Every state in the nation is searching for ways to mitigate the substance use crisis. While the primary focus of state efforts is often on saving people’s lives by increasing access to evidence-based substance use treatment, it is also essential to invest in services that support people in sustaining their recovery. Among recovery-oriented services are recovery community centers (RCCs). These centers are physical spaces where people with lived experience of recovery engage others seeking recovery to find strength in community, help them navigate the health care and social service systems, and celebrate their accomplishments. Many state Medicaid programs reimburse for recovery support services, such as peer support services that are delivered in RCCs.
The Better Care Playbook recently spoke with Michael Askew, Deputy Director of the Office of Recovery at the Substance Abuse & Mental Health Services Administration (SAMHSA) to learn more about the role of RCCs in the lives of people with substance use disorder and across the continuum of other addiction care services. Michael managed an RCC for 11 years and is a prominent recovery advocate with more than 30 years of experience. He also identifies as a person in recovery.
Q. How do recovery community centers fit in the context of the continuum of addiction care?
A. Recovery community centers (RCCs) are nonclinical spaces that provide recovery support infrastructure for individuals impacted by substance use conditions. They might also be known as recovery cafes or recovery support centers.
RCCs support people in building “recovery capital,” which are the resources within oneself and those resources available outside in the community that can help sustain recovery. Anyone can come in during business hours, even people not yet in recovery, including family members and allies.
"RCCs are loving places, where you feel nurtured, welcomed, and valued."
Recovery services include recovery coaching, all recovery meetings, and recovery enhancement groups, among others. RCCs also offer skill-building services, like financial literacy workshops or employment and job training, and recreational activities, like yoga and arts therapy. They host educational presentations from community-based organizations and screenings such as HIV testing led by health agencies.
These are loving places, where you feel nurtured, welcomed, and valued. RCCs have the ability to support the continuum of care. Those services, like outpatient or residential treatment, can help people with needed medical or clinical issues, but RCCs can connect them to the community. That’s very important for people leaving prison or other systems where they’ve been disconnected.
Q. How are RCCs managed, financed, and staffed?
A. RCCs are the physical spaces that are managed through Recovery Community Organizations (RCOs), which are independent nonprofit organizations led by people in the recovery community with experience establishing, creating, and maintaining RCCs. RCO boards of directors are suggested to be 51 percent of people with lived experience in recovery, and include family members or other allies and friends.
There’s been an evolution of funding. RCOs today rely on an array of federal, state, and local grants, as well as foundation grants and in-kind donations. But back in the mid-1990s, RCCs were not even a thought. The advocacy community was focused on raising awareness and eliminating stigma, which SAMHSA helped fund through their recovery community grants. But eventually there was a paradigm shift, when SAMHSA wanted RCCs to move to actually deliver the services. So in the early 2000s, I helped establish and manage one of CCAR’s (Connecticut Community for Addiction Recovery) first RCCs in Bridgeport, Connecticut with state and SAMHSA funds. Many grants for RCCs have increased over time.
RCCs believe in volunteering. There will always be some RCC staff — the executive directors and managers. But the structure recognizes that a lot of people who get into recovery also want to volunteer to give back. So there are various volunteer roles such as receptionists, recovery meeting facilitators, or leaders for yoga or computer lab classes to name a few. The volunteer program is an ideal place where people can build skills and become marketable for gainful employment.
Q. What roles do peer recovery coaches play in these settings and what types of supports can they provide there?
A. A major part of volunteering is learning recovery coaching. At CCAR, when the volunteers established 90 hours of volunteer work, they could receive a free scholarship to the weeklong CCAR Recovery Coach Academy, which helps build their skills and leads toward becoming designated as a CCAR recovery coach. A lot of times those individuals go on and find jobs in their communities, whether it's with clinics, outpatient programs, recovery houses, or somewhere where people are saying, “I want to hire recovery coaches.”
"A peer with lived experience can have a real impact and is an ideal guide to help others in recovery. They are an instrument of hope."
The whole idea of RCCs came from peers in recovery wanting to help others. A person with lived experience can have a real impact and is an ideal guide to help others. They are an instrument of hope. They show others how to stay on that path of recovery and can talk about what it took them to get where they are now. And they can talk with others to understand what that person is looking to do. What are their endeavors? And what supports will help them get there?
One example of the type of support recovery coaches provide in RCCs is telephone recovery support. For example, at CCAR’s Bridgeport RCC, we had telephone recovery support where trained volunteers would call people from the center (who had requested the service) to check in on them twice a week. The weekend can be especially challenging for people in recovery, so just checking in right before and after a weekend is an important type of support.
Q. How are recovery community centers different from treatment clinics?
A. RCCs are complementary to treatment services. RCCs are a way for people to continue getting support for their recovery, even outside of treatment settings. This model recognizes that people are often using multiple pathways of recovery — it’s not just 12-step fellowship. RCCs help give people an opportunity to engage in conversations that help them identify other pathways to recovery that they may want and supporting them on their journey.
We also refer people to access services or supports related to “social determinants of recovery.” For example, people might need support with their rent or food or getting identification, which can be a big concern for people coming out of incarceration.
We also make referrals to community resources for needed health-related services. Some people at RCCs may have lost their sense of health care. Not only for substance use-related conditions, but also for medical and dental care, and we can help connect people to primary care and dentists.
Q. What are the barriers to establishing and sustaining recovery community centers?
A. The ability to get funding to start up an RCO is not easy. A lot of people begin with small community development or foundation grants, or small partnerships with other community-based organizations focused on opening an RCC, the brick-and-mortar place where you can offer recovery support services. Subsequently, as RCOs start to make a name for themselves, hopefully other funding sources and in-kind donations start to grow.
But it is hard to become established, especially in underserved under resourced communities. There are major cities in America with large black communities that don't have RCOs at all. For instance, I formerly led the Center for African American Recovery Development (CAARD), and in our research, we discovered that the states of Tennessee and Louisiana had no RCOs. So over the last couple of years, CAARD has supported the establishment of RCOs in Memphis and New Orleans.
Sustainability is also challenging. Even “established” RCOs struggle when they want to do more because funding is limited.
Q. What impacts have been measured for people served in recovery community centers?
A. The Recovery Research Institute at Massachusetts General Hospital is a great resource for new research on RCCs and other evidence-based addiction treatment and recovery supports, including their monthly RCC seminars. The RCC that I managed was part of a longitudinal study evaluating the perceptions of impact from people who received services at several RCCs. This study identified participant characteristics (like involvement in parole or probation, level of education and income), which showed most new participants had high levels of clinical severity and little access to recovery capital. It found improvement in well-being across three-months.
Q. What policy activities would support the growth of RCCs?
We have made a lot of impact over the last 25 years with the development of RCCs. And we've seen more support for RCCs than ever before and that will continue to grow. For example, SAMHSA has recently increased funding for the Building Communities of Recovery grant that RCOs can apply for to develop RCCs or other recovery supports. And we see momentum building for reimbursements.
"An exciting development is opioid settlement dollars. While legislation surrounding these allocations will be unique to each state, some states are placing RCOs on the list of priorities, which can in turn help establish RCCs."
Many Medicaid programs are opening up to reimburse for some recovery support services, such as peer support services. And just in the last year, one commercial plan in Minnesota has started to reimburse for recovery support services. At the same time, RCC leaders are wary of the work that goes into billing for these reimbursements as the saying goes, “there's a lot of squeeze, but no juice.” Spending time identifying the right billing codes and documentation means time not spent supporting someone in recovery. So one thing to address is really taking a look at extending, eliminating, or somehow streamlining the billing codes.
An exciting development is opioid settlement dollars. While legislation surrounding these allocations will be unique to each state, some states, like Connecticut, are placing RCOs on the list of priorities for settlement dollars, which can help establish RCCs.