The twelve-step model is a multi-disciplinary, complete approach to treatment of addictions that is abstinence oriented and rooted in the principles of alcoholics Anonymous. There are varieties of elements that are generally linked with main treatment when using this model and they include physical activity/ chance for recreation, attendance of AA meetings, presentation of life history, twelve literature groups, use of twelve step program, family counseling, therapeutic work assignments, a therapeutic milieu, multi-disciplinary staff, recovering persons as counselors, lectures and group therapy. These elements are commonly integrated into a prearranged daily routine. Local NA/ AA groups offer the foundation of the aftercare phase.
This model emphasizes on chemical reliance as the main problem. It is neither punitive nor blaming and it sights seeking treatment as a suitable response. By far, this model is the majority extensively used treatment model. Persons are guided through a procedure of understanding the extent and nature of their drug/alcohol problem, how their distinctive characteristics generate strengths and barriers for recovery, and the significance of depending on powers or a power greater than they do more willingly than willpower using the Twelve Steps.
Alcohol abuse is an ailment according to this observation. Treatment accentuates admitting helplessness over alcohol, and promotes adopting the values and norms of the AA self-help group, a new social group, in order to attain total abstinence. These programs characteristically offer the best match for individuals with the following traits; have a spiritual orientation, benefit from support from self-help group, and physically reliant on alcohol.
The programs of hospital-based medical model are depicted as including the following parts; evening/day outpatient services and inpatient rehabilitation and detoxification services. The capacity of the program typically will differ in size and inpatient stays traditionally were about 28 days however have been strictly shortened largely due to funding considerations.
Evening outpatient services and day outpatient services are extended over a longer period and tailored to the requirements of the person. Additionally to the therapeutic section of the program, as its name suggests, this model also attends to the medical /health/physical needs of the patient. Typically, addicts or alcoholics presenting for chemical dependence treatment have abandoned their physical and health care. Indicative medical treatment may be needed for liver problems, malnutrition or other health care concerns.
The 12-Step programs accentuates treatment activities such as participating in psychoanalysis groups that cover topics like writing an autobiography, using the big book and working the steps; and attending Twelve Step meetings in the facility and community. The results expected in the twelve-step treatment include adherence to abstinence as treatment objective, acceptance of powerlessness/loss of control over the abused substance, and acceptance of an addict/alcoholic identity. There is also the importance of a solid aftercare arrangement to sustain ongoing recuperation after treatment completion. Classically, aftercare plans include securing a sober, safe living surroundings; attending Twelve Step or other AA support meetings numerous times every week; securing a supporter in AA; and ongoing counseling and support sessions to carry on the work begun in treatment.
The Social Model/Bio-Psycho-Social Model
The Bio-Psycho-Social Model is a peer oriented; experimental process that symbolize a much less costly alternative to medically oriented substance misuse treatment offered by clinicians. The Social Model has generally been classified as a sociocultural model and believes the problems linked to alcohol stems from a generational socialization process. In a particular cultural and social milieu, that explicitly or implicitly encourages alcohol drinking. This model is non-participatory versus participatory; and the community orientation is introduction versus integration (Kuhar, 2012).
Like AA (Alcoholics Anonymous), social model practitioners consider that alcoholism is a many-sided disease, one that is caused by a mixture of factors: environmental/ social, psychological, biological, and spiritual/moral. This explanation represents an extension of the medical models conceptualization of alcoholism as a unitary illness with physiological ancestry only, with medical expertise treating it the best.
In the social model, chemical reliance is believed to be caused by family or peer, social, cultural and environmental influences. Substance abuse is examined as a product of external forces such as family dysfunction, peer pressure, drug variability and poverty. The objective of treatment using this model is to advance the social functioning of substance abusers by either changing the social environment or changing the person's coping reactions to environmental stresses. The plans for altering the environment include avoidance of stressful surroundings where substances are available, residential treatment, attendance at self-help groups where one is bounded by nonusers, and couples or family therapy. The plans for altering a substance addicts coping responses include stress management, assertiveness or social skills training, individual therapy, and group therapy.
In the late 1940's, the programs of Social Model evolved out of the AA twelve Step of reaching out to assist other alcoholics as a way of supporting sobriety. Known in AA as Twelve Step or twelve stepping work and in educational circles as the helper-therapy principle, the main principle guiding both social model and AA programs is that addicts are themselves assisted when they offer service to others. Other likenesses to AA include the eschewing of hierarchy, self-supporting (maintaining) of the programs, and self-governance (participant taking part in the running of the programs).
The programs of social Model act as supporters for participants and put them in contact with society resources for employment, medical, family and legal problems unlike AA. A number of them encourage the society to create sober environment and activities. Several Social Model Programs have decline prevention groups (Kuhar, 2012), offer clients with educational sessions, regulatory agencies, accommodate funders, paid staff and other prearranged activities that surpass the AA paradigm. Another characteristic of the Social Model Programs emerged in 1980 that added community support to the program services. Its supporters recognized the necessity to promote not only individual recovery but also to change the practices, policies, values, and norms concerning alcohol in the society and community. This community facet looks at the context in which drinking happens and look for ways to adjust the environment.
As stated above, the program of the Social Model structure is rooted in the Twelve Traditions of AA and, seeks to form democratic group procedures in which leadership is rotated and shared with little hierarchy. Recuperating participants are observed as the top of an inverted pyramid, the program staff follows them, and then the trustees’ board at the bottom. Groups and individuals of recovering participants are given as much power as they can handle sensibly. The programs of Social Model arrange human resources in a different way than the programs of professional treatment. Volunteers, staff, and directors who contribute to recruitment are usually recovering drug addicts and alcoholics with experimental knowledge of recovery (Kuhar, 2012).
Recovering participants/ residents are contributors as much as users of service and individuals in recovery are viewed as significant to the peer recovery procedure. Programs are run by clients in day-to-day enforcement, rule making and problem solving by a Council of participants of Residents who have been sober in the program for a chosen time.
Exposure Theories: Biological Models
This theory argues that the introduction of a substance into the body repeatedly leads to addiction. As be against to conditioning models, the biological models this is an outcome of biology. Fundamentally, the exposure model is the postulation that the introduction of a narcotic into the body triggers metabolic adjustments needing continuation and escalating dosages of the drug to evade withdrawal.
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