Utilizing the Recovery
Model In Concurrent
Disorders Treatment
Chondrena Vieira-Martin, M.A.,
R.S.W., Manager, Concurrent
...
The Recovery Model
 The conceptualization of the road back from
substance abuse and dependence has a long
history in addi...
re-cov-er-y :wisdom from the
dictionary
noun Definition: 1. return to health: the return to normal health
of somebody who ...
re-cov-er-y
 The process of getting back something
lost, especially health, ability, possessions
etc. Cambridge Advanced ...
Recovery
 These literal definitions reflect ideas of
changes in state and process and exist in
both medical, 12-step, and...
Mental Health
 Mental health has most traditionally adopted a
medical model of care.
 While changes are occurring in the...
Medical treatment model
 Medical model is the term cited by psychiatrist
Ronald D. Laing* for the "set of procedures in
w...
The Medical Model
 The medical model in mental health can come under
criticism in that illness is defined behaviourally v...
Psychosocial recovery/Recovery
Model
 Psychosocial recovery, or the
Recovery Model, refers to the process of
recovery fro...
Recovery Model
 Recovery has been defined as "an
individual’s journey of healing and
transformation to live a meaningful ...
Recovery Model
 The concept of recovery in mental health
emerged from deinstitutionalization
which resulted in more indiv...
Recovery
 The psychosocial recovery model has been supported by
evidence from both quantitative and qualitative research....
Contrast Models
 Symptoms and
syndromes
 Pathology
 Diagnosis directs
treatment
 Journey of healing
and transformation...
Where are we now
 Movement in mental heath towards
recovery oriented consumer movement
 Significant amount of treatment ...
What does this mean in practice
 Differing views of the role of the patient
 Differing views of the role of the worker
...
Role of patient/client
 Who’s the boss
 Collaborative vs expert
 Someone to be treated versus someone
who is being prov...
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 ...
Primacy of Interventions
 Activity interventions versus process
interventions
 Changes in medication
 Referrals
 Engag...
Symptom Alleviation/Primacy
 Primary goal
 One step in a process (possibly not first step)
 Non-alleviation of symptoms...
Integrated treatment
 Clear evidence of benefits to integrated
treatment
 Treating the same client and expecting
differe...
Working Together
 Recognize and articulate as such differences in
philosophy
 Explain rationale for responses
 Use rela...
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Utilizing the Recovery Model In Concurrent Disorders Treatment

  1. 1. Utilizing the Recovery Model In Concurrent Disorders Treatment Chondrena Vieira-Martin, M.A., R.S.W., Manager, Concurrent Disorders Program, ADAPT
  2. 2. 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.
  3. 3. 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 injured 2. return to normal state: the return of something to a normal or improved state after a setback or loss 3. gaining back of something lost: the regaining of something lost or taken away 4. 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 habit Encarta® World English Dictionary [North American Edition] © & (P)2009 Microsoft Corporation. All rights reserved. Developed for Microsoft by Bloomsbury Publishing Plc.
  4. 4. 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
  5. 5. 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.
  6. 6. 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
  7. 7. 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),
  8. 8. 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.
  9. 9. 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.
  10. 10. 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).
  11. 11. 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
  12. 12. 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.
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. 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
  17. 17. Role of the worker  Expert  Collaborating  Advising  Treating  Coaching  Motivating  Supporting
  18. 18. Chronicity  Beliefs around long-term outcomes  Possibility of full remissions  Role of beliefs in outcomes  Providing care versus assisting process
  19. 19. Primacy of Interventions  Activity interventions versus process interventions  Changes in medication  Referrals  Engagement  Developing Rapport
  20. 20. 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
  21. 21. 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.
  22. 22. 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.

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