Questions Related to Residential Recovery Programs

What are some special counseling concerns for women in family shelters?

• A special strategy for people with drug and alcohol problems is essential -Not every adult who comes to the family shelter is addicted to alcohol and/or drugs. Yet, we must be mindful that addicts have special needs that the “garden variety” sinner does not have. By using a standard alcohol screening test in the normal intake process, we can identify those with drug and alcohol problems. They, then, must be channeled into activities that will help stabilize them in sobriety and begin an active personal program of recovery. These include: support groups, addiction therapy, educational activities, etc. If a shelter’s staff does not have expertise in this area, using other community resources is essential. Because addiction is a primary issue, all other help that is provided will amount to nothing if the person cannot become stabilized in a sober life.

• The Issue of Toxic Shame – By definition, “toxic shame” is an inner sense of being defective, faulty, unlovable, undeserving, unredeemable and hopeless. It is a root problem for all addicts, codependents and every adult who grew up in a dysfunctional family. I believe, 90% of the people in family shelters fall into one of these categories. Toxic shame is the “glue” that holds the wall of denial together. It often keeps people in need from accepting the help we offer them. They think – “If I admit to you that I have problems, it proves that I am a worthless, useless human being.” Because addiction leads to a total deterioration of a person’s moral life, many struggle with a destructive mix of toxic shame and guilt. The Gospel of Christ not only the promises forgiveness, through it we know admitting your problems is not an admission of hopelessness or defectiveness. Instead, it is the key to freedom from our pasts and a whole new self image.
• The Dynamics of Codependency – Another critical counseling issue for women in shelters is learning to overcome the destructive effects of codependency, which is, essentially, the result of a lifetime of abusive relationships. If this issue is not dealt with, codependent individuals will continue to become emotionally involved with people who are not good for them. Some of its most obvious symptoms are:
  • A sense of little or no control over the circumstances of one’s life – A child growing up in a dysfunctional family must somehow find a way to cope with all the pain and confusion in order just to survive. This often results in a faulty belief system that continues into adult life, where the individual has an all-pervasive sense of powerlessness about practically every situation in which they find themselves.
  • Passivity in the face of disturbing and dangerous situations – People from dysfunctional families are used to living life in constant crisis. So, painful circumstances that would motivate most of us to change our behavior do not do so for them. Instead, their learned helplessness results in a sense of resignation about even the most painful and dangerous circumstances.
  • Avoidance of social support – For those who struggle with “toxic shame”, almost everything that happens to them in life seems to support their assessment of themselves as being no good, useless, powerless, unable to change or do anything right. Codependent people tend to be filled with fear and insecurity, especially in social situations. All this makes relationships with others very difficult.
  • Guessing at what is normal – The home life is where an individual’s perspective of the world is formed. Because dysfunctional families have secrets and unhealthy rules, the children grow up feeling isolated and different from other people. As adults they are forced to guess at what “normal” is. This is also why so many people in our programs tend to be so self-conscious, and have such a hard time trusting, opening up and really feeling a part of things.
  • Out of touch with emotions – Learning to stuff one’s feelings is an essential survival skill in a dysfunctional family. This is why so many adopt their parents’ “better living through chemicals” approach. Managing one’s emotions through chemicals is one of the primary symptoms of addiction. When an individual stops experiencing emotions in the proper, appropriate, healthy way, they all get pushed down deep inside themselves. As a result, they get more out of touch with who they are and what they feel. That’s why they blame others, that’s why they keep hurting themselves. On the other hand, one of the first consequences of coming into recovery is the revival of the emotional life. Feelings often come out as anger and grief, often in seemingly inappropriate ways. Yet, this can be an important sign of growth.

What steps must be taken to comply with federal and state laws regarding the payment of the minimum wage when participants do work in a recovery program?

• The work must be therapeutic– In some residential programs, the lines have been blurred between employees and clients (beneficiaries). The most effective means of clarifying these lines is having a well-documented recovery program in place that uses a written recovery plan that lists the work performed by the client as being rehabilitative in nature. There is no problem in giving some stipend to program participants who perform work as part of their recovery program. If this is done, it is important to avoid the use of the terms “staff” and “wages” or any other terminology that could imply an employee/employer relationship. Instead, call this stipend a “sustenance allowance” or “gift.” In the initial intake session, clients should sign an agreement indicating that they understand that some hours of work will be a part of their recovery program, but that this is a part of their rehabilitation and not establishing an employee/employer relationship for which they will receive wages.
• Stipend amounts and level of participation in program activities must be equal for all clients – is acceptable to offer differing amounts for stipends during different phases of the program as a form of incentive. But, it is critical that all clients in the same phase receive the same amount – regardless of actual hours worked. Also, regardless of what “job” a client has been assigned, he must not be exempt from participating in the same activities required of others at the same level or phase of the recovery program. Tying compensation to hours worked or exempting certain individuals from fully participating in the program’s recovery-oriented activities may give the appearance of establishing an employee/employer relationship.
• “Key” positions are best filled by employees – It is very tempting to “missionize” or “programize” talented people by keeping them “in the program” indefinitely. A better arrangement is to fill important positions (cooks, drivers, etc.) with individuals in a latter phase of a program who become actual temporary employees. These individuals will naturally be more stable and dependable. Minimum wage requirements may be met by combining cash payments with the established “fair market” value of the housing and meals that are provided. In most cases, the program is then only responsible for the FICA withholding and matching payments, since non-cash compensation is usually not subject to state and federal employment taxes. Not only will this arrangement reward those who are doing well in their recovery, it also assists them to begin re-establishing an employment record.

How do we properly cope with the emotional distress that some staff members experience when called upon to dismiss residents for violating program rules?

• The Principle of “Tough Love” – One of the keys to overcoming staff difficulties in this area is educating them in the important principles of “tough love.” While it can be extremely difficult to dismiss certain people from a program, we really are doing what is best for them. For those in denial about their problems, consequences can be their salvation! People continue to abuse alcohol and drugs (and persist in dysfunctional behaviors) as long as they feel the benefits outweigh the costs.
  Additionally, being dismissed can often serve as an important learning experience. Such people may return to the program with a much better attitude, having had a chance to get a hard look at the pain and destruction in their old environments. Someone once said, “It’s hard to go back to digging around in the garbage after you’ve been feasting at the King’s table!”
  At times, people may have more problems than a program’s facility and staff are equipped to handle. Except for this situation, there seems to be only one other reason for dismissing an individual from a program – resistance! One manifestation of resistance is a refusal to abide by expectations and rules to which they initially agreed when they first entered your facility or program. Keeping them around is both bad for them and unfair to those who do have a sincere desire for a new life.
  Certainly, troubled people need a lot of love and compassion. Yet on the other hand, like Jesus, program staff members do need, at times, to confront people who are in sin and denial. Truth is always uncomfortable to the hard-hearted. People only recover when they learn to take responsibility (with God’s help) for their own actions and lives. We cannot do this for them!
• Protecting the Sincere Client – Another important principle to remember in the application of “tough love” is the need to protect those residents who are sincerely trying to change their lives from those who are not. Keeping hard-hearted and disruptive people around can be extremely discouraging to those individuals who are working hard at their own recovery. It can be truly amazing to sense the dramatic change in the atmosphere of a program when one or two disruptive individuals are removed. Sincere people can be further motivated and reassured if they know that their efforts toward recovery will not be undermined by disruptive, uncommitted, and dishonest people.
• Consistent Application of Program Rules and Expectations – It is extremely difficult for a staff member to dismiss a resident for a rules infraction that another resident has gotten away with. No one wants to play the “bad guy.” To prevent this situation, whatever rules a staff establishes must be applied equitably to all who stay at the facility. Furthermore, “bending the rules” leads people to conclude that the ministry’s staff members are not serious about enforcing any of them. “Playing favorites” by exempting certain individuals from your established rules will certainly lead to resentment toward staff members and their “pets” by other residents in the facility. It is also especially important that staff members are supported by their superiors who are not constantly over-ruling their disciplinary decisions. If there is a disagreement between staff members about such an issue, it must never be discussed in the presence of a resident. Forgetting this will certainly undermine the authority of the staff member in the eyes of the residents, rendering him ineffective in disciplinary matters.
  The most important element for successful application of program rules and expectations is a formal intake session for every individual before actually moving into the program’s facility. At this meeting, the rules and expectations that are conditions of staying at the facility must be clearly discussed with prospective residents. The best policy is to require them to sign a formal contract agreeing to abide by your expectations. This way, with everything explained at the very beginning of their stay, staff members will not be accused of “making up rules along the way.” It also means that residents cannot say, “I didn’t know about that rule.”
• The Principle of Good Stewardship – Program staff members must be assured that, if a program has limited space, they must practice the best possible stewardship of the resources God has entrusted to them. This involves, at times, a commitment to not allowing their time and resources to be wasted on people who are closed and resistant to what they have to offer. They must avoid turning away people they can work with because space is being taken up by those who are hard-hearted and resistant. Good stewardship can mean working with a smaller number of sincere people, rather than filling up their facilities with people who use and abuse often limited resources and have no desire to change their lives.
• Internal Struggles of Staff Members – When staff members are struggling with their own codependency-related problems, it can be very difficult for them to take disciplinary measures with program participants. Staff members must be committed to being part of the solution and not a part of the problem. Their own unresolved issues will inevitably hinder their ability to minister effectively to others. It is only proper and fair to those they work with that staff member seek out the right sort of help for themselves. (The “Wounded Warriors” tape has more insights on this topic.)

What are some strategies for preventing relapse?

(This section is from a seminar given at the 1996 AGRM Annual Convention)

In addition to introducing men and women to Christ, helping addicts to maintain sobriety is a primary responsibility of the rescue mission residential program. Learning to read, completing high school, and gaining other life skills are important. But, if residents cannot remain sober, we have only succeeded in creating smarter Biblically literate drunks. The act of using drugs or alcohol is an end result of a process that began long before. Addicts relapse when it is more painful to stay sober than it is to get “high.” The immediate benefits of ceasing drug and alcohol use include: improved health, better sleep, return of appetite, and clearer thinking. However, all addicts eventually face a challenge even more difficult than stopping drinking or using drugs — coping with life without them! Doing so involves a whole lot more than just “putting the cork in the bottle.” They must learn a completely new way of life. We often refer to this process as “recovery” — the Bible calls it “sanctification” — a definite ongoing program of personal growth.

Major Causes of Relapse

• Denial – inability to accept that one is indeed addicted to alcohol and/or drugs and that it is a primary cause of life problems.
• Post Acute Withdrawal Syndrome – inability to cope with a set of very stressful, physiologically- based symptoms that occur only after use of alcohol and drugs has stopped
• Emotional Dysfunction – inability to cope with feelings such as grief, depression, stress, fear, etc., without mind altering substances.
• Relational Dysfunction – inability to develop and maintain healthy relationships with others.
• Temptation – inability to deal with the issue of sin in one’s life.
• Dishonesty – the inability to maintain a commitment to rigorous honesty which is the foundation of a life of recovery.

Some Relapse Prevention Strategies

1. Scriptural Priority – Worship, prayer, Bible Study, and Scripture memory all equip the person new to sobriety to overcome temptation and live a life that is pleasing to God.
2. Take Relapse Seriously – It must be clearly understood that use of alcohol or drugs results in immediate dismissal from the program. This could mean simply being asked to leave the facility, demotion to “transient” status or referral to another program. After thirty days, the client can be reassessed for reentry to the program. The worst possible situation is to give residents the impression that everyone has at least one drunk “in the bank.” We can be assured that they will use it!
3. Addiction Education – Gaining more knowledge about addiction serves two very important functions. It helps the addict in denial accept his condition. And, this knowledge can be a tremendous source of comfort and reassurance for those struggling with post acute withdrawal symptoms and the emotional difficulties that come with early recovery. Newly sober addicts need to understand that they are suffering from a malady that is shared by others. Education also gives hope that change is possible. Many resources are available: lending libraries, literature, videos, and local professionals who can speak at the mission. Contact AGRM’s Education Office for information on educational resources for use in a mission setting.
4. One-on-One Counseling – Every participant in a long-term program needs at least one hour a week with a staff member who understands addiction to help them through the struggles of early recovery. Relapse is a process — no one is working a solid program of recovery one day and drunk the next. Therefore, one very important goal of these sessions is to help them to recognize their relapse patterns and learn to interrupt them before the process leads to actual use.
5. Support Groups – Good support groups provide recovering addicts with with a safe, non- judgmental setting to share their struggles, thoughts, and feelings without fear of rejection. Hearing the stories of others with similar difficulties and how they overcame them provides valuable encouragement for them to go on in a life of sobriety. Because addiction wreaks havoc upon an individual’s relationships with others, support groups are also a great place to begin the difficult and painful process of re-connecting with other people.
6. Relationships – One especially important area where those in recovery need special help is in learning how to form healthy relationship and avoid destructive ones. Unhealthy relationships, especially of the romantic sort, are one of the biggest causes of relapse. Teaching about godly relationships, even in the sexual area, helps them to avoid getting caught up with people that are not good for them. New relationships with the opposite sex should be put off for the first year of sobriety.

What is the proper use of drug and alcohol testing in a residential recovery program?

• Not the only means of maintaining a drug free program – While it is of utmost importance that a recovery program be kept “drug free,” it is especially cruel to use drug testing as a means of enforcing abstinence if there are no other active programs to support people in pursuit of a life of sobriety. Doing this is truly setting addicts up to fail. Testing can be most useful when there is an on-going program of recovery-oriented activities in place. Even then, drug testing should be a rare practice for the recovery program.
• Generally, it is best conducted when there is a good reason to suspect that use of drugs or alcohol has occurred – There may be some situations where routine drug testing of every program resident should be conducted. One instance might be when a client returns from a weekend or longer period away from the program. However, over-testing can actually work against developing an atmosphere of trust among the staff and clients. If we are operating a program where there is a systematic monitoring of the clients’ progress, there will usually be indicators of problems before the actual use occurs. Relapse is a process — no one is working a solid program of recovery one day and drunk the next.
• To maintain a commitment to “rigorous honesty” – An atmosphere of truthfulness is the most necessary ingredient for a successful recovery program. The first requirement for entering into the program must be a sincere desire to become free of mind-altering substances. This means that those who “get high” will be immediately expelled from the program. The knowledge that program participants who are suspected of using them will be tested is an “insurance policy” that lets all involved know that they will be held to their word concerning a commitment to recovery. Those involved in the program with a sincere desire for a new life can be reassured that their efforts toward recovery will not be undermined by disruptive, uncommitted, and dishonest people, whose use of drugs or alcohol will be discovered.
• To provide predictable consequences for using – Consequences are the addict’s salvation! In other words, people continue to abuse alcohol and drugs as long as they feel the benefits outweigh the costs. It must be clearly understood by all who enter the recovery program that any use of alcohol or drugs results in expulsion from the program. They must also understand that this consequence is applied equally to all program participants — no exceptions. This could be followed by a demotion to “transient” status or referral to another facility. Usually, after 30 days, the client can be reassessed for reentry to the program. The consistent application of this policy will actually promote a commitment to sobriety among program participants. If it is not followed through with consistently, staff members will be accused of favoritism or the program participants will assume that the staff does not take the use of alcohol and drugs seriously. The worst possible situation is to give them the impression that everyone has at least one drunk “in the bank.” We can be assured that they will use it!

---

Most of the above material was adapted from A Guide to Effective Rescue Mission Recovery Programs by Michael Liimatta

© Copyright 1993, Association of Gospel Rescue Missions. All rights reserved.

While developed originally for use in inner city rescue missions, this is a comprehensive resource for developing successful residential programs for drug addicts and alcoholics in any setting. It includes several hand-outs for staff in-service training, model program policies & procedures, and many useful forms.