No More Graduations
The acute care (AC) model of intervention that, with few exceptions, has dominated the modern treatment of addiction involves a brief–and seemingly ever-briefer–period of professional intervention followed by cessation of the service relationship. As addiction professionals working within this model, we are trained to screen, assess, admit, treat and discharge each person we serve. And as we approach the end of this sequence, we are trained to address “termination” issues in the counseling relationship, prepare “discharge” plans and, in many of our settings, participate in a “graduation” ritual that signals the end of primary treatment and the service relationship.
Nothing more personifies the AC model than this graduation ceremony–a ritual often cherished by patients and staff alike. The ritual reminds one of a group of individuals involved in some mass catastrophe all treated together to form a powerful community of survivors who then leave one at a time with each saying warm good-byes to their fellow travelers and their caregivers. There is a sense for those leaving via this “graduation” ritual that they can now get on with their lives and not look back. Chapter closed.
This AC model works well with acute trauma, and it can play a role for many in addiction recovery initiation and stabilization. Unfortunately, it does not work well with the treatment of addictions of high severity, complexity and chronicity–patterns that dominate admissions to specialized addiction treatment units. Brief episodes of crisis intervention do not support the transition from recovery initiation and stabilization through the stages of recovery maintenance and enhanced quality of personal and family life in long-term recovery.
Efforts to transform AC models of intervention into models of sustained recovery management analogous to the treatment of other life-threatening chronic health conditions require substantial changes in service practices. One such critical change is abandonment of the graduation ritual or reframing this ritual as something other than the “end” of treatment. No healthcare provider would think of providing a “graduation” ceremony marking the discharge of patients admitted for crisis care of diabetes, heart disease, asthma, chronic respiratory conditions or chronic pain because such interventions would not constitute the end of care and the service relationship. Discharging persons from primary addiction treatment should also not signal the end of care. It is time we altered practices that inadvertently convey this end of care message.
Rituals of transition have their place in addiction treatment but they should signal new beginnings–the transitions into or through addiction recovery, not something that has been completed.