Running head: INTEGRAL RECOVERY GROUP FROM ADDICTION 1
Integral Recovery Group from Addiction A Research Paper
Presented to
The Faculty of Adler Graduate School
______
In Partial Fulfillment of the Requirements for
The Degree of Master of Arts in
Adlerian Counseling and Psychotherapy
______
By:
Daniel Ronken Adler Graduate School
2014
INTEGRAL RECOVERY GROUP FROM ADDICTION 2
Abstract This project proposes to create a integral recovery group from addictions. Since addiction is a multifaceted and complex conundrum, ongoing recovery needs to address multiple levels of functioning. From an Adlerian view, addiction is a neurotic solution to deal with the inherent inferiority feelings of being born into this world as a human being. The framework and roadmap for the group will be focused on five levels of functioning: Physical, Cognitive, Emotional,
Ethical, and Spiritual. The current state of addiction and associated literature is reviewed highlighting the strengths and weaknesses of existing models. The proposed group may be offered to people seeking integral recovery from addiction as well as professionals in the helping field looking to work with addiction recovery in a more integrative fashion.
INTEGRAL RECOVERY GROUP FROM ADDICTION 3
Integral Recovery Group from Addiction
Addiction has a complex etiology requiring complex treatment approaches. Addiction work has come along way, but it’s not perfect. Humans are infinitely complex beings and there are varying degrees of processing stimuli as we relate with and integrate our experiences of the world. Research and programs such as the medical model of addiction and recovery 12 Step
Models tend to focus on slices of the whole human. Examining current research to date and existing treatment programs reveals that there are some important gaps in our knowledge base and treatment approaches that need to be considered and integrated into new treatment options.
According to Adler’s Individual Psychology (Ansbacher & Ansbacher, 1956), humans are innately whole but arrive into this world with an inherent inferiority feeling. Adler’s
Individual Psychology is a subjective psychology, thus proposing that humans create ‘tricks’ to make sense of his or her ultimately fictional reality. Humans experience a shock when confronted with a problem and a certain segment of the population who isolate from others are susceptible to the shock ultimately becoming a type of neurosis. The result is a mistaken belief of worthlessness. There are two ways humans choose to deal with this worthless feeling. First is the healthy approach of recognizing this mistaken belief and taking ownership of it and creating a new fiction. The second way is an unhealthy neurotic solution (trick and fiction) that serves to hide and distract and is accomplished by using various safeguarding strategies like excuses, aggressiveness, and exclusion (Ansbacher & Ansbacher, 1956). This is the plight of those who suffer from addiction. Addicts display many of the above-mentioned safeguarding strategies in their effort to keep the addiction a secret. The antidote to secrecy is to develop a striving toward more healthy behaviors that encourage social interest. INTEGRAL RECOVERY GROUP FROM ADDICTION 4
In light of this framework, this paper will examine biological, psychological, social and spiritual ways of understanding addictive processes and the treatment approaches that have emerged out of these understandings, and will then propose a new group recovery model that builds upon strengths of these programs while attempting to address the existing gaps.
Biological Aspects Addiction has a clear biological basis and is influenced by biological factors. Current brain research (Smith, 2012) has discovered that people who suffer from addictions have had their most evolved section of their brain (the neocortex) which is involved in decision-making
(technically called Executive Functioning) essentially highjacked by the pleasure and reward
(nucleus accumbens) area of their brain. From a biological perspective, Smith (2012), defines addiction as “a primary, chronic disease involving brain reward, motivation, memory and related circuitry.”
Furthermore, according to a publication put out by the Harvard Health, “the current theory about addiction, dopamine interacts with another neurotransmitter, glutamate, to take over the brain’s system of reward-related learning. This system has an important role in sustaining life because it links activities needed for human survival (such as eating and sex) with pleasure and reward. The reward circuit in the brain includes areas involved with motivation and memory as well as with pleasure. Addictive substances and behaviors stimulate the same circuit—and then overload it” (helpguide.org, n.d., Learning process, para. 2). Biological factors clearly influence addictive behaviors and the negative consequences associated with them. These biological propositions are helpful for understanding a particular aspect of the addictive process, but limited in the answering to what extent sociological or psychological factors influence the expression of the genes associated with addiction. INTEGRAL RECOVERY GROUP FROM ADDICTION 5
Although we know that certain neurochemicals are involved in the addiction process, we don’t know the extent of what other neurochemicals may potentially be involved in this sinister vicious cycle. Another missing component of the biological view is identifying what makes an individual susceptible to this highjacking while others seem to be able to take it or leave it. For example, some people can abuse substances (even during adolescence while their brain is still developing), and seemingly grow out of it and use chemicals responsibly upon entering adulthood, whereas others do not. The biological perspective doesn’t address this mystery, and thus purely biologically based treatment approaches will be inherently limited in the factors of addiction that they will be able to address or treat.
When it comes to recovery, physical exercise positively affects the neurochemicals in brains that have been negatively affected by addiction. However, that’s not the main purpose of exercising in recovery. Matesa (2014) states, “exercising in recovery is not about counter-jacking the reward system. It’s about re-establishing a foundation of fitness that helps us conduct our lives from a position of stability and strength” (p. 37). By moving the physical body, the biochemistry is positively affected as well. People in recovery benefit from gaining a better understanding of their physical selves and how the treatment of it affects their recovery (Brown et al., 2009). Topics such as diet, exercise, movement, body awareness, etc., are to be addressed in an integral treatment group.
Psychological Aspects
Since we are more than just our brain’s mechanistic electric impulses, addiction also affects our mental experiences of ourselves and how we relate to others in this world. Adler pioneered and advocated for the importance of social and contextual factors being incorporated into mental health in order for a person to be psychologically healthy. Overholser (2010) states, INTEGRAL RECOVERY GROUP FROM ADDICTION 6
“Adler’s theory emphasized the importance of social interest, cooperation, feelings of inferiority, and working for the betterment of society” (p. 348). As we grow and develop, environmental factors such as relationship with others and emotional validation influence how we find our place in the family, community, and society at large. The individual then creates private logic. A subjective ‘positive’ experience for the individual leads to healthy convictions (i.e., I am significant in this world). A subjective ‘negative’ experience for the individual would lead to a neurotic mistaken conviction such as ‘I am unloved.’ (Ansbacher & Ansbacher, 1956). These environmental factors influence personal traits that correlate with addiction. Mate proposes,
“Traits that most often underlie the addiction process: poor self-regulation, lack of a healthy sense of self, a sense of deficient emptiness, and impaired impulse control” (Mate, 2008). The great challenge for people susceptible to addiction is for them to learn how to accept all emotions and to not try and manage them via chemical intervention.
A good of example of an experience that influences the development of the above mentioned personality traits is the connection we feel early on and the type of attachment with our primary caregivers. Attachment theorist Bowlby (1951) felt that in order for an individual to grow up to be a healthy adult, they need to have experienced a healthy relationship with their primary care giver. He asserts that in order for humans to develop optimally, “the infant and young child should experience a warm, intimate, and continuous relationship with his mother (or permanent mother substitute) in which both find satisfaction and enjoyment” (p. 13). The key word here is ‘both’ (meaning the infant and the primary caregiver). If the primary caregiver is anxious and stressed in life, the infant will occasionally absorb these stressors thus making them part of his or her core personality.
Some theorists believe that this attachment process influences future vulnerability to INTEGRAL RECOVERY GROUP FROM ADDICTION 7
addictions (Fletcher, Nutton, & Brend, 2014). For example, an individual who is susceptible to addiction may find the ‘mother’ who was never there for them and thus they become attached to the drug. Marjot (2008) states, “To alcohol as if to one’s lover and to heroin as if to one’s mother. These chemical attachments are endowed with all the power, passion and drive of such attachments to a real person. As an adult you can, and in some cases will, cheat, beg, borrow, steal, wound or even kill to maintain these attachments.” (p. 103). This would be an example of an aggressive safeguarding strategy as mentioned above.
From an Adlerian perspective all human behavior is purposeful and goal directed (Mosak
& Maniacci, 2000). In addition, if a person’s goal is only directed at self interest (i.e., vertical striving) with disregard to social interest (i.e., horizontal striving), holistic healing will not take place (Adler, 1929). For example, if the person who suffered from an attachment disorder sought only to seek relief through attaching to various objects in life versus helping others find their sense of belonging in the world. This is especially true for people who suffer from addictions using neuroticism seeking to escape their feeling of inferiority.
Although attachment theory proposes our earliest relationships hold great weight as to the extent of intimacy we’re able to handle later in life, it does not offer insights into the ways in which people’s meaning making systems may be integral to addiction treatment. There are important questions that still need answering such as where do they find belonging in the world?
Or what would the world be missing if they are no longer part of it?
Building on the attachment literature, Leslie Greenberg studies the role of emotions and how they play a pivotal role as the impetus for changing one’s psychological maladaptive structures (Greenberg, 2008) which influence addictive processes. Brain functioning is networked and integrates experiences, and thus emotions cannot be easily separated from our INTEGRAL RECOVERY GROUP FROM ADDICTION 8
cognitions. Greenberg states “emotion thus is not cognition free, and ultimately we seldom have emotion without some conscious meaning” (Greenberg, 2012, p. 698). Greenberg’s theory provides a useful framework for the role and function of emotional processing and meaning- making within the context of interpersonal relationships which is a central aspect of addiction treatment in that it supports the inter and intrapersonal processes that contribute to healing.
However, this theory is not comprehensive enough to account for biological, genetic, spiritual and lifestyle factors that contribute towards the complexity of addiction processes. In addition, since Emotionally Focused Therapy is a structured therapy (and often limited to a specific number of sessions), it may not allow for as much spontaneity and non-linear experiences as a more open-ended and unstructured therapy might.
A new model for recovery will address the various psychological needs of individuals.
For some people, they may need to let go and attempt to unravel the safeguarding they’ve built up over the years (i.e., opinionated self-righteous types), while for others (i.e., those who have felt their opinion doesn’t matter), need support in becoming more conscious, choiceful and internally connected to find their voice and contribute meaningfully to themselves and their communities.
Humans are adaptive creatures and we learn how to survive based on our reactions to the environment. An integral group model supports an understanding of psychological defenses resulting from environmental failures, i.e., neurosis, safeguarding etc. Participation in the group also addresses interpersonal and intrapersonal work that needs to accompany recovery. Since addiction is a neurotic intrapsychic safeguard to the social discovery of inferiority, becoming vulnerable in relation to others is critical. According to Yalom and Leszcz (2005), Group therapy encourages member-to-member interaction, especially in the here-and-now: it is the lifeblood of INTEGRAL RECOVERY GROUP FROM ADDICTION 9
the group” (p. 441). People who suffer from addictions need to have new experiences with other people as it relates to his or her own inner felt sensations. By taking a risk and allowing for emotional vulnerability, the client will no longer have to feel enslaved to fleeting emotions they previously (and mistakenly) held to be a core aspect of their personality. When a wave of shame comes over them, they’ll have an opportunity to see it as a temporary feeling that is passing through rather than a concrete part of his or her being. This healthy detachment is possible because through the group experience itself (i.e., encouragement and validation), the group member will feel supported in his or her recovery.
Social Aspects
Since addiction is a neurosis based solution, people use substances as a reason and excuse to isolate (e.g., I feel bad about my worthlessness and ‘must’ hide it). Using substances is the reason and excuse to isolate. As a result, they hold a mistaken conviction that it’s fruitless to rely upon others for emotional support. Consequently, people who suffer from addictions often times feel an overwhelming sense of loneliness so if they are feeling valued as part of a community, chances of recidivism decrease significantly. According the Adlerian Psychology, a basic human need is to feel a sense of belonging and “when humans feel belonging, they function well. When they do not feel belonging, healthy functioning decreases” (Ferguson, 2010).
Compounding the feeling of worthlessness, many addicts contend with massive amounts of shame thus adding to the challenge of emotional risk taking with others. According to Adler, it is the intense level of shame felt by the addict that makes the inferiority feeling intolerable where others may experience inferiority as a minor nuisance. “Everyone has a feeling of inferiority. But the feeling of inferiority is not a disease; it is rather a stimulant to healthy normal striving and development. It becomes a pathological condition only when the sense of inadequacy INTEGRAL RECOVERY GROUP FROM ADDICTION 10
overwhelms the individual, and so far from stimulating him to useful activity, makes him depressed and incapable of development” (Adler, 1929, pp. 96-97). So with the active addict, they are often in such despair and have loss touch with the striving for social interest and instead are deep in a myopic experience of themselves and seeking only to medicate the pain of feeling worthless. In addition, this attachment to tolerating only a narrow state of consciousness may in part be what drives a person into addictive behaviors. Therefore, developing the ability to embrace all states of consciousness as fleeting and impermanent may be a critical factor in recovery from addiction. This is what surrendering means.
Recovery models needs to incorporate an understanding of the varying degrees of influence that social factors have on the course of treatment and resiliency of each individual. An integral treatment model would ask questions such as what does the individual think will happen if they seek support from others? Will they be rejected? Are other people incompetent to offer them intelligent advice? Since all behavior is purposeful, it’s important to understand the ‘why’ and not just the ‘how’ in people’s choices in life.
An important aspect of the popular 12 Step Model is providing a sense of belonging to its members. The proposed integral therapy group will capitalize on this important feature so the person in recovery feels a sense of social identity and connection (Buckingham, Frings &
Albery, 2013). According to Ferguson (1989), “Adler made it explicit that humans as a species strive to belong and that the goal, dictated by evolution, is to contribute to human welfare” (p.
354). Given this striving, recovery planning needs to promote inclusion regardless of the client’s background and the program must recognize and respect the individual.
Spiritual Aspects
For the purpose of this paper, spirituality is defined as “being concerned with our ability, INTEGRAL RECOVERY GROUP FROM ADDICTION 11
through our attitudes and actions, to relate to others, to ourselves, and to God as we understand
Him” (Cook, 2004). Human beings’ spiritual needs are to be included in a integral group therapy model. A variety of theorists speak to the importance of addressing spiritual needs as part of mental health (Wilber, 2000, (Smith, Clark, Grabovac, Inlakesh, & Tailor, 2013). For example,
Eckhart Tolle characterizes addiction as “you no longer feel that you have the power to stop. It seems stronger than you. It also gives you a false sense of pleasure, pleasure that invariably turns into pain” (Tolle, 1997, p. 18). While I agree that the pleasure invariably turns into pain, the pleasure an addict feels is not inauthentic or false. In fact, the pleasure derived from ingesting chemicals is the most exhilarating experience the addict has ever known.
In fact, addiction can be characterized as creative impulses gone awry in people who suffer from addictions. Adler views this creative energy as instinctive Creative Force that determines patterns and organization in the world (Dufrene, 2011). This creative energy is powerful life force that can be used in useful or useless ways. Examples of useless ways encourage vertical striving with an overly concern for oneself. For the addict, when they are unable to harness the life serving energy of this powerful creative force in a useful way, it can become a spiritual crisis (Gedge & Querney, 2014). Viewed in this way, the addict can be understood as essentially seeking transcendence of self in a misdirected manner using chemicals.
A healthy use of creative energy is harnessing for positive societal contribution.
While it’s a universal human need to strive for something bigger than themselves, some people may develop a hyper-focus on that particular aspect of recovery, thereby missing the importance of also developing a strong sense of self which allows them to recognize and accept his or her inherent inferiority feeling. INTEGRAL RECOVERY GROUP FROM ADDICTION 12
Recovery Models
Various models to treat addiction have evolved over time and address people’s biological, psychological, social and spiritual needs to varying degrees. With that said, no singular treatment has been found to more effective than another so researchers have focused more on the interactions between various treatments (Miller, 1994). This section will analyze the strengths and weaknesses of the 12-Step Model, individual therapy approaches, SMART
Recovery, Health Realization, and Harm Reduction.
12 Step Model
A revolutionary program indeed, the 12 Step Model has helped millions of people recover from their addictions. The program identifies itself as a spiritual program and I would argue it has significant humanist flare as well. The model works well as a social self help program promoting a sense of belonging and encouraging social interest by helping others who are suffering from addictions (Alcoholics Anonymous, 2001). Although the social interest aspects of the program are noble indeed, (i.e., subjugating one’s own needs for the greater good of others), negative interpersonal experiences with other members can often be avoided and repressed under the guise of ‘acceptance.’ This ‘live and let live’ viewpoint misses an opportunity for healthy confrontation and sets aside an active processing approach that would contribute to additional insights for all parties involved in the conflict. One of the major differences between the 12 Step Model and group therapy is that in the 12 Step Model, the focus is on the individual’s relationship with his or her higher power. In group therapy however, the focus is on the interpersonal experiences between members of the group. “Twelve‐Step programs can help keep the individual who abuses substances abstinent while group therapy provides opportunities for these individuals to understand and explore the emotional and interpersonal INTEGRAL RECOVERY GROUP FROM ADDICTION 13
conflicts that can contribute to substance abuse” (Center for Substance Abuse Treatment, 2005).
The 12 Step Model teaches that you are in charge of your reaction to any presenting emotional stimuli and it’s up to you to determine how you choose to experience it. In contrast, group therapy acknowledges emotional exchanges that happen in the ‘here and now’ and encourages open transparency throughout the process.
Individual Therapy Individual therapy works well with allowing a person to understand the intrapsychic workings of his or her mind in relation to self, others, and the world. In addition, the factors that influenced the type of person they’ve become, and wish to be in the future. As with group therapy, individual therapy also allows for a relationship between the client and therapist thus allowing therapeutic change to happen within the emotional exchange between the two of them.
The benefit of this therapeutic relationship in individual therapy is the available place to dig deeply in a dyadic fashion. This is important to the recovery process because it models what healthy communication looks like. In addition, interventions such as motivational interviewing have been found to be effective with people who suffer from substance abuse because it allows the client to be spontaneous in his or her own words within the interpersonal relationship between client and therapist thus promoting a sense of agency and potential for change (Moyers,
2014).
Individual therapy is limited, however, in that it lacks the felt sense of relating to society
(experientially) as a whole, and because learning insights are confined to their limited experience, knowledge, and skill. It’s important for the person in recovery from addiction to experience a feeling of belonging in a community, and while the therapeutic relationship INTEGRAL RECOVERY GROUP FROM ADDICTION 14
between client and therapist is a beginning, it’s not enough to be viewed as a holistic and integral treatment.
SMART Recovery
SMART Recovery was created as a group support system as an alternative to the popular
12 Step Model. The target market for SMART Recovery is people who feel a secular program is a better fit for them than the 12 Step spiritually based program. The SMART Recovery
“approach is premised on the assumption that psychological difficulties are caused by irrational beliefs which can be understood and overcome rather than by existential or spiritual deficits”
(Galenter, Egelko, & Edwards, 1993).
The primary difference between SMART Recovery and the 12 Step Model is that
SMART Recovery encourages an active participation and acknowledgement that thoughts are real and can be wrestled with and changed via self-efficacy (i.e., the belief that one has the power and ability to change). In contrast, the 12 Step Model views negative thoughts as simply part of the ego, which need to be turned over to a ‘higher power.’ Promoting self-efficacy is an important part of recovery, but focusing on the cognitive level (which has been highjacked by the pleasure / reward part of the brain) is limited as an agent of change due to its evolutionary drive for survival as mentioned in the biological section above.
However, SMART Recovery doesn’t address the interpersonal dynamics between the group members in the ‘here and now’ thus eliciting the discomfort to expose and deal with the maladaptive relational patterns learned by each person. The opportunity that is missed here is the acknowledgement of influence the interpersonal relationship between group members can have as an impetus for learning different relational dynamics INTEGRAL RECOVERY GROUP FROM ADDICTION 15
Health Realization The central premise of the Health Realization model is that we are in control of how we experience and react to our thought processes. According to (Baneriee, Howard, Mansheim, &
Beattie, 2007), the health realization model teaches “the nature of human psychological functioning through an understanding of the principles of Mind, Thought, and Consciousness based on the philosophy of Sydney Banks and treatment model developed by Mills and Pransky”
(p. 208). This model is helpful in that it focuses on causal factors and what is ‘granted’ (innate health and wellness) with humans versus what’s ‘missing’ (pathology). Adler would call this a
“fiction” we create for a “useful” or “useless” reason.
The research on Health Realization as an effective model for substance abuse treatment is not substantial. As with SMART Recovery, the issue at hand when it comes to addiction according to Health Realization is a problem of self-efficacy (Wartel, 2003). A drawback to this is if a person doesn’t experience a changed mistaken belief to a useful or healthy belief, they may think it’s due to a lack of willpower. This could exacerbate unnecessary self judgment, because the fact is, healing is much more complex and nuanced than simply ‘positive thinking.’ With that said, Health realization is an experiential approach and seeks to understand the subjective nature of conscious awareness. This would encourage seeking deeper than the cognitive level of thought but the drawback is the journey is an isolated individual pursuit. Ironically, Health Realization doesn’t directly address bodily health, i.e., diet and exercise. In order for a recovery group to be integral, it needs to address the physical level of wellness (e.g., diet and exercise) as well as psychological and spiritual aspects of functioning. A broader conceptualization of the aspects of wellness allows for a more holistic recovery. INTEGRAL RECOVERY GROUP FROM ADDICTION 16
Harm Reduction
Since the recovery process is not static and should be viewed on a continuum, the abstinence model that has been most prominently championed may not be the best route for all addicts and society as a whole. Harm Reduction is a progressive model for treating addiction by allowing for ingestion of the addict’s drugs in a controlled, safe, and managed environment
(Bartlett, Brown, Shattell, Wright, & Lewallen, 2013).
Consider The Buddha’s story from the Far East as it relates to Harm Reduction.
Guatama’s (The Buddha) young life was filled with limitless indulgences from his father (the
Brahmin King). The Buddha grew up secluded behind walls with unlimited wealth and power at his disposal. One day, the Buddha saw a glimpse of suffering outside the walls and was determined to seek truth and enlightenment. He committed to live the extreme way of asceticism
(fasting, and extreme minimalistic living). Then one day he ‘woke up’ after a prolonged meditation and concluded that both manners of extreme living (indulgence or asceticism) were too rigid so he came up with the idea of the ‘middle way’ (Damon, 1995). According to Blume
(2012), Alan Marlatt views harm reduction from a compassionate Buddhist perspective, “The middle way was analogous to the path of harm reduction in that extreme beliefs about addiction and its recovery were not necessarily helpful to those living with addictions” (p. 218).
Harm Reduction emphasizes another important Buddhist tenet; compassion. The reason compassion is important to a integral therapy group is because people who suffer from addictions seem to have a disproportionate amount of shame given the imperfect nature of simply being a human amongst humans. Addicts tend to fixate on the feeling of worthlessness (e.g., shame) which has unfortunately become a core part of their identity thus making the joys of recovery all the more difficult to experience (Cook, 1991). INTEGRAL RECOVERY GROUP FROM ADDICTION 17
Since addiction stems from the “shock” and a feeling of “worthlessness,” the neurotic solution, and inherently maladaptive movement is to escape the demands of life tasks and social interest.
In light of all the reviewed research, theory and recovery approaches, it is possible that a more integral model could address the biological (physical), psychological, social and spiritual needs in a holistic and integrative fashion that provides for more efficacious ongoing recovery.
Proposed Program
Traditional substance abuse programs for people in recovery from addictions are limited in efficacy and improvements to existing models is recommended. An Integral Theory has already been proposed and the approach conceptualizes human development along lines, levels, stages and states (Wilber, 2007). Drawing from Integral Theory, John Dupuy created a model of
Integral Recovery. One of his key innovations was to focus on an individual’s developmental levels of functioning: physical, cognitive, emotional, ethical, and spiritual (Dupuy, 2013). The proposed integral recovery group will use these levels of functioning as a framework to measure progress throughout the recovery continuum.
The proposed integral recovery group would meet weekly covering one of the Levels of functioning topic per week (Physical, Cognitive, Emotional, Ethical, and Spiritual). For example, the topic for week 1 would be Physical level of functioning, for week 2 it would be Cognitive level of functioning, etc. The full cycle would then be completed and repeated every 5 weeks.
These Levels of functioning correspond well with the above mentioned dimensions of life
(biological, psychological, social, and spiritual) that are affected by addiction. INTEGRAL RECOVERY GROUP FROM ADDICTION 18
Group Content and Outcomes
Session 1: Physical – body/diet/movement
There will be a brief group meditation signaling the start of the meeting. Groups will then follow a checkin/checkout structure. During check in, members will be asked to share a status update on how they’ve prioritized the 5 Levels of functioning (Physical, Cognitive, Emotional,
Ethical, and Spiritual) in the previous week. We’ll use a scale of 1-6 (1 being low priority and 6 being high priority) for each level of functioning. Facilitators will then provide didactic on the
Physical Level of Functioning as a topic and share how it supports the recovery process from substance addiction. Group members will then have an opportunity to share and process responses to the content presented. Lastly, individuals will check out and share their ‘here and now’ feeling as well as share their goal committed for the following week as it pertains to the
Physical Level of Functioning.
Upon completion of Session 1, group participants will be able to:
Have a better understanding of how physical health is affected by addiction.
Have a better understanding of how physical health affects mental health.
How to establish an exercise program tailored to individual needs.
Understand the effects of dietary choices on physical and mental health.
Examples: Walk/Run three times a week, eat more whole foods, intuitive eating practices, proactive reading and responding to somatic cues, how food affects chemical imbalances in the brain.
Note: The process stated in Session 1 is replicated for the remaining four sessions.
Session 2: Cognitive – reflections on insight and sense of self.
Upon completion of Session 2, group participants will be able to:
INTEGRAL RECOVERY GROUP FROM ADDICTION 19
Understand how their thoughts directly affect emotional states
Learn how the negative stories they told themselves (about themselves) are likely not
true.
Learn how to reframe above mentioned stories in a more realistic and positive light.
Have a better sense of their learning style.
Examples: Identifying and working with negative private logic fictions about oneself and the world. Skill building around how to stay present. Stress reduction skills. Commitment to learning and identifying their individual learning style (visual, aural, verbal, physical, logical, social, solitary). Compassionate Mind Training.
Session 3: Emotional – relationship with self and others. Upon completion of Session 3, group participants will be able to:
How to identify healthy relationships
How to identify unhealthy (or toxic) relationships
Healthy boundary setting
How to navigate key relationships
Examples: Dealing with unresolved past trauma. Coping with the present. Offering and receiving empathy. Active listening skills.
Session 4: Ethical -- values and the moral reasons of behavior
Upon completion of Session 4, group participants will be able to:
Understand the relationship between: Values, Morals, and Ethics.
Understand they are not a ‘bad’ person because of previous behavioral choices.
Understand how dishonesty is a precursor to relapse.
Understand how culture influences values, morals, and ethics. INTEGRAL RECOVERY GROUP FROM ADDICTION 20
Examples: Exploring how unethical behavior leads to self-justification, rationalizations, and dishonesty. Setting intentions and dedications. Exploring how culture influences thoughts, feelings, and behavior.
Session 5: Spiritual – finding meaning.
Upon completion of Session 5, group participants will be able to:
Articulate his or her own definition of spirituality.
Identify how to incorporate spirituality into daily life.
Have had an experience of seeking something larger than themselves
Examples: Exploration of a higher purpose in life. Cultivation of inner peace. Meditation.12 Step facilitation.
Schedule Outline (90 minutes)
Minutes Action 0-5 Group meditation 6-15 Brief status check in on 5 Levels of
functioning for the previous week
16-30 Weekly Level of Functioning Topic taught
via reading, lecture or video.
31-60 Group discussion on Topic
61-75 Skills work (i.e. tools) related to topic
76-90 Member check out (experience of the
meeting, present feelings, goals, etc.) INTEGRAL RECOVERY GROUP FROM ADDICTION 21
Group Requisites The group will comprise between 6-8 members Open to men, women, transgender, etc. The group will be available for people seeking recovery from substance abuse and/or addiction. Tools (examples of activities to be included during various groups) Creating a board of directors.
We are social beings who need each other to survive. Creating a roadmap for what support structure looks like is important. Group members will identify 1 person in their life they can use as a resource for advisement in each of the 5 Levels of functioning. The candidates for these roles should have some level of experience in the chosen level.
Physical: This board member should have basic knowledge around physical health and
wellness. It could be someone you respect from the gym, a friend who is an active runner,
etc.
Cognitive: This board member should have a certain level of awareness, mental capacity,
and a drive to learn. The ability to critically think is important as well. Examples could be
current teachers, former teachers, mentors, etc.
Emotional: This board member should be empathetic and emotionally healthy. Capacity
to offer support around wide ranges of feelings from despair to blissful joy. Examples
could be closer friends, immediate and extended family members.
Ethical: The board member should have life experience and have demonstrated they use
their moral compass when making tough decisions. Life experience may be more
important than ‘book smarts’ for this member’s role. INTEGRAL RECOVERY GROUP FROM ADDICTION 22
Spiritual: This board member will have some experience in seeking meaning beyond their
own needs. It not need be a member of clergy or anything of the sort. In fact, it may be
the older wise man or women you see at the coffee shop.
Using the 5 levels of functioning, the therapist is directly working with the areas of the addict’s life that have been most significantly affected by their addiction and a tool to measure levels of support along the way.
Group support. Validate other member’s emotional experiences through empathic listening so they can experience more connection in relationships outside of group.
Healthy confrontation between members so they can learn how to speak his or her own truth while respecting the view of others.
Establishing boundaries in a safe environment giving them practice in ‘real time.’
Compassionate Mind Training (CMT). Learning how to self soothe without chemical intervention is very important for sustained recovery. Drawing from principles of CMT (Gilbert
& Procter, 2006), exercises will be employed to work with threat/safety strategy formulation for shame and self-criticism, with compassion focus in the following ways:
Be in tune with the feelings associated with memories, which can have trauma-like and
sensory qualities. This allows for the addict to realize that they can own their feelings
rather than their feelings owning them.
Understand the development of the safety strategies as both conditioned emotional
responses and planned strategies to deal with perceived threats. An addict’s historical
safety strategy of becoming neurotic is no longer useful in recovery thus new planned
strategies involving social interest will be applied. INTEGRAL RECOVERY GROUP FROM ADDICTION 23
Learn compassionate acceptance and empathy for the origins and use of safety strategies.
This supports self-acceptance in that the addict wasn’t a bad person while in the throes of
addiction, it’s simply that they were looking for a way to feel safe even if it was a
maladaptive strategy.
Recognize that we have multiple subsystems that have different priorities pulling us in different directions. It’s important for addicts to own all aspects of themselves if they are to recover. Otherwise, their ‘shadow’ will stay unconscious thus potentially inhibiting recovery.
Develop compassionate imagery and compassionate and mindful ways of attending to fears and safety strategies that can provide the emotional basis for new forms of attention, thinking, behaving, and feeling (Gilbert & Procter, 2006).
Motivational interviewing. Utilizing the basic principles of Motivational Interviewing, the facilitator will employ the following tactics when deemed appropriate thus providing modeling for the group members in the following ways:
Express Empathy
Develop Discrepancy
Avoid Argumentation
Roll with Resistance
Support Self-Efficacy (Miller, 1994).
Journaling.Expression and reflection are keys to insight and recovery. Therefore, journaling will be encouraged as a medium for this expression. The diary will allow for measuring self-attacking and self-soothing language as well as free flowing streams of consciousness around the 5 levels of functioning. INTEGRAL RECOVERY GROUP FROM ADDICTION 24
Measuring Outcomes
As the adage goes, “if it can’t be measured, it doesn’t exist.” Successful recovery can be defined in many ways. Gathering reliable data from significant sample sizes poses challenge.
With that said, we’ll begin collecting both quantitative and qualitative data measures identifying perceptions of the effectiveness of the group as well as how the group stacks up against other recovery models.
Members Perceived Effectiveness of the Group
We will use a six-level Likert scale as a tool seeking feedback on the perceived effectiveness of the group by its members. Scale detailed below:
Strongly disagree
Disagree
Somewhat disagree
Somewhat agree
Agree
Strongly agree
Questions Posed:
1. The meditation at the beginning of the group was helpful
2. The check in each week on the Levels of functioning was useful
3. The Addition of the video helped solidify the teaching
4. The lecture was not valuable
5. I feel supported in the group
6. The check in time needs to be longer in duration
7. The allotted topic discussion time is sufficient INTEGRAL RECOVERY GROUP FROM ADDICTION 25
8. Everyone who desired to share, was given an opportunity to do so
9. Setting goals for the following week is helpful
10. I would recommend this group to others
11. There is not enough allotted time for check out
12. This group is important to me for my recovery
13. I feel indifferent toward this type of group support structure
14. I need this group to stay sober
15. I need more structured recovery support outside of this group
16. 90 minutes is too long for the content covered in this group
17. 90 minutes is not enough time for the content covered in this group
18. I would pay up to $20 each week for this group
19. Meeting once per week is not enough for this group
20. I feel unsupported in this group
21. There have been changes to my social circle since I started this group
22. My job satisfaction has increased
23. My level of intimacy with my partner has increased since starting this group
24. There have been negative changes in relational dynamics between me and my family
since starting in this group
25. The relational dynamics have changed for the better between my co-workers and me.
Data Collection Seeking Comparison to Existing Recovery Models
We will use a simple Yes/No questionnaire seeking nominal data
1. Sobriety: Are you abstaining from substances?
The most prominent study on the topic of substance abuse recovery is Project Match, INTEGRAL RECOVERY GROUP FROM ADDICTION 26
which covered 3 kinds of treatment (12 Step Facilitation, Cognitive Behavior Therapy,
Motivational Enhancement Therapy). The conclusion was that roughly 30% of participants in the study were still abstinent 3 years post treatment regardless of the treatment approach (Project
MATCH Research Group, 1998).
**If the group member maintaining abstinence at the 3 year mark since joining the group? 30% or greater would be on par with current models and considered successful.
2. Relapse Rates: Have you had a ‘slip?’ Results from a Hazelden study showed at the 12 month mark that 53% of participants were still abstinent and 35% reported a decrease in chemical use (Stinchfield & Owen 1998).
**50% or above abstinence at 12 months would be considered successful
3. Motivation: On your own accord, do you desire recovery?
The 2 most prominent predictors for long term success in Project MATCH are:
Readiness-to-change and self-efficacy (Project MATCH Research Group, 1998). We will use
Motivational Interview questions to determine member’s motivation to change.
4. Attrition: Number of member dropping out prior to attending all 5 Weeks of
Levels of functioning topics.
5. Participation: How many members complete the weekly Levels of functioning update?
Looking to the Future
By taking an integral approach to addiction, the recovery process from addictions is reframed and deepens our understanding of the multifaceted nature of the addictive and recovery process and suggests new avenues for a more effective recovery group. The benefit of viewing and identifying these different levels of functioning allows for honoring and working with these INTEGRAL RECOVERY GROUP FROM ADDICTION 27
distinct yet interdependent aspects of ourselves.
Working with these levels provides a relevant framework in which to gauge how one is doing along the recovery continuum. Therefore, one-day trainings could be offered for those in the healing profession who are looking to work with people in recovery in a more integrative fashion. In addition, a professional consultation group could be provided for practitioners who need support and consultation in implementing ongoing recovery approaches using this framework.
INTEGRAL RECOVERY GROUP FROM ADDICTION 28
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