Core Recovery Goals for RSAT Programming A web presentation by Fred Zackon Supporting recovery is probably the most important mission of RSAT programs. Well …duh! Yeah, but please hang on. . .
Who wants what from your program? § Funding & partner agencies: Assessments, reports, documentation § Institutional authorities: Secure, practical, reliable procedures § Program managers: Efficient and competent use of resources § You & colleagues: Satisfying employment § Inmates: Lower security and attention and/or help All normal and appropriate. And in each case, to get what they want actual people will repeatedly speak, call, write, or visit.
And one other big “want”: Society wants crime reduction. (Which is kinda the main mission of RSATs. Yes? ) But Society does not call to remind or guide you. A fundamental assumption for this presentation is: For most RSAT offenders, significant and sustainable crime reduction following release depends largely on significant recovery from substance abuse.
Why re-consider a program’s focus on recovery? § Many legitimate interests can distract from a program’s primary recovery focus. § Most treatment interventions, evidence-based or not, are employed according to a program’s existing design, not according to their likely function in recovery. § A given program or program design, even if evaluated as effective, might have good results due to one or more effective components and not because the programming as a whole is well focused on recovery. § Mature recoveries--variously enabled by various means--are now so numerous that programs might draw powerful new lessons from them. § No program is yet so effective that it can responsibly ignore how well it aligns with lessons of successful recoveries.
Let’s begin with looking at how programs are typically structured. Treatment models are representations of the services or interventions programs offer. Such as this: Group Counseling Individual Counseling Family Counseling AA/NA
A more expansive Treatment Model From the Canadian Correctional Services
The Treatment Model of a (hypothetical) Therapeutic Community Phase I Mode & Frequency IC G W D AN 3 -5 months The Road to Addiction & Crime G W Individual Counseling Group Weekly Daily As Needed Orientation 2– 4 wks Basics of Community Responsibility G W Phase II Introduction to 12 Steps G D Assigned Reading D Anger Management G Community Adjustment IC AN AA/NA G D 1 -2 days Chores D Urgent Issues IC AN Intake & Assessment Peer Level Meeting G W 2 -4 months Personal Issues IC W Cognitive Skills G W Making Amends G W Chores D Phase III 2 -3 months General Meeting G W/AN AA/NA G D Intensive RP IC & G W Principles of Recovery G W Transition Planning IC & G D Peer Level Mtg G W Personal Goals IC & G W Interpersonal Issues G AN Peer Level Mtg G W Continuous Role Modeling Chores supervision D Community Supervision D Release Prep IC AN General Mtg G W/AN General Mtg Supervision G x 4 Community Give-back G x 2 AA/NA G D Graduate 2 -4 weeks
A few obsolete Treatment Models 50 minutes, at least once weekly, per Doc 24/7 for ? Years Per Judge Drink up and you’ll be better soon
This one actually does end addiction. Quickly.
Beyond Treatment Models Successful recoveries--with and without standard forms of treatment--increasingly challenge how and why we run programs as most of us do. The challenge springs from the actual experience of recovery. To see and meet the challenge let’s first define “recovery”. For substance abusing offenders, let’s say: RECOVERY is the ongoing process of personal development that leads from addiction and crime towards a satisfying life that is drug-free, crime-free, productive, and socially connected.
This is a simple (minded) model of recovery. Feels great and never uses again Stops using and begins to feel better Learns he’ll feel better if he stops using Actively using addict feels sick and tired
An early, but thoughtful, model of recovery from alcoholism
The “Transtheoretical Model of Stage Change” Adapted from Jas. Prochaska, et al. circa 1984 forward
Twelve Steps Fellowships are powerful, and the Steps have become expected components of all kinds of programs and are applied to countless psychological, behavioral and spiritual maladies. They have also become sacred, and so not subject to modification based on empirical evidence. What empowers AA/NA? The Steps? The Twelve Traditions? The Fellowships? A combination? Or a Higher Power? What are the Steps? A recovery philosophy? A recovery model? A treatment model? Or something else?
TCs Too Most TCs even those for inmates have grown beyond the founders’ tough-love break-downbuild-up style. Today they incorporate a variety of practices and invoke various models of change. • • Social Learning Cognitive skills & restructuring Relapse prevention Psycho-educational Twelve Step Fellowship Family dynamic Neuro-chemical (medical) These approaches all have evidence of effectiveness to some degree. But what kind of recovery model might suggest how to organize and aim them most effectively? Consider an empirical recovery model derived from the actual recoveries of many addicts like those in RSAT programs
“Follow me!” Well-established treatment approaches have typically been defined by people who have had long-term recoveries and used their own experiences and ideas as their templates. Their styles, routes and vehicles have set the pattern.
Powered largely by the people they serve, programs function as vehicles for the recovery journey. Today’s multi-modality programs might be thought of as transport systems.
Look out your windows.
Naturally there is no single route to success that works for all successful recoveries.
And not all journeys and climbs are equally challenging.
More mature recoveries, supported by a variety of “vehicles” and along somewhat varied pathways, can tell us more about the features common to long-term success. Some common achievements have long been evident. Engages in healthy recreation Gets a job and keeps it Joins new healthy communities Identifies a new source of pro-social pro-sober truth Connects with helpers Bottoms out & detoxes The key is to learn from the people with the longest and most mature recoveries who resemble your own treatment population.
A proposed “trans-vehicle” recovery model that attempts to identify common developmental milestones of addict offenders who have achieved mature recovery. Resolves old shame & guilt Embraces a re-defined & honorable self-concept Pursues new self-determined horizons Disciplines attention & energy as needed Fully enjoys regular drug-free recreation Achieves extinction of most triggers Maintains productive daily routines Adopts regular spiritual or moral practices Makes recovery practices central to lifestyle Achieves substantial abstinence Makes recovery top personal priority Acquires fundamental skill-set for abstinence Bonds with new friends & community Identifies with redemptive or uplifting spiritual or moral Experiences recovery creedself-efficacy Fully acknowledges addiction and its costs Connects with a recovery-supportive group or community Embraces the vision of a good life, drug-free Identifies with a recovering role model Connects with a helpful person Endures withdrawal Bottoms out
Proposed Milestones of Mature Recovery • Resolves old shame & guilt • Embraces a re-defined & honorable self-concept • Pursues new self-determined horizons • Disciplines attention & energy as needed • Fully enjoys regular drug-free recreation • Achieves extinction of most triggers • Maintains productive daily routines • Adopts regular spiritual or moral practices • Makes recovery practices central to lifestyle • Makes recovery top personal priority • Solidifies friendships & community • Experiences recovery self-efficacy These usually require years of life in the free world. Most can barely begin before the person returns to the community. But RSAT programs can make those achievements much more likely.
Proposed Milestones of Foundational Recovery Achieves substantial abstinence Acquires fundamental skill-set for abstinence Identifies with redemptive or uplifting spiritual or moral creed Fully acknowledges addiction and its costs Connects with a recovery-supportive group or community Embraces the vision of a good life, drug-free Identifies with a recovering role model Connects with a helpful person Endures withdrawal Bottoms out These achievements represent core recovery issues for RSAT programming
Most early recovery achievements require: Inspiration Openness Commitment These qualities can be episodic, elusive, faked, and uncertain even to one’s self. RSATs can encourage and enable their development, but cannot ensure them or measure them.
SMART Treatment Goals for RSAT Programming 1. Remain drug-free for duration of program. 2. Comply with program rules for duration of program. 3. Participate in an appropriate recovery-supportive community (NA, prayer group, church, etc. ) 4. Learn the general nature of one’s disease/disorder (addiction, impulsivity, aggressive/anti-social attitudes, etc. ). 5. Learn select recovery principles (day-by-day abstinence, peer-support, replacement activities, thinking-behavior links, de-sensitization to triggers, etc. ). 6. Learn one’s personal dangers and triggers (situations, self-talk, etc). 7. Learn and apply practicable coping skills (RP, stress-management, cognitive, etc. ). 8. Prepare adequately for the next environment (community, lower security, general pop, etc).
S. M. A. R. T. goals are smart because they are: Specific The goal is described so clearly that there is no room for confusion. Measurable The degree of completion can be fairly and reliably determined. Attainable The time and all the resources for achieving the goal are available. Relevant The goal is an appropriate step on the way to a greater or subsequent goal. Time-bound The date or time by which the task need be completed is clearly stated.
SMART Treatment Goals for RSAT Programming 1. Remain drug-free for duration of program. 2. Comply with program rules for duration of program. 3. Participate in an appropriate recovery-supportive community (NA, prayer group, church, etc. ) 4. Learn the general nature of one’s disease/disorder (addiction, impulsivity, aggressive/anti-social attitudes, etc. ). 5. Learn select recovery principles (day-by-day abstinence, peer-support, replacement activities, thinking-behavior links, de-sensitization to triggers, etc. ). 6. Learn one’s personal dangers and triggers (situations, self-talk, etc). 7. Learn and apply practicable coping skills (RP, stress-management, cognitive, etc. ). 8. Prepare adequately for the next environment (community, lower security, general pop, etc).
When certain words begin the description of a treatment goal, the goal is probably not SMART. “Prevent” “Help” “Enhance” “Improve” “Reduce” “Become” “Always” “Never”
SMART goals are not aspirations, hopes, or ideals. “Stop getting angry. ” “Use the calming skill 3 times daily for a month. ” “Live drug free. ” “Remain drug-free one day at a time for the next week. ” “Improve relationship. ” “Discuss a shared interest for an hour. ” “Achieve more goals. ” See the above. These give no direction or practical steps to take. These do.
A rating scale can make almost any specific goal measurable Suppose a goal cannot, as a practical matter, be more specific than this one: Learn and use regularly three skills from the RP curriculum for at least the full month before Phase change. “Learn and use regularly” are not entirely clear and might be judged too subjectively. How can the inmate’s progress be fairly and reliably measured? Here’s one way to go at it, with a rating scale designed for the goal. A Use and Competence Scale Never, Not Competent 1 2 3 Seldom, Struggles 4 5 Occasionally, Adequately 6 7 Frequently Appropriately A scale like this can be designed and the rating points defined however best suits a program, its staff, and the goals established for inmates. What’s most important is that staff be fully familiar with the scale, and be trained so that everyone has the same understanding about how to apply it and what the various rating points mean (This is called inter-rater reliability). In this example, a variety of staff who have observed the inmate’s use of the skills in everyday activities would have input on a final rating. (The assumption here is that the inmate would be encouraged--and eager--to let staff know whenever an occasion to use the skill arose and how they used it. )
Standard Goals and an Individual Treatment Plan As part of an ITP, targeted counseling sessions might address issues like: • Early trauma or abuse • Returning to old job • Obsessing over one’s children • Anger • Despair over lost love • Chronic headaches But unless they are medically diagnosed, in most cases they cannot be resolved unless recovery is underway. Putting substantial program resources towards such individual issues may require modest expectations for progress in achieving foundational recovery.
Cognitive-behavioral skills training can provide inmates with a foundational skill-set. Skill acquisition and use will be greatly enhanced if the program clearly identifies particular skills or competencies for goal achievement. Reinforcing use of select skills on a daily program-wide basis makes the skills more natural and robust. Within the TC environment especially, a counselor’s deft use of Motivational Interviewing and Motivational Enhancement methods can sensitively and effectively align an inmate with the recovery journey itself, as well as particular treatment goals.
There is no substitute for close attention to one’s own personal and particular situation. Relapse Prevention training (which itself usually relies heavily on cognitive-behavioral skills) needs to be fine-tuned to individual circumstance and style. Most of all, an inmate needs rehearsal and practice for specific risks most likely to arise following discharge. Not least, every inmate should be fully acquainted with and if at all possible experience well-run Twelve Step groups wherein solid role models can be found. Even if the Steps and Fellowships are not to one’s liking, hearing from others about how they came to accept a truth and power greater than themselves can lead to one’s own community of support. Even if not of the Twelve Steps.
A Last Suggestion As a staff, schedule time for at least a few sessions where you can all share thoughts about what you see as a sound recovery model for your inmates. Not your treatment model, but the set of vital achievements that mark recovery no matter one’s treatment “vehicles. ” Every year or two, this is worth revisiting. And do your best to ensure your vehicle is doing its best to speed and ease the journey.
Main Points of this Webinar Main Point # 2 1. Distinguish treatment models from recovery models. 2. Adopt, adapt, or develop a “trans-vehicle” recovery model. 3. Identify recovery milestones that inmates could likely achieve while in your program. 4. Define SMART goals based on the milestones. 5. Aim evidence-based practices directly at the goals.
And concerning those evidence-based practices: USE THEM. A well-managed Therapeutic Community is a very sturdy, multi-functional, and goal-conducive vehicle for most of foundational recovery. Clearly it can facilitate abstinence and compliance with communal rules. A TC’s social-learning capacities are uniquely suited to fostering role modeling and early prosober, pro-social attitudes and behaviors that are at the heart of foundational recovery. Engaging and interactive psycho-education that focuses strongly on select principles of addiction and recovery can ensure vital understanding that allows for informed self-awareness.
This webinar is supported by grant No. 2010 -RT-BX-K 001 awarded by the Bureau of Justice Assistance, Office of Justice Programs, Department of Justice. Points of view or opinions in this document are those of the author and do not represent the official position or policies of the United States Department of Justice.
Thank you for time and attention. We hope you acquired useful ideas and suggestions. And please take note: OUR NEXT WEBINAR Wednesday, July 20, 2011, 2: 00 p. m. EDT Community as Change Agent: Incorporating Peer-to-Peer Learning in RSAT Programs The webinar educates registrants in the many benefits of creating a culture that supports accountability to a peer group that is, in turn, accountable to a “rational authority”. This model of accountability has been implemented and empirically validated in a prison based RSAT as well as in community corrections and sober house settings. The model incorporates elements of the twelve step fellowship, the cognitive-behavioral approach, and therapeutic community perspective to create an environment that supports change and a peer group that becomes a vital piece of the intervention. As each member becomes more accountable to the group, both the individual and the treatment community become stronger. Presenter Linda Gatson-Rowe, M. S. , Administrator
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