LITERATURE REVIEW
2.5 MODELS USED IN RESIDENTIAL TREATMENT CENTRES
2.5.1 DISEASE OR MINNESOTA MODEL
2.5.1.3 Maintenance of the Disease
In addition to the reinforcing qualities of alcohol that result from its use (Koob & Bloom 1988), defence mechanisms which deny the severity of drinking and its consequences also contribute to the maintenance of the disease.
This defence system is characterized by an effort to minimize alcohol or drugs consumption, rationalize problems it has bred, and blame others for the use behaviour.
Intimidation, angry defensiveness, manipulation, and oppositional behaviour may also arise as a defensive mechanism against interventions that prevent continued use of alcohol or other drugs (Levy 1993; Metzger 1988).
Thus, the defence mechanisms contribute to a state of denial. The individual rarely initiates self-improvement and lacks motivation in seeking assistance.
The assumption may be made that an individual will be shocked from denial into a state of reality as the disease progresses to a more chronic level. However three main factors contribute to the maintenance of the disease and the defence system namely:
• Physiologically one may continue in an attempt to avoid withdrawal symptoms and to quell cravings (Beck, Wright, Newman, & Liese 1993). However, some drugs like marijuana, do not instantly cause extreme cravings or withdrawals, whilst other drugs produce immediate withdrawal symptoms, which are short- lived and which can be reduced by medication. However, it is rare that detoxification alone will end addiction. It is more important that the brain be fundamentally altered, as proposed by current neuroscientists (Hyman 1996;
Leshner 1997). The individual may no longer be able to experience normal reward states without chemicals.
• Behavioural theorists believe that dependence is maintained by reinforcement caused either by the chemical itself or by environmental-stimuli justifying alcohol/drug use (Froelich & Li 1991; Miller & Brown 1997). Sometimes, the catalyst may be a combination of external and internal (cognitive) stimuli. For example addicts who return to their using environment after a long period of abstinence usually experience strong cravings, which make relapse likely.
• Another maintenance factor is the attitude and behaviour of family and friends.
Family members themselves often develop defence systems around the disease, thereby normalizing the dependent's behaviour. Thus part of the treatment includes helping significant others identify their own issues and behaviours surrounding the alcoholic and addict, and to make changes. In some disease models, this is termed co-dependency (Morgenstern & McCrady 1992).
An important aspect of Minnesota model treatment is teaching recognition of the above- mentioned factors and to make personal and lifestyle changes to address them. An important component of the disease model is that a patient is never fully cured. Due to the result of the brain's fundamental change in how the abused substances are processed, the individual may never safely use again. This can be understood as the maintenance phase in "stages of change" theory (Prochaska, DiClementi, & Norcross 1992), during
which time the individual deters from behaviour likely to cause relapse into active addiction.
2.5.1.4 Rationale for how the disease model of treatment follows from the theory Due to the complex and multifaceted nature of alcohol and drug dependence, treatment needs to be comprehensive. The full-blown dependency stage is likely to be consequential and complicated in the biological, intrapersonal, psychosocial, and mental health spheres of the individual's life (Sheehan, Owen).
Failure to consider the social need, environmental support for recovery, and Ignonng negative contributing factors, results in an incomplete approach to the complexity of the disease process. Treatment methods are based on ones capacity to learn skills and practice newly acquired behaviour. A multidisciplinary team is therefore required.
Roles ofthe multidisciplinary team are listed below:
• Physical Health Care
Physicians and nurses ensure that the road to abstinence is a smooth one, by monitoring symptoms, and establishing protocols to reduce seizure risk, promote physical comfort, and prevent related complications (Sheehan & Garretson 1994). They also diagnose and treat medical conditions. In the disease model of treatment, the goal is to stabilize ones physical state so that one can be more available for the treatment process.
• Mental Health Care
Psychological assessment identifies intellectual functioning, personality characteristics, and mental disorder. Objective personality tests also aid in identifying traits and characteristics relevant to treatment response. Psychiatrists and psychologists work as a team in assessing, diagnosing, and treating concurrent mental health complications.
Psychotherapy and non-addictive psychotropic medications may be used.
The disease model helps patients understand what aspects of their personalities or actual disorders may cause them to relapse, as well as to identify and build on personal strengths.
• Spiritual Care
Spiritual care helps individuals to examine their values and standards for behaviour. 'The basis for ethical living and behaviour change is provided, while addressing life's difficult questions. Chaplains undertake individual pastoral counselling and group sessions and frequently provide intensive grief work for those individuals experiencing losses related to addiction. From the disease model perspective, dependents have often abandoned values and connections that were once important to them. Finding meaning and strength beyond willpower may perhaps help the person learn new ways of living.
• Chemical Dependency Counselling
The main component of treatment services are provided by counsellors through ongoing assessment, treatment planning, and individual and group counselling tasks, which entail data collection, diagnosis and the development of behaviour-changing treatment strategies based on counselling methods used. The counsellor takes an active role as an agent of change (Sheehan, Owen).