Some States Using Federal Grant Money to Help People with Addiction Find a Path to Recovery

Some States Using Federal Grant Money to Help People with Addiction Find a Path to Recovery
By Christine Vestal 

This piece comes to us courtesy of Stateline. Stateline is a nonpartisan, nonprofit news service of the Pew Charitable Trusts that provides daily reporting and analysis on trends in state policy. 

JAMAICA PLAIN, MassachusettsAt 52, Dajaun Alexander says he’s looking for a fresh start. He graduated from a cooking course here last week and has been chosen for a paid apprenticeship. His prospects for a full-time job after that are very good, his chef instructor said. 

For Alexander, completing Community Servings' 12-week course represents a rare achievement in a life punctuated by what he calls "bad decisions." He is a recovering alcoholic with a history of incarcerations, broken relationships and spotty employment. Cooking, he said, "is my passion." 

It may also be his path to recovery. 

The local food preparation facility where Alexander trained is part of a national program known as Access to Recovery (ATR). The voucher program, launched in 2004, aims to help low-income people in recovery restart their lives and avoid relapse. 

Trainee Dajaun Alexander preps pizzas with chef instructor Susan Logozzo in an industrial kitchen at Community Servings in Jamaica Plain, Massachusetts. Career training programs like this have been shown to vastly improve a person’s chances of staying clean and sober. (Amanda Marsden/Community Servings) 

Eleven states receive ATR grants for services from addiction treatment to what is called recovery support.

"Treatment is only one aspect of recovery," said Rebecca Starr, a senior behavioral health consultant at Advocates for Human Potential and ATR project director in Massachusetts. "You’re still in a terrible neighborhood. You still have no money. And you still need a job," Starr said. "When someone has completed treatment, we don’t want to put them right back in the same situation they came from and expect a different outcome."

Because most residents have insurance under the state’s 2006 health care reform law, Massachusetts chose not to use its federal grant money to pay for addiction treatment. Instead, those funds go to what Starr calls a safety net for recovery.

In the greater Boston and Springfield areas, ATR serves low-income veterans, women who are pregnant or caring for young children and adults who have recently been released from jail or prison. 

ATR programs vary widely by state. But all include vouchers for necessities like interview suits, sets of tools, car repairs and cellphones. Some participants put the money toward driver's licenses or high school equivalency tests; others use it to purchase underwear or winter boots.

In addition to the vouchers, each state has developed a set of services and a target population. Michigan, for example, serves only Native Americans and uses tribal healing methods. Illinois and Ohio focus on adolescents in the criminal justice system. North Carolina works with local universities to help college students with addictions. 

But Massachusetts' career building program stands out. 

Employment and Addiction 

According to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA), the federal agency that funds the state-run programs, "employment is both an outcome and a core component of recovery." 

Massachusetts began offering career training, the project director said, because extensive research showed that finding and keeping a full-time job was a key indicator of success in overcoming drug and alcohol addiction. 

The state's analysis for the last round of ATR funding showed that the odds of having a positive re-entry/recovery status at program completion were significantly greater for those who were employed compared to those not employed. For example, the odds of criminal justice involvement were 40% lower for employed vs. not employed and the odds of being in stable housing were 2X greater for employed vs. not employed ATR participants. The research literature reinforces this finding, stating that employment facilitates successful substance use treatment, improves self-esteem, confidence and morale, and contributes to reduced recidivism.

"Career training was slow to take off," Starr said. Because the ATR participants come into programs such as ATR with their lives in such disarray, they need their immediate critical basic needs met before they can even contemplate the longer-term goal of finding a career. They needed to use their basic voucher monies to buy underwear or winter coats, get identification cards, and other basic needs. "It was then that we had an aha moment," Starr said. "We realized that participants would not opt for the career training unless they could also get their basic needs paid for by the ATR vouchers, so we set aside a reserve fund just for career training that they could opt into separate and apart from the basic needs vouchers." 

In addition, in order to provide some income while in career training, participants were also given an $8-an-hour work-study benefit for attending the job training classes. This allowed them to work on the longer term goal of obtaining occupational skills that could set them up for a career rather than a low paying revolving door type of job that they ordinarily would have to get just to put food on the table. The Career Building Initiative (CBI) program in Massachusetts demonstrated that employment is an important and necessary part of successful recovery and re-entry into the community. 

Enrollment soared. In addition to food services, the CBI program trains workers in occupations such as construction, commercial cleaning, hospitality services and computers. These are occupations that are more open to hiring people with criminal backgrounds, Starr said. 

Massachusetts ATR set aside a portion of its $7.8 million ATR grant for the CBI job training program – tuition at Community Servings’ culinary arts program, for example, is $5,000 for 12 weeks of training. Those ATR participants who opt into the CBI program can take advantage of these occupational skills training. Others who are not ready for a job search use their voucher money for basic needs (at a much lower cost per person). 

In the previous grant period (2010-2014), Massachusetts received $9.6 million for ATR. Nationwide, 30 states received grants then. Now in this most recent round of funding (2014-2017), only 10 states have received funding. SAMHSA has been winding down the ATR grant program and Congress said it would not re-fund it.

But Karen Pressman, planning director at the state Bureau of Substance Abuse Services, says the state hopes to continue the best elements of the program using existing state resources. In addition, state lawmakers may consider appropriating new funds, she said. 

Future Possibilities 

"ATR has given us a chance to try out some evidence-based practices and incorporate them into our overall systems for recovery," Pressman said. "For a long time we’ve known that people recover in many different ways. Treatment is one of those ways, but often people recover through other paths. We wanted to make sure we supported people in whatever path they chose to recovery." 

"Career training may not be for everyone in recovery, particularly if they don’t have stable housing," Pressman said. But many people need to get a job right away to pay rent or make court-ordered payments. Allowing people to get paid while they learned new skills helped get more people into the program, she said. 

Through its ATR grants, Massachusetts has built an infrastructure of providers like Community Servings who have been trained in how to work with people in recovery. They and others can provide services in the future if the state is able to find funding. Other ATR providers include certified addiction coaches, housing specialists and case managers.

For Alexander, a lanky man with expressive eyes and a timid demeanor, the phone call he got from Community Servings' training director accepting him into the program may have been the break he needed. "I thanked her a hundred times on the phone and a hundred times more when I met her," he said. 

His eyes welled up when he described the first day of class. "We got a chance to meet the CEO and the executive chef and everyone in the kitchen. Each one talked to us. For me it was inspirational," he said. In addition to the cooking skills, Alexander said the ATR program has given him "a sense of direction." 

Since he left Boston’s South Bay House of Correction in October, Alexander has been living in a nearby homeless shelter. He’s on several waitlists for subsidized housing. For now, he says his goal is to get a job cooking for the elderly in a nursing home or assisted living facility. "My instructor says I should aim higher. But who’s to say? I could do a job cooking for a little while and I might get recognized as someone who could be an executive chef."

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