“I would have died without help”: Connections, learning, and the de-stigmatization of substance use in rural communities in Maine

Abstract Information: Rural areas are experiencing a critical behavioral health workforce shortage, expediting the current opioid crisis in the U.S. One Maine program targets people with lived experience for entry into the behavioral health workforce. Through Recovery Jobs for Beginners, “lived experience”, or the fact of having lived through the experience one is trying to address, functions in equal parts as community-building, advocacy, skill, and evaluation. Peers and others with lived experience working in behavioral health mobilize the stories of their pasts to make connections with those who need help as well as with those who are thriving in recovery, and with those whose experiences shift between these categories. The common mantra, “the opposite of addiction is connection” is borne out through the retelling and ever-expanding dynamism of stories, where hope lies in the honoring and sampling of "multiple pathways to recovery". Also, by centering the universality of human pain and triumph, stories function to destigmatize Substance Use Disorder (SUD) and Mental Health help-seeking throughout rural communities, so that those who need it have greater access to care. While working in behavioral health fields, these experiences and stories form a vital part of the peer relationship, giving the peer the tools they need to tap into the strengths of people who may be entering or re-entering recovery spaces. Finally, stories about experiences with an intervention answer the “how?” and “why?” questions about our own programming that offer a blueprint for the way we implement in the future. During this presentation, we will exhibit these 4 uses of story, their interweaving within Recovery Jobs for Beginners and other training programs, and the impacts they are having on lives in Maine. We will show that within SUD Recovery spheres, story is more than a way of conveying information meaningfully – it is also an exercise in making the connections that contain the power to heal and to convert despair into living connection.

Relevance Statement: This proposal offers an antidote to the hegemony of quantification in evaluation and global health (see Adams, 2016 in the case of the latter), as well as highlighting a field within which storytelling has particular relevance, not only for evaluation but for the intervention itself. This relevance is made all the more urgent due to the heightened crisis of opioid use in the United States, and its impacts on families and communities. So far, we have not been able to address this issue through quantification. Rather, we can see that it is disconnection from stories and each other, distancing from the true contexts of SUD, and failure to answer the right questions that leaves us with skyrocketing overdoses and deaths in the wake of COVID-19. Using stories in our interventions and in our evaluations helps people to see themselves in the problem, and to find solutions where they didn't previously exist. Peers in behavioral health seem particularly well-poised to offer their expertise, skills, and compassion in this area of study.

References: Adams, V. (2016). Metrics: What counts in global health. Duke University Press. Brief bibliography of the relevance of peer/lived experience to behavioral health interventions: Drake, R. E., Essock, S. M., Shaner, A., Carey, K. B., Minkoff, K., Kola, L., ... & Rickards, L. (2001). Implementing dual diagnosis services for clients with severe mental illness. Psychiatric services, 52(4), 469-476. Forchuk, C., Martin, M. L., Chan, Y. L., & Jensen, E. (2005). Therapeutic relationships: From psychiatric hospital to community. Journal of psychiatric and mental health nursing, 12(5), 556-564. Kutash, K., Duchnowski, A. J., Green, A. L., & Ferron, J. M. (2011). Supporting parents who have youth with emotional disturbances through a parent-to-parent support program: A proof of concept study using random assignment. Administration and Policy in Mental Health and Mental Health Services Research, 38, 412-427. Obrochta, C., Anthony, B., Armstrong, M., Kalil, J., Hust, J., & Kernan, J. (2011). Issue brief: Family-­‐to-­‐family peer support: Models and evaluation. Atlanta, GA: ICF Macro, Outcomes Roundtable for Children and Families. Retrieved from hNps://www.ffcmh.org/sites/default/files/Issue Brief -­‐ Family to Family Peer Support Outcomes Roundtable 2011.pdf