Allowing Choice: Separating Personal and Professional Recovery The Human Experience Through Addiction, Treatment & Recovery MICHAEL W CROUCH CPSS CSAS OCONEE RECOVERY SERVICES Acknowledgements Ben Barth LPCS, LAC, CAC II Shaylin King MMFT, CAC-P Allison LaBrash LMSW, MSW, CAC-P Liz Rampy M.Ed, LPC, LAC Introductions: Who Am I ? Michael Crouch CPSS CSAS I am a Nationally and State Certified Peer Support Specialist, State Certified Substance Abuse Specialist, and current student at Tri County Technical College pursuing an Associates in Arts. My goal is to transfer into a bachelors program for Human Services and become a Certified Addictions Counselor and engage in many other career opportunities that present themselves. I am a person in long- term recovery, and I have been substance-free since January 2013. Introductions: Who Are You ? Indoctrination Objectives Participants will: Discuss the evolution of recovery and how it can be initiated within and outside of treatment facilities or other recovery services organizations. Understand how personal and systematic bias exists within the field of addiction and how it interferes with recovery. Build knowledge about inclusive ways to help individuals develop coping skills and build social support. Understand how an individual’s recovery choices can be based on internal and external locus of control. Participate in experiential activities to explore the power of personal choice and bias in treatment. Where it All Began Most believe the roots of recovery date back to the start of Alcoholics Anonymous (AA). AA began in 1935 in Akron, Ohio, as the outcome of a meeting between Bill W. and Dr. Bob S. two “hopeless alcoholics” (Alcoholics Anonymous, n.d.). Today, there are over 118,000 A.A. groups worldwide and AA’s literature has been translated into multiple languages for ease of accessibility (Alcoholics Anonymous, n.d.). “The Other Fellowship” Narcotics Anonymous was founded in 1953. Today, NA members hold nearly 67,000 meetings weekly in 139 countries (Narcotics Anonymous, n.d.). A Christian Option Celebrate Recovery (CR) started in 1991 at Saddleback Church in Lake Forest, California (Celebrate Recovery, n.d.). CR allows the person to incorporate his or her Christian faith into recovery efforts. Allowing Choice: Something Different SMART Recovery has grown steadily since its inception in 1994. It offers more than 2,000 local meetings and is available in many countries worldwide (SMART Recovery, n.d.). Another Pathway LifeRing was founded in 2001. LifeRing is based the belief that everyone has the power to overcome addiction and on the “3-S”: Sobriety, Secularity, and Self- Help (LifeRing Secular Recovery, n.d.). Mindful Exploration Refuge Recovery is grounded in Buddhist principles. It an abstinence-based path and based on the belief that the recovery process begins when abstinence begins. Refuge Recovery is based on eight factors or steps which do not necessarily have to be completed in order (Refuge Recovery, n.d.). Recovery Community Organization “A recovery community organization (RCO) is an independent, non-profit organization led and governed by representatives of local communities of recovery” (Valentine, White, & Taylor, 2007, p. 1). Connecticut Community for Addiction Recovery (CCAR) held its first Recovering Community Organization meeting in 1997 (CCAR, n.d.). Other examples include FAVOR Greenville, Midlands Recovery, and Reboot Jackson. Other Pathways Church Moderation Management Women for Sobriety National Alliance on Mental Health (NAMI) Wellbriety National Alliance of Methadone Advocates (NAMA) Phoenix Multisport Recovery Art Warriors (RAW) In The Rooms (online recovery) Outside the Box Natural Recovery Recovery can happen naturally over time with no treatment whatsoever. Some people in remission may never identify as having an addiction or as being in recovery. Some individuals experience natural recovery through a change in environment or everyday habits. Ultimate Goal: Whatever Works Elephant in the Room Systematic Bias The Minnesota Model Of Addiction Treatment 12 step bias stems from the Minnesota Model . Created in a state mental hospital in the 1950s by two men, neither of whom with prior experience treating addiction (Anderson, McGovern, & Dupont, 1999). The model spread first to an organization called the Hazelden Foundation, then throughout the country (Anderson, McGovern, & Dupont, 1999). The key element of this approach was blending professional and trained nonprofessional (in recovery) staff around the AA principles (Anderson, McGovern, & Dupont, 1999). Involves an individualized treatment plan with active family involvement in a 28-day inpatient setting and participation in Alcoholics Anonymous both during and after treatment (Anderson, McGovern, & Dupont, 1999). Examples of 12 Step Bias Only using 12 step mediation book to lead group. 12 steps on the wall without representation of other pathways. Strongly encouraging peer/client to find a sponsor. Only using 12 step work sheets for groups or individual sessions. Only offering the Big Book (AA) or Basic Text (NA) as recovery literature. Mandated 12 step participation in treatment plan without allow person time to explore multiple pathways of recovery. The term “12 step” appears in the Wiley addiction treatment planning book on 73 different pages (Perkinson, Jongsma, & Bruce, 2014)! “Higher power” occurs on 53 pages (Perkinson, Jongsma, & Bruce, 2014). No other pathways are suggested or mentioned. Another example of bias Objective/Interventions: Attend Alcoholics Anonymous/Narcotics Anonymous (AA/NA) meetings and especially Peer Support Meetings (PSS) as frequently as necessary to support sobriety. This will be evidenced by client verbalizing that she has attended a meeting at least once weekly. Intervention: Recommend that the client attend AA, NA, PSS meetings and report on the impact of the meetings; process messages the client is receiving. Peer Support- Detox/MAT : JOB DUTIES Promote peer support services to include orientation to 12 step recovery groups, community agency referrals as needed including primary healthcare providers, vocational services and other available services. Motivational Interviewing The spirit of MI (University of Oregon, n.d.) Collaboration Evocation Autonomy Compassion MI is person-centered and therefore rooted in offering choice. Locus of Control Locus of control refers to what a person believes causes his or her successes or failures. Internal locus – an individual attributes failure and success to factors inside him or herself such as own abilities or efforts. SMART recovery or other self-management programs – effort- and skill-based (Li, Feifer, & Strohm, 2000). External locus – failure and success are attributed to factors outside the person such as luck or fate. 12 step concept of powerlessness and higher power (Li, Feifer, & Strohm, 2000). Core Value of a Recovery Program Sense of Community (finding connection) Accountability (ultimately holding self accountable) Vulnerability Internal Changes—core values Extrinsic Changes Recovery Management - risk reduction and recurrence prevention Holistic Spiritual, emotional, relational, physical Wellness Focus Passing it Forward - volunteer work Mentorship - giving/receiving Environmental Change Coping Skills/Recovery Skills Coping Skills External – behavioral or external changes purposefully utilized to regulate emotions (ex. Basketball, working out, seeking social support) Internal – choices cognitions that regulate emotions without behavioral changes (i.e., thinking positive, acceptance, weighing the pro/con) Self-monitoring/self-awareness skills (shame/ self-esteem) Emotion identification Emotion expression Problem solving/Decision making Social Skills Relationship skills Communication Assertiveness and needs expression Conflict resolution – Negotiation Refusal skills Other Skills Reward inhibition – The ability to suspend my need for reward/benefit Distress tolerance – The ability to endure emotional pain over longer periods of time without immediate relief. Empathy building – The ability to both identify, understand, and value the emotional experience or perspective of others. Letting go- breaking obsessions – A radical acceptance skill, this can be labeled an “internal coping skill” but is often a focus of reducing cravings or cue reactivity with SUD Activity References Alcoholics Anonymous. (n.d.). The birth of A.A. and its growth in the U.S./Canada. Retrieved from https://www.aa.org/pages/en_US/historical-data-the-birth-of-aa-and- its-growth-in-the-uscanada Anderson, D. J., McGovern, J. P., & Dupont, R. L. (1999). The origins of the Minnesota Model of addiction treatment–A first person account. Journal of Addictive Diseases, 18(1), 107–114. https://doi.org/10.1300/J069v18n01_10 Connecticut Community for Addiction Recovery. (n.d.). History of CCAR. Retrieved from https://ccar.us/about-ccar/history/ Celebrate Recovery. (n.d.). History of Celebrate Recovery. Retrieved from https://www.celebraterecovery.com/about/history-of-cr Dennis, Foss, & Scott. (2007). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review, 31. ReferencesReferences u Horvath,Horvath, A.A. T.,T., & YeterianYeterian, J.J. (2012).(2012). SMARTSMART Recovery:Recovery: SelfSelf-Empowering,Empowering, ScienceScience-BasedBased AddictionAddiction RecoveryRecovery Support.Support. JournalJournal