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Utilizing the Recovery Model In Concurrent Disorders Treatment

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Utilizing the Recovery Model In Concurrent Disorders Treatment Utilizing the Recovery Model In Concurrent Disorders Treatment Presentation Transcript

  • Utilizing the Recovery Model In Concurrent Disorders Treatment
    Chondrena Vieira-Martin, M.A., R.S.W., Manager, Concurrent Disorders Program, ADAPT
  • The Recovery Model
    The conceptualization of the road back from substance abuse and dependence has a long history in addictions
    This has been greatly influenced by the traditions of 12 step philosophy and the self-help movement
    The mental health field is increasingly recognizing recovery philosophy as a model supported by quantitative and qualitative research.
  • re-cov-er-y :wisdom from the dictionary
    noun Definition: 1. return to health: the return to normal health of somebody who has been ill or injured2. return to normal state: the return of something to a normal or improved state after a setback or loss3. gaining back of something lost: the regaining of something lost or taken away4. extraction: the extraction of a substance or energy from a source, e.g. the reclamation of useful substances from waste or refuse[14th century. < Anglo-Norman recoverie, Old French reco(u)vree< recov(e)rer (see recover)]in re·cov·er·y in the process of recovering from an addiction or other destructive habitEncarta® World English Dictionary [North American Edition] © & (P)2009 Microsoft Corporation. All rights reserved. Developed for Microsoft by Bloomsbury Publishing Plc.
    View slide
  • re-cov-er-y
    The process of getting back something lost, especially health, ability, possessions etc. Cambridge Advanced Learners Dictionary
    the act, process, or an instance of recovering
    The process of combating a disorder or a real or perceived problem Merriam-Webster On-Line
    View slide
  • Recovery
    These literal definitions reflect ideas of changes in state and process and exist in both medical, 12-step, and bio psycho social models of addiction treatment.
  • Mental Health
    Mental health has most traditionally adopted a medical model of care.
    While changes are occurring in the field in North America, this presents a fundamental shift.
    Exploring the medical treatment model may help to understand the degree of transformation this entails and the applications for concurrent disorder treatment
  • Medical treatment model
    Medical model is the term cited by psychiatrist Ronald D. Laing* for the "set of procedures in which all doctors are trained."
    This set includes complaint, history, physical examination, ancillary tests if needed, diagnosis, treatment, and prognosis with and without treatment.
    The medical model is an approach to pathology that aims to find medical treatments for diagnosed symptoms and syndromes.
    *The Politics of the Family and Other Essays (1971),
  • The Medical Model
    The medical model in mental health can come under criticism in that illness is defined behaviourally versus by objective examination of a physical pathology. Research has not shown that patients experiencing mental health problems have pre-existing brain function abnormalities that treatment addresses nor that diagnostic criteria show strong reliability. (Whittaker, Anatomy of an Epidemic, 2010)
    The medical model drives research and theorizing about psychiatric difficulties on a basis of causation and remediation of symptoms. As cause has proved elusive, a focus on symptom alleviation has ensued.
    The consumer/survivor movement has developed in part to drawbacks perceived in a strictly medical model approach.
  • Psychosocial recovery/Recovery Model
    Psychosocial recovery, or the Recovery Model, refers to the process of recovery from mental disorder or substance dependence, and/or from being labeled in those terms.
  • Recovery Model
    Recovery has been defined as "an individual’s journey of healing and transformation to live a meaningful life in a community of his or her choice while striving to achieve maximum human potential” (U.S. Department of Health and Human Services, 2005).
  • Recovery Model
    The concept of recovery in mental health emerged from deinstitutionalization which resulted in more individuals living in community settings .
    Full recovery or integration into the community remained elusive despite these changes
  • Recovery
    The psychosocial recovery model has been supported by evidence from both quantitative and qualitative research. Longitudinal studies have shown that a psychiatric disorder does not necessarily take a course of inevitable deterioration and that, for a significant number of people, a return to full potential is possible.
    Other research, including studies of reports by consumers/survivors of mental health services, has identified resilience and resourcefulness, diverse and individual pathways of healing, and factors which can enhance or detract from recovery.
  • Contrast Models
    Symptoms and syndromes
    Pathology
    Diagnosis directs treatment
    Journey of healing and transformation
    Role of client/patient
    Relief of symptoms viewed as associated with but not entire goal of recovery
  • Where are we now
    Movement in mental heath towards recovery oriented consumer movement
    Significant amount of treatment still provided by staff operating from a medical model of care
    Increasing movements towards integration of addictions and mental health
  • What does this mean in practice
    Differing views of the role of the patient
    Differing views of the role of the worker
    Differing views around chronicity of conditions
    Differing views around the primacy of various interventions i.e. medication versus psycho-social interventions’
    Differing views around primacy of symptom alleviation
    Differing views around responding to changes in symptom presentation
    Differing responses to relapse
    IMPACT ON CLIENT
  • Role of patient/client
    Who’s the boss
    Collaborative vs expert
    Someone to be treated versus someone who is being provided a service
    Passivity versus self-direction
  • Role of the worker
    Expert
    Collaborating
    Advising
    Treating
    Coaching
    Motivating
    Supporting
  • Chronicity
    Beliefs around long-term outcomes
    Possibility of full remissions
    Role of beliefs in outcomes
    Providing care versus assisting process
  • Primacy of Interventions
    Activity interventions versus process interventions
    Changes in medication
    Referrals
    Engagement
    Developing Rapport
  • Symptom Alleviation/Primacy
    Primary goal
    One step in a process (possibly not first step)
    Non-alleviation of symptoms viewed differently
    Inefficacy of treatment versus non-compliance
    Increase in intensity of treatment/type of treatment
    Return of symptoms normalized i.e. relapse part of learning process
  • Integrated treatment
    Clear evidence of benefits to integrated treatment
    Treating the same client and expecting different behavioural roles, with differing treatment objectives, differing responses to changes in symptoms, different responses to relapse is not integrated treatment and is unlikely to produce better incomes.
  • Working Together
    Recognize and articulate as such differences in philosophy
    Explain rationale for responses
    Use relatable explanations (expert opinion, research examples for models)
    Refer to recovery philosophy
    Repeat. Repeat. Repeat.
    Collaborate and support consumer/peer initiatives
    Understand integration is a process as much as recovery is with everyone travelling their own path.