Model of Recovery Recovery Housing through the Social ...
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• Preventing and Addressing Relapse in Recovery Housing through the Social Model of Recovery Jason Howell, MBA, PRS
Transcript of Model of Recovery Recovery Housing through the Social ...
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Preventing and Addressing Relapse in Recovery Housing through the Social
Model of Recovery
Jason Howell, MBA, PRS
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Social Model Review
NARR’s Recovery Residence Levels of Support
I II III IV
Housing
Social Model Recovery
Formalized Recovery Support
Life Skills Dev’
Clinical
What is Social Model Recovery?
A recovery-oriented, chronic care approach to substance use disorders:
● Philosophy and practices are different than medical/clinical based treatment models
● Emphasizes social and interpersonal aspects of recovery using recovery as the common bond
● Values experiential knowledge and mutual support
● Views recovery as a person-drive, life-long and holistic process
Where did the Social Model come from?
● Social Model Programs emerged out of AA in the 1940s and continued to evolve to include a range of recovery residences and non-residential community centers (Borkman)
● Elements can be traced to back to Washingtonian recovery housing in the 1840s
● Predecessor to today’s addiction treatment● Modern recovery movement is stimulating a Social Model
renaissance and further evolving the model
Why the Social Model?
● Addiction is a chronic illness in need of a chronic care approach including Social Model Recovery
● Acute, episodic treatment: 50 to 69% of individuals relapse w/i 12 months
● Most return from treatment to environments that enable addictive lifestyles
● Social Model programs are a cost effective means matching needs across the a continuum of support
How is it measured?
Social Model Philosophy Scale (SMPS)● Assessment tool used to capture treatment program
philosophies overtime
● 33 items across 6 domains:1. Physical environment2. Staff role3. Authority base4. Recovery orientation*5. Governance6. Community orientation
(Kaskutas et. al. 1998)
To what degree does it feel like a home?
● Architecturally and functionally homelike
● Community space (%)● Everyone pitches in as a
family, e.g. food prep or house chores
The physical space of a social model program is vital. It must promote interaction between staff and participants and each other. Social model environments feel more like homes rather than clinical settings.
SMRS Domain: Physical Environment
SMRS Domain: Staff Role
Social model programs encourage staff to mingle with participants. Some of the best insight, feedback and interactions happen in an informal or community setting.
To what degree are staff respected peers vs. distant superiors?
● Community meals● Staff’s time is spent amongst the
residents● Resident progress is rewarded
with more responsibility
SMRS Domain: Authority base
Social model programs by enlarge employ persons in recovery (often alumni), believing recovery imparts experiential knowledge, an invaluable resource. Professional knowledge is not valued over experiential knowledge
To what degree is authority based on lived experience?
● Staff that are alumni and/or in recovery
● Key roles that don’t require professional credentials
● Mutual aid / social support is encourage
SMRS Domain: Recovery-orientation
Social models programs have a recovery-oriented view and approach understanding that recovery is person-drive, lifelong and a “whole-person” process. Plus, alcohol and drugs are only a part of the problem.
To what degree is the program recovery-oriented?
● Called recovery programs, residences or centers
● Called residents or participants● Have recovery plans
SMRS Domain:Governance
Social model programs utilizes peers to establish and enforce program rules in a significant way. Participants will feel more invested in the program and their own recovery and get to develop skills.
To what degree does accountability involve peers?
● Residents are expected/encouraged to hold each other accountable
● Residents/councils have influence
SMRS Domain:Community-oriented
Social model program recognize that individuals must learn how to reach out and connect with a web of support in the community including friends, mentors, social activities, employments.
To what degree is the community viewed as a resource?
● Recovery community is invited● Residents have mentor/Sponsor● Link residents to outside
services● Host recovery events
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Relapse Prevention
What are the causes of relapse?
● Withdrawal symptoms (anxiety, nausea, physical weakness)
● Post-acute withdrawal symptoms (anxiety, irritability, ….)
● Poor self-care (stress management, eating, sleeping)
● People (old using friends)
● Places (where you used or where you used to buy drugs)
● Things (that were part of your using, or that remind you of)
● Uncomfortable emotions (H.A.L.T.: hungry, angry, lonely, tired)
● Relationships and sex (can be stressful if anything goes wrong)
● Isolation (too much time to be with your own thoughts)
● Pride and overconfidence
The “relapse” before the relapse
Stages of Relapse• Emotional • Mental • Physical
Terence Gorski. Gorski, T., & Miller, M., Staying Sober: A Guide for Relapse Prevention: Independence Press, 1986.
The “relapse” before the relapse
Emotional Relapse• Emotions are setting up a relapse
Strategies: Selfcare
Terence Gorski. Gorski, T., & Miller, M., Staying Sober: A Guide for Relapse Prevention: Independence Press, 1986.
The “relapse” before the relapse
Mental RelapseMentally glamorizing, ruminating, experiencing…
Strategies: • “Play the tape through”, What are the consequences?• Tell someone• Distract yourself• Wait for 30 minutes• “One day at a time”
The “relapse” before the relapse
Physical Relapse Using
Strategies:• Maybe difficult to stop, but seek help
Terence Gorski. Gorski, T., & Miller, M., Staying Sober: A Guide for Relapse Prevention: Independence Press, 1986.
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Reframing Relapse from a Social Model Recovery
Perspective
What’s wrong with this picture?
Thinking and speaking in terms of “Relapse Prevention”1. Promotes moral framework, shame and stigma2. Promotes cultural pessimism, loss of hope3. Focus on deficits rather than strengths
(William White, 2017)
Flip the Script
Relapse Prevention to Recovery Management is a shift from:• Pathology/treatment paradigms to a recovery
paradigm• “Recovering from” to “Recovering to”• What we fear to what makes us come alive
(William White, 2017)
Flip the Script
Disease management vs Recovery managementDebt consulting vs Wealth management
Marriage counseling vs Marriage enhancementPrevention of illness vs Promotion of wellness
(William White, 2017)
