The Developmental Model of Recovery Compared With Traditional
Models
Traditional models of treatment are based on the idea that once
a person is detoxified, he or she can fully participate in the
treatment process. Although this is true for many patients in
the early stages of addiction who have had functional lives before
their addiction progressed, it is not true for most of the criminal
justice population. In addition, most traditional programs have
a program format that is applied to all people regardless of their
education, personality, or social skills. Patients whose needs
fit within the program usually do well. But those whose needs
do not fit, such as criminal justice patients, generally do not
do well.
The DMR recognizes that there are abstinence-based symptoms of
addiction that persist well into the recovery process. These symptoms
are physical and psychological effects of the disease of chemical
dependency. In the DMR, these symptoms must be stabilized and
the patient must be taught how to manage them before general rehabilitation
can take place. This model identifies the specific symptoms that
a patient needs to overcome.
This model also contains methods and techniques that recognize
the learning needs, psychological problems, and social skills
of the patient.
Post Acute Withdrawal
Some of the symptoms of withdrawal from alcohol or drugs are the
result of the toxic effects of these chemicals on the brain. These
symptoms are called Post Acute Withdrawal (PAW). PAW is more severe
for some patients than it is for others. Other factors cause stress
that aggravates PAW. Below is a list of conditions affecting the
criminal justice population that tend to worsen the damage and
aggravate PAW.
Physical conditions that worsen PAW through increased brain damage
or disrupted brain function:
- Combined use of alcohol and drugs or different types of drugs
- Regular use of alcohol or drugs before age 15 or abusive use
for a period of more than 15 years
- History of head trauma (from car accidents, fights, falling,
etc.)
- Parental use of alcohol or drugs during pregnancy
- Personal or family history of metabolic disease such as diabetes
or hypoglycemia
- Personal history of malnutrition, usually due to chemical
dependence
- Physical illness or chronic pain.
Psychological and social conditions that worsen PAW:
- Childhood or adult history of psychological trauma (participant
in or victim of sexual or physical violence)
- Mental illness or severe personality disorder
- High stress lifestyle or personality
- High stress social environment.
Addictive Preoccupation
The other major area of abstinence-based symptoms is addictive
preoccupation. This consists of the obsessive thought patterns,
compulsive behaviors, and physical cravings caused or aggravated
by the addiction. These behaviors become programmed into the patient's
psychological processes by the addiction. They are automatic and
can cause the recovering patient to return to use unless he or
she has specific training to identify and interrupt them.
Addictive preoccupations are activated by high-risk situations
and stress. Because of the environment surrounding most criminal
justice patients, they often experience high-risk situations and
stress. These situations and stresses can include
- Exposure to alcohol or drugs or associated paraphernalia
- Exposure to places where alcohol or drugs are used
- Exposure to people with whom the patient has used in the past
or people the patient knows who are actively using
- Lack of a stable home environment
- Lack of a stable social environment
- Lack of stable employment.
Traditional treatment focuses on either detoxification alone or
detoxification with movement into a rehabilitation program aimed
at changing the patient's lifestyle. Programs are similar for
all patients. Many programs omit teaching the specific stabilization
skills that are necessary before lifestyle rehabilitation can
take place.
The DMR first stabilizes patients so that they can take advantage
of lifestyle rehabilitation. It then places the patient into a
group that contains patients in similar stages of recovery and
works on tasks and skills for that stage of recovery. Specific
skills are taught to identify and manage relapse warning signs.
Chapter 3What Is Relapse?
Relapse is not an isolated event. Rather, it is a process of becoming
unable to cope with life in sobriety. The process may lead to
renewed alcohol or drug use, physical or emotional collapse, or
suicide. The relapse process is marked by predictable and identifiable
warning signs that begin long before a return to use or collapse
occurs. Relapse prevention therapy teaches people to recognize
and manage these warning signs so that they can interrupt the
progression early and return to the process of recovery.
Studies of life-long patterns of recovery and relapse indicate
that not all patients relapse. Approximately one third achieve
permanent abstinence from their first serious attempt at recovery.
Another third have a period of brief relapse episodes but eventually
achieve long-term abstinence. An additional one third have chronic
relapses that result in eventual death from chemical addiction.
These statistics are consistent with the life-long recovery rates
of any chronic lifestyle-related illness. About half of all relapse-prone
people eventually achieve permanent abstinence. Many others lead
healthier, more stable lives despite periodic relapse episodes.
Classification of Recovery/Relapse History
For the purpose of relapse prevention therapy, chemically dependent
people can be categorized according to their recovery/relapse
history. These categories are as follows:
- Recovery-Prone
- Briefly Relapse-Prone
- Chronically Relapse-Prone.
These categories correspond with the outcome categories of continuous
abstinence, brief relapse, and chronic relapse described above.
Relapse-prone individuals can be further divided into three distinct
subgroups.
Transition patients fail to recognize or accept that they
are suffering from chemical addiction in spite of problems from
their use. This failure is usually due to the chemical disruption
of the patient's ability to accurately perceive reality, or to
mistaken beliefs.
Unstabilized relapse-prone patients have not been taught
to identify the abstinence-based symptoms of PAW and addictive
preoccupation. Treatment fails to provide these patients with
the skills necessary to interrupt their disease progression and
stop using alcohol and drugs. As a result, they are unable to
adhere to a recovery program requiring abstinence, treatment,
and lifestyle change.
Stabilized relapse-prone patients recognize that they are
chemically dependent, need to maintain abstinence to recover,
and need to maintain an ongoing recovery program to stay abstinent.
They usually attend Alcoholics Anonymous (AA), Narcotics Anonymous
(NA), or another 12-step program in addition to receiving ongoing
professional treatment. They also make protracted efforts at psychological
and physical rehabilitation and recommended lifestyle changes
during abstinence. However, despite their efforts, these people
develop symptoms of dysfunction that eventually lead them back
to alcohol or drug use.
Many counselors mistakenly believe that most relapse-prone patients
are not motivated to recover. Clinical experience has not supported
this belief. More than 80 percent of relapse-prone patients admitted
to the relapse prevention program at Father Martin's Ashley in
Havre de Grace, Maryland, had a history of both recognition of
their chemical addiction and motivation to follow aftercare recommendations
at time of discharge. In spite of this, they were unable to maintain
abstinence and sought treatment in a specialized relapse prevention
program. he or she became aware of during this exercise.
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Last Updated 11-7-02