Rip van Winkle woke up from a 20 year sleep to discover the world had changed —he missed the American Revolution and he needed to get up to speed with what was new. Like Rip, I am trying to get up to speed with the changes that have happened in the world of behavioral health during my 12 year absence. When I returned I discovered something revolutionary—the use of recovery as a comprehensive way to deal with mental illness. I missed the beginning of this revolution.

I recall recovery was used primarily to describe persons who were successfully living lives of sobriety after problems with addiction. "He or she is in recovery," meant the person had found a way to manage the problem and get on with a better life usually aided by support groups like Alcoholics Anonymous. Today the process of recovery is also being used to overcome depression, anxiety, and on-going mental illness.

What is new to me is not new to the people I work with at TERROS and CHOICES Network who with their colleagues in other treatment settings are creating a revolution in behavioral health care. The people who lived through the American Revolution knew what it was about. Rip had to catch up and figure out what had happened. The recovery revolution is not as big as the American Revolution, but it is a significant change, and I am trying to understand what it means for all of us.

When did the Revolution begin?
I began my re-orientation with a basic question: when did the principles and processes of recovery, which for decades has been the foundation for addressing addictions, become a helpful way to deal with mental illness?

I went to the web site of the Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency responsible for improving both mental health and substance abuse services. The web site states:

"Over the years SAMHSA has demonstrated that—prevention works, treatment is effective, and people recover from mental and substance use disorders."

I also found a statement by SAMHSA that said "recovery is the single most important goal for the mental health services delivery system." The recovery revolution likely began in the early 1990’s on both national and local fronts. But what is meant by recovery?

What is meant by Recovery?
I frequently hear the word recovery in conversations, and I see it everywhere. Does it mean the same thing when referring to mental health recovery as it does referring to substance abuse recovery? Going back to SAMHSA we find a definition that is a good place to start.

"Mental health recovery is a journey of healing and transformation enabling a person with a mental health problem to live a meaningful life in a community of his or her choice while striving to achieve his or her full potential."

Many who personally know about recovery would likely agree with that definition, and they would use their own words to describe what recovery means to them. Here are quotes from TERROS and CHOICES Network clients describing their experience of overcoming mental illness or substance abuse, and in many cases, the combination of both disorders.

"I’m 51 years old, and for the first time in my life, I feel normal."

"Recovery means every day I chose to be a wonderful and sober mom for myself and my children."

"I’m fighting for my life here so I don’t slide back into that deep, black hole of hopelessness."

"Recovery means I keep moving forward despite setbacks."

Is recovery from addictions, mental disorders, or a combination of the two a similar process? I am learning that the answer is "yes." Our understanding of recovery comes to life when real people find healing and a better life. An example is Paula.

Recovery is Working for Paula

Paula has been dealing with a major mental health issue since her early 20’s. She graduated with honors from a prestigious art and design college. "Then I collapsed, and the psychiatrist told me I had a nervous breakdown." Paula describes her next 18 years as a long, horrendous struggle. For the past year she has been receiving services from CHOICES Townley Clinic. Her life is better because she is learning how to live a recovery life style. She has her own apartment, is active in the community, and is successfully managing her illness and her day to day life.

When asked to identify the factors in her recovery, Paula says, "support systems are so very important for persons with mental illness. It is very important to be pro-active in your recovery program, develop a strong relationship with people who care about you, and if necessary, use advocacy to gain your rights. Sometimes things happen to you that may not be fair, but you’ve got to keep going."

Ingredients of Paula’s Recovery

There are common ingredients of the recovery process. SAMSHA has identified 10 fundamental components. At least four of them can be seen in how Paula is living recovery.

Self-Direction

The recovery process is directed by the individual who defines her or his life goals and finds a personal path to those goals. When I met Paula I got a sense of how important it is for her to be in charge of her recovery and her life.

Empowerment

Through empowerment a person takes charge of their own destiny. Paula understands it is her job to recover, and she strongly advocates for herself.

Non-Linear and Continuing

The recovery path is not flat and smooth; there are hills and valleys. With support from others Paula keeps moving forward living a meaningful life.

Peer Support

Support from others plays an invaluable role in recovery. Paula is connected to others at church, in support groups, with her treatment team, and her parents.

Real life stories like Paula’s and a growing body of research convinces me that living the recovery philosophy is an effective way to deal with mental illness as well as substance abuse.

Treatment Centers are Becoming Recovery Cultures

Something else was occurring during my Rip van Winkle absence. The recovery movement is not only giving new hope to individuals—it is changing organizations. Treatment centers like TERROS and Choices Network are exploring how to become recovery-oriented systems of care. Recovery is more than a new treatment modality; it is a different way of thinking about care, and it is a comprehensive response to persons wanting help.

An organization that is developing a recovery culture aligns all aspects of a treatment organization with the philosophy and process of recovery as it is experienced by an individual. It is:

A welcoming place that exudes hope.

A place of positive relationships for everyone.

A place to develop new skills and personal strengths.

A place of acceptance and understanding when there are slips and setbacks.

A place of self-help and peer support.

A concrete example of change that is being pushed forward by recovery is the emergence of a new helping person.

Recovery Coaches – New on the Scene

A new worker on the scene- at least new to me—is the recovery coach, also called a peer to peer specialist. This role reminds me of the traditional AA sponsor except the recovery coach works from inside a treatment setting. Sponsors are generous persons who are walking the recovery path and are eager to share the wisdom of their experience. The role of the recovery coach is similar. A mother in a crisis describes what a recovery coach did for her.

"The day my beautiful baby boy was born I tested positive for alcohol and drugs. My ability to be a parent was questioned by Child Protective Services (CPS.) I was shocked. At the first CPS meeting I met a recovery coach from TERROS Families First Program. She became a life line for me and my family. She understood the complexity of my situation because she had been there herself and she was able to help us through the fog from an ‘I’ve been there’ perspective. She guided me to treatment and supported me through my struggles, my slip, and finally success with sobriety. My sober life is really enjoyable. My children are healthy, and my husband and I are creating a stable home for them."

The recovery coach was able to do a number of helpful things for her client:

She made a timely pre-treatment connection; it was her job as a recovery coach to be at that CPS meeting. It was the right moment for a personal link.

Her knowledge came from personal experience, and the client quickly trusted her.

She was living proof that a better life—a life of recovery—is possible.

From Meth Addict to Recovery Coach

Where do recovery coaches come from? They come from the place of having been there, having survived the ordeal, and now they are living life to the fullest. Kimberly, who is now a recovery coach, was hooked on methamphetamines. She was also helped by a recovery coach. After treatment she continued with active participation in support groups, and she found a job in a child care center.

She was approached about her interest in becoming a recovery coach, and she jumped at the opportunity. She completed the training program, and is now working full time as a recovery coach. Her training and her on-going recovery experience gives her the opportunity to do for others what her coach had done for her. Her life has come full circle, and others will benefit.

For decades people in recovery, at every professional level, have made contributions as staff of treatment centers. An extensive body of research attests to their effectiveness. Still, it is a bit startling to learn about a meth addict who is now an effective recovery coach. On second thought, it is more than startling —it is inspiring.

The Job of a Recovery Coach

What specifically does a recovery coach do? Kimberly’s job includes:

Assisting with connections to treatment.

Supporting persons in treatment and recovery groups.

Making home visits.

Coaching through hurdles and recovery’s ups and downs.

Providing recovery skills training by example and on-the-spot teaching.

An Emerging New Discipline

Recovery coaches and peer support specialists are becoming a key ingredient of the expanding recovery movement in substance abuse, mental health and co-occurring disorders. The Arizona Department of Health/Division of Behavioral Health Services reports:

"The growing body of scientific evidence and the personal, real-life experiences of individuals in recovery from addiction and mental illnesses support development of the role of peer workers as a unique discipline within the behavioral health workforce. The peer worker may be either an employee or volunteer/unpaid."

 

Wounded Healer

Perhaps recovery coaches and peer support specialists are contemporary wounded healers. For centuries, in cultures throughout the world, wounded healers have been important persons to bring health to individuals and families. They have been through an ordeal themselves; they have survived it and been positively changed by it. When they add their understanding to what they have experienced they have deep wisdom to bring to others. The wounded healer has had a limited role in western mainstream health care. However, they continue to be key persons in Native American communities.

I doubt many recovery coaches or peer support specialists identify themselves as wounded healers. However, the hope they bring to those in need is like the ancient tradition. Through their recovery they have profoundly changed themselves and found a positive way to live with their affliction. They have more to offer than simply "I’ve been there too." They have learned to distinguish what is core to recovery and at the same time understand every person’s path to improved health is unique. Recovery coaches don’t need to call themselves wounded healers, but I think it is important to understand they are a contemporary expression of a powerful healing tradition.

Over-doing Recovery

I have certainly come to the conclusion that a deeper and broader understanding of recovery principles is an exciting development. However, when we discovery a really a good thing, we sometimes over-do it. Too much of a good thing would be:

Making recovery prescriptive. This would be a failure to remember that every person finds his or her own way.

Recovery becomes a value judgment separating people into two groups.

The word itself gets over-used, tired, and becomes a cliché.

Future Possibilities

My concerns about over-doing recovery don’t diminish my enthusiasm. I now understand recovery is a helpful process to manage and live with and above mental health issues as well a substance abuse. Does it have other applications? I think so. The benefits can go beyond the boundaries of mental health and substance abuse treatment.

Recovery can be:

A way to manage and live with other chronic illnesses like diabetes and cancer.

A way to live life as fully as possible, for as long as possible, with the diagnosis of an incurable disease.

A way to heal from the trauma of losing someone you love, a job, your health, or financial security.

The benefits of recovery philosophy and process should not be limited to substance abuse and mental health.

One Last Question

Most of the questions I had when I began catching up from my Rip van Winkle absence have been answered. One last question: "Is recovery a result only – like sobriety and symptoms managed—or, is it a way to live life to the fullest?"

The answer: It’s both.