Life. Ring An Introduction for Addiction Professionals By Martin Nicolaus MA JD CAADAC Region 4 Training Sept. 19, 2009
Objectives To understand basic facts about Life. Ring To get how Life. Ring works To pick up tools that can be used with clients To facilitate client involvement with Life. Ring
Outline Hour 1: Basic Facts About Life. Ring Hour 2: The Three-S Philosophy Hour 3: How Life. Ring Works Hour 4: The Meeting Format Hour 5: How To Build Personal Recovery Programs Conclusion: It’s Time for Choices in Recovery
Hour 1 Basic facts about Life. Ring What is Life. Ring? Where is Life. Ring? Who goes to Life. Ring?
What is Life. Ring? Life. Ring is a network of recovery support groups Life. Ring is not a treatment program or a treatment protocol Life. Ring is compatible with any abstinence-based treatment approach
Where are Life. Ring meetings? There are more than 50 Life. Ring meetings in Northern California More than 12 in Canada 2 each in Ireland Sweden Growing
Where are Life. Ring meetings (2) Locally, Life. Ring meetings are at: Kaiser CDRPs (Oakland, Union City, Vallejo …) Herrick Hospital Merritt Peralta Institute Mills Peninsula Hospital Center for Recovery (Concord) Mandana Community Recovery Center
Where are Life. Ring meetings (3) Mary Isaak Center (Petaluma) Bayside Marin (San Rafael) Sierra Council (Roseville) Strategies for Change (Sacramento) The Effort (Sacramento) Veterans’ Administration Clinic (Ft. Miley)
Where are Life. Ring meetings? (4) LGBT Center (SF), Pacific Center (Berkeley) Alano Club (San Francisco) Sutter Medical Center (Santa Rosa) Home of Truth Spiritual Center (Alameda) St. Paul’s Episcopal Church (Benicia) First Presbyterian Church (Livermore) St. Joan of Arc Catholic Church (San Ramon) Unitarian-Universalist Church (Walnut Creek)
Where are Life. Ring Meetings (5) Greenwich Hospital (CT) St. Patrick’s Hospital (Dublin, Ireland)
Also: Meetings Online http: //lifering. org (a/k/a http: //unhooked. com) Chat room Email lists Forum Social network
Life. Ring comes recommended “Life. Ring has been extremely popular with our clients, and we offer it every Wednesday evening. MPI would recommend Life. Ring with enthusiasm and full support to any other drug treatment program. ”
Life. Ring comes recommended (2) “Our treatment team believes that there are many viable paths to recovery, Life. Ring being one very positive adjunct to our traditional offerings. The Life. Ring meeting is a bright spot in the patients’ week, and staff find that participation in the meeting enhances patients’ motivation to get well. ”
Life. Ring comes recommended (3) “I am happy to state that Life. Ring has always been able to coexist harmoniously with other support meetings. Patients report being satisfied with the format and some say they attend Life. Ring and 12 step support meetings. I am happy to recommend Life. Ring to any drug treatment program. ”
Who goes to Life. Ring? According to 2005 membership survey (n = 401): 37 % were referred to Life. Ring by a counselor 34% found it on the Internet
Who goes to Life. Ring (2) “What parts of your Life. Ring experience gives you the greatest satisfaction? ” 56%: Absence of religious content 56%: The atmosphere is positive, empowering 53%: Building personal recovery programs 52%: Crosstalk is encouraged
Who goes to Life. Ring (3) “Will you recommend Life. Ring to your friends? ” Yes: 98 %
Who goes to Life. Ring (4) “Have you participated in other recovery groups? ” 83% participated in 12 -step groups in the past 14 % participated in no other groups before Currently: 45 % do Life. Ring only 36% do both Life. Ring and 12 -step groups
Who goes to Life. Ring (5) Average length of sobriety: 2. 74 years Average age: 47. 8 Gender: 58 % male, 42% female High school graduates: 97% College degrees: 24% Professional-technical: 40% Blue-collar: 15%
Who goes to Life. Ring (6) Raised in religion as a child: 38% Protestant 25% Catholic 4% Jewish 8% Other religion 24% Not raised in a religion
Who goes to Life. Ring (7) In the past year, attended church (or other house of worship) at least once: 41 % Every week: 10% About once a month: 9% Did not attend during past year: 59% (National averages: Every week= ~20 % Not during past year = ~ 40%) Source: http: //en. wikipedia. org/wiki/Religion_in_the_United_States#Church_attendance
Who goes to Life. Ring (8) In the past year, received some type of professional counseling for substance use issues: 47% In past year, received diagnosis for co-occurring disorder: 45 % 33 % Depression 17 % Anxiety Details at http: //lifering. org/survey/2005_lifering_participant_survey. htm
Who Goes to Life. Ring: Summary • A fairly average cross section of recovery • Above average educational levels • Below-average religious involvement • High level of involvement in treatment
How is Life. Ring Organized? Life. Ring is a 501(c)(3) nonprofit corporation Annual Congress of meeting delegates 9 -member Board of Directors All officers and directors are volunteers Bylaws
History of Life. Ring Founded locally May 23 1999 in Albany CA Founded nationally Feb 17 2001 in Brooksville FL
Hour Two Basic facts about Life. Ring (continued): The Three-S Philosophy
The Three-S Philosophy (1) 1. 2. 3. Sobriety Secularity Self-Help
1 Sobriety = Abstinence Persons with the aim of moderating or controlling are referred elsewhere Persons who have relapsed are welcomed and praised for coming back The key is intent
Sobriety (cont’d) Grounds: Personal experience that moderation or control do not work for us Commitment to living with all senses clear Urge to realize our best potentials + Drugs suck
Sobriety (cont’d) Abstinence not only from alcohol but also from all other medically non-indicated drugs For example, a person abstaining from alcohol but using marijuana is not “sober” by Life. Ring standards Background: Modern trend: Poly-addiction Poly-abstinence Segregation by “drug of choice” obsolete All together in the same room (“one-shop stopping”) Same as integrated treatment model
Sobriety (cont’d) Nicotine: Not required but strongly encouraged to quit All meetings are non-smoking Support on quit anniversaries Education on web site (lifering. org)
Sobriety (cont’d) Nicotine (Background): Nicotine kills more alcoholics than alcohol does Negative example of AA founders More successful outcomes if you quit both Long-term goal: smoke-free Life. Ring
Sobriety (cont’d) Medications (Typically: anti-depressants, anxiety meds) Supported on two conditions: 1. Patient honest with physician 2. Physician competent in addictions Medications = sobriety tools Life. Ring convenors are not physicians!
Sobriety (cont’d) Medications (background) Too many persons harmed by refusing medications Too many physicians’ treatments undermined Medications hold potential as recovery aids (Ref: disease model)
Sobriety (cont’d) Methadone Exhaustively tested as effective v. heroin If used as prescribed, should be sobriety tool But wide gap between ideal and reality Medical marijuana Widespread abuse, “medical” scams If used legitimately (e. g. cancer), should be OK Not much experience to date
Secularity = Inclusiveness in matters of belief or disbelief
Secularity (cont’d) Secular Ecumenical Protestant -- Catholic – Jew -- Muslim Unaffiliated
Secularity (cont’d) NB ~ 40% of Life. Ring participants say they attend church But they prefer to perform their religious observances in church, not in recovery rooms In the Life. Ring meeting room, your belief or disbelief remains your private business.
Secularity (cont’d) Life. Ring not a religious organization No prayers in meetings Non-religious change agent ( TBD) Ref: Court decisions re First Amendment Inouye v. Kemna, 504 F. 3 d 705 (9 th Cir. 2007) Parole officer should have known that coerced referral to 12 -step groups violates Establishment Clause. Coerced referral to 12 -step liable for $$ damages More: Brochure, Counselor article, CAADAC talk
Secularity (cont’d) Life. Ring not an atheist-agnostic organization No atheist/agnostic advocacy in meetings No attacks on religion in meetings Peaceful Coexistence of all faiths and none No attempt to modify client’s belief system (e. g. God who observes v. God who controls) Many believers prefer secular environment Compare: family reunion
Secularity (cont’d) Secularity lets people relax and be real Absence of implied moral judgments Be what you are Safety and freedom in the atmosphere
Secularity (cont’d) Secularity is science-friendly E. g. animal research showing that addiction is the product of ingesting addictive substances; not of character attributes or moral qualities E. g. human research showing that every personality type is equally liable to become addicted E. g. research with pharmacological recovery tools
Secularity (cont’d) Secular spirituality (Not: supernatural spirituality) Life. Ring meetings are strong on Empathy Concern Caring Love Respect Other positive feelings TBD
Secularity (cont’d) Participants who want to explore theological issues: Refer to churches, synagogues, etc. Refer to other qualified professionals Our limits as Life. Ring members: Considerable experience with addiction & recovery Not qualified to teach theology
(3) Self-Help Personal responsibility for one’s own recovery Cannot be delegated away (to God, physician, etc. ) Implies a capability to take the responsibility Implies a duty to work and fight Can be a shocking premise for recovering people
Self-Help (cont’d) Moment of Existential Panic: Two Outcomes Energized Stimulated Takes Charge Gets to Work Paralyzed Defeated Passive Waits for recovery to happen Important for treatment providers to offer choices so that both can prevail
Self-Help (cont’d) Personal Recovery Programs (PRP) Universal element: Abstinence All other elements: Individualized
Personal Recovery Programs Abstinence
Self-Help (cont’d) Rationale for Personal Recovery Programs: "1. No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society. "- National Institute on Drug Abuse (NIDA), Principles of Drug Abuse Treatment -- A Research. Based Guide (1999)
Self-Help (cont’d) "The roads to recovery are many. "-- AA Cofounder Bill W. , The AA Grapevine, Sept. 1944, Vol. 1 No. 4.
Self-Help (cont’d) “Treatment should be individualized to accommodate the specific needs, personal goals, and cultural perspectives of unique individuals in different stages of change. ” -- Center for Mental Health Services and Center for Substance Abuse Treatment, Substance Abuse and Mental Health Service Administration (SAMHSA), 2006
Self-Help (cont’d) “There does not seem to be any one treatment approach adequate to the task of treating all individuals with alcohol problems. We believe that the best hope lies in assembling a menu of effective alternatives, and then seeking a system for finding the right combination of elements for each individual. ” -- Hester & Miller, Handbook of Alcoholism Treatment Approaches, Effective Alternatives, 1996, p. 33
Self-Help (cont’d) “With our two centuries of accumulated knowledge and the best available treatments, there still exists no cure for addiction, and only a minority of addicted clients achieve sustained recovery following our intervention in their lives. There is no universally successful cure for addiction – no treatment specific. ” – William L. White, Slaying the Dragon, p. 342
Self-Help (cont’d) “Each patient or client develops problems in unique ways and forms a unique relation to the substance of choice. Common sense dictates that treatment must respond to the needs of each individual. ” -- Joyce Lowinson, editor, Substance Abuse: A Comprehensive Textbook, 1996, p. xi.
Self-Help (cont’d) What goes for treatment goes for self-treatment Formula treatment plan + Personal Recovery Program = Individualized treatment plan + Formula recovery program = Individualized treatment plan + Personal Recovery Program =
Self-Help (cont’d) The clinician’s plan and the patient’s plan The most successful client in resisting relapse is one who “confidently acts as his or her own therapist. ” – Dimeff & Marlatt, Relapse Prevention, 1995 “Every patient carries his or her own doctor inside. ” -- Albert Schweitzer.
Self-Help (cont’d) When given a chance, people who were asked and involved in creating their treatment would regularly prescribe for themselves treatment that would work. Sometimes my only contribution to their success was believing in them until they believed in themselves. “ - Lori H. Ashcraft and William A. Anthony, “Breaking Down Barriers, ” Behavioral Healthcare (April 2008) p. 8
Self-Help (cont’d) “The first principle of recovery is the empowerment of the survivor. She must be the author and arbiter of her own recovery. … No intervention that takes power away from the survivor can possibly foster her recovery, no matter how much it appears to be in her immediate best interests. ” -- Judith Lewis Herman, Trauma and Recovery: The Aftermath of Violence (Basic Books, 1997) p. 133.
Self-Help (cont’d) “Alcoholics recover not because we treat them but because they heal themselves. ” -- George Vaillant MD, Natural History of Alcoholism Revisited, 1996 The dominant role in determining treatment success or failure is the role of the patient. (Study cited by Vaillant)
Self-Help (cont’d) What Life. Ring does is to take seriously the role of the patient in healing themselves, raise this project into consciousness, legitimize it, and provide support and tools for its accomplishment.
Self-Help (cont’d) HOW does the recovering person build their PRP? Deferred to Hours 4 and 5 Other dimensions of Self-Help Deferred to Hour 6
The Three-S Philosophy Summary
Hour Three How Life. Ring Works
How it works: Outline Empower Your Sober Self: What it Means In more depth: The Divided Self Horizontal Synergy Confrontation v. Support Strategies
How it works The main Life. Ring motto is Empower your Sober Self What does that mean? How does it work?
A Metaphor only – not brain anatomy Dominant inside the active alcoholic/addict’s head is the Addiction (A). Some people call it the Disease, the Beast, or the Devil. By whatever name, it controls the active alcoholic/addict’s behavior most of the time.
A S But also present in the active addict’s head, at the time when they are ready to commence recovery, is another force: a part of the personality that wants to be clean and sober (S). This is the “sober self. ”
A S Let’s have another, let’s get wasted, damn the consequences … No, it’s stupid, we can’t afford it, it’s boring, I have to work tomorrow… The inner conflict between these two camps in the mind is a common and unhappy experience of alcoholics/addicts.
A A S S When two or more addicts/alcoholics come together, their interaction can produce two kinds of changes:
A A S S If they meet in a drinking/drugging setting, and if the “Addict” parts of the two brains make mutual contact …
A A S S … they will reinforce one another’s addiction …
A A S S … at the expense of the sober place in the brain …
A A S S … ultimately leading to …
A S … overdose, irreparable body damage. . .
… and death.
A A S S But if these same individuals come together in a recovery environment, and …
A A S S … if the sober place in one connects with the sober place in the other …
A A S S … and the other connects back, completing the circuit …
A A S S … then the “S” in both of them will grow and become stronger …
A A S S … and stronger …
A A S S … until the sober self rises …
S A … and becomes dominant within the person …
S S A A … so that sobriety stops being an uphill fight …
S A … and becomes comfortable and almost effortless.
S A The “A” never vanishes entirely. Putting “fuel” into the body would make it come roaring back. In every other way, the person can lead a normal, happy, productive life.
A S S A Positive reinforcement is the “magic” that makes this transformation possible.
S S This is the basic meaning of the Life. Ring motto: “Empower your sober self. ”
How it Works -- Background (1) The Divided Self A person who is addicted is a person who has an inner conflict A S
The Divided Self
The Divided Self
The Divided Self
The Divided Self
The Divided Self Not just a literary metaphor but a clinical reality “Addicts simultaneously want – more than anything – both to maintain an uninterrupted relationship with their drug of choice and to break free of the drug. Behaviorally, this paradox is evidenced both in the incredible lengths to which the addict will go to sustain a relationship with the drug and in his or her repeated efforts to exert control over the drug and sever his or her relationship with it. ” – Wm. L. White
![The Divided Self “[T]he fierce power of an addict’s obsession with drugs is matched,](https://present5.com/presentation/f2cbd7350257d2654aebe70cfc02d019/image-94.jpg "The Divided Self “[T]he fierce power of an addict’s obsession with drugs is matched,")
The Divided Self “[T]he fierce power of an addict’s obsession with drugs is matched, when the timing is right, by an equally vigorous drive to be free of them. ” – Lonny Shavelson MD
![The Divided Self “The majority of substance abusers […] are intensely ambivalent, which means](https://present5.com/presentation/f2cbd7350257d2654aebe70cfc02d019/image-95.jpg "The Divided Self “The majority of substance abusers […] are intensely ambivalent, which means")
The Divided Self “The majority of substance abusers […] are intensely ambivalent, which means that there is another psychological pole, separate from and opposite to denial, that is in delicate, frequently changing balance with denial and that is a pole of healthy striving. ” -- Dr. Edward C. Senay, University of Chicago
The Divided Self “Alcohol abuse must always create dissonance in the mind of the abuser; alcohol is both ambrosia and poison. ” – George Vaillant, MD, Harvard Medical School
The Divided Self Addictive substances set off an “opponent process” in the brain’s neurochemistry, part pleasurable and part anti-pleasurable – George Koob MD, Scripps Institute San Diego
The Divided Self DSM-IV Criteria for substance dependence include: “a persistent desire or unsuccessful effort to cut down or control substance use” or “knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance. ” (In other words: inner conflict)
The Divided Self In short: The Basic Model of Addiction Psychology A S
The Divided Self The divided self appears to be a bad thing: “Paradox” – “fierce power v. vigorous drive” – “intense ambivalence, frequently changing” -- “dissonance in the mind” – “opponent process” – “knowledge of having a problem” The inner conflict may feel like torture
In division lies hope for change But without the Divided Self, recovery would not be possible If we see the person as all “S”, there is no reason to change: S If we see the person as all “A”, there is no way to change: A There are no living addicted persons who match either of these two diagrams
Division is the basis of change A reason to change A basis for change A S “The doctor within” – Albert Schweitzer
Another view: Disease Model Disease Immune System A S “Treatment rests entirely on recognition of the factors contributing to the resistance of the patient. ” -- Vaillant
Two therapeutic strategies Support the S Attack the A Confrontation Attack therapy “Tough love” Synanon Many TCs Steps 1 - 8 A S Strength-based MI CBT REBT DBT SFT (Fellowship) (Life. Ring)
Confrontation Doesn’t Work “Four decades of research have failed to yield a single clinical trial showing efficacy of confrontational counseling, whereas a number have documented harmful effects, particularly for more vulnerable populations. … Clinical studies show that more effective substance abuse counselors are those who practice with an empathic, supportive style. ” William R. Miller and William White, “Confrontation in Addiction Treatment, ” Counselor (October 4, 2007),
Examples of support strategy From Lonny Shavelson’s book, Hooked: Five Addicts Challenge Our Misguided Drug Rehab System
Examples of support therapy Example 1: Darlene
Example of support strategy (1) Darlene: “If an addict doesn't want to get off drugs, you can just talk at them until your eyes turn blue, and they'll just tell you to fuck off. " Dr. S: "Just possibly, that person who you're speaking about may have the teeniest of desires to deal with her drug problem. ” Darlene: "Well, what if that person only has the teeniest, teeeniest, tiniest wanting to be off drugs? “ Dr. S. , shakes Darlene’s hand: "Then I would think that such a person would do very well in this clinic. " (Shavelson 2001: 281)
Example of support strategy (1) Client has “teeniest, tinyest desire to be off drugs” Counselor shakes hands, forms therapeutic alliance with client’s “S” A S
Example of support strategy (2) Glenda Counselor Evelyn 'Evelyn tells me, “Glenda, you're a strong, wise lady. ” She says all kinds of things about me that make me feel really good. ' -(Shavelson 2001: 204)
Example of support strategy (2) Evelyn A S
Example of support (3) Drug court counselor Marillac Runs a group with Drug Shavelson asks: Why do Court clients, mandated you do that? Shouldn’t to be there you be reading them the Instead of talking tough riot act? to clients, spends time bringing out clients’ good points
Example of support (3) Marillac “It's just the opposite. I have to be more relaxed with them here. The fact that they're mandated to be in rehab doesn't make their treatment easier, it makes it harder. They have to show up, but then I have to win them over to wanting to change their lives. If I act tough, all I get is an addict who's pissed at another authority figure. So I've got to grab at what good they have inside of them, and they have to see me grabbing it, bringing it out – accepting them. ” -- (Shavelson 2001: 232)
Example of support (3) Marillac A S
Summary Different aspects of empowering the sober self: Recognizing Validating Pouring love into Building alliance with Holding up to light Honoring Responding to Relating to
Hour 4 The Life. Ring Meeting
The Engine A A S S
Circle seating
Large circle
Short Opening Statement Basic meeting philosophy (Sobriety, Secularity, Self. Help) Confidentiality Format Welcome Takes less than 2 minutes
“How was your week? ” Highlights and heartaches of recovery this week Plans and expectations for coming week My week went like this … I did … I felt … I thought … and then … Next week I face … my plan is … S
How was my week? My boss made me go to the office party, even though there was alcoholic punch and I was just a week sober, and I did it and I didn't drink. I feel great. I got together with my sober buddy and we watched the Raiders game and didn't drink, for the first tim e I can remember. I drove home and there were my parents in the living room smoking crack. I ran out of the house and got back in my truck and peeled out of there. My sister and I talked and hugged each other for the
All* Life. Ring Meetings Encourage Cross-talk I had something very similar happen … did you mean? … I think what you did is cool … S S *Except meetings in special settings with highly vulnerable populations
Cross-talk is powerful S S What happens if you only hook up one wire in the jumper cable?
Cross-talk is powerful Horizontal synergy S S S
Crosstalk is feedback “One general finding in the motivation literature is the persuasiveness of personal, individual feedback. Lectures and films about the detrimental effects of alcohol on people in general seem to have little or no beneficial impact on drinking behavior, either in treatment or in prevention settings. ” -- (Hester & Miller 2003: 138)
Some limits on Meeting Talk No attacks or confrontations No unsolicited advice No bashing other recovery programs No religion, pro or con No politics No uncivil behavior These are general rules of friendly conversation Crosstalk is just another word for conversation
Aim: Living Room atmosphere Friendly, safe, candid
“How was your week? ” Format YES Here and now focus Personal experience Small decisions NO Drunkalogues and Drugalogues Book recitals Infomercials about how the program saved them
Pluses of the HWYW Format Low entry barrier -- most people speak on Day 1 Speaking leads to self-knowledge One’s own sobriety meaningful to others Ever-changing panorama of issues Democratic, equal-opportunity format Brings sober scrutiny to life decisions Encourages sober planning Helps people carry the meeting with them Atmosphere is positive, encouraging, motivating
Negatives of the HWYW Format Limits size of meeting Meetings may split into two NB Some Life. Ring meetings modify the format or use a topic format
Closing ritual Round of applause for one another, because: The outside world little understands or appreciates our recovery journey. They tend to believe that we can 'just say no‘ and be done with it. But we who fight this battle every day know the inner struggles we go through and the work that's involved in rebuilding our lives. We appreciate the courage that it takes to be here. Recovery is an estimable project, and we have earned the sober self-esteem that we feel today. We are heroes and winners.
Meeting facilitators are ordinary persons in recovery (peer leadership) “Convenors” con = with, together venire = to come “People who bring people together” Six month minimum sobriety requirement
Practical details A signup sheet is passed To facilitate people’s contacts between meetings Phone and email A basket is passed for voluntary donations
Other issues Labels are optional Depends on how label affects person’s A-S balance For some, “alcoholic” label heightens vigilance For others, “alcoholic” label paves way to relapse It’s the individual’s choice whether to use label or not
Other issues Time keeping is optional But convenors must have six months Officers must have 1 year Directors must have 2 years Relapse = resignation
Other issues Sponsors Role in 12 -step Pilot through 12 -step program 2. Consult between meetings 1. PRP is not a formula-type program Usually no role for a pilot (authority figure) Everyone encouraged to consult everyone else between meetings Everyone can be the sponsor of everyone else Each person can have any number of sponsors
Convenor Handbook http: //lifering. com
Hour 5 How people build Personal Recovery Programs (PRP)
Two Pathways to PRP 1. Through the “How Was Your Week” Meeting Format 2. Through the Recovery by Choice workbook
(1) PRP via HWYW meetings “Random access”: progress and sequence of program construction depends on what happens in meetings and who happens to be present In each meeting, person may pick up a “nugget” that works for them, and make it part of their recovery plan Like making a mosaic from found stones
(1) “Random Access” Sequence (HWYW Meetings)
(2) Structed Sequence (Workbook)
(1) PRP via HWYW meetings Advantages: companionship, feedback, all the benefits of positive social interaction Disadvantages: little control over subject matter, may not want to expose private issues, group chemistry may or may not be good fit
(2) PRP via RBC Workbook Advantages: control over sequence, timing, subject matter; thorough range of topics; complete privacy; benefits of writing things down; ability to reflect back later; usefulness of a permanent record of one’s own recovery Disadvantages: Cost, lack of social interaction, literacy requirement Possible synthesis: Workbook study groups
Nine Domains (Work Areas) My Decision 1 My body 9 My Treatment 8 My Culture 2 My Exposure The Relapse Chapter 7 My History 3 My Activities 4 My People 6 My Life Style 5 My Feelings My Recovery Plan
My Decision A Should I move in with D? How it would reinforce my A How it would reinforce my S D’s main squeeze is probably a drunk D’s other roommate keeps wine in fridge There is a liquor store right on the corner I’ll have to work longer hours to afford it I hate the purple paint trim in the hallway, makes me want to drink I’ll have to listen to D’s dog barking at night sometimes, drive me nuts D does not drink or use or smoke I will be in a neighborhood with less drugs I’ll have a nicer room, less stress It’s quieter, not so much loud partying I’ll be able to bicycle to work, save commute money I’ll live closer to F and L (sober friends) and spend more time with them I’ll get away from my druggy roommates I’ll get to play with D’s dog There’s a washer-dryer there, don’t have to go to the stinky laundromat Good light, I can have house plants Eventually I can find my own place in that neighborhood S
The A-S T-chart Main point: To evaluate every decision in terms of recovery Will my plan strengthen my Sober Self (“S”) and lead me toward a stronger, broader, more satisfying recovery, OR Will my plan strengthen my Addict Self (“A”) and lead me in the direction of relapse?
The A-S T-chart Question: isn’t this narrow and dogmatic? If I always choose for the S, all my potentials can be realized. The S is the doorway to everything else If I opt for the A, the doors will shut and everything will go down the drain
Domain 1: My Body 2 Telltale Signs __ I have some telltale visible signs of my drinking/using on my body, namely: __ red eye __ burst veins in nose / face __ pot belly, overweight __ anemic, emaciated __ needle track scars __ nose damage __ stained fingers __ skin abscesses __ burst veins in legs __ shaky hands __ scar, fracture or other injury I got while under the influence __ bad teeth, gums __ other, namely _______________ __ Nobody could tell I drank/used, I look completely normal.
Domain 1: My Body 12 Exercise __ I am physically active and get plenty of exercise each week __ I get some exercise each week but a little more wouldn’t hurt __ While I drank/used I was an active athlete and in good physical condition __ While I drank/used I got very little exercise other than bending the elbow __ I am seriously out of shape now __ I’ve noticed that I feel better when I take some exercise __ I would like to exercise more but can’t figure out how or what or when __ I know perfectly well how to exercise more but I just don’t do it __ I have noticed that when I exercise it is easier to resist my cravings to drink/use __ I am disabled and cannot exercise except in very limited ways __ I am going to exercise more, starting _____ (date) __ I am not going to change my exercise patterns
Domain 1: My Body
Domain 1: My Body
Domain 4: My People
Domain 4: My People
Domain 4: People
Domain 4: People
Domain 4: People
Nine Domains (Work Areas) My Decision 1 My body 9 My Treatment 8 My Culture 2 My Exposure The Relapse Chapter 7 My History 3 My Activities 4 My People 6 My Life Style 5 My Feelings My Recovery Plan
Relapse Chapter
Relapse Chapter
Relapse Chapter
Relapse Chapter
Relapse Chapter
Nine Domains (Work Areas) My Decision 1 My body 9 My Treatment 8 My Culture 2 My Exposure The Relapse Chapter 7 My History 3 My Activities 4 My People 6 My Life Style 5 My Feelings My Recovery Plan
Pulling the PRP Together
Pulling the PRP Together
Pulling the PRP Together
Pulling the PRP Together
Result: Diversity of Programs Abstinence
Pros and Cons of PRP Cons May be more difficult than working a formula program No answer book Tough questions Forces you to THINK No authority figure Not for everyone Pros Investment Motivation Comfort Portability Adaptability Resilience Efficacy
Why PRP (more) The most successful client in resisting relapse is one who “confidently acts as his or her own therapist. ” – Dimeff & Marlatt, Relapse Prevention, 1995
Why PRP (more) “The assembly-line approach. . . may work when the content is purely cognitive. But when it comes to emotional competencies, this one-size-fits-all approach represents the old Taylorist efficiency thinking at its worst. . We change most effectively when we have a plan for learning that fits our lives, interests, resources, and goals. ” -- Daniel Goleman, Working with Emotional Intelligence (2006)
Why PRP (more) “A strong and consistent finding in research on motivation is that people are most likely to undertake and persist in an action when they perceive that they have personally chosen to do so. . When clients are told that they have no choice, they tend to resist change. When their freedom of choice is acknowledged, they are freed to choose change. ” --(Miller 1996: 93 -94).
Why PRP (final) Thirty years ago, at the beginning of the HIV crisis, the blood banks desperately needed more donors. They commissioned a study to find out how to reduce donor discomfort and increase donor repeats. They discovered two “magic words” that dramatically reduced donor discomfort and brought them back to donate again and again. “Which arm? ” Chase & Dasy, Harvard Business Review 2001: 83
Conclusions 1. Life. Ring is a strength-based approach 2. It’s time for choices in recovery
(1)Life. Ring is a Strength-Based Approach We see both the A and the S, but we concentrate our energies on building up the S A S
What we see when we see the strengths Seeing only the A Powerless Insane Can only surrender Morally defective Focus on errors Menace to others Clueless Diseased Genetically defective Seeing the S Able to abstain from No. 1 Capable of reason Able to fight Morally mixed Some wrongs, some rights Some harm, some help Capable of planning Capable of healing Not genetically programmed
What we see when we see the strengths (cont’d) Seeing only the A No hope within Nothing inside to build on Nothing within to respect No inherent dignity No goodness inside Can be helped Needs to hide Should be ashamed Deserves pity / contempt Seeing the S Ground for hope within Solid basis to build on Ground for respect Has inherent dignity Has inherent goodness Can help themselves Can well be seen Should be proud Deserves respect & credit
It makes a difference! In the Herrick 4 N 51 -50 ward: “The Life. Ring group approach encourages patients to look within themselves and to each other for the strength to achieve abstinence and a healthier lifestyle. … We have found that this approach encourages patients to begin to think positively about themselves and to find a reason to live productively…. The Life. Ring meeting is a bright spot in the patients’ week and staff find that participation in the meeting enhances patients’ motivation to get well. ”
(2) The Aim of Life. Ring is Choice Life. Ring does not aim to undermine or to replace any other support group or treatment approach The aim of Life. Ring is to provide recovering persons with an additional choice of recovery pathways And to provide the treatment professional with “another arrow in the quiver”
We need more choices AA Retention Rate; graph adapted from Don Mc. Intyre, “How Well Does A. A. Work? An Analysis of Published A. A. Surveys (1968 -1996) and Related Analyses/Comments, ” Alcoholism Treatment Quarterly, 18, No. 4, 2000.
AA affiliation rate: 5 per cent More than 80 % walk away within 30 days 90 % walk away within 90 days At the end of a year, only 5 % are left
Choice should not be controversial "The roads to recovery are many. "-- AA Cofounder Bill W. , The AA Grapevine, Sept. 1944, Vol. 1 No. 4.
It’s time for more choices "It is time that the recognition of multiple pathways and styles of recovery fully permeated the philosophies and clinical protocols of all organizations providing addiction treatment and recovery support services. " -- William White, MA and Ernest Kurtz, Ph. D, "The Varieties of Recovery Experience: A Primer for Addiction Treatment Professionals and Recovery Advocates" (2005)
What can providers do? (1) Get familiar with all the available support options Get, display, and distribute literature from all available support groups Make room space available to meetings Provide a level playing field in support group referrals Provide choices at first contact Eliminate “bounce” referrals Neutralize program forms and literature Neutralize signage and decorations
What can providers do? (2) Hire and retain staff with multi-path competency TSF and/or MI and/or CBT and/or DBT and/or Choice Theory and/or SFT … Provide clients with multiple treatment pathways Via multi-path protocol in same group, or Via separate groups with adapted protocols Support client initiative in building PRP Mesh with program’s own individualized trx plan
Choice is good program policy The 5% retention rate for AA holds lessons for treatment programs “The treatment system we currently have. . . was devised in 1975, when all we had for treatment was basically group counseling and AA…. Most people don't want it; they have to be forced into it. “ -- Mark Willenbring, Director of Div of Treatment and Recovery Research, NIAAA, in Technology Review (MIT) October 27, 2006
Choice is good program policy Single-path approaches limit and erode program census Widespread program camouflage Choice attracts and retains clients
More choices = more recoveries Life. Ring 12 -Step Other Recovery
For more information: www. lifering. org – Life. Ring, the organization www. lifering. com – Life. Ring Press e-commerce store Life. Ring Service Center, 1440 Broadway, Ste. 312, Oakland 94612 service@lifering. org 1 -800 -811 -4142
Available literature (1) Empowering Your Sober Self: The Life. Ring Approach to Addiction Recovery Published 2009 by Jossey-Bass, a division of John Wiley & Sons; with a foreword by William L. White. ISBN 978 -0 -470 -37229 -6
Available literature (2) Recovery by Choice: Living and Enjoying Life Free of Alcohol and Drugs; a Workbook Third printing, Life. Ring Press 2006 ISBN 0 -9659429 -3 -7
Available literature (3) How Was Your Week: Bringing People Together in Recovery the Life. Ring Way Version 1. 00, Life. Ring Press 2003 ISBN 0 -9659429 -4 -5
Available literature (4) Presenting Life. Ring: a Primer for Treatment Professionals Third ed. , Life. Ring Press 2006 ISBN 0 -9659429 -5 -3
Available literature (5) What is Recovery? A Quality of Life Perspective By B. J. Davis, Clinical Director, Strategies for Change (Sacramento) 55 -minute DVD Life. Ring Press 2009
Available literature (6) Life. Ring 101 45 -minute CD Slide show Runs on computer only Life. Ring Press 2001
Available literature (7) Brochures Welcome to Life. Ring If This is Day One Sobriety is Our Priority Secular is Our Middle Name Self-Help is What We Do Life. Ring Online We Come Recommended Give Something Back Choice of Support Groups: It’s the Law Food for the Sober Mind A Different Kind of Workbook
Available Tchotchkes (1) Life. Ring Lapel Pin
The End
Скачать презентацию Life Ring An Introduction for Addiction Professionals By
f2cbd7350257d2654aebe70cfc02d019.ppt