‘No More Graduation’ by Bill White

Something toGraduation reflect upon in Bill White’s latest blog.

‘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.’

Comments

  1. Eleanor Levy says:

    Well said, Bill. I have thought previously that the social myth of “rehab” is very unhelpful: the idea that people go away for a while and come back “cured” is very unrealistic. it presents obstacles to those seeking treatment and to those who want to support them. I still attend reunions of the treatment centre where I attended 27 years ago, another ritual and one that I treasure deeply. I remember some of my stay there and somewhere I probably could find the leaving cards. I am sure I am not alone in recalling that at times in earlier recovery I harboured thoughts of “going back”. The departure ritual has deep significance and “transition” is a good name for what is happening. There is a lot of professional and client concern about systematic failure to support such transitions, not just in addiction treatment but much wider in health and social care. I am sure that there will be a lot of people leaping to “save” graduation, rather than do something to improve multi agency coordination to support transition, so I hope the debate leans towards the latter

    • David Clark says:

      Great comment Eleanor. Thank you. Bill is right in my humble opinion. There needs to be some debate. Many treatment services will not like to hear what Bill has to say, but…

      My best, David

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