Mind and Body

The healing arts of recovery

An interview with Sandy Valentine, the new executive director of RICARES, as the recovery community changes and reacts to the ongoing epidemic

Photo by Richard Asinof

Sandy Valentine, executive director of RICARES, outside her office in downtown Providence.

Photo by Richard Asinof

A selfie of Richard Asinof, Sandy Valentine, the executive director of RICARES, and Ian Knowles, the program manager of RICARES.

By Richard Asinof
Posted 4/17/23
An in-depth interview with the new executive director of RICARES, Sandy Valentine, who believes that recovery is prevention.
When will the General Assembly and the Rhode Island Foundation publicly make the case that it is the failure to raise Medicaid rates for providers that is strangling the behavior health system? How should the outcome of the trial of Fox News for their knowing distortions of the truth when it came to falsely reporting on the former President’s loss in the 2020 Presidential election change viewing habits of the general public? How should the mounting evidence connecting the forever chemicals PFAS to serious health consequences change the federal and state regulatory requirements? When will Gov. McKee come clean and share what was in the email sent to the state regarding the allegedly shocking bad behavior exhibited by DCAMM Director Patten? Is anyone paying attention to the fact Optum, the for-profit manager for two of the three Medicaid MCOs in Rhode Island’s behavioral health services, apparently just opened up a payday lending service for health providers?
A bill put forward by Sen. Linda Ujifusa, which would instruct the Auditor General to hire an independent consultant to compare the costs and patient outcomes of the current MCO Medicaid programs, has sparked renewed interest in accountability about the expenditures made by the state to private contractors to manage Medicaid care. Senate President Ruggerio said that he has not yet the opportunity to review Sen. Ujifusa’s proposal. Sen. Josh Miller said he was in favor of the legislation, in principle, but wanted more clarity around who should be conducting the audit: the AG, OHIC, or perhaps the Brown School of Public Health.
What is at stake is approximately some $300 million in savings if Rhode Island was to switch back to a state-run fee for service program, similar to what an audit by Connecticut resulted in such savings. Sen. Sam Bill is supporting the effort. Stay tuned.
In an email, John Fernandez, Lifespan’s President and CEO, outlined significant changes to the future of the state’s largest hospital system. Dr. Steven Lambert, president of Lifespan Physician Group, will be retiring at the end of the month. Dr. Saul Weingart, president of Rhode Island Hospital and Hasbro Children’s Hospital, has departed, immediately. In turn, three new positions – a chief physician officer, a chief of hospital operations, and an executive vice president of ambulatory services will be hired, following a national search. Translated, Lifespan’s current leadership team has officially imploded, it seems.
Dinner invitations this week go out to all the former communications executives who worked for either Lifespan or Care New England to have candid discussion about the failure by Lifepan’s current board of directors to engage with woman on an executive level of leadership – including Gail Carvelli and May Kernan – as well as Drs. Megan Ranney and Elizabeth Goldberg, who recently left their staff positions at Lifespan.

PROVIDENCE – The recovery community in Rhode Island has been blessed with many strong leaders over the past two decades, from the late Jim Gillen and Tom Coderre to Linda Hurley, Colleen Ndoye and Abbie Knapton.

The leaders have often cobbled together innovative responses to the ever-changing dynamics of the ongoing opioid epidemic – from launching the Rally4Recovery to creating a program of peer recovery coaches at hospital emergency rooms, from launching a drop-in teen center to developing a mobile van intervention in order to meet people where they are. And, the latest innovation-to-be: the launch of a pilot harm reduction center in Providence.

The shape of the epidemic crisis has also morphed. What began as an epidemic stoked by unscrupulous pharmaceutical companies pushing addictive prescription painkillers has changed: As author Sam Quinones wrote in a recent Washington Post op-ed: “To anyone paying attention to the overdose crisis in the United States, it should be clear that the country no longer faces only a drug problem. It faces a national poisoning [emphasis added]. The supplies of fentanyl and methamphetamine here have surpassed anything previously imaginable.”

The Biden administration announced on Friday, April 14, that it is increasing cooperation with Mexico to combat the trafficking of fentanyl coming north while also cracking down on the trafficking of guns going south into Mexico.

Translated, the Biden administration is making the connection between two of the greatest public health threats – the flow of illicit substances such as fentanyl and the flow of illicit guns.

ConvergenceRI recently sat down and talked at length with Sandy Valentine, the new executive director of RICARES, the R.I. Communities for Addiction Recovery Efforts, which describes itself on its website as a grassroots effort focused on creating “a socially just community for all Rhode Islanders impacted by substance use.”

Valentine, who previously worked with the UConn Recovery Community, serves as the cohost of the “Recovery Matters” podcast. Valentine also spent three decades working with the insurance industry for The Hartford.

For Valentine, the focus of her work is on recovery. At the same time, as she acknowledges, “You can’t get into recovery without a heartbeat.”

She herself has been in recovery for more than 31 years, and she views recovery as “a lifetime journey.”

“I lost three siblings to different forms of cancer, and my husband survived, successfully, stage-four cancer,” Valentine said “So, it’s a metaphor that is up close and personal for me. But when you get cancer treatment, when you start with one thing in your treatment plan, and when the cancer comes back, you adjust the treatment plan.”

There is a need to be able to make adjustments along the way with your own recovery, Valentine believes. She drew a distinction between the folks on the street, “who can’t even get to that place of being substance free for a day and not being so painfully sick,” and getting to that place where there are seeds that can be planted to seek out a pathway toward recovery, what Valentine termed “a magic moment” – the willingness to embrace recovery as an option in their own lives.

“No matter what habit or addiction you are experiencing, recovery tools and practices are a pathway to healing, and people in recovery can bring that to their communities,” she said.

Here is the ConvergenceRI interview with Sandy Valentine, the executive director of RICARES, during a time of transition for the recovery community as the strategies for interventions change to meet the way that the epidemic has changed.

ConvergenceRI: First, thank you for making time to meet with me. You come into your leadership position at RICARES at an incredibly tumultuous time. Could you describe the landscape as you see it, and what is happening, in behavioral health, in harm reduction, in programs for substance use disorders?

For years, the problem was often the lack of resources. And now, the state is loaded down with resources [from legal settlements with drug companies]. But they seem to been investing in programs that didn’t work before – and may not work in the future.
VALENTINE: It is interesting that you begin with that question, because I have a 33 years of experience working for a Fortune 200 insurance company.

ConvegenceRI: Which one?
VALENTINE: The Hartford. One of the things that I experienced there, after being there for so long, was that there was this [pattern of a] three, three-year cycle. What would happen is that every three years, they would decide that a new strategy had to come into play about something.

But they would [replicate] the strategy that had been in place nine years before, without asking anybody who had experienced it nine years before, what worked, and what could we do differently moving forward.

And, when I moved into higher education, I saw a lot of the same things, where they would repeat strategies from other places, without really investigating what went wrong, and where did they get stuck. And, what could be done differently to make it a success this time?

And, so, I am grateful, in this space at RICARES, to have someone like Ian [Knowles, program manager], who, if I come up with what I think is a brilliant idea, can tell me, “Well, we tried that then; and we don’t rule it out because it was tried before, but what’s different?” Asking, what’s different about the landscape? What’s different about the skills that have changed in the recovery movement across the United States? That maybe that idea will work now, because it is the perfect timing? Or, we have the right resources, or that the underlying conditions are better.

ConvergenceRI: So, what do you see? In this week’s edition of ConvergenceRI, I brought up a new research paper published by Shannon Monnat Do you know who she is?

ConvergenceRI: She is a sociologist, the director of the Lerner Center at Syracuse University. She just did an analysis of the opioid epidemic, “Demographic and Geographic Variations in Fatal Drug Overdoses in the United States, 1999-2020.” It is a remarkable study. What she says is that we keep making the wrong investments. [Monnat tweeted her description of her study: “When it comes to the #overdose crisis, both supply & demand have been driven by bad federal and state policy choices, nefarious corporate behavior, & neoliberal policy regime that prioritizes maximizing profit over protecting population health.”] I can send you the link to the study.

I brought Monnat here in 2016 to give a talk at RIC. The night before, I set up a dinner with her and Sen. Josh Miller to talk about harm reduction strategies. I would like to bring Monnat to Rhode Island again, perhaps with author Beth Macy, to talk about harm reduction, and to set the stage for the harm reduction center pilot, to have a robust, data-driven discussion.

Have you read Macy’s latest book, Raising Lazarus?

ConvergenceRI: Have you seen “Dopesick?”
VALENTINE: Yes. It was so well done.

ConvergenceRI: Back to my initial question: What’s the landscape? Where are the challenges?
VALENTINE: It’s been two months and a couple of days [since I began this job]. And, while I don’t have Rhode Island completely figured out, some of the things that I have been seeing nationally that I think I am seeing here is: We have all this money, really aimed at opioid overdose. So, a lot of the money is coming down [targeted] at very specific strategies around that, because we keep losing people, and losing them suddenly. And, losing people who don’t even have an addiction, because they have encountered the wrong drug.

Alcoholism is really underplayed. So, from a national perspective, the liquor industry has been strong and thriving for hundreds and hundreds of years. The deaths have a much more varied time line.

One of the things that has grabbed my attention is that the sudden deaths from opioids has a higher priority than the longer timeline of deaths caused by alcoholism. Which, as of last year, is still higher than deaths caused by opioids.

ConvergenceRI: As I recall, the latest statistics I saw, it could be a couple of years old, is that 80 percent of all opioid overdose deaths had alcohol as a contributing factor [co-morbidity].
VALENTINE: And, what I see with that timeline, something that often gets forgotten about, is the central influence that alcoholism has on the children, on the parents, on the siblings, on their spouses, on their workplace, and on their community.

So, while the timeline is longer, the damage to community, to people, can have extraordinary results in a negative way, where the next generation is self-medicating, because of that influence, to some degree.

For me, I try to find the pathway where we focus much more on recovery and less about the substance.

We are living in a hurting world; there are countless research articles that talk about the cure for addiction is connection.

I had the privilege of being in the audience when Bill White [author of Slaying the Dragon: The History of Addiction Treatment and Recovery in America] shared at a multiple pathways to recovery conference a few years ago, that he believes that it is people in recovery that have what it would take to help heal our world.

That it is those recovery tools and practices, no matter what habit or addiction you are experiencing, recovery tools and practices that are a pathway to healing, and people in recovery can bring that to the table to their communities. It really inspired me to a great degree.

ConvergenceRI: How do we grow that connectivity in Rhode Island, that engagement at the community level, and what is the best way to do that?
VALENTINE: One of the things that I am seeing in Rhode Island is, over time, with these national funding opportunities, and organizational priorities, that people working in the recovery community are becoming very fragmented.

You know, you have a lot of organizations, all striving toward the same goal. And, I’m hearing a lot about burnout from people working in the field, and a lot about “not feeling connected” with each other.

The difference in Connecticut was: there was one central recovery community organization that all the other players, they kind of buzzed around each other in a very collaborative way.

And so, my hope for RICARES is that we can be very supportive to organizations and individuals who are supporting recovery in their day-to-day work, and that we can bring them into connection and not competition, and rally all those different voices and different experiences.

ConvergenceRI: I think that is an admirable goal. For me, the largest problem is often the government bureaucracy, which tends to pit organizations against themselves….
VALENTINE: …Because they are competing for the same money.

ConvergenceRI: …and the bureaucracies seem to make sure that you jump through a never-ending series of hoops. And, the people who are in charge of the bureaucracy often tend to discourage conversation and connectivity, in my observation. What’s the Lenny Bruce line about the only justice in the halls of justice is in the halls.
VALENTINE: One of my favorite recovery organizations has some underlying principles. One is to err on the side of generosity. I have watched this organization give away so much that they could have created a competitive structure around. And all of that gifting and generosity has created a very vibrant, healthy organization, because that is the way they are run. So, erring on the side of generosity but, most importantly, putting recovery first.

ConvergenceRI: How do you put recovery first?
VALENTINE: So, this is a little bit about my my career. I was on a team at UConn with a lot of younger folks, young adults. I had left this one career. I had a skill set from working for over 30 years in a corporation. Now, my colleagues, my youth peers, were like 10 years younger.

I was [willing to take] a whole lot of risks that they are not in a position to take. I came to this mindset, that in this second act of my work life: I was going to be working for recovery.

So, right now, RICARES signs my paycheck. But I work for recovery. My focus is through that lens of providing recovery to more and more human beings, not only so that they can redeem the life that they are on track for, but I would say, a more beautiful life than they could ever imagine in recovery. And, focusing on that.

So, one of the things I saw when I got here was that there is such a heart’s desire on the recovery coaches’ part to try and solve all the problems for the folks who are walking in our door, all their needs – and they have so many basic needs.

But, it kind of derails from what our primary focus really is: having folks who come in the door that have a twinkle in their eye to initiate recovery.

And, by focusing our efforts, helping them to initiate and then to sustain recovery in a way lthat ooks right for them, and treating them as a resource in their own recovery.

We’re not going to solve the problem of homelessness in total, or basic needs, in total, but we can help put them on a pathway to recovery and help them walk through solving some of those other problems.

ConvergenceRI: So, the pathway to recovery is connectedness And, the role that RICARES can play is creating the pathway of an engaged community that allows people to choose a path toward that connectivity. Is that accurate?
VALENTINE: That is a great summary of it. I think one of the things that I think we have, as a benefit, is that we are almost all completely grant-funded. And donations.

We don’t have to charge for our recovery coaching. And, there is such an emphasis now on meeting certain requirements that come down from a clinical perspective.

Which was not what recovery coaching was initially intended to be. So, you are having to start to treat your “recover-ees” as clients, instead of connecting as human to human – especially if you have lived experience, whatever form that takes.

Many of the folks who are coming in here are often homeless or one step above homelessness. And so, even if they had more “care,” when you talk to them about completing what is required to interact with a recovery coach, who is on a fee-basis [from insurance providers], already you are bringing them into a bureaucratic process. And so, my hope here is that we can just become that vehicle for folks who aren’t at a place of being able to navigate all of that, because that is a barrier.

I’ve always talked about “the magic moment” – creating this connection, so that when that individual has the “magic moment,” they have a person to call, and they don’t have to go through all of this.

[Sometimes] the process of actually getting a service from a resource is so in-depth, and so legalistic that that “magic moment” can escape in a second.

There are so many social services agencies right here in the downtown area and across this state, but actually navigating it, navigating the phone call, navigating the website, you have all of that navigation, that shrinks the magic moment. And, you may miss it. But, hopefully we have created enough of a connection that they will come back again.

Because they know that you’re not going to put all that between us and them, we’re going to talk to them straight up, whether they fill out any form or even tell us their name.

ConvergenceRI: Have you had a chance to meet with the “bureaucratic” leadership of the state? Have you met with Richard Charest, for instance, the director of BHDDH?
VALENTINE: No. I have met with Tom Martin and Candace Rodgers. She is the director of prevention and recovery at BHDDH.

But, we have had a lot of infrastructure things, so I have been taking care of the foundation at RICARES and actually, I am at 60 days, so over my next 30 days my plan is to get more out and about.

ConvergenceRI: What I see is that often there is a disconnect that happens, you can create the program, but what happens after two years? Because recovery is a lifetime of experiences and it is not a path that is a straight line. Things change in people’s lives. So, how do you create metrics or measurements of success, based on two-year grants?
VALENTINE: And, how do you quantify recovery? Because recovery doesn’t have to mean “substance free,” which is an old paradigm. Now, substance free is at the core of my own recovery. I have been in recovery for 31 plus years. It’s the core of my recovery program. But it is not everybody’s [recovery].

So, how do you quantify the fact that your family members may have chosen perhaps, to have the occasional alcoholic beverage.

There are some who would say, well, you’re not in recovery. But, that person has not over-indulged, and is working, and is a contributing member of their community. How do you quantify that?

ConvergenceRI: I often get annoyed with the health care system. Because, invariably, a provider will ask me a question about my pain scale, from zero to 10, what’s your pain? And, I always refuse to answer, because I believe that it has no meaning.

What would you rather ask, a provider challenged me. My response: Perhaps, you’d want to engage with the patient, and ask: “What’s the best thing that has happened to you in the last week?”
VALENTINE: That’s a great example. I have the privilege of co-hosting a podcast for the past two years, called, “Recovery Matters.” And, I have learned more about recovery and social justice through the interviews in that podcast than anything else.

One of the things that you made me think of was we did an interview with a young person – he’s 44, I am 57, and 44 sounds pretty good.

But someone who had spent the better part of 25 years incarcerated – in and out, in and out, in and out. Part of his sharing his story about being in recovery, I think it has been for about three years, was he has a relationship with his teenage daughter, but he doesn’t have a relationship with his brother.

And so, those are the types of things that, for a person in recovery, is impossible to quantify. For me, it’s been important that when you are doing recovery coaching, and working with individuals, you understand: what’s the most important thing in your recovery for you right now? And then, celebrating all those milestones. That it is important for that individual that they got to 90 days substance free, we want to celebrate with you.

If it’s important for that individual that they showed up to work, five days in a row, let’s celebrate that. Because, in one of Bill White’s famous line, there are many pathways to recovery and all are cause for celebration.

It teaches about community, about serving and being served, loving and being loved, celebrating and being celebrated. Knowing and being known.

And, I think that the recovery community does that better than any other type of community.

Because we share, we reveal, and we allow space for folks to reveal themselves to us. Thr word “and” is a powerful piece of it. So, if I share with you, and we’re in a relationship, and I share with you, but you never tell me anything, there is a connectedness that is missing

Recovery coaching has the benefit that the therapeutic interventions don’t, in that you can choose wisely to disclose your experiences and build your art inside the practice of recovery to know, what’s appropriate to disclose in this situation that will create that connectedness.

In recovery coaching, you have that privilege to ask: do you want to be connected?

ConvergenceRI: The premise of my newsletter is sharing. And, the belief, that our personal stories are our most valuable possessions, and sharing them is what makes us human. And by doing so, we create a community of engagement.

In his latest op-ed, Sam Quinones described what is happening as the “poisoning of America” – the influx of dangerous, illicit substances such as fentanyl. It’s no longer addictive prescription drugs that are driving the epidemic. How does an organization such as RICARES, and perhaps more importantly, bureaucratic government institutions, have the capability to respond to the changing nature of the epidemic?

VALENTINE: That’s a really big and hard question. I have bias that nobody, that most humans, do not stop doing something because somebody tells them it wasn’t good for them. So, part of me is a little jaded at prevention efforts. Instead, I pitch recovery as prevention. When you get someone in a family to find recovery, you are influencing that family and future generations

We keep shining a light on the despair of addiction, and it’s important for us to understand addiction, and to understand it as the brain disease that it is. But we also need to shine a light on what you can do – and not keep focusing on what you can’t do.

And to remove those barriers that keep folks from being in recovery, to reduce their reliance on the disease that is controlling their lives, and finding a way for recovery to seep in.

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