Substance Abuse
Introduction
Addiction:
A chronic, relapsing disease characterized by compulsive drug seeking and use,
despite serious adverse consequences, and by long-lasting changes in the brain.
Substance
Use: A maladaptive pattern of substance use leading to clinically significant
impairment or distress, occurring within a 12 month period.
Diagnosis
The
DSM-IV was updated this past year to the DSM-V after an extensive look at the
disorders listed within. The Diagnostics and Statistical Manual of Mental
Disorders, or DSM for short, explains in detail the criteria for each mental
disorder that has been identified. While the DSM-IV is no longer in effect, the
old definitions and changes may help to better understand the disorders and the
terminology still in use by those not yet up-to-date on the revised manual.
DSM IV Substance Abuse
Substance abuse was defined
as significantly interfering with one’s life, more specifically disrupting
education, relationships, work, or putting one in dangerous situations or legal
problems. Although substance abuse and substance dependence are now combined,
they had different connotations in the DSM IV. There, substance abuse was
listed as a mild or early phase of substance use, while substance dependence
was seen as more severe. For your general knowledge, the criteria for substance
abuse is shown below, simply to compare and contrast the differing diagnosis’.
The general criteria for substance abuse, substance dependence, and substance
use are all shown in Figure 1.
A. A maladaptive pattern of
substance use leading to clinically significant impairment or distress, as
manifested by one (or more) of the following, during the same 12-month period:
- Recurrent substance use resulting in a failure to
fulfill major role obligations at work, school, or home (e.g., repeated
absences or poor work performance related to substance use;
substance-related absences, suspensions, or expulsions from school;
neglect of children or household)
- Recurrent substance use in situations in which it is
physically hazardous (e.g., driving an automobile or operating a machine
when impaired by substance use)
- Recurrent substance-related legal problems (e.g.,
arrests for substance-related disorderly conduct)
- Continued substance use despite having persistent or
recurrent social or interpersonal problems caused or exacerbated by the
effects of the substance (e.g., arguments with spouse about consequences
of intoxication, physical fights)
B. The symptoms have never
met the criteria for substance dependence for this class of substance.
Addictive Disorders
- different from dependence
- dependence can be a normal body response to the
substance
- gambling disorder was added as a new category
- found similarities to substance disorders in clinical
expression, brain origin, comorbidity, physiology, and treatment
Changes
- cannabis(marijuana) withdrawal, caffeine withdrawal, and
tobacco use have been added in DSM V
- early remission: at least 3 months but less than 12
months without substance use disorder criteria (except craving)
- sustained remission: at least 12 months without criteria
(except craving)
Course specifiers:
- Early Full Remission
- Early Partial Remission
- Sustained Full Remission
- Sustained Partial Remission
- On Agonist Therapy
- In a Controlled Environment
Severity specifiers:
- Moderate: 2-3 criteria positive
- Severe: 4 or more criteria positive
Specify if:
- With Physiological Dependence: evidence of tolerance or withdrawal
(i.e., either Item 4 or 5 is present)
- Without Physiological Dependence: no evidence of
tolerance or withdrawal (i.e., neither Item 4 nor 5 is present)
As
shown below in Figure 1, the DSM-IV separated Abuse and Dependence as two
distinct disorders, each with their own criteria. The DSM-V has combined these
two disorders into a single category of substance use disorders, with the hope
that they can be specifically identified easier and pinpoint individual
problems by varying in degree of severity and lumping all criteria together to
form a more complete and total diagnosis.
The following are the
differences switched from the differing DSM IV criteria to the new and improved
Substance Use Disorder criteria:
·
One
or more abuse criteria within a 12-month period and no dependence
diagnosis; applicable to all substances except nicotine, for which DSM-IV abuse
criteria were not given.
·
Three
or more dependence criteria within a 12-month period.
·
Two
or more substance use disorder criteria within a 12-month period.
·
Withdrawal
not included for cannabis, inhalant, and hallucinogen disorders in DSM-IV.
Cannabis withdrawal added in DSM-5.
Substance Use
DSM V merges substance abuse
and substance dependence into single disorder
measured on continuum of mild
to severe. The single substance use disorder better matches the symptoms the
patients experience, with every substance classified as separate use disorder.
Each substance use type requires multiple symptoms in order to be diagnosed.
Types of Addictions
Drugs
(Prescription & Illicit)
Alcohol
Gambling
Smoking
Types of Substances
Depressants
- substances which slow normal function of the central nervous system
- result in slowed pulse and breathing, slurred speech, drowsiness,
lowered blood pressure, poor concentration, fatigue and confusion,
impaired coordination, memory, and judgment
- used to reduce anxiety, induce sleep, lower inhibitions
Examples:
- barbiturates (sedative-hypnotics)
- benzodiazepines (tranquilizers)
- alcohol
- sometimes marijuana and some inhalants also considered
Stimulants
- psychostimulants
- psychoactive drugs that induce temporary improvements in
either mental or physical function
- enhance activity of central and peripheral nervous
system
- effects may include (depending on substance): enhanced
alertness, awareness, wakefulness, endurance, productivity, motivation,
increased arousal, locomotion, heart rate, blood pressure, perception of a
diminished requirement for food and sleep
- may improve mood, relieve anxiety, induce feelings of
euphoria
- can also cause anxiety
Types:
- caffeine
- nicotine
- amphetamines
- ecstasy
- cocaine
- NRIs & NDRIs (Norepinephrine reuptake inhibitor)
- modafinil
- ampakines
Hallucinogens
- similar to natural neurotransmitters
- temporarily interfere with neurotransmitter action or
bind to their receptor sites
- highly variable and unreliable
- produce different effects in different people at
different times
- because they are unpredictable, they can be very
dangerous
- distort perception of reality
- can see images, hear sounds, feel sensations, rapid
emotional swings
- distributes throughout the brain and spinal cord
- change mood, hunger, body temperature, sexual behavior,
muscle control, sensory perception
Examples:
- LDS
- Peyote
- Psilocybin
- PCP
Opiates
- most effective pain relievers available to physicians
- produce pleasure and pain relief
- can create addictions when used improperly - taken in
excessive doses
Examples:
- Morphine
- Codeine
- Heroin
Others
- Inhalants
- Steroids
Specific Needs
People
who have a substance use disorder use the substance as their main activity and
focus. Their particular substance solves many if not all of the psychological
ideas listed below:
- substance use is main recreational activity
- when substance removed, ample free time created that is
empty
- replace benefits of drugs
- need to find new ways to satisfy needs met through drug
use
- curiosity
- boredom
- peer acceptance
- pleasure seeking
- social interaction
- self-discovery
- rebelliousness
- “quick fix” fun & pleasure
- reduced stress
Treatment
In order to effectively treat
one with a substance use disorder, we as therapists must create new areas to
direct their energy and focus into these same psychological outlets, but in a
more constructive, safe, manner. Depending on the individual, some activities
can be more beneficial than others. Listed below are a couple of the most used
options.
A) Group therapy
B) Leisure/recreational
activities
C) Join support group
D) Community activities
E) Hobbies
Therapy can be helpful to
some, while others do not enjoy talking about their feelings. In these
instances, leisure or recreation activities can help individuals overcome their
fears and help them see that they can succeed and do well in other activities,
as well as accomplish things in daily life. Support groups and community
activities bond individuals to each other, in different ways depending on the
activities and discussions that may ensue. They can learn to be part of a group
and feel part of something important, or they may gain energy and emotional
strength from each other in support groups.
Tests
There
are many forms of prescriptive tests and voluntary tests that are given for
medical purposes as well as treatment. If someone simply wants to know for
themselves than self-evaluation tests are also available. Examples of a couple
and where to find them are listed below.
Drug
Abuse Screening Test (DAST):
alcoholism.about.com/od/tests/l/blquiz_drug.htm (this test was created by
Vanderbilt University).
Equipment
Most
common forms of equipment to test for levels of drug use or intoxication are
most often used by police officers and medical professionals when individuals
have been placed into custody or are going through treatment.
Breathalyzer
Urine
Test
Blood
Test
Multi
Drug Test Kit
Saliva
Test Kit
Medication
To
assist individuals trying to overcome addictions, some medications may be
prescribed to reduce cravings as well as withdrawal symptoms such as shaking,
convulsions, or headaches. Medications that are used today for this purpose can
only aid with certain drug addictions such as opioids (heroin and morphine),
tobacco (nicotine), and alcohol. Doctors and researchers are in the process of
creating medication to help with the recovery process with addictions to
stimulants (cocaine and methamphetamine) and cannabis (marijuana).
Although
medication can be an important part in the recovery process and treatment plan,
it is still simply one part. Medication given to those who do not have a
treatment plan, support group, or therapy are more likely to continue with
their addiction. Therefore, for more probability of success, individuals must
participate in more than simply taking medication to ease painful withdrawal
symptoms.
Specific
Medications Used in Treatment:
Opioids
A)
Methadone
B)
Buprenorphine
C)
Naltrexone
These
medications assist with suppressing withdrawal symptoms and cravings. They also
allow individuals to disengage from drug seeking and criminal behavior and
become more receptive to treatment.
Tobacco
A)
The patch
B)
Spray
C) Gum
D) Lozenges
E) Bupropion
F)
Varenicline
These
formulations of nicotine replacements and prescription medications are used to
help prevent relapse.
Alcohol
A) Naltrexone
B) Acamprosate
C) Disulfiram
D)
Topiramate (showing positive results in clinical
trials)
The
effect that these medication have on alcoholics can alter how alcohol is
absorbed in the brain. They can reduce relapse for those involved in heavy
drinking but do not have the same effect on all patients. Many of the effects
and results depend on an individual’s personal motivation with other treatment
as well as genetics.
TR
Implications
Where
would you find a CTRS? Examples are as follows:
A) Residential treatment centers
B) Within the criminal justice system (prisons and juvenile
detention centers)
C) Community-based programs such as Alcoholics Anonymous
How
does TR impact those suffering from addictions or substance abuse?
TR
can potentially provide the following benefits within any treatment program:
A) Leisure education
B) New sense of purpose
C) Problem solving skills
D) Feeling good without being under the influence
E) Physical exercise and health education
F) Rebuild important relationships (leisure participation with
family and friends)
G) Many more!
Possible
TR group or individual activities
1. Candy-bar
Relapse Game
Find
out what each group member’s favorite candy or treat is. At the beginning of
the group introduce the activity by giving each person their favorite candy and
explaining how the candy represents their addiction. Give no further
instructions at this point.
Mentally
take note of anyone in the group who refuses to accept the candy (knowing that
it represents their addiction).
Ask
group members to share their plans on how they are going to prevent relapse
upon finishing with treatment and going home.
Tempt
group members to open their candy (if some people haven’t already). Then tempt
everyone to eat the candy.
Discuss
how if the candy represents their addiction and ask why they accepted it from
me?
Ask
“Who do I represent?” (People outside of their support group, old friends, bad
influences, anyone who might possibly offer them their drug or drink of choice)
Ask
further questions such as: “How will you avoid these people/places?” “Who can
you really trust and be safe with?” “Who is in your support system?” “Where
will you go and what will you do instead of doing drugs, drinking, or
gambling?” “Who will you be accountable to if you are not following your plan?”
Etc.
Have
each group member write down their detailed plans to prevent relapse and ensure
that they share this plan with their support system (family and friends).
2. Popular
Music Group Activity
For
those individuals who value and love music, this activity might be impactful in
helping them gain sobriety.
Pick
several popular songs that often come on the radio. Have each group member
right down words or phrases that might potentially lead to thoughts of relapse
and why.
Have
each group member share what they wrote and why, and have each member commit to
not listed to any songs that have these same types of ill-encouraging lyrics.
Listen
to short clips of popular songs that are empowering and inspiring as opposed to
demeaning and negative and help each individual discover wholesome music that
they can enjoy listening to.
3. Relapse
Prevention
Have
each group member write down their plan to stay sober and not relapse when they
return home from treatment.
Go
around the circle and have each member read their plan out loud. While they are
reading, encourage everyone else to silently raise their hand when they hear
something in their plan that could potentially lead to relapse.
This
will help each person recognize where they need to revise or adjust their plan
in a non-threatening environment where everyone is working together to help
each other succeed.
Great
resource for more group activities: http://www.ehow.com/info_8141909_substance-abuse-recovery-games.html
Other
forms of TR that can help with addiction recovery include the following
examples:
A) Equestrian Therapy
B) Joining athletic teams with other people fighting addictions; e.g.,
Addicts to Athletes
C) Art therapy
D) Music therapy
HOW
DOES THERAPEUTIC RECREATION APPLY IN THE TREATMENT OF
ADDICTIONS?
Shelagh
Keesmaat, Hons BA (TR)
Homewood
Health Center
Guelph,
Ontario, Canada
Introduction
"Alcohol/drug addiction is a
leisure disease and a disease of leisure! People pay for the feeling because
they don't know how to get it free. That is, they don't know how to play in a
manner that produces the desired feeling." (Faulkner, 1991, p.7). Addicts
spend each day thinking about when, where and what they will use to achieve
their next "high". Substance abuse and other addictive behaviors
penetrate every facet of their lives and eventually their leisure time is
totally consumed by addictive behavior. So what happens when they stop using
chemicals and have free time on their hands? This article will help answer this
question and examine the relationship between addiction and leisure, emphasize
the importance of leisure in a healthy recovery, and make recommendations for
treatment.
The
Addiction - Leisure Relationship
There is little written work about
the connection between therapeutic recreation and recovery from an addiction.
Therefore, it may benefit the reader to gain a basic understanding of the
meaning of addiction. There are many different definitions of addiction but for
the purpose of this article it is defined as "...a physical and/or
psychological dependence on a chemical agent or behavioral process. This
disorder is characterized by the inability to resist using a substance and
increasing one's use which eventually leads to compulsive use in terms of
dosage and/or frequency." (Csiernik, 1993). This definition acknowledges
that addiction is not restricted to chemicals such as alcohol or drugs but that
it is also possible to have what is known as a process addiction.
Schaef (1987) describes a process addiction as an addiction to
relationships or to certain patterns of behavior such as gambling or sex. These
people are "hooked" on a process rather than a chemical substance. It
is important to recognize that this behavior is not simply compulsive in
nature, but that it is accompanied by an adrenaline "rush" as well as
other physiological changes. The experience produces a "natural high"
that the addict will seek out in future experiences with the same activity.
When clients enter treatment, they
abstain from all chemical substances and/or addictive behaviors and begin their
journey in recovery. "Recovery is viewed as a long-term process of
abstinence and change in physical, psychological, family, social, and/or
spiritual areas" (Daley, 1989, p. 106). It requires that a person shift
their focus from alcohol or drugs to other healthier areas of interest, learn
healthy coping mechanisms, and emphasize increased valuing of self, others and
life concerns (Brown, 1985). These are all new skills and behaviors for the
recovering addict to learn, practice and incorporate into a balanced lifestyle.
It can, therefore, be said that abstinence is only a small part of recovery
compared to changes in lifestyle. This is where therapeutic recreation
interventions play a key role to aid in the development of new skills so that
healthy changes can be implemented successfully into a recovery oriented lifestyle.
It is widely accepted that most
people take their first drink or drug during their leisure time. Society has
created a link between substance use and leisure time in the sense that social
drinking or experimentation with drugs is socially appropriate behavior and
often an expectation in various settings. Addiction, as a result, has been
described as a leisure disease and dysfunctional leisure is a symptom of
addiction (Faulkner, 1991). Faulkner (1991) states that once the addiction
takes hold, people often abandon leisure pursuits thatdo not permit substance
use because they would rather stay home and satisfy their craving. This is how
dysfunctional leisure becomes a symptom of addiction.
The sacrifice of healthy leisure for
addictive behavior illustrates the reciprocal relationship between addiction
and leisure. As the addiction increases in severity, the amount of healthy
leisure decreases. This process of deterioration is described by Kinney and
Leaton (1991) as they outline four stages in the development of alcoholism as
it relates to leisure. This process can be applied to the development of
addiction in general. The first stage is Social Use in which most people take
their first drink or drug as a part of their leisure activity. As a result of
this use they experience a positive mood change which enhances their leisure
experience. The second stage is called Goal-Oriented Social Use. At this stage
the unhealthy behavior is propelled by the individual's desire to achieve the
goal of euphoria that was reached once before. Addictive behavior impacts upon
the individual's leisure time without directly effecting work or family life.
The third stage is called Harmful Dependence. This is when
dependency becomes an issue and the things that were once enjoyed as leisure
activities no longer matter. The individual recognizes that their using has
negative consequences but decides that the positive effects outweigh the
emotional, physical and social cost.
In addition, activities that do not allow the use of substances
are abandoned as the addict begins to lose sight of what is important. The
final stage is Addiction. At this point, an individual uses to feel normal and
avoid emotional pain and physical withdrawl. There is no more experience of
euphoria and chemicals are used solely to cope with the issues of the past and
problems of the present. There may be no healthy activities at this point
because using has become the main focus. Therefore, using is no longer the
choice, but the need. When the addiction takes hold, there is an overall
decrease in all areas related to quality of life.
Leisure
In Recovery
Two of the main goals of recovery
are rebuilding relationships and learning how to enjoy life again (Mooney,
Eisenberg & Eisenberg, 1992). Leisure is an ideal context for the
redevelopment of family bonds and relationships (Hood, 1995) while having fun
at the same time. Many people in early recovery find it difficult to imagine
having fun without using drugs or alcohol. Yet most people, for the first time
in many years, experience tear-producing, hysterical laughter during leisure
time with their friends in treatment as they begin to enjoy living sober.
Austin and Crawford (1991) state
that therapeutic recreation plays an important role in addiction treatment
because of the emphasis on treating the whole person. It is the therapist's job
to help recovering clients develop functional leisure activities and behaviors
that are in tune and in balance with other lifestyle needs, and discover the
good things in life that were missing in an intoxicated state (Faulkner, 1991).
Restoring this balance requires a person to assess the routine
duties and obligations of life ("shoulds") and the self-indulgent,
enjoyable activities ("wants") and make sure that the former does not
outweigh the latter (George, 1989). When there are more obligations than
enjoyable activities, feelings of deprivation tend to surface and cause an
overwhelming need for self-satisfaction which can result in addictive behavior
as a "quick fix". Therefore, participation in regularly scheduled
constructive indulgences can maintain wellness and remove the imbalance that
threatens sobriety (George, 1989).
It is important for recovering
persons to adopt leisure as a way of living in order to make the necessary
lifestyle changes and create a healthy balance. Godbey (1985) defines leisure
as "living in relative freedom from the external compulsive forces of one's
culture and physical environment so as to be able to act from internally
compelling love in ways which are personally pleasing, intuitively worthwhile,
and provide a basis for faith" (p. 9). Essentially, this means living
one's life to its fullest from a leisure perspective. In recovery, this
requires moving from a life described as hectic, restless, depressed, anxious,
withdrawn, and bored to a life that is relaxed, easygoing, playful, at peace,
and having the ability to get lost in the moment (Rifkin, 1994). To this end,
leisure involves a sense of intrinsic satisfaction (Kelly, 1982) that cannot be
bought, ingested or forced on a person.
Recreation and leisure in recovery
involves taking risks by trying new activities for the first time or engaging in
past leisure interests for the first time in many years. It is often the case
that clients refrain from trying anything new because they are afraid of
failing or appearing foolish. A little encouragement goes a long way when
clients are unsure of themselves and when they succeed, they experience a sense
of pride, self-confidence and increased self-esteem.
Participation in recreation and
leisure in early recovery aids in the development of many skills that are used
on a daily basis. Because isolation is such a common behavior in people who are
addicted, social skills development is emphasized and these skills are
practiced and improved through interactions with other recovering individuals.
The meetings of Alcoholics Anonymous encourage people to "come early and
stay late" in order to connect with other people in recovery and create a
sense of belonging that has been absent for so long.
Other skills include
decision-making, problem solving, relaxation training, assertiveness training,
stress management and organizational skills. Learning and practicing these new,
healthy coping skills helps clients deal positively with emotions such as
anxiety, disappointment, confusion, and frustration which often occur during
leisure activities.
Support for the inclusion of a
fitness program in the treatment of addiction can be found in the literature.
It is often the case that clients led a very sedentary lifestyle before
entering treatment which resulted in a deteriorated state of physical health.
These people require time to rebuild their physical strength and achieve a
basic level of fitness. Sinyor, Brown, Rostant and Seraganian (1982), in a
study of the role of recreation in an addiction treatment facility, found that
those who took part in a fitness program during treatment had greater
abstinence rates and experienced healthy changes in their fitness levels.
Although not being able to provide a definitive reason for the results, Sinyor
et al. (1982) put forward a number of possible explanations. It was suggested that
an improvement in fitness levels allows a person to cope better with stress and
can help in alleviating depression and anxiety. They said that enhanced fitness
levels may allow people to deal more effectively with emotional upset without
resorting to substance use. Finally, the authors speculated that the individual
may become more receptive to change, that the program may assist in the
reorganization of leisure time and that new activity patterns may make the
transition back to the work environment less traumatic.
A combination of a physical fitness
program, healthy recreation activities and fulfilling leisure time will aid in
the development of a healthy recovery by addressing the individual's physical,
social, emotional and spiritual needs - by addressing the whole person.
Treatment
Recommendations
Addiction treatment programs are
very intense and often overwhelming for the client who is trying to gain
insight into themselves and their behaviors while experiencing withdrawal
symptoms. This process often consumes clients physically, emotionally and
cognitively, leaving them with an overwhelming amount of information to digest
and practice. The recreation therapist's role is to create a balance in their
program to increase the overall effectiveness of treatment (Hood, 1995).
There are a number of issues
regarding a client's leisure lifestyle that must be addressed during treatment.
One of the first things the therapist needs to address is the client's
perceptions of leisure. What are the core values and beliefs regarding leisure?
Was leisure valued by the family of origin? Most clients will have little
motivation towards healthy leisure because they had no use for it when they
were active in their addiction. In their eyes, leisure activities are of little
value because they don't provide the immediate gratification that was met
through addictive behavior. It is the therapist's duty to challenge these
perceptions and help clients in their journey to discover meaningful leisure.
"Finding leisure" is an
experiential process that involves experimenting with a number of different
recreational activities to determine which ones meet a client's needs. The
therapist must introduce clients to healthy leisure choices in a structured,
non-threatening environment. Clients should be encouraged to take risks and try
something they have never done before. The result is almost always positive.
After all, success, failure, likes and dislikes are all a part of personal
growth and discovery.
An activity inventory is a useful
tool to compare current levels of participation (upon entering treatment) to
past levels of participation (before addiction). Normally there is a
significant decline in leisure interest and participation when the addiction
increases in severity. The activity inventory can reveal important treatment
issues regarding balance and variety of activities, and the number of interests
that were abandoned during active addiction.
In order to facilitate the client's
understanding of why healthy leisure decreased during their addiction, it is
beneficial for them to look at their motivation for engaging in addictive
behavior. In my experience, when clients are asked why they engaged in this
behavior, the most common responses are:
1.
To relieve tension and pain (emotional & physical).
2.
To escape from reality.
3.
To be more sociable and outgoing.
4.
To increase sense of power and control - feel stronger and more confident.
5.
To increase ability to cope with the problems and stresses of everyday life.
6.
To create a positive mood - get happy, have fun.
7.
To gain a sense of belonging.
8.
To relieve boredom.
If
you look closely at this list you will see that these are all needs that can be
met and benefits that can be derived from healthy leisure. This process helps
clients realize that the benefits of using are the same benefits of leisure so
that they can begin to see how healthy activities can help them cope with these
issues. It is easier for addicts to give up the rewards from their addiction
when they know they can get gratification from healthy activities.
The next step is to give clients the
opportunity to experience these benefits first hand. The addict must now
replace using with a balance of healthy activities which may involve learning a
whole new set of skills and behaviors. Clients often surprise themselves by
succeeding at something they did not think they could do. When this happens
they experience an increase in pride, self-esteem, and self-worth while doing
an activity that creates a positive mood, relieves boredom and provides a sense
of belonging to a group.
Experimenting with different leisure
activities in treatment provides an opportunity for clients to feel at ease
with others and feel comfortable with themselves. For an addict who was never
allowed to laugh and be silly as a child, it is important to emphasize that
this kind of behavior is appropriate during leisure time. In fact it is
necessary in order to get in touch with the inner child.
The therapist must be aware that solitary
activities are not recommended for addicts in treatment. Addicts spent a great
deal of time in isolation during addiction and for many clients, isolation is
an unhealthy way of escaping from the problems of life. There are more benefits
to group activities which provide clients with an opportunity to connect with
others. For example, a scheduled fitness walk that is incorporated into
treatment on a daily basis as a group activity acts as a deterrent for
isolation.
In addition to recreation activities, clients must also be
introduced to coping skills like stress management and relaxation training.
These are skills that can be used in conjunction with leisure or on their own.
Addicts need to be taught how to achieve a state of relaxation and deal with stress
appropriately because these needs were previously met in unhealthy ways with a
"quick fix".
It is also important to explore
barriers to healthy leisure. Two of the most common barriers that addicts
identify include feeling guilty about doing something for themselves and an
activity's affiliation with using. The first barrier is very common because
addicts in early recovery often experience extreme guilt over the time they
lost with their loved ones when they were actively using. The therapist must
help clients understand that they cannot take care of anyone else until they
take care of themselves. Positive self-talk and healthy self-rewards can assist
in the growth process toward feeling worthy of time to themselves.
The second barrier must be addressed
for "safety" reasons. If an activity, such as golf, had a strong
affiliation with drinking, then it may be "unsafe" to return to that
activity in early recovery. Safety refers to the risk of exposure to old
behaviors. The recovering addict needs to take precautions when returning to
activities in which addictive behaviors took place by changing the people and
the place that surround the activity. Different groups within Alcoholics
Anonymous have organized sober events such as dances, hockey teams, camp-outs
and even cruises. Making the choice to socialize and engage in activities with
sober people will create a safe environment that promotes recovery.
Prior to discharge from treatment, clients should be planning
for leisure and setting goals that they can work towards after being
discharged. Planning for leisure is an important step because it helps the
clients follow through with their intentions. Kelly (1982) describes leisure as
free time - time outside the obligations of life such as work and maintenance
activities. For the addict this was always a time to use. Therefore, in
recovery the addict needs to structure their free time and use that time to
engage in healthy activities. In addition, clients need to look at the time of
day when they routinely engaged in addictive behavior and implement these
healthy activities as a replacement during that time. Setting specific goals
and determining the steps that must be taken to reach those goals can help
clients move from the contemplation stage to the action stage and create a
motivation to succeed.
Most importantly, the therapist must
act as a role model for healthy behavior. Therapists must practice what they
preach and live a leisure lifestyle using healthy coping skills or else they
will lose credibility in the client's eyes.
Conclusion
There is clearly a difference between living and existing, and
leisure is the part of recovery that allows a person to live. In treatment,
therapeutic recreation is an essential service that models lifestyle change,
balance and healthy coping skills. For the addict, it answers the question
"What am I going to do for fun now that I'm not using?" and it is the
piece of the recovery puzzle that makes it complete.The client's overall goal
should be sobriety (beyond abstinence) and in order to achieve this goal, the
therapist must assist the client in reshaping lifestyles and values and
eliminating the dependence on addiction (Kunstler, 1991). In other words, the
therapist must help the client find healthy means to satisfy the needs
previously met through using.
Leisure is an ideal context for
trying new identities in sobriety and to determine the results of these new
identities on self and others; therefore, re-creating oneself (Hood, 1995).
Finally, leisure may be the ideal context for self-discovery in which clients
will realize that it is possible to have fun without the use of chemicals.
References
Austin,
D. & Crawford, M. (1991). Therapeutic Recreation. An Introduction.
Englewood Cliffs, NJ: Prentice Hall.
Brown,
S. (1985). Treating the alcoholic: A developmental model of recovery. New York:
John Wiley & Sons.
Csiernik,
R. (1993). Substance use and abuse: An overview. Hamilton, ON: McMaster
University and Bookstore, Customer Courseware.
Daley,
D.C. (1989). A psychoeducational approach to relapse prevention. In D.C. Daley
(Ed.). Relapse: Conceptual, research and clinical perspectives. (pp. 105-124).
New York: The Haworth Press:
Faulkner,
R. (1991). Therapeutic recreation protocol for treatment of substance addictions.
State College, PA: Venture.
George,
W.H. (1989). Marlatt and Gordon’s relapse prevention model: A
cognitive-behavioral approach to understanding and preventing relapse. In D.C.
Daley (Ed.). Relapse: Conceptual, research and clinical perspectives. (pp.
125-152). New York: The Haworth Press.
Godbey,
G. (1985). Leisure in your life (2nd ed.). State College, PA: Venture.
Hood,
C.D. (1995). Drug and alcohol abuse intervention: Does therapeutic recreation
have a place? Toronto, Ontario: Presentation at the Recreation Therapy
Conference.
Kelly,
J. (1982). Leisure. Englewood Cliffs, NJ: Prentice-Hall.
Kinney,
J. & Leaton, G. (1991). Loosen the grip: A handbook of alcohol information
(4th Ed.). St. Louis, MO: Times Mirror/Mosbey College.
Kunstler,
R. (1991). Substance abuse. In D.R. Austin & M. R. Crawford (Eds.).
Therapeutic recreation: An introduction (pp. 119-137). Englewood Cliffs, NJ:
Prentice-Hall.
Mooney,
A.J., Eisenberg, J. & Eisenberg, H. (1992). The recovery book. New York:
Workman.
Rifkin,
L.G. (1994). The importance of leisure to the recovery process. In D. Compton,
& S. Iso Ahola. (Eds.). Leisure & mental health (pp 191-2031). Park
City, UT: Family Development Resources.
Schaef,
A.W. (1987). When society becomes an addict. San Francisco, CA: Harper &
Row.
Sinyor,
Y., Brown, T., Rostant, L., & Seraganian, P. (1982). The role of a physical
fitness program in the treatment of alcoholism. Journal of Studies on Alcohol.
43. 380-386.
Resources:
A) Local
1.
New Haven; Lehi, UT
2.
Discovery House; Orem, UT
3.
Alliance Critical Services; American Fork, UT
4.
Addicts to Athletes; Provo, UT
B) National
1.
Center for Substance Abuse Treatment
2.
National Drug and Alcohol Abuse Hotline: 1-877-437-8422
C) International
1.
International Guide to Drug and Alcohol Rehab
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