| HOW TO CHOOSE YOUR MOST EFFECTIVE | | | | that the 12-step way of recovery is superior to all |
| DRUG OR ALCOHOL TREATMENT PROGRAM (A | | | | others is not at all backed by the research. People can |
| Chapter from "AA Not the Only Way" By Melanie | | | | recover without AA or any other 12-step program and |
| Solomon | | | | be just as healthy as those who find them helpful. |
| Note: This is NOT a free product. You do not have the | | | | Within traditional treatment, there was a tendency |
| right to give it away or sell it without proper written | | | | toward a "one-size-fits-all" approach to recovery, |
| consent from the author. | | | | which contributed to high dropout rates. And by |
| The product is copyright © by Melanie Solomon. | | | | defining addiction as an incurable, progressive disease, |
| No part of this product may be reproduced, stored in a | | | | many people will find it difficult to change their addictive |
| retrieval system, or transmitted by any other means: | | | | behaviors or decide to give up alcohol or drug use on |
| electronic, mechanical, photocopying, recording, or | | | | their own. In recent decades, an alternative model has |
| otherwise, without prior written consent of the | | | | emerged that challenges the traditional disease model |
| copyright holder. | | | | and its "one-size-fits-all" approach to recovery. This |
| This product is supplied for information purposes only | | | | model is based on the assumption that addictive |
| and, as experienced in this subject matter as the | | | | behavior has multiple components and that individuals |
| contributor is, the material herein does not constitute | | | | vary in risk depending on their unique bio-psycho-social |
| professional advice. | | | | history. Due to the fact that both habit acquisition and |
| This product is designed to provide accurate and | | | | habit change are primarily influenced by cognitive and |
| authoritative information with regard to the subject | | | | behavioral principles, this approach has become known |
| matter covered. It is given with the understanding that | | | | as a cognitive-behavioral model. A major emphasis in |
| the publisher and contributor are not engaged in | | | | this model is placed in the reward consequences of |
| rendering any medical, legal, accounting, or any other | | | | engaging in the addictive behavior, including both |
| professional advice. | | | | positive reinforcement, such as enhanced euphoria |
| If medical advice or other professional assistance is | | | | associated with getting high, and negative |
| required, the services of a competent professional | | | | reinforcement, such as self-medication resulting in |
| should be sought, like one found in the comprehensive | | | | tension reduction or relief. By bringing the attention |
| directory section of AA Not the Only Way. | | | | back to the person with the substance abuse problem, |
| The reader is advised to consult with an appropriately | | | | treatment goals now shift from being strictly set by a |
| qualified professional before making any medical | | | | treatment program provider, with abstinence as the |
| decision. The contributor, Melanie Solomon, does not | | | | only acceptable option, back to the consumer, (you), |
| accept any responsibility for any liabilities resulting from | | | | who now has a choice in their own treatment goals. |
| the medical decisions made by the readers of this | | | | Individuals can choose from a variety of goals, ranging |
| product. | | | | from abstinence to reduction in harmful consequences, |
| Copyright 2009 Melanie Solomon | | | | and by placing this choice into their hands, there is now |
| HOW TO CHOOSE YOUR MOST EFFECTIVE | | | | acknowledgment that most addictive behaviors |
| DRUG OR ALCOHOL TREATMENT PROGRAM (A | | | | represent a problem in self-management that can be |
| Chapter from "AA Not the Only Way" By Melanie | | | | resolved by the individual. The substance abuser is no |
| Solomon | | | | longer "powerless" but is taking back power over his |
| How do you know what you are getting when you | | | | or her own life. This model respects the client's choice |
| choose a rehab program? There are basically four | | | | and tries to meet clients where they are in the varying |
| types of programs: " Moral " Disease " Behavioral " | | | | stages of behavioral change. This differs greatly from |
| Holistic It is important to compare the different types of | | | | the traditional disease model, where emphasis is on |
| programs before making your decision. Many of them, | | | | client confrontation and enforcement of abstinence as |
| especially in the U.S., are based on old ways of | | | | the only acceptable goal. The holistic model, or |
| viewing the addicted person, and therefore their | | | | biopsychosocial model, is the emerging model, which |
| approach is often outdated. In short, the moral model | | | | takes a more holistic approach to health and well-being |
| says that a person is bad if they make bad choices. | | | | and incorporates the strengths of the various models |
| (This was the main view before the disease model | | | | of the past and uses those various insights to effect |
| came into play in the 1930's.) The disease model views | | | | change. New understandings from years of research |
| addiction like having a disease, akin to diabetes; the | | | | are coming into play and the holistic model is basing its |
| addicted person is completely powerless over their | | | | approach on this important information. It is being |
| disease. The two models taken together offer a very | | | | discovered that social, economic, cultural and |
| bleak outlook. Addicts are bad people who have no | | | | environmental conditions, as well as behavioral choices, |
| control over their own lives. 12-step programs lean | | | | impact both psychological and biological processes. In |
| more toward the disease model. After these models, | | | | turn, psychological and biological changes influence |
| the behavioral model, or cognitive-behavioral model | | | | behavioral patterns. Now, motivational techniques, brief |
| was developed. It says that each person has the | | | | interventions, cognitive-behavioral therapy and |
| power to change him or herself by changing the way | | | | pharmacotherapy co-exist with new approaches, |
| they think. The newest model to emerge is the holistic | | | | including acupuncture, meditation, good nutrition and |
| model, which builds upon the good points of the older | | | | stress management (see previous section for more |
| models. This approach uses the cognitive-behavioral | | | | details). What has become clearer and clearer is the |
| model as a core component of its approach, and | | | | competence of individuals to manage their lives when |
| accounts for the many different contributing factors of | | | | information, support and choices are available. Since |
| the individual's unique addiction problem. This approach | | | | the best predictor for your success is your ability to |
| addresses the health of mind, body and spirit, helping | | | | choose your own program and set your own goals, it |
| the individual to both prevent and respond to their | | | | is advisable to ask the following crucial questions to |
| problems. It teaches self-management skills and | | | | ensure that an appropriate drug and alcohol program is |
| techniques to prevent relapse and advocates a | | | | chosen that will meet your particular needs. 1. What |
| multi-faceted approach to support the individual. Most | | | | kinds of treatment programs do they offer? Is it |
| importantly, the holistic approach views individuals as | | | | primarily 12-step based, or do they offer other self-help |
| competent to help themselves when given the right | | | | options as well, i.e. SMART Recovery, SOS, or |
| education, tools and support. Let's look a bit deeper into | | | | Women For Sobriety? So they match treatment |
| the history and new developments in the addictions | | | | settings, interventions and services to each individuals |
| field, especially since addiction may be the most | | | | particular problems and needs, since this is critical to |
| controversial topic that has been addressed in the | | | | one's ultimate success in returning to productive |
| public health and medical communities over the years. | | | | functioning in the family, workplace and society? 2. |
| The addictions field has evolved through several | | | | Does the program address multiple needs of the |
| phases over the past 100 years. What follows is a | | | | individual, not just his or her drug use, such as any |
| brief overview of some of the changes in belief | | | | associated medical, psychological, social, vocational and |
| regarding the basic nature of "addiction" or substance | | | | legal problems? 3. What types of credentials does the |
| dependence, how to prevent its occurrence and how | | | | staff have, such as doctors, counselors, and anyone |
| to intervene once dependence has become apparent. | | | | else who has contact with the clients, and what is the |
| As shown above, addiction has been viewed as an | | | | ratio between the staff and clients? 4. Is there a |
| individual moral problem, a medical disease and a | | | | doctor on the treatment's premises 24 hours a day, or |
| behavioral disorder and now there's an emerging | | | | just a couple times a week to dole out medication? 5. |
| holistic model. The Moral Model is the belief based on a | | | | What is the treatment program's philosophy or theory |
| moral theory. According to this theory, people are | | | | towards addiction? Is it religious, bio-psycho-social, |
| individually responsible for the behavioral choices they | | | | psychological, neurological, physical and psychological, |
| make, good or bad. Those who choose good behavior | | | | trauma-based (addiction that has stemmed from a |
| should be praised, while those who choose bad | | | | sole traumatic event in one's life), and does their |
| behavior need punishment. This leads to people with | | | | particular approach suit your own personality, beliefs |
| addiction problems to be stigmatized, labeling anyone | | | | and values, or is it one that you can believe in, and |
| with a "bad habit" as a "bad person." The downside of | | | | rebuild your life based on it? 6. Does the treatment |
| this model has become increasingly clear over the | | | | program detail positive approaches towards treatment, |
| years. People with addiction problems are stigmatized | | | | using up-to-date methods, such as motivational |
| and are therefore often demoralized by feelings of | | | | therapy, cognitive-behavioral therapy, stress personal |
| self-blame, guilt and shame to the extent that they are | | | | responsibility, this is a disease/not a disease but a |
| unwilling or unable to seek any help or treatment. In the | | | | choice among many others? 7. Do you think this |
| 1930's, the new Disease Model began to be | | | | approach resonates with you, or your loved one, that |
| formulated. This new view was that addiction was a | | | | may need inpatient help? 8. Does the program offer |
| disease caused by genetic and biological factors. The | | | | counseling (individual or group) and other behavioral |
| addict was then no longer held personally responsible | | | | therapies, where issues of motivation, building life-skills |
| for their 'bad behaviors" since these behaviors were | | | | to resist drug and alcohol use, relapse prevention, |
| now caused by biogenetic factors beyond their control. | | | | improving problem-solving skills and facilitation of |
| A strong argument could be made that addicts were | | | | interpersonal relationships and ability to function in the |
| patients deserving treatment, rather than criminals | | | | family and community often take place? 9. How does |
| deserving punishment. The 12-step recovery | | | | the rehab program assist an individual during the |
| movement with its accompanying treatment system | | | | withdrawal process, i.e. medical treatment for |
| enthusiastically accepted this model. Now, officially, | | | | withdrawal provided, or must this be done somewhere |
| addiction was a progressive disease for which there | | | | else, prior to entering the facility? 10. To what extent is |
| was no cure, and the only way to put the disease "in | | | | the family involved in the treatment process? |
| remission" was by a lifelong commitment to total | | | | If a treatment program is determined to be necessary, |
| abstinence. Any use of alcohol or other mind altering | | | | asking these critical questions will at least give you the |
| substances was considered a relapse, regardless if it | | | | important information of whether or not they are |
| resulted in any harmful consequences. So whether it | | | | simply a traditional treatment center, only offering one |
| was one drink or 100, it was treated the same. Despite | | | | option, the 12-step method, or whether they have |
| the wide acceptance and appeal of this disease model | | | | taken all the vital research into account and have now |
| (over 90% of U.S. alcohol and drug treatment | | | | incorporated many different alternative modalities into |
| programs adhere to it), a number of shortcomings and | | | | their program. Remember, the notion that "one size fits |
| limitations have emerged through years of research. | | | | all" in the treatment of alcohol and other drug problems |
| Although these programs do work for some people, | | | | has been completely destroyed by the scientific |
| there are certain contradictions and paradoxes that | | | | evidence, and therefore, there can not be a "one size |
| prevent others from finding them helpful. The notion | | | | fits all" solution. |