Social Research & Development
Field Guide
Our Approach
Person-Centred
Seeing participants as people, rather than their problems or choices, and supporting their self-determined journey to recovery.
Trauma-Informed
Acknowledging that most participants have experienced some form of trauma in their life, and that the health care system and providers can
re-traumatize clients.
Harm-Reductionist
Prioritising the reduction the negative social and physical consequences of drug use (and society's drug policies).
Evidence-Based
Delivering medical and social interventions with strong empirical data to support their effectiveness in harm-reduction, and contributing to the scientific knowledge base.
How is River Stone Recovery Centre Person-Centred?
We proactively decentre clinicians as the "experts" in group therapy sessions, and encourage peer support, exchange, and ultimately agency in the development and maintenance of dosing regimes and self-care/management.
The nature of care provided in a group appointment helps empower participants with information, supports them as ‘experts’ of their own lived experience with knowledge they can share, and models different methods of recovery through witnessing others’ journeys.
The group setting optimizes the opportunity to have peer supporters be present, and to cultivate the goals of participants to in turn become peer supporters themselves.
"Recovery is unique to each person, where they start from and where they want to get to.
What it does not look like is the same thing for each person.
It also does not look like a line that goes in one direction, relapse and remission are anticipated aspects along the journey.
RSRC is focused on person-centred care so our definitions of recovery in general reflect what people's self determined ones are."
- Dr Sara Davidson, Medical Director
For us, being person-centred means seeing people as people, rather than their problems or choices.
It means meeting people where they are and letting them be in the driver’s seat of their recovery journey.
This stands in contrast to traditional approaches to medical practice, where clinicians are trained to "fix" problems.
Feedback provided by participants who came to the BBQ information session
We used human-centred design methods to integrate the expertise of participants in the design of the space, services, and culture of River Stone.
We hosted conversations with existing program participants about what they loved, liked, disliked, and wished about existing recovery services.
We created prototypes to get feedback of the overall concept, the services that should be provided, the times at which they should be provided, and the room in which injectable opiate replacement therapy would be offered for the first time.
We co-created a code of respect with staff members and program participants to establish mutual expectations and boundaries.
We understand that providing access to pharmaceutical replacement therapies will have positive but limited impact if participants' basic human needs of safe shelter, social inclusion, and purpose are not met.
We provide psychosocial supports and act as a bridge to other support services with the community.
We developed life skills programming, but recognize the challenges that people face in cultivating and sustaining interests when they are preoccupied with the problem of survival on the street.
We recognize the need for supportive housing and are working independently and with partners to increase the number of units in the city.
We responded to the devastation that COVID-19 had on the provision of essential services to our participants and others in the community living at the intersection of substance use disorder, mental illness, homelessness, and poverty.
We opened an emergency drop in centre, the Phoenix Learning Centre (PLC), and worked with guests to understand what a safe space with purpose means to them, while working with community members to communicate our vision and address their concerns.
After Phoenix 2.0 closed, our search for another space continues as we continue to advocate for affordable housing, safe spaces, and social and economic inclusion.
How is River Stone Recovery Centre Trauma-Informed?
Our services are provided through a lens of trauma-informed care.
This approach shifts the focus from “what is wrong with you?” to “what happened to you?”
It involves acknowledging that most participants have experienced some form of trauma in their life, and also that the health care system, and therefore providers, can re-traumatize clients.
A complete picture of a patient’s life situation — past and present — is necessary in order to provide effective health care services with a healing orientation.
The Code of Respect which was co-designed by River Stone Recovery Centre staff and participants is displayed at the centre and forms the basis of a contract that the team and participants sign.
Six key principles of trauma informed care are:
Safety
Trustworthiness and transparency
Peer support
Collaboration and mutuality
Empowerment, voice, and choice
Cultural, historical, and gender issues
How is River Stone Recovery Centre Harm-Reductionist?
River Stone Recovery Centre meets participants where they are to create individualized plans to help them achieve their goals, whatever they may be. We do not insist on abstinence or even reduced use of opioids and stimulants, though many of our participants have set such goals. River Stone offers medical supports to help participants safely avoid withdrawal sickness and psychosocial supports to address the conditions that led to and feed their substance use disorder and to help them make desired changes in their lives.
The principle of harm reduction is core to the centre's practice; evident in the services, space, and support provided.
Harms associated with Opiate Use Disorder: Anyone who takes opiates, whether they’ve been prescribed for pain or purchased on the street, is at risk of developing opiate use disorder. Opioid use disorder can ruin lives. Opioid overdose can end them. Canada is in the midst of an opioid use and opioid death crisis. 2020 saw an 89% increase in opioid overdose deaths over the previous year, with 17 deaths per day, or one every 85 minutes (at time of writing in August 2021).
Harms associated with Stimulant Use Disorder
Chronic misuse of stimulants, whether diverted prescription medications or street drugs such as cocaine, “crack,” “speed” and “crystal meth,” can result in paranoia, anxiety, irritability, anger and depression, or dramatic mood swings. Delusions, hallucinations, hyper-vigilance, hyper-activity and confusion are also common in people with more severe cases of stimulant use disorder. Physical dangers include damage to the respiratory, cardiovascular and central nervous systems. Death from stimulant overdose is possible, but rare.
Harms associated with Unsafe Opiate Supplies
One of the reasons opioid overdoses are becoming more common is the unpredictable and increasingly toxic street drug supply, a trend that has been exacerbated by Covid-19 border restrictions that have had the effect of limiting illegal opiates coming into the country. Opiates are often cut with other synthetic opioids that can be extremely dangerous. Fentanyl, which is frequently found in the street supply, is 50 times more potent than heroin and 100 times more potent than morphine. Carfentanil, an extremely potent fentanyl analog, is estimated to be 10,000 times more potent than morphine.
Harms Associated with IV drug use in unsafe spaces
People who inject drugs, especially when unhoused, often have to do so in a hasty manner, at times without clean or unused supplies. This can lead to complications such as bacteria or viruses entering the bloodstream, causing infections that can lead to chronic disease or death. Normal skin bacteria that enters the bloodstream can stick to the heart valves, leading to endocarditis, or in small areas of injury in bones, leading to discitis or osteomyelitis. Both of these can lead to sepsis and death, or can cause permanent damage to the area of infection and beyond, such as leading to heart failure, chronic pain, paralysis, or stroke. Sharing unclean supplies can lead to Hepatitis C or HIV transmission. All of these harms are reduced by providing a safe, supported, clean space, with education about optimal injection techniques and safer venous locations to inject into.
How is River Stone Recovery Centre Evidence-Based?
Our treatment programs are based on the latest research into pharmaceutical and psychosocial treatments for substance use disorder and harm reduction techniques, and our research with data from program participants will add to that evidence base.
Traditional oral opiate agonist therapy (oOAT), such as Methadone and Suboxone, works well for 85-90% of people with opiate use disorder. The remaining 10-15% continue to crave injection of opiates. River Stone is one of five pilot projects funded by Health Canada’s Substance Use and Addictions Program to study the effectiveness of intravenous opiate agonist therapy (iOAT) in saving lives and changing lives. We are tracking how well iOAT together with our extensive wraparound services makes possible behavioural and health improvements for our participants. We plan to launch a study on contingency management for stimulant use disorder and are part of a CIHR-funded study looking at interventions based on personality type.