Las Vegas Recovery Center’s Twelve-Week Discover Recovery Inpatient Program
Phase III (Weeks 10 - 12) The Journey Continues
The purpose of this final phase of the twelve-week program is to help you maximize your capacity to successfully transition from the safety and supervision of a structured treatment setting back to the community, prepared to assume full responsibility for your recovery. Our twelve-week length of stay is consistent with research by the U.S. National Institute on Drug Abuse (NIDA), which concluded that for most individuals, “the threshold of significant improvement is reached at about three months in treatment.” This time frame correlates with the most challenging period of post-acute withdrawal, which can continue for weeks or months after you complete medically-supervised detoxification. Active addiction dramatically changes brain functioning in the areas that govern thinking, feeling, and behavior. During post-acute withdrawal, when the brain and body are beginning to heal and rewire themselves to adjust to living without substances, difficulties in thinking, concentration, judgment, memory, sleep, appetite and mood are quite common. The discomfort of post-acute withdrawal is a driving factor in the relapses of many people during early recovery. A twelve-week length of stay has the additional benefit of providing therapeutic shelter until the storm of the most severe symptoms of post-acute withdrawal can pass. We want to give you the best possible chance to continue your recovery.
Like any structure, your recovery will only be as strong as the foundation on which it is built. Phase III assists you in solidifying the foundation of your recovery by providing you with expanded opportunities to practice your new recovery-oriented lifestyle in a setting where positive changes in your thinking and behavior can be nurtured. Moreover, your emerging attitudes and behaviors can offer positive models for newer clients. In Phase III, you are allowed additional privileges, such as off-site passes and attending twelve-step meetings with your temporary sponsor. This gradual, progressive, and supervised reintegration into your family and the community gives you the ability to process difficulties as they are encountered, while in the safety of an intensive inpatient treatment environment.
Phase III focuses on helping you make the transition from reliance on the structure of the treatment environment to taking initiative and personal responsibility for your recovery. This phase is designed to increase opportunities to strengthen the recovery principles and the skills you have learned by applying them in daily experience. Through continued practice of new, recovery-oriented ways of relating to yourself, to others, and to the world, positive changes in thinking and behavior gain critical traction.
PHASE III GOALS
• • • • • • • • • Verbalize a solid understanding of the disease of addiction (mental, emotional, physical, and spiritual dimensions) and its potential manifestations in your life. Write daily in the guided journal, My First Year in Recovery. Attend all assigned groups and complete specified writing assignments. Demonstrate recovery-based behaviors and the ability to model these for other clients. Read and highlight Chapters Nine and Ten in the Narcotics Anonymous basic text. Continue to work on relationship with your temporary sponsor. Complete Step-Working Guides Six and Seven and process with your counselor and temporary sponsor. Attend outside twelve-step meetings with your sponsor. Exercise at Sports at least three times weekly.
For your family and friends • Participate in twelve-step meetings, Friday night family support groups, family sessions, and other recommended workshops, and if they did not during phases I and II, attend Family Renewal Program. Practice the plan developed during Phase I as needed to utilize, maintain, and strengthen the leverage available to the family in setting and enforcing boundaries to support the recovery process for both you and your family.
LVRC’s comprehensive assessment of each client, which begins in Phase I and expands in Phase II, continues in Phase III. This ongoing assessment focuses on the eleven life areas below to determine the extent to which your status and functioning in these areas have helping or obstructing effects on your ability to stay clean and continue in the recovery process. These assessment areas are also used to develop individualized treatment plans and discharge/aftercare plans. 1. Family/Significant Others • Quantity and quality of relationships with family members/significant others and degree to which these relationships help or hinder your recovery process. • Knowledge of addiction and family recovery.
Motivation and willingness to continue providing agreed upon leverage. Use of and involvement in recovery resources, including family support group, Family Renewal Program, workshops, lectures, and, and twelve-step programs. Quantity and quality of your social relationships and degree they help or hinder your recovery process. Strategies for strengthening your “helping” relationships and reconsidering, modifying, or ending your “hindering” relationships. Strategies for establishing new supportive relationships. Employment status, history, and skills. Transitional issues regarding returning to work. If applicable, the quality of your relationships with your employer and other coworkers. Interest in or necessity of vocational training.
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Health • Current state of health. • Health issues needing attention or treatment, e.g., medical conditions, exercise, nutrition. • Plan for ongoing exercise and nutrition/weight management as appropriate. • Plan for regular check-ups with physician, dentist, and other health care providers. Emotional • Emotional state and degree of balance. • Style of emotional expression. • Areas of greatest emotional discomfort and their connections to your substance use. • Ability to identify and cope with feelings and emotions. • Remaining “secrets” in your emotional closet that may need to be addressed in this phase. Mental/Thoughts • Mental health status and history, including treatment and medications. • Cognitive/thinking style and degree of balance. • Type and degree of hindering thoughts or patterns of thinking. • Status of your recovery-oriented thoughts and patterns of thinking. • Capacity for using reading and writing resources, including recovery literature. Spiritual • Spiritual beliefs and practices. • Current state of acceptance regarding the disease of addiction, including powerlessness and willingness to seek support. • Capacity to use the spiritual aspects of recovery, e.g., meditations and prayer. • Reservations or obstacles related to to spirituality as a recovery-supportive resource.
Financial • Current financial issues affecting recovery process. • Financial status, stressors, and viability. • Actions needed to stabilize your financial situation. Hobbies/Interests • Use of down time in treatment and plans for use of free time post-treatment. • Activities you engage in for fun and recreation. • Special interests and/or hobbies you can develop to enrich the quality of your life Legal
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Need for a plan to resolve any pending legal issues upon discharge. Need for LVRC contact with probation, parole, judges, attorneys, etc. Need for documentation of your completion of treatment/discharge plan.
Patterns of Recovery • Degree of your understanding of the recovery process. • Previous recovery and related experience. • Extent to which your motivation for treatment and recovery is internal vs. external. • Degree of your demonstrated honesty, open-mindedness, and willingness. • Specifics of how you are working a program of recovery. • Quality of work on Steps Four and Five.
PhASE III GROUPS, LECTURES, AND ASSIGNMENTS
Groups/Lectures The Pathways and Barriers Series
• Post-acute withdrawal • Dealing with stress • Managing medically-required medications • Staying clean in challenging neighborhoods/communities • healthy communication • Dealing with pain (chronic and acute) • Embracing powerlessness without feeling helpless • Dealing with anxiety • Dealing with depression • Non-substance manifestations of addiction • Family recovery/healing • Dealing with trauma • healing past wounds • Avoiding complacency • Grief and loss • Anger and resentment • Shame and guilt • Sponsorship • Relationships • Expectations in recovery
Reentry Preparation Group
To normalize, validate, and process the issues, concerns, and emotions natural to transitioning from the safety and security of the inpatient setting to returning to the community.
Alumni Aftercare Group
An individualized strategy will be developed for you to be involved in a process for mentoring other clients that will include
• Orienting clients newly admitted. • Providing leadership in group settings. • Demonstrating a solution-oriented attitude and responsible, recovery-supportive behaviors. Off-Site Passes
An individualized strategy will be developed for prearranged day and weekend passes as appropriate. These can help reinforce progress you have made, as well as give you more responsibility for handling some of the outside logistics with regard to preparing for your discharge. This also provides opportunities to practice the knowledge and skills you have learned in treatment by applying them in such areas as
• How you will respond when returning to your home/community. • Confronting drug-using acquaintances. • Structuring and using free time. • Spending time with family/significant others/friends. Reading/Writing/Activities • Continue daily writing in the guided journal, My First Year in Recovery. • Read and highlight Chapters Nine and Ten in the Narcotics Anonymous basic text.
Time Use Charts
This assignment requires you to make a hour-by-hour chart of your last two weeks of active addiction prior to admission to LVRC to the best of your memory. Activities that should be addressed include, but are not limited to
• Active drug use. • Acquisition of drugs. • Work and the extent to which drugs were used while working. • Time spent with family and friends and whether drug use was part of the activity. • Exercise and the extent to which drug use was part of the activity. • Recreational activities and the extent to which drug use was part of the activity. • Sexual activity and the extent to which drugs were used by your or your partner(s). • Meals and the extent to which drug use was involved.
Your addiction time use chart will be processed with your primary counselor. As part of this review, your counselor will assign you to complete a recovery time use chart to represent what your use of time will look like after you complete treatment at LVRC. Activities that should be addressed include, but are not limited to
• Outpatient/aftercare treatment attendance. • Meeting attendance. • Step or writing assignment time. • Sponsorship contact. • Recreational activities/hobbies/leisure time • Time with family and friends.
• Exercise. • Employment.
Identifying Character Defects (Steps Six and Seven)
Make a list of character defects, after reviewing your life inventory and fifth step, and indicate how each contributes to and results from your addiction.
Identifying Relapse Risk Factors
Review your written description of three external/environmental factors and three internal characteristics or behavior patterns that you identified in Phase II as the most active threats to maintaining your recovery. Add three more external/environmental factors and three more internal characteristics or behavior patterns that you identify as the next most active threats to your recovery.
Generating Solutions/Strategies for Overcoming Relapse Risks
Use your list of risk factors and develop at least three solutions or strategies you can use to overcome each one. These should be detailed, directly related, and behavior-specific. For example, if external threat #1 is a partner who drinks in the home, then “Go to meetings regularly” is important, but not specific enough to be very helpful. A more detailed, action-specific strategy would be, “Ask him to get a separate fridge to keep alcohol in so I don’t have to reach past the beer to get food to make dinner,” in combination with, “Go to a meeting whenever I find myself uncomfortable at home when my partner is drinking.”
DISChARGE AND AFTERCARE PLANNING
The LVRC clinical staff will work with you to finalize details of arrangements for the living situation to which you are returning and coordinate referrals to other levels of care. This will include discussions with your family/significant others to reinforce established leverage; clarify and solidify expectations, boundaries, and goals; and develop a detailed plan to implement leverage and apply consequences in the event that you do not follow through with the agreed upon recovery plan. Staff will also collaborate with you to assess your plan for maintaining your recovery after discharge and to modify and strengthen your recovery plan as needed. If you are considering or referred to a transitional living setting, staff will work with you to gather information, narrow the selection, and finalize the details of those arrangements.
In preparation for discharge, it is essential for you to have a detailed and comprehensive recovery plan in place. Your recovery plan will be developed in collaboration with you, LVRC clinical staff, and your family and will address physical, mental, emotional, and spiritual needs, as well as follow-up treatment/aftercare, and NA or other twelve-step meetings. Your level of motivation for making changes recommended to continue your recovery will be assessed and any barriers to making such changes will be addressed with you and your family at this time. Your recovery plan will also include referral to the LVRC alumni group. Staff will arrange for you to meet with LVRC Alumni and attend some Alumni group meetings to facilitate smooth transitioning. Referrals and other arrangements for follow-up treatment/aftercare will be finalized in advance of discharge. You will be given responsibility to participate directly in this process. Whenever possible, direct connection between you and the Intensive Outpatient Program (IOP) or other levels of care or services that you will be attending will be arranged in advance of your discharge from LVRC in order to help prepare you for the next part of your journey in recovery.