Attempted organizational change: implementation and outcomes

¶ … Addiction recovery

Theoretical models

A brief overview of some prominent theoretical models relating to behavior modification is felt to be a pertinent starting point for his study, as many of these aspects can be compared to the actual interviews and case studies of the subjects. Research suggests that the recovery from drug and alcohol addictions is commonly a long-term process and can involve relapses before sustained and permanent rehabilitation is achieved. Behavioral theories have been shown to be effective in this process. Theories such as cognitive behavioral relapse prevention are a method that has been proven to have a sustained success rate. This theory relates specifically to the formations of behavioral changes in that patients are taught ways of acting and thinking that will assist them in avoiding previous addictions.

For example, patients are urged to avoid situations that lead to drug use and to practice drug refusal skills. They also are taught to think of the occasional relapse as a "slip" rather than as a failure. Cognitive behavioral relapse prevention has proven to be a useful and lasting therapy for many drug addicted individuals.

(NIDA InfoFacts: Behavioral Change Through Treatment)

There are numerous theoretical aspects in this regard, including contingency management to aid the process of rehabilitation. One of the more accepted models for understanding and conceptualizing behavioral change is the theory ascribed to Prochaska. This model of behavior development posits five developmental stages in the motivation and process of change. These include the pre-contemplative stage, in which the individual is not aware of the need for change; which leads to the contemplative stage in which the individual becomes aware of the need for change and seeks information as to the advantage and disadvantages of change. (PROMOTING BEHAVIOUR CHANGE)

This is followed by the preparation or decision stage. The action stage is the actual turning point where individual behavioral and value changes are implemented. This is followed by the often difficult maintenance stage, where the possibly of relapses becomes a problem. "The person is quite comfortable in the new behaviour but may still have to guard against reverting to the old behaviour." ( ibid)

This model also emphasizes an important aspect that was encountered in the case studies. This is the importance of environmental factors in the rehabilitation and recovery of the addicted individual. Environmental factors are therefore extremely important throughout, but particularly in the maintenance stage of the recovery process. " It helps if the environment is conducive to the change and reinforces the new behaviour. Thus, environmental support for the change remains very important in the maintenance phase. Sustaining behavioural change is very difficult if the environment provides cues that trigger the old behaviour."( ibid) The importance of environment is a factor which is emphasized in various studies.

Studies also point out that the rehabilitation of the addicted individual should be seen for a holistic point-of-view. "The treatment perspective ... is that drug abuse is a disorder of the whole person -- that the problem is the person and not the drug, and that addiction is a symptom and not the essence of the disorder."(Inciardi & Lockwood, 1994, p. 64)

Subject 1: John

John (a fictitious name) is a 19-year-old male whose history of drug abuse extends over a period of three years. His addictions were mainly to alcohol, LSD, and amphetamines. He has also been arrested on drug related charges. John eventuality made the decision to attempt to stop his addiction after an experience which precipitated a reassessment of his situation. This has been successful, with no periods of relapse. One of the most important aspects that feature in his history and the attempts at recovery is personal family history.

Family background

One of the central influential aspects of John's life has been his dysfunctional family background. In his interview this aspect surfaces as a cardinal and pivotal of both the addictive and recovery phases. John's father was an alcoholic and his mother, it seems, did not intervene effectively to maintain a stable home environment.

John states that, "From as early as I can remember, my father would come home drunk. There were very few occasions that I can remember when he was not drunk." This also resulted in continual arguments between the parents and a tense and unpleasant early home environment. John does state though that physical violence and abuse was very rare and that the conflicts were mainly verbal. However this created an influential psychological tension in the home which John states was one of the factors that caused him to seek relief in drugs.

One of the significant aspects gleaned from the interview was that John developed a sense of frustration and helplessness at the deterioration of his father and in the general family situation. " I always had the feeling that somehow I must have been at least partly responsible for the situation," he stated.

While John was successful academically and took part in sports and school activates, he eventually drifted towards a different set of friends and peer influences. This was also facilitated by the fact that Johns' father lost his work due to his addiction and the family had to move to a less amenable neighborhood, where drug trafficking and addiction was more prevalent. This led to John's experimenting first with marijuana and then other 'harder' drugs, until he became thoroughly addicted to Heroin. This led to deterioration in his school work which was also followed by a decline in relationships with his family, particularly his father.

When he was 18, John was involved in a car accident while under the influence of heroin. One of his fiends was killed in the accident. This event proved to be the start of a self-reassessment and the beginning of the "contemplative" stage of his recovery process. John then went through months of attempts to give up drugs. He states that he would be filled with remorse and flush the drugs on one day, only to begin the search more drugs the next day.

The start of his rehabilitation came with his confession to his mother that he was a drug addict. This was, says John, the first time that he had actually truly realized this fact. He had been avoiding this realization for months. It as in fact through a reestablishment of family dynamics and connections, essentially through the mother, that John entered the program known as Narcotics Anonymous (NA) The program provided him with security and friends which allowed him to expand his initial change of heart and values and also provided a peer-support system. John is now free of his drug addiction. He ascribes his problem to his poor relationships with his family and his father. " If my father had not always been drunk, I would have received more attention and possibly would not have been attracted to drugs" This aspects relates to research findings which link drug addiction among young people with alcoholic parents.

Alcoholic parents who suffer marital disruption over alcohol abuse may neglect to provide a moral foundation for their children who may grow up to believe that parental abuse and substance abuse are normal parts of life. It should come as no surprise, then, that COAs ( Children of Addiction) are more likely to use drugs than are non-COAs. In addition, drug use is often accompanied by delinquency, depression, low self-esteem, lack of self-control, and a high level of social enstrangement

(Yeh & Hedgespeth, 1995 p. 413)

Discussion

It seems clear that John's initiation into drug abase was instigated firstly by his family situation and secondly by peer influences. These two factors drew him deeper into the drug world and eventual into a serious addiction. Throughout this period his family situation was a catalyst for his addiction. Due to his own addiction his father did not pay enough attention to his son and possibly did not even notice signs of John's growing addiction. The mother was also involved in the problems created by the father's addiction for the family as a whole. The negative child-parent situation is often cited as cause of addictive behavior. " ... negative parent-child relationship is common in COAs (Seilhamer, Jacob, & Dunn, 1993) and must be considered a reason for drug abuse onset and continuation." ( ibid)

John's case is a classic example of addiction as a result of the lack of positive role models. The main reason for his rehabilitation was his internal decision to "do something" about his situation after a traumatic experience. His mother's intervention was crucial at this point as she directed him to the NA. This also succeeded in providing the crucial connection that he needed with his family. Coupled with this was the therapeutic environment of the NA which provided the necessary support structure which facilitated his final rehabilitation. This environment also had a further impact on the very source of his addiction in the first place; namely his family. John began to have a better relationship with his mother and his siblings as a result of his improving condition -- although his relationship with his father still remained distant.

These factors find concurrence in studies on the subject.

It has been found that adolescents do not make serious intrapsychic changes unless their families are ready to deal with them in a new way. The adolescent, as part of a family system, may be expressing the relationships within the family system in which he or she exists, or could be acting as a scapegoat for family issues and frustration.

. (Yeh & Hedgespeth, 1995 p. 413)

In essence these factors facilitated a change in perception and values for John. This can be seen to correspond to Prochaska's action stage of developmental change. This means that John underwent a deeper, more intensive change in views and lifestyle. " Behavior change occurs only after the trauma has been repeatedly examined and the grief has been fully experienced."

(Recovery: A Journey Toward Healing.)

An aspect of this case study that should be noted is that it emphasizes the view that rehabilitation is rarely completely successful in isolation from family and other support structures.

Substance use disorders of adolescence rarely occur in isolation from other problems ... These findings reinforce the need for broad-spectrum biopsychosocial (as opposed to problem-specific) screening and assessment procedures, and the need for multi-disciplinary, multi-agency intervention models that can provide an integrated response to multiple, co-occurring problems of youth and families. (White, Dennis & Godley, 2002 p.172)

Subject 2. Peter

Peter is a 20-year-old man who has achieved only partial rehabilitation His case is more complex and less successful than Johns. He is a cocaine addict and although he had achieved certain stability, he is still under treatment and suffers from numerous relapses.

History

Peter's addiction history differs from John's in that his family was not as dysfunctional -- although the parents were divorced and not as attentive to their son as they might have been. However, another aspect that has to be considered in this case is the possibility of physical and genetic factors which may account for the difficulty in rehabilitation. Furthermore cocaine is very addictive and Peter states that after his fist " hit" the habit become a $200 a week problem. While his family was slightly distant, they were caring and provided him with sufficient care.