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
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.
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 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.
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