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The professionalization and industrialization of addiction treatment was accompanied by a number of mechanisms aimed at protecting the safety of those being served: informed consent, confidentiality regulations, program accreditation standards, background checks for volunteers and job applicants, credentialing/licensing of addiction professionals, professional codes of ethics, patient grievance procedures, manual-guided therapies, and clinical supervision, to name just a few. Such mechanisms were Intended to prevent the inadvertent harm in the name of help that had historically existed within the treatment of substance use disorders. But how can such safety concerns be extended to the ancillary recovery supports to which addiction treatment programs routinely refer?
Assertive linkage of patients/families from addiction treatment programs to recovery mutual aid and other recovery support institutions (e.g., recovery community centers, recovery homes, recovery schools, recovery ministries) is a common service procedure. Patients and families so referred enter these other institutions often assuming that the safeguards existing within the treatment setting extend to these allied service institutions. There is, however, growing recognition that this may not be the case. Highly publicized accounts of attacks by sexual predators and violent criminals perpetrated by individuals met within these mutual aid contexts, increased discussions within?the recovery media of sexual predation, and a new documentary film (Monica Richardson's The 13th Step) are calling attention to threats to personal safety that may exist within these settings. And they are raising the questions of the responsibility of treatment programs to enhance the safety of patients referred to these recovery support resources.
The potential responsibilities of treatment programs to enhance personal safety within this referral process span at least five areas.
Due Diligence Prior to Referral
- Onsite investigation of all referral sources prior to referral and assertive linkage of patients
- A recovery advisory committee to assist with review and approval of such resources
- Surveys of former/current patients to assess quality/safety of community-based recovery support resources
Safety Cautions at Point of Referral
- Discussing vulnerabilities within intimate relationships during recovery initiation and stabilization
- Reviewing potential benefits and risks of participation in mutual aid organizations
- Noting differences between safeguards in treatment and the fewer safeguards in mutual aid contexts
- Acknowledging the potential presence of individuals with predatory histories whose presence may be legally mandated
- Discussing safety strategies within these contexts
- Using a recovery coach to facilitate this linkage and engagement process
- Noting availability of treatment team to assist with any safety issues that might arise
- Assuring that men as well as women receive these cautions
Active Monitoring of Patient Response to Referral
- Conducting a telephone check-up following referral to assess patient response to the referral resource and any safety concerns that have arisen
Providing Emotional Support
- Maintaining continuity of support over time for patients responding to traumatic victimization within mutual aid organizations
- Exploring other avenues for the emotional support provided by the mutual aid organization (or enhanced safety strategies within that context)
Supporting Patients Seeking Redress
- Discussion options for redress with any patient who feels they have been (are being) harmed within the mutual aid context
- Supporting patient to take steps to assure personal safety and justice (e.g., filing criminal charges, seeking restraining orders, filing complaints to funding authorities, etc.)
- Assertive responses within the community to reported patterns of predatory behavior, (e.g., meeting with institutional representatives, cessation of all referrals until risks are resolved)
There will be an inevitable defensiveness among treatment programs and mutual aid organizations in response to reports of victimization within these contexts. It is important that we rise above such defensiveness, acknowledge the vulnerabilities and risks that exist within these recovery support settings, and do all that we can to assure the safety of everyone seeking sanctuary. Harm in the name of help is an ever-present risk requiring our utmost vigilance.