Continuing Care | 3rd Phase of Addiction Treatment
Continuing Care | 3rd phase of addiction treatment – what is meant by this? Doesn’t completing a rehab program or involvement with a 12-step program fix it?
First to the Issue of Continuing Care | the 3rd Phase of Addiction Treatment
Because addiction – whether it’s an addiction to illegal or prescription drugs or to alcohol — is a chronic, often relapsing brain disease. The very nature of this disease is that it causes chemical and structural changes in areas of the brain that are vital to a person’s ability to think straight, behave normally and act responsibility. It is not possible to heal all of the neural circuitry impacts caused by the brain disease of addiction in just 28 days.
Nonetheless, an addict/alcoholic can make great progress in rehab, which is typically a 28-day stay at a residential treatment program or an IOP (intensive outpatient program, whereby the person lives at home and visits the treatment center for treatment program offerings). And 28-day rehab programs are but one of the ways** a person goes about beginning their recovery, which is defined as abstinence AND a productive, enjoyable, forward-moving life. But it takes continuing care to carry on the progress that begins in rehab.
For you see, 21st century brain and addiction-related research now shows that treating addiction must follow the same treatment protocols as treating other diseases, such as cancer, diabetes or heart disease. Instead of the old acute care model (i.e., 28-day rehab), treating addiction must follow the disease management model, which is a three-pronged approach and involves: 1) detox/stabilization, 2) rehabilitation (rehab) and 3) continuing care (also known as after care).
Just as a person with diabetes, heart disease or cancer has a continuing care program/plan to help them continue their recovery once the acute care treatment (e.g., surgery, radiation, chemo) is complete, so too must the alcoholic / addict. These continuing care plans must go far beyond the “typical” drug testing and 12-step meeting attendance monitoring. They must include plans for how to integrate with the family; for how to deal with the fall-out of not dealing with “life” while in their addiction (e.g., credit destruction, parenting issues, relationships problems, foreclosure, lost jobs, lost friendships — the “life” situations than can trigger a person who is in early recovery (day 29, 30, 45 or 72, for example) to relapse; for what the family needs in order to help themselves and in that process, help their loved one.
And, Now to Continuing Care Plans | Living Arrangement Agreements – a Tool to Insuring Success in the 3rd Phase of Addiction Treatment
In this day and age, we have Plans and Coaches to help us with training for a triathlon, completing a walk for breast cancer fundraising, succeeding on a diet, changing careers or getting through the college application process, to name a few. Designing a Continuing Care Plan — a Living Arrangement Contract — to strategize how best to carry on in one’s recovery after rehab is equally important.
Continuing Care Plans Help to Insure Success with Continuing Care | 3rd Phase of Addiction Treatment
The purpose of a Continuing Care Plan | Living Arrangement Contract is to involve family member(s) and the addict/alcoholic in a comprehensive conversation on what happens after rehab; thereby helping all concerned better appreciate that treating addiction diseases is no different than treating other diseases in that the disease treatment model is three-fold: 1) detox/stablization, 2) rehab (e.g., 28-days at a treatment center) and 3) continuing care, of which the Plan/Living Arrangement Contract is the first step. All concerned need to understand that as a brain disease, addiction recovery requires the continued work to “wire around”/“unwire” the embedded addiction-related coping brain maps and replace those with healthy coping brain maps.
To that end, all concerned need to understand how daily living is fraught with their (both family member’s and addict/alcoholic’s) respective relapse triggers. Clearly identifying what those are, how to cope with them, what to expect, how to self-care, pros and cons of SLEs, AND for the addict/alcoholic, how to tackle the things that fell apart during their addiction (e.g., parenting, credit, employment, relationships) can be critical for lifelong recovery for all concerned.
Below you will find a few of the items that I cover with my clients when we work out a Continuing Care Plan/Living Arrangement Contract. As I explain to my clients, it is an agreement for how to integrate the addict/alcoholic into the family without giving up self or jeopardizing anyone’s recovery. To this end, all parties to jot down their thoughts around the following issues to then be discussed as part of the boundaries both ‘sides’ need to establish in a written agreement. (You don’t have to have all of the answers, but it helps to think about this BEFORE you try living together again – otherwise, the grooved neural networks of coping and responding to each other will take over and without wanting it to happen, you’ll spiral back into old ‘communication’ patterns, which are counter-productive to the recovery of all concerned.) Issues include:
1) what the addict/alcoholic should expect from family (i.e., not to try manage their recovery and specifically what is meant by this)
2) what family members should expect from the addict/alcoholic (i.e., to tolerate their fears and reactions and specifically what is meant by this)
3) identify what recovery will look like for both (i.e., individual therapy, 12 step or other self-help meetings, daily exercise class, private down-time activities, volunteer work, …)
4) what kinds of ‘life issues’ (fall out as a consequence of the addiction) need to be dealt with – credit repair, improve job skills, build resume,… — include strategies and time-frames
5) identify relapse triggers for the family member (e.g., addict/alcoholic not following through on promises, not working their recovery, not taking responsibility for actions, not taking proactive steps to let the family members know what is going on)
6) identify relapse triggers for the addict/alcoholic (e.g., family member always asking questions, feelings of being watched, vibes of “You owe me after all I’ve done for you!”…)
7) decide on a code-word that can stop conflict from escalating without having to resolve it or admit guilt (in essence, the code word ‘says,’ “I’m feeling squirrely and don’t know how to do this right; I know what I’m doing is not helpful; this is not an admission of right or wrong; so for now, let’s walk away, and I’ll put it on the list for things to discuss in our weekly meeting – see #8)
8 ) strategy for how to conduct weekly follow-up sessions that are ‘managed’ by a neutral third party, e.g., therapist or myself, to address concerns or unresolved conflict. Again, this is not to solve anything, necessarily, as it is difficult to resolve the deeply rooted issues that lurk below the surface while in early recovery – will explain why – but mostly to feel heard and to decide when it might be healthily addressed (e.g., put it on the calendar to talk about in 3 months)
9) decide what is off-limits (e.g., talking about or asking questions about the work that will be done in therapy – trauma issues, coping issues, anger, depression, etc.)
10) discuss bottom-lines, e.g., “You use, and I will __________.” Make sure all know what has been done to put these into play if the boundary is breeched.
11) other…
Drafting this kind of an agreement allows neural network pathways for healthier coping skills to form and time to heal/change the brain and physical body before trying to unravel each other’s deeper feelings about what has happened, either individually in individual therapy or together in family therapy or via separate self-help groups or a non-12-step group or a 12-step group or ___________________ .
For questions or to discuss working with me to complete a Continuing Care Plan, please email: lisaf@breakingthecycles.com. I often do them using Skype when distances are too great for in-person meetings.
I also offer consulting services to families (with or without their loved one present) to help them better understand the disease of addiction, secondhand drinking and how to move forward. Ask for: “Informational Consulting: Connecting the Research and Clinical Findings to the Practicality of ‘Living’ with the Family Disease of Addiction.”
©2010-11 Lisa Frederiksen. All Rights Reserved.
Lisa Frederiksen
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My family is in recovery as a family. We worked diligently as a family to break the cycle, reestablish our integrity, and return to sobriety and a responsible way of life.
Addiction had robbed all of us of our integrity and threw us into a pit of deception. After rehab, AA, NA, alanon, naranon, individual counseling and another rehab all of us were very frightened, discouraged, and angry. We had hit bottom many times but the floor kept dropping. Alanon and naranon are for the those who know the addict while AA & NA are for the addict only. This leaves a huge gap in family understanding and communications. We needed to address our disease as a family.
We enlisted the help of Lisa Fredericksen, addiction consultant, to work with our family.
Lisa taught us the science and indisputable evidence that addiction is a horrific brain disease that if left untreated it will destroy everyone in it’s path. We learned that in our desperation to control the addict and fix the problem we became very ill ourselves.
Now we know that there is no cure for this disease but their is effective treatment to help us achieve and maintain recovery. We learned to communicate, set boundaries, and support each other. We learned that addiction is a “family disease” and Lisa taught us to build a stronger family structure.
Thank you very much for taking the time to share your experience.
Enjoyed this Lisa,very interesting and helpfull.Thank you…Have a nice day Maam.
All to often families have not discussed continuing care plans. When they finally have this discussion it is after the fact. It is important to have these discussions with family members prior to any incident so one understands the true desire of the patient.
…and not only the person with the disease, but the family members’ voice and needs to be addressed and incorporated in a continuing care plan, as well. In this way, the entire family heals and their individual recoveries support/enhance the recoveries of everyone else. This link shares more information on this concept, http://www.breakingthecycles.com/blog/family-continuing-care-plans-addiction-recovery/. Thanks for adding your comment!