Persons in treatment at Herrington have addiction. Herrington provides professional treatment to persons

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1 Why AA? For Patients in Residential Treatment at the Herrington Recovery Center Medical Director Herrington Recovery Center Rogers Memorial Hospital Persons in treatment at Herrington have addiction Herrington provides professional treatment to persons who have not achieved their goals via self-help or via professional treatment at a less intensive level of care. Persons with addiction may try to quit on their own, or reduce their use so they don t experience problems, or they may seek professional treatment: 1:1 visits with a counselor, doctor, or mental health professional; or enrollment in an IOP or PHP or in another residential program Rogers Memorial Hospital 1

2 ASAM Public Policy Statement on Alcoholism as a Primary Disease Based on many years of clinical experience, reinforced by recent and continuing research into the genetic, biochemical and physiological aspects of the effects of alcohol on living systems and of alcoholics and their families, the American Society of Addiction Medicine finds that alcoholism is a complex primary physiological disease, and neither a primary behavior disorder nor a symptomatic manifestation of any other disease process. Adoption Date: October 1, 1983; revised October 1, 1996 When the disease is still active When substance use is still happening and the person doesn t exhibit control over their use When problems due to use keep accumulating When addressing the problem yourself hasn t worked When other professional help hasn t worked then, people come to Herrington at Rogers Rogers Memorial Hospital 2

3 So, why so much emphasis on AA? Residents at Herrington attend AA or NA almost nightly Residents attend meetings on campus these are open meetings including persons from the community, but are almost like institutional meetings established for persons in inpatient/residential treatment Other Rogers patients attend as well: from other residential and IOP programs, or from inpatient psychiatry unit or inpatient eating disorders unit Why not just do professional treatment without all the involvement in 12-Step groups (which are NOT professional treatment)? AA is a supplement to treatment It is for recovering people, and offered by recovering people, without a trained professional to lead the group, without any charges or documentation It is NOT treatment. It promotes recovery. Rogers Memorial Hospital 3

4 Who is AA for? Not just for persons with addiction Not just for persons who identify themselves (admit it) that they have addiction The only criterion for attendance: A person with a desire to stop drinking. (or, for N.A., using. ) It s for persons not pursing professional treatment. It s for persons pursing professional treatment. (It can help treatment work better!) What are we trying to accomplish through Professional Treatment? ASAM Public Policy Statement on Treatment for Alcohol and Other Drug Addiction Addiction Treatment is the use of any planned, intentional intervention in the health, behavior, personal and/or family life of an individual suffering from alcoholism or from another drug addiction, and which is designed to enable the affected individual to achieve and maintain sobriety, physical, spiritual and mental health, and a maximum functional ability. Addiction Treatment services are professional healthcare services, offered to a person diagnosed with addiction, or to that person s s family, by an addiction professional. Addiction professionals providing addiction treatment services are licensed or certified to practice in their local jurisdiction and may be nationally certified by a professional certification body for their professional discipline. Adopted by ASAM Board of Directors May 1980; revised September 1986, October 1997, July 2001, October 2009, and January Rogers Memorial Hospital 4

5 Targeted Therapeutic Changes in Addiction Treatment BEHAVIORAL CHANGES Eliminate alcohol and other drug use behaviors Eliminate other problematic behaviors Expand repertoire of healthy behaviors Develop alternative behaviors Identify triggers for using behaviors/relapses BIOLOGICAL CHANGES Resolve acute alcohol l and other drug withdrawal symptoms Physically stabilize the organism Develop sense of personal responsibility for wellness Initiate health promotion activities (e.g., diet, exercise, safe sex, sober sex) Address cravings through medical interventions (treatment medications) Targeted Therapeutic Changes in Addiction Treatment COGNITIVE CHANGES Increase awareness of illness Increase awareness of negative consequences of use Increase awareness of addictive disease in self Decrease denial AFFECTIVE CHANGES Increase emotional awareness of negative consequences of use Increase ability to tolerate feelings without defenses Manage anxiety and depression Manage shame and guilt Rogers Memorial Hospital 5

6 Targeted Therapeutic Changes in Addiction Treatment SOCIAL CHANGES Increase personal responsibility in all areas of life Increase reliability and trustworthiness Become resocialized: reestablished sober social network Increase social coping skills: with spouse/partner, with colleagues, with neighbors, with strangers SPIRITUAL CHANGES Increase self-love/esteem; decrease self-loathing Reestablish personal values Enhance connectedness Increase appreciation of transcendence Taken from: Miller, Michael M. Principles of Addiction Medicine, 1994; published by American Society of Addiction Medicine, Chevy Chase, MD What can AA do for you? Follow the Steps 1. We admitted we were powerless over alcohol that our lives had become unmanageable. 2. Came to believe that a Power greater than ourselves could restore us to sanity. 3. Made a decision to turn our will and our lives over 4.Made a searching and fearless moral inventory of ourselves. 5. Admitted the exact nature of our wrongs (and stated this openly to another human begin) 6. Were entirely ready to have all these defects of character [removed]. 7. [Humbly asked to have these shortcomings removed ]. 8. Made a list of all persons we had harmed, and became willing to make amends to them all. 9. Made direct amends to such people wherever possible, except when to do so would injure them or others. Rogers Memorial Hospital 6

7 Readiness for Change Stages of Change Precontemplative Contemplative Preparation Action Maintenance [Motivational Enhancement Therapy] Downward Spiral / Progression Addi Addiction (constriction of affects, behaviors, social network) Rogers Memorial Hospital 7

8 Atrophy Of social network People Of activities / interests Places, Things Of emotions Flatness, less expressive, dysthymic / alexithymic Everything is anger/resentment Of rewards Salience Downward Spiral of Addiction and Upward Spiral of Recovery Addiction (constriction of affects, behaviors, social network) Recovery (expansion of feelings, rewards, activities, social connections) Copyright (c)2011, Covington, Griffin, & Dauer Rogers Memorial Hospital 8

9 How to come out of the depths? How to RECOVER? Re-people-ization AA Sponsor Church Social clubs Activities with others Family Professional Treatment (group therapy, meet others) Re-Connectedness So What Can AA Give Us? A place to go (structured daily activity) Something on your daily schedule Accountability to be somewhere Be reliable: keep your promises A place to be A supportive physical environment A place that is alcohol/drug free Separation from people/places/things l /thi that t are unhealthy People to be with A group of folks you can identify with Identify similarities to others, not focus on differences Find real-life examples of persons who are succeeding Rogers Memorial Hospital 9

10 So What Can AA Give Us? People to be with Whenever two or more are gathered Overcome isolation Supportive recovery environment (people support your abstinence vs. oppose/sabotage it) People to listen be there with you on your journey Accept, not criticize, not debate, not berate No cross talk : people talk, people listen So What Can AA Give Us? A Group even if it s not a professionally-led psychotherapy group it s different from professionally-directed group therapy, where a therapist might provide active advice (vs. the feedback that comes in the hallways at an AA clubhouse after a meeting) but the curative factors seen in professionally-led groups, can happen in AA groups Rogers Memorial Hospital 10

11 Irvin Yalom's Curative Factors of Group Treatment Instillation of Hope - faith that the treatment mode can and will be effective. Universality - demonstration that we are not alone in our misery or our "problems". Imparting of information - didactic instruction about mental health, mental illness, psychodynamics or whatever else might be the focal problem of the group (Ex. ACOA, Alanon; learning about the disease process itself). Altruism - opportunity to rise out of oneself and help somebody else; the feeling of usefulness; get out of yourself; give back Corrective recapitulation of primary family group - experiencing transference relationships growing out of primary family experiences, providing the opportunity to relearn and clarify distortions. The Theory and Practice of Group Psychotherapy, 4th Ed., Irvin Yalom's Curative Factors of Group Treatment Direct Advice - receiving and giving suggestions for strategies for handling problems. Interpersonal learning - receiving feedback from others and experimenting with new ways of relating. Development of socializing techniques - social learning or development of interpersonal skills Imitative behavior - taking on the manner of group members who function at a higher level el (model the experienced ones) Catharsis - opportunity for expression of strong emotions Existential factors - recognition of the basic features of existence through sharing with others (e.g. ultimate aloneness, ultimate death, ultimate responsibility for our own actions). Rogers Memorial Hospital 11

12 Treatment can make AA work better! Twelve Step Facilitation treatment /Vie ention asp The principles include acknowledging that willpower alone cannot achieve sustained sobriety, that surrender to the group conscience must replace self-centeredness, and that long-term recovery consists of a process of spiritual renewal. Therapy focuses on two general goals: (1) acceptance of the need for abstinence from alcohol and other drug use and (2) surrender, or the willingness to participate actively in 12-Step fellowships as a means of sustaining sobriety. Treatment can make AA work better! The TSF counselor assesses the client's alcohol or drug use, advocates abstinence, explains the basic 12-step concepts, and actively supports and facilitates initial involvement and ongoing participation in AA. The counselor also discusses specific readings from the AA/NA literature with the client, aids the client in using AA/NA resources in crisis times, and presents more advanced concepts such as moral inventories. A key is for the therapist to ask follow-up questions to the patient about their experiences when they attend AA meetings, what s working for them, what barriers they are experiencing. Setting goals is important: Are you attending the number of meetings you said you would? Are you talking with a sponsor? Are you talking with people you got phone numbers from? Are you talking when you attend, or just saying I pass? Rogers Memorial Hospital 12

13 So What Can AA Give Us? A place for re-people-ization and to establish a new Social Network of sober/recovering people! A place to try out new things SAY SOMETHING, get out of your shell, break the No Talk rule of your family of origin A place to ASK FOR HELP from someone else It s not all me Help comes from outside, to turn it over How Does it Work? Fake it till you make it Just Do It! (Nike) Show Up! (attend; establish the habit/regimen) Talk! Be a participant in A.A. Don t just be a spectator at A.A. Don t just pass each time Do SOMETHING different. Take a (healthy) risk. Rogers Memorial Hospital 13

14 How Does it Work? Listen! To the stories To those who have made it vicarious learning modeling Do more than just listen be a part of it! take a risk and share your experiences, what s going on for you this can decrease your shame and guilt as you experience acceptance when you do this, you ll end up being able to identify with others at the level of shared experience. The bottom line like they say around the tables at AA It works only if you work it. How It Works (paraphrased from Chap. 5 of The Big Book) Remember that we deal with alcohol cunning, baffling, powerful! Without help it is too much for us. It s bigger than us. But there is help: outside of yourself, beyond yourself. May you find it now. Half measures availed us nothing. We stood at the turning point. We asked our Higher Power for protection and care, with complete abandon. Rogers Memorial Hospital 14

15 AA is a Spiritual Program of Recovery What does this mean????????? Does this mean being religious? Does this mean I have to believe in God? Have a religious faith Not be agnostic or atheistic ASAM Definition of Addiction Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. Addiction is a Bio-Psycho-Social-Spiritual Disease Rogers Memorial Hospital 15

16 ASAM Definition The orientation of the ASAM work group was that the spiritual dimension could be looked at as describing the basic values which give meaning to a person s life and which provide a framework for a human being s relationship beyond oneself and with the transcendent. Mayo Foundation for Medical Education and Research Spirituality has many definitions, but at its core spirituality helps give our lives context. It s not necessarily connected to a specific belief system or even religious worship. Instead, it arises from your connection with yourself and with others, the development of your personal value system and your search for meaning in life. For many, this takes the form of religious observance,,prayer, meditation or a belief in a higher power. For others, it can be found in nature, music art or a secular community. Spirituality is different for everyone. Rogers Memorial Hospital 16

17 Recovery and Connectedness Connectedness to self Connectedness to others Connectedness to a greater whole Get out of your emptiness/your hole Get out of your self Recovery is HOPE It s been Hell on earth, but it doesn t have to stay that t way. Unmanageability can be replaced by sanity. Yes, it can happen to you. Yes, it s a gift. An attitude of gratitude helps. Rogers Memorial Hospital 17

18 AA Works! Persons who have long-term recovery Regular/long-term attendees of AA are over-represented among those in long-term recovery Some persons can do it on their own Strong-willed; will-power This actually isn t that common Fellowship is the key plus some accountability to others as well as yourself Rogers Memorial Hospital 18

19 Evidence for 12-Step Facilitation Dennis M. Donovan, Ph.D. Alcohol & Drug Abuse Institute and Department of Psychiatry & Behavioral Sciences University of Washington Dennis M. Donovan, Ph.D. Alcohol & Drug Abuse Institute And Department of Psychiatry & Behavioral Sciences University of Washington NIDA Blending Conference, Blending Addiction Science & Treatment: The Impact of Evidence-Based Practices on Individuals, Families, and Communities. Cincinnati, OH, June, 2008 NIDA Blending Conference, Blending Addiction Science & Treatment: The Impact of Evidence-Based Practices on Individuals, Families, and Communities. Cincinnati, OH. June, 2008 Results from Previous Research on 12-Step Involvement AA and NA participation is associated with greater likelihood of abstinence, improved social functioning, and greater self-efficacy 12-Step self-help groups significantly reduce health care utilization and costs Combined 12-Step and formal treatment leads to better outcomes than found for either alone Engaging in other 12-Step group activities seems more helpful than attending meetings. Donovan, NIDA Blending Conference, June 2008 Rogers Memorial Hospital 19

20 Results from Previous Research on 12-Step Involvement Consistent and early attendance/involvement leads to better substance use outcomes Even small amounts of participation may be helpful in increasing abstinence, whereas higher doses may be needed to reduce relapse intensity Reductions in substance use associated with 12-Step involvement are not attributable to potential third variable influences such as motivation, psychopathology, or severity. Donovan, NIDA Blending Conference, June 2008 Abstinence Rates at 1-Year Follow-Up as a Function Post treatment 12-Step Group Attendance 80 Percent Abstinent None (n = 1326) (n = 614) (n = 570) (n = 506) Number of Meetings Attended. Donovan, NIDA Blending Conference, June 2008 x 2 = 248.3, p <.001 Moos, et al., 1999 Rogers Memorial Hospital 20

21 Abstinence Rates at 8-Year Follow-Up by Duration of 12-Step Meeting Attendance in the First Year x 2 = 25.5, p <.01 Percent Abstinent None (n = 201) (n = 89) (n = 89) (n = 94) Weeks of Participation in 12-Step Groups. Donovan, NIDA Blending Conference, June 2008 Moos, et al., 2004 Abstinence Rates at 8 Years by Duration of Meeting Attendance in Years 2 to 8 Percent Abstinent None (n = 128) (n = 43) (n = 39) (n = 62) Months of Additional Participation in AA. Donovan, NIDA Blending Conference, June x 2 = 28.3, p <.01 Moos, et al., 2004 Rogers Memorial Hospital 21

22 Drug and Alcohol Use (During the 6 Months Prior to 24-Month Post-treatment Follow-Up) as a Function of Frequency of Attendance at 12-Step Groups ubjects Reporting Any Use % S (n Yes = 128) (n No = 134) (n = Yes 103) (n = No 25) Any 12-Step Participation Weekly or More Frequent Participation. Donovan, NIDA Blending Conference, June ** *** * *** Drug Use Alcohol Use * p <.05 ** p <.01 *** p <.001 Fiorentine, 1999 Drug and Alcohol Abstinence (During the 6 Months Prior to 24-Month Post-treatment Follow-Up) as a Function of Frequency of Attendance at 12-Step Groups Use tinent from Drug and Alcohol in Prior 6 Months % Abst Never Less than Weekly Weekly (n = 134) (n = 25) (n = 103) 12-Step Meeting Attendance Drug Use Alcohol Use Fiorentine, Donovan, NIDA Blending Conference, June 2008 Rogers Memorial Hospital 22

23 Percentage of Persons Abstinent at Both 6- and 12-Month Follow-Ups, Based on Self-Help Group Meeting Attendance Percent Abstinent No Yes No Yes At least 1 Meeting At least 1 Meeting per Week. Donovan, NIDA Blending Conference, June 2008 Timko & DeBenedetti, 2007 Do People Use 12-Step Support During or After Treatment? 75% of persons with alcohol use disorders entering residential treatment reported they had attended AA meetings previously. However, only 16% indicated that they had ever worked any of the 12 Steps. Despite strong encouragement to attend, 30% of persons with cocaine use disorders receiving outpatient treatment and 40% of those discharged from inpatient treatment reported that they had attended 12-Step groups.. Donovan, NIDA Blending Conference, June 2008 Rogers Memorial Hospital 23

24 Jones would walk through a blizzard to score his dope. The question remains: What will he do to get to a meeting?. Donovan, NIDA Blending Conference, June What do we expect at Herrington? That you ll TRY IT That you won t say AA sucks, it s not for me without t having had your own personal experience with it That you ll experience different groups That you ll take risks and go on your own to new groups That you ll have some experience with the sponsorsponsee relationship before you leave That you ll attend AA in your home area and, ideally, secure a local sponsor, before you leave the structured/protected environment of residential treatment. Rogers Memorial Hospital 24

25 Is it just AA? No, but we think you need to engage and participate in something that can do for you what AA can do Other 12-Step programs Narcotics Anon, Cocaine Anon, Nicotine Anon, Gambling Anon, Sex Addicts Anon, Overeaters Anon Alanon Adult Children of Alcoholics (ACOA) groups Rational Recovery (RR) / SMART Recovery Summary Do something every day to affirm your recovery (admit your disease, commit to change) Establish a routine, a set of healthy behaviors Get outside of yourself; don t go it alone It s available everywhere Phone number lists for people in your home group When out of town, you can go (plan ahead) When in crisis: if it s not unfamiliar to you, you re more likely to use it Rogers Memorial Hospital 25

26 What can AA do for you? How to live the Steps 1. ADMIT IT your life wasn t as rosy as you were making it out to be, you and others were being hurt; you were NOT handling it 2. The source of your life s unmanageability is no mystery: it s your pathological pursuit or reward or relief, your drug 3. Trying to overcome it by the sheer force of your will, generally won t work--and it ll leave you disappointed/frustrated and your loved ones not trusting your declarations and platitudes 4. There is hope and getting outside of yourself is a path, and doing it different Acceptance. Willingness. Readiness to change. Actually changing. Admitting what you have done that you could have done differently/ better. Being fully prepared to behave differently Actually changing what you do. Have regrets, say you re sorry, make amends. Changing how you deal with your feeling life be aware of your feelings, let yourself experience them, let yourself show them Changing how you relate to others. Getting connected with yourself, with others, and with the larger whole (H.P.) A bit of history From Alcoholics Anonymous, the Big Book of A.A. A Rogers Memorial Hospital 26

27 Foreword to First Edition PRECISELY HOW WE HAVE RECOVERED Better understand the alcoholic The alcoholic is a very sick person Anonymity Non alliance Foreword to the Second Edition By 1955 a miracle has happened 6,000 groups; 150,000 members The two elements of recovery Carry the message alcoholic to alcoholic Spiritual principles A brief history of the early days Rogers Memorial Hospital 27

28 Foreword to the Third Edition By 1976 over 1,000,000 members and 28,000 groups At its core it remains simple and personal. One alcoholic talks to another alcoholic sharing experience strength and hope. Thank you!, FASAM, FAPA Medical Director Herrington Recovery Center Rogers Memorial Hospital 28