All right, without any further ado, let's get started. So good afternoon, everyone, and welcome to today's webinar, titled Harm Reduction and Recovery Support Services, Complementing and Supporting Pharmacotherapy for Substance Use Disorders, hosted by the Providers Clinical Support System in partnership with the National Council for Mental Well-Being. Thank you all for joining us today. So before we begin, I'd like to cover a few housekeeping notes. Today's webinar is being recorded, and all participants will be kept in listen-only mode. The recording and slides will be made available on the PCSS website within two weeks. And there will be an opportunity to ask questions at the end of the webinar, so we encourage you to submit your questions throughout the webinar in the Q&A box located at the bottom of your screen. So today's presenter is Elizabeth Burden. Liz is a senior advisor with the National Council for Mental Well-Being. In this capacity, she works to advance substance use prevention, treatment, and recovery support services while providing technical assistance and training to a wide range of organizations and participants. Liz also has experience leading diverse for-profit and non-profit organizations. She has provided consultations to non-profits and developed and presented trainings around the country under the funding initiatives of several federal agencies and programs. Liz has no relevant financial relationships with ineligible companies to disclose. The overarching goal of PCSS is to train healthcare professionals in evidence-based practices for the prevention and treatment of opioid use disorders, particularly in prescribing medications as well as for the prevention and treatment of substance use disorders. At this time, I'd like to turn it over to Liz, who will review the educational objectives and begin the presentation. Thanks so much, Emma. Thanks to those of you who put in the Q&A that the chat is disabled. I'm not sure if we can rectify that. If we can, Emma or Casey, please do so so that people can type in both Q&A as well as the chat. And good afternoon, everyone. Thanks, Carrie-Ann, and welcome. So we have four learning objectives for our conversation today. I'm going to summarize the differences between the acute care treatment model and the recovery-oriented system of care model, and hopefully by the end, you all will be able to do so as well, as well as recognize the research that supports recovery-oriented and harm-reduction approaches as two separate, distinct, yet complementary or parallel approaches. After the session, you should be able to describe the role harm-reduction practices and recovery support services can play in supporting clinical use of medications for addiction treatment. And in that, we think broadly, not just medications for opioid use disorder, but also for other medications like those that are used for alcohol use disorder, and as an extension, maybe farther down, medications that are used for tobacco use as well. And lastly, to identify strategies to implement and sustain harm-reduction practices and recovery support services within substance use disorder treatment provider organizations. Before we go to the next slide, though, it would be great for me to get a sense of who's in the room. So we have a poll that we've developed for that. So Emma, can you bring up the poll? So if you will, will you just indicate your role? And that will give me a sense of how I might frame some of this. Okay, we'll just take another 30 seconds. And thanks to those of you who are putting the other in the chat, we've got some researchers, we've got a really diverse audience. So I'm gonna encourage you all to, as Emma noted, put your questions in the chat, excuse me, questions in the Q&A and also have a conversation in chat as well to help with this because we do have a really diverse audience that's here with us today to cover all of the use cases, if you will, of the information that I'm going to share. Thanks for that, Casey, you can, excuse me, Emma, you can end the poll, it's very helpful. And just to share the results so that all of you all can see the diverse group that's here as well. Next slide, please. So I wanted to start our conversation today with talking about the paradigm shift that started 15, 20 years ago around substance use disorder treatment and is still ongoing, if you will, today. Next slide, please. So part of the paradigm shift really has to do with the changes in the science of addiction and our understanding of that science and what the process of addiction, the science tells us about the process of addiction. We know the way that the system was designed back in, what, 50s, 60s, 70s, was an acute model of substance use disorder treatment where in theory, the model was an individual would go into treatment, they would come out of treatment and resume their life, love, work, and play, and life in the community where they had housing, belonging, all of these kinds of things that were at their disposal after an acute episode, whether that be 30 days, 60 days, 90 days, or maybe even longer in the past, and that there would be one episode, they would come out, would be in remission and move forward with their lives. Next slide, please. We know how the acute model actually worked and in those places where there has been less of a shift toward recovery-oriented systems of care, the way that it still continues to work is more like what we see on the screen here where someone may go into detoxification and then they go into treatment and then they have a second episode of treatment and they go out in the community and then they go back into, that it tends to be a more cyclical process within that left-hand circle that we may have peer support now as a part of that continuum and that happens after treatment in the acute care model. And then there's a return to, if you will, love, work, and play, housing, and all the things in community, a life in the community in recovery. Next slide, please. What we know about that traditional acute care approach to recovery is like a burning building and many of you may have heard John Kelly, who's with the Recovery Research Institute, talk about this and his model. And this is borrowed from a presentation by John Kelly. And what he talks about and what the research supports is that the system, that acute care system is doing a pretty good job of stabilization and helping people to abstain from use, if you will. It can do a good job of that and of detoxification as well, if and when that is needed. That that system is less well-structured for preventing re-ignition of the burning that happened with the individual building, if you will, that is less prepared to do relapse prevention. And this model, Kelly talks about the need for doing architectural planning to basically rebuild a building that has had fire damage and in the treatment and recovery space, that means a recovery planning, the architectural planning, which under the acute care model is almost totally neglected, right? So it's thinking about post-treatment or sometimes in lieu of treatment, what are the things that need to be done to really think about how to rebuild the structure in a way that is sustainable across time. Then he also poses that what is largely absent in that acute care model is rebuilding materials, that would be recovery capital. And some of the science around the recovery capital that we're gonna talk about really shows that those rebuilding materials are important, especially at particular points in the recovery process. And then lastly, that Kelly would note that granting rebuilding permits, that is removing the legal or structural barriers to recovery, that is expunging criminal records, for example, are rarely considered or that the acute care model does a poor job of granting those building permits. That again, acute care does a very good job with the first bullet and may address the second bullet, but the others are largely missing. And he would posit that all five of these things are really necessary for a life in recovery to really fully be built. Next slide. And so in some respects to address those limitations of the acute care model, recovery-oriented systems of care as a model emerged in the 1990s and the 2000s, if you will, about helping to build those last three bullets, if you will, helping to build the recovery planning into the process, helping to build recovery capital, helping to remove barriers to a quality life in recovery. And so recovery-oriented systems of care in many respects help to try and answer the question, what connections are not yet in place for a person and what needs to be done to establish or reestablish them and cultivate them? So recovery-oriented system of care really looks at taking the definition, if you will, SAMHSA's definition of recovery that includes health, home, purpose, and community and ensuring that all of the systems or institutions, organizations that an individual may come into contact with in the community are there as a complement, as a supplement, as an integration to the care that they are receiving as a part of perhaps a treatment process, or again, sometimes in lieu of treatment, but in this context and the context we're talking about today as a supplement to treatment in which medications are being used as a part of the recovery process. Next slide, please. And so I presume because of you all's work that you're extremely familiar with the science of addiction. So we're really not gonna cover that here. There's a deep and growing body of knowledge about what happens to the brain and the body during the addictive process and what happens in how you obviously in your roles, many of your roles, how you're clinically diagnosing substance use disorder up and to and through addiction, if you will. I think there's less knowledge and there's an emerging body of knowledge over the last decade or a little more that really relates to the science of recovery. And these are, again, complimentary core bodies of knowledge, if you will, in which there, if you were to do a Venn diagram, there is some overlap, if you will, in the interests and in the questions that the researchers ask, but there's a different process and different way of thinking about it that comes from the science of recovery. Next slide, please. And so I wanted to start with this, a slide that's actually from the CDC and a part of one of their campaigns about prescription or medication, prescription use and abuse, if you will, that may lead to substance use disorder issues. Recovery is amazing and you get to a place where you're proud of yourself again. And I think that's the ideal sentiment, if you will, that may underlie a lot of the research, if you will, of the science of recovery. Next slide. So what is recovery? This is the SAMHSA definition from back in 2012, a process of change through which individuals improve their health and wellness, live a self-directed life and strive to reach their full potential. I think a part of the science of recovery is looking at those components, if you will, that are very different from the diagnostic criteria of what is an addiction, right? What does it take to restore a life, put out the fire and then do all of those things that are restoring the burning building, if you will, are within this definition of recovery. A couple of things that are always important to note to me about this definition is it doesn't actually talk about abstinence as a part of the definition. That may be one person's, an important part of one person's path towards recovery, but it's not, and it may be necessary in many people's paths toward recovery, but it's not necessarily the center of this definition of recovery. Next slide, please. And so I'm gonna start this talking about the science of recovery with actually some research back in 2007 by Dennis Foss and Scott that actually did look at abstinence-based recovery over time. And what this research said to us was really about looking at the course of recovery and how abstinence looks after a period of one to 12 months, one to three years and four to seven years. And what this research study told us is that after one to 12 months, only about a third of people with one to 12 months of abstinence would sustain it for another year. And after one to three years, two thirds of those will make it another year. And after four years of abstinence, 86% of those will make it another year. But even after seven years of abstinence, about 14% of those who have abstinence-based recovery across time might still, this study says, or relapse might return to use. Now, this study, again, didn't address multiple pathways for recovery, and they were defining really recovery as abstinence. But one of the important things I think that this says is that there are key points in that process where recovery supports and harm reduction might be important for us to talk about. And it might also explain a little bit more in that acute care model why we were seeing a revolving door. Next slide, please. The other piece of that same study by Dennis Foss and Scott tells us, however, that there are some key milestones or tasks that happen at each of these points as well that also indicate the potential importance and that future science, if you will, science after 2007, looking at the recovery process, tells us about recovery supports, about peer recovery supports, about other types of services and support that might be important to have. Because what they found is of that population in the one to 12 months, there's evidence of more clean and sober friends. Again, this being their language, not necessarily the language we would use today, but that there would be more pro-social friends, if you will, who are in recovery. There would be less illegal activity and incarceration, less homelessness, violence, and victimization, less use by others at home, work, and by social peers. And at one to three years, you would see the virtual elimination of illegal activity, illegal income, better housing and living situations, and increasing employment income. And within four to seven years, there's more social and spiritual support, better mental health, housing and living situations continue to improve, like they may move from being renters to homeowners, for example, a dramatic rise in employment income, and a dramatic drop in people living below the poverty line. And so again, this indicates both those recovery support services, as well as recovery capital that may be being built across time that helps people live a life that has health, home, purpose, and community, those four elements of the SAMHSA definition. Next slide, please. This is another slide borrowed from John Kelly. And what's important to note in this particular slide, it does reference, again, his burning building metaphor and expands that timeline, if you will, that Foss and Scott talked about to have an earlier, even initial zero to three months, and then a four to 12 months, and then a one to five year, and then a five plus years. So he adjusts the timeframes a little bit, but it's the same concept. And what he talks about in this more recent research that he and his team has done, that the convalescence, the fire is out, happens at that zero to three months. And that the curve is the improvements and functioning and quality of life that happened across this time. And so, he's got them at third of the way down, if you will, that there's some functioning and some hope. And then the dawning reality that he would call the alarm or the smoke that's clearing with the mind clearing as substance use is reduced or fully eliminated that there's actually a drop in functioning. And that this can be explained by the dawning of reality of all the things that have been lost in the state of one's life at this particular point in time that is a point of importance of intervention, especially of peer recovery and other recovery supports to help bolster people at that dip and keep them moving through the dip and towards the upward curve that we start seeing at the 12 month point that is the rebuilding, supplying some of those rebuilding materials and recovery planning that says, you can do this, you can make it. Yes, things may seem overwhelming at this point, but we're here with you, we're in this together and life does get better, things can get better. And so, the reconstruction that happens, especially in that year one to five with those building materials, those building permits are crucial. And then at that kind of five year period, the need for those recovery supports doesn't necessarily go away, but it shifts across time towards growth, towards preventative risk-based maintenance that is really individualized. I think it's also important, even though we won't talk about it here, to look at some of that research and that John Kelly has done about this because he also explodes this across different populations now to show how those curves look different depending on the substance used, depending on the demographic characteristics and the like, that there are some differences in the look of this curve as well. And differences that include, I think he has one graph that also looks at those who are using medication as a part of their recovery process and how their curve might look a little different as well. Next slide, please. There's also some other recovery research around the dimensions of recovery that I think John is also working into some of his new frameworks that are really coming out of the UK and looking at both mental health and substance use disorder recovery, especially among criminal justice populations, not solely, but that is a big part of the body of research. And that Leni Bird-Lebottier, probably massacring his name, Williams and Slade in 2011, and there's been research since this time building on this notion of that there are, in their framework, five things that are important, dimensions of recovery for moving forward. And again, you can also see how some of this shifts across time in their research. So connectedness being the first one. And I know that you have probably heard many people in the field talk about the opposite of addiction is not necessarily recovery, it's connectedness. And through that connectedness, that people are then able to engage, to further their recovery. And that's some of what the social aspects of the science of recovery does tell us. That connectedness then also helps to lead and to bolster and continue to develop hope and optimism that are important, if you will, for moving through that dip that was on that last slide and continuing back towards that upward trend. They also have, as a part of this model, identity, and that's really moving toward a pro-social identity. And that has to do with connectedness and identity being formed in relation to others in a community. Meaning being re-established and the like, or the meaning shifting from the substance, the disordered process, if you will, and the meaning of life being continually in search of a substance of choice and use toward another kind of meaning, and then an empowerment that needs to happen that is both self and community, if you will, empowerment that's a part of this particular model. Next slide, please. Out of all of this then, that there are really four important frameworks that are, again, evidence-informed or evidence-based that we talk about as being important frameworks for the process of recovery as well. They are ones that many of you may already be familiar with and use in your work. They are the stages or process of change, which is Prochaska, DiClemente, and Norcross model that was initially applied to tobacco cessation and subsequent research of theirs and others has looked at it in other health issues, not just substance use disorder related as well, health issues around understanding the process of change and believing that it's possible. Stages of recovery, which we'll go, we'll look a little bit more deeply at each of these models, but that's a model that looks at understanding the specific process of recovery from substance use disorders across time. So building on Dennis, Foss, and Scott and some of the research since that time that are looking more at the stages of recovery and theorizing some of the stages of recovery. A recovery capital research that is building, enhancing, and using existing assets to motivate and support change that building materials, as well as recovery milestones, a lifetime in recovery and some emerging research around what are some of the key, adding more depth to the Dennis, Foss, and Scott research about what are some of the key tasks that sustain growth and change across several life domains across time of a life and recovery. Next slide, please. So I'm not gonna spend a whole time on stages of change, otherwise known as, or more officially known as, more formally known as the trans-theoretical model, other than to say that there's ongoing research about this in a variety of settings. And it's usefulness in thinking about the process of change and helping people through the change that is the recovery process in our particular context. So pre-contemplation, contemplation, preparation, action, and maintenance. And again, really looking at the process of treatment and use of medications with treatment as an effect that helps people to stabilize and move through those pre-contemplation, contemplation, preparation, action. It's actually an action phase, if you will. And then the other recovery supports really helping with maintenance and moving from treatment into recovery and the rest of life as a part of that process. Next slide, please. The stages of recovery model, again, is one that William White, as a theorist and a practitioner, has put forward an evidence-informed model that talks about, very similar in many respects to the Prochaska and DiClemente, about pre-recovery engagement. And I think John Kelly is starting to talk about this a lot as recovery priming, if you will, that is the conversations that individuals, that clinicians, that peer support specialists, that social workers that can have with individuals that are in pre-contemplation or contemplation stage that primes them for moving through the recovery process. And as an aside, I think one of the things that I would share is I've had a couple of conversations that, as an example, a clinician at a tribal behavioral health clinic in Wisconsin shared that she was really working with an individual who, in some respects, in her work with this individual was going backwards in treatment and in their substance use disorder progress. And she decided to actually have them take a break and work solely with a recovery coach that was a part of their clinic. And what she talks about is in the six months that the individual stepped away from the counseling, if you will, and worked with a recovery coach, there was a process of this recovery priming that then when the individual came back into counseling with her as a licensed clinical social worker was able to really take full advantage of the tools that she had to offer because they were now fully primed for that process. And so looking at peer recovery support services as a parallel process, if you will, as a complementary process that is not replacing treatment or any clinical, we know this, but instead it is something that help with recovery priming, with recovery mentoring and recovery management and looking at this whole stages of recovery model. The second stage then be recovery initiation and stabilization, which is ostensibly where treatment occurs and the overlap with that and recovery maintenance that as people then leave acute treatment moves forward and then long-term recovery and recovery management. Again, you should see some parallels in those stages that Dennis and Foss and then John Kelly are talking about as well. Next slide. So this slide, I wanted to include some research that is around the neuroscience of social support. And why I'm including this is because a lot of the science we know of addiction or substance use disorders talks about the neuroscience and the neurobiology of the addictive process, if you will. And I just wanted to point out that there is also a body of research. It's a smaller body of research than we see of the neuroscience or the neurobiology of chemical dependency, if you will, old term. But there is a body around the neuroscience of social support. And what these researchers are looking at is that can social factors change the brain? Can they mitigate stress? Can they up-regulate, down-regulated receptor systems, if you will, that have been damaged by substance use and can they increase or by other mental health challenges actually not just substance use. And can social support increase the chances of long-term remissions from problems related to substance use disorder and mental health disorders. And the research tells us that related to psychobiology does indicate that yes, indeed, there are stress buffering effects of positive social relationships. The researchers have started to examine the possible neurobiological connections between social support and individual stress responses. So this model that's on the screen comes from a study by Hostanar, Sullivan and Gunnar in 2014, there has been subsequent research to this. Again, there's not a lot of it out there, unfortunately, but it is beginning to be more relevant. So there's research from 2006, 2014, 2018, 2019 that's really looking at this process of the stress buffering effects of social relationships. And that if you will, whole social model of recovery on which much of the science of recovery is based. Next slide. I think I need to speed up. So I wanna have a chance for us to have questions and dialogue, my apologies. So recovery capital. This is just a definition of recovery capital and those who have posited it and most of you have probably heard this, the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery. What I wanna get to, let's go through the next slide but I'm gonna go through very quickly. Next slide. Is that there are different, previous slide, I'm sorry. Thanks. Domains of this different researches top up recovery capital, if you will, in different ways. Excuse me, I need to take a drink real quick. I'm just getting over a bout of COVID and I now have a COVID cough, my apologies. So four domains, physical, human, family and social, cultural, community domains of recovery capital. Apologies, they're important for us to keep in mind. Next slide, please. Why those domains are important, and if you will, they connect to health, home, purpose, and community, those four domains, and SAMHSA's definition of recovery is that those, again, are all the areas, then, that we need to think about how social supports interact and can help build recovery capital in each of those domains. So this is a framework, again, you'll see on the slide where you see recovery mentoring and recovery management, those stages of recovery that John Kelly talks about. This is one that's an adaptation that is evidence-informed that many recovery community centers are using to think about this pathway of recovery. And so, again, the milestones of stabilization, deepening, connectedness, integration, and fulfillment, and what the experience of people in those stages of recovery are really thinking about and maybe focusing on as a part of the recovery process. So the example, during stabilization, they're committing to recovery, they're learning about recovery and about substance use disorders and perhaps addiction. They're learning about what it means and will take to heal physically. Again, that may be why that downturn and that dip that John Kelly talks about happens here, because they've learned all this, and then their realization, their awareness is, oh my God, I have to heal physically, I have to heal my brain, which is also obviously physical healing, I have some emotional healing to do, I may have to do family healing and repair all of that, and that we have to keep despair from sinking in, if you will, that we need that hope and optimism really bolstered at this point to help people to move forward. And then deepening, connectedness, integration, all of those have different experiences at that time that peer recovery supports and recovery supports can help to bolster. And thanks for the comments in the chat, I love this chart needs to be on all our walls and it's an insurmountable job without social support, thank you all for that. I'm glad that you all are having the conversation in chat. Next slide, please. And so this may be a duh, but I wanted to present it anyway, what exactly are recovery support services? So there are a broad range of non-clinical services that assist individuals and families to recover from alcohol or drug use challenges. They include social support, linkage to and coordination among allied service providers and a full range of human services that facilitate recovery and wellness contributing to an improved quality of life. I'm reading this definition, that's why I'm looking to the side. These services can be flexibly staged and may be provided prior to, during and after treatment. Recovery support services may be provided in conjunction with treatment as separate and distinct services to individuals and families. That's SAMHSA's definition from 2008. And why I talk about that is, sometimes in conversations people will say, well, recovery support services, that's just social services. And I think there are some things that differentiate recovery support services from our old thinking and definition about social services, which are very important. There is something that distinguishes housing as a social service from housing as a recovery support service. And I think it has to do with how we think about and incorporate the previous things that we've been talking about, about the stages of recovery, about the whole recovery process into the service that is recovery housing or housing that differentiates it from a social support. And I don't even wanna say a mere social support because we know that housing is a crucial support for recovery. But again, how we do housing, how we support housing and recovery and how we think about it differently is what makes it a recovery support service. Next slide, please. All right, and so I'm coming back to this. What connections are recovery support services in this recovery-oriented system of care? We focus on the not yet, what connections are not yet in place and what needs to be done to reestablish them. So if you recall on the earlier slide, some of these things were broken, like the recovery housing or the recovery support of employment, recovery support of campus, recovery community connections. So the circles, if you will, in this chart have changed slightly to really make them recovery-oriented social supports and not just social services. A recovery support of employment, what does that look like? A recovery support of campus, what does that look like as opposed to just having education that's available in the community that we refer to? Next slide, please. All right, oh, and so I already covered this. So what makes them recovery support services and not plain old social services? Person-centered and self-directed, strengths-based, supporting and augmenting the movement through those milestones of recovery, which I've already covered, integrate services and ensures a continuity of care, culturally-responsored, anchored in the recovery community, low-barrier entry, and values living and lived experience, which is also a piece of what we're trying to do is also a piece of harm reduction. Wow, I really need to speed up because we have all of our reduction to go through. Next slide, please. And so I just like for you to consider, we're really not gonna have time to chat about this a lot, but in chat to talk a little bit about, if you haven't been already, and it looks like you have, one of the main, thanks, Michelle, for your comment in chat about one of the main differentiators about the approach to trauma. Thank you. And I think that leads us into what is the value added for changing systems to be more recovery-oriented, to thinking about what makes them recovery support services versus social services, and what does or integrating that kind of support into your work mean for your organization? I know some of you are already sharing that, but if you would talk a little bit more in the chat with one another about what does it mean really to do that in the work that you're doing. Next slide, please. Because I wanna talk a little bit about harm reduction and I've really not managed my time well, apologies. We only have about five or six minutes left because I do wanna leave time for Q&A. So what is harm reduction? So there is also a science of harm reduction, and I actually would have to say, it's a deeper or older or more longstanding science than really the science of recovery. A lot of the science of harm reduction comes out of Europe. There is some that's being done here, but it's coming out of Europe and out of Canada because of their difference in the way that they approach harm reduction. Next slide. Harm reduction being a transformative approach that addresses structural harms and encompasses practical strategies and ideas aimed at reducing negative consequences associated with drug use. It's grounded in principles that center the living and lived experience of persons who use drugs, especially those in BIPOC and marginalized communities. So harm reduction is more than risk reduction. Even the risk reduction and safer practices are an important part of harm reduction. It's a different way of thinking, almost like another paradigm shift, if you will, from thinking about what are the things that we need to do in organizations and systems to address the structural harms that happen in society because of drug use, especially being illegal within most systems. And it may not mean legalization, but decriminalization and the like are a part of a broad harm reduction strategy. Thanks for that, Jamie. Yes, harm reduction is rooted in self-determination empowerment. That's one of the other pillars or principles. Next slide, if you will, that talk about pillars of harm reduction include that it's led by people with living and lived experience. And with living experience means people who use drugs, who, and the end result of harm reduction and engagement in this framework is not necessarily treatment or recovery. It really is, that might be the individual's goal in all of this, and if so, great, but that's not really a necessary element for a person to engage in harm reduction. Yes, any positive change. The second pillar embraces inherent value of people. Harm reduction commits to community, not just the individual, but community. It promotes equity, rights, and justice. It offers no barrier access to services. And I'll pause there for a moment. This isn't saying low barrier, it's no barrier. And it focuses on any positive change as someone in chat shared. Next slide. Here are some of the principles of harm reduction. I'm not gonna spend a lot of time with them. These are from the Harm Reduction Coalition. I will note that SAMHSA is actually working on a framework to update its pillars and principles of harm reduction as well. So you may see some additional principles informed by the field, not done in a vacuum, but informed by the field coming from SAMHSA later this year or early next year as well. The key thing being that harm reduction is non-judgmental, non-coercive, affirms people who use drugs as the primary agent of reducing harms in their life and in their community. All of these things are important principles of harm reduction. And so we have to think about in the context of treatment, and there are harm reductionists in the treatment world, right? And hopefully there are many of them on this call who will chime in and chat. We have to think about how we do the paradigm shift, how we transform treatment. Is it microdosing, for example, which I know there's a conversation about in the harm reduction world? What are the ways that we make access, not low barrier, but no barrier in the spirit of harm reduction? Next slide, please. So this is really what we wanted to get to. And again, my apologies for getting to it late. It is around how harm reduction practices and recovery support can support your work. Next slide. Thanks, Rachel. If treatment is not using harm reduction for clients, it is not trauma informed or using evidence-based practice. Thank you. Thanks, Erica. I'm a harm reductionist in the treatment world and love to hear more about your experience. Gregory Jacobs, yes. SAMHSA may not be revising its definition of recovery, it might be, but there is a recovery summit on the horizon where there's gonna be a conversation about it, a revisiting of what that looks like. Coming up here relatively quickly in the next couple of weeks, so thanks for that. How are harm reduction and recovery support services related? This slide kind of compares the two. You'll see common language across, right? Recovery support builds on the strengths and resilience of individuals, families, and communities. Harm reduction embraces the inherent value of people, so on and so forth. They are perhaps two sides of the same coin or twins or parallel processes of parallel thinking. Next slide. So again, and you're already doing this in the chat, what does or could integrating harm reduction, those of you who are harm reductionists in the treatment space, I would love if you would share with your colleagues in the chat, what does or could integrating harm reduction mean for your organization if you are doing it? What are the challenges that you're seeing in integrating it? What's the value that it's added in the settings that you're working with, especially those settings where medications are being used, medications for addiction treatment, medications for opioid use disorder. I know we think a lot about harm reduction in this space now as being around opioid use disorder, but it's also true of other drug use as well. So I'm really encouraged and would love to see what you all say in chat. Next slide, please, though. Let's talk about some strategies. Here's, and next slide. And so there are four kind of core components that I would pose to you based on some of the research that's come out of the harm reduction field about integrating harm reduction practices into your work that you all may already be doing. That includes assessing overdose risk, and likely all of you or many of you are doing that, so doing a collaborative risk assessment. And there are tools out there that you can find that are tools for assessing and reducing risk and doing risk reduction planning, doing safer practices planning in clinical settings that also look not only at safer practices, but around questions around safer settings, around safer supply, around safer transitions to care, all of which are part of, I think, the harm reduction framework that harm reductionists have used for a long time, and that may be a part of the new SAMHSA framework that's coming out. So, and that being a collaborative process. And so on this slide, we have some of the strategies and you all, I'm sure, could add others and administrative concerns about integrating these into a clinical setting. Overdose education and naloxone distribution, key. Again, naloxone distribution is a safer practice. And of course, as medications for opioid use disorder and addiction treatment as well, are in and of themselves safer practices, harm reduction practices. And so this is also really looking at integrating other things into a comprehensive program to work with individuals. So in addition to overdose education and naloxone distribution, there are other harm reduction strategies, such as providing access to supplies, such as fentanyl test strips and syringes and hygiene kits and all of those kinds of things that there is a depth of research that supports all of this really working both for harm reduction and promoting a path towards recovery. And then lastly, linkage to a community-based harm reduction services as well. So when they're outside of your clinical walls, where are the other places to get support in the community? Next slide. And then this is a framework on integrating peer recovery support services into clinical settings as well. And there are some essential elements that are on this slide. You all can see this and download it at your leisure. There are design factors to think about. There are some drivers of success and there are some process steps, if you will. So train peers is an appropriate one. I'm really thinking about choice and access as essential elements. Centering lived experience in that, again, partnering. These are all things that we need to think about when integrating peer recovery support services into settings where you're using medications and how to really, again, shift from, I know it's falling out of practice, but from medications for addiction treatment and medication-assisted treatment to medication-assisted recovery, if you will, and what that looks like. Next slide. And the last thing I'll just talk about and we'll have a few minutes for questions is to talk about, we often encourage people in integrating either harm reduction or peer recovery support services to think about what is the ideal participant journey in your clinical setting that, to think about that and to map that client journey, if you will, and then what are the barriers to that ideal journey? And what are the ways that recovery support and harm reduction might help to address those barriers and to move people through what you're envisioning as an ideal participant journey from day one, an intake into your clinical setting to the output as well. And with that, I'm gonna start talking and hopefully we can answer just a few questions. So next slide, please. Thank you so much, Liz. That was a lot of great information. There's a lot of compliments for you in the chat, just really appreciative of all the information that you've shared with us today. So the first question is removing barriers to recovery, such as a criminal record, important in all aspects and dimensions of life. Would a criminal record really stop someone or anyone from recovering? I think that's a good question and thank you for that. And again, I would encourage you all to weigh in and chat as well. Don't just consider me the expert. We have many experts in the room. What I would say is if your definition of recovery is abstinence, then probably not. But if your definition of recovery, excuse me, health, home, purpose, and community, then I would say yes. And the example that I would actually use is my experience as a mother, a person who is in recovery from substance use, mental health challenges, and the trauma of incarceration, who is challenged every day in her recovery because of the challenges of finding a job. And so we have to think about going back to the stresses that that record puts on one to be able to do purpose and employment and education and community things that leads them back into a stress response that may lead to return to use. So, and I know that Suzanne and some others are also putting some things into the chat. Is there another question? I know we only have a couple more minutes, but. Yeah, is there room for harm reduction processes within peer support programs, such as AA, NA, or Alcoholics Anonymous, or are they primarily abstinence-based? You know, John Kelly, again, I know I've talked about him a lot, has done some interesting work. And I would say, yes, kind of. And we as a crew can find some of the research that he points to about this to share with you all, because I'm not as familiar with it, but we will find it. And I think he would say, yes, there's the space, or that people, it's not an either or, as he's talking about now. Individuals don't see it as a problem. Participants, clients don't see it as black and white as we do. And even though AA is not harm reduction centered, that people have figured out a nuanced way of using it that may be surprising to us. And there's new research that's published, like literally this year, that speaks specifically to that question. So we will find it and we will share it. Thanks, Liz. I think we have time for one more question. How do experiential therapies fare in terms of modulating stress and aiding recovery compared to treatment, TAU, CBT, 12 steps, et cetera? You know, I don't know the answer to that question, and we'll definitely find what we can find and share as a part of the resources that I know go out after the webinar. I don't know the answer to that question. And I'm sorry that I don't, but we will find one and include that as a part of our webinar follow-up. And also maybe we'll try and look at some of the questions that we didn't get to and combine them. And maybe we can, if we don't answer them, we can point you to some of the research that is answering the questions that you're asking. Yes, we can definitely create a Q&A handout to share along with the recording and slides that will be archived on the PCSS website. Thank you, Liz. You're welcome, thank you. Back to you, Emma. Okay, well, that's all the time we have for questions. I'd like to thank Liz again for presenting today. We are so appreciative of your willingness to share your knowledge and expertise with everyone. As a reminder, the recording and slides will be posted on the PCSS website within two weeks from today. I'd like to make you all aware of two resources offered through PCSS that may be of interest to you. First is the PCSS Mentor Program, which is designed to offer mentoring assistance to those in need of more one-on-one interactions with one of our colleagues to address clinical questions. You have the option of requesting a mentor from the mentor directory, or PCSS can pair you with one. For more information, please visit the PCSS website noted on this slide. Secondly, PCSS offers a discussion forum comprised of PCSS mentors and other experts in the field who help provide prompt responses to clinical cases and questions. There's a mentor on call each month who's available to address any submitted questions through the discussion forum. You can create a new login account by clicking on the image on the slide to access the registration page. And this slide lists the consortium of lead partner organizations that are part of the PCSS project. Finally, the PCSS website, contact info, and social media handles are listed here if you would like to find out more about the resources and trainings offered. So thank you all again for joining our webinar today, and we hope you all have a great rest of your day and week.

Harm Reduction

Recovery Support Services

Pharmacotherapy

Substance Use Disorders

Providers Clinical Support System

National Council for Mental Well-Being

Recovery-Oriented System of Care

Stages of Recovery

Harm Reduction Principles

Integrating Harm Reduction