Transition and Continuum of Care

continuum of care

Sobriety is a lifelong endeavor. The idea of having to do something for the rest of your life-even if you recognize your very life depends on it- is difficult for the alcoholic ego to accept. When looking to the future the ego cleverly seeks to imagine the exception or invent circumstances which would permit compromise or allow for wiggle room. Perhaps we are willing to admit that we can’t safely use heroin ever again, but what about having a glass of champagne at a family wedding years from now?  The shear finality of making a commitment to lifelong sobriety is intimidating and unsettling, despite the ever-worsening consequences our addictions have forced us to endure before entering the continuum of care.  This is just one example of what “alcoholic thinking” can look like.

The typical BRC client is a chronically relapsing individual with previous treatment experience. The fact that they end up in our care shows that they have once again fallen victim to this thinking and returned to alcohol or drugs hoping things might turn out differently. Their previous treatment experiences would suggest that they have been made aware of the dangers of their usage, yet what they know intellectually appears to lack the power to affect their behavior. The unfortunate reality for the overwhelming majority of our clients is that their addictive thinking will never entirely disappear.

The effectiveness of Twelve Step recovery is that its focus is on changing behavior rather than changing thinking. At BRC we live by the notion that “right action precedes right thinking”–the proper action provides an experience which results in a change in our thoughts, and thus in our perception of the world around us. The caveat for this, however, is that a lack of action or action which is inconsistent opens the door for the swift return of our destructive way of thinking. In short, the actions taken daily through adherence to Twelve Step disciplines and principles, also known as maintaining spiritual fitness, keep our addictive thoughts at bay and gradually diminish the influence they have on us.

Our clients often face personal difficulty in making these drastic changes to their behavior and adopting the design for living prescribed by the Twelve Steps. Change requires doing something different, and what is unfamiliar is often perceived as uncomfortable. Even as clients make real progress, there are inevitable ups and downs which invite the temptation to resort to the more familiar old ways of doing things. It is at these moments that being surrounded by their community of peers, supportive staff, and a consistent message provides the power to persevere. By the time our clients receive a recommendation to discharge from treatment, they have consistently demonstrated the use of and dependence upon Twelve Step disciplines and principles in their daily lives.

Discharge from treatment presents an entirely new set of challenges. Treatment is by design a safe environment where distractions are drastically limited and day-to-day life is reliably predictable. For our clients to be successful in their return to normal life they will need to consistently apply Twelve Step disciplines and principles to their work, school, relationships, or other responsibilities. BRC created the Continuum of Care to facilitate this transition because we recognized that struggle is an unavoidable part of early recovery. The Continuum of Care is a step-down from the rigid accountability of treatment to an environment in which levels of accountability and autonomy adjust based on progress. As clients show the ability to live responsibly, they gradually increase their autonomy.

As part of the Continuum of Care, all clients will discharge directly from treatment into a High-Accountability sober living house for a minimum of 45 days. Similar to the experience of treatment, several Twelve Step disciplines are incorporated into the daily schedule, such as morning meditation groups, daily chores, and multiple weekly house meetings. Clients are required to work, volunteer, or attend school during the day, in addition to maintaining their Twelve Step disciplines. Clients in these houses evaluate each other’s performance, and a client is only permitted to move to the next phase of increased autonomy after having the approval of staff and his/her peers. We recommend clients to stay a minimum of 90 days in either High-Accountability or Graduate level sober living, but the average stay is seven months.

Another vital component within the Continuum of Care is the Segue case management program. Segue is individualized recovery coaching by state certified Peer Recovery Support Specialists, which can be specifically tailored to the needs of the client. Coaches meet with the client on a regular basis to bring accountability when necessary, but primarily to support the achievement of the client’s recovery goals. Because we know that challenges will occur, the coach is positioned to identify obstacles before they become significant and help the client apply recovery tools and overcome them. Recovery coaches also maintain contact with family members to keep them accurately informed as to the client’s progress and to guide the family as to how they should respond if issues arise.

The basic text of Alcoholics Anonymous describes the Twelve Steps as a “design for living.” It is important to emphasize that this design or plan for engaging life is NEW to most our clients. It is also new to their families. A client may be able to flawlessly execute their recovery program while in treatment, but that is not a guarantee that at certain times the slings and arrows of life will not persuade that person to stray from this new design in favor of the more familiar yet self-destructive plan they have been using for years, sometimes decades.  There is an awful lot to unlearn. We know that the longer someone remains in an environment of accountability, the greater the chances of their long-term success. BRC’s Continuum of Care provides the support and monitoring to facilitate our clients’ transition and return to society.

Written by: Tim May