At Las Vegas Recovery Center (LVRC), we believe abstinence-oriented treatment that incorporates the twelve-step approach to establish and maintain ongoing recovery is a time-tested and proven method. While the twelve steps are not treatment, we do recognize that introducing the process of working the steps, in addition to developing a comprehensive clinical plan of treatment utilizing research-based, best treatment practices, provide a foundation for clients to experience a successful treatment outcome. According to a recent study on participation in twelve-step programs “…increased affiliation in twelve-step groups was associated with higher abstinence from drugs, less severe distress and psychiatric symptoms, and more employment at one-year follow-up. The twelve-step model shares a number of common change strategies with effective behavioral treatment and with mechanisms used by successful self-changers.”
The efficacy of twelve-step programs
The principles embodied in the twelve steps are universal regardless of a client’s religious, spiritual, or non-religious preferences and provide a natural and organic progression from treatment to maintenance of post-treatment recovery. “The twelve steps can themselves be viewed as a process of cognitive restructuring—learning to recognize and change unhealthy thoughts and attitudes.”2 In other words, clients feel better about themselves and improve their lives in many areas, which is the purpose of treatment. After clients complete one of LVRC’s treatment programs, we encourage them to continue their involvement with twelve-step programs as an integral component of an effective aftercare plan. This plan advances several critical treatment goals: a.) to reinforce commitment to the recovery process; b.) to provide a forum for identification and support; c.) to utilize positive recovery principles; and d.) to provide peer support and accountability for the recovery process.
“The early installation of hope for the future is a key element to recovery through the twelve steps. The personal stories told by members of overcoming adversity, although there may have been many ups and downs, help give those who are in early recovery the hope that they too will ultimately succeed. Hopelessness is correlated with depression, suicidal ideation, and suicidal behavior in clinical populations, including substance abusers.”3 Our clients are encouraged to participate in twelve-step programs in an interactive manner. Attending meetings is a minor part of that experience. We urge our alumni to select a home group, get a sponsor, and volunteer for service work within the fellowship of their choice. We have seen more positive results with those clients who get involved with a fellowship instead of staying on the periphery.
The following diagram (National Institute on Drug Abuse) highlights the percentage of clients who participate in a twelve-step program and remain drug-free during a six month follow-up.
Our orientation regarding Narcotics Anonymous
At LVRC, we believe addiction is a primary disease with many manifestations that are not all drug-related. We do not focus on any one particular substance or behavior. Rather, we address the underlying aspects of addiction—obsession, compulsion, self-centeredness, and denial—as they pertain to substance use and other manifestations. We assist our clients in addressing these issues physically, emotionally, mentally, and spiritually through collaborative work with our staff while providing an interactive and multidisciplinary education about addiction. Understanding the dynamics and underlying factors of addiction are essential to learn how to maintain a drug-free life. Narcotics Anonymous’ philosophy of addiction as a disease and of total abstinence from all substances fits well with our philosophical orientation.
One size may not fit all…
We provide orientation and information on other fellowships since some clients may find a better fit by selecting an alternate venue for self-help. As part of our clients’ aftercare plan, we collaborate with them to create an effective plan that works. While clients attend Narcotics Anonymous meetings during treatment, we recognize that one size may not fit every client’s needs.
Some clients may have attended another twelve-step fellowship prior to coming to treatment at LVRC. They even may have been an active participant in it. Other clients may feel more comfortable in another fellowship or just would like to “see what’s out there.” We believe it is beneficial to assist them in the transition into that fellowship as part of their aftercare plan.
Our assistance includes tools for participation while they “shop” for the fellowship they feel offers the most support. We ensure our clients have the education, tools, and resources needed to provide a safe and secure integration into the twelve-step fellowship they choose to attend. This includes how to introduce themselves at meetings, meeting etiquette, program traditions, and how each of these fellowships’ customs relates to members sharing and finding help. We want to make their transition as safe and easy as possible. We stress utilizing the tools they have learned for identifying healthy, non-shame-based meetings and to gravitate toward members with solid recovery.
LVRC and our alliance with the twelve-step community
Each of our clients is required to get a temporary (volunteer) sponsor while in treatment. This serves a two-fold purpose: 1.) to assist the client in understanding twelve-step meetings and the philosophy of that fellowship; and 2.) to begin the process of working the twelve steps while still in treatment. Temporary sponsorship differs from traditional sponsorship since these individuals are more of a volunteer group that work closely with the client’s primary counselor to assist in dealing with client issues. All of these individuals are screened by LVRC and receive an orientation on what treatment is, what their roles as temporary sponsors are, what the program rules are, and how to work with clients while they are in treatment. This provides a collaborative environment between the primary counselor, temporary sponsor, and the client. Temporary sponsors must submit a copy of their driver’s license and proof of insurance prior to taking any of our clients on pass. We also require they sign appropriate releases of confidentiality.
By actively selecting appropriate meetings and linking the clients to a temporary sponsor, we achieve a much greater chance of success. We believe this partnership with the twelve-step community allows a seamless transition for our clients to integrate into the recovery community. The confidentiality release and interaction with the counselor ends at discharge. The explicit understanding is that the client may ask this volunteer or another member to sponsor him or her after treatment and develop the new relationship in a manner consistent with the customs and norms of the applicable fellowship.
Sometimes clients are initially resistant to twelve-step support. This usually is not related to the lack of efficacy of these programs, but is often predicated on misconceptions from what they have heard or from having undesirable experiences. We assist clients in identifying and resolving these issues and guide them to healthy support meetings while they are in treatment.
LVRC considers healthy groups to be those meetings that have a good mix of new members (identification and peers), mature members (experience, strength, and hope), and are solution-oriented. These are important components that can be critical for the new member to feel comfortable in ongoing twelve-step meeting participation. We encourage our clients to find a primary fellowship that has a solid base of support and to focus their recovery in that fellowship.
A number of clients, based on their needs, may be encouraged to supplement their primary twelve-step fellowship with secondary support groups that provide a more focused opportunity to address ongoing recovery issues. Some examples of secondary support groups may include Recovering Couples Anonymous, Chronic Pain in Recovery groups, and professional diversion programs. Often the diversion programs will be a prerequisite for maintaining professional licensure.
Some clients find the twelve-step environment uncomfortable, so their aftercare plan may require utilizing multiple sources for the support and resources they will need for ongoing recovery. If a client chooses a non-twelve-step method for support, we work with him or her to identify and build a practical aftercare plan. However, it is important to note that the built-in support network for non-twelve-step approaches for recovery is not as easy to identify and utilize for the reinforcement of abstinence.
If clients choose another path, again they must identify something that will work. Often this involves multiple types of interactions in order to provide the comprehensive support inherent in twelve-step fellowships that LVRC believes is important to maintaining recovery. For example, utilizing church or other religious groups can be a powerful tool for some former clients, but usually requires additional focus on addressing individual issues through either individual or group counseling. Even with these two tools combined, it is important to also include the means to finding a mutual support network that will address identification, isolation, and other integral social interactions that are so necessary for recovery.
We assist these clients in their search for avenues of peer support to ensure their discharge plan has a complete set of recovery tools. Our goal is to provide them with a success-oriented plan for maintaining abstinence, continuing to address the underlining issues that led to their treatment episode, and finding growth and success with their newfound recovery lifestyle.