Tag: AA

5 Step and AA/NA

The 5 Step Program and AA/NA

  • Self-examination
  • acknowledgement of character defects
  • restitution for harm done
  • working with others

If you are interested in the 5 Step program, it is important that you understand – and “accept” – the basic philosophies that govern our efforts.

Inpatient Treatment – Detox

  • If you are unable to voluntarily discontinue the use of alcohol or other drugs, you will need to enter a treatment program or participate in a detoxification effort.
    • 5 Step treatment participation is based on your desire, and physiological ability, to stop using alcohol or other drugs.

12 Steps to Sobriety

  • The program design is based on indisputable proof that the 12 Steps of Alcoholics/Narcotics Anonymous work.
    • AA/NA attendance and study are mandatory elements.
      • Claims that the program is religious, members are obnoxious, serves lousy coffee, is boring, inconvenient etc. are irrelevant.
        • Meetings deal with behaviors and attitudes
        • Meetings are attended by folks who have won the drug battle.
        • Meetings provide us with an opportunity to help others and volunteer.
      • Our species has social needs that can be met with other AA/NA members. We need different “playmates”.
      • Experience will provide evidence that some solutions get solved – out of the blue.
  • If you are married, we encourage family members to attend meetings of Alanon. The result of family attendance is that our TEAM “mates” tend to stop “enabling” our destructive behaviors.

The Alcoholics Anonymous (AA) guidelines were published in 1938.  This book summarizes the tasks and thought processes that worked for the early founders of AA.

Self-examination, acknowledgement of character defects, restitution for harm done, and working with others are the base elements brought to AA from the Oxford Group.

Since the organizations founding, millions of individuals have discontinued the use of drugs and have improved other destructive behaviors following these precepts.

 One of the founders of AA advocated that AA groups have not the “slightest reform of political complexion”. In 1946, he wrote “No AA group or members should ever, in such a way as to implicate AA, express any opinion on outside controversial issues — particularly those of politics, alcohol reform or sectarian religion. The Alcoholics Anonymous groups oppose no one. Concerning such matters they can express no views whatever. “Reworded, this became the 10 Traditions of AA.”

One of our reasons for trusting the thought processes of the AA founders is the 10 Traditions.  This organizational consideration is “profound”.  We know of no other organization, in the world, that insures that its purposes are never affected by outside issues.  There are no leaders – no politics – no joint finances – each group is autonomous.

Traditional Treatment vs 5 Step (AA/NA/Hazelden/Thinking Errors) 

  • Treatment programs for clients who can afford treatment; recommend intense “post release” monitoring that includes counseling, consistent U.A.s and other elements. These activities are considered effective; but, are expensive; require employer participation and other personal resources.
    • The 5 Step program was designed to provide similar benefits for those of us who have limited resources.
    • Communications are mobile (text & verbal) and electronic.
    • Tele-healthcare counseling and other remote services are used.
  • One element of your treatment will be studies of AA publications. These lessons deliver effective directives on how to change thinking and how to get rid of destructive behaviors.
  • In addition to AA lessons, you will have access to studies produced by the Hazelden Foundation. This non-profit has been working with destructive behaviors since 1954 and is an excellent resource for individual self-directed therapy.
  • Some correctional entities wish to include Thinking Errors lessons and a package of lessons is available for our use.
  • Another critical treatment element included in the 5 Step syllabus, are exercises in meditation. Meditation benefits are indisputable but there are very few of us folks who can spare the few minutes it takes.  Youtube meditations may become a friend.
  • Note on therapy lessons: At most facilities, the tools used for group lessons and therapy are stored – “in house”.  The skills of the group facilitators and the availability of content affect the quality of these on-site sessions.

We have turned meaningful content into form and PDF documents.  These lessons include questions that are completed after reading the lessons.  We have found that these processes provide more knowledge retention than traditional group sessions.  Obviously, these web-based, downloadable, tools are convenient and comprehensive – fitting our real world needs.

Based on your input during registration, other resources will be made available that will guide you through other learning and therapy experiences.  Resources for Local vocational, health, financial and legal assistance will also be provided

As you move through the steps of the iMR program, your participation will be monitored.  These computerized reports will insure that you are completing the “doable” tasks that you committed to – during the Intervention.  Our experience has shown that when individuals are responsible positive results can be expected.  Our processes do insure that irresponsible actions result in immediate accountability.

Your treatment TEAM members are supporting your treatment efforts and will be responsible for completing their tasks.  Communications between TEAM members will be continuous and will support your treatment efforts. There are no “voids” in communications – it is continuous.

Don’t worry!  We’re Educated!  We’ve got things under control!

 A few other treatment comments:

DSM-5 (Psychologists, Psychiatrists and Counselors)

Research conclusions pertaining to addictions and relative behaviors are as varied as the government and medical entities producing them.  Medical professionals and mental health professionals have published documents that do not agree on the origin of some destructive behaviors. The DSM-5 (Diagnostic Statistical Manual) indicates that a collection of disorders is responsible for destructive behaviors.  This American Psychiatric Association publication includes 279 disorders that may relate to our needs.  The experience and skills of the professionals determine how to best treat destructive behaviors.  The role of personal “traumas” also influences treatment modalities and adds to the analysis tasks each professional must complete.

Most insurance payments are based on DSM codes and our Compu-Tools software computes DSM-5 criteria.  Many state agencies require that treatment processes adhere to ASAM criteria.  With varying elements, adhering to these two guidelines can get a little difficult.  Compu-Tools also provide quantitative diagnosis of ASAM Criteria.  Provided with this information, professionals can assist their clients using the tools that fit their specific needs.

ASAM (American Society of Addiction Medicine)

iMR adapted the ASAM criteria for its processes.  This maintains addiction is a “disease” – not a result of a psychological disorder.

Public Policy Statement: Definition of Addiction

Short Definition of Addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

An illustration that supports our ASAM focus is:

Bill Wilson – one of AA’s founders could not stop smoking during his 37 years of alcohol sobriety.  Here is a guy who was able to overcome one addiction; but, not another.  It would be interesting to know what disorders the DSM-5 would focus one, when one addiction is managed and another is not.

This brings up another topic worth discussing.  Giving up one life destroying drug and continuing to use another life destroying drug is not rational.  We encourage our TEAM members to support behaviors that are positive and beneficial to continued good health.  My sister and my AA co-sponsor both bought into AA philosophies and stopped the use of alcohol and drugs; however, they both continued to smoke and it, probably, killed them a decade or two before old age would have got them.

The affect of “Vaping” on the human body will require new government studies: however, it doesn’t seem rational that sucking vapors into our lungs is really a constructive behavior.  Seems like meditation and exercise might be better for our health.

The 5 Step program includes lessons on thinking habits, behaviors, wellness or health, exercise, meditation and other topics that are not part of AA.

I’ve never been to a bad meeting!  It’s a matter of perspective!

Rambling through Treatment

Rambling through – Interventions – Treatment – Enabling – Case Management

Don’t expect any profound treatment miracles to expose themselves as I move through this ditty.  I was preparing a 5 Step marketing piece and began to reflect on things that negatively affect behavioral healthcare treatment.  The following things came to mind; but, I was unable to create a smoothly flowing framework.  So bear with me.

In an ideal world, all our treatment chores would be completed in a timely and effortless manner.  Unfortunately, this is a pipe dream or a conclusion that one would reach after using the wrong kind of drugs.  The gist of today’s message is – “we should minimize the obstacles that prevent “ideal” treatment circumstances”.

Communications, administrative stuff, rules and regulations, emergencies, fatigue, eating, sleep and more – all interfere with flawless goings on.  The 5 Step program design is intended to reduce the impact of these nuisances and provide our Team members with some efficient solutions.

This author believes most individuals want to end each day feeling good about what they accomplished.  They do their best in completing tasks that were presented.  The issues addressed in this article are not intended to be criticisms.  The points made, herein, reflect real world happenings that can affect what we are trying to accomplish.

The other issue that came to mind is: administrative tasks can be a pain in the ass.

Don’t Worry!  I got this under Control!!

For example, I have just completed a fruitful session with an individual and it is important that I document the elements of the session so that my other team members know how we are doing.  I judiciously began my administrative task and an emergency pops out of the woodwork.  Then, ongoing daily tasks prevent me from getting back to my unfinished administrative duties.  These are real world issues and result in less than optimum treatment conditions.  Case management data entries are often done – when possible.  If group activities or external partners are included as treatment elements, getting these case entries into the system may also take some time.

Also, when administrative time is available, the first thing that needs to be completed is the paperwork – to get paid.  Government and Organization processes have been most creative.  They have provided thousands of new code options to make our lives easier and more efficient.

As I compare the data entry tasks for behavioral treatment clients, with regular medical care, I find that the behavioral efforts are more complex and time consuming.  My last two visits with my cardiology team have been 5-10 minutes of silent computer review by the professional and then approximately 5 minutes of a one sided discussion and then a closing silent computer spectacle – that results in a visit summary.

Automating verbal and text input data, using efficient forms, shifting priorities to our clients or patients and simplifying electronic data transfer and integration processes is a start.

Experience with Treatment Processes – (Sensitivity – Empathy)     

Our experience with treatment endeavors has lead us to a bias for AA/NA 12 Step programs.  The principal reason for this focus is that these organizations’ team members believe in individual responsibility and accountability.  Enabling continuing destructive behaviors is not part of their program objectives.

Our experience with counselors and other professional clinicians provides a different set of insights.  To continuously work with a client a degree of sensitivity must be established to provide meaningful dialogue.  Based on human nature, degrees of empathy may also occur.  These relationships will, obviously, be different as we move from clinician to clinician and from client to client.  Perspectives and skills are needed to insure that a tough love atmosphere is part of all treatment programs.

Interventions – Treatment – Enabling

 Helping – can be – Hurtful   

38 years of association with treatment efforts that are related to legal/illegal drug use and dependency have resulted in a few conclusions:

  1. Ignoring that drug dependency is a disease and runs in families’ = kills’ people.
  2. Enabling destructive behaviors is common with family members = kills’ people.
  3. The K.I.S.S. principal needs to be adhered to – or – results will deteriorate.
  4. Keeping it simple means – staying unaffected by alcohol and drugs.
Trauma – DSM-5

Treatment for DSM-5 “trauma – disorders” would be classified as a supplement to the iMResponsible.com programs.  A principal focus of our programs is an effort to stay focused on daily behaviors that need to be changed.  Treatment for trauma disorders is important; however, it is our position that “trauma” treatment results are improved when an individual is sober, stable and working a solid program.

The DSM-5 has defines these trauma disorders as Stressor-Related Disorders :  Anxiety Disorder, Trauma- and Stressor-Related Disorders Acute Stress Disorder, Adjustment Disorder, Posttraumatic Stress Disorder, Reactive Attachment Disorder and Dissociative Identity Disorder.  Physical or medical issues – such as brain trauma, etc., must also be considered.

Interventions

TEAM Interventions conducted to develop righteous and doable treatment plans provide the client with a feeling of group support.  The Intervention also provides the TEAM with an indication that definitive objectives have been established.  “Enabling” behaviors by friends and family are minimized as TEAM objectives are definitive and have been agreed to by all participants.

As an aside, all 5 Step clients do not win.  It has been proven, however, that a TEAM Intervention will assist those who fail to meet treatment contract conditions.  This assistance takes place when the next crisis occurs.  Personal denial is reduced or eliminated and the next try at wellness is enhanced.  20 years of Interventions in Idaho schools has statistically proven that the percent of student violations has reduced since these Intervention practices were initiated.

Enabling

Enabling ones’ destructive behaviors to continue from Intervention – through Treatment is normally a family issue.

 John Southworth has been an Interventionist for several decades and was one of the developers of the 5 Step Intense monitoring solutions.  Last week we met, went to an AA meeting and then had lunch.  John showed me a “no name” copy of a letter he had just received – thanking him for his efforts – with the senders – father.  The letter advised John that the father had died and was found by the family as they visited their vacation home.  John explained that the “father” was participating in an intense treatment and monitoring program that John had recommended.  All was going well.  The client and his wife convinced treatment management that all was going well and they could manage their behaviors in a less intense program.  This new program did not work. The patient died.  John indicated that family enabling is the most consistent anti wellness effort he runs into.

During our discussion, John also indicated that finding treatment facilities that had a treatment priority, higher than the bottom line priority, was becoming more difficult. It seems that business tasks, administrative requirements, regulations, HR matters and finances share time and resources with treatment.

www.southworthassociates.net/

Gotcha’s keep coming up – Even in a well designed Program!

Summary:

The combination of administrative, strategic and relationship conditions associated with each client and clinician affect the results of treatment.  Based on the subjective nature of counseling, it is also difficult to determine when clinical actions are resulting in degrees of dependency or independence.

In our view, anything that interferes with the clients’ acceptance of personal responsibility for treatment tasks is suspect.  The 5 Step program has been designed to emphasis “objective” analysis of treatment elements.  Clients’ become more responsible at case communications and data entry.  TEAM members are provided with forms that enable efficient and effective submission of case information.  Communications via mobile devices are automatically entered into iMR case files.

 Monitoring processes provide quantifiable evidence of how an individuals’ program is working.  These processes also provide an accurate treatment effectiveness score.  This beats the heck out of emergency phone calls just before the reports are due.

One Step at a time!  One Day at a time!  One Life at a time!

I am Responsible!

Team Enabling Tough Love

Key Treatment Elements

Key Treatment Factors – iMResponsible.com – 5 Step Program

Behavioral Case Management

There are many software applications being used to manage behavioral treatment programs.  Most of these programs are focused on entity needs and not on client or individual requirements.  Bureaucratic demands guide software development challenges and results.

There are a few key elements that affect healthcare treatment results. Some are philosophical in nature and beyond the insights and skills of our domestic and international developers and coders.  Real world experience has proven to iMResponsible.com that these solutions are usually supplements or additions to established application programs.

These key factors are: (1) Client must accept responsibility for their behaviors, (2) Diagnosis must be comprehensive, accurate and convincing, (3) Treatment Contracts must be personalized and doable, (4) TEAM tasks must be completed as specified in the plan and (5) case data and communications must be continuously available to the TEAM.

iMR Key Factors  (Note dates on PDF exhibits – iMR has been doing this since 2000.

Step One – Introductory Documents – (Description, Benefits, Requirements and Acceptance.

Key Elements 5 Step

5 Step Implementation

TEAM TREATMENT WORKS

Brief Intro:

This program does not require that you purchase anything!  All tools are provided as needed.  Case management, communication and data entry tasks are completed by each of the treatment TEAM members.  iMR provides web based case management, reports, monitoring alerts and other tools that enable automatic case data entries as authorized.  (e.g. email, phone, phone text, direct entry, etc..)  Program enrollment is based on client and TEAM acceptance of program conditions.

Summary:

This Summary is being published – first – before any factual basis is established. Our busy lives reduce the amount of time we spend reading stuff.

I have been involved with Behavioral Treatment clinics and agencies for four decades. This has included Inpatient, Outpatient and Self treatment processes. Experience with AA/NA has convinced me that long term alcohol/drug abstinence is as successful via these 12 Step meetings as by organized treatment enterprises and government agencies. AA/NA activities are long term and based on real world conditions. Organized treatment is short term and done in unique environments.

Experience with intense monitored treatment programs that are used for critical employees – i.e. medical, airline, transportation, etc.. has proven that these TEAM treatment processes can provide dramatically improved results. They provide the atmosphere and communications needed to improve “real world” treatment results – on a continuous basis. I am convinced that if these “intense” TEAM treatment processes were available to – all individual’s – positive behavioral and substance abuse results would exceed any treatment processes currently used.

TEAM treatment means that a TEAM* is active and supports diagnosis, treatment plans, treatment tasks and other real world circumstances. (*TEAM = Medical, Clinical, Vocation, Family, Social, Legal and supporting processes)

Historical and Current Treatment Efforts

This nation is inundated with programs that claim they improve drug induced destructive behaviors.  Unfortunately, Federal statistics over the last 5 decades verify that these processes aren’t working. Why is this?

  1. The results of drug assessments do not convince the individuals involved that they are actually responsible for their past behaviors and the results of these behaviors.
  2. Treatment plans include a package of activities that are:

►designed to protect the designer against liability issues

►not designed by a treatment TEAM and the client

►not accepted as doable by the client

  1. Treatment tasks are not definitively monitored, published and updated as needed.
  2. Treatment TEAM members are not defined. Treatment participant roles are not formalized.

Note: A growing number of Professionals are managing treatment programs that use drug management as a component.  These professionals are, in fact, assuming responsibility for the client’s welfare.  They are also assuming responsibility for the results of any treatment programs where drugs are a key component.  Recent issues pertaining to the conflicts between ASAM Treatment criteria and DSM-V elements are related to treatment perceptions.  Substance Abuse and Addiction are classified by some as a Disease and by others as Destructive behaviors – that can be fixed with drugs.  This is not a Common Sense playground.

Personal

With 39 years of recovery, this is what, my final Inpatient Treatment did for me!
1. Kept me from using alcohol/drugs for a period of time
2. Provided an atmosphere that helped develop some new thought processes
3. Convinced me of the benefits of 12 Step Programs
4. Provided me with some educational facts
5. Provided me with a post treatment contact that was a 12 Step participant and willing to work with me as I participated in real world activities. Dan was a Sponsor and TEAM member.

Step #5 is the reason I have 39+ years of sobriety. AA/NA participation is still going on and provides a positive impact on my attitudes and life.

Miscellaneous

My four decades of healthcare experience has created a skeptical perspective of programs that have been designed by treatment entities, agencies and universities. Many propose that behaviors and chemical imbalances can be a reason for dependency, addiction and disease. Most are designed because the one before it hasn’t worked. Nationally, trillions have been spent, hundreds of agencies have been created, thousand of grants used and hundreds of programs introduced and then phased out. During these efforts, the principles of the 12 Step programs that have successfully turned millions of lives around have been ignored or discounted. AA/NA traditions prevent actions that could minimize the possibility of individual improvements, such as: building treatment organizations. Objectives are different.

Many clinicians are ‘recovering’ individuals themselves and are dedicated to providing effective services to their clients.
Most clinics, who employ these clinicians, are concerned with continuing their operations and this requires balancing treatment deliverables with cash flow. Eventually, the focus must be on cash flow and treatment deliverables and effectiveness become secondary. Regulations and audits guide general deliverables; however, bed and group counts are the principal measurement of success.

Common sense would suggest that the diagnosis of an individual’s psychological, social and criminal behaviors would be negatively affected if they are using drugs. (e.g. Alcohol is a depressant, Amphetamines can result in paranoia and stress, etc.) Question: how valid are these diagnosis if the client is using? Shouldn’t substance abuse issues be addressed before behavioral diagnosis processes are begun?

The use of opiates, illegal drugs and medical prescriptions have created withdrawal needs that must be provided by Inpatient treatment and, in some cases, include the use of alternative drugs to ease withdrawal symptoms.  These processes have shifted professional treatment focuses from becoming abstinent from drug use to using appropriate drugs to fulfill individual needs. Individuals that are using these “new generation drugs” are not suitable for the iMResponsible.com TEAM treatment program until they are drug free.

Personal experience with drug recommendations made by physicians has led me to believe that significant study should occur before any drug is used.  I have not taken any prescription that did not have undesirable side effects.  Some are long lasting.  The song that is sung = “the benefits outweigh the negative side effects”.  Common sense is also useful in these circumstances.

TEAM – Key Elements

The attached PDF includes a description of all of the 5 Step Intensive Treatment Elements. 

iMR Program Program Implementation 2017 V1

These Treatment Processes have been used effectively with “Critical Employees” during the last 15 years.

For more info – contact david@imresponsible.com