The Thirteen P’s: A Comprehensive Approach to Addiction and Recovery
Dr. Michael Flaherty is a long-time friend and colleague with whom I regularly discuss addiction and recovery issues, and ways to promote recovery for affected individuals and families. Mike is a practicing psychologist, researcher, educator, author, consultant, trainer, and advocate for recovery oriented systems of care. During his stellar career, Mike created, expanded, and managed a large continuum of clinical and prevention services as well as a research and training institute; consulted with numerous federal, state, and local agencies and organizations; published books, articles, and papers; and influenced the field of addiction in ways like no other. Mike is following his passion, promoting recovery by influencing larger systems to maintain recovery-focused care. His perspective is compelling and worth discussing.
Following are his ten P’s and three I added that are needed to address addiction and recovery in a unified way from multiple perspectives to reach and evolve science with a broad audience of individuals, families, treatment providers, policy makers, payers, and others. Leave out any one of these groups and progress may be halted by emotion or antiquated belief. Included in this discussion are a few examples from several of the P’s.
A large continuum of treatment and ancillary services, and easy and quick access to care are needed to help individuals engage in treatment and recovery at any point in their addiction. Since over 80 percent of those with addiction do not get help, the key challenges are influencing (or pressuring) these individuals to enter treatment or recovery, stick with it long-term, and quickly get back on track if they relapse. There are no easy, quick fixes for addiction. Professional therapies or counseling approaches, medications to support withdrawal or “replace” addictive drugs, mutual support programs, and services for co-occurring psychiatric, social, housing, medical or legal problems are needed for a comprehensive approach to helping addicted individuals.
A woman with alcoholism sought treatment and initially resisted the notion of taking a medication to aid her recovery, despite a history of multiple relapses. After several months she agreed to try a medicine that helped those with alcoholism reduce the severity and frequency of relapse. She reported her desires to drink decreased markedly, and she established the longest period of sustained recovery ever.
Family and marital systems—as well as relationships with parents, grandparents, and siblings—are often harmed by a loved one’s addiction. Addiction causes higher rates of breakup due to separation, divorce, child abuse, domestic violence or poverty. Individual members, including children, are at higher risk for medical, psychiatric, substance use, and other problems. In addition, children are at higher risk for academic problems (poor grades, poor performance, amd drop-out).
When possible, families need to be involved in treatment and recovery. They can do many things to help and support their loved one. Also, family members can benefit from their own therapy or counseling, involvement in mutual support programs like Al-Anon or Nar-Anon, and focus on self-care. Too many family members expend their efforts on the addicted member or the addicted member’s children, often becoming emotionally or financially drained. They spend considerable amounts of money they cannot afford on treatment, legal or other costs associated with addiction. Grandparents sometimes take custody of their addicted son or daughter’s children, otherwise the children may be removed by Child Welfare Services. While they love their grandchildren, their idea of retirement was not to raise young children, which happens in some instances.
Unfortunately, too many providers do not offer services to families affected by a loved one’s addiction. Or, they offer educational programs aimed at helping families understand addiction and how they can support their loved one in treatment. While this is beneficial, more emphasis needs to be placed on the issues of families affected by addiction and what they can do to improve self-care, rather than expend most of their energy and time on the addicted family member.
After a recent weekend education program we provided for families, a mother told me she initially decided against attending our program because she felt hopeless as well as responsible for her adult son’s addiction. She thought, “Why even bother wasting my time?” However, she showed up and, as a result of attending our half-day program involving presentations and small group discussions, she told me that she felt hopeful and knew she needed to let go of her guilt that she was responsible for her son’s addiction. In addition, over a half dozen participants in this educational program joined the Bridge-to-Hope (B-2-H), a local family support program that cosponsored this event. The B-2-H program aims to help family members deal with the havoc created by addiction and engage in their own growth and recovery. These outcomes show how family members benefit from education and support from other.
3. Providers of Care
Addicted individuals and families need easier access to care and more help with long-term continuing care treatment needs. We treat addiction, which is a chronic disorder or disease, like an acute problem when it comes to funding services. Individuals with chronic medical or psychiatric disorders are routinely offered long-term care; the same should hold true for addicted individuals. Providers need to incorporate science-based interventions, as many effective treatments exist. Studies of motivational incentives show robust findings such as higher rates of adherence to treatment, and reduction of substance use at follow-up. Yet, this intervention is underutilized. Studies also show that involvement in continuing care after acute treatment is also effective in helping addicted individuals sustain the gains they made in early treatment.
Our partial hospital program—attended by patients five days per week—offered incentives for program attendance. Patients earned “points” for attending the program, which they could use to “purchase” household and related items usually of small value, from $1 to $10. The more consecutive days attended, the more points earned. As a result, attendance and completion rates for the treatment program increased significantly. Rewards thus were used to help jump start recovery by helping addicted individuals attend more sessions and complete an episode of treatment.
4. Practitioners of Health Care
Professionals in emergency rooms, primary care, internal, family, pain, trauma units, and other medical practices need to know how to screen, assess, and facilitate treatment entry for addicted patients or arrange for other team members to intervene with these patients. Mental health systems need to train all disciplines to deal with patients who have co-occurring addiction since it is a common problem seen in psychiatric systems, which, if untreated, often impedes recovery from a mental disorder. Clearly, better integration of addiction assessment, referral, and treatment services in medical and psychiatric systems is needed. Addiction is a disorder we all need to “own” and address, not just the addiction specialists.
More research is needed to better understand the neuroscience of addiction, and to study effective clinical and prevention interventions. According to Dr. Flaherty, we need to build a “science of recovery” that helps identify factors that enable addicted individuals to sustain recovery and make positive personal and lifestyle changes over time.
Medical, dental, pharmacy, and nursing schools, and behavioral health (BH) and social science programs for psychologists, social workers, counselors, pastoral counselors, and others need to educate students on addiction and recovery. Those training for any medical or BH profession need to understand addiction and how to help affected individuals and families as well as facilitate their involvement in community recovery programs.
In addition, educators need to disseminate information about substance use, addiction, treatment, recovery, family issues, and relapse prevention strategies to individuals and families affected by an addiction. The National Institutes (NIDA, NIAAA, SAMHSA) have published an extensive array of easy-to-access educational materials for clients or families as well as research findings, treatment manuals, and toolkits on evidenced-based therapies for providers.
6. Pastors/Other Religious Professionals
These individuals need to know strategies to help individuals with addiction get help as well as how families can get their loved one into treatment or recovery. They can also persuade family members to engage in services for themselves so the focus is not only on the addicted member. The first person often asked for help by individuals or families is a religious professional.
Part two of this column in the next issue of Counselor will complete Mike’s ten p’s and present my three p’s for addressing addiction and recovery.
Flaherty, M. T. (2006). Special report: A united vision for prevention and management of substance use disorders: Building resiliency, wellness, and recovery – A shift from an acute care to a sustained care recovery management model. Retrieved from http://www.nattc.org/resPubs/recovery/SpecialReport06northeast.pdf