Philosophy of Treatment
Our Philosophy of Treatment
In seeking to identify the underlying principles that influence the direction of treatment in this program the following quote from Aviel Goodman M.D. (Minnesota Institute of Psychiatry) describes the concepts and thinking influencing this program.
The Buttery is a Drug and alcohol rehabilitation centre"In the course of healthy growth, people develop effective, adaptive means of managing their feelings and of getting their needs met. When some combination of genetic and environmental factors interferes with this process, people learn to avoid being overwhelmed by feelings and unmet needs by taking in a substance (food, alcohol, other drugs) or by engaging in some rewarding activity (sex, gambling, stealing etc).
The essential process, the addictive process is the compulsive dependence on an (apparently self-initiated and self-controlled) external action in order to regulate the internal state. Once this process has been developed, the intelligent human organism has the flexibility to shift among various addictions, or to combine them, according to the requirements and limitations of the situation. It follows that an effective program for the treatment of an addicted person should address not only the addictive behaviour but also the underlying addictive process. This is particularly important when the behaviour which has been used addictively also has a role in healthy functioning e.g. eating or sexual behaviour.
Progress in recovery from addiction is a function of development of healthy adaptive means for handling feelings. This in turn depends on awareness of inner feelings, needs and conflicts, as well as the identification and challenging of maladaptive core beliefs. Treatment thus first of all requires abstinence from addictive behaviour, which would otherwise function to distort or prevent this inner awareness.
Treatment itself may then be conceptualised as three inter-related processes:
1. fostering awareness of inner feelings, needs, conflicts and core beliefs, particularly as they arise in the context of interpersonal relationships;
2. encouraging development of more healthy, adaptive means of handling feelings, getting needs met and resolving inner conflicts;
3. a more directive, cognitive-behavioural teaching of effective strategies for promoting abstinence from addictive behaviour (what constitutes abstinence for a given person depends on which behaviours are being used addictively, and on how addictive use of behaviour may be distinguished from healthy behaviour in that individual)."
Addiction: Definition and Implications. Aviel Goodman M. D.
British Journal of Addiction 1990 85, 1403-1408.
It is believed that by accepting this particular view of addiction that an integrated approach to its treatment can be applied.
In developing and documenting the philosophy behind its approach to the treatment of chemical dependence The Buttery has also accepted the fact that a number of people present to this therapeutic community will have a degree of psychopathology which complicates their treatment. The integrated approach being implemented does allow this to be taken into account and appropriate action taken to assist their recovery within the therapeutic community if feasible.
Again referring back to Goodman the following set of diagnostic criteria is used in conjunction with self reporting by the individual in treatment and participation in Psychiatric diagnosis based on DSM-111-R.
"Addictive Disorder" (or Addiction)
Recurrent failure to resist impulses to engage in a specified behaviour.
Increasing sense of tension immediately prior to initiating the behaviour.
Pleasure or relief at the time of engaging in the behaviour.
A feeling of lack of control while engaging in the behaviour.
At least five of the following:
1. frequent preoccupation with the behaviour or with the activity that is preparatory to the behaviour.
2. frequent engaging in the behaviour to a greater extent or over a longer period than intended.
3. repeated efforts to reduce, control or stop the behaviour.
4. a great deal of time spent in activities necessary for the behaviour, engaging in the behaviour or recovering from its effects.
5. frequent engaging in the behaviour when expected to fulfil occupational, academic, domestic or social obligations.
6. important social, occupational or recreational activities given up or reduced because of the behaviour.
7. continuation of the behaviour despite knowledge of having persistent or recurrent social, financial, psychological or physical problem that is caused or exacerbated by the behaviour.
8. tolerance, need to increase the intensity or frequency of the behaviour in order to achieve the desired effect or diminished effect with continued behaviour of the same intensity.
9. restlessness or irritability if unable to engage in the behaviour.
Some symptoms of the disturbance have persisted for at least 1 month or have occurred repeatedly over a long period of time.
Read the next chapter on Treatment Goals and Objectives
