FEASIBILITY STUDY

The following is a holistic study of the feasibility of a program of recovery set forth by the Hope Hill Rehabilitation Centre in the North West Province. The drug trade is increasing globally in intensity and in reach. Substance use disorder is a growing problem in this country and the demand for treatment, prevention and harm reduction are at an all-time high. This study will focus on the potential effectiveness of a 12 step based inpatient program administered during the primary phase of treatment at Hope Hill Rehabilitation Centre.

In conducting the study focus will be placed on the use of mind, body and soul in combating Substance use disorder:

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Cognitive Group Therapy

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Bio-psychosocial Treatment

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12 Step Recovery Programs

The study will also focus on the maintenance of a program of recovery after the completion of an in-patient treatment program.

COGNITIVE GROUP THERAPY

Cognitive group therapy has proven benefits when working with individuals who suffer from substance use disorder and is actively being used in many treatment centres from across the world. Structured cognitive group therapy is used to identify irrational patterns of thinking and pointing out how these thought patterns affect the actions of the individual. Structured cognitive group therapy teaches the individual how to identify the thoughts that underlie their feelings. It then provides a simple way of using the group to determine if those thoughts are realistic. If a thought is not realistic, it can then be replaced with a more realistic thought previously worked out and then provided by the counsellor / facilitator of the session. Substance use disorder is characterized by dysfunctional thinking derived from dysfunctional beliefs. These beliefs are formed from early childhood experiences or from traumatic events that occur in the life of the affected person. Changing the cognitions, the way a person looks at something, changes how they feel. The counsellor / facilitator is interactive and serves as a coach who teaches the skill set of identifying thoughts underneath feelings. Once identified thoughts are tested for rationality, healthy ideas, new concepts and guided discovery are used to help the person see things differently.

Hope Hill Centre Cognitive-Group-Therapy

BIO-PSYCHOSOCIAL TREATMENT MODEL

The disease model of addiction describes a substance use disorder as a disease. The bio-psychosocial model as first proposed by George L. Engel in 1977 states that the development of a disease is influenced by biological factors (genetic, biochemical etc.), Phycological factors (mood, personality, behaviour etc.) and Social factors (cultural, familial, socioeconomic etc.) present in an individual`s life and all these factors should be considered when a treatment strategy is developed. It is not possible to identify precisely what causes an individual to develop a substance use disorder. It is therefore not possible to pinpoint one specific are of focus when considering treatment. The bio-psychosocial model emphasises how many different elements from all aspects of the individual’s life and life experience can influence and trigger the development and subsequently the treatment of such a disorder.

The Model suggests that when looking at a person who suffers from a substance use disorder, it is important to understand that there are many factors contributing to the problem behaviour, and treating the substance use and resulting physical deficiencies alone will not guarantee a prolonged period of abstinence. In order for an individual to achieve a sustainable state of being free from substance use, there has to be a method of treatment focused on understanding contributing factors in each individual`s life. Once an understanding of the patterns of behaviour starts to emerge the focus of the treatment needs to be shifted to providing sustainable alternative forms of behaviour.

Studies show that when attempting to change the behaviour in regards to an illness education of the risks relating to the illness alone is insufficient. Education sessions on the negative effects of the substances of abuse is not strong enough to motivate abstinence from the substance. In the case of a substance use disorder the individual needs to be educated on the emotional process happening within that triggers the problem behaviours. The belief systems of the individual dictate the emotion that life situations bring forth within the person and these emotions dictate the individual’s behaviour. These belief systems relate to the core beliefs and values of a person, and false belief systems that contribute to problem behaviour can be identified and altered using cognitive group therapy and by working a 12 step recovery program with another person in recovery. These forms of therapy allow the individual to gain a better understanding of how the disease interacts with them personally, and this self-education enables the individual to identify the feelings that motivate their acting out by using their substance of choice.

Experience shows that there are many other mechanisms that a person will use to enable themselves to stay in a hopeless state of active substance use but are unable to identify within themselves. Using substances is the addicted persons way of attempting to avoid life on life`s terms and avoiding their feelings. When the substance is used the individual`s real feelings are suppressed and replaced by a false feeling of happiness brought on by the chemical they have ingested. This happiness is not real but for the substance user this false state of being is better than what being present in their own life feels at that moment. This self-deception is a cornerstone of the disease and is built up over time to allow the substance user to avoid taking personal responsibility for their situation and for their substance use disorder.  What is happening in their real life has little effect on the substance user when the possibility of escaping to that place of false happiness is easier than dealing with whatever state their life is in at that moment. >>>

The substance user then makes use of many other self-deceptions to keep themselves from seeing what effect the substance has on their life. These tools of the disease include blame shifting, dishonesty with self, dishonesty with others, manipulation, denial, instant gratification, procrastination etc. Individuals suffering from substance use disorder need to be educated on these character defects as well in order for them to initiate a sustainable change in their lives. These defects of character are a key aspect of the disorder and can be identified when discussed in cognitive group therapy or can be identified and brought to light by a counsellor or a 12 step sponsor. This process is completed by the introduction of spiritual principles to counteract these deficiencies.

Along with education and identifying feelings that motivate action there is also a need for the cultivation of hope within a person. This hope is best cultivated by exposing the individual to other individuals who are living a life in recovery and are able to share their stories of strength and hope. This sparks the individual to hope that they will also be able to live a successful life in recovery and rise above their own circumstances and socioeconomic limitations. This is an important part of the initial phase of treatment and is most effective when coupled with guidance on how to bring about change in one’s self. This hope is cultivated in the primary phase of the inpatient treatment program and the guidance is facilitated by the counsellors. Once the inpatient treatment is complete the individual will be able to go to a 12 step meeting (AA / NA) and find the hope and guidance needed there.

There is also a need to look at the spiritual side of the person. When a person develops a substance use disorder, they become completely self-centred. This self-centred mindset perpetuates the belief that the affected person is always right and enables the person to justify their behaviour. When a person becomes completely self-centred their sense of right and wrong becomes corrupted because there is no more outside power to answer to regarding their actions. Once the individual has performed an action and crossed over moral lines it becomes easy for that person to commit the same action again despite the moral values of the individual. This cycle of behaviour starts small, usually with dishonesty about where the person was at a certain time or what he was doing, but as the substance use disorder becomes a stronger driving force within the individual it becomes more natural for the person to turn to more immoral patterns of behaviour. Without intervention or treatment, the self-centredness of the individual can grow to the point where even violent crime towards others is an acceptable means to being able to use their substance of choice.

The substance use disorder brings about many changes within the user and the effect is an inability to manage one’s life with or without the substance. The aspects mentioned above are but a few key aspects to consider when treating substance use disorder and show that a multi-faceted approach in line with the bio-psychosocial model is required when dealing with substance use disorder.

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12 STEP RECOVERY PROGRAMS

The program set forth at Hope Hill Rehabilitation Centre is based on the 12 step program outlined in the book “Alcoholics Anonymous: The Story of How Many Thousands of Men and Women Have Recovered from Alcoholism “. This book was first published in 1939 and lays out a 12 step solution on how to recover from alcoholism. This 12 step formula along with regular attendance of Alcoholics Anonymous meetings has proven to be an effective alternative and has helped many men and woman recover from alcoholism. This model of recovery has been so successful that it has provided the base for many other recovery groups like Narcotics Anonymous, Cocaine Anonymous etc. These recovery fellowships are active all over the world and provide thousands of men and woman with a solution to their substance use disorders. It has also been our experience as recovering addicts that these fellowships provide a happy and fulfilling life without the use of any mind or mood-altering substances. This model of treatment is commonly known as the Minnesota Model and was first developed in 1950. This model of treatment promotes adherence to the 12 step program guidelines during and after inpatient treatment.

When a person leaves the safety of an in-patient facility their lives are back in their hands and their freedom of choice is once again theirs. They can make the choice not to seek out a fellowship or any other form of aftercare and attempt to maintain their program of recovery on their own. this is NOT advised. Abstinence from the substance of abuse will not change the different factors and character deficiencies that led to the individual developing a substance use disorder. In order to facilitate true change, there has to be willingness to work at freedom from substances every day. The disease of substance abuse disorder will not be cured after any length of inpatient treatment and recovery is a lifelong process. Recovering from substance use disorder is proving to be difficult and studies show that taking part in some form of aftercare is essential.

Hope Hill Centre 12-Step-Recovery

Aftercare programs are usually expensive and are out of the financial reach of many South Africans that fall victim to substance use disorder. The 12 step organisations that our program of recovery is based on is free of charge and any person who wishes to recover from a substance use disorder is welcome to join these fellowships. The individual will find all that he/she needs in terms of aftercare upon joining one of these organisations and this is an essential and sustainable part of the relapse prevention plan.

Meetings are an essential part of how 12 step recovery programs as they provide the substance user with a way to connect with others who are able to understand what the person is experiencing and in turn can provide strong guidance on how to recover through their own experience. No one person can better understand the struggles of another than the person who has faced those same struggles and has made it through. Hope Hill Rehabilitation Centre will be making use of counsellors who are in recovery themselves and are active members of a recovery fellowship. These counsellors will make it their mission to take what they have learned about living clean and giving it to those who are new to recovery. The fellowship provided by these 12 step organisations is an essential part of their effectiveness and provides the individual with a place to go and find acceptance and support after inpatient treatment. It is essential that the individual be introduced to these meetings while they are in the primary phase of treatment to build the courage and understanding needed in order to join a fellowship upon re-integration to society.

A Sponsor is a person who has been through treatment and has been living life free from substance use for a period of time and has in turn been through many of the situations that life in early recovery will present. This person will then make themselves available to the person new to recovery and offer their help in any way possible. The sponsor forms an integral part of the persons support structure and will also help the person through their program of recovery after their in-patient treatment is complete. The idea of sponsorship was first put forth by the founders of Alcoholics Anonymous who found great value in working with others and spreading the message of recovery.

Step work is the section of the program where the 12 steps are examined, and the work is done to complete each step, in preparation for the next. The work is focused on the individual and is design to help him / her identify self-destructive patterns of behaviour enabling the individual to break these cycles and change how he / she reacts to life on life`s terms. The step work works well when used in conjunction with cognitive group therapy during the inpatient phase of treatment. The 12 steps are a fundamental element in losing the desire to use substances and is a powerful tool for bringing about change. The process of working through the steps will bring a spiritual awakening upon the individual and will provide the person with a long-term solution to substance use disorder. The 12 steps are design to in the long run have the individual living a life that is free from the issues and pressures that the substance user attempts to avoid when using substances. During the primary phase of treatment in an in-patient facility the individual should complete step 1, step 2 and at least be in the process of completing step 3 when their treatment period ends. The step work will be read and quality graded by an experienced counsellor and relevant guidance given to ensure the work is of the right quality to be of maximum effectiveness. When the individual completes their in-patient phase, their chosen sponsor at their chosen home group will take over where the counsellor has left off.

Spiritual principles are introduced to the individual seeking recovery. These spiritual principles provide the individual with new ways of reacting to life by challenging the person to live by a new set of values. The spiritual principles as set forth by the program work in conjunction with the rest of the program. During cognitive group therapy and step work sessions in the inpatient phase of treatment, defects of character are identified and their destructive potential explored. These include being dishonest, unteachable, irritable and impatient etc. Once these negative traits have been identified the individual is provided with a new principle to counter the defect, instead of being dishonest the person is challenged to be completely honest at all times. Instead of being unteachable the person is encouraged to be open minded to the suggestions of others. Instead of acting irritable or inpatient the person is introduced to unconditional love and patience. Changing one’s views and core values is not an easy task but it is essential in the process of sustainable change and abstinence from substances. In order to mend relationships with family, friends and employers the individual has to replace the problem behaviour with something new or the same relationship issues will return as soon as they reintegrate into society. In the inpatient phase there is a need for guidance during this process of change that will be provided by a counsellor and when the person joins one of the 12 step programs their chosen sponsor will guide them to a point where the spiritual principle has replaced the desire to act out inappropriately.

The quality of life of a recovering person is a crucial factor of the recovery process. Life in recovery has to reach a point where it is more enjoyable to live in the moment than what it would be to escape the current reality. 12 Step groups provide the individual with an opportunity to make friends who are on the same journey of self-discovery and are able to understand and respect the individual. 12 Step organisations also have events, outings, conventions and offer various gatherings to promote a happy and healthy lifestyle. During the inpatient treatment phase, it is important for the individual to be exposed to healthy activities that he / she can engage in upon reintegration to society. It is necessary to find something besides using substances that can excite the individual and provide them with an alternative method of self-expression.

A Higher Power is a power that is greater than the individual who is a Loving and Caring entity. This is the way that these individuals who have been completely self-centred for some time are introduced / re-introduced to spirituality. The program is formulated to awaken the spirit of the afflicted person and to get the person experiencing emotion, life and a connection with the world around them, and with a higher power. The person has the opportunity to get in connection with a God of their understanding without any pressure from others or any preconceived ideas. Many of the individuals entering recovery have had to rid themselves of any forms of higher powers in order for them to continue on living the self-centred life of an active substance user. It is important that a cautious approach is taken when introducing the spiritual concept to these individuals as it will be easy for them to reject the idea and severely diminish their chance at recovery. The idea should be explained and explored with the individual in a calm and safe space. An introduction to nature or a nice quiet and tranquil environment will aid the individual in this journey of discovery.

Conclusion
The Minnesota Model of treatment of substance use disorder has proven to provide a strong base for lifelong recovery. The model encourages the individual to join the 12 step fellowship that best suits them as soon as they complete their in-patient phase of treatment. These fellowships have proven to be able to provide any person who desires to recover from substance use disorder with a solution and a way of life that promotes sustainable health, abstinence and happiness.

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