The SOBER-HOME© Model Program
(Social Organization Building Effective Recovery Helping Ourselves through Mutual Experience)
By Chris Fajardo MS, CADC, NCACII, MAC
The Chinese symbol for the word "crisis" is exactly the same as their
symbol for the word "opportunity". The current crisis in health care
has allowed many of the less fortunate to fall through the cracks in the system.
With managed care, welfare reform, federal cutbacks, and brief therapy, the
need for an effective low cost solution to alcoholism and other addictions is
clear. Too often, addicts and alcoholics in need of care are not able to access
it because of cost, lack of, or inadequate insurance coverage.
We believe that the SOBER HOME Model Program gives these people the opportunity to save their own lives. This model can help chronic recidivist alcoholics/addicts; particularly those who require something more than a quick two or three week stay (if that much) in a residential setting. This is NOT a treatment model, and does not replace traditional treatment. It is a long-term model for recovery that places the burden of work on the alcoholic or the addict rather than on the professional. This model does not rely on an individualized treatment plan as defined by the Joint Commission for Accreditation of Hospitals and Organizations (JCAHO). Rather, its key is a simple defined program outlined in the book Alcoholics Anonymous.
A Long Term
Recovery Program
Often the chronic recidivist needs a long-term program in order to start and
stabilize their recovery. Without insurance or a large cash flow, these people
are simply unable to access help. The SOBER HOME Model Program may cost
as little as twenty-five dollars a day. This is possible because of the "barter
principle". The people needing assistance have limited financial resource;
all they have is themselves, and their personal efforts. Of course, Alcoholics
Anonymous is available to all who want it, but many are unable to grasp this
simple program, and many others need a jump-start while in the safety of a residential
program.
In traditional treatment settings, the patient's responsibility is rather narrow.
The facility and its personnel provide most of the necessary services from a
bed, meals, laundry, housekeeping, counseling, group therapy, to maintenance.
Of course, this is partly responsible for the increased cost of treatment and
the subsequent decrease in available treatment beds. While some of these activities
require an assortment of skilled technicians and trained professionals, many
do not and may be done by minimally trained people. Professionals may provide
supervision thus compounding their impact. Many issues of an alcoholic or addict's
life may be addressed while in a traditional treatment program as part of an
individualized treatment plan. Employment, sexual abuse, mental problems, emotional
problems social skills, education, vocational training and housing may all be
addressed in treatment planning. The traditional treatment model anticipates
the patient will make changes outlined by the doctor, counselors, social workers,
therapists, nurses, (the treatment team), and the patient. The patient typically
attends group therapy and participates in counseling, recreational therapy,
occupational therapy, while case management may also include many of these other
issues and AA meetings. The issues typically addressed in a traditional treatment
program as part of an individualized treatment plan are not even discussed until
the second phase of our social model recovery program. These issues, while important,
are normally not addressed until after the individual has begun to grasp the
nature of his/her problem, the solution to the problem, and the program of action
necessary to recover from addiction. Phase One of this process usually takes
12 to 14 weeks. Issues of employment, sexual abuse, social skills, education,
vocational training, housing, and others are addressed in a life skills format
only after the person begins to effectively understand and deal with addiction.
Focusing on these issues earlier may enable the client to deny the serious nature
of his/her disease. This chronic recidivist population is typically in the middle
and late stages of addiction. Clients tend to have multiple issues that need
attention as the results of their addiction. These issues are not the cause
of addiction: they are more often the results.
Alcoholics Anonymous and Recovery Dynamics
For over sixty-eight years, Alcoholics Anonymous has shown the world it works.
Based on the Twelve Steps and one alcoholic helping another, AA is providing
sobriety and a new way of life for many. These non-professional folks have demonstrated
the power of mutual help. Common experience (of both suffering and recovering)
and mutual help are proven principles.
The primary activity in a social model recovery program consists of doing written
homework assignments from a curriculum ("Recovery Dynamics") developed
by the Kelly Foundation of Little Rock, Arkansas. This is an inspired, in-depth
study of the 12-step program outlined in the book Alcoholics Anonymous. Clients
are required to complete a series of written assignments in order to progress
through the program. Illiterate people receive help and may have someone else
write for them. When a lesson is completed, it is checked for correctness and
accuracy. Everyone must also be able to answer the questions verbally. If he
cannot do it, the assignment may not be accepted as complete.
"Recovery
Dynamics": the Lifeblood; Community Meetings: the Heartbeat
The priority of The SOBER HOME Model Program for alcoholics and addicts
must have a consistent focus on sobriety. Failure to consistently emphasize
sobriety as the number one requirement will invite denial and exploitation of
services throughout the facilities. The social model recovery program environment
has very little in common with a Therapeutic Community; it is a virtual democracy.
"Learning Experiences" in this community model are used, however.
While " Recovery Dynamics" is the lifeblood of the model, the community
meeting is its heartbeat. This model's philosophy has been developed over a
thirty-year history of developing a recovery-oriented community for alcoholics
and addicts.
These two methods ("Recovery Dynamics" and Community Meetings) are
the working parts of the social model recovery program. Role models are also
an essential part of this environment; as they provide the visible message of
hope, hope that they, too, can change. By developing a system where people are
encouraged to help each other as they help themselves change fosters. Appendix
II of Alcoholics Anonymous says change is the essence of the spiritual experience
described throughout the book. This change is what recovery is all about. This
change is the goal of The SOBER HOME Model Program as well.
The purpose of community meetings is to give people the opportunity to be responsible
for themselves and to one another in a loving environment. Sharing concerns
with each other when they arise and in community meetings does this. We seek
a balanced solution for the community and the individual. Our goal is learning
equal respect and love for the individual and the community. We seek balance
with each other.
This philosophy has been developed over 36 years of working with alcoholics
and addicts. In-house community meetings may be held three to five times weekly.
In the community meeting format, inappropriate behavior is addressed or confronted.
The people involved may bring up the issue themselves or another community member
may bring it into the meeting. In the early days of developing this therapeutic
environment, some significant work is required. Many, if not most, of the community
members have lived for years in an environment where the "rules" say
no snitching, ratting, or the like, on other community members. Men and women
in prison learn this as a survival "rule". They have learned to look
the other way, mind their own business. This attitude is one that must change
in order to develop a therapeutic environment for change. Staff, residents and
volunteers are either part of the problem or part of the solution.
Caring, Voting and Consequences
Caring about each other is a principle underlying the community model. Anything
from transgression of program policy to a bad attitude may be discussed in community.
After some discussion, anyone in the community may suggest a consequence for
the indiscretion. These consequences take the form of behavior contracts, or
learning experiences that, if followed, will benefit the individual in question.
Typically, seven or eight alternatives are written on the board. Two consequences,
which are extremes on a continuum, are always part of this process. They are:
1) Do nothing and, 2) Bed only. These are the most drastic measures on which
the community may vote. The clear message to everyone is either the behavior
is endorsed by the community who does not care enough to confront it or, the
behavior is deemed so totally unacceptable that the client is asked by the community
to move back into the an emergency bed only phase of the shelter without any
other services. This means the loss of many privileges. Of course, other consequences
are offered as well. A simple majority establishes the contract offered to the
client. The interesting dynamic here is often elusive to the uninformed as these
men and women are not just suggesting consequences for their peer, but they
are looking at someone who is operating like they have, currently or in the
past, and making decisions that impact not only the individual in question but
also may affect them. The caring, compassion, confronting and the wisdom demonstrated
in these meetings are remarkable at times. Remember, recovery is about change.
AA Meetings
AA meetings are a required part of the program. In-house meetings may be held
three to five times weekly and out of facility meetings are encouraged daily.
In order to go through the program, 90 AA meetings must be documented, half
of which must be outside meetings. This introduction to meetings outside of
the facility where the program is housed is essential. Clients need to become
familiar with outside AA meetings where they will find long-term sobriety, a
richness of experience, strength and hope they may not find at in-house meetings,
no matter how good those may be. Remember, a transient population, not a permanent
one, is our goal. My father, who is one of my mentors, once said that recovery
requires a continuous, constructive confrontation. Continuous means developing
an ongoing habit of attending AA meetings, constructive, because it is specific
to the issue of alcoholism and addiction, and confrontation because unlike church,
family outings and the many other healthy activities the alcoholic or addict
could enjoy, AA meetings are a constant reminder of their disease and the need
for recovery. Forgetting these facts can be fatal.
Peer Counselors and Mutual Help
Mutual help of one alcoholic or addict to one another having demonstrated its
effectiveness has become a powerful part of this recovery model. "Peer
counselors" have been utilized in many programs over the years. This effective
tool allows professionals to expand their usefulness to others by directing
and supervising these peer counselors. Peer counselors are not therapists or
counselors, they are recovering people who share their "experience, strength
and hope" (as described in the book Alcoholics Anonymous) with other alcoholics
or addicts in order to help them recover. These men and women, who themselves
are recovering, work with clients in the manner described in Chapter seven of
the book. They lead classes as outlined in "Recovery Dynamics"; they
show relevant films and share what it used to be like, what happened, and what
it's like now with their own personal recovery. They serve as role models to
clients and demonstrate responsible behaviors.
This is Not Treatment
The tendency to compare this model to traditional treatment is natural. This
would be the same as comparing apples and oranges. Both are foods and both are
fruits and they satisfy a need; however, they have different combinations of
nutrients, vitamins, taste, etc. The strengths of this model's effectiveness,
its cost and its potential availability make it a valuable addition to the resources
in any city or hamlet addressing alcoholism and addiction issues in the chronic
recidivist population.
This model will not replace the need for competent credentialed professionals.
It provides an effective forum that can compound professionals' effectiveness
while assisting people who otherwise would simply die. Some may feel threatened
that this social model recovery program will replace traditional treatment.
We think not. The spectrum of the disease is such that many can and will respond
to the shorter traditional treatment model. But, in these days of financial
conservatism, managed care, government cutbacks and the like, this social model
recovery program provides a much needed resource in the continuum of care. Some
professionals in the addiction field may, at first glance, argue that non-professionals
are doing counseling or therapy and see this as a threat to professional treatment.
For over fifty years, professionals have labored to develop standards and credentials
for our profession, credentials, which, in fact, protect the consumer. The SOBER
HOME Model Program was born out of such concern as many people may suffer
and die from addiction if they do not receive the needed help. This model requires
more from the individual alcoholic or addict and less from the third party payers
or government programs. Prior to the development of the Medical, or the Minnesota
Model, of treatment, a social model program may have been thought of as treatment.
Today, this mutual help model is much closer to AA than it is to traditional
treatment. Thank God it is for, like AA, it can be made available to those less
fortunate who cannot access treatment or for which treatment stays are much
too brief. If the chronic recidivist has free time (frequently this may be a
homeless person or inmate although they maybe functional & working) and
the willingness to change, this model provides them with the opportunity for
a new way of life. In fact, they may not only help themselves but they may help
others as well. With this population, free time and willingness are often their
biggest assets.
The SOBER HOME model program is a living program.
Since it requires a smaller professional staff working in a primary supervisory
and supportive role, this model is being used in several states at this time.
The recovery program clients rotate through a series of tasks that keep the
facility functioning (i.e., cooking, maintenance, housekeeping, office work,
security, laundry). No more than 10 to 20 hours a week are spent in these tasks.
This barter system defrays cost of the model. However, all recovery activities
take priority in the program. Priorities with regards to recovery (First Things
First - an AA slogan) are thus taught to all clients. Recovery is always the
primary focus.
As The SOBER HOME Model Program grows, a system of administration, a bureaucracy,
may appear to be necessary. The act of governing any organization seems to dictate
this inevitable end. But, it should be remembered that The SOBER HOME
Model Program is a living program. Because it is made up of people and operates
with principles, it is a beautiful thing to see and experience. The principles
are stable but the people are constantly changing. The principles of honesty,
hope, action, courage, integrity, willingness, humility, brotherly love, self-discipline,
perseverance, spiritual awareness, and service are the essence of the AA 12
step program. As people are constantly turning over in this model (seventy to
ninety percent of the community will change every six to eight months), it is
essential to instill sound spiritual values or principles on a consistent basis.
The orientation of people in The SOBER HOME Model Program, their view
of recovery, the role of peer staff, the basis of authority and governance are
different than those of traditional medical model programs. In an organization
operating The SOBER HOME Model Program with 400 beds, a typical staffing
pattern will be about 40 FTEs. If the model is working well, people will move
through the program and towards successful sober living in their communities,
working, rejoining families, employment, school and the like. The SOBER HOME
Model Program being Alcoholics Anonymous based means it is a social network
and environment where abstinence is regarded positively (just as in AA) and
is expected. There exists awareness that relapse may occur but there is always
a positive support system to avoid and discourage it from happening.
A Learning Organization, A Chaord* Organization
A learning organization is one in which people at all levels, individually and
collectively, is continually increasing their capacity to produce results they
really care about. Studies regarding learning organizations done at MIT have
coined a word for this type of L.O. that aptly describes AA and social model
recovery programs. The word "chaord"* refers to organizations that
exhibit characteristics of both order and chaos. Visa & Master Card are
textbook examples of chaord* organizations. Like AA, Visa has enough organization
to make it a successful model worldwide.
Some characteristics of a chaord* organization, such as: the organization being
owned equitably by all participants; power and purpose being shared to the maximum
degree possible are, of course, fundamental principles of community meetings.
The organization should be extremely durable while flexible, and it must embrace
diversity and change. All of these characteristics are true of Alcoholics Anonymous,
and of The SOBER HOME According to AA traditions; AA has no ultimate authority
other than a loving God as He may express himself in a group conscience. There
is no Board of Directors in AA, as "leaders are but trusted servants, they
do not govern". In The SOBER HOME Model Program, every effort is
designed to share responsibilities and authority with residents of the community.
The responsibilities for day-to-day operations from the laundry to the classes
are shared with the community, to include even the selection of supervisors
(who serve in a temporary time frame), which is done by peers.
Principles of The SOBER HOME Model Program
The SOBER HOME Model Program is a social model program. Research from
the work of Dr. Lee Ann Kaskutas, with the Alcohol Research Group in Berkeley
California, taught us these defined principles of the social model program:
The program and staff's basis of authority is an experiential hierarchy, authority
is shared to the maximum degree, and participation is strictly voluntary. Program
participants, volunteers, and Alumni help run the program. They deliver services
to one another, as everyone carries their own weight, so to speak. The living
environment of social model program is not institutional but more like a home
whenever possible. Social wellness, economic independence and recovery from
addiction are goals of social model program by design these goals are approached
in the reverse order. It is a matter of prioritizing. Spending resources on
people with untreated addiction is wasting valuable limited resources. We think
The SOBER HOME Model Program is an excellent example of a social model
program at its best.
* Chaord Organization Definition
(kay=ord) 1: any auto catalytic, self regulating, adaptive, nonlinear, complex
organism, organization, or system, whether physical, biological or social, the
behavior of which harmoniously exhibits characteristics of both order and chaos.
2: an entity whose behavior exhibits patterns and probabilities not governed
or explained by the behavior of its parts. 3: the fundamental organizing principle
of nature and evolution.
Please think of this article as an overview rather than a blueprint. While the
model is based on simple AA principles professionals have developed it over
many years of experience. The idea that this is a blueprint for action may lead
to frustration, failure and a conclusion it doesn't work. We will be happy to
assist you and your agency in developing this model.