OBJECTIVE I
Understand program phases and stages of recovery

Estimated time for delivery: 3 hours

TRAINER NOTE

It is essential that professional staff are not only knowledgeable in all aspects of the treatment program but can also teach effective communication of this information to peers. The peers themselves will be expected to orient newcomers to the program and manage therapeutic groups.

CONTENT

The traditional TC contains a "treatment protocol organized into phases that reflects a developmental view of the change process" with the "emphasis on incremental learning at each phase, which moves the individual to the next stage of recovery" (De Leon, 1997 pg. 8). The Recovery Clinic program consists of an orientation phase (one month), engagement phase (three months), pre-vocational phase (two months), re-entry phase (three months), and the final phase - aftercare (four to six months). Each phase is associated with its own unique set of behaviors to be learned. The trainer outlines the program description, phases of treatment, and behaviors to be learned during each phase (see handout #I.1 Overview of Program and Phases of Treatment) in a one hour lecture format. The program phases were developed in accordance with stages of recovery. Stages of recovery are reviewed during this segment (see appendix I.A Stages of Recovery) as well as common terminology used in the Recovery Clinic program compatible with a TC model of care (see appendix I.B). The special vocabulary used in the Recovery Clinic program reflects not only individual integration into the peer community but also clinical progress. According to DeLeon (1997), the gradual shift in attitudes, behaviors, and values consistent with recovery is reflected in how well members master the terms of the glossary. Use of the TC terminology constitutes an explicit measure of peers' affiliation and socialization in the TC community.

EXERCISE

Have group test their recall concerning phases of treatment and behaviors to be learned by breaking into dyads and role play description of the program phases to each other using TC terminology. Trainees should alternate playing the role of peer versus role of professional staff member and make use of orientation phase contract form (see Appendix I.C).



Handout I.1 OVERVIEW OF PROGRAM AND PHASES OF TREATMENT

WHAT IS RECOVERY CLINIC? HOW DOES IT WORK?

Recovery Clinic is a drug-free, peer-led treatment program for individuals addicted to cocaine and other drugs. The program helps these individuals achieve stable abstinence and develop positive behaviors and attitudes necessary for drug-free living.

The program consists of structured groups, job functions, and social activities. The program meets Monday through Friday from 9:00 a.m. until 2:00 p.m.

Treatment at Recovery Clinic is different from treatment at other clinics. At Recovery Clinic the main treatment does not come from a doctor, nurse or therapist. Instead, treatment comes from the member community. It is the community which teaches "right" thinking and behavior, and identifies destructive thinking and behavior. The community supports and encourages its members. This is what makes Recovery Clinic a "self-help" program.

WHO IS ELIGIBLE FOR ADMISSION?

• Addicted individuals

• Mentally ill individuals addicted to crack/cocaine as well as other substances.

• Women addicted to crack/cocaine as well as other substances, who are pregnant or have infants up to the age of three. Recovery Clinic provides parenting education and infant assessment.

WHAT IS THE PERINATAL PROGRAM?

The Perinatal Program is part of the day treatment Recovery Program at Bellevue Hospital and provides comprehensive services for pregnant women and women with infants. When appropriate the women's family and child placement workers are included in the treatment plan.

These women participate in the overall recovery community's groups to gain insight into behaviors associated with addiction and to build a peer support system for recovery.

HOW LONG IS THE RECOVERY PROGRAM?

The day treatment program (Monday through Friday) is nine months, followed by a four to six month Aftercare Phase (with one weekly group).

Phases of Treatment

I. ORIENTATION PHASE (one month)

For newcomers to Recovery Clinic, the first phase of treatment is Orientation. The purpose of Orientation is to determine whether the program is appropriate to the individual's treatment needs, or whether the individual should be referred to a different program.

During Orientation the peer is expected to fully participate in the program and follow all the rules and regulations. Peer orientation consists of the peer doing the following:

    ~ Signing an Orientation Contract and complying with its conditions.

    ~ Attending a weekly orientation group which is co-led by a senior peer. In this group, peers will get information about how the program works and what is expected. Peers also receive support and advice about how to benefit most from Recovery Clinic.

    ~ Submitting daily urines for the first two weeks.

    ~ Starting to identify personal issues (including denial) that impact on recovery.

    ~ Focusing on becoming a part of the recovery community.

    ~ Meeting with staff to complete medical, psychological and social assessments.

    ~ Completing process for obtaining public assistance and Medicaid if necessary.

For Perinatal mothers:

    ~ Introduction to Parenting Skills.

    ~ Stabilizing relationship with birth father.


IMPORTANT BEHAVIORS TO BE LEARNED DURING ORIENTATION PHASE

• PUNCTUALITY AND ATTENDANCE: Peers should be at the program by 9:00 am Monday through Friday (half hour before group) in order to register at the front desk, submit urine samples, check in with their counselors and see the nurse to address any medical issues.

• SELF-DISCLOSURE refers to peers' truthfully telling their story. Honesty is emphasized as the cornerstone of recovery.

• LISTENING: Keeping an open mind.

• SUBMITTING URINES ON TIME DAILY: No later than 9:30. If peers have excused lateness they may turn urines in between 12:15 and 12:30.

• RESPECT FOR AUTHORITY: Peers are expected to follow directions of community leadership and staff.

• FRUSTRATION TOLERANCE: Start to talk out their feelings without acting them out.

• COMPLETE THEIR JOB TASKS: Every peer starts out on service crew. This is their opportunity to begin showing their commitment to the community and their recovery.

• ATTEND OUTSIDE 12-STEP MEETINGS: They are encouraged to ask for help and follow suggestions.

• LEARNING THE RULES OF THE PROGRAM.

• RECOGNIZE THE FIRST STEP: "We admitted we were powerless over our addiction and our lives had become unmanageable."

For Perinatal mothers:

• ATTEND ALL MEDICAL APPOINTMENTS FOR THEMSELVES AND THEIR INFANTS.

• LEARN ACTIVITIES TO INCREASE BONDING WITH NEWBORNS.


II. ENGAGEMENT PHASE (three months)

During Orientation peers have learned about how the program works and what is expected of them. In addition to what they have learned in Orientation, for the next three months they will focus on the following:

~ Achieving sobriety, one day at a time.

~ Identifying triggers to relapse ("people, places and things"). This will be accomplished by learning to be honest and open about their feelings and behaviors.

~ Learning ways to protect their sobriety (relapse prevention.)

~ Learning from any mistakes: If they relapse, learning how to deal with them honestly by talking to their peers and discussing it in groups.

~ Understanding and using 12-step principles.

For Perinatal mothers:

~ Learning and utilizing parenting skills.

~ Improving relations with birth father.

~ Involving family in child care.

~ Learning to negotiate systems on behalf of self and baby.



IMPORTANT BEHAVIORS TO BE LEARNED DURING ENGAGEMENT PHASE:

(Addressing negative behaviors)


• LEARNING TO "WALK THE WALK NOT JUST TALK THE TALK."p> • GETTING A HOME GROUP AND A SPONSOR.

• EARN A PROMOTION ON COMMUNITY JOB LADDER BY PERFORMING JOB FUNCTIONS RESPONSIBLY.

• LEARN TO HOLD ONE'S BELLY.

• TAKE RESPONSIBILITY FOR ONESELF: Admit when one is wrong. Take credit when one is right.

• SHOW RESPONSIBLE CONCERN: Give pull-ups, push-ups, drop slips, avoid negative contracts, no hiding drug behaviors of others.

• BE SELF-MOTIVATED: Do the task one is assigned without needing to be reminded.

• TAKE PRIDE IN ONE'S WORK: Do the best job possible.

• LET GO OF ONE'S STREET IMAGE: Stop swearing, no visible beepers, no sunglasses worn inside, no listening to walkmans.

• PARTICIPATE IN HEALTHY DRUG-FREE ACTIVITIES: Both in the program and in outside community.

• BEGIN TO PARTICIPATE IN TAKING CARE OF ONE'S HEALTH CARE NEEDS: Report health care needs to staff and keep medical and dental appointments.

• BEGIN KEEPING TRACK OF ALL ONE'S OWN MEDICAL AND SOCIAL SERVICE APPOINTMENTS

• MAINTAIN STABLE HOUSING: Don't lose housing. Follow the rules of one's residence or shelter.

• DO NOT BORROW FROM OR LEND MONEY TO PEERS.

• LEARN TO MANAGE ONE'S MONEY: So one can pay one's dues and be sure to have carfare to get to all outside appointments.

• CONTACT A MINIMUM OF 2 PEERS DURING THE WEEK AND TWO PEERS OVER THE WEEKEND BY TELEPHONE.

• RECOGNIZE THE SECOND STEP: "We came to believe that a Power greater than ourselves could restore us to sanity."


III. PRE-VOCATIONAL PHASE (two months)

Upon completion of the Engagement Phase of the program, the peer enters the pre-vocational phase, adding on to what they have learned in Orientation and Engagement. For the next two months, peers will be focusing on the following:

~ Continuing to pursue the goals of engagement while exploring educational and vocational goals.

~ Attend the pre-voc group.

~ Begin to think about interests and explore their feelings about school or career.

~ Building self-motivation.

For Perinatal mothers:

    ~ Learning to balance one's own needs with needs of children and family, emphasizing recovery to be one of the peer's family's needs.

    ~ Increasing sense of empowerment and self-esteem.

    ~ Improving coping skills.



IMPORTANT BEHAVIORS TO BE LEARNED DURING PRE-VOCATIONAL PHASE:

(Developing positive behaviors)


• HAVE A SPONSOR AND HOME GROUP: Keep a schedule of weekly meetings attended.

• HAVE A PHONE NETWORK.

• ACHIEVE A LEADERSHIP ROLE ON THE JOB LADDER: Become an Assistant Department Head, Expediter, Assistant Encounter Master, or Department Head.

• BE A POSITIVE ROLE MODEL: Express one's feelings responsibly. Describe how one feels without using street language or threats.

• SHOW RESPONSIBLE CONCERN BY REACHING OUT TO PEERS: Do this by sharing one's experience.

• INCREASE ABILITIES TO SELF-DISCLOSE: Every peer is expected to tell his/her your story.

• INCREASE SELF-ESTEEM: Take a pull-up without blowing one's stack, present oneself in a respectful manner (neat, clean, and well-groomed). Go the extra mile in performing one's job functions.

• BE RESPONSIBLE FOR ONE'S FINANCES: Develop a budget with the counselor or housing case manager.

• HAVE A DAILY PLANNER/CALENDAR APPOINTMENT BOOK: The member is expected to carry it always and keep track of personal appointments, activities, and medications.

• RECOGNIZE THE THIRD STEP: "We made a decision to turn our will and our lives over to the care of God as we understand him."


IV. RE-ENTRY PHASE (three months)

Peers are ready for the Re-Entry phase when they have maintained abstinence and demonstrated a commitment to the values of a drug-free life. Adding on to what they have learned in the previous phases, during the next three months they will be preparing to assume their roles as responsible, productive members of society. In order to reach this goal they must focus on the following:

~ Participate in the weekly Re-Entry group.

~ Participate in the weekly S.H.A.R.E. group.

~ Meet weekly with their vocational-rehab counselor to undergo education/work skills assessment and prepare to pursue their educational and employment goals.

~ If they want to be considered for Work Development they must demonstrate the following job skills: Perfect attendance and punctuality.

~ If appropriate, they will prepare for the responsibilities of being parents.

For Perinatal mothers:

    ~ Assess ability to take on parenting responsibilities of children in foster care.

    ~ Learn to balance family responsibilities, voc-rehab, and recovery.

During Re-Entry they may spend less time at Recovery Clinic. Nevertheless, they will be expected to be role models and assume positions of leadership. If they are working, they are expected to be at their work-site three days a week and in the program two days a week.

IMPORTANT BEHAVIORS TO BE DEMONSTRATED DURING RE-ENTRY PHASE:

• BEWARE OF THE "WELLNESS SYNDROME": Keep recovery their #1 priority. Attend at least four to five meetings outside the program Monday through Friday and attend at least one meeting on the weekends.

• MAINTAIN REGULAR WEEKLY CONTACT WITH SPONSOR.

• MAINTAIN GRATITUDE AND HUMILITY FOR SOBRIETY: Know the difference between abstinence and sobriety. They will be asked to assume a variety of positions within the community job ladder which will allow them to see how far they have really come.

• APPLY FOR ANY APPLICABLE WORK DEVELOPMENT OR JOB TRAINING PROGRAM (i.e., VESID)

• RECOGNIZE THE FOURTH STEP: "We made a searching and fearless moral inventory of ourselves."

• RECOGNIZE THE FIFTH STEP: "Admitted to God, ourselves and to another human being the exact nature of our wrongs."



V. AFTERCARE PHASE (four to six months)

Advancement to this phase indicates that peers have made the transition from attending the day treatment program to pursuing personal goals in the community.

As their lives becomes more rewarding, peers may also encounter stresses and complications. They will no longer have the intense support of the Recovery Clinic community. From now on it will be up to them to apply what they have learned in the Recovery Clinic to staying drug-free.

In order for peers to adjust to living drug-free at this phase they are expected to do the following:

~ Attend the weekly transition group where they will discuss each others progress and problems. During this time they will give each other feedback and support each other's abstinence.

~ Submit weekly urines.


IMPORTANT BEHAVIORS TO BE DEMONSTRATED DURING TRANSITION PHASE:

• ASSUME RESPONSIBILITY FOR COORDINATING THEIR OWN MEDICAL CARE.

• ACTIVELY PURSUE WORK, SCHOOL, AND PARENTING RESPONSIBILITIES.

• ASSUME A LEADERSHIP ROLE IN A SELF-HELP OR RECOVERY GROUP IN THEIR COMMUNITY OUTSIDE BELLEVUE HOSPITAL.

• GET INVOLVED IN COMMUNITY ACTIVISM (i.e.,vote, join a block association, etc.)

• RECOGNIZE THE SIXTH STEP: "Were entirely ready to have God remove all these defects of character."

• RECOGNIZE THE SEVENTH STEP: "Humbly asked Him to remove our shortcomings."


SUMMARY

By the end of this section trainees should understand the Recovery Clinic Program phases and their association with stages of recovery. They also should be aware of TC specific vocabulary and be able to describe aspects of the program in such terms.

Summarize the section by noting the following:

Objective I offered a general understanding of the program phases and stages of recovery, thereby laying the structure for the therapeutic milieu. This was accomplished by detailing specific sequences of the treatment program (i.e., orientation, stabilization, prevocational, aftercare/reentry) and tasks associated with each phase.

Now we will address how the principles of self-help are incorporated into this overall structure (Objective II).

   

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