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Alternatives to 12-step groups
Persons addicted to drugs often are among the most marginalized psychiatric patients, but are in need of the most support.1 Many of these patients have comorbid medical and psychiatric problems, including difficult-to-treat pathologies that may have developed because of a traumatic experience or an attachment disorder that dominates their emotional lives.2 These patients value clinicians who engage them in an open, nonjudgmental, and empathetic way.
Eliciting a patient’s reasons for change and introducing him (her) to a variety of peer-led recovery group options that complement and support psychotherapy and pharmacotherapy can be valuable. Although most clinicians are aware of the traditional 12-step group model that embraces spirituality, many might know less about other groups that can play an instrumental role in engaging patients and placing them on the path to recovery.
SMART (Self-Management and Recovery Training) Recovery5 is a nonprofit organization that does not employ the 12-step model; instead, it uses evidence-based, non-confrontational, motivational, behavioral, and cognitive approaches to achieve abstinence.
Women for Sobriety6 helps women achieve abstinence.
LifeRing Secular Recovery7 works on empowering the “sober self” through groups that de-emphasize drug and alcohol use in personal histories.
Rational Recovery8 uses the Addictive Voice Recognition Technique to empower people overcoming addictions. This technique trains individuals to recognize the “addictive voice.” It does not support the theory of continuous recovery, or even recovery groups, but enables the user to achieve sobriety independently. This program greatly limits interaction between people overcoming addiction and physicians and counselors—save for periods of serious withdrawal.
The Community Reinforcement Approach (CRA)9 is an evidence-based program that focuses primarily on environmental and social factors influencing sobriety. This behavioral approach emphasizes the role of contingencies that can encourage or discourage sobriety. CRA has been studied in outpatients—predominantly homeless persons—and inpatients, and in a range of abused substances.
Click here for another Pearl on familiarizing yourself with Alcoholics Anonymous dictums.
Disclosure
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
1. Kreek MJ. Extreme marginalization: addiction and other mental health disorders, stigma, and imprisonment. Ann N Y Acad Sci. 2011;1231:65-72.
2. Wu NS, Schairer LC, Dellor E, et al. Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addict Behav. 2010;35(1):68-71.
3. Moderation Management. http://www.moderation.org. Accessed April 12, 2013.
4. Moderation Management. What is moderation management? http://www.moderation.org/whatisMM.shtml. Accessed August 6, 2013.
5. SMART (Self Management and Recovery Training) Recovery. http://www.smartrecovery.org. Accessed April 12, 2013.
6. Women for Sobriety. http://www.womenforsobriety.org. Accessed April 12, 2013.
7. LifeRing. http://lifering.org. Accessed April 12, 2013.
8. Rational Recovery. http://www.rational.org. Published October 25, 1995. Accessed April 12, 2013.
9. Miller WR, Meyers RJ, Hiller-Sturmhofel S. The community-reinforcement approach. http://pubs.niaaa.nih.gov/publications/arh23-2/116-121.pdf. Accessed August 6, 2013.
Persons addicted to drugs often are among the most marginalized psychiatric patients, but are in need of the most support.1 Many of these patients have comorbid medical and psychiatric problems, including difficult-to-treat pathologies that may have developed because of a traumatic experience or an attachment disorder that dominates their emotional lives.2 These patients value clinicians who engage them in an open, nonjudgmental, and empathetic way.
Eliciting a patient’s reasons for change and introducing him (her) to a variety of peer-led recovery group options that complement and support psychotherapy and pharmacotherapy can be valuable. Although most clinicians are aware of the traditional 12-step group model that embraces spirituality, many might know less about other groups that can play an instrumental role in engaging patients and placing them on the path to recovery.
SMART (Self-Management and Recovery Training) Recovery5 is a nonprofit organization that does not employ the 12-step model; instead, it uses evidence-based, non-confrontational, motivational, behavioral, and cognitive approaches to achieve abstinence.
Women for Sobriety6 helps women achieve abstinence.
LifeRing Secular Recovery7 works on empowering the “sober self” through groups that de-emphasize drug and alcohol use in personal histories.
Rational Recovery8 uses the Addictive Voice Recognition Technique to empower people overcoming addictions. This technique trains individuals to recognize the “addictive voice.” It does not support the theory of continuous recovery, or even recovery groups, but enables the user to achieve sobriety independently. This program greatly limits interaction between people overcoming addiction and physicians and counselors—save for periods of serious withdrawal.
The Community Reinforcement Approach (CRA)9 is an evidence-based program that focuses primarily on environmental and social factors influencing sobriety. This behavioral approach emphasizes the role of contingencies that can encourage or discourage sobriety. CRA has been studied in outpatients—predominantly homeless persons—and inpatients, and in a range of abused substances.
Click here for another Pearl on familiarizing yourself with Alcoholics Anonymous dictums.
Disclosure
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
Persons addicted to drugs often are among the most marginalized psychiatric patients, but are in need of the most support.1 Many of these patients have comorbid medical and psychiatric problems, including difficult-to-treat pathologies that may have developed because of a traumatic experience or an attachment disorder that dominates their emotional lives.2 These patients value clinicians who engage them in an open, nonjudgmental, and empathetic way.
Eliciting a patient’s reasons for change and introducing him (her) to a variety of peer-led recovery group options that complement and support psychotherapy and pharmacotherapy can be valuable. Although most clinicians are aware of the traditional 12-step group model that embraces spirituality, many might know less about other groups that can play an instrumental role in engaging patients and placing them on the path to recovery.
SMART (Self-Management and Recovery Training) Recovery5 is a nonprofit organization that does not employ the 12-step model; instead, it uses evidence-based, non-confrontational, motivational, behavioral, and cognitive approaches to achieve abstinence.
Women for Sobriety6 helps women achieve abstinence.
LifeRing Secular Recovery7 works on empowering the “sober self” through groups that de-emphasize drug and alcohol use in personal histories.
Rational Recovery8 uses the Addictive Voice Recognition Technique to empower people overcoming addictions. This technique trains individuals to recognize the “addictive voice.” It does not support the theory of continuous recovery, or even recovery groups, but enables the user to achieve sobriety independently. This program greatly limits interaction between people overcoming addiction and physicians and counselors—save for periods of serious withdrawal.
The Community Reinforcement Approach (CRA)9 is an evidence-based program that focuses primarily on environmental and social factors influencing sobriety. This behavioral approach emphasizes the role of contingencies that can encourage or discourage sobriety. CRA has been studied in outpatients—predominantly homeless persons—and inpatients, and in a range of abused substances.
Click here for another Pearl on familiarizing yourself with Alcoholics Anonymous dictums.
Disclosure
The authors report no financial relationships with any company whose products are mentioned in this article or with manufacturers of competing products.
1. Kreek MJ. Extreme marginalization: addiction and other mental health disorders, stigma, and imprisonment. Ann N Y Acad Sci. 2011;1231:65-72.
2. Wu NS, Schairer LC, Dellor E, et al. Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addict Behav. 2010;35(1):68-71.
3. Moderation Management. http://www.moderation.org. Accessed April 12, 2013.
4. Moderation Management. What is moderation management? http://www.moderation.org/whatisMM.shtml. Accessed August 6, 2013.
5. SMART (Self Management and Recovery Training) Recovery. http://www.smartrecovery.org. Accessed April 12, 2013.
6. Women for Sobriety. http://www.womenforsobriety.org. Accessed April 12, 2013.
7. LifeRing. http://lifering.org. Accessed April 12, 2013.
8. Rational Recovery. http://www.rational.org. Published October 25, 1995. Accessed April 12, 2013.
9. Miller WR, Meyers RJ, Hiller-Sturmhofel S. The community-reinforcement approach. http://pubs.niaaa.nih.gov/publications/arh23-2/116-121.pdf. Accessed August 6, 2013.
1. Kreek MJ. Extreme marginalization: addiction and other mental health disorders, stigma, and imprisonment. Ann N Y Acad Sci. 2011;1231:65-72.
2. Wu NS, Schairer LC, Dellor E, et al. Childhood trauma and health outcomes in adults with comorbid substance abuse and mental health disorders. Addict Behav. 2010;35(1):68-71.
3. Moderation Management. http://www.moderation.org. Accessed April 12, 2013.
4. Moderation Management. What is moderation management? http://www.moderation.org/whatisMM.shtml. Accessed August 6, 2013.
5. SMART (Self Management and Recovery Training) Recovery. http://www.smartrecovery.org. Accessed April 12, 2013.
6. Women for Sobriety. http://www.womenforsobriety.org. Accessed April 12, 2013.
7. LifeRing. http://lifering.org. Accessed April 12, 2013.
8. Rational Recovery. http://www.rational.org. Published October 25, 1995. Accessed April 12, 2013.
9. Miller WR, Meyers RJ, Hiller-Sturmhofel S. The community-reinforcement approach. http://pubs.niaaa.nih.gov/publications/arh23-2/116-121.pdf. Accessed August 6, 2013.
Managing boundaries when your patients are your neighbors
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Psychiatrists—especially residents—often prefer to reside close to the hospitals in which they train and work. Training programs in urban settings may offer their residents housing either attached to the hospital or immediately adjacent to it.
Psychiatry residents often discover their most ill patients also prefer to live close to the hospital. They become acquainted with their neighbors on the streets and in the emergency room. As a consequence, new residents must learn how to maintain appropriate boundaries in these situations.
Patients as neighbors
Chronic psychiatric patients are likely to utilize the services of the closest hospital. Individuals with severe mental illness seem especially prone to move to and live in areas near a hospital. For example, a study of VA patients with schizophrenia, bipolar disorder, and depression found those with schizophrenia and bipolar disorder were more likely to move closer to their health care providers.1 Also, many hospitals and training programs are located in inner-city areas, where individuals with severe mental illness are known to cluster.2-4
Managing boundaries
When encountering their chronically mentally ill patients on the street, psychiatric residents could have a host of reactions—ranging from becoming over-involved in their patients’ lives to completely avoiding them—that could cause them and their patients significant distress. The literature on boundary management in these situations is immense, and conclusions often are nebulous. Most authors suggest if a psychiatrist encounters a patient outside of the office, he or she should follow the patient’s lead while trying to avoid discussing the patient’s problems in public.5
It is important for residency training programs to educate residents on how to manage these professional boundaries. Residents should seek out support from their training department when they encounter these difficult situations.
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
1. McCarthy JF, Valenstein M, Blow FC. Residential mobility among patients in the VA health system: associations with psychiatric morbidity geographic accessibility, and continuity of care. Adm Policy Ment Health. 2007;34(5):448-455.
2. DeVerteuil G, Hinds A, Lix L, et al. Mental health and the city: intra-urban mobility among individuals with schizophrenia. Health Place. 2007;13(2):310-323.
3. Almog M, Curtis S, Copeland A, et al. Geographical variation in acute psychiatric admissions within New York City 1990-2000: growing inequalities in service use? Soc Sci Med. 2004;59(2):361-376.
4. Silver E, Mulvey EP, Swanson JW. Neighborhood structural characteristic and mental disorder: Faris and Dunham revisited. Soc Sci Med. 2002;55(8):1457-1470.
5. MacKinnon RA, Michels R, Buckley PJ. The psychiatric interview in clinical practice. 2nd ed. Arlington VA: American Psychiatric Publishing Inc.; 2006.
Discuss this article at www.facebook.com/CurrentPsychiatry
Psychiatrists—especially residents—often prefer to reside close to the hospitals in which they train and work. Training programs in urban settings may offer their residents housing either attached to the hospital or immediately adjacent to it.
Psychiatry residents often discover their most ill patients also prefer to live close to the hospital. They become acquainted with their neighbors on the streets and in the emergency room. As a consequence, new residents must learn how to maintain appropriate boundaries in these situations.
Patients as neighbors
Chronic psychiatric patients are likely to utilize the services of the closest hospital. Individuals with severe mental illness seem especially prone to move to and live in areas near a hospital. For example, a study of VA patients with schizophrenia, bipolar disorder, and depression found those with schizophrenia and bipolar disorder were more likely to move closer to their health care providers.1 Also, many hospitals and training programs are located in inner-city areas, where individuals with severe mental illness are known to cluster.2-4
Managing boundaries
When encountering their chronically mentally ill patients on the street, psychiatric residents could have a host of reactions—ranging from becoming over-involved in their patients’ lives to completely avoiding them—that could cause them and their patients significant distress. The literature on boundary management in these situations is immense, and conclusions often are nebulous. Most authors suggest if a psychiatrist encounters a patient outside of the office, he or she should follow the patient’s lead while trying to avoid discussing the patient’s problems in public.5
It is important for residency training programs to educate residents on how to manage these professional boundaries. Residents should seek out support from their training department when they encounter these difficult situations.
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
Discuss this article at www.facebook.com/CurrentPsychiatry
Psychiatrists—especially residents—often prefer to reside close to the hospitals in which they train and work. Training programs in urban settings may offer their residents housing either attached to the hospital or immediately adjacent to it.
Psychiatry residents often discover their most ill patients also prefer to live close to the hospital. They become acquainted with their neighbors on the streets and in the emergency room. As a consequence, new residents must learn how to maintain appropriate boundaries in these situations.
Patients as neighbors
Chronic psychiatric patients are likely to utilize the services of the closest hospital. Individuals with severe mental illness seem especially prone to move to and live in areas near a hospital. For example, a study of VA patients with schizophrenia, bipolar disorder, and depression found those with schizophrenia and bipolar disorder were more likely to move closer to their health care providers.1 Also, many hospitals and training programs are located in inner-city areas, where individuals with severe mental illness are known to cluster.2-4
Managing boundaries
When encountering their chronically mentally ill patients on the street, psychiatric residents could have a host of reactions—ranging from becoming over-involved in their patients’ lives to completely avoiding them—that could cause them and their patients significant distress. The literature on boundary management in these situations is immense, and conclusions often are nebulous. Most authors suggest if a psychiatrist encounters a patient outside of the office, he or she should follow the patient’s lead while trying to avoid discussing the patient’s problems in public.5
It is important for residency training programs to educate residents on how to manage these professional boundaries. Residents should seek out support from their training department when they encounter these difficult situations.
Disclosure
The authors report no financial relationship with any company whose products are mentioned in this article or with manufacturers of competing products.
1. McCarthy JF, Valenstein M, Blow FC. Residential mobility among patients in the VA health system: associations with psychiatric morbidity geographic accessibility, and continuity of care. Adm Policy Ment Health. 2007;34(5):448-455.
2. DeVerteuil G, Hinds A, Lix L, et al. Mental health and the city: intra-urban mobility among individuals with schizophrenia. Health Place. 2007;13(2):310-323.
3. Almog M, Curtis S, Copeland A, et al. Geographical variation in acute psychiatric admissions within New York City 1990-2000: growing inequalities in service use? Soc Sci Med. 2004;59(2):361-376.
4. Silver E, Mulvey EP, Swanson JW. Neighborhood structural characteristic and mental disorder: Faris and Dunham revisited. Soc Sci Med. 2002;55(8):1457-1470.
5. MacKinnon RA, Michels R, Buckley PJ. The psychiatric interview in clinical practice. 2nd ed. Arlington VA: American Psychiatric Publishing Inc.; 2006.
1. McCarthy JF, Valenstein M, Blow FC. Residential mobility among patients in the VA health system: associations with psychiatric morbidity geographic accessibility, and continuity of care. Adm Policy Ment Health. 2007;34(5):448-455.
2. DeVerteuil G, Hinds A, Lix L, et al. Mental health and the city: intra-urban mobility among individuals with schizophrenia. Health Place. 2007;13(2):310-323.
3. Almog M, Curtis S, Copeland A, et al. Geographical variation in acute psychiatric admissions within New York City 1990-2000: growing inequalities in service use? Soc Sci Med. 2004;59(2):361-376.
4. Silver E, Mulvey EP, Swanson JW. Neighborhood structural characteristic and mental disorder: Faris and Dunham revisited. Soc Sci Med. 2002;55(8):1457-1470.
5. MacKinnon RA, Michels R, Buckley PJ. The psychiatric interview in clinical practice. 2nd ed. Arlington VA: American Psychiatric Publishing Inc.; 2006.