Therapeutic alliance building, establishing psychosocial stabilization/safety and the promotion of abstinence are the key goals in this phase and tract of treatment. Reliance is upon therapy in a structured group designed to engage, stabilize, and further assess the patient. The patient receives the core of his treatment in the twice weekly Evaluation and Engagement Group. Patients are seen individually if the patient is unable to tolerate groups or cannot maintain sobriety in groups. The group meets twice a week. Individual counseling is set up at a frequency that meets the patients’ needs. Abstinence is encouraged, but not required. This flexible approach is based on the fact that this co-occuring disorder mitigates against engagement in treatment. Patients are encouraged to focus on behavioral changes that can assist them in establishing and maintaining abstinence. Frequently symptoms of PTSD become more acute with the onset of sobriety, and, therefore group therapists introduce coping strategies for managing re-emergent PTSD symptoms. In addition, attending adjunct treatment such as Anger Management or Seeking Safety Groups are encouraged for further stabilization and promotion of safety. Medications to assist with sleep problems associated with PTSD are sometimes prescribed. 1. Interested in exploring negative impact of SUD and potential for sober living 2. Combat or Military event-related PTSD 3. Wanting assistance with psychosocial SUD and PTSD-related problems.
POssible engagement individual tract
If a patient does commit to abstinence, they move to the Educational and Learning Tract of Phase One treatment. Twice weekly attendance in a Phase One Group is the core of this tract. Due to the importance of maintaining the therapeutic alliance with this complex co-occuring SUD/PTSD population and the benefit of more structure early on in treatment, patient occasionally continue to attend the EEG group. If the patient chooses to continue with their home-base group is contingent on their regular twice weekly attendance in their Phase One group. Within the Phase One group, there are psycho-educational and supportive psychotherapeutic components. Models of relapse prevention, group function, and how to use groups more effectively are presented by staff. Psycho-educational modules include the ways that PTSD and substance abuse interact with each other to militate against recovering from either, the recent scientific data about various drugs of abuse, and the misuse of drugs to control emotional states of mind. Trauma-related themes are discussed in an educational context in order to reduce the chances of flooding the patient with overwhelming PTSD related affects. Patients learn about the distortions of thinking that occur because of both conditions. Additional SUD/PTSD adjunctive individual and group treatment is done if clinically indicated. 1. Has attended at least three weeks of Phase One/Home-Base. 2. Has committed to abstinence and improving their SUD relapse prevention skills. 3. Has an interest in learning about PTSD symptoms that are impeding their psychosocial goals. 4. Willing to commit to twice weekly Phase One group treatment.
PW, TM, GW
Once a patient has learned basic information and coping skills regarding their SUD/PTSD disorder, they move into the action-oriented tract of Phase One. We expect them to begin developing and using emotional regulation and psychosocial coping skills through Phase One group treatment, adjunctive group treatments and in their outside lives. SUPT want the patients to begin to re-engage with life goals and start to practice the coping and affect modulating skills they have learned in their earlier Phase One work. As such, we expect everyone in the Practicing Tract to take part in at least one adjunctive group that has them practice affect modulation or techniques for stress reduction. Additionally, if their case coordinator feels they have the ability to do homework and tolerate some distress, we also expect them to take @ least one SUD/PTSD adjunctive group that teaches them how to reduce their PTSD avoidance. After a six to twenty four month period of work, an assessment is made by the case coordinator to see if the patient has the requisite skills and interest in pursuing further intra-interpersonal work in Phase Two. If so, the patient is moved to Phase Two treatment. If not, the patients continue in this SUPT Practicing Tract in consultation with their case coordinator until they meet their individual treatment and life goals. Has attended @ least three months of a Phase One group. Maintains educational treatment goals from Phase One/Educational and Learning Tract Has developed enough SUD relapse prevention skills to manage the additional PTSD learning goals of the Practicing Tract. Agrees to attend @ least one SUD/PTSD adjunctive group for stress reduction or affect modulation. As clinically indicated, agrees to attend @ least one SUD/PTSD adjunctive group to reduce avoidance.
The core component of this tract is once weekly insight-oriented group therapy. The main focus of this group treatment is to explore the self-defeating intrapersonal dialogues and the difficult interpersonal interactions that occur both in and outside the group. The Phase Two group also gives the patients a chance to problem-solve and gain insight about these common SUD/PTSD difficulties in a supportive group environment. Building on their Phase One work, this exploration improves the patient’s overall level of social functioning and engagement in their relationships and life goals. Since SUD/PTSD is a life-long chronic and relapsing condition, we also expect completion of at least one additional SUD/PTSD adjunctive group in this phase of treatment. Has attended at least six months of Phase One/Practicing Tract. Shows a desire to work on PTSD/SUD specific interpersonal issues that are impeding their relationship and life re-engagement goals. Shows an ability to work interpersonally as evidenced by affect tolerance skills, ability to self-observe, and is open to feedback. Is willing to commit to at least one year of Phase Two group treatment
Phase Three/Maintenance Tract provides a place for patients who have completed their treatment goals in Phase One/Practicing Tract or Phase Two/Exploring Tract. The goal for patients in this Phase is to maintain their SUD/PTSD psychosocial gains in a supportive group environment. Emphasis is placed on relapse prevention, both to substance abuse problems and to the ongoing problems of PTSD hyper-arousal and avoidance, building psychosocial support and coping skills. The life-long learning of coping skills and affect modulation skills through attendance at SUD/PTSD adjunctive groups, 12-Step or other Self-Help Meetings is encouraged but not expected. Has completed their treatment goals in their Phase and Tract treatments. Wants to maintain SUD relapse-prevention skills in a supportive group environment Wants to maintain SUD/PTSD psychosocial and relational gains in a supportive group environment.
DA, JD, JF
fear of groups
APD/or other severe Axis II