SUPPORTING A SUCCESSFUL TRANSITION

INTO RECOVERY

RECOVERY COACHING

A BRIEF HISTORY

Imported the problem

1792 – 2,579 distilleries w/annual per-capita consumption 2 ½ gallons

1810 – 14,191 w/annual consumption 4 ½ gallons

1830 – consumption rose to 7.1 gallons

A BRIEF HISTORY

Dr. Benjamin Rush – possible father of the disease concept

Attitude changed towards social value of alcohol

Late 1700s – start of the Temperance Movement

A BRIEF HISTORY

Groups formed to assist chronic alcohol abusers

Signed a pledge for abstinence

Fraternal Temperance Societies and Reform Clubs later provided financial support

Failed because of inconsistencies in membership requirements & mission purpose

A BRIEF HISTORY

Late 1800s – special institutions & professional roles

Inebriate “homes”, “dry hotels”

Inebriate asylum - large medical directed facilities

AA physicians & nurses & “AA Wards”

A BRIEF HISTORY

Emmanuel Church of Boston (1906)

Used religion, psychology & medicine

Clinics pioneered use of lay alcoholism psychotherapists

Jacoby Club – support meetings & social events

Used “friendly visitors”

A BRIEF HISTORY

1935 – founding of Alcoholics Anonymous

Industrial alcoholism specialists

Entrepreneurs opened “AA farms” & “AA retreats”

A BRIEF HISTORY

1940s & 50s – Yale Center of Alcohol Studies

Pioneered new outpatient model

Continued lay therapist mode

Codification of “Counselor on Alcoholism”, “Minnesota Model” pioneered by Hazelden

A BRIEF HISTORY

1970s – roles rapidly professionalized

Education & training requirements escalated

Today’s focus on (acute) bio-psycho-social stabilization

Many service models focus on reduction of client’s deficits and pathology

STABILIZATION VS RECOVERY

Treatment is viewed at the “magic” solution

Short, well defined period with special protocol

Goal – to develop skills & resources to maintain abstinence & find quality of life

get to treatment with varying levels of motivation, awareness, knowledge, & capacity of dealing with their disorder

SUSTAINED RECOVERY MANAGEMENT

Recovery – (process) of implementing these skills into strategy that accomplishes those goals

Disengagement – relapse

Recidivism rates are much lower in monitored programs

SUSTAINED RECOVERY MANAGEMENT

Remember – treatment focuses on deficits & pathology

Long-term recovery support emphasis – assisting client to focus on strengths rather than pathology

DEVELOPMENTAL MODEL OF RECOVERY

Pretreatment stage

Recognition of addiction

Stabilization stage

Withdrawal & crisis management

Regain control of thought processes, emotional processes, judgment, and behavior

DEVELOPMENTAL MODEL OF RECOVERY

Early recovery stage

Acceptance & non-chemical coping

Moves it from the head to the heart

Stops talking about what to do and begins to mostly do what they are supposed to

May last from one to two years

DEVELOPMENTAL MODEL OF RECOVERY

Middle recovery stage

Focus on balanced lifestyle

Reestablishing broken relationships

May set new occupational goals

Participates in more social & recreational activities

A SHAMELESS PLUG

ONLINE RECOVERY RESOURCE

THE PARETO PRINCIPLE

Roughly 80% of the effects come from 20% of the causes

Identifying your 20%

A WORD FROM A TWENTY PERCENTER

“I’m no longer employed by (blank) due to my own ignorance, stupidity, and TnPAP. I can not do an inpatient rehab because it is not warrented and my insurance is cut off. I will be sober 2-1-12 because of my dedication to myself and my conscience. I am free of (blank) and TnPAP to live fron alcohol abuse and the requirement to lie if in my ultimate best interests. I AM FREE!

HOW DO WE DEAL WITH THEM NOW?

Monitoring

Monitoring Agreement Extensions

More treatment

More evaluation/therapy

Non-compliant discharge

RECOVERY COACHING

Scope of services

Monitoring – compliance with MA requirements

Drug testing – random testing for enhanced accountability

Case management – additional referrals that support client’s goals and choices

Life skills coaching – to support personal growth

RECOVERY COACHING

Qualifications:

Credentialing – depending on State requirements (peer based)

Ability to establish empathy with client

Ability to work with diverse populations & backgrounds

Ability to focus on & reinforce positive strengths & behaviors

Should not have a single view of pathway to recovery (personal choices)

RECOVERY COACHING

General professional competencies:

Aspects of addiction treatment & how to access

Stages of change (Trans Theoretical Model of Change)

Motivational interviewing or motivational enhancement techniques

Case management activities & knowledge of community resources

STRENGTH BASED RECOVERY PLANNING

Focus on individual strengths rather than pathology

Interventions are based on client self-determination

People suffering from SUD or mental illness continue to learn, grow, and change

Chinese Proverb - “Give a man a fish & you feed him for a day. Teach a man to fish & you feed him for a lifetime”.

WORKING WITH THE PARTICIPANT

Motivational interviewing

Non-confrontational behavioral intervention used to increase awareness of SUD and assist in transition through first three stages

Four therapeutic components:

Express empathy (active listening skills)

Develop discrepancy

Roll with resistance

Support self-efficacy (how other people view their own capacities & strengths)

WORKING WITH THE PARTICIPANT

Contingency Management – based on operant learning theory (voluntary actions of human beings) Links consequences with behaviors

Behavior is learned by its consequences & can be changed by changing the consequences

Motivates people to learn new or alternative behaviors by providing positive reinforcement

Used to keep people engaged until the process becomes reinforcing

REFERENCES

Manual for Recovery Coaching & Personal Recovery Plan Development – David Loveland, PhD, dloveland@fayettecompanies.org

Slaying the Dragon – William L. White, Chestnut Health Systems/Lighthouse Institute, Bloomington Ill

Escaping From the Bondage of Addiction – John O. Edwards, BS, CEAP, SAP, www.therecoverycoach.co

International Coach Federation, www.internationalcoach.org