The 3rd Phase of Addiction Treatment — Continuing Care Plans/Living Arrangement Contracts
Posted Jan 17 2011 7:44pm
by Lisa Frederiksen
In this day and age, we have Plans and Coaches to help us with training for a triathlon, completing a walk for breast cancer fundraising, succeeding on a diet, life coaching, job searching — even coping with ADHD. Designing a Continuing Care Plan — a Living Arrangement contract — to strategize how best to carry on in one’s recovery after rehab is equally important.
The purpose of a Continuing Care Plan/Living Arrangement Contract is to involve family member(s) and the addict/alcoholic in a comprehensive conversation on what happens after rehab; thereby helping all concerned better appreciate that treating addiction diseases is no different than treating other diseases in that the disease treatment model is three-fold: 1) detox/stablization, 2) rehab (e.g., 28-days at a treatment center) and 3) continuing care, of which the Plan/Living Arrangement Contract is the first step. All concerned need to understand that as a brain disease, addiction recovery requires the continued work to “wire around”/“unwire” the embedded addiction-related coping brain maps and replace those with healthy coping brain maps.
To that end, all concerned need to understand how daily living is fraught with their (both family member’s and addict/alcoholic’s) respective relapse triggers. Clearly identifying what those are, how to cope with them, what to expect, how to self-care, pros and cons of SLEs, AND for the addict/alcoholic, how to tackle the things that fell apart during their addiction (e.g., parenting, credit, employment, relationships) can be critical for lifelong recovery for all concerned.
Below you will find a few of the items that I cover with my clients when we work out a Continuing Care Plan/Living Arrangement Contract. As I explain to my clients, it is an agreement for how to integrate the addict/alcoholic into the family without giving up self or jeopardizing anyone’s recovery.To this end, all parties to jot down their thoughts around the following issues to then be discussed as part of the boundaries both ‘sides’ need to establish in a written agreement. (You don’t have to have all of the answers, but it helps to think about this BEFORE you try living together again – otherwise, the grooved neural networks of coping and responding to each other will take over and without wanting it to happen, you’ll spiral back into old ‘communication’ patterns, which are counter-productive to the recovery of all concerned.) Issues include:
1) what the addict/alcoholic should expect from family (i.e., not to try manage their recovery and specifically what is meant by this)
2) what family members should expect from the addict/alcoholic (i.e., to tolerate their fears and reactions and specifically what is meant by this)
3) identify what recovery will look like for both (i.e., individual therapy, 12 step or other self-help meetings, daily exercise class, private down-time activities, volunteer work, …)
4) what kinds of ‘life issues’ (fall out as a consequence of the addiction) need to be dealt with – credit repair, improve job skills, build resume,… — include strategies and time-frames
5) identify relapse triggers for the family member (e.g., addict/alcoholic not following through on promises, not working their recovery, not taking responsibility for actions, not taking proactive steps to let the family members know what is going on)
6) identify relapse triggers for the addict/alcoholic (e.g., family member always asking questions, feelings of being watched, vibes of “You owe me after all I’ve done for you!”…)
7) decide on a code-word that can stop conflict from escalating without having to resolve it or admit guilt (in essence, the code word ‘says,’ “I’m feeling squirrely and don’t know how to do this right; I know what I’m doing is not helpful; this is not an admission of right or wrong; so for now, let’s walk away, and I’ll put it on the list for things to discuss in our weekly meeting – see #8)
8 ) strategy for how to conduct weekly follow-up sessions that are ‘managed’ by a neutral third party, e.g., therapist or myself, to address concerns or unresolved conflict. Again, this is not to solve anything, necessarily, as it is difficult to resolve the deeply rooted issues that lurk below the surface while in early recovery – will explain why – but mostly to feel heard and to decide when it might be healthily addressed (e.g., put it on the calendar to talk about in 3 months)
9) decide what is off-limits (e.g., talking about or asking questions about the work that will be done in therapy – trauma issues, coping issues, anger, depression, etc.)
10) discuss bottom-lines, e.g., “You use, and I will __________.” Make sure all know what has been done to put these into play if the boundary is breeched.
Drafting this kind of an agreement allows neural network pathways for healthier coping skills to form and time to heal/change the brain and physical body before trying to unravel each other’s deeper feelings about what has happened, either individually in individual therapy or together in family therapy or via separate self-help groups or a non-12-step group or a 12-step group or ___________________ .
For questions or to discuss working we me to complete an Living Arrangement/Continuing Care Plan, please email: email@example.com. I often do them using Skype when distances are too great for in-person meetings.
I also offer consulting services to families (with or without their loved one present) to help them better understand the disease of addiction, secondhand drinking and how to move forward. Ask for: “Informational Consulting: Connecting the Research and Clinical Findings to the Practicality of ‘Living’ with the Family Disease of Addiction.”