Utilizing the Recovery Model In Concurrent Disorders Treatment

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 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.

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

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.