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Addictions

What The Pros Know: The Practical Recovery Model

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D.

The Practical Recovery Model is a set of principles for organizing self-empowering addiction treatment and recovery. This model is most suitable for people with an internal locus of control. The model is not a form of treatment. Instead, it serves as a guide for self-directed recovery. The model aids in the selection of professional services. These may include addiction treatment; health and mental health treatments; and holistic healing; participation in support groups; and other recovery-related experiences. The model is most applicable to the client who needs to have an intensive treatment experience with several providers.

therapist and patientThe principles for therapists are:

1) Client choice: Collaboration

The best plan is the one the client will follow. Support harm reduction. Be patient.

2) There are as many paths to recovery as there are individuals.

Your job is to collaborate with the client to find his or her path. Don't close off any options prematurely. Have lots of options available. Be creative.

3) Patients need to learn some lessons by trial and error (vs. social learning).

You'll get points for predicting what happens. However, there is no substitute for direct experience by the client. Relapse is likely, keep moving forward.

4) The primary focus for most participants is their underlying issues.

Get to them as fast as you can. Begin the cost-benefit analysis by focusing on benefits: "What do you like about the addiction?" For instance, if your client likes drinking because it is relaxing, "difficulty relaxing" may be an underlying issue. There is much less hope for recovery without some solid gains here. You typically don't need to focus much on the costs. The client already knows them well!

5) Other major issues to address in recovery include: basic life skills (especially for younger clients); motivation; craving; relationships; lifestyle balance; and living with meaning and purpose.

6) The treatment team needs to meet regularly.

The client will re-enact with you and your team the fundamental problems carried forward from childhood. A coordinated team effort can help identify these problems more quickly.

The principles for clients are:

1) You can't learn from an experience you don't have.

If the therapist recommends you try something once, unless you have strong reasons to avoid it, give it a try. You might learn something.

2) If you've tried it and it didn't help, move on.

However, discuss with your other team members what you've learned.

3) This project is likely to take longer, and take more effort, than you expect.

It's OK to complain about how hard it is. Just stick with it. You can't solve a problem if you don't remain focused on it.

What doesn't work: Confrontation is harmful

The previously listed treatments are evidence-based treatments for addiction. The National Register of Evidenced-Based Programs and Practices (NREPP) lists other evidence-based treatments. There is a remarkable diversity in these treatments. While evidence-based treatments are effective for many people, they are not effective for every person.

Unfortunately, addictions treatment has long been associated with a confrontational approach. The basis for this hostile method rests on the faulty premise that addicted persons are "in denial" about their addiction. This incorrect conclusion causes people to believe it is necessary to force addicted persons to face "the truth." In this approach, the therapist aggressively confronts the therapy participant about their behavior. This approach is NOT an evidence-based practice. Moreover, there is good reason to believe it is harmful. Despite this fact, confrontational approaches continue in common use.

"The American detour into a denial-busting confrontational style for addiction treatment was, from our perspective, an aberrant wrong turn justifying treatment practices that would be blatantly unprofessional and unethical in any other area of health care, and clinical trials of such approaches have yielded uniformly negative results." (Miller, Forchimes & Zweben, 2011, pg. 260)).

At the beginning of treatment, you may feel pretty badly about yourself. It may be difficult for you to stand up for yourself and insist on changing therapists, or choosing another program. However, if you begin to feel your therapy team treats you with disrespect, or that they do not validate your input and preferences, you need to speak up. You should not experience a sense of criticism and contempt. This does not mean you should bolt at the first signs of discomfort. Sometimes therapists must call to your attention unpleasant truths. This may occasionally result in some initial discomfort but your therapist should deliver such messages with respect and compassion. If you do not assert your right to dignity and respect, your recovery may be at stake. No matter how many mistakes you have made in the past, you are now looking for someone who helps you to make new and better decisions.

 

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