FROM ABSOLUTES TO CONTEXT:

THE ROLE OF PEERS IN THE CHANGING PHILOSOPHIES OF ADDICTION

AND RECOVERY

Patrick Roff MA, LCADC, CPRS, CPP

Center of Addiction Education Recovery and Success (CARES)

Morris County Prevention is Key

Rockaway, NJ

proff@mcpik.org

OUTLINE

1. The Emerging SUD Peer Workforce

2. The History of Peerness in Addiction & Recovery

3. Two Languages of Addiction and Recovery

4. Creating a Coherent Philosophy of Peerness for SUD

5. SUD Peer Work in Action: Theory and Practice

THE EMERGING SUD PEER WORKFORCE

Message From SAMHSA

The effectiveness of peer support

• Educating through shared Lived Experience

• Empowerment of Service Recipients

• Reduction in Self- Stigma

• Long-term Recovery Management

• Reduced Morbidity

THE EMERGING SUD PEER WORKFORCE

The Need for Training and Credentialing

International Credentialing & Reciprocity Consortium

(IC&RC)

The Peer Recovery Credential (PR)

• Ethical Guidelines

• Advocacy

• Mentoring and Education

• Wellness and Recovery

A HISTORY OF PEERNESS

The Field of Addiction & Recovery

• Origins

• The Peer = Experientially Credentialed

• Professionalization

• The Clinician = Academically Credentialed

• Danger of Losing “The Wounded Healer”

• Peer Recovery Specialists as New Wounded Healers

THE ROLE OF LANGUAGE

The Relationship Between Language & Reality

Two Paradoxes

Mirrors Creates

Reveals Obscures

TWO LANGUAGES OF ADDICTION & RECOVERY

Paradoxical Nature of Language Applied to Addiction & Recovery:

Two Languages Emerge

1. Traditional and Absolute

Singular/Exclusive/Objective

2. Contemporary and Contextual

Multiple/Inclusive/Subjective

TWO LANGUAGES OF ADDICTION & RECOVERY

When The Two Languages are Complimentary:

The Creation of a Holistic & Coherent

Philosophy of Peerness

Becomes Possible

THE LANGUAGE OF ABSOLUTES

When Something is Understood in Absolute, it is:

Given Assumed & Implied

Universal Comprehensive & Independent

Unequivocal Authoritative & Certain

Permanent Forever & Unchanging

ABSOLUTE ADDICTION

The Definition of Addiction is:

Given we all know what it is

Universal it is the same every time

Unequivocal without doubt

Permanent one way street

THE VALIDITY OF ABSOLUTE ADDICTION

DSM IV

• Abuse & Dependence

• Problems are uniform, discernable & treatable

• Authority & Objectivity of Science

• Certainty in Diagnosing of a Disease

• Matches Tradition of Alcoholics Anonymous

• Exclusivity of Unique “Spiritual Malady”

ABSOLUTE LANGUAGE OF DSM IV

THE PROBLEM OF ONE LANGUAGE OF ABSOLUTE ADDICTION

Singular -- The “Yes” and “No”

of a Diagnosis

Exclusive -- Absolute Uniformity of

the Disease

Objective -- Absolute Certainty in the

need for Recovery

False Hopes

&

Stigma

ABSOLUTE RECOVERY

The Definition of Recovery is:

Given we all know what it is

Universal it is the same every time

Unequivocal without doubt

Permanent one way street

ABSOLUTE RECOVERY

Yes NoAre you Clean And Sober?

THE VALIDITY OF ABSOLUTE RECOVERY

80 years of Enduring Success

• Simplicity of Abstinence

• Maintenance of Cognitive/Behavioral Changes

• Countless Millions Helped

THE LANGUAGE OF CONTEXT

When something is understood in Context, it is:

Diverse Unalike & Unfamiliar

Unique Specific & Personal

Fallible Human & Imperfect

Grounded Supported & Justified

CONTEXTUAL ADDICTION

The Definition of Addiction is:

Diverse Unalike & Unfamiliar

Unique Specific & Personal

Fallible Human & Imperfect

Grounded Supported & Justified

CONTEXTUAL ADDICTION

DSM 5

Substance Use Disorder

A Continuum Rather than a Dichotomy

Mild Severe

Moderate

DSM 5

Mild Moderate Severe

A Substance Use Disorder exists on a continuum over a lifespan

THE VALIDITY OF CONTEXTUAL ADDICTION

DSM 5

• Absolutes Alienate Mild and Moderate Users

• The Ending of Absolute Dichotomies

Innovative Treatment

• Motivational Interviewing

• Emphasis on Meet the Person Where They Are

• Rather than Confrontation

THE PROBLEM OF ONE LANGUAGE OF CONTEXTUAL ADDICTION

• Multiplicity – Problem of “not now”

or “depends”

• Inclusive – Loss of a tangible definition Inaction & Indecision

of the Disease

• Subjective – Obvious Need for Recovery

becomes relative

CONTEXTUAL RECOVERY

The Definition of Recovery is:

Diverse Unalike & Unfamiliar

Unique Specific & Personal

Fallible Human & Imperfect

Grounded Supported & Justified

THE VALIDITY OF CONTEXTUAL RECOVERY

SAMHSA

Four Domains of Recovery

1. Health

2. Home

3. Purpose

4. Community

Self -Defined

&

Person-Driven

THE VALIDITY OF CONTEXTUAL RECOVERY

SAMHSA - 10 Principles of Recovery

1. Hope 6. Relational

2. Person-Driven 7. Cultural

3. Many Pathways 8. Trauma-Informed

4. Holistic 9. Strengths-Based

5. Peer Supported 10. Respect

THE PROBLEM OF ONE LANGUAGE OF CONTEXTUAL RECOVERY

Excessive Diversity --- No Common Ground

Terminal Uniqueness --- Immunity from harms Rudderless &

Vague

Endlessly Fallible --- Indecision & Apathy

Unmovably Grounded --- Isolation & Rigidity

COMBINING THE TWO LANGUAGES:EMBRACING PARADOX

Addiction:

Given Universal Unequivocal Permanent

Diverse Unique Fallible Grounded

Recovery:

Given Universal Unequivocal Permanent

Diverse Unique Fallible Grounded

A COHERENT PHILOSOPHY OF PEERNESS

FOUNDATION OF ABSOLUTES & CONTEXT

BUILT ON THREE PILLARS

Mutuality ……………We identify and support – learn from our sameness

Reciprocity …………We give and take – learn from our differences

Pluralism ……………We respect different paths

SUBSTANCE USE DISORDERPEER WORK

Scope of Practice

Non-Clinical Assistance

Support & Support Services

Contextual Peer Identities

Abstinence Peers

Harm Reduction Peers

Family Peers

SUD PEER WORK

Contextual Peer Roles:

Confidant & Truth Teller

Coach & Cheerleader

Mentor

Case Manager

Navigator

SUD PEER WORK

Contextual Settings:

Peer Run Recovery Centers

Treatment Centers & Sober Living

Courts

Jails

Hospitals

Government Agencies

SUD PEER WORK

Contextual Services:

After-Care Planning

Re-Entry

Crisis Intervention

Recovery Management

Linkage to Outside Resources

Individual & Group Sessions

PEER WORK ACROSS A RECOVERY CONTINUUM

• Person Still Using

Peer

• Referral to TX

Peer• Early

Recovery

Peer

• Stabilization

Peer• Recovery

Maintenance

Peer

SUMMARY

The Paradox of Addiction & Recovery Language:

• Creation of Coherent Peer Philosophy

• Built on Theoretical Foundation of Absolutes & Context

• Operating From Three Pillars:

• Mutuality/Reciprocity/Pluralism

• Articulation of Contextual Peer Identities

• Identification of Contextual Peer Roles

• Operating Context-Based Environments

• Quality Peer Services Across a Recovery Continuum