Presentation to the Kansas City MO City Council

Right Length for a Residential Recovery Program?

addiction-recovery-programAwhile ago, I was asked by a staff member of a rescue mission, “We want to lengthen our drug/alcohol program from ninety days to 42 weeks. Is this too long a time to expect a man to stay on a program?”

Unlike programs that rely on government or insur ­ance funds, rescue missions have no funding constraints to restrict how long an addict can remain in their programs. There is no set formula that we can use to determine how long it will take people to put their lives back together. Therefore, it is best to avoid setting definite time limits for pro ­grams. When a program has a set 90 day length, often on about day 80 the residents’ minds and hearts are already out the door. Even though we might feel they need more time in the program, when graduation day is not far off, it is extremely difficult to convince them to stay any longer.

A. Goal Oriented vs. Time Oriented — Instead of limiting programs to a certain number of days or months, it is best to divide them into definite phases that are goal oriented rather than time oriented. Some mission programs use three phases based on the Twelve Steps: Phase I — Steps  1-5,  Phase 2 — Steps 6-9, Phase 3 — Steps 10-12. Others use different activities or accom ­plishments to determine when residents move to the next phase. This approach creates a sense of movement, with genuine bench ­marks of achievement for participants to work toward. A string of such successes can promote greater self-esteem and commitment to completing the program.

B. The Key to an Individualized Program – Personalized goals and objectives are best developed after an in-depth intake and assessment process. Taking time to identify par ­ticipants’ needs in this manner communicates that the program staff is committed to really knowing them and will work with them on a personal basis. With this type of system, how long an indi ­vidual will stay in the program can be addressed by saying, “We ask all those who come into our program to make a commitment of at least 90 days. Most stay anywhere from 6-8 months.” We can say this because people grow at different rates. Some can accom ­plish their treatment goals and objectives in a shorter time period, while others with more issues in their lives to work on may need a longer stay.

Here’s a few other responses were I got from other program staff and directors:

“When a man receives Christ, he is a new creation, but he still carries a lot of baggage from the old life. To quote Jerry Dunn, author of  God Is For The Alcoholic,  you can get rid of the stinking drinking in two days (detox), but it takes two years to get rid of the stinking thinking.”’ (Michael Fishback, Bakersfield Rescue Mission)

“I have come to the conclusion, after 22 years of observa ­tion, that programs must be custom designed to the individual. Some need 6-8 months and others need one year or more. Alert case workers [manage] the process of moving the client into the next phase of recovery… either a job, college or trade school and! or private living conditions outside the mission.” (Frank Jacobs, Miami Rescue Mission)

“The rule of thumb at Mel Trotter Ministries is one month of treatment for every year of addiction.” (Bill Dodge, Grand Rapids, MI)

“Our program is 12 months long and is divided into 4 phases, each one goal driven with a specific minimum time required. This is about a minimum for an addict/alcoholic to reach middle to late recovery, and have established a relationship with Christ, and The Body. About 60% of all men who enter our program stay to completion. I think one of the keys is to make the program increasingly challenging, and rewarding, so the program member stays alert, and interested.” (Bill Roscoe, Redwood Gospel Mission, Santa Rosa, CA)

“We increased our minimum time on the program to ten months. (The maximum time can be tailored to the individual.) Increasing the length of time on our program brought fewer gradu ­ates for a while, but the quality of graduates increased tremen ­dously, and the number of relapses and returning clients decreased.” (David Ganzert, John 3:16 Mission, Tulsa, OK)

I would appreciate your feedback on this question!

March/April 1997


Using Drug Tests in Residential Recovery Programs

Drug-TestCertainly, drug testing is an important tool for managers of residential recovery programs.   Dishonesty is one of the hallmarks of addiction. So, keeping those who have expressed a desire to change accountable is a good thing.   But, is it possible to overdo it?

Another critical element of the recovery process is building trust between staff and clients.   In a residential program where the level of daily interaction is so intense at times, this is doubly important.   Programs really work in an effective manner when residents truly take ownership of their own personal recovery processes.

With these thoughts in mind, allow me to offer a few suggestions about ways to use drug testing most effectively in the residential setting.

A. Not the only means of maintaining a drug free program –   While it is of utmost importance that a recovery program be kept “drug free,” it is especially cruel to use drug testing as a means of enforcing abstinence if there are no other active programs to support people in pursuit of a life of sobriety.   Doing this is truly setting addicts up to fail.   Testing can be most useful when there is an on-going program of recovery-oriented activities in place.   Even then, drug testing should be a rare practice for the recovery program.

B. Generally, it is best conducted when there is a good reason to suspect that   use of drugs or alcohol has occurred –  There may be some situations where routine drug testing of every program resident should be conducted.   One instance might be when a client returns from a weekend or longer period away from the program.   However, over-testing can actually work against developing an atmosphere of trust among the staff and clients.   If we are operating a program where there is a systematic monitoring of the clients’ progress, there will usually be indicators of problems before the actual use occurs.   Relapse is a process — no one is working a solid program of recovery one day and drunk the next.

C. To maintain a commitment to “rigorous honesty” –  An atmosphere of truthfulness is the most necessary ingredient for a successful addiction recovery program.   The first requirement for entering into the program must be a sincere desire to become free of mind-altering substances.   This means that those who “get high” will be immediately expelled from the program.   The knowledge that program participants who are suspected of using them will be tested is an “insurance policy” that lets all involved know that they will be held to their word concerning a commitment to recovery.   Those involved in the program with a sincere desire for a new life can be reassured that their efforts toward recovery will not be undermined by disruptive, uncommitted, and dishonest people, whose use of drugs or alcohol will be discovered.

D. To provide predictable consequences for using –  Consequences are the addict’s salvation!   In other words, people continue to abuse alcohol and drugs as long as they feel the benefits outweigh the costs.   It must be clearly understood by all who enter the recovery program that any use of alcohol or drugs results in expulsion from the program.   They must also understand that this consequence is applied equally to all program participants — no exceptions.   This could be followed by a demotion to “transient” status or referral to another facility.   Usually, after 30 days, the client can be reassessed for reentry to the program.   The consistent application of this policy will actually promote a commitment to sobriety among program participants.   If it is not followed through with consistently, staff members will be accused of favoritism or the program participants will assume that the staff does not take the use of alcohol and drugs seriously.   The worst possible situation is to give them the impression that everyone has at least one drunk “in the bank.”   We can be assured that they will use it!