OBJECTIVE II
Understand and promote self-help and mutual help
Estimated time for delivery: 1 hour 40 minutes TRAINER NOTE
The underlying philosophy of the treatment model is that the peers themselves are the most significant change agents. The role of staff is to support peers' sense of competence and facilitate their leadership skills through graded responsibilities. Thus, the professional staff are charged with refraining from playing the role of "expert", which would undermine the role of the peers in themselves taking a leadership role. The staff's role is to provide the safe structure in which such self-help and mutual help will unfold.
CONTENT
The professional's role in the self-help ambulatory treatment program is as follows:
introduces each peer to the treatment community and establishes the linkage with a "big sister" or "big brother" in the program;
assesses the psychosocial needs of each peer (i.e., housing, entitlements) and provides the necessary level of ongoing guidance and support so that the member can best pursue whatever steps are indicated;
monitors all peer-conducted treatment groups to ensure that a prosocial environment is maintained at all times;
provides psychoeducational interventions to inform peers regarding their own management of their psychiatric and addiction-related symptoms and promotes them as competent consumers of mental health (e.g., identifying warning signals that professional help is needed).
The trainer during a 30 minute lecture reviews information concerning psychoeducational group sessions (see handout II.1), common dangers that increase risk for relapse (see handout II.2), symptoms leading to relapse (see handout II.3), and behaviors indicating preparation for relapse (see handout II.4) below.
EXERCISE
Entire training group will be asked to brainstorm all clinic functions, including leadership of groups. Then, all functions will be classified according to the dimension of whether peer vs. staff leadership is necessary.
Handout II.1 Psychoeducational Group Sessions
At Recovery Clinic participation in various groups is emphasized. Each group focuses on crucial issues related to addiction and recovery. Purpose of groups:• Provide structure
• Educate
• Provide mutual support and a sense of community
• Lead to improved self-awareness
COMMUNITY MEETING - Forum for peers and staff to discuss community issues as they arise during the course of the program. At this time the monthly social is planned as well as other social events (i.e. Thanksgiving, Christmas socials, graduation celebration.) The purpose is to encourage peers to interact, discuss and resolve problems, and build decision making skills.
ENCOUNTERS - The purpose of this group is to heighten individual/group awareness of specific attitudes and behaviors through responsible confrontation. The encounter provides a forum for participants to express feelings about themselves and each other, channel community friction and express community concern and support.
EXECUTIVE MEETING - A weekly meeting with community leaders and staff to discuss issues concerning the community and program functioning.
HOME GROUP - Weekly meeting with primary counselor to discuss various issues.
HOUSE MEETING - Held the last fifteen to twenty minutes of the day. All peers must attend unless excused by their counselors. The meeting is run by senior peers (coordinator and expediters). The purpose is to apply social pressure in order to encourage individual change. This is done by public acknowledgment of positive or negative behavior in the community. Announcements that are made generally deal with pull-ups, adherence to contracts, and public commitments to behavior change. Those peers who have appointments or job changes to take place the following day, may make announcements during this time.
INFANT STIMULATION - Supervised by a Child Development Specialist, this group provides age appropriate developmental activities for the infants while their mothers are attending Encounter groups.
MONTHLY SOCIAL - Once per month the clinic will participate in a social event or activity which promotes unity among peers and offers an opportunity to learn how to socialize without using drugs. Birthdays can be celebrated at this time. The Hospitality Crew is responsible for the monthly collection of dues ($2) which is used in planning and carrying out the event. The events are the responsibility of the community with support from staff.
MORNING MEETING - Community run meeting to begin the day on a positive note with fun and energy.
PATIENT SEMINAR - Medical director (or other staff) speaks on psychological and medical aspects of addiction and recovery.
PERINATAL PARENT CHILD DYAD - Combines developmental information and activities with supportive counseling around the emerging role of motherhood. Led by the Child Development Specialist.
PERINATAL PARENTING SKILLS - Practical educational information for parenting children while peers are in recovery.
PSYCHO-EDUCATION - Exploration of issues of concern to those who have a mental illness in addition to an addiction.
RE-ENTRY - Exploration of individual goals and interests in area of school and career/job training. Report on individual progress. Discussion of issues specific to this phase of recovery (re-entry into community).
RELAPSE PREVENTION - Education - Discussion of relapse as a process; Post-Acute withdrawal signs and symptoms; Substance abuse education; Relapse prevention techniques.
SELF-DISCLOSURE - Group in which a peer of the community shares his/her drug experience and its consequences, struggles with recovery and hopes for the future.
SELF-HELP ADVANCED RECOVERY (S.H.A.R.E. group) - For peers in Re-Entry phase of treatment. The purpose is to establish ongoing connections to peers who have achieved a stable level of abstinence. Peers work on tasks of "living life on life's terms" and "giving back" what they have learned.
STRESS MANAGEMENT - Dealing with stress in early recovery; relaxation and meditation techniques are used to develop and enhance healthy coping skills.
TRANSITION GROUP - For peers who have completed the day program. In this phase of treatment, peers continue to work on individual goals in areas of education and career.
TWELVE-STEP GUIDELINES - Introduction to the 12 step concept, the disease of addiction and need for treatment. This is a time to review one's experiences with drugs and alcohol and one's attempts to deal with it alone leading to concepts of powerlessness, Higher Power, etc.
WEEKEND PLANNING - Preparation for and structuring of peers' weekends. Utilization of time and recovery tools to prevent relapse. Reporting of any possible triggers one may encounter and strategies to deal with them.
WEEKEND PROCESS - Review of weekend activities, discussion of relapses, near relapses: socializing while in recovery.
Handout II.2 PUTTING ONESELF AT RISK FOR RELAPSE
THE TEN MOST COMMON DANGERS1. Being in the presence of drugs, drug users, or places where one used to cop or get high.
2. Negative feelings, particularly anger, but also sadness, loneliness, guilt, fear, and anxiety.
3. Positive feelings that make one want to celebrate.
4. Boredom.
5. Getting high on any drug.
6. Physical pain.
7. Listening to war stories and just dwelling on getting high.
8. Suddenly having a lot of cash.
9. Using prescription drugs that can get one high even if used as prescribed.
10. Believing that one is finally well - that is, no longer stimulated to crave drugs by any of the above situations, or by anything else - and, therefore, feeling that it is safe for one to get high occasionally. Called "The Wellness Syndrome" by peers.
Handout II.3 A Check List of Symptoms Leading to Relapse
• ExhaustionAllowing oneself to become overly tired and/or unhealthy. Good health and enough rest are important. If one feels well, one is more apt to think well. If one feels poorly, one may not think clearly. If one feels bad enough, one might begin to think that a drink and/or drug couldn't make things any worse.
• Dishonesty
This begins with peers exhibiting a pattern of unnecessary lies and deceits with peers, friends, and family. Then come important lies to oneself or "rationalizing"-- making excuses for not doing what one knows one should do.
• Impatience
Things are not happening fast enough. Others are not doing what they should be doing or what one wants them to do.
• Argumentativeness
Arguing small and ridiculous points indicates a need to always be right and expecting others to agree with one's own opinions. Peers may look for an excuse to drink or use drugs?
• Depression
Unreasonable and unaccountable despair may occur in cycles and should be dealt with -- talked about.
• Frustration
Feeling discouraged because things may not be going one'sway. Everything is not going to be just the way one wants it.
The peer may express thoughts suggestive of the following:
• Self-pity
"Why do these things happen to me? .Why must I be an addict/alcoholic?"
"Nobody appreciates all I am doing -- (for them?)"• Cockiness
Got it made. No longer fear addiction. Going into drinking/drugging situations to prove to others they have no problem.
• Complacency
"Drinking was the furthest thing from my mind. Not drinking/using was no longer a conscious thought either". Peers are encouraged to be vigilant. They are advised that always having a little fear is a good thing; more relapses occur when things are going well than otherwise.
• Expecting too much from others
"I've changed: why hasn't everyone else?"
• Letting up on disciplines
Prayer, meditation, daily inventory, AA attendance may be discontinued by the peer stemming either from complacency or boredom.
• Use of mood-altering chemicals
Peers may feel the need to ease things with a pill or alcohol, and get a doctor to prescribe medication or the member may self-medicate with alcohol.
• Wanting too much
The peer may set goals that are beyond their reach. Peers are advised that "Happiness is not having what you want, but wanting what you have."
• Forgetting gratitude
Peers may be looking negatively on their lives, concentrating on problems that still are not totally corrected. Peers are advised to remember that it is good to remember where they started from -- and how much better life is now!
• "It can't happen to me."
Peers are advised that this is dangerous thinking. Almost anything can happen to them, and it is more likely to happen if they get careless. Peers are reminded that they have a progressive disease, and that they will be in worse shape if they relapse.
• Omnipotence
This is exhibited when peers behave as if they have all the answers for themselves and others. No one can tell them anything. They ignore suggestions or advice from others. Relapse is probably imminent unless drastic changes take place.
Handout II.4 Behaviors Indicating Preparation for Relapse
The following statements made by peers are suggestive of preparation for relapse:• I start taking on other people's work, neglecting my own.
• I smile a lot - dishonest with my feelings.
• I become argumentative.
• I start playing old resentment tapes.
• I don't share my depression with my friends.
• I get cocky.
• I stop following-up, don't keep promises.
• I become complacent.
• I start expecting things of others, and resent it when they don't live up to my expectations.
• I get into "should-ing" all over myself.
• I stop praying and meditating.
• I stop doing my inventory.
• I become bored (and boring).
• I lose my faith and become flooded with irrational fears.
• I become scattered and can't concentrate.
• I become judgmental. I stop accepting people for who they are, and start judging them because they are not what they "should" be.
• I stop listening to that small, still voice.
• I become a martyr.
• I stop asking for help.
SUMMARYBy the end of this segment trainees should have an understanding of the nature of psychoeducational groups provided in the Recovery Clinic program and nature of roles that define professional staff member and peer. Trainees should also be prepared to aid peers in detecting signs of relapse.
Summarize the section by noting the following:
Objective II provided a rationale for staff divesting themselves of the role of "expert". The distinction between staff and peer leadership of clinic functions was clarified.
The next step in training builds on this new way of staff conceptualizing their role. Trainees are encouraged to see themselves as agents of positive behavioral change by themselves learning and adhering to the rules of the therapeutic community.
