Recovery and Gratitude in Los Angeles and Orange County!

life-is-good-blog-imageQ. What does gratitude have to do with recovery?

A. Addicts and alcoholics who are able to achieve recovery not only experience relief from the traumatic consequences of their substance abuse, they often use gratitude as a means toward maintaining their recovery. Remembering what it was like, what happened and being grateful toward what’s it is like now strengthens commitment and motivation toward recovery.

Q. Why do so many alcoholics and addicts in Los Angeles and Orange County engage in recovery?

A. Recovery has become a “badge of honor” in Los Angeles and Orange County communities. People who need help getting “clean and sober” are easily able to access many varieties and types of treatment and/or support. In Los Angeles and Orange County, there are more twelve step meetings and other mutual support groups for drug and alcohol recovery than perhaps anywhere else on the planet.

Q. What does it feel like to achieve recovery from alcoholism or addiction?

A. Relief that you don’t need to worry about consequences and mounting problems is often the first discovery people in early recovery encounter. Awakening to a fresh new world of color and warmth is different from the days when waking up meant facing the problems and hangovers you created the night before. The need to repetitively seek out chemicals for pleasure or relief is replaced by a larger life and broadened interests and activities.
Q. What are changes caused by recovery from addiction or alcoholism?

A. Relationships with others such as family members and loved ones improve once drugs and/or alcohol are no longer a priority. Work, school and recreational activities become enjoyable and challenging again. Personal effectiveness, self-esteem and performance improve. Emotions and moods slowly become more stable and moderate. Physical and psychological health and wellbeing return.

Q. The term “grateful alcoholic/ addict” is often used in Los Angeles and Orange County recovering communities. How could anyone possibly be grateful for being a recovering alcoholic or addict?

A. Once you have fought a war and survived, you are grateful for your life as never before. When you have finished an intense and frightening learning experience, you find that you have skills built skills and insights that you wouldn’t have otherwise obtained. There exists a great advantage to encounter problems, learn from them, learn the skills to overcome them, and then share them with others who are needing the same type of help you needed. You have something finally to “pass forward”.

Q. How does the gratitude from recovery change your self-esteem and personal effectiveness?

A. In recovery we learn about building personal self-esteem and that of others. What is learned is “to build self-esteem, practice estimable acts”.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS.

All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation.
Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

How Does Drug and Alcohol Rehabilitation (Rehab) Provide Solutions?

94107729Many people have a difficult time finding pleasure or coping with distress and pain. In the beginning, alcohol and drugs often provide some of them a solution- a short-cut to relieving discomfort/ pain and access to pleasurable sensations.

When people cease to develop or practice new paths to accessing pleasure or managing pain/ distress due to their reliance on chemicals, they lose the interest and ability to use relaxation, recreational and social skills. This addiction/ alcoholic “short-cut” to pleasure or pain reduction becomes a habit- the “short cut” continues to be used in the face of problems and consequences it creates.

The consequences of drug addiction and alcoholism result in experiences of profound loss and shame. Learning and practicing new skills and coping strategies rather than falling back to the “short cut” of addictive drug and alcohol use is the progressive and therapeutic solution. Tolerating discomfort, emotional upset and craving requires support and training.

Drug and alcohol rehabilitation programs (rehabs) should instill insights into the progression of each individual’s drug and alcohol misuse. Skills which will be used to avoid chemical use in the future requires coaching. Achieving pleasure or reducing discomfort and pain without chemicals requires education and direction.

The term “rehab” implies picking up skills which were lost and now relearned. Drug and alcohol rehabilitation should teach and support the practice of forgotten and new solutions toward achieving pleasure and managing distress and pain without substance abuse.

Following are examples of solutions that drug and alcohol rehabs should provide. These are a few of the “recovery skills” which are needed to sustain sobriety and to replace destructive drug and alcohol “short cuts”.

  • Explore and practice the most effective/ least risky means of reducing or managing craving, pain and distress.
  • Learn how to have fun, achieve pleasure, and to socialize without chemicals. Set aside time for daily recreation, hobbies, exercise and play.
  • Actively participate in daily mutual recovery support activities and meetings. Maintain an awareness of the benefits of recovery and the risks of sliding back.
  • Identify situations and triggers which lead to personal discomfort, cravings and potential relapse. Establish and practice a plan for managing your feelings and behavior.
  • Practice following your step-by-step plans through to completion.
  • Asking more senior people in recovery to help sponsor or mentor you in recovery activities. Practice asking others for help.
  • Practice expressing your feelings and reactions to others in recovery.
  • Inform family and friends of your recovery needs and establish boundaries to protect against conflicts, triggers and relapse. Establish and practice setting boundaries with friends and associates at work, school and recreation to protect your recovery.
  • Reach out to fellows in recovery and build a practice of fellowship and sober social activities.
  • Clean up your living environment to eliminate drug and alcohol triggers, and to create a relaxing and safe space for recovery.
  • Establish a routine for caring for self- physically, emotionally and spiritually.
  • See your doctor for a thorough health screening and treatment of medical problems. Inform your doctor and therapist of your recovery needs and risks.
  • Revise your social media habits to eliminate triggering sites and activities, replacing them with recovery enhancing activities.
  • Take actions which are consistently responsible and caring for others.
  • Take responsibility for your own actions and feelings. Avoid blame.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS.

All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation.

Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

How Do I Know If I Have a Drug or Alcohol Problem?

thow-do-i-know-if-i-have-a-drug-or-alcohol-problemQ. What are common signs of drug and alcohol problems?

A. People who encounter problems which coincide with their alcohol and/or drug use but continue to drink or use drugs are most likely to have a problem. Usually people stop doing things which create problems. People with drug or alcohol abuse problems have many ways to deny or avoid seeing that alcohol and drugs are connected to their troubles.

Q. If I enjoy drinking or using drugs, why should I worry about abusing or overusing them?

A. People who develop addiction to substances at some point lose their ability to control their use. Relationships, career, self-esteem, health and safety are placed in increasing jeopardy.

Q. How do I know if I’ve lost control?

A. If you use drugs and/or alcohol as your primary way to relax, have fun, socialize or relieve discomfort/ pain, you are getting close to losing control. Replacing activities and skills with chemicals is the basis for addiction.

Q. What are common problems which alcohol and drugs create?

A. Relationships with others such as family members and loved ones suffer when drugs and/or alcohol become priority. Work, school and recreational activities become secondary to alcohol and drugs. Personal effectiveness and performance fall off. Emotions and moods become unstable or extreme; non-prescribed chemical use disrupts physical and psychological wellbeing and development.

Physical symptoms can be detected by your doctor through blood or urine tests, inquiry into your personal history, or from a review of brain, stomach, heart or liver function. Ask your doctor about your alcohol and/or drug use patterns.

Q. Does your personality change from alcohol or drug use problems?

A. When your hobbies, recreational and entertainment interests are replaced by activities which include alcohol and drug use, your interests and priorities change. If personal problems go unresolved for long periods of time, people often avoid facing the problems with increased alcohol and drug use. People with a drug and alcohol problem often lose their sense of purpose and worth and start doing things of which they become ashamed.

Q. What can I do to determine if I have a drug or alcohol problem?

A. If you have friends or family with whom you don’t drink or use drugs, ask them for their observations. Make an appointment with a trustworthy therapist, doctor or program who is aware of or specializes in substance abuse disorder assessment.
If you find that you drink or use more than what you initially intended, or are encountering consequences related to your chemical use, get help. Your life can be freed of the entanglements commonly known as addiction and alcoholism.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS.
All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation.
Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

Drug and Alcohol; Solution or Problem?

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Q. If drug abuse, addiction and alcoholism are diseases, why do people start using drugs or alcohol in the first place?

A. Many people have a difficult time finding pleasure or coping with distress and pain. In the beginning, alcohol and drugs often provide them relief- a short-cut to pain/ stress relief and pleasure.

Q. What are some of the reasons why people continue to use drugs and alcohol to the point of their addiction or alcoholism?

A. When people cease to develop or practice new paths to pleasure or pain/ distress management due to their reliance on chemicals, they lose the interest and ability to use recreational and social skills. This addiction/ alcoholic “short-cut” becomes a habit, being practiced repetitively even in the face of problems and consequences.

Q. What are some of the physical effects of drug and alcohol use, which replace recreational and social activities?

A. Addictive drugs and alcohol increase the neurotransmitter, dopamine at the receptor site, which produces an experience of reward/ pleasure, dulling unpleasant sensations. Social connections and communication, exercise, relaxation, meditation, intimate relations, etc. produce a similar but less intense effect in the brain.

Q. How does the treatment of addiction and alcoholism help people replace drugs and alcohol when they become a problem?

A. The consequences of addiction and alcoholism usually result in an experience of profound loss and shame. Learning and practicing new skills and coping strategies rather than falling back to the “short cut” of addictive drug and alcohol use is the progressive but therapeutic solution.

Q. Can’t other chemicals be used to replace those that created the problems in the first place?

A. In the absence of learning new, healthier ways of achieving pain and alleviating stress and pain, different chemicals usually become another short-cut which eventually result in similar problems and consequences.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS.
All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation.
Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

Orange County Drug and Alcohol Rehab- Business or Healthcare Service?

twin-town-money-pills-featured-imageQ. Does Orange County have affordable, accessible and reputable drug rehab options?

A. It is recommended that you seek a referral from your healthcare provider(s), another professional or your healthcare insurance plan. Many treatment options are available but there exist many seductive sales tactics which mislead people toward high cost and questionable drug and alcohol rehabilitation businesses. Professionals and insurance companies are reliable sources for quality, reputable alcohol and drug rehabilitation providers.

Q. What are some of the problems people encounter if they find themselves at a less-than-reputable Orange County drug and alcohol rehab?

A. Sometimes drug and alcohol rehabilitation businesses will represent that they “accept” or “take” your insurance coverage but later clients and families discover that only a fraction of the cost was actually covered. They subsequently face enormous and avoidable debt. Out of network providers may also recommend tests and services which are not necessary or proven helpful towards achieving recovery.

Q. Why does Orange County, California rank second in the country for disreputable or unethical drug rehab business practices (after South Florida)?

A. Much investor attention was created by the insurance mandates to cover drug and alcohol rehabilitation brought by the affordable care act and “Parity” legislation. The capacity to advertise, optimize and compete on a national level is best made in expensive, residential or “Florida Model” drug rehab settings. Often the highest ranked drug rehabs rely upon high, out-of-insurance-network charges, which help pay for extraordinary marketing campaigns and patient acquisition strategies, including paying for referrals.

Q. Do celebrity endorsement and fantasies of luxury and fame influence people to select expensive, out-of-network drug rehabs?

A. Long-term recovery is usually attained by placing sobriety first, even before looking good or feeling pampered. Feelings of loss and shame from substance abuse and alcoholism are best met with learning new skills and coping strategies rather than covering them over with illusions of grandeur…

Q. Are celebrity testimonials accurate representations of alcohol and drug rehabilitation effectiveness and quality?

A. Endorsements from people successful with their recovery are important, especially when you can respect their sobriety and changes in lifestyle.

Q. Do all drug rehabs place profit above their effectiveness to assist clients achieve recovery?

A. No. Orange County has many reputable, accessible and affordable alcohol and drug rehabilitation programs available. Those which are most accountable and affordable contract with HMO’s and MediCal. Ask your insurance company or a professional for a referral for alcohol and drug rehabilitation.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS.
All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation.
Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

Hollywood, Los Angeles, Malibu Drug Rehab – Fame and Glory vs Recovery

Q. When surfing the web for alcohol and drug rehabilitation, why do all of the expensive and distant drug rehabs rank first in any search?

A. Money to advertise and optimize on a national level is best made in expensive, residential drug rehab settings. Often the highest ranked drug rehabs rely upon high, out-of-insurance-network charges, which help pay for extraordinary marketing campaigns and patient acquisition strategies, including paying for referrals.

Q. Is celebrity endorsement and fantasies of luxury and fame important considerations when selecting alcohol and drug rehab?

A. Recovery, especially long-term recovery is attained by learning to “check” your ego, not to defend ingrained feelings of shame and loss with flights into grandiosity. Endorsements from people successful with their recovery are important, especially when you can respect their humility.

Q. Why are so many of the exotic and luxury drug rehabs located in Hollywood, Los Angeles/ LA, and Malibu.

A. Los Angeles/ LA, especially Hollywood and Malibu are easy locations to advertise and acquire patients. Often people burdened with addiction fantasize about escaping their sense of defeat and humiliation with grand and exotic people, places and things. Recovery is actually based in authenticity and humility.

Q. Are all drug and alcohol rehabilitation centers (drug rehabs) in Los Angeles, Hollywood and Malibu based in fantasy and priced out of range of most people in need?

A. No. Los Angeles, just as any community has affordable and accessible drug rehabs which contract with HMO’s and MediCal. Go to the provider directory provided by your insurance carrier to find an affordable and reputable alcohol and drug rehabilitation provider.

Twin Town Treatment Centers is immediately accessible to all Los Angeles and Orange County residents, is accredited by The Joint Commission, and is certified by the California DHCS.
All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol rehabilitation.
Our phone is answered by real people. We can see people on the same day you call. (866) 594-8844

“Drug Rehab”: What is “Alcohol and Drug Rehabilitation” and what is “Addiction Treatment”

http://www.merriam-webster.com/dictionary/rehabilitate: to bring (someone or something) back to a normal, healthy condition after an illness, injury, drug problem, etc.; to teach (a criminal in prison) to live a normal and productive life; to bring (someone or something) back to a good condition.

http://www.merriam-webster.com/dictionary/treatment: the action or manner of treating a patient medically or surgically <treatment of tuberculosis>; an instance of treating <the cure required many treatments.

“Drug and alcohol rehabilitation” assumes that the person with a drug or alcohol problem had a healthy condition prior to their addiction to which they can return, or a capacity to learn to become productive and “normal”. “Rehabilitation” is learning to achieve or returning to a healthier state once alcohol and drug use has been discontinued.

“Alcohol and drug treatment” describes addiction as a chronic, relapsing disease which requires professional intervention to bring the alcoholic/ addict to a healthier condition. Some people with a substance use disorder may not have an original state of health to which they can return and “learning” is only a part of the process of “treatment”.

Both “rehabilitation” and “treatment” provide an assessment of the person’s condition, medical withdrawal from the chemical when needed, guidance to reverse the progression of the disease, counseling and training to improve adaptation and life skills, and an introduction to a recovery-supportive lifestyle.

Considering the “chronic”, life-long nature of addiction as a disease, ongoing monitoring is necessary to assist people to maintain their fitness for recovery.

The National Institute on Drug Abuse includes the following as essential elements of drug (and alcohol) treatment:

  • Addiction is a complex but treatable disease that affects brain function and behavior.
  • No single treatment is right for everyone.
  • People need to have quick access to treatment.
  • Effective treatment addresses all of the patient’s needs, not just his or her drug use.
  • Staying in treatment long enough is critical.
  • Counseling and other behavioral therapies are the most commonly used forms of treatment.
  • Medications are often an important part of treatment, especially when combined with behavioral therapies.
  • Treatment plans must be reviewed often and modified to fit the patient’s changing needs.
  • Treatment should address other possible mental disorders.
  • Medically assisted detoxification is only the first stage of treatment.
  • Treatment doesn’t need to be voluntary to be effective.
  • Drug use during treatment must be monitored continuously.
  • Treatment programs should test patients for HIV/AIDS, hepatitis B and C, tuberculosis, and other infectious diseases as well as teach them about steps they can take to reduce their risk of these illnesses.

Twin Town Treatment Centers is accredited by The Joint Commission and certified by the State of California Department of Healthcare Services.

All network HMO/PPO/EPO insurance plans and Medi-Cal contract with Twin Town Treatment Centers to provide drug and alcohol treatment and rehabilitation.

Our phone is answered by real people. We can see people on the same day as each call. (866) 594-8844

Preventing Addiction When You Are Genetically Predisposed

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Science and medicine have determined that about forty percent (40%) of an individual’s addiction or substance use disorder arises from their genetic predisposition. Several genes are suspected in passing the “code for addiction” which creates and individual’s dulled response to the brain messenger (neuro-transmitter) dopamine. Family histories and twin studies have for years provided science strong evidence of the inherited addictive predisposition by one generation from the former.

What can I do if one of my parents or grandparents had a drinking or drug problem?

Start with reading more information about addiction/ substance use disorder. Becoming aware of the characteristics, signs and symptoms will help you in the event you begin to lose control over your drug or alcohol use.

Are there risk factors which can lead to or detect the development of a substance use disorder/ addiction?

Interpersonal conflicts and/or neglect within families and other relationships can coincide with addiction/ substance use disorder. Impulsive or emotionally reactive behavior, emotional instability, depression or anxiety are also common. Trauma, unresolved grief or shame often correlate with the development of substance use disorders. Using friends and access to drugs and alcohol enable increased use and the development of addiction.

Are their signs or symptoms that I should watch which can lead toward or indicate the beginning of a drinking or drug problem?

Behaviors indicating a problem or the development of a problem include: drinking under the influence; riding in a car driven by someone under the influence; drinking or using more than attended; forgetting or being embarrassed about drunken or drugged behaviors. One of the best indications of addiction/ substance use disorder is continuing to drink or use after encountering consequences from drug or alcohol use (i.e. shame, guilt, loneliness, illness, hang-overs, legal or career entanglements, interpersonal problems).

What can I do if I believe that a relative or child might be developing the “family affliction” of addiction?

Define addiction as an inherited disease. Take the shame and stigma out of it. Be open and honest, and talk about the family secrets openly. It is only by looking at the facts in the light of day do we start to develop a real understanding and plan. Don’t keep secrets but also be respectful and compassionate.

Can I or my family take steps toward preventing addiction/ substance use disorders from developing?

Many people who come from alcohol or addicted families avoid alcohol and drug use. If you don’t drink or use drugs, addiction can’t develop. (Watch for overeating, compulsive spending, sex or gambling, or excessive risk-taking). If you can’t drink or use in moderation, talk with someone in recovery or a professional.

Talk openly about your concerns and plans to keep track of your or other’s alcohol and drug consumption and related behaviors. Share your concerns and plans with loved ones and people with whom you share alcohol or drugs. If you are losing people with whom you can share these concerns, seek help.

Set a plan regarding drinking and using occasions and stick to them. If you can’t follow-through, ask for help from someone in recovery or a professional.

Developing and Implementing a Recovery Management System

hands-holding-sunPolicy and Administration Changes are required to implement the move from an acute-care model to an outpatient and recovery management system. Included in these changes are prerequisite revisions in administration:

  • SUD treatment and recovery management must be integrated with primary medical care, mental health treatment and management.
  • Government and private funding sources must move away from purchasing time, or session-limited units of service to purchasing an integrated program of management and support for long-term recovery. The emphasis must shift away from treatment intensity (crisis stabilization) to treatment extensity (prolonged recovery maintenance).
  • Treatment and management outcomes should be evaluated on intermediate and long term results rather than immediate and/or results.
  • Provider education and training must place a greater emphasis on recovery principals and processes. Peer-based recovery support should be expanded. Staff turnover must be minimized to achieve better continuity toward recovery support relationships.
  • Organizational paradigms and interpersonal relations must shift from paternalism to partnership- from hierarchical control to reciprocal respect.
  • Individual, unit and organizational performance should be based on key recovery indicators. (1)

Programmatic and service changes will necessarily include improvement in therapeutic strategies and objectives:

  • Attraction: Identify and engage clients and families as early as possible (assertive community education, screening and outreach).
  • Engagement: Enhance access, therapeutic alliance, and retention (expedite service initiation, focus on relationship-building and regular re-motivation, altered policies related to administrative discharge).
  • Assessment: Develop assessment protocols that are global, family-centered, strengths-based and continual.
  • Service Planning: Transition from professional-developed treatment plans to client-directed plans.
  • Service Menu: Focus on service elements that have measurable effects on recovery outcomes; expand the service menu to include non-clinical, peer-based recovery support services.
  • Service Duration: Shift from “emergency room” models that emphasized brief, crisis-oriented services to “recovery modes” that emphasize long-term, lower intensity recovery maintenance services.
  • Service Relationship: Shift from a professional expert model to a long-term recovery partnership/ consultant model; philosophy of choice for individuals and families.
  • Continuing Care: Shift from “aftercare” as an unfunded afterthought to assertive models of continuing care for all clients (regardless of discharge status). (Monitor client after discharge, provide stage appropriate recovery education and coaching, link clients to communities of recovery, and provide intervention again). Expand use of cell phones and internet for long-term monitoring and support.
  • Relationship to the Community: Increase utilization of indigenous recovery support resource in the community (recovery support groups, recovery community organizations).

(1) White, W.L. & McLeallan, A.T. (2008) Addiction as a chronic disease: Key messages for clients, families and referral sources. Counselor, 9(3), 24-33.
(2)White, Boyle, Loveland, 2003; Evans, 2007, White, in press

Outpatient Treatment & Recovery Management: Longterm Support and Monitoring of SUD Recovery

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Addiction, otherwise known as “Substance Use Disorder” (SUD) is a relapsing, chronic disease which requires lifelong cognitive, behavioral, social and physiological change and maintenance. Outpatient treatment and “recovery management” are designed to prevent addiction related deterioration, morbidity, relapse, and death. Outpatient treatment and recovery management also provide solutions which guide addicted people toward resources designed to better meet their needs and away from inappropriate, costly, and restrictive levels of supervision such as residential institutions, hospitals, and jails.

Since the 1930’s it has been demonstrated that successful, lifelong recovery from the disease of addiction can be achieved by engaging in recovery promoting activity, social support and benevolent service. Attempts at providing professionally provided acute care medical and time-limited psycho-social interventions to this chronic disease as resulted in partial solutions and modest outcomes.

What appears to be missing in the current model of addiction treatment is long-term recovery follow-up and monitoring. Investments in thirty-day to nine-month courses of treatment in inpatient, residential or sober living settings are being lost when the patient returns home and/or over the course of time.

Cognitive and behavioral gains fail to generalize into normal life settings after discharge from a residential setting. Relapse often follows. In the absence of practicing recovery in real time, in real life, over time, recovery deteriorates. Recovery management aids to assess and supervise recover in the long-term.

The commercialization of addiction treatment and recovery has resulted in expensive services which result in occasionally good short-term outcomes. The motive for providing these services is too often fee-for-service profiteering. When the payor and payment for services is exhausted, there are no resource left for integrating clinical gains into real-life circumstances. Recovery management has been abandoned to “self-sustained” sobriety, sometimes with peer support.

“Shift by government and private sources from purchasing time, or session-limited units of service – to purchasing and integrated program of management and support for long-term recovery; shift in emphasis from treatment intensity (crisis stabilization) to treatment extensity (prolonged recovery maintenance).”(1)

Mutual support groups offer peer support on a voluntary basis. This has been an effective model for people who remain willing and open to recovery despite its challenges and demands for change. People who encounter periods of ambivalence, avoidance, defiance or other roadblocks benefit from professionally provided recovery management which is designed to anticipate and prevent incidents of recovery deterioration and relapse. Recovery management also offers professional contact, support and access to assistance regardless of the person’s level of willingness.

Outpatient treatment and recovery management differ from the “acute care model” in that a multitude of highly restrictive and costly resources is not required in the entry level of care, save medical detox in selective cases. Outpatient treatment and recovery management provides case management, coaching and support over the long-term, in the natural environment where the client resides.

The distractions, triggers and the wreckage from reckless drug/ alcohol influenced behavior must be encountered early in sobriety so that specific recovery skills are exercised in the context where they are needed. If a person new to recovery encounters these stimuli for the first time without the support and guidance of professionals and peers, relapse is likely.

Outpatient treatment and recovery management must be provided in “real time” during “real life”, to pursue “real life opportunities” and to cope with “real life events”.

“Treatment on an outpatient basis allows a more valid assessment of environmental, cognitive and emotional antecedents of drinking episodes and drinking urges on the part of the patient, and allows the patient to test new coping strategies while still within a supportive counseling relationship.

These conditions would be expected to foster greater generalization of learning in treatment to the patient’s natural environment” (2)

Learned ideas and behaviors are not applied in real life unless new skills are practiced and coached. (3) Studies reveal that didactic teaching provides participants no practical benefit. Didactic teaching which includes role-playing or in-class practice results in no lasting practical benefit. Only when teaching and practice are applied to real life situations followed by coaching and follow-up are behavioral improvements achieved. (4) (5)

Outpatient treatment of substance use disorders and recovery management allows for the practice and exercise of pro-recovery skills in the real world. Coaching and follow-up after real-world exercise allow for supportive, reinforcing and corrective steps toward strengthened recovery and guiding away from relapse towards greater resilience.

Patients develop the skills and self-confidence to cope with high-risk situations such as negative emotional states, interpersonal conflict, and social pressure to drink. The informal use of similar coping strategies may contribute to the success of 12-step self-help programs. (5)

References:

(1) White, W.L. & McLeallan, A.T. (2008) Addiction as a chronic disease: Key messages for clients, families and referral sources. Counselor, 9(3), 24-33.
(2) Annis, 1986, p. 183
(3) “Meta-analysis of Effects of Training and Coaching on Teacher’s Implementation in Classroom”, Joyce & Showers, 2002
(4) “Impact of Formal Continuing Medical Education- Do Conferences, Workshops, Rounds and Other Traditional Continuing Education Activities Change Physician behavior or Health Care Outcomes”, Dave Davis, MD, The Journal of the American Medical Association
(5) Kelly et. al. 2000
(6) “Evaluating Substance Abuse Treatment Process Models: I. Changes on Proximal Outcome Variables during 12-step and Cognitive Behavioral Treatment”, Finney, Moyes, Coutts, Moos, Journal of Studies on Alcohol, ‘98