centered on peer support and a connection to services that promote long-term recovery. Substance-free does not prohibit prescribed medications taken as directed by a licensed prescriber.” <ref>https://www.samhsa.gov/resource/ebp/recovery-housing-best-practices-suggested-guidelines.</ref> There are a variety of types of recovery home certifications and credentials:

* '''The National Alliance for Recovery Residences (NARR)''' is a 501(c)3 nonprofit organization dedicated to expanding the availability of well-operated, ethical, and supportive recovery housing. NARR offers recovery homes a suite of certifications.<ref> https://narronline.org</ref>

* '''The Commission on Accreditation of Rehabilitation Facilities (CARF)''' is an independent, non-profit accreditor providing accreditation services worldwide at the request of health and human service providers. CARF accreditation demonstrates a provider's commitment to enhance its performance, manage its risk, and distinguish its service delivery.<ref>http://www.carf.org </ref>

* '''Oxford Houses''' are self-run and publicly supported. A 501(c)3 corporation serves as an umbrella organization connecting networked Oxford Houses. It also allocates resources to duplicate their model. <ref>https://oxfordhouse.org</ref>

* '''Independently-Owned and Operated Homes''' Recovery homes may also be independently owned and operated as a small business outside of an existing credentialing network - offering flexibility and ease of admission. These homes are often peer-led, allowing the residents to provide mutual support to one another and become financially self-sufficient. Although independently-owned recovery houses do not provide on-site licensed professional services, they often have resources and relationships with local recovery support professionals. Even though independently owned recovery homes do not hold a license or formal certification, they conform to local zoning and building safety codes for residential occupancy.

Note: States may have independent certification or credentialing requirements. Please check the recovery residence certification guidelines within your own state for more information.

=Relevant Research=

'''The National Council for Behavioral Health''' has documented research findings that detail the benefits that recovery housing has provided to individuals in obtaining and maintaining long-term recovery. These include: <ref>https://narronline.org/wp-content/uploads/2017/09/Recovery-Housing-Issue-Brief_May-2017.pdf</ref>

Benefits of living in recovery housing include:

* Reduced risk of relapse/recurrence
* Lower rates of incarceration and recidivism
* Higher income
* Increased employment
* Improved family relationships
* Overall higher recovery capital

'''“Understanding Challenges for Recovery Homes during COVID-19.”''' This article addresses the different ways that recovery homes have had to alter their model and structure as a result of COVID-19. Recovery homes use a social model approach to recovery that contrasts with mitigation procedures such as social distancing and stay-at-home orders. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7566762/</ref> Individuals residing in recovery housing are at a higher risk of contracting COVID-19 due to the group living environment. NARR has adopted the CDC guidelines and has applied them to recovery home settings. Recovery houses other than those with NARR certification that are licensed through the state also follow strict health and safety guidelines. Recovery homes that are independently licensed have less oversight.

=Impactful Federal, State, and Local Policies=

'''The National Council for Behavioral Health''' developed suggested policies for recovery housing nationwide to adopt and implement. These suggestions can be found in the recovery housing toolkit titled “Building Recovery State Policy Guide for Supporting Recovery Housing.” <ref>https://www.thenationalcouncil.org/wp-content/uploads/2018/05/18_Recovery-Housing-Toolkit_5.3.2018.pdf?daf=375ateTbd56</ref> In this guide, Alan Johnson, Florida Chief Assistant to the State Attorney, stated “We recommend that states be given the ability to require certification under NARR (National Alliance for Recovery Residences) or similar standards, or other recognized programs such as Oxford House™ to protect the vulnerable residents living in sober homes.” For more information, visit “Building Recovery State Policy Guide for Supporting Recovery Housing” toolkit.

'''The 2018 SUPPORT Act (Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment).''' In an effort to improve and expand recovery housing, Congress directed SAMSHA to collaborate with stakeholders and to facilitate the development of best practices for operating recovery housing. These best practices may include model laws that seek to prevent relapse and overdose (including greater access to MAT), as well as the development of indicators that could be used to identify fraudulent recovery housing operators. <ref>https://www.samhsa.gov/sites/default/files/housing-best-practices-100819.pdf</ref>

'''SAFE Project''' has compiled and maintained a list of the current legislation in regard to recovery housing by state. For more information please contact us at Community@safeproject.us.

=Available Tools and Resource=

* '''SAMHSA''' provides a guide titled "Best Practices for Recovery Housing." <ref>https://store.samhsa.gov/sites/default/files/pep23-10-00-002.pdf</ref>

* '''NARR''' hosts an annual summit on recovery housing, and its website offers a variety of resources and services.

* '''NASTAD''' Thinking about starting a supportive housing program? recommendations and considerations for the planning process" Recommendations and considerations for the planning process <ref>https://nastad.org/sites/default/files/2023-10/Resource-PDF-Housing-Program-Recommendations-and-Considerations-102323.pdf?utm_source=newsletter&utm_medium=email&utm_content=Thinking%20About%20Starting%20a%20Supportive%20Housing%20Program%3F%20Recommendations%20and%20Considerations%20for%20the%20Planning%20Process&utm_campaign=UA-179397308-1</ref>

=Promising Practices=

* '''What First Responders in Portland, Oregon, Are Doing''' First responders direct people to recovery housing that offers peer to peer support, employment training and assistance, and an extended safe place to build their foundation of recovery. <ref>https://www.nbcnews.com/nightly-news/video/portland-tackles-opioid-epidemic-with-community-paramedics-1227745347553</ref>

=Sources=

Collect and Share Data

2024-03-13T13:07:49Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Data collection, analysis, and reporting are critical components to strengthening a community’s response to drug misuse and substance use disorder (SUD). By sharing and regularly monitoring data, communities can build credibility, raise awareness and political will, share knowledge, identify more effective interventions and strategies, guide decision making, and allow for better budgeting and allocation of funds. For a community coalition to be successful, it will need to understand how the community perceives a number of elements of addiction, as well as what resources are already at work across the many stakeholders set in your community. Systems-building is a complex process. The role of data in this process can be understood using a chemistry metaphor. Data are the atoms, and in proper combination, they form molecules of information. In complex systems, these molecules interact in a variety of ways. So, having the right amount of data and converting that data into information is essential for the optimal functioning of a balanced system. When the system is out of balance, as we see in the SUD crisis, then the identification of the right data and the conversion of that data to information that can be used within the social system is essential.

= Key Information =

A key goal of any effort to address the current epidemic is to use multi-sector data to inform assessment, planning, and implementation. It is not uncommon for most communities to have to break down existing data silos so that various public, private, and community partners can engage effectively. This process is important because it increases understanding and fosters collaboration. All participants need to understand what is happening in their community in order to have agreement about what strategies would be most effective.

'''Where to Start and Key Questions to Consider''' Drug misuse and SUD are complex problems requiring a complete set of solutions. Data collection and building a sufficient data set can often be challenging, so communities should expect to be met with some level of resistance. Many agencies who represent important sources of data are often not accustomed to working with others and sharing the data they have available. There might be questions of confidentiality, and many communities work hard to establish trusting relationships with outside entities. One way to overcome this challenge is to first establish an identified leader(s) to coordinate and gather needed data and regularly summarize and report on data findings. These are often individuals in the public health sector, who have the experience and expertise necessary to collect, analyze, and present data in a way that is clear and easy to understand. Once leadership of the data effort is determined, discussions can take place between agencies and other sources to determine what data each has, if they are willing and able to share it, and what restrictions may exist in doing so. In most cases, all parties want to help save lives and improve their community, and any issues can be worked out with little difficulty.

In some communities, there may not already be a data collection effort across the entire system. In that case, start with your exploration of data by looking at the most severe harms - including fatal and non-fatal overdoses. Knowing the numbers is important to understand the scope of the problem, but to guide response, more data is required. For example, where are the geographic regions of where overdoses are occurring? What are the demographics of those areas? What type of substance, or combination, is involved? How often are we collecting data?

This starting point typically leads to other questions that require additional data in order to identify gaps in services and the implementation of strategies to fill such gaps. Some examples might include:

*For non-fatal overdoses, how many go to a hospital or community health center?
*How many non-fatal overdoses are revived with naloxone? Who administers naloxone - first responders or others?
*Are there clusters of overdoses occurring in specific areas and neighborhoods?
*What are we currently doing? Are overdose prevention services being offered in areas with high overdose rates?
*What drugs are residents using? What are the trends? What are youth substance use rates?
*What are the local opioid prescribing practices?
*Are people experiencing overdose being connected to services? How is this being done, and by whom?
*Are area treatment and other support services at capacity? Are there wait times or wait lists to get in?
*How many who need medication-assisted treatment (MAT) are receiving it? Does this include the criminal justice system?
*Are recovery support services - including housing, job training, coaching, and education available, and do they meet the needs of the community?
*For those involved in the criminal justice system, is there a history or presence of substance use problems?

'''Other Potential Data Sources''' Before collecting any new data, the next step is to scan existing sources and locate the data. Identify where the data is currently being captured and who has access to the needed data. Perhaps, your community has already conducted a recent needs assessment? During this process, you may find that some data is missing or interpreted differently across organizations. Spend time with administrators discussing how they compile their data and what data elements are composed of specific indicators. To make sure your data is statistically sound and there are no errors, it is important that administrators are working from the same definitions and make an effort to link potential data sources where applicable.

In some cases, you may be able to access local data through public records. Common sources and the types of data organizations can typically provide include:

*Local and State Health Departments (number of overdoses, locations, demographics)
*Fire/EMS Services (portion of overdoses, connection to services, naloxone administration)
*Police and Public Safety Departments (number of overdoses, drug seizures, drug-related crime, diversion, and MAT in correctional facilities)
*Medical Examiner/Coroner's Reports (cause of death from overdose, type of substance(s) involved)
*911 Calls (calls related to suspected overdose)
*Local Hospitals and Community Health Organizations (number of non-fatal overdoses, connection to services, naloxone administration)
*Local Harm Reduction Service Providers (naloxone and needle distribution, connection to services)
*Treatment Providers (treatment capacity and availability, wait times, MAT providers)
*Pharmacies (records on naloxone distribution to indicate awareness and/or increased use)
*Prescription Drug Monitoring Program (PDMP) (identify high risk prescribers)
*Recovery Support Services (amount and adequacy of peers, availability of housing, access to job training, tracking data on clients remaining in recovery)

'''The Story Behind the Data'''

Communities should explore the ultimate root cause of the problem that might not be immediately apparent. In addition to the availability of quantitative data, communities may capture and track qualitative data to describe the story behind the numbers through community surveys, listening sessions, public forums, interviews, observations, case studies, or focus groups that analyze trends in drug use, types of drugs, and community perception of the problem. For deeper examination, ask questions about accessibility, affordability, availability, and cultural relevance of programs and policies. As you seek input, honor the perspectives and voices of those who will be most impacted by the coalition’s decisions and engage with individuals who you are directly trying to serve in discussions and decision-making in order to understand barriers that residents face. And, if you are able, provide compensation for their time.

'''Scanning Community Resources'''

Sometimes when individual community sectors do their work to mitigate the opioid and addiction crisis, they are so busy doing good work that they aren’t aware of other services the community offers and how they might interact. They don’t have the time to survey the landscape and see what else is available. Focusing your community’s efforts does not mean doing only one thing to combat the epidemic. By identifying your community’s attitudes and perceptions, as well as gaps in services, you will be better able to focus your available time and energy on paths that have the most opportunity for impact.

'''Reviewing Your Assessment'''

Once you have reviewed any existing data, work alongside your stakeholder group or coalition to identify any gaps in data and determine if any new data should be collected. Did you find everything you were looking for? How will we know when we have enough data? Communities can spend a lot of time analyzing and discussing data. While data should be at the forefront of the coalition’s decision-making, it’s important to balance how much time is dedicated to data discussions, in order to move from planning toward prioritization and action.

'''Tracking and Monitoring Data'''

Communities might initially collect only baseline data, but the benefits of tracking data trends over time include accountability, monitoring changes with statistical significance to act more swiftly, influencing policy, and being able to communicate and raise awareness about a particular problem. The identified lead should determine the frequency on how often to collect data and coordinate collection efforts to regularly monitor data. Where communities are able, they should disaggregate population level data by race and ethnicity to identify disparities. Other options for how to disaggregate data include: age, sex, veteran status, marital status, education, citizenship, disability status, primary language spoken at home, and employment status. Similarly, communities can use their data to drill down to specific areas in the community to explore gaps in access to services and ensure appropriate allocation of resources by analyzing data by city, village, service area, neighborhood, district, or even census tract. To help put your community data into context of the bigger picture, you may consider comparing your data or benchmarking across other communities with a similar makeup at the state and even national levels. Some national sources of data might include:

*Centers for Disease Control (CDC) <ref>https://www.cdc.gov/</ref>
*Substance Abuse and Mental Health Services Administration (SAMSHA) <ref>https://www.samhsa.gov/</ref>
*National Survey on Drug Use and Health <ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>
*Robert Wood Johnson County Rankings and Roadmaps <ref>https://www.countyhealthrankings.org/</ref>
*U.S. Census Bureau American Community Survey (ACS)<ref>https://www.census.gov/programs-surveys/acs</ref>

'''Reporting Data'''

It will be up to each community to decide what data to collect and report about, and what data should be made public. The data report should continually educate and drive informed decision-making. Data used to track the number and locations of overdoses, for example, can provide the community with the knowledge of where overdoses are taking place and what hot spots exist. This allows a community to focus resources where they are needed by adding or expanding services like those related to prevention, harm reduction, and connection to services through peers or other means. Other parts of the reports may include available treatment and recovery housing beds, naloxone distribution numbers, number of prescribed MAT in various settings, number of interventions, and so forth. What is required is what is needed to first guide strategy and then be able to track the effectiveness of those strategies over time.

Analysts may choose a variety of methods for sharing their data, including Geographic Information Systems (GIS), line graphs, bar charts, tables, and pie charts. It is critical for an analyst to use care when displaying and illustrating data because it is important to find a balance between creating a visualization that is effective and provides a picture for their audience, but also doing it in a way that accurately displays the data rather than skews the interpretation. Charts and graphs should be easy to read, aesthetically pleasing, well-labeled, include the totals for columns and rows, be scaled accurately, and developed with the audience in mind. Illustrate the most important information and keep the graphic simple. Research best practices or ask for help if you are not well versed in the creation of charts and graphs.

'''Data Systems'''

To maintain a strong data infrastructure, communities have a variety of options. Investments in off-the-shelf software systems are available for purchase and can help to combine and monitor data from various state and local organizations, provide a connection to services, and serve as a tool for tracking system performance indicators and outcomes over time. If there is limited funding available, communities can do this using spreadsheet or database software (like Microsoft Excel or Access).

'''Making Data-Informed Decisions'''

A targeted data collection and analysis effort will enable decision makers to develop effective approaches to achieve results. Continued communication and sharing of data is key. This will lead to greater collaboration between agencies that have and share data as well as other community stakeholders involved with developing and implementing strategies and programs. These community stakeholders can help "translate" the data from multiple sources to help with decision-making. Often new partnerships are forged when the data reveals what needs to be addressed and who can effectively address those identified needs.

Another common lesson learned from experience is that decision makers need to be willing to experiment and constantly adjust the approaches they take. Even at the local level, aspects of this epidemic change and sometimes change rapidly. Leaders need to continually collect and analyze data in order to detect these changes and make adjustments.

= Impactful Federal, State, and Local Policies =

Often, when agencies wish to share data, some type of data sharing agreement is required. Parties will want to know that confidential or other sensitive data will not be disclosed publicly or beyond a limited number of participants. While the creation of such documents is often done by counsel in order to address privacy issues and compliance with laws and regulations, there are many boiler-plate examples that can be used and altered to meet the requirements of most agencies and other community partners. It is important for communities to understand the federal and state legal framework since some data might contain protected health information. The US Bureau of Justice Assistance has worked with the Justice Center of the Council of State Governments to create a guide about best practices for sharing data across behavioral health and criminal justice systems. <ref>https://bja.ojp.gov/sites/g/files/xyckuh186/files/Publications/CSG_CJMH_Info_Sharing.pdf</ref>

= Available Tools and Resources =

* '''Harvard Institute for Excellence in Government''' – Includes case studies on data-driven approaches.<ref>https://scholar.harvard.edu/files/janewiseman/files/data_driven_approaches_to_fighting_the_opioid_crisis_jane_wiseman_april_2019.pdf</ref>

* '''SAMHSA''' has compiled extensive information on the Strategic Prevention Framework (SPF), a data-driven approach. Two starting points for accessing decades of experience on the role of data processes within SPF can be found in "A guide to SAMHSA’s strategic prevention framework" <ref> https://www.samhsa.gov/sites/default/files/20190620-samhsa-strategic-prevention-framework-guide.pdf </ref> and "Selecting Best-fit Programs and Practices: Guidance for Substance Misuse Prevention Practitioners." <ref>https://www.samhsa.gov/sites/default/files/ebp_prevention_guidance_document_241.pdf</ref>

* '''SAMHSA''' Welcome to the Data Analysis System for SAMHSA Studies. Explore and analyze substance use and mental health data to better understand critical public health issues. Run a quick crosstab analysis and view your results as tables and charts. <ref>https://datatools.samhsa.gov/?utm_source=SAMHSA&utm_campaign=3cbd395252-EMAIL_CAMPAIGN_2023_10_23_08_31&utm_medium=email&utm_term=0_-3cbd395252-%5BLIST_EMAIL_ID%5D</ref>

* '''The Monitoring the Future Study''' <ref>http://monitoringthefuture.org/</ref> from the University of Michigan is an ongoing study that provides communities with data necessary to frame the issue related to the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th, and 12th grade students are surveyed (12th graders since 1975, and 8th and 10th graders since 1991).

* '''The SAFE Community Pulse Survey''' in SAFE Project’s Community Playbook <ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref> examines your community’s perceptions of the opioid and addiction crisis through a short survey. It is not meant to be a scientific analysis of attitudes and perceptions, but rather to give you a snapshot of how the community as a whole perceives the issues your coalition will be tackling. This is also a great way to let the broader community know about your coalition’s focus and to engage with other community members. Not everyone will agree on the best approaches; the climate survey allows the community to “speak for itself.”

* '''The SAFE Community Resources Exercise''' in SAFE Project’s Community Playbook <ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref> helps coalition members understand the resources that their fellow members bring to the table as well as to educate the coalition about the depth and breadth of other services that are offered in the community.

= Promising Practices =

In many cases, not all data collected will be made public. However, developing a data report that is made public is done by most communities due to the fact that it raises awareness about the problem and the real impacts it is having within the community. This can be done through a dashboard or other regularly updated reports made available by the local government or a local task force/opioid response team where they exist. Three examples follow:

* Cincinnati Overdose Response <ref>https://insights.cincinnati-oh.gov/stories/s/Heroin-Overdose-Responses/dm3s-ep3u/</ref>

* New Hampshire Drug Monitoring Initiative <ref>https://www.dhhs.nh.gov/programs-services/health-care/substance-misuse-data-page</ref>

* New Jersey Overdose Data Dashboard <ref>https://www.state.nj.us/health/populationhealth/opioid/</ref>

= Sources =

Collect and Share Data

2024-03-13T13:06:18Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Data collection, analysis, and reporting are critical components to strengthening a community’s response to drug misuse and substance use disorder (SUD). By sharing and regularly monitoring data, communities can build credibility, raise awareness and political will, share knowledge, identify more effective interventions and strategies, guide decision making, and allow for better budgeting and allocation of funds. For a community coalition to be successful, it will need to understand how the community perceives a number of elements of addiction, as well as what resources are already at work across the many stakeholders set in your community. Systems-building is a complex process. The role of data in this process can be understood using a chemistry metaphor. Data are the atoms, and in proper combination, they form molecules of information. In complex systems, these molecules interact in a variety of ways. So, having the right amount of data and converting that data into information is essential for the optimal functioning of a balanced system. When the system is out of balance, as we see in the SUD crisis, then the identification of the right data and the conversion of that data to information that can be used within the social system is essential.

= Key Information =

A key goal of any effort to address the current epidemic is to use multi-sector data to inform assessment, planning, and implementation. It is not uncommon for most communities to have to break down existing data silos so that various public, private, and community partners can engage effectively. This process is important because it increases understanding and fosters collaboration. All participants need to understand what is happening in their community in order to have agreement about what strategies would be most effective.

'''Where to Start and Key Questions to Consider''' Drug misuse and SUD are complex problems requiring a complete set of solutions. Data collection and building a sufficient data set can often be challenging, so communities should expect to be met with some level of resistance. Many agencies who represent important sources of data are often not accustomed to working with others and sharing the data they have available. There might be questions of confidentiality, and many communities work hard to establish trusting relationships with outside entities. One way to overcome this challenge is to first establish an identified leader(s) to coordinate and gather needed data and regularly summarize and report on data findings. These are often individuals in the public health sector, who have the experience and expertise necessary to collect, analyze, and present data in a way that is clear and easy to understand. Once leadership of the data effort is determined, discussions can take place between agencies and other sources to determine what data each has, if they are willing and able to share it, and what restrictions may exist in doing so. In most cases, all parties want to help save lives and improve their community, and any issues can be worked out with little difficulty.

In some communities, there may not already be a data collection effort across the entire system. In that case, start with your exploration of data by looking at the most severe harms - including fatal and non-fatal overdoses. Knowing the numbers is important to understand the scope of the problem, but to guide response, more data is required. For example, where are the geographic regions of where overdoses are occurring? What are the demographics of those areas? What type of substance, or combination, is involved? How often are we collecting data?

This starting point typically leads to other questions that require additional data in order to identify gaps in services and the implementation of strategies to fill such gaps. Some examples might include:

*For non-fatal overdoses, how many go to a hospital or community health center?
*How many non-fatal overdoses are revived with naloxone? Who administers naloxone - first responders or others?
*Are there clusters of overdoses occurring in specific areas and neighborhoods?
*What are we currently doing? Are overdose prevention services being offered in areas with high overdose rates?
*What drugs are residents using? What are the trends? What are youth substance use rates?
*What are the local opioid prescribing practices?
*Are people experiencing overdose being connected to services? How is this being done, and by whom?
*Are area treatment and other support services at capacity? Are there wait times or wait lists to get in?
*How many who need medication-assisted treatment (MAT) are receiving it? Does this include the criminal justice system?
*Are recovery support services - including housing, job training, coaching, and education available, and do they meet the needs of the community?
*For those involved in the criminal justice system, is there a history or presence of substance use problems?

'''Other Potential Data Sources''' Before collecting any new data, the next step is to scan existing sources and locate the data. Identify where the data is currently being captured and who has access to the needed data. Perhaps, your community has already conducted a recent needs assessment? During this process, you may find that some data is missing or interpreted differently across organizations. Spend time with administrators discussing how they compile their data and what data elements are composed of specific indicators. To make sure your data is statistically sound and there are no errors, it is important that administrators are working from the same definitions and make an effort to link potential data sources where applicable.

In some cases, you may be able to access local data through public records. Common sources and the types of data organizations can typically provide include:

*Local and State Health Departments (number of overdoses, locations, demographics)
*Fire/EMS Services (portion of overdoses, connection to services, naloxone administration)
*Police and Public Safety Departments (number of overdoses, drug seizures, drug-related crime, diversion, and MAT in correctional facilities)
*Medical Examiner/Coroner's Reports (cause of death from overdose, type of substance(s) involved)
*911 Calls (calls related to suspected overdose)
*Local Hospitals and Community Health Organizations (number of non-fatal overdoses, connection to services, naloxone administration)
*Local Harm Reduction Service Providers (naloxone and needle distribution, connection to services)
*Treatment Providers (treatment capacity and availability, wait times, MAT providers)
*Pharmacies (records on naloxone distribution to indicate awareness and/or increased use)
*Prescription Drug Monitoring Program (PDMP) (identify high risk prescribers)
*Recovery Support Services (amount and adequacy of peers, availability of housing, access to job training, tracking data on clients remaining in recovery)

'''The Story Behind the Data'''

Communities should explore the ultimate root cause of the problem that might not be immediately apparent. In addition to the availability of quantitative data, communities may capture and track qualitative data to describe the story behind the numbers through community surveys, listening sessions, public forums, interviews, observations, case studies, or focus groups that analyze trends in drug use, types of drugs, and community perception of the problem. For deeper examination, ask questions about accessibility, affordability, availability, and cultural relevance of programs and policies. As you seek input, honor the perspectives and voices of those who will be most impacted by the coalition’s decisions and engage with individuals who you are directly trying to serve in discussions and decision-making in order to understand barriers that residents face. And, if you are able, provide compensation for their time.

'''Scanning Community Resources'''

Sometimes when individual community sectors do their work to mitigate the opioid and addiction crisis, they are so busy doing good work that they aren’t aware of other services the community offers and how they might interact. They don’t have the time to survey the landscape and see what else is available. Focusing your community’s efforts does not mean doing only one thing to combat the epidemic. By identifying your community’s attitudes and perceptions, as well as gaps in services, you will be better able to focus your available time and energy on paths that have the most opportunity for impact.

'''Reviewing Your Assessment'''

Once you have reviewed any existing data, work alongside your stakeholder group or coalition to identify any gaps in data and determine if any new data should be collected. Did you find everything you were looking for? How will we know when we have enough data? Communities can spend a lot of time analyzing and discussing data. While data should be at the forefront of the coalition’s decision-making, it’s important to balance how much time is dedicated to data discussions, in order to move from planning toward prioritization and action.

'''Tracking and Monitoring Data'''

Communities might initially collect only baseline data, but the benefits of tracking data trends over time include accountability, monitoring changes with statistical significance to act more swiftly, influencing policy, and being able to communicate and raise awareness about a particular problem. The identified lead should determine the frequency on how often to collect data and coordinate collection efforts to regularly monitor data. Where communities are able, they should disaggregate population level data by race and ethnicity to identify disparities. Other options for how to disaggregate data include: age, sex, veteran status, marital status, education, citizenship, disability status, primary language spoken at home, and employment status. Similarly, communities can use their data to drill down to specific areas in the community to explore gaps in access to services and ensure appropriate allocation of resources by analyzing data by city, village, service area, neighborhood, district, or even census tract. To help put your community data into context of the bigger picture, you may consider comparing your data or benchmarking across other communities with a similar makeup at the state and even national levels. Some national sources of data might include:

*Centers for Disease Control (CDC) <ref>https://www.cdc.gov/</ref>
*Substance Abuse and Mental Health Services Administration (SAMSHA) <ref>https://www.samhsa.gov/</ref>
*National Survey on Drug Use and Health <ref>https://nsduhweb.rti.org/respweb/homepage.cfm</ref>
*Robert Wood Johnson County Rankings and Roadmaps <ref>https://www.countyhealthrankings.org/</ref>
*U.S. Census Bureau American Community Survey (ACS)<ref>https://www.census.gov/programs-surveys/acs</ref>

'''Reporting Data'''

It will be up to each community to decide what data to collect and report about, and what data should be made public. The data report should continually educate and drive informed decision-making. Data used to track the number and locations of overdoses, for example, can provide the community with the knowledge of where overdoses are taking place and what hot spots exist. This allows a community to focus resources where they are needed by adding or expanding services like those related to prevention, harm reduction, and connection to services through peers or other means. Other parts of the reports may include available treatment and recovery housing beds, naloxone distribution numbers, number of prescribed MAT in various settings, number of interventions, and so forth. What is required is what is needed to first guide strategy and then be able to track the effectiveness of those strategies over time.

Analysts may choose a variety of methods for sharing their data, including Geographic Information Systems (GIS), line graphs, bar charts, tables, and pie charts. It is critical for an analyst to use care when displaying and illustrating data because it is important to find a balance between creating a visualization that is effective and provides a picture for their audience, but also doing it in a way that accurately displays the data rather than skews the interpretation. Charts and graphs should be easy to read, aesthetically pleasing, well-labeled, include the totals for columns and rows, be scaled accurately, and developed with the audience in mind. Illustrate the most important information and keep the graphic simple. Research best practices or ask for help if you are not well versed in the creation of charts and graphs.

'''Data Systems'''

To maintain a strong data infrastructure, communities have a variety of options. Investments in off-the-shelf software systems are available for purchase and can help to combine and monitor data from various state and local organizations, provide a connection to services, and serve as a tool for tracking system performance indicators and outcomes over time. If there is limited funding available, communities can do this using spreadsheet or database software (like Microsoft Excel or Access).

'''Making Data-Informed Decisions'''

A targeted data collection and analysis effort will enable decision makers to develop effective approaches to achieve results. Continued communication and sharing of data is key. This will lead to greater collaboration between agencies that have and share data as well as other community stakeholders involved with developing and implementing strategies and programs. These community stakeholders can help "translate" the data from multiple sources to help with decision-making. Often new partnerships are forged when the data reveals what needs to be addressed and who can effectively address those identified needs.

Another common lesson learned from experience is that decision makers need to be willing to experiment and constantly adjust the approaches they take. Even at the local level, aspects of this epidemic change and sometimes change rapidly. Leaders need to continually collect and analyze data in order to detect these changes and make adjustments.

= Impactful Federal, State, and Local Policies =

Often, when agencies wish to share data, some type of data sharing agreement is required. Parties will want to know that confidential or other sensitive data will not be disclosed publicly or beyond a limited number of participants. While the creation of such documents is often done by counsel in order to address privacy issues and compliance with laws and regulations, there are many boiler-plate examples that can be used and altered to meet the requirements of most agencies and other community partners. It is important for communities to understand the federal and state legal framework since some data might contain protected health information. The US Bureau of Justice Assistance has worked with the Justice Center of the Council of State Governments to create a guide about best practices for sharing data across behavioral health and criminal justice systems. <ref>https://bja.ojp.gov/sites/g/files/xyckuh186/files/Publications/CSG_CJMH_Info_Sharing.pdf</ref>

= Available Tools and Resources =

* '''Harvard Institute for Excellence in Government''' – Includes case studies on data-driven approaches.<ref>https://scholar.harvard.edu/files/janewiseman/files/data_driven_approaches_to_fighting_the_opioid_crisis_jane_wiseman_april_2019.pdf</ref>

* '''SAMHSA''' has compiled extensive information on the Strategic Prevention Framework (SPF), a data-driven approach. Two starting points for accessing decades of experience on the role of data processes within SPF can be found in "A guide to SAMHSA’s strategic prevention framework" <ref> https://www.samhsa.gov/sites/default/files/20190620-samhsa-strategic-prevention-framework-guide.pdf </ref> and "Selecting Best-fit Programs and Practices: Guidance for Substance Misuse Prevention Practitioners." <ref>https://www.samhsa.gov/sites/default/files/ebp_prevention_guidance_document_241.pdf</ref>

* '''The Monitoring the Future Study''' <ref>http://monitoringthefuture.org/</ref> from the University of Michigan is an ongoing study that provides communities with data necessary to frame the issue related to the behaviors, attitudes, and values of American secondary school students, college students, and young adults. Each year, a total of approximately 50,000 8th, 10th, and 12th grade students are surveyed (12th graders since 1975, and 8th and 10th graders since 1991).

* '''The SAFE Community Pulse Survey''' in SAFE Project’s Community Playbook <ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref> examines your community’s perceptions of the opioid and addiction crisis through a short survey. It is not meant to be a scientific analysis of attitudes and perceptions, but rather to give you a snapshot of how the community as a whole perceives the issues your coalition will be tackling. This is also a great way to let the broader community know about your coalition’s focus and to engage with other community members. Not everyone will agree on the best approaches; the climate survey allows the community to “speak for itself.”

* '''The SAFE Community Resources Exercise''' in SAFE Project’s Community Playbook <ref>https://www.safeproject.us/safe-community-playbook-and-safe-solutions/</ref> helps coalition members understand the resources that their fellow members bring to the table as well as to educate the coalition about the depth and breadth of other services that are offered in the community.

* '''SAMHSA''' Welcome to the Data Analysis System for SAMHSA Studies. Explore and analyze substance use and mental health data to better understand critical public health issues. Run a quick crosstab analysis and view your results as tables and charts. <ref>https://datatools.samhsa.gov/?utm_source=SAMHSA&utm_campaign=3cbd395252-EMAIL_CAMPAIGN_2023_10_23_08_31&utm_medium=email&utm_term=0_-3cbd395252-%5BLIST_EMAIL_ID%5D</ref>

= Promising Practices =

In many cases, not all data collected will be made public. However, developing a data report that is made public is done by most communities due to the fact that it raises awareness about the problem and the real impacts it is having within the community. This can be done through a dashboard or other regularly updated reports made available by the local government or a local task force/opioid response team where they exist. Three examples follow:

* Cincinnati Overdose Response <ref>https://insights.cincinnati-oh.gov/stories/s/Heroin-Overdose-Responses/dm3s-ep3u/</ref>

* New Hampshire Drug Monitoring Initiative <ref>https://www.dhhs.nh.gov/programs-services/health-care/substance-misuse-data-page</ref>

* New Jersey Overdose Data Dashboard <ref>https://www.state.nj.us/health/populationhealth/opioid/</ref>

= Sources =

Improve Access to Quality Treatment Programs

2024-03-12T19:17:08Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

Over 20 million Americans ages 12 and older are addicted to drugs or alcohol, but only about 11% receive treatment. <ref>https://drugfree.org/drug-and-alcohol-news/new-data-show-millions-of-americans-with-alcohol-and-drug-addiction-could-benefit-from-health-care-reform/</ref> There is an increasingly important need to provide options for individuals who may benefit from quality and affordable alcohol and drug treatment programs. The demand for treatment is met with a shortage of quality recovery centers in America, which makes it difficult for individuals to receive the care they need. The small populations in rural communities, for example, cannot support the specialized treatment or trained primary care practitioners who are willing to treat individuals living with addiction. This leads many individuals to either go without care or join waitlists for treatment.

Those living with substance use disorders are among the highest cost of healthcare users. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Overdose patients in particular place a heavy burden on first responders, emergency departments, and the foster care system. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Some options to solve this issue could include innovations such as expanded use of online tools and assessments, integration of primary care treatment, and virtual reality. <ref>Volkow, N. D., Frieden, T. R., Hyde, P. S., & Cha, S. S. (2014). Medication-Assisted Therapies—Tackling the Opioid-Overdose Epidemic. New England Journal of Medicine, 370(22), 2063–2066. https://doi.org/10.1056/NEJMp1402780</ref>

= Key Information =

Most recovery support services fall under the Recover-Oriented Systems of Care (ROSC) model which is based on the idea that severe substance use disorders are treated most effectively through chronic care management which involves outpatient care, recovery housing, recovery coaching, and management checkups. These are meant to be culturally sensitive and easy to navigate. ROSC follows recovery-related values and beliefs which include the following concepts: <ref>The Surgeon General’s Report on Alcohol, Drugs, and Health. (2016), Drug-Free Communities, Retrieved from: https://obamawhitehouse.archives.gov/sites/default/files/ondcp/dfc/AdministratorEnomotoMeetDFCTeamPresentation.pdf</ref>
*People who suffer from addiction have essential worth and dignity.
*The stigma related to addiction is something that prevents many people who are addicted from seeking help and this must be combated.
*There are many paths to recovery.
*Access to treatment is a human right, even though recovery might mean something more
*People who are in recovery, as well as their families, have valuable experiences and support to offer to those who are still struggling with substance abuse.

'''Treatment Options'''

Many treatment programs are based on the 12-Steps of Alcoholics Anonymous (AA), but there is little scientific evidence showing that the AA process is effective. Dr. Lance Dodes stated in the documentary ''The Business of Recovery'' that 12-Step programs are typically only helpful for 5-10% of people who partake in them, meaning that they are largely ineffective for the vast majority of people. Treatment programs that are based on AA's 12-Step program, therefore, are not necessarily providing effective treatment, but are still charging exorbitant prices, especially considering that AA is a fellowship that is free to participants outside of treatment programs. <ref> Inside The $35 Billion Addiction Treatment Industry. (n.d.). Retrieved December 5, 2019, from https://www.forbes.com/sites/danmunro/2015/04/27/inside-the-35-billion-addiction-treatment-industry/#c20c67817dc9</ref>

Other treatment programs include recovery coaching, recovery housing, recovery management, peer-led recovery community centers, and recovery-based education. ''Medication-Assisted Treatment (MAT)'' is available in accredited and certified private and public clinics across the United States. A combination of medication, counseling, and behavioral therapy is regarded as the most effective in treating opioid dependency. <ref>https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions</ref> The Substance Abuse and Mental Health Administration (SAMHSA) is responsible for overseeing the certification of opioid treatment programs which use Buprenorphine, Methadone, and Naltrexone. <ref>https://www.samhsa.gov/medication-assisted-treatment</ref>

'''Implementing treatment in the Primary Care Setting'''

Primary care providers are highly likely to come in contact with individuals who are struggling with substance use disorders however, only about 3,600 physicians are board-certified in treating addiction. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> Approximately 4% of all physicians nationwide are certified to prescribe medication for opioid use disorder. <ref>https://www.commonwealthfund.org/publications/2017/sep/focus-expanding-access-addiction-treatment-through-primary-care</ref> A majority of individuals must obtain their medication from Methadone clinics. While these clinics are helpful in assisting people in getting their medication, it is difficult for specialty clinics to meet the demand for services. This calls for more primary care providers to obtain the training and certifications to treat complex cases of substance use disorders. One possible solution for getting more primary care physicians to assist in this issue is to incentivize the screening and treatment of addiction. There are many challenges that primary care providers may face when choosing to treat addiction patients, including stigma, the complexity of this population, and reimbursement for services.

= Relevant Research =

'''This article''' provides a review and meta-analysis of treatment services for patients with alcohol use disorders. The research found that pharmaceutical interventions when used with psychosocial co-interventions, resulted in better outcomes. This supports the advantage of the strategy of adding medication to treatment programs for opioid users. <ref>Pharmacotherapy for Adults With Alcohol Use Disorders in Outpatient Settings: A Systematic Review and Meta-analysis | Research, Methods, Statistics | JAMA | JAMA Network. (n.d.). Retrieved December 5, 2019, from https://jamanetwork.com/journals/jama/fullarticle/1869208</ref>

'''Cost/Benefit Analysis.''' Drug treatment programs are known for being expensive and difficult to find. Current research suggests that when people are able to enroll in treatment, the benefits impact not only on individuals living with a substance use disorder but also healthcare administrations, law enforcement, and the criminal justice system. Recent data suggests that every dollar spent on substance use treatment centers saves $4 in health care costs and $7 in criminal justice and law enforcement involvement. <ref>https://americanaddictioncenters.org/rehab-guide/public-assistance</ref> Over $8,200 can be saved on health care and productivity costs per individual who spends at least 60 days in a quality substance abuse treatment program. <ref>https://americanaddictioncenters.org/rehab-guide/public-assistance</ref> Thus, it is effective to invest taxpayer dollars and government resources to implement accessible, affordable, and quality treatment centers -- regardless of access to insurance or financial status.

= Impactful Federal, State, and Local Policies =

'''California.''' The Safe Neighborhoods and Schools Act (Proposition 47) reclassified certain theft and drug charges from felonies to misdemeanors enabling focus on more violent crimes and serious offenses. This resulted in monetary savings being directed to school programs, victim services, and mental health. The creation of new drug treatment programs offered a way to decrease recidivism and to support those with newly classified misdemeanor drug possession charges to have more options for recovery. <ref>https://crimesolutions.ojp.gov/ratedprograms/740</ref>

= Available Tools and Resources =

'''SAMHSA''' hosts FindTreatment.gov -- a website that allows users to search for treatment centers while filtering for treatment type, location, and payment options to include private health insurance, Medicaid, or free or no-cost care. There are also filters for special populations such as veterans, LGBTQ+, differently abled individuals, age groups, and language preference. <ref>https://findtreatment.gov/locator</ref>

'''SAFE Project''' administers a treatment locator based upon awareness that the first challenge a person or loved one faces after deciding to accept treatment is finding an effective and affordable treatment center. Treatment locators may help those to find an appropriate center that is suitable for the individual based on their insurance, ability to pay, type of addiction, ability to address co-occurring mental illness, distance from home, and other factors. The SAFE Project Treatment Locator was developed with the University of Maryland to provide a platform that is easy to navigate and that provides the ability to search the SAMHSA database using more criteria to help find the best options available. <ref>https://safelocator.org/en/search</ref>

'''American Addiction Centers''' has a website that describes how and where to locate free or low-cost drug rehabilitation programs. It highlights options for state-funded drug treatment programs, who qualifies for services, and how to local find state-funded treatment options. It also gives information about other possible payment options for treatment such as scholarships, loans, insurance, and how to ask friends and family for support. <ref>https://americanaddictioncenters.org/rehab-guide/free</ref>

'''Advanced Recovery Systems''' is a behavioral health company focused on helping people on their path to recovery from substance abuse and mental health issues. It operates a network of inpatient and outpatient addiction and mental health treatment facilities and hosts a website that provides a assistance in navigating insurance for treatment. <ref>http://Drugrehab.com</ref> and a tool that checks if your insurance provider covers addiction care. <ref>https://www.drugrehab.com/insurance-check/</ref>

'''Pew Trusts''' 10 Ways That States Can Improve Substance Use Treatment. <ref>https://www.pewtrusts.org/en/research-and-analysis/articles/2023/09/18/10-ways-that-states-can-improve-substance-use-treatment</ref>

'''Apps and Online Resources:'''
*'''Life Recovery Program''' is an online program that could be a useful option for people who live in rural areas or for people who are incarcerated. The program consists of bi-weekly online video/audio workshops and practical tools, along with homework exercising, grounding techniques, and supportive emails. It is designed to last 3 to 6 months. <ref>https://www.liferecoveryprogram.org/</ref>
*'''myStrength''' is an online and smartphone platform that can enhance the capacity of mental health service providers by enabling them to serve more people more effectively. It can also provide tools to support people between professional consultations. There is solid and growing research on the value and effectiveness of the platform. <ref>http://mystrength.com/outcomes</ref>
*'''reSET-O.''' Digital Therapeutics Alliance developed this eFORMULATIONS treatment tool for opiate dependence. It is a mobile medical application that is used in conjunction with pharmaceutical therapies to treat opioid dependence. Clinical trials have shown reSET-O to be a promising solution to opiate dependence, showing that reSET-O plus pharmacotherapy achieved enhanced abstinence from opioids, reduced drop-outs in treatment, and reduced required clinical intervention when compared to traditional face-to-face therapy. <ref>https://dtxalliance.org/products/reset-o/</ref>
*'''ShoutOut''' is an app developed by Recovery Centers of America Telehealth. It delivers comprehensive and evidence-based outpatient treatment for addiction and co-occurring disorders. There are three available levels of treatment available to serve each individual’s needs. Group, individual, and family options are implemented into the program. <ref>https://recoverycentersofamerica.com/outpatient/</ref>

= Promising Practices =

'''Kentucky.''' In Kenton County, the prison has become an important treatment facility. Instead of focusing on punishing or just locking up people with substance use issues, the Kenton County Detention Center focuses on turning a time of incarceration into a time for much-needed treatment. Leaders in Kenton County believe that jail may be the best place to initiate recovery. People often end up in jail for minor crimes, long before they commit more serious crimes that warrant a prison sentence. Kenton County is one of over 20 Kentucky county jails that have started full-time therapeutic communities that focus on rehabilitation within their walls, providing inmates the type of services that private treatment centers offer on the outside. <ref>Opinion | Addicts Need Help. Jails Could Have the Answer. - The New York Times. (n.d.). https://www.nytimes.com/2017/06/16/opinion/sunday/opioid-epidemic-kentucky-jails.html</ref>

'''Maryland.''' The Baltimore County Health Department provides treatment through community providers for substance users and their families, and develops, coordinates, and monitors a countywide network of substance use prevention and disorder treatment services. It operates a dedicated phone line staffed with clinical social workers with specialized training in helping people with substance use issues move toward recovery. <ref>https://www.baltimorecountymd.gov/departments/health/health-services/substance-use/</ref>

'''Massachusetts.''' Boston Medical Center opened its Faster Paths to Treatment Opioid Urgent Care Center in August 2016. This center, which is specifically for treating patients addicted to prescription painkillers, is located next to the hospital emergency room, giving patients immediate access to comprehensive care including counseling, case management, home visits, and transportation to detox. <ref>https://www.bmc.org/faster-paths-treatment</ref>

= Sources =
</div>
[[Category:SAFE-Treatment and Recovery]]

Support and Advance Effective Treatment

2024-03-12T19:04:46Z

AlexFigueroa: /* Available Tools and Resources */

= Introductory Paragraph =

According to a 2022 national survey, about 29.5 million people ages 12 and over in the United States had an alcohol use disorder and 48.7 million people had a substance use disorder within the past year. <ref>https://www.hhs.gov/about/news/2023/11/13/hhs-samhsa-release-2022-national-survey-drug-use-health-data.html</ref> Alcohol and substance abuse are commonly treated with talk therapy, medications and support groups. Alcohol and substance use impacts not just the user but the entire family. There are several evidence-based therapies for alcohol and drug misuse. The most common evidence-based therapies are cognitive behavioral therapy and 12 step-programs. Medication-assisted treatment has proven effective in treatment of opioid use disorder. Medication in combination with talk therapy can reduce withdrawal symptoms and promote long-term recovery.

= Key Information =

There are multiple effective pathways leading to long-term recovery and improvements in work, family, relationships, and overall mental health and well-being. Substance use disorders are treated to meet the needs of the individual and may include the following:<ref>https://www.goodrx.com/conditions/substance-use-disorder/best-therapies-for-alcohol-and-drug-use</ref>
*Therapy (individual, group, couples & families)
*Medications
*A combination of therapy and medications
*Peer support programs
*12-step or recovery programs
*Family support and family recovery programs

Evidence-based treatments that have been researched and scientifically proven include:

*Cognitive behavioral therapy (CBT) is therapy during which a therapist provides one-to-one attention. It has been proven to reduce substance use and have a positive impact for life improvements. CBT has also been proven to be effective with trauma which may coincide with substance use disorders. <ref>https://www.apa.org/ptsd-guideline/patients-and-families/cognitive-behavioral</ref>

*12-step therapy programs, such as Alcoholics Anonymous and Narcotics Anonymous are self-help group therapy programs that are evidence-based in assisting with maintaining sobriety. <ref>https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3753023/</ref>

*Medication-assisted treatment (MAT) is a combination of medications and talk therapy. Depending on the substance, MAT is an evidence-based option for recovery from alcohol and opioid use. <ref>https://www.samhsa.gov/medication-assisted-treatment</ref>

There are inpatient treatment options, such as residential treatment, and outpatient choices, depending on what is best suited for the level of care for an individual. Treatment may require detox on either an outpatient or inpatient basis, depending upon professional medical advice.

= Relevant Research =

'''HHS''' has a report titled "Best Practices and Barriers to Engaging People with Substance Use Disorders in Treatment." This study addresses the models of care, quality improvement interventions, and best practices used by higher-performing health plans to improve initiation and engagement in SUD treatment. It also describes the provider, beneficiary, and market factors that affect their ability to successfully initiate and engage beneficiaries in substance use treatment services. <ref>https://aspe.hhs.gov/sites/default/files/private/pdf/260791/BestSUD.pdf</ref>

'''This NIDA article''' provides a literature review of treatment communities, such as community lodges and sober houses that have seen themselves as a mutual self-help alternative to medically oriented strategies to address addiction. <ref> "Therapeutic Communities Research Report - What Are Therapeutic Communities?" https://nida.nih.gov/publications/research-reports/therapeutic-communities/what-are-therapeutic-communities</ref>

'''This book''' is in its third edition and is titled "Principles of Drug Addiction Treatment: A Research-Based Guide." It offers health professionals and other stakeholders information on principles of effective drug addiction treatment, answers to frequently asked questions, an overview of the drug addiction treatment landscape in the United States, and an outline of evidence-based treatment approaches. <ref>https://nida.nih.gov/sites/default/files/podat-3rdEd-508.pdf</ref>

'''This book''' provides a set of analyses focused on the evaluation of alcohol and drug treatment programs. <ref>https://books.google.com/books?hl=en&lr=&id=LgclBQAAQBAJ&oi=fnd&pg=PP1&dq=Support+and+Advance+Effective+Treatment+substance+use&ots=z6SXDo7zXf&sig=5s1IZ8fM_dRUr9R4uusM9d7Tlas#v=onepage&q=Support%20and%20Advance%20Effective%20Treatment%20substance%20use&f=false</ref>

'''This article''' provides a comprehensive review of empirical studies that have addressed differences in patient outcome and dropout rates and their correlation to the effectiveness of the therapists. It notes that the differences appear to be independent of both the therapists' professional background and the patient factors at the start of therapy and that the primary therapist characteristic associated with higher effectiveness is the possession of strong interpersonal skills. <ref>https://pubmed.ncbi.nlm.nih.gov/8069169/</ref>

= Impactful Federal, State, and Local Policies =

'''The STOP Act.''' The Sober Truth on Preventing (STOP) Underage Drinking Act authorized community coalition enhancement grants, the national adult-oriented media campaign, the Interagency Coordinating Committee to Prevent Underage Drinking (ICCPUD), epidemiological research on excessive and underage drinking, and the annual report to Congress on state underage drinking and enforcement activities. <ref>https://www.cadca.org/stop-act</ref>

'''Facing Addiction in America: The Surgeon General's Report''' provides a review of prevention, treatment, and recovery policies and programs and discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment<ref>https://www.hhs.gov/surgeongeneral/reports-and-publications/addiction-and-substance-misuse/index.html</ref>

= Available Tools and Resources =

'''SAMHSA''' has numerous resources including:
*Behavioral Health Treatment Services Locator -- a confidential and anonymous source of information for persons seeking treatment facilities in the United States or U.S. Territories for substance use/addiction and/or mental health problems.'' <ref>https://findtreatment.samhsa.gov/</ref>
*The Evidence-Based Practices Resource Center which provides communities, clinicians, policy-makers, and others with the information and tools to incorporate evidence-based practices into their communities or clinical settings. <ref>https://www.samhsa.gov/resource-search/ebp</ref>
*"Selecting Best-fit Programs and Practices: Guidance for Substance Misuse Prevention Practitioner," This resource places the selection of programs and practices within the broader context of evidence-based prevention and covers the value of embedding program and practice selection in a strategic planning process. It provides information on programs and practices, how to choose among them, and tips for their adoption, adaptation, and implementation, and continual improvement. <ref>https://www.samhsa.gov/sites/default/files/ebp_prevention_guidance_document_241.pdf</ref>

'''BJA''' has published "Promising Practices Guidelines for Residential Substance Abuse Treatment." This aims to assist correctional administrators and practitioners at the state and county levels in establishing and maintaining programs that adhere to the promising practices suggested by current research and related standards developed for substance-use disorder treatment and criminal justice programming. <ref>https://bja.ojp.gov/library/publications/promising-practices-guidelines-residential-substance-abuse-treatment</ref>

'''SAFE Project''' offers a Treatment and Family Support Locator> to "find critical resources and options best matched to your needs or the needs of a loved one." <ref>https://www.safeproject.us/safe-treatment-family-support-locator/</ref>

'''The National Association of Addiction Treatment Providers''' has a web page titled "Navigate Treatment Options. This provides addiction and treatment FAQS as well as evaluates new methods based on developments in neurobiology and behavioral health, integrating practices within a best practice bio-psycho-social-spiritual treatment model. <ref>https://www.naatp.org/addiction-treatment-resources/types-treatment</ref>

'''American Addiction Centers''' provides Treatment Solutions an online resource dedicated to helping people find solutions that meet their specific treatment needs. <ref>https://treatmentsolutions.com/admissions/</ref> It also provides a succinct overview of SAMHSA programs, Grants, and treatment services. <ref>https://treatmentsolutions.com/treatment/rehab-guide/samhsa/</ref>

'''Optum Health Education''' Current Opioid Prescribing Guidelines: Ensuring Safe and Effective Pain Management.<ref>https://www.optumhealtheducation.com/disease-management/opioid-guidelines-2023?utm_source=Newsletter&utm_medium=email&utm_content=Available%20On-Demand%21%20Current%20Opioid%20Prescribing%20Guidelines%3A%20Ensuring%20Safe%20and%20Effective%20Pain%20Management&utm_campaign=09%2001%2023%20Opioid%20On-demand%20Eblast%201&vgo_ee=g/XZU9F9RR9uQVFxDgSGQhNXozItrmfJ0XlBPTuZT3b4VXZJ8K5nKlO8b6S7iOJohkQ%3D%3AfSJLSPlvPLxD/qAWDDWceG4an0rqTuC2</ref>

= Promising Practices =

'''Drug Free Communities (DFC)''' There are hundreds of local substance use prevention coalitions that have participated in the DFC Program. Funding by the White House Office of National Drug Control Policy (ONDCP) provides up to $125,000 per year for five years to local community coalitions to apply evidence-informed strategies. <ref>https://www.whitehouse.gov/ondcp/grant-programs/dfc/</ref>

'''New Jersey''' There are nearly 400 Municipal Alliances in New Jersey -- all organized to provide substance use prevention education services.
Each alliance focuses on its community’s particular needs and may include: <ref>https://www.sussex.nj.us/cn/webpage.cfm?TID=7&TPID=6596</ref>
*parenting workshops to enhance parent’s ability to assist their children to live a healthy and drug free lifestyle,
*peer leadership programs to train students to develop leadership skills and goal oriented behaviors and to be role models and helpers to other students,
*drug awareness events that offer families and community members drug-free activities while providing information about substance abuse and community-wide prevention programs, and
*collaboration with the Division of Senior Services to provide education on potential consequences of medicinal interactions with other medicines, over-the-counter drugs, or alcohol.

= Sources =