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  • 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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  • 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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  • Addiction and Youth

    Posted on July 24, 2013
    Addiction, Recovery and Society How society should view addiction Ending recoveryism Let’s stop insisting addiction is a disease Will insurance cover addiction treatment if addiction is not a disease? AA’s dominance in the US is harmful Court-ordered 12-step attendance is illegal CRAFT: An alternative to addiction "intervention" Substance abuse evaluations in child custody cases Addiction and youth Teach teens drinking before it kills them Why do college students drink so much? Why does anyone? From adolescent substance experimentation to addiction Helping your troubled teen without making things worse Alcohol advertising targets youth Addiction impaired professionals On June 30, 2008, the state of California stopped its medical diversion program.  ...
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  • Substance Abuse Evaluations in Child Custody Cases

    Posted on July 24, 2013
    A. Tom Horvath, Ph.D., ABPP I make a number of assumptions when conducting a substance use evaluation as part of a litigation process: The individual’s use is usually not less than the individual reports, but it might often be more (or much more). Inaccurate accusations of substance abuse are common because there is usually little negative consequence for inaccurate accusations. The parties to the litigation, and those connected with them, may provide biased and inaccurate information. Therefore outside corroboration of their reports is essential for determining the extent and consequences of substance use. Getting outside corroboration: As a practical matter, getting outside corroboration (information from sources not connected with the litigation) is difficult because suc...
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  • CRAFT: An alternative to addiction “intervention”

    Posted on July 24, 2013
    By: Tom Brown, Ph.D. CRAFT (Community Reinforcement and Family Training) is a non-confrontational approach to getting a loved one to enter addiction treatment. It is an approach designed for the concerned other (spouse, family member, friend), who is seeking assistance in getting their loved one help. CRAFT can also help the person you are concerned about reduce their substance use, even without their direct cooperation. CRAFT is successful in getting people into treatment by a three to one margin over traditional intervention strategies. CRAFT is motivational rather than confrontational. Concerned Significant Others (CSO) learn how to motivate loved ones to change, by rewarding sober activities and discouraging activities that include drugs or alcohol. The motivational approach to ...
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