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Chapter 15 Substance-Related Disorders 395

tudes, beliefs, and behaviors. Sobriety is the overall goal of al- Preventive education is another multidisciplinary inter- cohol and drug rehabilitation. vention. Adolescents and preteens who have not used alco- The recovery model is a vital part of rehabilitation that hol or other drugs need anticipatory guidance to help them views chemical dependence as a chronic, progressive, and cope with the inevitable choices they will have to make. Many often fatal disease. The responsibility for recovery is on the community alcohol and drug projects and school-based pre- client, and any attempt to shift responsibility to others, such vention programs are helpful for parents and children and as to family or friends, is confronted directly. Recovery is offer support groups and literature. The goal is to protect considered a lifelong, day-to-day process and is accomplished children from the many adverse consequences of smoking, with the support of peers with the same . Recovery drinking, and illicit drug use. programs typically are 12-step programs, first introduced by The need for community education continues. The med- AA, in which honesty is valued very highly. These programs ical community recognizes addictive disorders as brain dis- are deeply spiritual, and recovery is thought to depend, in eases, but the concept of moral failure is still evident in the part, on faith in a higher power. See chapter 9 for more thinking of U.S. citizens. Our country has a higher in- detailed information on 12-step programs. Clients are re- vestment in criminal justice than in treatment, including ferred to AA, Cocaine Anonymous, or Narcotics Anonymous. the denial of health insurance payment for addictive dis- Partners are encouraged to join Al-Anon, children are en- orders. Some states offer treatment options in place of jail couraged to join Alateen or Alatots, and adult children are en- for nonviolent offenders. The cost of keeping a person in couraged to join Adult Children of Alcoholics (ACOA). (The prison for a year is approximately $30,000, whereas treat- 12 steps of AA are found in chapter 9 , Box 9.2.) For ment for a year costs $6,000 to $12,000. Nurses must con- those actively involved in 12-step programs, the rate of con- tinue to fight for innovative treatment programs for those tinuous abstinence is 44% for year 1, 83% for the second through the fifth years, and 90% for those involved for more than 5 years (Miller & Adams, 2005). Levels of the New Life Program Treatment programs have traditionally been designed for BOX 15.6 and 13 : men, and many people believe that women require different, Women for Sobriety gender-specific approaches. Believing that causes of substance abuse are poor self-esteem, relationship problems, and his- Level I: Accepting as a Physical Disease tory of abuse and depression, treatment for women focuses I have a drinking (life-threatening) problem that once had me. on competence, strengths, and confidence. Confrontational models are less effective for women than are treatment ap- Level II: Discarding Negative Thoughts, Putting Guilt Behind, and Practicing New Ways of Viewing proaches framed in terms of relationships. Women for Sobri- and Solving Problems ety (WFS) is the first self-help support group founded Negative thoughts destroy only myself. specifically for women who are alcohol dependent. It is an Problems bother me only to the degree I permit them to. emotional and spiritual growth program in which members The past is gone forever. use positive affirmation and share experiences to aid in the re- Level III: Creating and Practicing a New Self-Image covery process. The group process helps decrease the isolation I am what I think. and loneliness many substance-abusing women experience. I am a competent woman and have much to give life. Box 15.6 shows the 13 affirmations of WFS. Level IV: Using New Attitudes to Enforce SMART Recovery offers free face-to-face groups and on- New Behavior Patterns line mutual help groups. It is a nonreligious self-help group Happiness is a habit I will develop. that may be appropriate for those who do not believe in a Life can be ordinary or it can be great. higher power, or those who do not want to mix their reli- Enthusiasm is my daily exercise. gious beliefs with substance recovery. The four points of the Level V: Improving Relationships as a Result of Our New program are enhancing and maintaining motivation to ab- Feelings About Self stain; coping with urges; problem solving; and lifestyle bal- Love can change the course of my world. ance. While the SMART approach differs from the 12-step All love given returns. programs, it does not exclude them. Level VI: Recognizing Life’s Priorities: Emotional and Spiri- Family therapy helps family members identify situations tual Growth, Self-Responsibility in which they act as enablers. They then suggest alternative The fundamental object of life is emotional and spiritual growth. actions or statements that could be used in those situations. I am responsible for myself and my actions. These new behaviors are practiced in a variety of settings. SOURCE: Reprinted with permission from Women for Sobriety Inc., PO Box 618, The family then moves on to making a contract with the Quakertown, PA 18951. client to use new, nonenabling strategies in the future.

100366 C P Ed /NJ/CHET A F i P N 395 C/M/Y/K/PMS DESIGN SERVICES OF