LITERATURE REVIEW
2.5 MODELS USED IN RESIDENTIAL TREATMENT CENTRES
2.5.1 DISEASE OR MINNESOTA MODEL
2.5.1.7 Treatment ingredients, structure, goals, and approaches
The clinical process of care, deals with the application of the 12 steps through a treatment strategy. Counselling techniques such as person-centred, cognitive behavioural, or existential approaches are made use of to:
• Heighten comprehension of each step and reasoning;
• Reduce obstacles to continued progress;
• Resolve risk factors for relapse; and
• Mobilize potential strengths.
Progress is evaluated by observing attitude changes, and/or behavioural change related to accepted outcomes from each treatment plan.
• Self-Discovery
Initial treatment goals encourage problem-recognition and acceptance. These realisations allow the individual to understand and apply Step 1 from Alcoholics Anonymous (1955), which reads, "We admitted we were powerless over alcohol-that our lives had become unmanageable". Due to defence mechanisms of denial, educational interventions help to promote self-discovery.
These interventions may be via psycho-educational services, such as group instruction and lectures that explain the dynamics of alcohol and drug dependence. Alcohol and drug assessment data are used to identify self-defeating problems related to relationships, career and health.
The first step has two parts. The first phase refers to the involuntary loss of control over alcohol and provides the rationale for continuous abstinence. The second component refers to the devastating consequences of the disease.
• Self-Efficacy
The second stage in the process of care focuses on self-efficacy. Step 2 counselling deals with hope for change. During this stage, emphasis is placed on the individual's ability to recover by accessing resources beyond the limits of one. For example, treatment methods may include a daily journal of positive events, daily meditation, or reading selections fromAlcoholics Anonymous (1955).
During this stage, the concept of a Higher Power is introduced which is a positive factor that may impact on the quality of one's life. Spirituality is a self-defined, personal experience. For many, a Higher Power may be a therapeutic support group, a counsellor, or AA itself. For most, it is a combination of spirituality that helps provide a reason to life with the support of other recovering peers.
• Taking Action
With the development of trust, individual and group counselling helps progression from Step 2 to Step 3. During this stage, behaviour may focus on social skills tasks that involve self-disclosures and risk-taking behaviours in the practice of newly learned behavioural skills. Step 3 deals with taking action in response to reaffirmed beliefs, expectations, and values. Step 3 of Alcoholics Anonymous reads, "Made a decision to turn our will and our lives over to the care of God as we understood Him.11
This step signifies varIOUS changes. First, a conscious decision is made, to trust emerging values, which will help shape decisions and actions. Next, a willingness to trust this evolving spirituality, to the extent of willingness to abandon one's unsatisfactory functioning in exchange for suggested methods of recovery.
• Self-Inventory
Improvement that comes about due to each of the steps treatment method is self- renewing and incremental. Step 4 treatment method builds upon the changes, attitudes, and behavioural skills from Steps I, 2, and 3. Input from people in varying circles of the individuals life, is used to help understand problems or behaviour patterns, existing strengths, and potential blocks to continue growth and change.
Step 4 is about making a fearless moral inventory of one-self. Treatment methods applied to Step 4 include support and education. The inventory is totally confidential.
This allows one to realize past problems and mistakes, while considering strengths and personal resources. Step 4 processes often provoke negative feelings.
People have difficulty on Step 4, perhaps due to either continued blaming of others, being preoccupied with anger and resentment, or anxiety from painful memories. Single treatment strategies are then planned, to treat and reduce the emotional behavioural obstacles, to participation in a fourth-step treatment process.
Any personality changes linked to Step 4 treatment frequently involve a willingness to consider one's shortcomings, which act as risk factors for relapse, a balanced self- perception of strengths and limitations, and resolution of shame and self-reproach.
• Letting Go
Step 5 treatment methods provide reasons for surrending, by sharing the contents of the Step 4 inventory with another. Step 5 of Alcoholics Anonymous reads, "Admitted to God, to ourselves, and to another human being the exact nature of our wrongs."
Treatment methods include consulting a trusted spiritual adviser to lay a foundation for self-disclosure. An accepting environment facilitates step 5 where personal information is shared without judgment.
The process of honest disclosure is the essential therapeutic value in this treatment process. At the conclusion, the participant is free to request feedback or engage in a dialogue regarding the inventory with the fifth-step listener.
• Continuing Care
The initial phase of recovery is usually associated with Steps 1-5. The first steps are closely linked to a spiritual awakening. Awareness of the reality of ones situation is reached and acceptance of the guidance from others for sober-living skills is acquired This is further strengthened by Steps 6-12, the relapse prevention steps which deals with continued elaboration of skills learned in Steps 1-5 (Sheehan, Owen 1998).
For the purpose of this study, steps 6 - 12 involving aftercare are not relevant and therefore not discussed in detail. Post-treatment services, assists recovery process by helping to prevent future relapse. Based on the extent of severity, care options are individually prescribed. Recommendations of one-on-one counselling and referral to a 12-step self-help support group are frequently suggested to those who have a supportive family and social environments, employment, and a successful response to treatment.
Many are referred to mental health professionals for the treatment of mental health complications such as unresolved childhood trauma, serious relationship dysfunction, or poorly controlled depression and anxiety. For those individuals with unstable family and social environments, prior unsuccessful treatment attempts, unresolved mental disorder, and limited vocational options, halfway house placement is recommended.