Organizing the Addiction Counseling Process Part 3

Because they do not receive government and insurance monies, rescue missions that serve the homeless are not bound to strict time limits on the days of service they can render.   There is no magic to 30-day, 90-day 120-day programs.   These have always been set by the people who provided the dollars.

That’s why I recommend a program for  homeless addicts that is  based totally on accomplishing a set of treatment goals — instead of one based on the calendar.   Still, there are some special considerations for the first 30 days of sobriety to which we need to pay special attention.   If we make a special effort to help a newly recovering people through them, more of them will stay around longer and go forward in recovery. A “pre-program” program has definite advantages.

A. Taking time to assimilate into the program – Most rescue mission workers will tell you that new people walk away from a recovery program within the first few weeks. Some leave because they are not ready to stop using drugs and alcohol — something over which we have little control.   On the other hand, jumping directly into an intensive program from a life on the streets can be overwhelming. A 30—day transition period is one way to provide newly sober addicts a chance to build up their health and become oriented to a life without drugs and alcohol. Many rescue missions have instituted month-long “pre-program” programs where time is spent in less intense activities focusing on daily support groups, work therapy and preparing for the next step in the life of recovery.

B. The issue of detoxification — While alcohol and drugs normally pass through the human body in about 72 hours, it takes a full thirty days for the brain to begin functioning normally.   Until then, newly sober addicts have problems with logical thinking, short-term memory, and motor coordination.   With this in mind, in this first month, detailed reading and writing assignments and job assignments that could be potentially dangerous to such people like work on ladders, handling of potentially hazardous materials, etc. should be avoided.

C. Medical/optical/dental screening — By the time homeless addicts find their way to a rescue mission program, it has usually been a long time since they have had a physical or a dental or optical examination.   Every program participant must receive this sort of assistance before beginning the intensive phase of the recovery program.   If not properly addressed, health problems will have a negative impact on an individual’s ability to recover from addiction.   A new pair of glasses or the right prescription for a medical condition can do a lot in assisting newly sober addicts become fully functioning recovery program participants.

D. Mental health screening — Every recovery program must establish a working relationship with community mental health providers.   Some studies estimate that one-third or more of homeless adults suffer from a debilitating mental illness, ranging from depression to schizophrenia.   This is especially a person comes in with a bag of pills with prescriptions that have been written by several different physicians.

E. Legal assistance — The majority of people who come to rescue mission recovery programs have had run-ins with the law.   They come with outstanding warrants, court dates, child support and marital issues and so on   If they are going to be able to concentrate on the program and a commitment to spiritual growth, we need to be sure they don’t have theses sorts of issues hanging over their heads.

F. Daily support groups While their brain functions are returning to normal, support groups are more effective than direct counseling.   For the pre-program, mandatory daily attendance at addiction recovery support groups is essential, along with chapel attendance and one-on-one case management sessions   is way to help the new person remember not to drink or use drugs.   Hearing the stories of those who a living a sober and successful life provide hope, plus it helps them to feel a part of the recovery community.

G. A chance to show they are serious — Most rescue mission recovery programs have no trouble filling up their beds.   Still, it is better to have a smaller program with committed participants than a large one with people who are not serious about changing their lives.   For this reason, setting aside a special part of the building dedicated to the pre-program makes sense.   A 30-day trail period provides prospective program members a means by which they can demonstrate their commitment to recovery.   If that desire is truly there, they will go on to enter a program with others who are just as serious are they are

 

For downloadable forms and other helpful information for creating recovery plans, see the Guide to Effective Rescue Mission Recovery Programs.

 

  For the rest of this series go to the Organizing the Counseling Process Index

Organizing the Addiction Counseling Process Part 2

In this installment, I would explore a very basic question; “Just what can we expect to accomplish in the life of a homeless addict during their stay at a rescue mission program?”   The answer comes from recognizing some basic needs that need to be addressed so those we work can develop productive, satisfying sober lives.

The answer comes from recognizing some basic needs that need to be addressed so those we work can develop productive, satisfying sober lives.   The goal of a written recovery plan is to set down these goals, in order of priority, and then develop a strategy for working through them while in the program.   This plan, then, becomes the basic road map for the counseling process with the individual.   Weekly one-on-one sessions should always begin with revisiting the written plan and discovering what progress has been made toward accomplishing its jointly agreed upon goals

A. Help Addicts to Overcome Denial – Twelve Step groups recognize that recovery does not begin until the addict accepts the reality of his or her personal state of powerlessness.   We need to assist clients to move beyond an intellectual acknowledgement that alcohol and/or drugs are the cause of their problems. They need a deep inner knowing that they are completely and absolutely powerlessness over their “drug of choice.” Powerlessness means, essentially that the user cannot predict the out come of even the most limited using experiences. Until this happens, “recovery” will remain and intellectual exercise without ever getting into the heart.   They will always have the illusion of “controlled use” and the option to return to it when the inevitable pain that is an integral aspect of recovery begins.   The term “hitting bottom” is often used to describe the experience of surrender to the reality of the addict’s sense of personal powerlessness.   A peer-centered First Step therapy group strategy can be used to bring the bottom up to the addict.

B. Help Clients to Establish a Personal Program of “Self-Care” — We need to help them to answer the question “What must I do to maintain a growing personal program of recovery and spiritual growth?”   Personal self-care includes learning the disciplines of the Christian list, along with fellowship with other recovering people, avoiding negative relationships, learning not to “stuff” feelings, practicing “rigorous honesty,” hygiene, exercise, etc.   This is an important issue because shame is a major factor in addiction.   Often the addict’s shame-based self concept says, “I don’t deserve to be taking care of.”   Instead, our goal is to help him understand that, because of what Christ has done, we indeed are loved made worthy of care.

C. Help Them to Become Integrated into a Supportive Community- Establishing accountability, fellowship, and hope through both support groups (recovering community) and the church (spiritual community).   It is critical that we have definite strategies for moving our clients into the local church.   This is where an on-going relationship with a Christian support group can be a great help.

D. Help Clients to Gain Necessary “Life Skills” — These may include:

  • Ability to handle and reduce feelings of stress
  • Decision making skills
  • Ability to assert oneself
  • Parenting skills
  • Financial and other planning skills
  • Physical maintenance skills (nutrition and physical hygiene)
  • Ability to delay gratification
  • Ability to access community resources
  • Ability to identify and reduce negative feelings (e.g. guilt, resentment, hate and fear)
  • Understanding of the basic spiritual principles of Christian discipleship (i.e. prayer, Bible study, fellowship, etc.)
  • Basic relationship skills; honesty, healthy expression of feelings, self-awareness, detachment and other codependency issues
  • Vocational skills – basic education, healthy work attitudes, marketable skills, job search skills, etc.
  • Getting medical help for drug related and other physical problems.   Whenever possible, each client should receive a medical screening before beginning a recovery program.
  • Addressing psychological problems. The term “dual diagnosis” is often used to describe individual who has genuine problems with mental illness combined with an addiction to drugs and/or alcohol.
  • Developing adequate living arrangements (housing and food, etc.) once the client has completed the recovery program.

Rarely are all of these services provided at the mission itself. Therefore, it is very important to develop a network of trusted referral resources.   With referrals be sure to develop a system of feedback to the mission from the referral agency about what services are being rendered to the mission’s clients.   Using a formal “Release of Information” form is usually necessary. When using outside support groups, a card may be signed by the group’s leader to document the mission client’s attendance.

 

For downloadable forms and other helpful information for creating recovery plans, see the Guide to Effective Rescue Mission Recovery Programs.

 

  For the rest of this series go to the Organizing the Counseling Process Index

 

Organizing the Addiction Counseling Process Part 1

In the past thirty years of my work, I have had the opportunity to visit many facilities that help the homeless.   When I see a man in a recovery program I like to ask, “How is he doing?”   I usually just get a pat answer like, “Well, he’s been with us for six months.”   The problem with this answer, of course is that a sober, healthy lifestyle is not automatically picked up just by hanging around the mission for a certain length of time.

The only way to really know is by keeping accurate written records that show how we are meeting the individual needs of the people in our programs.   A formal needs assessment process is needed.   The information that is gathered provides the foundation for a written recovery plan (or discipleship plan).   The purpose of such a plan is to help program people think through their options, to identify their own needs, and to determine which specific actions they must take to get their needs met.   To ensure maximum “buy in,” the plan should be developed with lots of input from counselees themselves.

An effective recovery plan describes how the resources of the mission plus appropriate community resources are to be (or have been) used to meet the unique needs of each individual during his or her time in the program.   This is done by scheduling in-hourse resources, such as books, tapes, videos, a work program, recreational activities, one-on-one counseling, support groups, classes, etc. and using outside resources like agencies that provide various services, other Christian organizations and so forth.   While we may start with the most pressing needs, a good recovery plans moves step-by-step toward the ultimate goal of equipping program participants to live the life that God wants them to live

There are five elements that are necessary to have an effective plan

A. Identify and prioritize the client’s problems.   Everyone who walks through our doors has unique needs.   Generally speaking, we could say they need to know the Lord, they need to be sober, etc.   For some of these issues we need regularly scheduled classes, worship, work therapy, and so forth in which all program members participate.   But there also needs to be a weekly one-on-one session with a staff member who can help each one with the various personal problems that need can only be dealt with on an individual basis.

B. Set goals for recovery that are attainable within the context of the program.   For the best chance of success, it is important to develop realistic goals.   Make sure they are challenging and make sure they are attainable within your program.   This can only be accomplished when a formal assessment has been conducted to identify   resources and expertise that is available to clients; both in-house and externally.

C. Develop measurable objectives that lead to accomplishing the goals.   Good objectives can include assignments, activities, action projects, etc. — but they must be something that can be measured.   Specific habits to be developed, people to call, appointments to make, tests to take, books to read, amends to specific people are all good objectives.   Setting dates and describing the exact circumstances of conditions that demonstrate the objectives have been accomplished makes them truly measurable.

D. Establish a timeline for when   the various objectives are to be met.     Don’t say “sometime in the next three months you will read this book.”   Instead say, “this book will be read by the end of the week” or by this specific date.

E. Assign a staff member to assist   the individual to meet his or her objectives.   Every program member needs one primary staff person who is responsible for overseeing his or her progress in the program; whether it be a counselor, chaplain, or case manager.   Someone has to meet with the individual at least weekly to review progress in the program and to coordinate the meeting of program goals and objectives with other staff members, outside referrals, family members, and anyone else who will be involved with helping the person.

A written, regularly updated written recovery plan can be one of the best ways to motivate people in the change process.   A regular, weekly review allows rescue mission program participants to evaluate their options, to see progress and establish “benchmarks” for measuring their personal growth.   The best way to ensure that this happens is to adopt a set of policies that embody an approach to counseling that will be used by all mission staff members who counsel program residents.

In   future installments, we will discuss some methods of gathering data in order to identify and prioritize the problems faced by counselees.   We will also look at the details of creating and updating the recovery plan.   For downloadable forms and other helpful information for creating recovery plans, see the Guide to Effective Rescue Mission Recovery Programs.

 

  For the rest of this series go to the Organizing the Counseling Process Index