Term Paper: Relapse Prevention Therapy Breaks Down

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[. . .] The recovering person must learn about the addiction and recovery process (Gorski and Kelley, 2003). He or she must separate from friends who use and build relationships that support long-term recovery (Gorski and Kelley, 2003). This may be a very difficult time for criminal justice patients who have never associated with people with sobriety-based lifestyles (Gorski and Kelley, 2003).

They also need to learn how to develop recovery-based values, thinking, feelings, and behaviors to replace the ones formed in addiction (Gorski and Kelley, 2003). The thoughts, feelings, and behaviors developed by people with criminal lifestyles complicate and hinder their involvement in appropriate support programs during this period (Gorski and Kelley, 2003). Major intervention to teach the patient these skills is necessary if he or she is to succeed, and this period can be expected to last for 1-2 years (Gorski and Kelley, 2003).

The primary cause of relapse during the early recovery period is the lack of effective social and recovery skills necessary to build a sobriety-based lifestyle (Gorski and Kelley, 2003).

Middle Recovery Period: middle recovery is marked by the development of a balanced lifestyle: during this stage, recovering people learn to repair past damage done to their lives (Gorski and Kelley, 2003).

The recovery program is modified to allow time to re-establish relationships with family, set new vocational goals, and expand social outlets (Gorski and Kelley, 2003). The patient moves out of the protected environment of a recovery support group to assume a more mainstream and normal lifestyle (Gorski and Kelley, 2003). This is a time of stress as a person begins applying basic recovery skills to real-life problems (Gorski and Kelley, 2003).

The major cause of relapse during the middle recovery period is the stress of real-life problems (Gorski and Kelley, 2003).

Late recovery period: during late recovery, a person makes changes in ongoing personality issues that have continued to interfere with life satisfaction (Gorski and Kelley, 2003). In traditional psychotherapy, this is referred to as self-actualization (Gorski and Kelley, 2003). It is a process of examining the values and goals that one has adopted from family, peers, and culture (Gorski and Kelley, 2003). Conscious choices are then made about keeping these values or discarding them and forming new ones. In normal growth and development, this process occurs in a person's mid-twenties (Gorski and Kelley, 2003). Among people in recovery, it does not usually occur until between 3-5 years into the recovery process, no matter when recovery begins (Gorski and Kelley, 2003).

For criminal offenders, this is the time when they learn to change self-defeating behaviors that may trigger a return to alcohol or drug use (Gorski and Kelley, 2003). These self-defeating behaviors often come from psychological issues starting in childhood, such as childhood physical or sexual abuse, abandonment, or cultural barriers to personal growth (Gorski and Kelley, 2003).

The major cause of relapse during the late recovery period is either the inability to cope with the stress of unresolved childhood issues or an evasion of the need to develop a functional personality style (Gorski and Kelley, 2003).

Maintenance Stage: the maintenance stage is the life-long process of continued growth and development, coping with adult life transitions, managing routine life problems, and guarding against relapse (Gorski and Kelley, 2003). The physiology of addiction lasts for the rest of a person's life (Gorski and Kelley, 2003). Any use of alcohol or drugs will reactivate physiological, psychological, and social progression of the disease (Gorski and Kelley, 2003).

The major causes of relapse during the maintenance stage are the failure to maintain a recovery program and encountering major life transitions (Gorski and Kelley, 2003).

Sticking Points in Recovery (Gorski and Kelley, 2003)

Although some patients progress through the stages of recovery without complications, most chemically dependent people do not (Gorski and Kelley, 2003). They typically get stuck somewhere (Gorski and Kelley, 2003). A "stuck point" can occur during any period of recovery, and usually it is caused either by lack of skills or lack of confidence in one's ability to complete a recovery task (Gorski and Kelley, 2003). Other problems occur when the recovering person encounters a problem (physical, psychological, or social) that interferes with his or her ability to use recovery supports (Gorski and Kelley, 2003).

When recovering people encounter stuck points, they either recognize they have a problem and take action, or they lapse into the familiar coping skill of denial that a problem exists (Gorski and Kelley, 2003). Without specific relapse prevention skills to identify and interrupt denial, stress begins to build (Gorski and Kelley, 2003). Eventually, the stress will cause the patient to cope less and less well: this will result in relapse (Gorski and Kelley, 2003).

The Developmental Model of Recovery Compared With Traditional Models (Gorski and Kelley, 2003)

Traditional models of treatment are based on the idea that once a person is detoxified, he or she can fully participate in the treatment process (Gorski and Kelley, 2003). Although this is true for many patients in the early stages of addiction, who have had functional lives before their addiction progressed, it is not true for most of the criminal justice population (Gorski and Kelley, 2003). In addition, most traditional programs have a program format that is applied to all people regardless of their education, personality, or social skills: patients whose needs fit within the program usually do well, but those whose needs do not fit, such as criminal justice patients, generally do not do well (Gorski and Kelley, 2003).

The DMR recognizes that there are abstinence-based symptoms of addiction that persist well into the recovery process (Gorski and Kelley, 2003). These symptoms are physical and psychological effects of the disease of chemical dependency (Gorski and Kelley, 2003). In the DMR, these symptoms must be stabilized and the patient must be taught how to manage them before general rehabilitation can take place (Gorski and Kelley, 2003). This model identifies the specific symptoms that a patient needs to overcome (Gorski and Kelley, 2003).

This model also contains methods and techniques that recognize the learning needs, psychological problems, and social skills of the patient (Gorski and Kelley, 2003).

Post-Acute Withdrawal (Gorski and Kelley, 2003)

Some of the symptoms of withdrawal from alcohol or drugs are the result of the toxic effects of these chemicals on the brain (Gorski and Kelley, 2003). These symptoms are called Post Acute Withdrawal (PAW), which is more severe for some patients than it is for others (Gorski and Kelley, 2003). Other factors cause stress that aggravates PAW (Gorski and Kelley, 2003). Below is a list of conditions affecting the criminal justice population that tend to worsen the damage and aggravate PAW (Gorski and Kelley, 2003).

Physical conditions that worsen PAW through increased brain damage or disrupted brain function: Combined use of alcohol and drugs or different types of drugs; Regular use of alcohol or drugs before age 15 or abusive use for a period of more than 15 years; History of head trauma (from car accidents, fights, falling, etc.); Parental use of alcohol or drugs during pregnancy; Personal or family history of metabolic disease such as diabetes or hypoglycemia; Personal history of malnutrition, usually due to chemical dependence; Physical illness or chronic pain (Gorski and Kelley, 2003).

Psychological and social conditions that worsen PAW include: Childhood or adult history of psychological trauma (participant in or victim of sexual or physical violence); Mental illness or severe personality disorder; High stress lifestyle or personality; High stress social environment (Gorski and Kelley, 2003).

Addictive Preoccupation (Gorski and Kelley, 2003)

The other major area of abstinence-based symptoms is addictive preoccupation (Gorski and Kelley, 2003). This consists of the obsessive thought patterns, compulsive behaviors, and physical cravings caused or aggravated by the addiction (Gorski and Kelley, 2003). These behaviors become programmed into the patient's psychological processes by the addiction (Gorski and Kelley, 2003). They are automatic and can cause the recovering patient to return to use unless he or she has specific training to identify and interrupt them (Gorski and Kelley, 2003).

Addictive preoccupations are activated by high-risk situations and stress: because of the environment surrounding most criminal justice patients, they often experience high-risk situations and stress (Gorski and Kelley, 2003). These situations and stresses can include: Exposure to alcohol or drugs or associated paraphernalia; Exposure to places where alcohol or drugs are used; Exposure to people with whom the patient has used in the past or people the patient knows who are actively using; Lack of a stable home environment; Lack of a stable social environment; Lack of stable employment (Gorski and Kelley, 2003).

Traditional treatment focuses on either detoxification alone or detoxification with movement into a rehabilitation program aimed at changing the patient's lifestyle (Gorski and Kelley, 2003). Programs are similar for all patients, and many programs omit teaching the specific stabilization skills that are necessary before lifestyle rehabilitation can take place (Gorski and Kelley, 2003).

The DMR first stabilizes patients so that they can take advantage of lifestyle rehabilitation (Gorski and… [END OF PREVIEW]

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