• Introducing collaborative addiction treatment to the client

    Posted on July 24, 2013
    Practical Recovery aims to offer ideal addiction treatment for any substance or activity addiction. We describe our approach as “collaborative addiction care.” Because each client is unique, and we are fully collaborative, no two treatment plans are alike. Hence we do not offer a “program.” Our treatment intensity can be as high as alcohol and drug rehab or our treatment-in-residence program, and can range downward to brief outpatient services. The treatment-in-residence program is a combination of day-long intensive outpatient services, and residence either in our six-bed sober living facility or an adjacent hotel. Our services work best for local clients, who can begin with high intensity treatment (if needed), then transition to a gradually decreasing intensity over whatever time per...
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  • Is collaborative addiction care effective?

    Posted on July 24, 2013
    Unfortunately, Practical Recovery does not yet have any long-term follow-up data on our clients. The task of designing the data collection is daunting. No two clients do the same treatment! However, we are in the process of designing a basic data collection system. We expect it to reveal that our clients do about as well as clients in well-run studies. Our lack of data should not be surprising. We are a for-profit facility in a highly competitive market. We are also blazing a trail that few others seem to be following on (so far). Blazing this trail has kept us fully occupied. Raising fees to cover the cost of extensive research (because it would require additional staff) would make our approach even more expensive.  We are hopeful that as “collaborative addiction care” becomes more ...
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  • Introduction to Collaborative Addiction Treatment

    Posted on July 24, 2013
    Why consider a collaborative addiction treatment relationship with someone who, by definition, is making very bad decisions?  Addicts and alcoholics keep using and drinking and are often irresponsible in other ways.  How could they meaningfully contribute to treatment decisions?  Don’t they need to be told what to do, and be made to do it long enough for changes to last? Not necessarily.  At Practical Recovery we suggest that 1) supporting recovery is about engaging motivations that are more fundamental than the motivations to use or drink and 2) we best engage these motivations when we collaborate with (rather than confront, direct or “motivate”) our clients.  To support this suggestion these articles will 1) review scientific findings about treatment, 2) place treatment in the larg...
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  • Leading Edge Psychotherapy: The psychotherapy team

    Posted on July 24, 2013
    A psychotherapy team involves multiple therapists who meet successively with the same client for individual therapy. Therapy teams have begun to emerge, in varying degrees, in a few state-of-the-art addiction treatment facilities. Their emergence may have occurred somewhat serendipitously but as Pasteur remarked “chance favors the prepared mind.” To my mind the experience with the team format highlights the illusion of believing that a client exists as such and that the client’s problems or difficulties exist as such. By “as such” I am referring to the idea that the client and his or her difficulties can be apprehended or discovered as they “really” are, objectively, in pretty much the same way that a physician (with the help of lab tests, etc.) can detect/diagnosis an established me...
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  • Treating psychiatric and addiction comorbidity with a cognitive-behavioral (non-12-step) approach

    Posted on July 24, 2013
    As more addiction treatment programs treat comorbidity it seems likely that client confusion about treatment approach will increase.  Comorbidity is here defined as having both a mental health disorder (such anxiety or depression) as well as an addictive disorder.  Client confusion might arise because CBT (cognitive behavior therapy) has become the treatment of choice for many mental health disorders, but 12-step based treatment remains the most widely available treatment for addictive disorders.  Clients receiving CBT for their mental disorders can be confused when they compare the self-empowering strategies of CBT with the emphasis on powerlessness in a 12-step approach.  Although 12-step treatment now often incorporates relapse prevention and other CBT components, there remains a fun...
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  • Are Non-12-Step Recovery Approaches Effective?

    Posted on July 24, 2013
    There are many effective alternatives to the 12-step addiction recovery approach.  This article will describe the major treatments and support groups that one might choose if interested in a non-12-step (alternative) approach.  These alternatives need to be widely known because individuals who might never attend an AA (Alcoholics Anonymous) meeting might attend treatment or a support group with a different approach.  What might not be possible for them in AA might be possible elsewhere.  It would benefit everyone if the alternative approaches were as widely known and as easily available as AA and other 12-step groups.  Even AA would benefit from the individuals who chose to go elsewhere.  Those remaining in AA would know that they were attending because they had freely chosen to attend,...
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  • Choices in Addiction Treatment and Recovery

    Posted on July 24, 2013
    Should individuals who need help have choices when it comes to treatment and recovery from addiction?   Imagine talking to your child or partner, who is obviously drinking or drugging too much. “Why don’t you get it?  It’s SO obvious!  You are becoming addicted!  Look at the damage you are causing, to yourself, to me, and to everyone who cares about you.  YOU NEED TO STOP!  I’m arranging to send you to treatment.” And imagine an angry response, perhaps something like “This is my life, I’ll live it the way I want…You just don’t respect my lifestyle…You are blowing this way out of proportion…Just because you are a prohibitionist doesn’t mean I have to be one…You can take your treatment program and…” Looking in from the outside, we could say that this drinking/drugging indi...
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  • Self-empowering addiction support groups

    Posted on July 24, 2013
    Although Alcoholics Anonymous (AA) and other 12-step groups are far more widely known, there are other addiction support groups worth knowing about.  They are listed here in approximate order of size and influence.  All support abstinence, with Moderation Management supporting both abstinence and moderation with alcohol. SMART Recovery http://smartrecovery.org Women for Sobriety http://womenforsobriety.org LifeRing Secular Recovery http://lifering.org Secular Organizations for Sobriety http://www.sossobriety.org Moderation Management http://moderation.org/ All of these non-profit organizations are active communities of recovery with websites, publications and face-to-face meetings in some locations. Several also have online meetings and active message boards.
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  • Coping with craving

    Posted on July 24, 2013
    If you have had strong cravings, you may not need a description of one!  Like hunger (which is what we call craving for food), craving is a complete (cognitive, emotional, and physical) experience.  Your mind is distracted.  You feel tense and/or frustrated.  You get physically uncomfortable.  Craving motivates us to engage with whatever we are craving.  Craving is specific, although we may gain some relief by using a substitute.  If you are craving red wine, beer would be a (poor) substitute!  If you are just craving alcohol, beer or wine will do. We only crave what we have had experience with.  If you have never used heroin, you can’t crave it.  You might have a “craving” to try it, but that is craving for a new experience, not for heroin itself.  On the other hand, when we quit so...
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  • What Is the Best Alcohol Treatment?

    Posted on July 24, 2013
    There are three myths about alcohol treatment, according to some of the foremost researchers in the area, led by psychologist William R. Miller (Handbook of Alcoholism Treatment Approaches: Effective Alternatives, 3rd edition, edited by Hester & Miller, published in 2003 by Allyn & Bacon). The first myth, and possibly the worst, is that there is one and only one effective approach to addiction recovery. If you are seeking treatment and a facility tells you a version of this myth, it would be better to look elsewhere for help. Alcohol treatment research, and addiction treatment research generally, shows there is no single approach that is best for all individuals. Many paths to addiction recovery The first principle of the 12 Guiding Principles adopted by SAMHSA’s Center for Su...
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