What we have done is successfully to integrate the caring philosophy of Alcoholics Anonymous into the professional treatment programme. This is a team concept, including counselling, nursing, medical, psychological and psychiatric staff who have had special training and experience with addictive diseases.
In doing this, something profound seems to have occurred – a humanising of a complex treatment programme with the close sharing found in both AA and NA.
Perhaps the most important factor in the programme is the opportunity the patient has to learn and grow in small structured peer groups. There is an immediate effectiveness in the sharing of a common experience. This common identity appears to be based on the admission and acceptance of human limitation. Non-addictive people seem to have no problem in accepting their own limitations. Most addictive people find this reality unacceptable.
In the commonality of accepting limitation, patients draw strength and help from other patients, and in turn help other alcoholic and chemically dependent people to recover. In simple terms, people who have made a career of abusing alcohol or drugs, and who have been dishonest, manipulative and intolerant towards their family and friends, learn to change when confronted with each other and their common, chronic addiction.
From this human ‘peak’ or spiritual experience, for the alcoholic or addict comes the courage to face up to the illness of chemical dependence and to recover.
The primary function of any chemical-dependence programme is to evaluate and initiate the proper treatment for people who are suffering from alcohol or drug dependence. We see this illness as dependence on or abuse of alcohol and/or drugs. These drugs can be prescribed or illegal; most patients substitute one for another during their career of dependence.
A wide range of services is provided by the treatment team. We think very few, if any, professionals can work successfully outside a team. It is just too draining and too emotionally stressful.
Based on the patient’s history, current physical and emotional condition, employment and family situation, a referral may be made to the out-patients’ department at our London centre or at Farm Place, our treatment centre in Ockley, Surrey, or to inpatient treatment at Farm Place. We insist on involvement in the appropriate self-help group of AA or NA.
Out-patient treatment begins with a medical assessment and detoxification, followed by necessary therapy by counselling, group therapy and family counselling – as indicated by the
individual treatment plan which is developed by the treatment team.
The patient requiring in-patient treatment receives a full medical examination and is placed on a detoxification regimen if necessary. In order to assist the newly admitted patient to understand the programme, there is an introductory and orientation session explaining the structure of the programme and the patient’s responsibilities and rights while in treatment.
Soon after admission, each patient is assessed several times so that an individual treatment plan can be developed. Treatment-plan designs are based on a series of interviews supplemented by co-operation from the family, GP and other referrants – employers and other significant people in the patient’s life.
This plan is designed to enable each individual to progress according to his or her capabilities. All patients have frequent sessions of individual counselling to enable them to recognise their dependence on alcohol or drugs and to resolve problems relating to the special needs of each individual and the family members.
Structured group therapy takes place twice daily. By sharing their experiences, patients come to terms with their dependence and the damage this has caused to themselves and to others. With the support of their peers, patients face their mutual problems with chemicals and begin to change.
Families are encouraged to involve themselves in the treatment programme. They participate in multiple family groups and in individual family-counselling sessions. This is to ensure that the family members, or significant others, understand the nature of chemical dependence. This understanding benefits both the patient and the family. Individual treatment plans are developed by the team for families, or significant others, to maximise their involvement. This is sometimes described as a ‘family-systems’ approach to addiction.
In recent years it has been recognised how much the families of chemically dependent people have become emotionally involved and damaged by association with the illness. The patient has often blamed his need for alcohol and drugs on other people or problems. Usually most families have initially believed this to be the case. They have taken the blame on themselves and have sometimes become immobilised and/or complicit in the illness.
Family programmes must therefore be geared to teach the family to modify their reactive behaviour and to detach from the patient while still caring. Another object is to help the family to know what to expect when the patient comes home. They must learn to live for themselves and not to be a weathervane for the chemically dependent person: to accept that their own personal growth is good for them, and that what is good for them is good for the chemically dependent person.
Of further assistance to the patient are the self-help groups of AA and NA, in which they participate while in treatment and which are their on-going support system in recovery. This applies equally to family members in Al-anon, Alateen and FA.
Early in treatment, each patient is given a psychological assessment, which is communicated directly to them in an understandable way. This is to help the patient to develop increased insight and understanding into the psychological problems that usually develop as addiction progresses and how these problems usually recede as recovery stabilises.
Patients are also assessed to ensure that no serious psychiatric problems, related to chemical dependence or independent of it, are present. This assessment is integrated into the individual treatment plan and updated as appropriate.
Further information is given to patients during treatment in the form of lectures giving guidelines for recovery, ways of coping and the way roles in the family change in recovery.
Exercise and relaxation sessions are provided to enhance the patient’s physical and emotional well-being, and also to promote social interaction. Having fun without chemicals is often a new experience which must be learned or relearned after years during which alcohol or drugs have been the main social lubricant.
Some patients need a longer period of treatment than four to six weeks of primary care. Extended care is provided within the residential centre of Farm Place. The aim is to help patients make changes in lifestyle and attitudes, and to develop self-worth without the risk of returning to alcohol and drugs.
Some patients need to spend between six months and a year in a halfway house – usually those who need to be able to spend a long period in a structured environment in which they can take time to consolidate recovery. This is necessary for some young people with a long drug history and little structure in their life, and for alcoholics with a previous extensive history of relapse. The halfway house provides counselling and on-going group therapy, as well as opportunities to work, continue education and progress to normal living while involvement in AA or NA is developing.
Plans are made to ensure, as far as possible, that the patient has the best chance for recovery. After-care services include introduction to the appropriate self-help group, out-patient follow-up and group therapy. The main goal of after-care is to continue progress made in treatment and to work towards happiness and normal living. All patients are followed for at least five years.
Recovery really begins when the patient returns home to use the tools that have been given and the skills acquired with the ongoing assistance of the self-help groups of AA and NA.
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Anti-Smoking
