Therapeutic recreation and relapse prevention intervention.The substance-abuse problem in our society remains a predominant concern as it affects a greater number of young individuals. Often left with little or no adult supervision (because of current lifestyle demands), more and more young people turn to alcohol and drugs as a means of relieving boredom Boredom See also Futility. Aldegonde, Lord St. bored nobleman, empty of pursuits. [Br. Lit.: Lothair] Baudelaire, Charles (1821–1867) French poet whose dissipated lifestyle led to inner despair. [Fr. Lit. , peer acceptance, and recreation alternatives. Moreover, many of those who are substance abusers as teens or children remain dependent throughout their twenties and thirties, some for the rest of their lives. It is the "chronic" substance-abuse population, which is often underserved, that poses a major challenge to adjunctive ad·junct n. 1. Something attached to another in a dependent or subordinate position. See Synonyms at appendage. 2. A person associated with another in a subordinate or auxiliary capacity. 3. health care systems. The potential contribution for therapeutic recreation is considerable and often underutilized (Kunstler, 1992). Therapeutic recreation programs endeavor to structure healthy, beneficial leisure and recreation activities while educating the individual who is substance dependent about alternatives to drugs and alcohol consumption during his or her leisure time. Through appropriate interventions, the therapeutic recreation specialist may help retrain re·train tr. & intr.v. re·trained, re·train·ing, re·trains To train or undergo training again. re·train negative thoughts and determined behaviors. Leisure education programs may assist clients in learning new coping strategies The German Freudian psychoanalyst Karen Horney defined four so-called coping strategies to define interpersonal relations, one describing psychologically healthy individuals, the others describing neurotic states. as well as gratifying grat·i·fy tr.v. grat·i·fied, grat·i·fy·ing, grat·i·fies 1. To please or satisfy: His achievement gratified his father. See Synonyms at please. 2. , non-substance-related methods of engaging in leisure activities. Historically, the greatest potential for substance abuse among young people and adults is during their leisure time -- either after school or during non-working hours. More importantly, and often disregarded, is the fact that certain leisure activities may present "high-risk" situations that can trigger a relapse in those persons actively abstaining from substances. High-risk leisure situations include leisure-based situations that pose a threat to an individual's sense of control in maintaining sobriety. For example, if an alcohol-dependent individual went bowling in a facility where alcohol beverages were served, the bowling facility could then be considered a high-risk leisure situation. If the person is able to implement an effective coping response to high-risk leisure situations, the chance of relapse decreases considerably. Intervention and the Relapse Process Because of the high prevalence of relapse among substance-dependent people, it is important that therapeutic recreation specialists understand the relapse process. Relapse is characterized by setbacks and the substance abuser's failure to maintain sobriety (Beck, Wright, Newman & Liese, 1993). Figure 1 represents a relapse process model that depicts how high-risk leisure situations can increase an individual's probability of relapse. Theory-based therapeutic recreation programs, specifically designed to address leisure-related social and psychological needs, can play a pivotal role in helping substance-dependent individuals maintain sobriety and ameliorate a·mel·io·rate tr. & intr.v. a·me·lio·rat·ed, a·me·lio·rat·ing, a·me·lio·rates To make or become better; improve. See Synonyms at improve. [Alteration of meliorate. the relapse syndrome. Unfortunately, there remains a dearth of such programs in the therapeutic recreation arena today, despite the potential benefits. [Figure 1 ILLUSTRATION OMITTED] Attribution at·tri·bu·tion n. 1. The act of attributing, especially the act of establishing a particular person as the creator of a work of art. 2. Retraining re·train tr. & intr.v. re·trained, re·train·ing, re·trains To train or undergo training again. re·train "Retraining" the thinking process of the person who is substance dependent, referred to as attribution retraining, is a possible therapeutic recreation intervention that can help clients learn new coping skills A coping skill is a behavioral tool which may be used by individuals to offset or overcome adversity, disadvantage, or disability without correcting or eliminating the underlying condition. Virtually all living beings routinely utilize coping skills in daily life. regarding high-risk leisure situations. The attribution Retraining Leisure Education Model (ARLEM) is a recently developed therapeutic recreation intervention based on Marlatt's (1985) Relapse Process Model (Figure 1) for use with chronic substance abusers. Based upon cognitive therapy cognitive therapy n. Any of a variety of techniques in psychotherapy that utilize guided self-discovery, imaging, self-instruction, and related forms of elicited cognitions as the principal mode of treatment. procedures (Beck et al., 1993; Marlatt, 1985; Seligman et al., 1995) the ARLEM is a nine-session leisure education program that uses techniques such as recreation and leisure activity, experiential education  The perspective and/or examples in this article do not represent a world-wide view. Please [ edit] this page to improve its geographical balance. , group discussion, and role
playing role playing,n in behavioral medicine, learning exercise in which individuals assume characters different from their own. The individual may also be asked to simulate a particularly difficult situation and apply the characteristics that are common to his to help clients "retrain" their thought processes This is a list of thinking styles, methods of thinking (thinking skills), and types of thought. See also the List of thinking-related topic lists, the List of philosophies and the . to be more optimistic op·ti·mist n. 1. One who usually expects a favorable outcome. 2. A believer in philosophical optimism. op . A typical substance-dependent individual attributes successful leisure outcomes to external forces such as fate or luck (external pessimistic pes·si·mism n. 1. A tendency to stress the negative or unfavorable or to take the gloomiest possible view: "We have seen too much defeatism, too much pessimism, too much of a negative approach" attributions) instead of personally taking the credit. In addition, these individuals perceive successful leisure outcomes as being a "one-shot deal," unlikely to be repeated. The irrational ir·ra·tion·al adj. Not rational; marked by a lack of accord with reason or sound judgment. irrational adjective Unreasonable, illogical belief that successful events cannot be repeated is referred to as "unstable attributions." With the use of ARLEM, the therapeutic recreation specialist can attempt to turn the substance abuser's pessimistic, externally based, and stable ones. In other words Adv. 1. in other words - otherwise stated; "in other words, we are broke" put differently , substance-dependent individuals who have participated in the nine sessions of ARLEM may come to recognize that they can attribute positive, successful leisure outcomes to their own liabilities and repeat these experiences over time. Through attribution retraining, they learn to change pessimistic attributions into optimistic attributions. Maintaining healthy, internal, and stable attributions is an essential step for developing a sense of control (self-efficacy) when experiencing successful leisure situations. The nine sessions of ARLEM, described in the following section, take place within the "Coping Skill" component in Figure 1. How ARLEM Works Session one helps clients become more aware of the importance of leisure. Session two is oriented o·ri·ent n. 1. Orient The countries of Asia, especially of eastern Asia. 2. a. The luster characteristic of a pearl of high quality. b. A pearl having exceptional luster. 3. toward awareness of high-risk leisure situations. Sessions three through six help clients learn to recognize their "automatic attributions" (or first thoughts) when experiencing a high-risk leisure situation. Sessions seven through nine teach clients to evaluate whether their "automatic attributions" are accurate or not, and how to generate more optimistic thoughts. All sessions should be led by a therapeutic recreation specialist who is trained in working with substance-dependent populations. Session 1: Awareness and appreciation of leisure * Clients explore, discover, and develop awareness regarding the health benefits of leisure. * Clients are asked to reflect upon past leisure experiences that have been successful without the use of abusive Tending to deceive; practicing abuse; prone to ill-treat by coarse, insulting words or harmful acts. Using ill treatment; injurious, improper, hurtful, offensive, reproachful. substances. Session 2: Awareness of high-risk leisure situations and current use of coping skills * Clients become aware of the relapse process (Figure 1). * Clients identify past leisure activities or situations that posed a threat to their sense of control regarding sobriety and articulate coping skills that were used. * Clients identify potential leisure activities or situations that could pose a threat to their sense of control regarding sobriety. Session 3: Awareness of assignment of causality causality, in philosophy, the relationship between cause and effect. A distinction is often made between a cause that produces something new (e.g., a moth from a caterpillar) and one that produces a change in an existing substance (e.g. during and after leisure activity * Clients realize that providing automatic attributions is a natural part of the thought process and an important aspect of any coping skill. Session 4: Understanding center of control * Clients understand how attributions can be based upon internal or external dimensions. Session 5: Understanding stability * Clients understand how attributions can be premised on stable or unstable dimensions. Session 6: Awareness of optimistic and pessimistic attributions * Clients understand the difference between optimistic and pessimistic attributions. Session 7: Attribution retraining (a new coping skill) * Clients learn that attribution retraining is a new coping skill. * Clients learn how to evaluate and dispute their pessimistic attributions regarding leisure situations. In particular, all clients learn coping techniques that will help them deal with high-risk leisure situations. Session 8: Actively challenging pessimistic attributions * Clients actively challenge pessimistic thoughts. Disputing pessimistic explanations can be facilitated in many ways such as role playing, writing in a journal, and experiential education. Session 9: Actively challenging pessimistic attributions and termination * Clients actively practice challenging pessimistic attributions and bring closure to the ARLEM program. For additional information regarding the theoretical base of ARLEM, as well as an explanation of therapeutic technique that can be utilized by helping professionals, see Seligman et al. (1995) and Beck et al. (1993). An actual case study of ARLEM is presented in Figure 2. The client (Mr. A) was diagnosed as alcohol dependent and was in his fifth treatment facility. FIGURE 2. CLIENT ACTIVITIES AND REACTIONS Session 1 Mr. A explained how he was able to have a peaceful and relaxing experience hiking hiking Walking, often among hills or mountains, as recreational sport. It represents an activity in its own right and also figures in backpacking, camping, hunting, mountaineering, and orienteering. in the canyons with a good friend. Mr. A was able to write down a list of health benefits that could occur from participating in constructive leisure. Session 2 Mr. A understood the relapse process (Figure 1) and identified golfing as a past high-risk leisure situation. Mr. A disclosed that this primary high-risk leisure concern was golfing, because he enjoyed the activity but was afraid he would go into the clubhouse to drink after he finished golfing. Session 3 Mr. A told about a time he "really lucked out" while playing his best round of golf and then wanted to celebrate with his friends in the clubhouse. His automatic attribution of "really lucked out" was brought to his awareness. Session 4 Mr. A discovered that when he golfs well he usually attributes his performance to luck (external attribution). Session 5 Mr. A discovered that luck is an unstable attribution and also became aware that he usually wants to party an exceptional golf performance but does not want to celebrate when he golfs poorly. Session 6 Mr. A became aware that when he golfs well his attributions are very pessimistic. Mr. A discovered that his irrational and pessimistic belief (luck) that he would not repeat an exceptional golf performance stimulated his urge to party. Session 7 Mr. A learned 10 possible questions to ask himself to challenge pessimistic explanations. (Seligman et al., 1995). Session 8 Via role playing and role reversal In psychodrama, role reversal is a technique where the protagonist is asked, by the psychodrama director, to exchange roles with another person (an auxiliary ego) on the psychodrama stage. The former assumes as many of the roles of the other as possible and vice versa. , Mr. A demonstrated how to actively challenge irrational pessimistic thoughts regarding golfing. Mr. A was asked to keep a "daily record diary" (Beck et al., 1993) regarding leisure activities, in which he documented irrational pessimistic thoughts, how he challenged his pessimistic explanations, and how he changed them to healthier optimistic attributions. Session 9 Mr. A decided that he was ready to challenge pessimistic attributions that he made during golfing and other leisure activities without the direct help of the therapeutic recreation specialist. Conclusion While chronic substance-abuse relapse remains a problem in our society, treatment modalities treatment modality Medtalk The method used to treat a Pt for a particular condition that may contribute to the rehabilitation rehabilitation: see physical therapy. of substance-dependent individuals do exist. As previously mentioned, there is a lack of theory-based therapeutic recreation programs for individuals who have had many substance-induced relapses. It should be noted, however, that incorporating any type of treatment under the rubric RUBRIC, civil law. The title or inscription of any law or statute, because the copyists formerly drew and painted the title of laws and statutes rubro colore, in red letters. Ayl. Pand. B. 1, t. 8; Diet. do Juris. h.t. of leisure education should be considered cautiously. For example, ARLEM is specifically oriented toward the substance dependent individual who has had frequent relapse problems. ARLEM may not be appropriate for individuals who are entering treatment for the first time. While ARLEM, adapted from the field of psychology, is fairly recent in its conception, the current exigency of health care-delivery systems continues to herald a necessity of proven effects and positive outcomes. Further empirical research Noun 1. empirical research - an empirical search for knowledge inquiry, research, enquiry - a search for knowledge; "their pottery deserves more research than it has received" efforts with documented results, based on ARLEM's theory of attribution retraining, will be warranted. References Beck, A. T. Wright, F.D., Newman, C.F., & Liese, B.S. (1993). Cognitive therapy of substance abuse. New York New York, state, United States New York, Middle Atlantic state of the United States. It is bordered by Vermont, Massachusetts, Connecticut, and the Atlantic Ocean (E), New Jersey and Pennsylvania (S), Lakes Erie and Ontario and the Canadian province of : Guilford Press. Kunstler, R. (1992). Therapeutic recreation's role in treating substance abuse. Parks and Recreation, 27(4), 58-60. Marlatt, G.A. (1985). Relapse prevention: Theoretical rationale and overview of the model. In G.A. Marlatt & J.R. Gordon (Eds.), Relapse prevention (pp. 3-70). New York: Guilford Press. Seligman, M.E.P., Reivich, K., Jaycox, L., & Gillham, J. (1995), The optimistic child. Boston, MA: Houghton Mifflin Houghton Mifflin Company is a leading educational publisher in the United States. The company's headquarters is located in Boston's Back Bay. It publishes textbooks, instructional technology materials, assessments, reference works, and fiction and non-fiction for both young readers Co. |
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