EXIT FROM TREATMENT: Strategies A short talk by Tim Leighton Director of Professional Education & Research, Action on Addiction. Recovery from Addiction Conference: Bridging the Gap between Policy and Practice. Chester, April 29 2014. Exit from treatment.
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EXIT FROM TREATMENT: Strategies
A short talk by
Director of Professional Education & Research, Action on Addiction
1.Discontinuing prescribed treatment
Withdrawal period Motivation
Cravings ‘Fed up with lifestyle’
Vulnerability (e.g. mood, drug offers) Proud of achievement
May still be around drug use (cutting down or stopping)
Previous failed attempts
2. Coming out of residential treatment
Have to face ‘triggers’ Fully detoxed
Loss of 24 hour support A lot of ‘recovery training’
Possible loneliness new potential/actual friends
Pull of old friends/places Proud of achievement
Vulnerability (e.g. Mood, drug offers)
Previous failed attempts
Desistance (stopping) vs. maintainance (staying stopped)
Reported desistance factors ‘Quite a lot’ or ‘a lot’
Fed up with lifestyle 89.5%
Psychological health factors 58.5%
Family pressure, criminal justice, physical health problems cited by 40-50%
Reported maintenance factors ‘Quite a lot’ or ‘a lot’ ‘Not at all’
Moving away from drug-users 83.5%
Having reasonable accommodation 72%
Support from friends 65%
Religious or spiritual beliefs 58.4% 31.3%
Info on this slide from Best et al. (2008) Breaking the habit.
Similar factors are found in other studies.
Self-efficacy (confidence that I can remain drug/alcohol free)
Negative affect self-efficacy: confidence that I can stay drug free even if I am feeling bad.
Social self-efficacy: confidence that I can stay drug-free in social situations.
2. Changes in Social Network
Breaking away from using friends
Increased association with drug-free friends
maybe not always religious practices, but meaningful activities, renewed values, caring about life, self and others, connectedness etc.
Recovery addresses a person’s ultimate concerns
“I didn’t know what I liked – I knew I liked drugs and money but I couldn’t think of anything else”
Everyone knows feelings are important in recovery
In the rather little known DTORS qualitative study participants often mentioned shame and other painful feelings as crucial to relapsing.
Margaret Archer describes ‘human emotions’ as ‘commentaries on a person’s ultimate concerns’
“I get help from my drugs worker who suggests I go to the Job Centre. We work on skills like filling in forms but when I get to the centre I get emotionally overwhelmed and after a while I just walk out.”
Shame, feelings of failure, feeling less than others
Who are we in relation to society?
Our values, what we do, what we are concerned with
How we develop our lives in relation to an identity or role which is available to us in the society we live in.
It would be possible to develop an identity project as an artist, an academic, a parent etc., maybe a combination of these.
They provide values and ways of living.
Identities are profoundly related to our emotional lfe
Major vulnerability in exiting treatment
In my view: disconnection leading to overwhelming negative emotions.
The old identity as a drug user is available to manage this.
People exiting treatment would benefit from understanding that recovery is an identity project.
Negative feelings can be tolerated if you care enough.
Caring about things comes from being part of a social group which supports your evolving identity.
There are lots of versions of recovery
See for example: Livingston, W., Baker, M., Jobber, S., & Atkins, B. (2011). A Tale of the Spontaneous Emergence of a Recovery Group and the Characteristics That Are Making It Thrive: Exploring the Politics and Knowledge of Recovery. Journal of Groups in Addiction & Recovery, 6(1-2), 176-196.
Some are more publically visible, others are more private.
The basic mechanisms probably don’t vary that much.
Having a strong identity as a recovering person does not prevent individuality and creativity.