PROVIDENCE – On Friday afternoon, Jan. 4, 2019, ConvergenceRI sat down to talk with Debra A. Dettor, the director of Recovery Support Services at Anchor Recovery Community Centers at its interim headquarters at the Jim Gillen Teen Center on a busy stretch of North Main Street across from Gregg’s Restaurant.

The interview took place in the computer room, in an impromptu setting that afforded privacy of conversation amidst a veritable white noise of wired connections, with Dettor, ConvergenceRI, and Jake Bissaro, the communications staffer from Care New England, sitting in.

At the end of December 2018, Anchor Recovery had been forced to vacate its long-time headquarters when the owner of the property in Pawtucket, an insurance company, said that it was selling the building. The agency is now in search of a new space to house its growing network of recovery programs, ongoing meetings and counseling efforts.

The wish list for the new space includes: a stand-alone building with between 7,000-8,000 square feet, with a big meeting space, in a very visible location, where Anchor Recovery can serve as “a beacon of recovery, where people can see recovery in their community,” according to Dettor. Another key item: up to 75 parking spaces to serve both staff and visitors.

The move to a new headquarters comes at a time when the state, as part of the effort to rewrite the next three-year strategic plan for the Governor’s Task Force on Overdose Prevention and Intervention, is wrestling with how best to develop new metrics to measure the benchmarks for recovery outcomes, moving away from an acute-care metrics toward a continuum of recovery care that better reflects the nature of recovery as a longer-term process.

It also coincides with nascent clinical research efforts now underway to measure the effectiveness of peer recovery coaching as part of the process of recovery, compared to embedded social workers at Rhode Island Hospital. [See link below to ConvergenceRI story, “The problem with rewriting news releases as news.”]

The hub of recovery in Rhode Island
Anchor Recovery, a division of The Providence Center, which is owned by Care New England, about to be acquired by Partners Healthcare, has been at the nexus of recovery efforts for much of the last decade.

Anchor Recovery currently serves as the home to:

• Anchor ED, one of the first such programs of its kind in the nation, which connects certified peer recovery coaches with individuals treated at Rhode Island emergency rooms for substance use disorders and overdoses. Anchor ED is now partnered with every hospital in the state; the innovative program, created by Jim Gillen and Holly Cekala, was first deployed in 2014. [See link below to ConvergenceRI story, “Recovery intervention at emergency rooms, by the numbers.”

• Anchor MORE – or Mobile Outreach Recovery Efforts, through which peer recovery specialists go out into the community and talk with individuals who may be struggling with substance use disorders, reaching out to all 38 towns and cities in Rhode Island, visiting places such as soup kitchens, shelters, bus stations and needle exchanges.

• The connection to the PVD Safe Stations initiative. Anchor serves a critical cog, providing the go-to link to help connect and transport individuals who seek help at Providence Fire Stations to treatment support and services. It also serves as a way to connect clients to BH Link, the new state initiative to provide triage and wraparound services to those with behavioral health issues.

• Telephone Recovery Support, an innovative, peer-to-peer support service that provides weekly telephone calls to check in on people in recovery. Those in recovery are given support and encouragement as well as information about community resources, support meetings, and alternative recovery pathways that may help them maintain their recovery.

• The Jim Gillen Teen Center provides ongoing support and counseling for high school students confronting issues of substance use and risky behaviors, providing a safe place to talk about those issues. [See link below to ConvergenceRI story, “The best way to honor Jim Gillen.”]

Translated, Anchor Recovery serves as the community hub of recovery efforts in Rhode Island, and Dettor is often at the center of the recovery beehive, directing and coordinating those efforts. She brings more than three decades’ wealth of experience and insight working in the recovery field.

And, unlike the scripted agenda at a Task Force meeting, where much of the actual dialogue in shaping policy seems to occur off-stage, the conversation with Dettor has a sense of immediacy and directness, as she shared her observations of what is happening on the ground.

When asked to define the unique perspective that Anchor Recovery brings, Dettor said: “I see us as on the ground. What is happening comes here. We see it, we meet it; we talk to the folks who are having different issues. Our staff [consists] of people in recovery from different paths, with different histories.”

The strength of that, Dettor continued, “is we know how to speak to people that come to us with whatever issue.”

Moving forward, Dettor told ConvergenceRI, she believes there is the need to change the focus from the old methodology of dealing with addiction as a pathology and responding to it within the framework of an acute care model, to move toward a recovery care model.

“Let’s use that language,” she said. “It is really about recovery care in a lifetime, recovery that changes. It doesn’t mean you need to treat it over a lifetime. It means that different resources have to be available to you at different stages of your recovery.”

The addiction epidemic, Detttor said, “is a bigger epidemic than just opiates. As John Kelly, [the founder and director of the Research Recovery Institute at Massachusetts General Hospital and Associate Professor of Psychiatry at Harvard Medical School], wrote in a recent article in Psychology Today, talking about the statistics on alcohol and alcoholism, the fact that it is the still the biggest killer and it is on the rise.” [See link below to article, “The Forgotten Addiction.”]

Dettor continued: “What we try and remind people of, over and over, is that alcohol is still in the game. There are higher numbers of deaths, there are high incidences of alcohol. For me, it is an addiction crisis, not an opiate crisis.”

Here is the ConvergenceRI interview with Debra Dettor, the director of Recovery Support Services at Anchor Recovery Community Centers.

ConvergenceRI: How do you see your role at Anchor Recovery Community Centers?
DETTOR: I am not sure how to answer that question.

ConvergenceRI: Anchor Recovery is at the nexus of so many activities and initiatives – from Providence Safe Stations to peer recovery coaching, from mobile outreach efforts to teen counseling.
DETTOR: I can speak to how I see what we are doing and what we are bringing to the whole situation.

I think you know that [the addiction] epidemic is a bigger epidemic than just opiates. The fact is that alcoholism is still the biggest killer and it is on the rise.

ConvergenceRI: One of the questions that I have consistently asked the co-chairs of the Governor’s Task Force is where is the data that connects the diseases of despair in Rhode Island – alcohol, suicide and drugs.
DETTOR: You’re exactly right. What we try and remind people of, over and over, is that alcohol is still in the game. And, it’s getting bigger, while people are not paying attention. There are a higher number of deaths; there are higher incidences of alcohol [intoxication]. I want to make sure that we don’t lose track [of that]. For me, it’s an addiction crisis, not just an opiate crisis.

The crisis is so much bigger than just what we think; there are so many issues underlying what’s happening with the illness. We need to address all of that. And, it’s a really daunting challenge.

ConvergenceRI: One of the pilot programs that the Providence Center was involved in was the Recovery Navigation Program, which ended in July of 2018, focused on creating an alternative to sending EMS transports with individuals with impressions of alcohol intoxication to an alternative facility other than the ER. I have been told that the BH Link facility is meant to replace that program. Is that accurate? Are patients referred to BH Link who may have issues with alcohol?
DETTOR: There are. What I will tell you is that our recovery coaches will send people to BH Link from the hospital; they will get referred there sometimes for the next level of care.

And, the mobile outreach takes people there, and the Safe Stations will take people there, too. We actually see a higher incidence of people with alcohol [issues] than with opiates in most of our programs.

We have an upcoming meeting with BH Link to talk about how we collaborate, to figure out how to bring the right people there for the right services, to make sure that they get the care that they need. We are in those conversations.

ConvergenceRI: You are one of the first persons that I have talked with who is saying that alcohol is a bigger problem that opiates. Why do you believe that is so hard for people to recognize?
DETTOR: My opinion is that we are frightened by what’s happening with opiates, it has come on so big, and so strong, and so powerful, that I think we are overwhelmed by the fact that this new epidemic is mushrooming and growing so fast.

I think fentanyl changes the game, too. It’s no longer just heroin or coke, now you have to worry about people dying from fentanyl in the mix.

And, the fact that fentanyl is laced in cocaine and so many other drugs right now, we’re not even sure what’s in them, people are not even sure what they are taking. So, I think the game has changed so much that we have to put so many resources and attention to that.

It’s easy to get over-focused. You know how things are; people say, “Oh my goodness, we’ve got to take care of that.”

ConvergenceRI: In early 2018, reporting on the statistics for emergency medical services transports to hospitals ERs in Rhode Island, in light of the closing of the Memorial Hospital ED, what I uncovered was the fact that alcohol intoxication was the number-one reason for EMS transport to Memorial Hospital in 2017, and it was in the top five “impressions” for EMS transports at other hospital EDs, too. [See link below to ConvergenceRI story, “Moving beyond dilly dilly.”]

I also published a piece that had been written by an emergency room doctor in Rhode Island about his frustration in dealing with a patient who was a chronic alcoholic. [See link below to ConvergenceRI story, “The recurring dance of chronic intoxication and the ER.”]

The ER doc talked about his frustrations about the lack of medical care he could provide to the patient; the patient sobered up, walked out of the ER, and then got drunk again.
DETTOR: Retox. We call that retox.

ConvergenceRI: What is retox?
DETTOR: Going in and out of the detox syndrome without getting the next level of care that you need. It is a gap in the system that shouldn’t be there.

ConvergenceRI: Is there a way to change the conversation in terms of policy at the state level, through the Task Force?
DETTOR: Whatever is going on at the state level, with the task force, came together because of opiates. They came together for that crisis, which makes sense.

That’s why they focus on opiates and how the state is going to handle that. And, you know, that a lot of that has to do with following the federal agenda, which is making medications available, making sure that folks have access to methadone, suboxone and vivitrol, all of that.

ConvergenceRI: As you say, you are on the ground. You see all the different things that are happening. How does the information flow? Does it need to be shared differently?
DETTOR: That’s a good question. Remember, we are state-funded, so we have reports we turn in. They do get our reports. They see how many opiate calls, how many alcohol calls, [are being handled]. That information gets funneled back to them. That is about funding and the work that they are commissioned to do.

We are also in consultation with numerous other states; we provide consultation to a lot of different organizations that are going the same work nationally and in Canada.

We are learning about what other states are doing; and they are talking to me about learning from us about what is going on in Rhode Island. I’m encouraged.

ConvergenceRI: Here in Rhode Island, have other reporters sought you out, in the same way we’re doing now, to talk with you? To learn about your activities? To better understand the unique vantage point you have about knowing what is happening on the ground?
DETTOR: I am relatively new to the state. But, no, since I’ve been here, I’m not seeing that. People have sought us out for bits of information, but not necessarily for the trends about what is happening.

ConvergenceRI: Moving forward, Care New England is in a transition period. Anchor Recovery is in a transition period. Here you are, in temporary headquarters, looking to establish a new location. What are you looking for in that new location?
DETTOR: The wish list is a [standalone building with] 7,000-8,000 square feet. A very visible location, like the previous Anchor headquarters was. We want to make sure that people can find us.

The other part of that is, by being visible on the street as a recovery organization, we serve as a beacon of recovery, that you can see recovery right there. As recovery advocates, we want to make sure that people see recovery in their community.

Our wish list includes things like a very big meeting space, like we had before, but one that we can close off, where we can have privacy while we are running other programming.

We need to have build-out space for our computers, for our phone banks and telephone recovery support, and then private spaces for coaches to meet with people, one on one.

We’ve included all these in specs that we have already put out specifically; then there are things like sprinklers we have to worry about.

And parking. Parking is a big one. We need to make sure that all of our staff can find parking nearby, and so can the folks that come to us. So that it means having something like 75 spaces available.

ConvergenceRI: One of the central components of Anchor Recovery, which began as an improvisation by the late Jim Gillen and Holly Cekala, is peer recovery coaching interventions at hospital emergency rooms. In retelling the story of how that improvisation happened, there always seem to be a lot of mothers of invention in Rhode Island.
Do you have any insights to share about that story?
DETTOR: [laughing] I can tell you, because I was in Connecticut at CCAR [Connecticut Community for Addiction Recovery], when Anchor started doing peer recovery coaching here; when Jimmy was here, they used the CCAR model. That’s the model we currently use.

ConvergenceRI: There is a new clinical study being conducted by Brown that compares the efficacy of embedded social workers at Rhode Island Hospital with peer recovery coaches. Can you talk about what you think is the best way to look at peer recovery coaching to measure its effectiveness?
DETTOR: Here’s the cool thing I want to throw into the conversation. With peer recovery coaching, it is often about creating the opportunity for a longer engagement, to get someone to the next level of care, than just what happens in the emergency room.

You might be a coach in so many different environments, where you might have a window of opportunity, where we can maybe get over the hump and take those next steps toward recovery.

We are going to keep engaging with you until we can help get over that precipice. That’s the hope.

ConvergenceRI: At what point does the work of peer recovery coaching become better integrated into the entire clinical model of care? I just did a story about how the Care Transformation Collaborative has piloted two initiatives, screening for depression and anxiety and substance use as part of primary care. The training for the screening is being done by the Rhode Island College Department of Social Work. It would seem to me that the experiential knowledge of peer recovery coaching could add greater dimensions to that effort.
DETTOR: Here’s the problem. We don’t have really the data yet about some of the efficacy of peer recovery coaching. That stuff is just starting to be studied.

That’s where I call people like John Kelly at Harvard and say, what kind of studies are you conducting about per recovery coaching to make that a priority, to find the money, because we need good researchers who understand peer support to start studying the efficacy of coaching,

Here’s the thing I know anecdotally. We can reach people differently than a clinician can.

Because when we sit with people, the stigma and shame that people have about struggling with addiction can get lessened right on the spot, just by somebody sitting down and saying, “I’ve been where you are.” Clinicians can’t offer that.

We have to study the ways that our interventions can make a difference. We see it, but we don’t have the metrics.

In August of 2018, I was a technical expert [convened] by SAMHSA in Washington, D.C., on a panel looking at research and evaluation for recovery support services.

ConvergenceRI: I think you have put your finger on the need for what would better research but also better metrics, metrics which move away from the perverse metrics of reporting when people die, and not what happens when people are in recovery.
DETTOR: Exactly right. William White, [an Emeritus Senior Research Consultant at Chestnut Health Systems and past-chair of the board of Recovery Communities United], he’s really the father of the recovery advocacy movement.

He’s been saying all along: we have to study recovery outcomes, we have to study people in recovery, to understand the recovery process and what makes recovery work, to understand it. Because we have been studying pathology for so long, we have not studied the solution, which is recovery.

For this August panel, the focus of that was recovery support services, bringing together researchers from six domains, to talk about how do we do better research, what are the prime gaps, how do we research those things so we can understand what’s going to help.

It’s just starting to catch fire in ways that interest me. I’ve been doing this work a long time.

ConvergenceRI: How long have you been doing the work?
DETTOR: Thirty-six years. I have a master’s in counseling and doing work in recovery for 36 years. And, I have been in recovery for 33 and a half years, so it is personal.

ConvergenceRI: Here is Rhode Island, a new strategic plan has been being developed by the Governor’s Task Force; a lot of the work is focused on metrics, wrestling with what the metrics should be for recovery. How much input have you had into that process, to redefine recovery metrics?
DETTOR: I was able to give feedback online. And, it is difficult to get metrics about recovery, because there is a lot of controversy about recovery measures and what that looks like.

That has not been convergence around what are the things we should study and how should we study it, and how should we put it together. That’s real.

It is about how we move from anecdotal [accounts] to research [findings].