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Laudet,!Alexandre!B.!(2013).!Proceedings!from!the!4th!Annual!Collegiate!Recovery!Conference:! Collegiate"Recovery"Programs:"Results"From"The"First"National"Survey.!Lubbock,!TX.!

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Alexandre!Laudet!gave!this!presentation!during!the!4th!Annual!Collegiate!Recovery!Conference! held!at!Texas!Tech!University,!April!3:5!2013.! ! The!presentation!uses!data!collected!through!a!National!Institute!on!Drug!Abuse!grant!that!that!was! awarded!to!the!National!Development!and!Research!Institutes,!Inc.!! The!presentation!includes!the!following!sections:!! Context:!Recovery!!What!and!How?! Overview!of!Peer!Recovery!Support!Services! Collegiate!Recovery!Programs!(CRPs):!NIDA!!funded!nationwide!survey! The!initial!findings!presented!in!this!research!capture!the!national!landscape!of!collegiate!recovery! programs!for!the!first!time!in!recent!history.!

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!!!!!!!!!!!!!!!!!!!!!!!!!!P.!O.!Box!6448!!Reno,!NV!89513!!Phone:!760:815:3515!!! !

Collegiate Recovery Programs: Results from the first national survey

Alexandre B. Laudet
4th National Collegiate Recovery Conference
Center for the Study of Addiction and Recovery @ Texas Tech University April 3-5, 2013

The presentation uses data collected through a project supported by Grant Awards Number R01 R01DA14409, R01DA015133 and R21DA033448 from the National Institute on Drug Abuse to the National Development and Research Institutes, Inc. (NDRI). The content is solely the responsibility of the author and does not necessarily represent the official views of the National Institute on Drug Abuse or the National Institutes of Health

The team
Alexandre Laudet, NDRI, Principal Investigator (MPI) Kitty Harris, Texas Tech, Principal Investigator (MPI) Ken Winters, U of Minnesota, Co-investigator

D. Paul Moberg, U of Wisconsin, consultant

Thomas Kimball, Texas Tech , project coordinator

Presentation Overview

Context: Recovery What and How?

Overview of Peer Recovery Support Services

Collegiate Recovery programs (CRPs): NIDA funded nationwide survey

Addiction career
Impairments in

Age Age first first drink drug

13.8 15.2

Physical health Mental health Family/social

Age first Relapse/recovery treatment cycle


Legal status
Housing Employment Economic/financial

Stable recovery?

LOSS TO THE INDIVIDUAL & TO THE NATION = 16 years of active use + up to a decade of cycling

Summary of research findings about reasons to seek recovery

Problem recognition Health concerns Financial issues Legal issues Psychological distress about these problems Social context: ultimatum, pressure or encouragement to change and/or seek help from parents, spouse or employers New responsibilities e.g., becoming a parent Social consequences of use e.g., embarrassment about a specific incident Cognitive factors e.g., re-evaluations of the pros and cons of continued use

Substance users try to quit because they want a better life

To what extent was [item] a factor in your decision to stop using drugs this time? Not at all, a little, moderately, very

much, extremely (N = 354)

Laudet & White, 2004a

Why do people seek help?

Priorities at outpatient admission

What are the priorities in your life right now? (N = 314)

Abstinence is top goal but not only goal!!!

Treatment: Expectation of help at admission

Overall, how much do you think your coming to this treatment program will help you address your needs and priorities?

NYC Outpatient treatment outcome

Completion rate on par w/ national average of 36% for outpatient modalities

Laudet, Stanick, & Sands, JSAT 2009

A voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.
(Betty Ford Institute, JSAT 2007)

Benefits of recovery: Open-endeda

What, if anything, is good about being in recovery? RECOVERY = A BETTER LIFE

Add to > 100% because up to 3 answers were coded

Stress and Quality of Life Satisfaction as a Function of abstinence duration (N = 354)


Mean (scale range = 0 to 10)






Overall life satisfaction Stress rating pst yr



>6 months Six to 18 mos

18 to 36 mos RECOVERY STAGE

3+ years

Laudet, Morgen & White, Alc. Tx Q. 2006

Recovery guiding services

SAMHSA Recovery Oriented Systems of Care (ROSC) Recovery is more than abstinence from alcohol and drugs; it is about building a full and productive life in the community. Our treatment systems must reflect and help people achieve this broader understanding of recovery. (Dr. W. Clark, CSAT) ROSC: Coordinated multi agency continuum of care aiming: To intervene early with individuals with substance use problems; To support sustained recovery for those with substance use disorders; To improve the health and wellness of individuals and families.

Recovery guiding policy

2010 Presidents Drug Strategy calls for expanding recovery supports in the community: Foster the Expansion of Community-Based Recovery Support Programs, Including Recovery Schools, Peer-Led Programs, Mutual Help Groups, and Recovery Support Centers (Chap 3.
Integrate Treatment for Substance Use Disorders into Health Care and Expand Support for Recovery, ONDCP)

May 2011: US Department of Education stated goal of ensuring a continuum of recovery supports in academic settings, from HS to postgraduate.

Recovery Support Services: Basic Premises

WHY? For many, substance use disorders (SUD) are chronic

Chronic conditions have no known cured but can be arrested and the symptoms managed
The acute care intensive, professionally-delivered treatment model is ill suited to chronic disease management WHAT? Chronic disease management = Mix of professionally and peer-driven services/supports + self-management, based on individual needs, resources and remission stage Recovery supports conceptualized as accessible to all persons in recovery regardless of formal diagnosis, recovery path (e.g., whether formal treatment was every sought) or duration HOW? SUD recovery support services can be professionally- or peer-delivered WHERE? Diverse urban and rural community-based venues- e.g., recovery community centers, faith-based institutions, sober housing, criminal justice settings, HIV/AIDS and other health/social service centers, addiction and mental health treatment agencies

Implications for Recovery Promoting Services Development

Federally funded Recovery Support Services Initiatives

SAMHSAs Recovery Community Services Program initiative (RCSP)
Funds community based agencies for peer-to-peer recovery support services to help prevent relapse and promote sustained recovery 50 funded projects since it began in 1998 Services include peer coaching and mentoring, educational and skill-training services, stress management, sober activities, facilitated access to multiple systems e.g., primary and mental health care, child welfare, and CJ systems. No formal evaluation to date; 6-month follow-up service data report improved functioning lower substance use, criminal involvement, mental health problems, and improved housing and employment

SAMHSAs Access to Recovery (ATR)

Voucher based program to increase consumer choice To increase access to treatment and recovery support for special underserved populations (e.g., pregnant women, rural dwellers, CJ involved individuals) No formal evaluation; ATR-funded states provide encouraging results. E.g., Washington state compared ATR client outcomes with SUD treatment only clients: ATR services were associated with increased length of stay in and completion of treatment, and increased likelihood of becoming employed.

Professionally-delivered recovery support services

Continuing care/aftercare: Stepped down course of outpatient services typically following intensive inpatient or residential treatment Innovative forms of professionally-driven recovery support services have been developed and shown to be effective, including: Telephone-based continuing care (McKay et al)

Regular recovery management check-ups (RMC) and early re-intervention to monitor clients status, minimize relapse risk and provide linkage to services when relapse has occurred to shorten the cycle (Scott, Dennis et al)
Web-based multimedia recovery support intervention offered following residential SUD treatment. Intervention included tailored clinical content delivered in a multimedia format + access to a recovery coach (Klein et al., 2012).

Peer-based recovery support services

Giving and receiving nonprofessional, nonclinical assistance to achieve longterm SUD recovery Provided by experientially credentialed individuals to assist others in initiating and maintaining recovery and enhancing quality of life Peers work as volunteers or in paid service worker positions Peer-based approaches implemented extensively to address a range of chronic conditions, e.g., mental health, asthma, breast cancer, depression, and diabetes

Peer recovery coaches

PEER RECOVERY COACH: Acts as mentor and guides individual seeking long term recovery- e.g., Assists in setting recovery goals and a recovery plan, serves as role model in recovery Helps connect to recovery-supportive resources Serves as advocate and liaison formal and informal community supports

No systematic evaluation to date

Emerging evidence for the benefits of the approach from state level outcome reports of broader recovery oriented efforts (e.g., ATR, Mangrum 2008)

Sober residences
E.g., Oxford House & Sober Living Houses: Self-governed, selffinanced democratic communal-living environments following inpatient treatment or incarceration, during outpatient treatment or as an alternative to treatment No limit on stay duration Extensive scientific support for: Benefits of model on recovery related domains (e.g., substance use, employment, psychiatric severity, and arrests) across subpopulations - women, African Americans, veterans, dually diagnosed and deaf individuals (Jason et al) Cost effectiveness to society

Specific Context: In Recovery AND in college...

Substance use among young people

Substance use typically begins in early adolescence Substance use disorders (SUD) start in late adolescence/emerging adulthood, making this transitional period critical to SUD onset and progression Effective treatments exist for youth but relapse is common For youth with in SUD remission wishing to attend pursue educational goals, the high rates of substance use on college campus represent a serious threat to continued sobriety.

Importance of peer support to recovery

Social support, especially support from peers, has consistently been shown beneficial to sustaining significant behavior change e.g., remaining abstinent from drugs and/of alcohol Peer support is especially important among young people as fitting in with ones peer group is a key component of identity and psychosocial adjustment

Collegiate Recovery Programs (CRPs)

Seek to meet the support and peer affiliation needs of college student in SUD remission Campus-based recovery support Peer driven CRPs are growing exponentially YET, the model has not been evaluated systematically, hindering its wider dissemination to ambivalent institutions

Collegiate Recovery Programs: Results from the first national survey

Project Aims and Methods

Study Objectives
Since CRPs start organically, they may differ on key dimensions that may influence student outcomes and must therefore be identified before the model is evaluated. As a first step to informing a rigorous evaluation study, this NIDA funded project seeks to:

Identify the breadth of models, structures, philosophies, services and aggregate outcomes across CRPs nationwide
Subsequent study component examines student characteristics: Data collection currently ongoing- COME BACK NEXT YEAR FOR RESULTS!

Study Methods
Online survey Launched in October 2012 Programs that completed the survey and provided their contact received $400 as a thank you 26 of 31 programs completed the survey (84% participation) Two felt it was too new to answer most of the questions Two could not be contacted in spite of repeated attempts (no director or new director) One refused

Thank you to these 26 participating CRPs!

Augsburg College Baylor University Greenfield Community College Jiann-Ping Hsu College of Public Health/Georgia Southern University Kennesaw State University Ohio University Penn state university Southern Oregon University St. Cloud State University Texas Tech University The College of St. Scholastica The University of Alabama The University of Texas at Austin Tulsa Community College University of Massachussetts Amherst University of California Riverside University of California Santa Barbara University of Michigan University of Mississippi University of Nevada University of North Carolina Charlotte University of Southern Mississippi University of Vermont University of Virginia Vanderbilt University William Paterson University


CRPs: Context and Structure

Growth of CRP model when did your

program start enrolling students?

Context: Type of host institution

CRP affiliation with specific institution division

CRP campus based space

Does your program maintain a social media presence?

CRP Staff and Governance

Range Mean 07 03 0-4 35% 69%

Number reporting no assigned staff 6 5 6

Full time staff Part-time staff Paid staff in recovery Program uses volunteers (yes) Program involves students in governance? (yes)

1.6 1.2 1.5

Students role in Governance

Among programs who report students have a role in governance (69%):
Students sit on executive board Peer Council, review board, governing board, leadership team, Resident Advisors Make all decisions for program (for programs that are registered student organization) OR/AND Provide input on overall program direction and development OR Provide input on specific events/elements (e.g., meals) Staff the community space

In some program students are Elected officers

The program is a registered student organization within University or Student club. Since the program is still fairly new, the students that are involved are all equally a part of the development of the program. Students are encouraged to be as involved as their schedule and time allows.

CRP Budget and related financials

80,970 (0 $495,000)

Annual budget (mean, range)

Have NO budget


Estimated cost to program per student (mean, range)

$ 1,835 (0 $15,000)

Program charges students (no)


Program capacity (mean, range)

92 (8 - 500)

Number of Students currently served

27 (2 - 120)

CRP Funding sources

Outreach and Recruiting

Does your program actively seek to recruit/inform through public relations or other means? YES 92%
How, where and to whom?
Brochures/referral materials Website Social media Staff presentations locally and in other cities statewide Tabling to greater campus audience, college fair Student orientation presentation Parent orientation presentation Conferences Networking Membership with the Association of Recovery Schools Alumni magazine story & student life newsletter Alumni organization Greek organizations Student affairs/resident life 12 step meetings (word of mouth) Local recovery community groups Develop relationships with local MH/SUD service providers Judicial affairs

CRP Referral sources

Other Sources of Referral to CRP

University generated emails and online bulletin Association of recovery schools University website Dean of students office Judicial affairs Dean of students office Website UM CRP website 12 step meetings Local 12-step meetings (announcements) Recovery high schools

About the students CRPs serve

Gender Age Ethny Race Female Mean Youngest Oldest Latino (yes) 42% 25 18 60 5% (0 - 30) 2.3% (0 - 50) 3.9% (0 - 25) 84.5% (5-100) 16 months 1 month 16.7 years

Asian African american White Abstinence duration Mean Shortest Longest Students status at program entry Freshmen Transfer Students' academic rank Fresh Sophomore Junior Senior Graduate

32% (0 - 100) 35% (0 - 100)

19.2% (0 - 80) 19.6% (0 - 35) 28.1% (0 - 60) 16.9% (0 - 38) 16.1% (0 - 50)

Policies and Procedures

CRP procedures: Enrollment

Program has Formal application process (yes) When do students typically apply to your program? (check all that applies) Before applying to institution Simultaneously with applying to institution After institution application/acceptance Number of student inquiries past academic year (mean, range) Number of applications past academic year (mean, range) Number of students accepted (mean, range) 23.10% 69.20% 53.80% 50%

34 (3 - 345) 11 (0 - 73) 9 (0 -51)

CRP enrollment requirements (among

programs w/formal enrollment process)
Minimum Abstinence duration required (Yes) IF YES: Minimum Abstinence duration in months (mean, range) Formal treatment history required (Yes) Recommendation letter (s) required (Yes) IF YES: Number of recommendations required (mean, range) OTHER ACCEPTANCE REQUIREMENTS Acceptance Requirement(s) pertaining to recovery (Yes) Acceptance Requirement(s) pertaining to academics (e.g., GPA) 100.00% 52.40% 46.20% 6 (2 - 12) 11.50% 23.10% 2 (1 - 3)

Reasons for not enrolling a student applicant

CRP Participation Requirements

Once a student is enrolled, are there participation requirements? Yes Participation Requirement(s) pertaining to recovery (Yes) Participation Requirement(s) pertaining to academics (e.g., GPA, SATs) Program requires signed behavioral/sobriety contract (yes) Are student 'members' monitored in terms of Recovery (yes) Academics (yes) Program has a wait list (Yes) IF YES: Number of students on wait list (mean, range) Program accepts students on medication assisted recovery (Yes) Are students ever mandated to program (yes) Ever dismiss a student? (Yes) Students dismissed in a given year Ground for dismissal: Relapsed AND lost interest in recovery 57.70% 88% 73.30% 36% 66.70% 66.70% 29.20% 3.9 (0 - 18) 64% 7.70% 52% <1% 100%

Urine sample monitoring

How is substance use handled -regardless of how found

Programs response is generally guided by desire to help student (rather than punish) while not endangering other students recovery or the program's mission. Student commitment to recovery is assessed. ASSUMING STUDENTS CONTINUED COMMITMENT TO RECOVERY (examples of responses) Student invited to remain member of recovery community but could not remain an officer of the program Staff and student develop individual plan based on the situation; may involved individual counseling and/or 12-step and/or referral to treatment

Student is confronted about use, discussion about their intention to move forward, conversation with community
If program has sober residence/recovery housing, student re-located out of recovery housing and program works with him/her to develop a individual plan based on the situation; Some programs also support students who are still using & struggling with their identity of being an addict or alcoholic. They get regular access to staff for support and the services connected to the drop in center e.g., peer mentoring.

CRP Services and supports

Program Philosophy, model or theory

CRP Services available & required



Other Services/supports available

24/7 space for students in recovery to relax, study, and/or socialize. Crisis intervention, case management, peer supports individual counseling and medication management Recovery Coaching, peer support groups Most of the staff here are licensed drug and alcohol counselors but we do not do any professional counseling. We may do what we call 'band aid' therapy, or recovery coaching, if a student needs immediate assistance, but this is more about life skills/relationships than substance abuse issues. Assistance with registration for Disabled Students Program, financial aid advising. Counseling not available on-site specifically for substance abuse but counseling is offered for depression, anxiety, eating disorders and other mental illness condition that often occurs among the recovering population Accommodations for learning and/or psychiatric disabilities

Academic CRP scholarship

CRP Staff available 24/7

Alternative models (example)

We use a Holistic approach. All are welcome. We do not "accept" and "not accept" students. We are a free, lifesaving resource, we would never want to erect barriers around a community/resources/supports that could save a life. Fitness, meditation, yoga, compassion. In line with the stage-of-change model, a pre-contemplative individual who is attracted to, and aligns him or herself with ANY aspect of our community life is more likely to be open to contemplating further involvement with other aspects of recovery life. This survey is not really applicable to our program; we are a two year college. Coordinating this effort is not part of my job but I do it because I'm in recovery. We have a club, monthly meetings, AA meetings and peer mentoring.

CRP Outcomes

Relapse: Definition and Rate past year

Relapse rate past academic year (mean, range): 8% (0 25%)

Academic Performance:
CRP vs. Institution-wide

Conclusions and Implications

Wrap up: Context

Substance use disorders (SUD) are chronic conditions for many
SUD have negative consequences for all areas of life Substance use related services and policy are increasingly adopting a recovery orientation Two paradigmatic shifts: From acute to chronic care model From symptom- to wellness focused Growing recognition of the importance of peers in promoting recovery For young people in SUD recovery, college attendance may jeopardize recovery Peers especially influential in adolescence and emerging adulthood COLLEGIATE RECOVERY PROGRAMS Designed to meet the support needs of college students in recovery Model adoption growing exponentially Never evaluated or studied empirically

Wrap up: Nationwide Collegiate Recovery Program Survey

Substance use disorders (SUD) are chronic conditions for many
SUD have negative consequences for all areas of life Substance use related services and policy are increasingly adopting a recovery orientation Two paradigmatic shifts: From acute to chronic care model From symptom- to wellness focused Growing recognition of the importance of peers in promoting recovery For young people in SUD recovery, college attendance may jeopardize recovery Peers especially influential in adolescence and emerging adulthood COLLEGIATE RECOVERY PROGRAMS Designed to meet the support needs of college students in recovery Model adoption growing exponentially Never evaluated or studied empirically

Wrap up: Context

Substance use disorders (SUD) are chronic conditions for many
SUD have negative consequences for all areas of life Substance use related services and policy are increasingly adopting a recovery orientation Two paradigmatic shifts: From acute to chronic care model From symptom- to wellness focused Growing recognition of the importance of peers in promoting recovery For young people in SUD recovery, college attendance may jeopardize recovery Peers especially influential in adolescence and emerging adulthood COLLEGIATE RECOVERY PROGRAMS Designed to meet the support needs of college students in recovery Model adoption growing exponentially Never evaluated or studied empirically

Wrap up: Findings from the first nationwide survey of Collegiate Recovery Support Programs
2 to 5 new programs starting annually COMMONALITIES Most operating out of public universities Small (or no) budget: Most common sources of funding are Private donations and university Supporting students free of charge Generally Small staff, Peer driven: students involved in governance Overwhelmingly 12-step based philosophy (e.g., abstinence based, onsite meetings) KEY DIFFERENCES Size of Budget and program space Standardization of program procedures and policies (from none to formalized) Half have a formal application process; enrollment requirements chiefly based on Abstinence duration and academics Extent of Student monitoring Availability of sober housing, academic scholarship, professional services Required participation in specific program elements

Next steps: CRP Student survey

Seeks to gain information about participating students :
Profile and background Current psychosocial functioning status How/why they came to a CRP Level/satisfaction with various CRP Services/supports Additional services/support needs Survey Launched Feb 11, 2013

Goal is to obtain maximum participation: every student in every CRP

nationwide The greater the participation rate, the more meaningful and useful the study will be to programs and to the field 235 completed thus far

Sneak Peek at the Students Survey

Take home Message

How important was the presence of campus-based recovery support program to your decision to apply to/enroll in your current institution? (N = 235)

Students feedback
What are the main reasons why you decided to enroll in the recovery support program in your school? So that I could go to college and be sober. Without this program there is

no way I would have stayed sober in college.

What if anything do you like about your collegiate recovery support program? It's where my friends are, I can be apart of something bigger than myself. it's

not what it does for us but what we can do for each other
Overall, what has been your experience, good and/or bad, with your Collegiate Recovery Program? I have been sober for 5 months and these have been the happiest months of my life and I am really turning myself around. Thank

you for what you

are doing!

Belleau C, DuPont R, Erickson C, et al. What is recovery? A working definition from the Betty Ford Institute. J Subst Abuse Treat. 2007;33:221-228. Dickard N, Downs T, Cavanaugh D. (2011) Recovery/Relapse Prevention in Educational Settings For Youth With Substance Use & Co-Occurring Mental Health Disorders. US Department of Education Jason, L. A., & Ferrari, J. R. (2010). Oxford house recovery homes: Characteristics and effectiveness. Psychological Services, 7, 92102. Klein, A. A., Slaymaker, V. J., Dugosh, K. L., & McKay, J. R. (2012). Computerized continuing care support for alcohol and drug dependence: A preliminary analysis of usage and outcomes. Journal of Substance Abuse Treatment, 42, 2534 Laudet, A. and White, W. (2004a) Toward a Recovery Research Agenda: Promises, Pitfalls and Preliminary Experience. 47th International Conference of the International Council on Alcohol and Addiction, Venice, Italy, Nov. Laudet, A., Morgen, K., & White, W. (2006) The role of Social Supports, Spirituality, Religiousness, Life Meaning and Affiliation with 12-step Fellowships in Quality of Life Satisfaction among Individuals in Recovery from Alcohol and Drug Use. Alc. Treatment Quarterly, 24: , 33-74. Laudet, A., Stanick, V. & Sands, B. (2009) What could the program have done differently? A qualitative examination of reasons for leaving outpatient treatment. J. Subst Abuse Treatment, 37, 182-190. Mangrum, L. (2008). Final evaluation report: Creating access to recovery through drug courts. Austin, Texas: Texas Department of State Health Services, Mental Health and Substance Abuse Services Division: Gulf Coast Addiction Technology Transfer Center. McKay, J. R., Lynch, K. G., Shepard, D. S., & Pettinati, H. M. (2005). The effectiveness of telephone-based continuing care for alcohol and cocaine dependence: 24-Month outcomes. Archives of General Psychiatry, 62, 199207. Office of National Drug Control Policy. National Drug Control Strategy. Washington, DC: Office of National Drug Control Policy; 2010. Scott, C. K., Dennis, M. L., & Foss, M. A. (2005). Utilizing recovery management checkups to shorten the cycle of relapse, treatment reentry, and recovery. Drug and Alcohol Dependence, 78, 325338. Scott, C., & Dennis, M. (2009). Results from two randomized clinical trials evaluating the impact of quarterly recovery management checkups with adult chronic substance users. Addiction, 104, 959.

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