PFR recognizes recovery as an ongoing process that starts before sustained abstinence is achieved. While the recovery process typically involves common benchmarks, each individual's path is unique.
PFR convenes and garners input from individuals in the addiction treatment field and recovery support providers to define recovery, refine outcome measures, and develop and disseminate long-term, community-based recovery resources that increase the likelihood of sustained abstinence from illegal drugs and prevent the abuse of alcohol and the misuse of prescription drugs.
To provide stakeholders and the public with a deeper understanding of the process of recovery from addiction to alcohol and other drugs, PFR prepared a report entitled, "Pathways to Healing and Recovery: Perspectives from Individuals with Histories of Alcohol and Other Drug Problems" (PDF | 975 KB). This report examines qualitative focus group and interview findings and offers greater insight into people's individual journeys of recovery. More specifically, the report explores the terminology individuals in recovery use to describe their experiences, the range of pathways to healing that exist, and the barriers and supportive influences involved in the recovery process.
Resilience—the context-specific ability to respond to stress, anxiety, trauma, crisis, or disaster—is a key component of the process and experience of recovery from mental and substance use disorders. To assist prevention, treatment, and recovery professionals with identifying and locating peer-reviewed research about resilience, PFR developed the Resilience Annotated Bibliography (PDF | 532 KB). This product includes references and brief descriptions of 67 articles published since 2000 related to resiliency and risk and protective factors of mental and substance use disorders.
To advance SAMHSA's goal of developing a standard recovery measure, PFR prepared the "Environmental Scan of Measures of Recovery" (PDF | 919 KB), which identifies and reviews current available measures of recovery from addiction. This document identifies and provides summaries of the development, psychometric properties, and uses of such measures in the addiction field. This information is supplemented by a review of selected measures of recovery from other chronic conditions, including mental health disorders.
The PFR Initiative recognizes the value of Recovery Support Services (RSS) as they contribute to recovery. RSS are nonclinical services that assist individuals and families working toward recovery from substance use conditions. To provide information about the funding sources that support RSS, PFR prepared a report entitled, "Financing Recovery Support Services: Review and Analysis of Funding Recovery Support Services and Policy Recommendations" (PDF | 1.2 MB). This report provides an overview and analysis of federal, state, and private funding streams currently used to fund RSS, and it identifies RSS offered through various funding streams. The report also makes recommendations on how laws and regulations can be changed to allow states greater authority, flexibility, and resources to provide RSS throughout the continuum of care to individuals and families.
Recovery-Oriented Systems of Care (ROSC)
PFR conducted five regional recovery meetings between April 2007 and January 2008 to build on the work on Recovery-Oriented Systems of Care (ROSC) initiated at the Center for Substance Abuse Treatment (CSAT)’s National Summit on Recovery. The meetings were designed to achieve several goals, including:
- Informing individuals about the National Summit on Recovery
- Providing resources related to the operationalization of ROSC
- Allowing states and organizations to share lessons learned
- Providing a venue for individual state team planning
Further, the meetings expanded and continued a dialogue across the country about ROSC.
The guiding principles and system of care elements developed at the National Summit served as a foundation for the meetings' discussions and for a proposed ROSC improvement framework. The framework, which applies a comprehensive public health approach to implement the systems elements, is a tool to support policy development and planning to address substance use problems and related health conditions. Fundamental to the framework is the vision that systems and services should be responsive to the needs and desires of individuals, families, and communities and support health, wellness, and recovery.
The "Summary of CSAT's Regional Recovery Meetings" (PDF | 225 KB) provides further detail. And the Resources and Links page lists additional documents on the National Summit on Recovery.
Mutual Aid Groups
Mutual aid groups, which provide non-clinical and non-professional help to achieve long-term recovery from addiction, represent a valuable tool in the recovery process. The Faces and Voices of Recovery (FAVOR) Guide to Mutual Aid Resources provides contact information and descriptions of a variety of mutual aid groups, as well as supplemental written resources, for people in or seeking recovery from addiction, their families and friends, treatment service providers and allied professionals.
Working Definition of Recovery (PDF | 72 KB) is a resource handout.
All organizations and systems that engage people who have, or are at risk of having substance use disorders (for example, primary care, criminal justice, child welfare), must work in concert to create a fluid continuum of services, including prevention, intervention, treatment, and recovery support. The PFR Initiative provides a means for organizations in both public and private sector service systems to come together.
PFR work in the area of cross-systems collaboration focuses on fostering meaningful partnerships among the many federal, state, and local agencies and organizations that serve and interact regularly with populations that have substance use disorders. These include representatives of the child welfare, criminal justice, education, health, addiction treatment, prevention, and mental health service systems. The purpose of these collaborations is to develop strategies to effectively address the needs of substance-involved individuals.
The PFR leadership has made the reduction of discrimination and promotion of social inclusion a priority. In support of this initiative, PFR and the CSAT Office of Consumer Affairs have sponsored the development of English and Spanish versions of a Know Your Rights (KYR) brochure. The Resources and Links page provides a complete listing of these brochures.
The Legal Action Center (LAC) prepared the PowerPoint presentation Know Your Rights-Legal Rights of People with Alcohol and Drug Histories and Criminal Records (PDF | 1.2 MB) and an accompanying brief User's Guide (PDF | 65 KB) for the PFR Initiative. The presentation is intended to be used as a training tool by alcohol and drug treatment professionals and provider associations, government oversight agencies, recovery support providers and organizations, attorneys with an interest in these topics, and other allies of people in recovery. The training is for people with or in recovery from alcohol or drug problems, people in treatment or recovery with criminal records, and anyone supporting the rights of people with current/past alcohol or drug problems or criminal records.
The training objectives are to educate individuals about their rights under federal and state laws and to provide information about how to exercise those rights when necessary. The training covers laws prohibiting discrimination against people with disabilities in: employment, housing, public accommodation; for example, health care, schools, etc., and government benefits and services.
The presentation is divided into six parts to allow flexibility in presenting the information. They are:
- Introduction: What is Discrimination?
- Which Laws Prohibit Discrimination against People with Alcohol/Drug Histories?
- What Rights Do These Laws Give People with Current or Past Alcohol/Drug Problems?
- Responding to Violations of Your Rights under Anti-Discrimination Laws
- Medication Assisted Treatment: Special Issues
- Legal Rights of People with Criminal Records
Parts 1-4 provide a cohesive overview of the rights of people with alcohol/drug histories and should be presented together. Also, it is recommended that Parts 1-5 be shown together and that Part 6 be used with Parts 1-4 or Parts 1-5, or used separately. You may download a copy of the PowerPoint presentation and/or request an electronic copy.
The PFR Initiative produced a KYR Brochure designed to assist individuals in Medication-Assisted Treatment (MAT) and to educate and inform others. Individuals in MAT often face discrimination despite laws that clearly prohibit it. This discrimination is largely due to a lack of knowledge about MAT's value, effectiveness and safety, and a lack of knowledge about the anti-discrimination laws that protect people in MAT. The "Medication-Assisted Treatment Know Your Rights Brochure" (PDF | 415 KB) presents and explains the federal laws that prohibit discrimination against individuals with disabilities and how they protect people receiving MAT for opioid addiction. This brochure aims to reduce discrimination by providing people in MAT (and their advocates) basic information necessary to exercise their rights or, at a minimum, know where to turn for help. It also seeks to reduce discrimination by educating those who might discriminate (for example, employers, housing providers, and government agencies) about such laws, as well as about MAT itself.
PFR also produced a series of five Know Your Rights webinars that were conducted and repeated once. Five PowerPoint presentations and supporting materials that included audio links to the presentations, question and answer handouts, and a resource handout were prepared and made available. The presentations focused on individual rights and areas of discrimination for people with alcohol and drug histories.
Following are the PowerPoint presentations:
- Employment Discrimination Against People with Alcohol/Drug Histories (PDF | 526 KB)
- Housing, Health Care, and Other Forms of Discrimination Against People with Alcohol/Drug Histories (PDF | 572 KB)
- Medication-Assisted Treatment: Special Anti-Discrimination Issues (PDF | 619 KB)
- Legal Rights of People with Criminal Conviction Histories (PDF | 878 KB)
- New Federal Parity Legislation for Insurance Coverage of Addiction Treatment (PDF | 522 KB)
Following are the PowerPoint presentations with audio:
- Employment Discrimination Against People with Alcohol/Drug Histories
- Housing, Health Care, and Other Forms of Discrimination Against People with Alcohol/Drug Histories
- Medication-Assisted Treatment: Special Anti-Discrimination Issues
- Legal Rights of People with Criminal Conviction Histories
Following are the four factsheets that correspond to the four presentations:
- Employment Discrimination Against People with Alcohol/Drug Histories (PDF | 76 KB) - Q&A session
- Housing, Health Care, and Other Forms of Discrimination Against People with Alcohol/Drug Histories (PDF | 50 KB) - Q&A session
- Medication-Assisted Treatment: Special Anti-Discrimination Issues (PDF | 51 KB) - Q&A session
- Legal Rights of People with Criminal Conviction Histories (PDF | 60 KB) - Q&A session
A resources handout, "Helpful Resources to Address Discrimination Against People in Medication-Assisted Treatment" (PDF | 50 KB), is also available.
PFR and the LAC have further collaborated on a series of four webinars exploring how to apply the federal alcohol/drug confidentiality regulations—42 C.F.R. Part 2—to Health Information Technology (HIT). Topics covered included:
- The confidentiality regulations in the context of the HIT and Health Information Exchange (HIE) environment, including which programs must follow 42 C.F.R. Part 2
- Situations in which patient information may or may not be disclosed
- Different HIT patient choice models
- Issues relating to patient consent and information-sharing agreements
- Current SAMHSA HIT programs and activities
Two of the webinars further explained FAQs on 42 C.F.R. Part 2 prepared by PFR, the LAC, and SAMHSA.
The PowerPoint presentations and audio can be accessed on the Legal Action Center website, along with the 42 C.F.R. Part 2 confidentiality regulations and FAQs.
Workforce issues are complex and link to almost every challenge facing the addictions treatment and recovery field. Like other health care professions, the field has encountered many barriers to effective staff recruitment and retention, and to maintaining competencies. In addition to these common workforce challenges, the treatment and recovery field frequently experiences discrimination, lack of public support, under-funding, and misconceptions about treatment and recovery. PFR provides resources and tools to support and sustain the addictions workforce's day-to-day and long-term endeavors.
Health Care Reform
To thrive in the evolving health care landscape, behavioral health prevention and treatment providers must position their organizations in a marketplace that includes many other competing health service providers, centers, and systems. To build the marketing capacity and know-how of this provider community, PFR and the State Associations of Addiction Services (SAAS) developed and delivered a comprehensive educational series for organization leaders on marketing provider organizations in the new health care environment. The series explores topics including the scope of the new health care environment, ways to reposition your organization in the marketplace, market research, branding, and marketing action plans. PowerPoint presentations and accompanying marketing tools from this series, as well as videos of the training session, are at the SAAS website.
Working with Veterans and Military Personnel
An essential component of building a competent workforce involves helping substance use treatment and recovery professionals understand and connect with the individuals they serve. PFR prepared two papers focusing on military personnel and veterans to help clinicians and policy makers alike familiarize themselves with the backgrounds, specific characteristics, and needs of these populations. "Understanding the Military: The Institution, the Culture, and the People" (PDF | 1.4 MB) provides an overview of the Armed Forces as an organization and approaches to treating military personnel in behavioral health settings. "Addressing the Substance Use Disorder (SUD) Needs of Returning Veterans and Their Families: The Training Needs of State Alcohol and Other Drug Agencies and Providers" (PDF | 2.2 MB), a paper developed by PFR and the National Association of State Alcohol and Drug Abuse Directors (NASADAD), aims to improve SUD treatment services by describing the training, outreach, and resources offered by Single State Agencies (SSAs) to meet the needs of returning veterans and their families. The document also contains recommendations for future development of technical assistance and training materials to address gaps in services.
Strengthening the Addictions Workforce
PFR has identified workforce development as a critical issue and has sought input from many groups, including professional associations, colleges and universities, recovery support providers, state directors, treatment providers, Addiction Technology Transfer Centers (ATTCs), federal agencies, clinical supervisors, human resource managers, and key leaders. The input from the field was gathered and synthesized in a report entitled, "Strengthening Professional Identity: Challenges of the Addictions Treatment Workforce" (PDF | 780 KB), which informed the development of the "Report to Congress: Addictions Treatment Workforce Development" (PDF | 392 KB).
In response to the recommendations presented in the "Strengthening Professional Identity: Challenges of the Addictions Treatment Workforce" report, PFR and the SAAS developed a report illustrating strategies for strengthening the addictions treatment provider system. "Strategies for Strengthening Substance Use Prevention, Treatment, and Recovery Systems: Provider Networks and Impact on the Workforce" (PDF | 2.1 MB) describes nine successful alcohol and other drug (AOD) addiction provider networks that are highly diverse in size, scope, complexity, and service array. The report describes formation and structure of provider networks, range of services offered, collaborative efforts, and impact on the workforce. Strengths and challenges of the networks and considerations in forming the networks are identified.
Also, PFR developed two PowerPoint presentations that focus on strengthening networks for addictions treatment providers. Built on the recommendations from the "Strengthening Professional Identity, Challenges of the Addiction Treatment Workforce" report, the presentations discuss findings of the Provider Network Study. Aimed at defining and identifying provider networks nationally, the "Provider Networks: Strategies to Strengthen Addiction Treatment and Prevention Service Systems," July 2009, (PDF | 1.8MB) and "Provider Network Models: Strategies to Strengthen Addiction Treatment and Prevention Service Systems," October 2009, (PDF | 3.3 MB) presentations discuss the challenges and solutions to workforce development and network benefits for addictions treatment providers through outlining nine case studies from the Provider Network Study.
Hiring, Retention, and Recruitment
PFR supported the development of three reports on workforce development in the areas of retention and recruiting of the addiction workforce:
- The first report, "Addictions Treatment and Recovery Workforce Retention and Promising Practices Pilot Study" (PDF | 240 KB), explores retention strategies among facilities with low turnover rates.
- The second report, "Informing Marketing Strategies for Recruitment into the Addictions Treatment Workforce" (PDF | 383 KB), summarizes the findings from the seven focus groups convened to respond to a need to develop recruitment and marketing messages for the addictions treatment recovery field.
- The third report, "Minority Recruitment for the 21st Century: An Environmental Scan" (PDF | 1.9 MB), responds to two issues: the dearth of treatment and recovery personnel, and a growing body of evidence suggesting that clients are more likely to engage in and benefit from services provided by a clinician with similar demographic characteristics. This report describes the challenges to bringing minorities into the addictions workforce and presents promising recruiting strategies to diversify the field.
In addition to the three reports on retention and recruiting of the addiction workforce, PFR supported the development of three additional resources for workforce development, focusing on the hiring process, recruitment, and addressing substance use within the addictions treatment workforce:
- The first resource is a manual to guide organizations toward better hiring and recruitment practices, entitled "Recruiting and Hiring Manual for Addictions Professionals" (PDF | 7.6 MB). The manual addresses challenges in the workforce and the specific needs of addictions treatment and recovery professionals. In addition, the manual presents the benefits of more effective hiring and recruiting practices.
- Based on the recommendations in the "Recruiting and Hiring Manual for Addictions Professionals," the main message in a recruiting effort should be, "Working in addictions treatment allows one to fulfill oneself while (and because) one is helping others change their lives." Through a series of advertisement testing and field testing, PFR developed a compelling graphic design for the addiction treatment field that can be downloaded and customized by inserting the name of any organization on the graphic. To include your organization's name, please use the fillable form at the bottom of the advertisement. The Recruitment Advertisement (PDF | 347 KB) and Instructions (PDF | 17 KB) provide additional information.
- The third resource, entitled "Supporting Our Greatest Resource: Addressing Substance Use, Misuse and Relapse in the Addiction Treatment Workforce" (PDF | 1.5 MB), provides meaningful and practical guidance to the problem of substance misuse among addictions professionals. Developed through the contributions of the PFR Steering Committee, the toolkit identifies issues and solutions related to wellness and the retention of employees in use, misuse, and relapse situations. More broadly, the toolkit can assist employers in creating a work environment that supports the needs of employees, engages and retains employees in the addictions field, and in the case of use, misuse and relapse, intervenes in a way that is effective while being legally and corporately responsible.
The field of addiction treatment is facing a transition as many current leaders in the profession are retiring. The PFR Initiative is working to support leadership development activities, including the sponsorship of Regional Leadership Institutes, which, through concentrated six-month programs, will focus on developing a cadre of emerging leaders.
Since 2006, PFR has supported several Leadership Institutes for behavioral health care professionals. With the passage of the Affordable Care Act, preventive care has received heightened prominence. There is now an increased emphasis on substance use prevention and mental health promotion in the nation's health care delivery system. In light of the evolving U.S. health care environment, PFR—in collaboration with the Community Anti-Drug Coalitions of America (CADCA) and the Graduate School USA—piloted SAMHSA's first School for Prevention Leadership (SPL) designed specifically for substance use prevention professionals. This pilot integrated general leadership skill-building exercises for professionals with specific knowledge relevant to the prevention field. The SPL assisted community- and state-level prevention professionals in developing a set of leadership skills and a knowledge base to effectively navigate the anticipated changes brought about by health care reform.
A summary report (PDF | 915 KB) prepared by PFR provides a snapshot of the SPL and includes a synopsis of the school's objectives and structure, participants' feedback, and lessons learned.
PFR also developed State health care reform informational sheets (ZIP | 16 MB) for the SPL, which were distributed during an SPL in-person training session. These sheets—one for each state, the District of Columbia, and Puerto Rico—serve as a quick and easy reference for:
- State data such as health spending or percentage of uninsured residents
- The status of efforts to create a health insurance exchange
- Health insurance enrollment services offered in the state
- Other enrollment opportunities offered by the state, such as Medicaid, the Children's Health Insurance Program (CHIP), or other miscellaneous assistance
In 2012, PFR supported activities to strengthen leadership among recovery community organizations (RCOs). Leaders of RCOs not only must fulfill the traditional roles of a recovery community leader but also must confront issues that require attention to participate in the current health care environment, such as obtaining certification and/or accreditation for the peer services they deliver, collecting quality measures and outcomes, utilizing technology, and collaborating with a variety of new entities.
On June 13 and 14, 2012, PFR held a Recovery Community Leadership Symposium in Providence, Rhode Island to create a forum in which leadership strengths and needs for RCOs could be addressed. PFR prepared a summary report (PDF | 1.1 MB) of the two-day meeting to contribute to a greater understanding of these issues so that strategies, tools, and resources can be developed to support capacity-building among current and emerging RCO leaders.
The Resources and Links page lists additional documents about leadership and leadership development.