OBJECTIVE VI
Understand and promote adherence to program rules
Estimated time for delivery: 2 hours TRAINER NOTE
Administer pretest (see below).
CONTENT
The program involves adhering to rules and accepting behavioral disciplinary contracts. The consistency and stability in the program structure helps to foster a sense of the world as reliable and offers the chance for peers to practice negotiating skills within a community in which rules are applied fairly. Professional staff must be made aware of all program rules and regulations. In a 40 minute lecture the trainer presents information concerning program rules and regulations (see handout VI.1) as well as specific procedures related to morning meeting (see handout VI.2 ), encounters (see handout VI.3), and behavioral guidelines applicable to group sessions (see VI.4). The information contained in the handouts is worded in terms of the peer's perspective.
EXERCISE
Trainees will test their recall and presentation of program rules by breaking into dyads and role playing descriptions of program rules to each other.
Administer post-test (see below).
PRETEST
Community Rules and Procedures
Answer the following TRUE or FALSE:
1) Urine bottles may be taken home by the peer.
2) Peers are permitted to leave group sessions for a few minutes and come back if they get angry.
3) Peers will be subject to discharge from Recovery Clinic for forming a romantic or sexual relationship with another peer.
4) Lending or borrowing money from peers is encouraged.
5) It's not considered a slip if a peer uses a drug different from the peer's drug of choice.
6) Morning meeting is the peers' time to have fun and build motivation for the day.
7) Rules and regulations are necessary to keep the community a safe place.
8) Peers may pay monthly dues if they want to.
9) A pull-up is a sign of responsible concern.
10) Outside meetings are not necessary because the peer can get all that is needed in the Recovery Clinic program.
11) A significant other makes a good sponsor.
12) If a senior peer is seen by a junior peer breaking a rule, the junior peer should not report it.
13) The counselor should be notified by the peer if the peer is going to be late or if an emergency comes up.
14) There are peers in Recovery Clinic who don't have a drug problem.
15) Not everyone starts out on service crew.
16) Breaking a contract is a serious treatment issue.
17) It is the peer's responsibility to stop someone from using drugs.
18) Smoking is permitted in the bathroom.
19) If the peer does not like a group, the peer does not have to attend the session.
20) Refusal to turn in a urine sample is considered a dirty urine.
21) The only time it is okay to insult someone's inborn dignity is during an encounter group.
22) Keeping someone else's secrets will not harm a peer's recovery.
23) Recovery is a process not an event.
24) It's okay to feel angry, but not to act out one's anger.
25) Senior peers know everything there is to know about recovery.
26) It's important for the peer to be on time and present because it will help the peer be successful in achieving a career.
27) Each peer is responsible for the results of his/her own decision.
28) It's not important for a peer to tell staff everything about the peer's health.
29) The program's phases of treatment in order are:
Transition. Pre-Voc. Orientation. Re-entry and Engagement.30) Rules are made to be broken.
Note: A post-test identical to this pre-test appears prior to the summary for Objective VI (pp. 51-52). The answer key appears in Appendix II (p. 64).
Handout VI.1 Program Rules and Regulations
Why do we have rules and regulations?• For the efficient functioning of the program.
• To provide consistent and fair treatment to all peers.
• To inform peers of their responsibilities.
• To ensure that irresponsible behavior on the part of an individual will not jeopardize the treatment of the other peers. So the community will be a safe place to come to.
Anyone who cannot or will not follow these rules is not appropriate for treatment at this program. Violation of any of the rules and regulations will result in a warning and mandatory self-disclosure before the community. Repeated non-compliance will lead to suspension, probation, and possible termination. Input from community representatives is important and will be taken into consideration. However, staff will decide which consequences are appropriate.
1) TOTAL ABSTINENCE
• Continued drug or alcohol use is prohibited. It is expected that upon enrollment in the program you have made a commitment to stop using all abusable substances.
• By committing to total abstinence you agree not to expose yourself or your peers to situations which are likely to lead to picking up. An obvious example is going to a bar/club where alcohol or drugs are available. Such behavior indicates denial or other dangerous thinking. Your peers, as well as staff, will confront you about this kind of behavior. Your feelings and rationalizations prior to picking up will be explored. If you continue to violate this rule, you are telling peers and staff that your commitment to abstinence is questionable. In that case, staff will decide on appropriate consequences (suspension, probation, or termination).
2) URINE TESTING
• Urine is to be turned in before the first group begins. This means between 9:00 and 9:30. For late arrivals, urines may be turned in between 12:15 and 12:30 only. If you miss both collection times, you can turn your urine in only to your individual counselor.
• Peers absent on a urine collection day are responsible for turning in a sample on the next day.
• Failure (forgetting) or refusal to turn in a urine sample will be considered equivalent to a dirty urine.
• Under no circumstances is a urine bottle to be taken from the clinic area.
• Remember that recovery requires honesty to self and others. If you have picked up, inform your counselor and peers immediately so that they can help you learn from your mistake and support your recovery.
Procedure for a dirty urine:
1) Drop a slip on yourself.
2) Service crew for 2 weeks.
3) Daily urines for 2 weeks.
No exceptions to the rule!
Remember: Lab errors are extremely rare. It is much more likely that your disease made you pick up and is making you deny it. It's not that we don't trust you - we don't trust your disease. We would rather risk making a mistake and treat you unfairly than risk your recovery.
3) ATTENDANCE AND PUNCTUALITY
• Daily attendance is required and you must be here on time! You must register and sign in daily. This is proof of your attendance and punctuality - not just for carfare reimbursement.
• If you have an emergency, unavoidable lateness or absence, you must call in that morning and speak directly to your counselor.
• If you have appointments, notify both your counselor and clerical crew in advance.
• Appointments should be scheduled after program hours whenever possible. Any exceptions should be cleared with your counselor.
• You will be required to provide documentation for appointments, absences, or if you come to the program late. In addition, if you are late to a group you must obtain a slip from your counselor to join that group.
• Once you arrive, you may not leave the clinic without permission until the program ends. This includes celebrations, socials and outings.
4) PROGRAM
• Participation in all groups and other activities is mandatory. This includes field trips and events scheduled by the clinic, one-on-one sessions with your counselor which may occur after program time, outside NA/AA meetings, phone contracts with your peers etc.
RECOVERY DOES NOT END AT 2:00 P.M. IT IS A CONTINUOUS PROCESS!5) ANY ACTS OF VIOLENCE AND/OR THREATS ARE PROHIBITED
• This will result in automatic termination.
6) NO FINANCIAL TRANSACTIONS OR SOLICITATIONS
• No borrowing or lending money. This can lead to negative contracting.
7) NO ROMANTIC OR SEXUAL RELATIONSHIPS WITH PEERS
• All peers must be treated as members of your family. Violation of this rule undermines not only your recovery but also the community's recovery. If you have sex or form a romantic relationship with a peer of the Recovery Clinic community you will be discharged from the program.
8) TELEPHONE USE
• Use of office phones is restricted. The clerical crew may have access to staff phones at a specified time to contact absentees. Counselors phones may be used with their permission.
9) PRESCRIPTIONS/MEDICATION
• Speak with the nurse or medical director before you run out of medication. Arrangements will be made to get prescriptions to you promptly with your counselor.
• You are to inform the nurse of ALL medications that you are taking.
• It is also your responsibility to inform your physicians and dentists that you are in recovery and narcotic or other addictive substances should be prescribed with caution. Please notify your counselor if you are prescribed any medications.
10) APPEARANCE AND PERSONAL HYGIENE
• Your appearance and presentation is an extension of yourself. It is an indication of how you feel about yourself and how others will perceive and interact with you. Respect yourself and have consideration for those around you. Dress appropriately and practice cleanliness. Please do not dress in a sexually provocative manner.
DRESS CODE:
* Skin-tight skirts or shorts exposing underwear and skin are inappropriate.
* Tights or stretch pants should be worn with a long top to cover behind.
* No see-through or transparent tops exposing brassiere or skin.11) PROFANITY IS STRONGLY DISCOURAGED
• Remember there are children in the community.
12) CONFIDENTIALITY
• Self-disclosure is an important element of recovery. Self-disclosure is inhibited when the community cannot be trusted to keep sensitive information within the program. This means no gossiping or using information maliciously.
Handout VI.2 Procedures Relating to Morning Meeting
PURPOSE:When we were using drugs, we did what we felt like doing when we felt like doing it. We were only interested in taking care of our wants and we neglected our needs. It didn't work. Today we are learning in our treatment to build a structure in our lives. A good structure sets aside time for all of our needs: A time to eat, a time to sleep, a time to work, and a time to play. This is our time to play. And in our play we build our motivation to do the hard work our recovery requires of us in our groups. We learn how to interact with others and discover that we are not alone. For the first time in our lives we are part of something larger than ourselves--our community; we know that what we were never able to do for ourselves is starting to happen--together, within our structure.
PLANNING:
Planning the morning meeting is absolutely essential. Leaders of the morning meeting should be selected at least a week before hand so that they have time to prepare and have their plans reviewed by staff. The success of the morning meeting depends upon the time and care spent on its preparation. While the specific activities may vary, the following elements are usually included:
• SERENITY PRAYER
• WEATHER
• CONCEPT: a single concept is presented each day. It incorporates the "word of the day". The Group leader will give a one or two minute explanation - especially from his/her own experience.
• SKITS, JOKES and/or MOCK AWARDS: These always need to be upbeat and positive -- never at someone's expense.
• SONGS or GAMES
• Close with reciting RECOVERY CLINIC PHILOSOPHY (See Appendix II.B).
RULES:
1) One is never forced to do something he/she does not want to do.
2} Activities should be done for fun, not for negative responses and should never be confrontational. Save confrontations for encounters.
Handout VI.3 Procedures for Encounter Sessions
THERE ARE 3 STAGES TO THE ENCOUNTER: The THREE C's :
Confrontation
Conversation
Closure
The Encounter should be 15 minutes in total. 1) CONFRONTATION: Any peer can be confronted about a specific behavior or attitude (a collection of thoughts, feelings and behaviors).
PURPOSE: To see oneself more objectively, although it may be painful or uncomfortable.
LIMIT: 5 minutes
2) CONVERSATION/QUESTIONS: The confronted person is given a chance to respond to the confrontation. The Encounter Master says, "The group is on you. Tell us how you feel."
PURPOSE: To explore reasons behind the behavior and associated feelings and to make a commitment to change the behavior.
LIMIT: 5 minutes
PROCEDURE:
A. If necessary, questions can be asked of the confronted person to break through denial.
B. Questions come from the INNER CIRCLE first.
C. After the confronted person responds, the person who dropped a slip can ask a question of the confronted person. The confronted person then responds to this question. If the person asking the question is not satisfied with the response, then he/she can ask a second question.Then move on to the next person.
D. Limit of 2 questions per person. However, if Encounter Master deems it necessary, he/she can allow more questions.
E. The Encounter Master decides if questions will be permitted from people in the OUTER CIRCLE.
F. The Encounter Master will follow the order of calling on people who dropped a slip first, then go to the rest of the INNER CIRCLE, then the OUTER CIRCLE.
G. If confronted person responds fully, questions should not be necessary.
3) CLOSURE/FEEDBACK: The person confronted is now given feedback by the group. Feedback comes in the form of comments from people who can identify with the problems or issues and who can explain how they have dealt with these problems, issues or feelings in the past.
PURPOSE: To be supportive of the encountered person.
LIMIT: 5 minutes
On the day of the Encounter, the Encounter Master (under staff supervision) will set up the group to be in the INNER CIRCLE.
The INNER CIRCLE consists of:
• The Encounter Master
• The Assistant Encounter Master
• All the people with slips dropped on them
• All the people dropping slips
• Person(s) representing peer strength in the community.The group should number 13 to 15 people. If too many slips have been dropped, the Encounter Master will prioritize the slips and select those slips to be honored that day.
Handout VI.4 ENCOUNTER RULES
• No physical violence or threats of physical violence.• No leaving your seats.
• No rat-packing (collective assault on one peer.)
• No red-crossing (playing lawyer for the person being confronted.)
• Use honesty (not just a tit-for-tat.)
• Show responsible concern for the person being confronted.
• Confidentiality - information learned in the encounter groups is to be used supportively within the community. This means no gossiping or using information maliciously.
• No walking out of group.
• No cross talking.
• During the encounter one must respect the Encounter Master. This may mean that one has to hold one's belly.
• Anyone can disagree with the Encounter Master when the group is over.
PEOPLE WITH APPOINTMENTS DURING ENCOUNTERS SHOULD SIT NEAR THE DOOR AND EXIT QUIETLY.
Handout VI.5 Behavioral Guidelines While Group is in Session
While group is in session, please observe the following rules:l ) Get involved! Share your feelings, especially those that bother you. Talk about any urges, cravings, slips and other changes you are experiencing. But please, no monopolizing.
2) No talking with your neighbors No cross talking or other disruptions, including getting up from your seat and walking around the room.
Consequences:
A) You will be given a pull-up
B) You will be asked to apologize to the community
C) If you refuse to apologize, you will be asked to leave the group
D) Coordinator or expediter will get medical director if necessary3) No going to bathroom. Try to go during break time. Exceptions only with medical note: (i.e. pregnancy, changing baby, etc.)
4) Sit close to the door if:
A) Coming in late
B) Leaving earlySEATS ARE TO BE LEFT BY THE DOOR FOR LATE-COMERS.
5) Late-comers:
A) Come in quietly
B) More than l0 minutes late: LISTEN ONLY6) No eating or drinking in group.
7) Dress Code:
NO BEEPERS
NO SUNGLASSES
NO WALKMANS8) No walking out of group.
Consequences:
Scenario #1:
A) See counselor before going back to any group
B) Drop a slip
C) Apologize to the communityScenario #2:
A) Emergency: send expediter or group leader9) Expediter will sit by the door.
10) No sleeping in group.
11) During Encounter Group, babies must go to Infant Stimulation.
12) Counselors will not escort member back into group.
POST-TEST
Community Rules and Procedures
Answer the following TRUE or FALSE:
1) Urine bottles may be taken home by the peer.
2) Peers are permitted to leave group sessions for a few minutes and come back if they get angry.
3) Peers will be subject to discharge from Recovery Clinic for forming a romantic or sexual relationship with another peer.
4) Lending or borrowing money from peers is encouraged.
5) It's not considered a slip if a peer uses a drug different from the peer's drug of choice.
6) Morning meeting is the peers' time to have fun and build motivation for the day.
7) Rules and regulations are necessary to keep the community a safe place.
8) Peers may pay monthly dues if they want to.
9) A pull-up is a sign of responsible concern.
10) Outside meetings are not necessary because the peer can get all that is needed in the Recovery Clinic program.
11) A significant other makes a good sponsor.
12) If a senior peer is seen by a junior peer breaking a rule, the junior peer should not report it.
13) The counselor should be notified by the peer if the he/she is going to be late or if an emergency comes up.
14) There are peers in Recovery Clinic who don't have a drug problem.
15) Not everyone starts out on service crew.
16) Breaking a contract is a serious treatment issue.
17) It is the peer's responsibility to stop someone from using drugs.
18) Smoking is permitted in the bathroom.
19) If the peer does not like a group, he/she does not have to attend the session.
20) Refusal to turn in a urine sample is considered a dirty urine.
21) The only time it is okay to insult someone's inborn dignity is during an encounter group.
22) Keeping someone else's secrets will not harm a peer's recovery.
23) Recovery is a process not an event.
24) It's okay to feel angry, but not to act out one's anger.
25) Senior peers know everything there is to know about recovery.
26) It's important for the peer to be on time and present because it will help the peer be successful in achieving a career.
27) Each peer is responsible for the results of his/her own decision.
28) It's not important for a peer to tell staff everything about the his/her health.
29) The program's phases of treatment in order are:
Transition. Pre-Voc. Orientation. Re-entry and Engagement.30) Rules are made to be broken.
Note: A pre-test identical to this post-test appears at the outset of Objective VI (pp.40-41). The answer key appears in Appendix II (p.64).
SUMMARYBy the end of this segment, trainees should achieve an understanding of program rules and regulations and how peers' adherence to such rules plays a role in recovery from addiction.
Summarize the section by noting the following:
With the completion of Objective VI, trainees will be ready for the final objective, VII, facilitation of communication with dually disordered to minimize resistance. In a program targeted to a patient population, some of whom are psychiatrically compromised, one can expect that at times peers will be inflexible on certain points. It is important that staff learn how to communicate with peers at such times in a flexible fashion so that conflict is reduced and the "spirit" of the program is followed.
