The River IOP's Recovery Flow
One-on-One sessions are critical to the development of a crucial relationship between the patient and the therapist. The content of the individual sessions is primarily concerned with setting and checking on the progress of the patient’s individual goals. These can include working on thought restructuring and distress tolerance skills, as well as family/work issues that the client may be dealing with in their life.
The eight Early Recovery Skills Groups are designed for patients in the first month of treatment or those who need extra tutoring in how to stop using drugs and alcohol. The purpose of the group is to teach patients:
- How to use cognitive tools to reduce craving
- The nature of classically-conditioned cravings
- Time Management and Scheduling
- About discontinued use of secondary substances
- To connect patients with community support services necessary for a successful recovery.
The reduced size of the groups allows the therapist to spend more individual time with each patient of these critical early skills and tasks. Patients who destabilize during treatment are often encouraged to return to the Early Recovery group until they re-stabilize.
The Relapse Prevention groups occur at the beginning and end of each week from the beginning of treatment through Week 8. They are the central component of the River Model treatment package. They are open groups run with a very specific format for a very specific purpose. Most patients who have attempted recovery will agree that stopping using is not that difficult; it is staying stopped that makes the difference. These groups are the means by which patients are taught how to stay in sobriety.
The purpose of the Relapse Prevention groups is to provide a setting where information about relapse can be learned and shared. The 32 relapse prevention topics are focused on behavior changing the patient’s cognitive/affective orientation, and connecting patients with 12 step support systems. Each group is structured with a consistent format during which:
- Patients are introduced if there are new members
- Patients give an up to the moment report on their progress in recovery
- Patients read the topic of the day and relate it to their own experience
- Patients share their schedules, plans, and commitment to recovery from the end of group until the group meets again.
Input and encouragement from other group members is solicited but the group leader does not relinquish control of the group or promote directionless cross talk about how each member feels about what the others have said. The therapist maintains control and keeps the groups topic centered and positive with a strong educational element. Care is taken not to allow group members to share graphic stories of their drug and alcohol use. Therapists specifically avoid allowing the groups to become confrontational or extremely emotional.
The 8-week series is presented to patients and their families in a group setting using slide presentations, videotapes, panels, and group discussions. The educational component includes such program topics as:
- The biology of addiction, describing concepts such as neurotransmitters, brain structure and function and drug tolerance
- Conditioning and addiction, including concepts such as conditioned cues, extinction, and conditioned abstinence
- Medical effects of drugs and alcohol on the heart, lungs, reproductive system, and brain
- Addiction and the family, describing how relationships are affected during addiction and recovery.
Successfully engaging families in this component of treatment can significantly improve the probability of retaining the primary patient in treatment for the entire 8 weeks.
Designed to help patients establish new healthy friendships and activities, these groups are less structured and topic-focused than the Relapse Prevention Groups. Patients begin the groups during the last month in treatment at the end of the family education series, in order to ensure that they feel connected before they graduate from the Relapse Prevention Groups. The content of the groups is determined by the needs of those members attending. If patients have relapsed, relapse prevention work may be in order, unstable patients are given direction to help stabilize them and patients moving successfully through the stages of recovery are aided and encouraged to continue with the lifestyle changes that they are making.
The optimal arrangement is to have a 12-Step meeting on site at the treatment center one night each week. This meeting does not have to be an official meeting. Rather, the patients presently in treatment and graduated members can conduct an “Introduction to 12-Step Meeting” using the same format as an outside meeting with the purpose of orienting patients unfamiliar to the meetings in a safe setting with people they already know. Attending these meetings often makes going to an outside meeting for the first time much easier and less anxiety provoking. These meetings, along with outside 12-step meetings chosen by patients and the Social Support Group provide strong continuing support for graduated group members.
Urine testing is done randomly on a weekly basis. Positive urine tests revealing previously undisclosed drug use serve as points of discussion rather than incrimination. Patients struggling with secondary drug or alcohol use should also be tested for those substances.
A specific exercise is used when a patient relapse happens unexpectedly or repeatedly and does not seem to understand the cause of the relapse(s). The optional exercises and forms are designed to help the therapist and the patient understand the issues and events that occurred preceding the relapse(s) in order to help prevent future relapses. This exercise is typically conducted during an individual session with the patient and, possibly, a significant other.