Monday, 18 August 2008

Therapeutic principles underlying behavioural change and recovery

What are the key therapeutic principles that underlie behavioural change and recovery? Here are some of my reflections on this issue. These principles need to be an integral part of any treatment programme that aims to help people find their path to recovery. What do you think?


Anonymous said...

I like the value and priority you attach to clear and accurate information. I would like to see alot more about the qualities of the workers required to assist behavioural change (forming a therapeutic alliance)- being more important than the ability of the individual to be and continue to be motivated.
I continue to find the terms 'addict' and 'addiction' unhelpful.

Anonymous said...

Great stuff David, an excellent presentation of the processes of recovery from addiction.

The latter is an ugly word for an ugly condition, but it is a realistic term A vital ingredient of recovery is for the addicted to face the stark reality of their condition and to accept responsibility for their recovery.

More obscure terms such as’ Entrenched patterns of drug misuse’, problematic substance misuse, and so on, all of which lack definition, criteria and realism, whilst obscuring the stark reality of the numerous problems caused by addiction. Their suggested use as a way of reducing stigma attached to addiction is ineffective, since any stigma emanating from the public is not so much due to addiction, but from the behaviour of some of those who are addicted. I would add that the view of the majority of addicts I have encountered over the years is that such terms are patronising. There is also the undeniable stigma generated by addicts, between those who feel that their drugs should be supplied on prescription and those who find it difficult to access drug free treatment.

Dirk Hanson said...

I agree strongly with your initial point: Information is key. And I don't just mean what is commonly called "education" or "outreach" or the usual public service campaigns against drugs.

For addicts, knowledge is power. That is why I concentrate my own efforts on the front end of the process--the educational part. Addicts have to come to understand clearly the relentlessly biochemical nature of what has happened to them. Only then can the other crucial efforts go forward successfully, in my opinion.

Confusion said...

David, yes i totally agree in all you stte and the comments made, all make totally logical sense, yet for myself at the start of my own journey I seriuosly would not of understood any of what has been written, maybe this is just me, yet simplisty for the individual is I feel what helped me understand that I wanted to give up drugs,this with eating and letting the professionals teach me, allow me to chose the tools that I felt comfortable with and allow me to relapse, slip or have a blip with out being judgemental, as for me it was and still is a onward learning process with recovery.

Anonymous said...

A "Real" understanding of how addiction works in a persons life is important, indeed. Replacing the "powerless" and "spiritual" concepts found in the disease model with a positive self-affirmation, is critical to a lasting recovery. Recovery can be Fun!

"labeling" oneself or others is unproductive, and can compromise the recovery. We need to build on self-esteem, not destroy it!!How about "a complex maladaptive behaviour?"

The AA cult is on its way out!!!

The sooner, the better!!

tim1leg said...

"labeling" oneself or others is unproductive and can compromise the recovery" .....anonymous whats your problem with AA disease model etc, If you have any evidence of that id love to see it.
"Everyone has many personality labels yet most of us resist being labeled. Over a lifetime, we each will have hundreds of labels because we have unique life experiences. The main way that we learn our labels is from others. We generally resist these learnings as it feels that the labels have a negative connotation. Yet most of our labels are positive and negative at the same time. Addict has always been positive for me mainly beacause i learnt what it meant in recovery, but hey thats just my experience. If any narrative or rhetoric holds or is strong enough in a variety of contexts then identity can be stabilised and personal wholeness can be experienced.

The story we tell ourselves and others and how we and others construct that story from the baggage of our lives could come near the top of the hierarchy of levers that professionals need to fiddle with in order to empower clients to think, feel and behave in ways that make sense for themselves and their social relations, not mine.
So the business of storytelling is actually be quite a serious one, both to the addicted individual who wants to change and to the professional hoping to motivate that change.

The addict in transition needs to be able to reliably order and recall the baggage of their lives, they need to do so in way that resolves all their major conflicts and be aware that this is the process they are engaged in.

If they can be helped to do this in a simple straighforward way using laungage that they/we understand all the better, I would suggest to anyone interested in the launguge or rhetoric of addiction to check out Bill Whites paper on this exact subject.

Anonymous said...

A therapeutic principle,as individuals enter treatment an immediate briefing on why its important to complete the treatment giving the individual the information that they will start to feel well after a couple of weeks,then this is the time to realise the treatment is starting to work and the best is yet to come,this being the time when drop out accurs.Motivational interviewing with good counseling skills.Retention in treatment from a brief counseling session.Then continuity as we know retention in treatment works.

Anonymous said...

I was at a conference today where a consultant psychiatrist presented the evidence for group therapy and Alcoholics Anonymous in treatment. He stated that Alcoholics Anonymous had done more for alcoholics than anything else before or since. Certainly, with between 2 and 3 million members worldwide and a large and growing evidence base for its efficacy, few who've benefitted could sign up to anonymous's comments about wanting to see the back of it!

The evidence base for spirituality in recovery is also growing. Connectivity, finding meaning and purpose and rediscovering core values are elements of healthy human experience. This is spirituality. Nobody can reoover without it. Affirmation is a core part of the 12 step programme. Addicts may be powerless over their addiction, but they are not powerless over what to do about it.

I'm always interested in strong negative views about the AA programme. What's provoked them I wonder?