Mind & Body

Tom Coderre goes to Washington

Will the recovery community in Rhode Island become a political constituency of consequence?

Photo courtesy of Tom Coderre

R.I. Senate President M. Teresa Paiva Weed, left, and her chief of staff, Tom Coderre.

By Richard Asinof
Posted 7/21/14

Tom Coderre’s appointment to serve as as a senior advisor at SAMHSA brings both personal and political expertise to the future development of public policy on substance abuse and addiction.
The challenge ahead for the recovery community in Rhode Island is to develop into a constituency of consequence, as Coderre said – making its voice heard not just in the community but at the ballot box. The planned candidates’ forum in August provides an opportunity to do that.
The larger issue, according to Coderre, is the integration of the delivery of mental health and behavioral health and substance abuse services not as silos, but within a primary care framework.
With Buddy Cianci, a twice-convicted felon, running for office again, will he champion the right of people in the recovery movement to become active participants in the electoral process, even those with felony convictions? What are the gubernatorial candidates’ positions on substance abuse, coordination of health care delivery for behavioral and mental services, and support for recovery services? Will the ongoing study being conducted to quantify the costs of mental health and behavioral health services in Rhode Island provide a framework to discuss what kinds of additional resources need to be invested by state? Is the pilot program underway with Care New England, the Providence Center and Blue Cross & Blue Shield of Rhode Island replicable and scalable?
The R.I. Chronic Care Sustainability Initiative, or CSI-RI [and its rebrand of PCMH Rhode Island], has grown from a pilot program to one that now serves about one-quarter of Rhode Island residents in primary care patient-centric medical homes. A new initiative is planned to address children, known as CSI-Kids. Would a similar, all-player program provide a model for how to provide a continuum of care for persons with substance abuse, addition recovery, behavior and mental health issues? Is this the kind of innovative approach that can be developed as part of the State Innovation Model planning?

PROVIDENCE – One of Rhode Island’s true comeback success stories, Tom Coderre, is on his way to Washington, D.C., to work as senior advisor with the Substance Abuse and Mental Health Services Administration, or SAMHSA, to help shape policies on substance abuse prevention, treatment and recovery programs at the agency.

Coderre, who has been chief of staff for Senate President M. Teresa Paiva Weed since 2009, has been front-and-center as a prominent voice of the Rhode Island recovery movement, having overcome his own personal addiction to drugs to re-emerge as a successful political aide and analyst.

Coderre also served as the board chair for the R.I. Communities for Addiction Recovery Efforts, or RICARES, and was the former national field director of Faces & Voices of Recovery, based in Washington, D.C.

A former Rhode Island state senator, Coderre brings well-honed political skills as well as his work as an advocate for recovery to his new position at SAMHSA.

Coderre spoke at length with ConvergenceRI following the announcement of his new position, talking about the challenges facing the recovery movement in Rhode Island to become “a constituency of consequence.”

As the epidemic of accidental overdoses from prescription and illicit drugs swept across Rhode Island in the last year, with more than 100 deaths since January, Coderre has often been a forceful advocate, both on stage and behind the scenes, attempting to put the focus on the need to treat addiction not as an acute care condition but rather as a chronic disease that needed a continuum of support from the health care delivery system.

The efforts to make naloxone available law enforcement and emergency responders in Rhode Island appears to be making some difference, with a decrease in the number of deaths, pushing the story off the front pages.

Some policy progress has also been made in developing more coordination of care options for Rhode Islanders with substance abuse problems, including making recovery coaches available at hospital emergency rooms and health insurance parity

But a spike in the number of newborns with drug addiction and the fact that only 20 percent of physicians are participating in the prescription monitoring program point demonstrate that there will be no quick fixes.

ConvergnceRI: The new appointment recognizes both your political acumen as well as your personal knowledge of addiction and recovery, doesn’t it?
CODERRE:
It’s a big honor to be able to do this work. I’m very passionate about it. I bring to it my own experience in addiction recovery, my own personal story. I have been involved in advocacy since I got into recovery in 2003.

ConvergenceRI: How would you describe the context of where the recovery movement is today – both in Rhode Island and nationally?
CODERRE:
What we’ve seen is that recovery community organizations, such as RICARES, have popped up all around the country in the last 10-15 years. Initially, the focus was to put a face and a voice on the people involved in recovery, to create a safe place for people to go, and to counteract the negative image, the stigma, of addiction.

When these groups began to do their advocacy work, many public officials and legislators didn’t understand the policies. The groups have grown, created legislative agendas, held rallies and marches, and become very real entities in the community.

The recovery community organizations also recognized the need to provide recovery support services [across a continuum]. Traditionally, if you were diagnosed with cancer, God forbid, you would go to your doctor, and create a treatment plan, it could involve surgery, medications, a hospital stay, and some kind of ongoing recovery support.

In recovery, we didn’t have the same model, we had an acute care model: stay in the detox unit, and then maybe some time a treatment center, if your insurance covered it, then spread the wings and fly, you’re all better now.

ConvergenceRI: Obviously, that doesn’t work very well. What needs to change?
CODERRE:
Addiction is not an acute illness, it’s a chronic illness. Recovery community organizations are trying to fill that gap. The Anchor Community Center offers recovery coaches, telephone recovery support, meetings, mutual support group meetings, trying to be a hub for a recovery. They offer yoga and art therapy, to become this holistic healing place for people in recovery.

ConvergenceRI: Is there a need, as Dr. Lynn Taylor, an advocate for Hep C, says, to have a more aggressive political group, such as Act Up, as the HIV/AIDS community did, to apply more political pressure to bring change?
CODERRE:
The recovery community needs to become more sophisticated politically. That may mean a whole host of things, such as hiring a lobbyist to be at the State House on a regular basis.

On Aug. 22, RICARES is planning to host a forum for the gubernatorial candidates. We hosted a similar forum two years ago for congressional candidates. These are opportunities; we can ask the candidates questions, we can show that the recovery community exists, that they vote, that they care about certain things.

For instance, we’re going through an epidemic of overdose deaths; it’s really serious, so many people are dying. We’ve had a very real response to that crisis. State agencies have come together and developed new policies.

This forum is an opportunity for the recovery community to be seen as a constituency of consequence. What it says, basically, is that there is a constituency – not only people in recovery, but also their family members, friends and allies. You have a multiplier effect going on here.

Nationally, the estimate is that there are 25 million Americans in recovery from addiction.

Another political strategy is something we did as a project at the Faces & Voices of Recovery for a couple election cycles, but never took it to scale. It was a civic engagement campaign, with the message: recovery voices count.

It had three prongs: voter registration, voter education, and get out the vote.

People who are in recovery often have been involved with the criminal justice system. A lot of them think they don’t have the right to vote, because of a felony conviction. But a lot of states have lifted those bans, including Rhode Island.

If you ask a sample of people who have been convicted of felonies if they can vote, nine out of 10 thought they couldn’t vote.

It’s an education process. You [have to let them know that they] can vote, that they have the ability to vote, and then you need to get people registered to vote.

It’s also about educating the candidates, and also educating the recovery community about who the candidates are and how they stand on the issues. And, if they got elected, how would they vote on these issues.

The third leg of the stool is to get out the vote, letting people in recovery know when election day is, where they vote, and that their voice counts.

We want to make sure that we are seen – and heard – as a constituency of consequence.

ConvergenceRI: Is there a need to commit more budget resources to substance abuse and addiction recovery? At the same time that mental health and behavioral health was given parity in terms of health insurance, some $10 million was cut from community mental health centers.
CODERRE:
The rationale behind those cuts, or shifts in resources, has been that as the Affordable Care Act takes effect, and people who have previously been uninsured and had to rely on community mental health centers, now these people now are covered and have insurance.

What I have heard from advocates is that there may need to be some kind of bridge between those two systems of care. When you’re dealing with high uses, high incidences of mental health issues and mental illness, the population is not going to transfer because of a switch getting flicked.

If you asked someone from the House Finance Committee, they may tell you there was a need to start shifting these resources right away.

If there is a short fall, and if there is a crisis, that’s why you have a budget process; it doesn’t mean that it can’t be changed. If there is a significant shortfall, you can come back to the General Assembly and petition for a supplemental budget. There is an advocacy moment.

ConvergenceRI: What do you see as the most important priority moving forward?
CODERRE:
The number one goal has to be to get our arms around the prescription drug epidemic. That has to be the number-one priority. It’s not just prescription drugs; it’s street drugs and illicit drugs as well.

Number two, we need to look at our health care delivery system. We are still very much in an acute care model of health care delivery. We need to transition to a chronic care model, where we fund and support recovery services for people, post treatment.

The third focus is to recognize that we have a broken system. We don’t treat mental health and substance abuse as part of the system. We don’t treat mental illness and addiction within the confines of the primary health care system. We’re off in this separate system.

We need to ask the candidates: is this the right structure? Is this the right way to deliver resources and services? Or, do they want to keep this siloed system, which has not worked, and has not been effective?

ConvergenceRI: Is there a natural link between the recovery community and the Hep C community to develop stronger advocacy ties?
CODERRE:
You’re right. There are a lot of people in recovery affected by this. There is a natural advocacy alignment. The recovery community could get involved in this. The recovery community doesn’t shy away from controversy.

At the same time, we have to keep our eyes on the prize. We only have the ability to do so much.

[As a matter of transparency, Coderre worked with the reporter as a colleague at United Way of Rhode Island from 1994-1997.]

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