Michael Liimatta

Most rescue recovery programs for homeless addicts have no trouble filling up their beds. Yet, it is better to have a smaller program with committed participants than to have a large one filled with people who are not serious about changing their lives. A well-organized long-term recovery program is —  “A planned, organized, and systematic delivery of services — using both internal and external resources— with the goal of meeting the unique needs of each individual.”.

A 30-day “pre-program” can be instituted to serve as a trail period where prospective program members can demonstrate their commitment to recovery.   Inevitably, this approach will promote stability in the long-term program by avoiding the turmoil that occurs when men and women come and stay for just a few days or weeks.   A more consistent, serious group of people who can support one another on the road to recovery will surely develop.

So, what are some of the essentials of an effective long-term program?   Let me offer a simple definition.   A well-organized long-term recovery program is:

“A planned, organized, and systematic delivery of services — using both internal and external resources— with the goal of meeting the unique needs of each individual.”

Let’s look at the basic elements of this definition:

A.   Planned, organized, and systematic delivery of services — Without good planning, rescue mission programs can experience real problems.   For instance, in too many cases, the specifics of the long-term program have been based upon personalities instead of established policies.   So, from year to year, as staff members change so does the program – often in radical ways!   While staff members must be free to tweak and improve the program, top management must establish the essentials through well-thought out policies and hire accordingly.   These policies answer questions such as; Are the 12 Steps used? Do we use secular support groups? What is our core curriculum? When do program members begin outside jobs?   When can they date?   And so forth.

B.  Using both internal and external resources — The most effective services are provided when we understand the capabilities that staff members bring to the table.   Knowing their unique skills, specialized training, and special gifts allows us to work with clients using a team approach.   While every person in the program needs a primary counselor, good programs bring other team members in to work with their clients on those areas where they need special help.   Additionally, to truly meet the needs of those who participate in our long-term programs, we have to look for resources outside of the mission.     The best approach to making such referrals is to make those individuals and agencies as much a part of the recovery team as possible.   This means lots of communication with them before and after they work with our clients.

C.    The goal of meeting the unique needs of each individual — Does everyone in your program get at least one hour of one-on-one counseling or case management each week?     If not, your program is understaffed!   In which case, you need to hire more people or reduce the number of people in the program.   We cannot begin to meet the needs our clients if we do not spend the time that is needed to really get to know them.   This begins with a thorough intake process that makes use of forms and questionnaires that enable us to identify their unique needs and challenges.   And, as long as they remain in the program, we must maintain an accurate written record that documents their progress in meeting their individual goals and objectives.

With this last thought in mind, our next installment will deal with the issue of creating and updating a simple written recovery plan that can be used by rescue mission counselors and chaplains.

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

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

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