24 HOURS IN SERVICE TRAINING
Abdullah Baniyameen
baniyameen@aol.com
May 20, 2009
OVERVIEW OF THE COURSE:
- Overview of Addiction,
- Recovery Process & Abstinence,
- Understanding Relapse,
- Relapse Prevention,
- Staying Sober & Stabilized,
- D.I.Y. Program,
- Principle of Effective Treatment,
- Development Model of Treatment,
COMMUNAL CHANGE:
- More mobile, transient society,
- Lack of communal spirit, neighborliness, et cetera,
- Fewer extended families,
- Increase of single parents, High divorced rate,
- Increase of both parents working,
- Busy hectic lifestyle on the go,
- Negative influence by media,
- Unhealthy role modeling,
- Alienation caused by electric gadgets e.g., computer games,
- Easy availability of intoxicant.
UNDERSTANDING ADDICTION:
WHY PEOPLE USE DRUGS?
There are many diverse viewpoints and understanding on this subject - from biochemical dysfunction, anti-social or deviant behavior to inborn vulnerability, but the basic truth is that People Use Drugs Because They Choose To:
REWARD POTENTIAL:
As a response to peer pressure-rite of passage,
Animalistic behavioral tendency - behavioral that increases pleasure or that which decreases discomfort,
Immediate consequences - reward or punishment has a stronger impact that delayed consequences.
WHY DO PEOPLE BECOME ADDICTED?
PEOPLE BECOME ADDICTED FOR A NUMBER OF REASONS, NAMELY – SOCIAL LEARNING:
Learned Behavior - Must be taught for the first time how to smoke the drug and recognize its effect, then they must be taught by those more experienced what to look for in terms of effects and why the drug-induced feelings are so desirable,
Individual Expectation - May influence the individual’s decision to use or not to use drugs.
STAGES OF CONTRA CULTURE:
Stage 1:
Formulating Of Behavior Continent:
- This is an early stage where the new behavior is accumulated and begins to formulate in the early teens period.
- Dressing and code of conduct e.g., style and musical the acceptance of peers.
- A sense of belonging.
- Relates to particular inclination.
- The art to terminology and jargons.
- Image seeking thrills.
Stage 2:
Deviations Of Norms / Rules:
- At this stage a new patterns of behavior emerges before conforming against the normal social norms / rules.
- Becoming rebellious.
- Unpleasant in adult present.
- Building sub-culture, showing constant negative attitudes.
- Showing visible signs in paraphernalia.
- Defiance of norms / rules.
- Frequently lying and dishonest.
- Showing constant negative attitudes.
Stage 3:
Adaptation Into Deviation Behavior:
- At this stage, it is a slippery path towards downfall to the sub-culture. An early intervention is essential to uplift these adolescent back to mainstream society.
- Values to abstract.
- Difficult of observing rules.
- Problems suppressing / delaying impulses.
- Experiencing guilt feelings.
- Poor struggle with adult or authority.
- Building up defense mechanism (denial, alibis etc)
- Not rigid conforming to “Norms of Honesty.
- Engaging towards a more serious form of deviations.
Contra Culture:
Behavior Patterns – Deviation from Norms & Rules:
- Become rebellious;
- Uneasy in presence and distrustful of adults;
- Truancy, if schooling or absenteeism if working;
- Lack of moral values e.g., dishonest, etc…;
- Indulgence with paraphernalia;
- Starts hanging out e.g., late nights, staying out, etc…; and
- Involved with sex, street-corner gangs, crime or DRUGS.
The Nine Criteria of Addiction:
- Preoccupation with the use of chemicals in between periods of use;
- Larger or more frequent doses of the chemical that anticipated;
- Development of tolerance to the chemical;
- Characteristic withdrawal syndrome when use is discontinued;
- Use of the chemical to avoid or control withdrawal symptoms;
- Repeated efforts to cut back or stop usage.
- Intoxication that causes interference on a daily basis;
- Reduced social, occupational, and recreational activities to accommodate further substance abuse; and
- Continuation of substance abuse despite having suffered drug-related social, emotional or physical problems
Recovery:
- Abstinence from any mood altering substance.
- Learning to live normally, healthy & productivity without drugs.
- Healing process of physiology, psychology & social skills.
- It is an individual process as no 2 people recovers at the same rate.
- Recovery has no limit, it’s a lifetime process.
- Relapse is a part of recovery.
- Developing an open relationship with the surrounding.
Recovery Process – Basic to Complex
PRODUCTIVITY:
Learning how to build a meaningful sober life
SOBRIETY:
Learning to cope with life without drugs.
COMFORTABLE LIVING:
Learning how to live comfortably while abstinence.
ABSTINENCE:
Learning to live without drugs
Six Developments of Recovery
SIX DEVELOPMENTS OF RECOVERY:
1. Pretreatment,
- The recognition of addiction that comes because of treatment is part of the pretreatment process,
2. Stabilization,
- The major motivational life crisis that caused an addict to enter this period of stabilized,
3. Early recovery,
- Healing period may be difficult for some because the post acute withdrawal syndrome,
4. Middle recovery,
- Sobriety can be maintained in this period with a less restricted recovery program than in the early recovery period,
5. Late recovery,
- Those whose arrested emotional growth and development resulted from early use of drugs must undergo a long course of habilitation - developing healthy beliefs and attitudes for the first time,
6. Maintenance,
- Recovery from chemical dependence is a lifestyle process; the disease of addiction never goes away.
Relapse Process:
ADDICTIVE PERSONALITIES:
- Resentment,
- Denials,
- Easily gives up hope,
- Disappointment.
INADEQUATE COPING SKILLS:
- Maintain meaningful relationship- rebuilding family ties,
- Acquiring assertiveness- family fun,
- Making amends- new relationship,
- Crisis management.
UNFULFILLED EMOTIONAL & SPIRITUAL NEEDS:
- “I’m not good enough”,
- Exaggerated mood swing,
OLD REFERENCE:
- People,
- Places,
- Things,
- Events, etc…
FAULTY BELIEF SYSTEM:
- Concept of save use,
- Triggering psychological symptom,
- Paranoid, anxiety, lack of self-esteem, loneliness, depression, fear, self-pity etc...
Phases of Relapse:
RETURN OF DENIAL:
- Concern about well being,
- Denial of concern.
AVOIDANCE AND DEFENSIVE BEHAVIOUR:
- Belief they will never relapse,
- Worrying about others instead of themselves,
- Defensiveness,
- Compulsive behavior,
- Impulsive behavior,
- Loneliness.
CRISIS BUILDING:
- Tunnel vision,
- Minor depression,
- Loss of constructive planning,
- Plans begin to fail.
IMMOBILIZATION:
- Daydreaming and wishful thinking,
- Feeling that nothing can be solved,
- Immature wish to be happy.
CONFUSION AND OVER REACTION:
- Periods of confusion,
- Irritation with friends,
- Easily angered.
DEPRESSION:
- Irregular eating habits,
- Lack of desire to take action,
- Irregular sleeps habit,
- Loss of daily structure,
- Periods of deep depression.
BEHAVIOURAL LOSS OF CONTROL:
- Irregular attendance of support group meetings,
- Development of “I don’t care” attitude,
- Open rejection of help,
- Dissatisfaction with life,
- Feeling of powerless and hopelessness.
RECOGNITION OF LOSS OF CONTROL:
- Self-pity,
- Thoughts of social drinking or using,
- Conscious lying,Complete loss of self-confidence.
OPTION REDUCTION:
- Unreasonable resentment,
- Discontinuance of all support group meetings,
- Overwhelming loneliness, frustration, anger, and tension,
- Loss of behavioral control.
THE RELAPSE EPISODE:
- Initial use,
- Shame and guilt,
- Helplessness and hopelessness,
- Complete loss of control,
- Bio-psychosocial damage,
- Complete collapse.
FACTORS CONTRIBUTING TO RELAPSE:
- Failure to understand and accept the disease of chemical dependence,
- Denial of loss of control, Dishonesty,
- The dysfunctional family,
- Lack of spiritual program, Guilt over the past,
- Stress and the inability to cope with it,
- Isolation and failure to become an active member of a support group,
- Cross-addiction,
- Holiday syndrome,
- Return to friends who abuse drugs,
- Unrealistic expectation
RECOVERY:
- Stabilization,
- Self-assessment,
- Relapse education,
- Identifying warning signs,
- Managing warning signs,
- Inventory training,
- Reviewing the recovery program,
- Involvement of significant others,
- Follow-up and Reinforcement.
WHAT DO WHEN RELAPSE OCCURS?
- Call your sponsor,
- Go to support group meetings,
- Call support friends,
- Discuss the relapse with your counselor,
- “Pick up white chips” - starting from basic,
- Talk with their spouses, families or significant others.
What Is Treatment And Rehabilitation?
PRINCIPLE OF EFFECTIVE TREATMENT:
- No single treatment is appropriate for all individuals.
- Treatment services must be readily available.
- Effective treatment attends to multiple needs of the individual, not just his / her drug use.
- An individual’s treatment plan must be developed as assessed periodically and modified as necessary to ensure that the plan meets the person’s changing needs.
- Retaining client in treatment for adequate period is critical for treatment effectiveness.
- Counseling (individual / group) and other behavioral therapies are critical component of effective treatment for addiction.
- Medications are an important element of treatment for many patients, especially when combined with counseling and other behavioral therapies.
- Addicted or drug abusing individuals with coexisting mental disorders should have both disorders treated in an integrated way.
- Medical detoxification is only the first stage of addiction treatment and by itself does little to change long-term drug use.
- Treatment does not need to be voluntary to be effective.
- Possible drug use during treatment must be monitored continuously.
- Treatment programs should provide assessment for HIV/AIDS, Hepatitis B&C, Tuberculosis, and other infectious diseases, and counseling to help patients modify or change behaviors that place themselves or others at risk of infection.
- Recovery from drug addiction can be a long term process and frequently requires multiple episodes of treatment.
- Engaging the family while the addicted client is in treatment should be a component of treatment.
- Treatment must be clearly define to meet the challenges ahead by the service providers, significant others and clientele.
DEVELOPMENT MODEL OF RECOVERY:
- The development model recognizes that recovery is a progressive process of growth that includes the mastery of a series of emotional, psychological, social and recovery related tasks.
- These development tasks, which begin as basic and become more complex, serve as the building blocks for recovery.
- Recovery is then define as the ongoing process of improving level of functioning while striving to maintain abstinence from mood-altering chemicals.
PRE – TREATMENT PHASE:
- Cognitive,
- Affective,
- Acting Out.
- Experience unpleasant consequences and have been unable to maintain control over their life because of their substance use.
- Develop awareness that their problems are related to their substance use.
- Experience some level of emotional pain, which motivates them.
- Make a decision at some level to consider the possibility of engaging in the treatment process.
INITIAL STABILIZATION STAGE:
- Pattern of use interrupted.
- Period of abstinence, which allows for recovery from withdrawal.
- Detoxify from other impulsive behaviors.
EARLY STAGE RECOVERY:
- Struggles with acceptance and understanding of addiction.
- Recognizes triggers, Recognizes and verbalizes feelings.
- Begins to learn skills, which promote personal development, i.e., problem solving, impulse control.
- Assumes personal responsibility for choices, decisions, and behaviors.
- Familiarizes self with concept of treatment models.
- Verbalize struggle with ambivalence.
- Begins to manage triggers and drug hunger.
- Embraces recovery – integrates principles of recovery.
- Begins to develop a drug-free image.
- Acknowledge the need to make lifestyle changes.
- Address the issues, which predated use.
- Tries on new behavior and attempts to apply skills they have learned.
- Experiences hope based on small successes.
- Tests and affirms what they have learned in treatment.
- Struggles with family issues.
- Period incident of use.
MIDDLE PHASE:
- Experiences resolution of ambivalence.
- New behaviors are integrated into new self-concept.
- Experiences a commitment to recovery.
- Prove to them that they can thrive.
- Faces and deals with “life” problems.
- Becomes comfortable with feeling state.
- Begins catching up on development lags.
- Becomes aware of need for spiritual growth.
- Continues to struggle with family issues.
- Comfortable with lifestyle changes.
- Seek help on addressing clinical issues, which predated use.
ADVANCE PHASE:
- Begin development of a spiritual program.
- Learn coping mechanisms for dealing with family.
- Broadens scope of life, begins fulfilling potential.
- Develops healthy relationship with others.
- Develops independence from treatment center.
- Develops balance in life.
- Experience age appropriate resolution to developmental trauma.
- Experience acceptance with identity as a recovery person.
MAINTENANCE PHASE:
- Continues personal growth.
- Recovery is part of their life but not their entire life.
- Focuses on spiritual development.
- Post independence from treatment centre.
- Reentry Readiness .
Orientation For Re – Entry:
- Cognitive,
- Affective,
- Acting Out.
- Issues of separation – Post Independence,
- Clarify client expectation of re-entry,
- Significant others readiness:
- Threats of slip, sex, et cetera,
- Budgeting Management,
- Support Group,
- Post Counseling,
- Pre reintegration.
Pre/Post Re – Entry and Aftercare:
- The preparatory for Re-entry and Aftercare must be clearly define to meet the challenges ahead by the service providers, significant others and clientele.
- A concerted effort must be established prior implementation for Re-entry and Aftercare service.
- Regulators, N. G. O.’s, Inter Agencies.
Assessment:
- What continued problems or further stressors ought to be addressed while the client is in treatment before they can be safely discharge?
- Are there legal, social service, financial resources, educational resources, or vocational incentives that may enhance client level of care?
- Does the client have any awareness or recognition of skills with which to cope to his / her potential threats?
- How aware is the client of their relapse triggers, coping with cravings, skills to prevent any disposition?
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