Minnesota Chemical Dependency Program
for Deaf and Hard of Hearing Individuals
2450 Riverside Avenue
Minneapolis, Minnesota 55454
Abstract
Accessing chemical dependency treatment and
beginning a program of recovery presents many problems for
any individual, but those who are chemically dependent and
deaf or hard of hearing face additional barriers to treatment
and recovery. Barriers may include lack of recognition or
a problem within the community; confidentiality issues; lack
of substance abuse resources for deaf/hard of hearing people;
enabling on the part of family, friends and professionals;
funding concerns; and lack of support for ongoing recovery.
Issues related to communication impact deaf and hard of hearing
persons along the substance abuse services continuum. Specialized
treatment approaches developed by the Minnesota Chemical Dependency
Program for Deaf and Hard of Hearing Individuals help to accommodate
the communication and cultural needs of clients. Based on
the Twelve Steps of Alcoholics Anonymous, the Program approaches
feature the use of drawing, role play, education and American
Sign Language and other appropriate communication systems.
The article includes examples of treatment assignments, philosophy,
purpose statements and expected outcomes. Also covered are
behavior management philosophy and techniques, aftercare considerations,
and information about treating mentally ill clients who are
chemically dependent.
Introduction
Getting treatment and beginning a program of
recovery presents many problems for any individual, but those
who are chemically dependent and deaf or hard of hearing face
additional barriers to treatment and recovery. At the present
time, little data is available to describe the extent of the
substance abuse problem with deaf and hard of hearing young
people or adults. The majority of the research indicates that
deaf and hard of hearing people face at least the same risk
of alcoholism and drug abuse as do hearing people (Lane, 1985).
Dennis Moore (1991) also points to what he terms "the
paucity" of epidemiological data related to the prevalence
of substance abuse in the Deaf Community. To date, there have
only been two residential school for the deaf studies (Boros,
1981; Isaacs, Buckley & Martin, 1979, Johnson and Lock,
1981) and one state wide study estimating the incidence of
substance abuse in the young deaf population.
Barriers to Treatment Services
In addition to the problems of insufficient
data to describe the dimensions of the drug abuse problem
among deaf and hard of hearing persons, typical treatment
and recovery resources pose barriers to these individuals.
Deaf and hard of hearing people have unique needs which are
often not adequately addressed in a non-specialized substance
abuse treatment program because of inadequate accessibility
(Rendon, 1992, Whitehouse, Sherman & Kozlowski, 1991;
Lane, 1985). The Minnesota Chemical Dependency Program for
Deaf and Hard of Hearing Individuals has identified the following
barriers to treatment and recovery for persons who are deaf
or hard of hearing.
1. Recognition of a problem - There is
a general lack of awareness of the problem of substance abuse
within the Deaf Community. This situation is influenced by
a lack of appropriate education/prevention curricula and limited
access to recent widespread efforts to educate people about
alcohol and other drugs through the mass media.
2. Confidentiality - Traditionally, the
Deaf Community has communicated information about its members
very efficiently through person to person contacts. This grapevine-line
system of communication within the Deaf Community has kept
deaf people informed of community news and concerns. But,
individuals in treatment often fear that their treatment experience
will become a part of the grapevine information and are therefore
reluctant to share their story.
3. Lack of Resources - Few resources
along the continuum of substance abuse services exist that
meet the communication and other cultural needs of deaf and
hard of hearing persons. Historically, the array of treatment
services available to hearing individuals has not been accessible
for deaf and hard of hearing people. There is also a lack
of qualified professionals trained in the areas of substance
abuse and deafness. Deaf and hard of hearing individuals,
their families or professionals serving them may struggle
for lengthy periods of time attempting to locate and access
appropriate programming.
4. Enabling - The tendency of family
members, friends and even professionals to take care of and
protect individuals who are "disabled" or "handicapped"
is often played out with deaf and hard of hearing persons.
The addition of substance abuse only exacerbates this problem.
Often this results in the deaf or hard of hearing individual
not being held accountable for his/her behavior. Enabling
also sends the unintended message that the deaf or hard of
hearing person is not able to take care of him/herself.
5. Funding Concerns - Specialized programming
to meet the needs of deaf and hard of hearing persons is costly
due to the need for specially trained staff, travel costs
and the depth and breadth of the clients needs. The
process of accessing funding sources may act as a barrier
itself to deaf and hard of hearing persons. It is not uncommon
for funding agencies to require a number of assessments with
various professionals in order for funding to be approved.
Again the shortage of appropriately trained professionals
in these various fields impacts the accessibility of prerequisite
services.
6. Lack of Support in Recovery - Disengaging
from old friends may be especially difficult for people who
are deaf. Small numbers of deaf people within the community,
many of whom use mood altering chemicals leave the recovering
person with few socializing opportunities. The relatively
small number of recovering deaf role models also results in
a lack of a sense of support. Also, until recently, alcoholism
or drug addiction was often viewed as a moral weakness instead
of a chronic disease sometimes contributing to the ostracizing
of dependent individuals from the Community.
Communication
In order to access treatment services, the deaf
or hard of hearing person must be able to access communication
of the treatment process. For many, accessing spoken and written
language is a struggle. Concern about accessibility problems
related to communication that deaf and hard of hearing people
face in entering most treatment programs have been repeatedly
documented (Berman, 1990; Lane, 1985; Miller, 1990). It has
been found that treatment programs in Illinois, for example,
were only minimally compliant in meeting the federal legal
mandates as far as accessibility for disabled persons (Whitehouse,
Sherman, Kozlowski, 1991). Similar situations exist in most
other states.
For any person who is deaf, communication is
a crucial issue. Most deaf people depend on American Sign
Language (ASL), a visual language, to communicate (Stokoe,
1981). Because they do not hear language and learn it as hearing
children do, they often struggle with English language--written
and verbal. Traditional treatment approaches often emphasize
the use of reading/writing tasks and "talk therapy"
and thus make it difficult for anyone who has language difficulties.
Hard of hearing persons face a different set of barriers related
to communication in treatment including poor acoustical environment,
inadequate lighting, or inability to follow a conversation
in a group (Ancelin, 1992).
Communication difficulties also mean that many
deaf and hard of hearing persons have had less access to educational
information about alcohol and other drugs than their hearing
peers. School education/prevention programs and media information
often preclude access by deaf people for a variety of reasons
including the lack of captioned or signed materials, use of
unfamiliar vocabulary and other communication related issues.
Often, deaf people receive little or no information about
drugs and alcohol or misunderstand the information presented
in the media. Historically, few residential (state) schools
and almost no mainstream public school programs involve deaf
students in substance abuse curricula (McCrone, 1982).
Some treatment programs have attempted to resolve
the communication issue by using a sign language interpreter
and integrating deaf clients into the regular treatment process.
Although this is successful for some individuals, many deaf
people do not experience treatment in an effective way in
this setting. Often, the interpreter is provided only for
formal programming and the deaf person misses out on communication
with other patients at various times during the day or evening
such as free time or meal time. In many instances, there is
a shortage of available interpreters so communication is not
provided to the client. Deaf and hard of hearing individuals
in treatment need more than just interpreting services. It
is essential that a full array of services such as education
from a qualified teacher of deaf students, direct communication
with clinical staff, captioned or sign video material or innovative
treatment approaches be provided. Sometimes, the deaf person
is unable or unwilling to establish a bond with treatment
staff and patients who do not understand what it means to
be deaf or know how to communicate in ASL. For many deaf individuals,
this experience could be equated to a hearing individual being
placed in a treatment program where Spanish is spoken and
an English interpreter is brought in for several hours a day.
The difficulty of developing meaningful relationships without
fluent communication seems clear.
Lack of awareness or understanding of deaf culture
on the part of treatment staff or peers can also add to difficulties
in a non-specialized program. For example, the experiences
of socializing with deaf peers is cherished in Deaf Culture.
However, for a deaf person attempting to recover from chemical
dependency, socializing with deaf peers can be problematic
when the number may be small and many are using or abusing
alcohol and other drugs. Letting go of using friends may mean
leaving the Deaf Community, at least for a period of time.
While still recommending separation from peers who are using,
treatment staff who are knowledgeable about Deaf Culture can
appreciate the special difficulty this presents when it leaves
the person with few deaf friends, or none at all. The Deaf
Club, which serves as the central gathering and socializing
place for deaf people, is often supported by the sale of alcohol.
Attitudes toward alcohol in the Deaf Community are also important
to understand. For example, a study of the attitudes of deaf
high school students toward alcohol shows their perception
of drunkenness as a "sin" or a sign of character
weakness (Sabin, 1988). Understanding of these dynamics is
essential on the part of treatment staff. Further, because
deafness is considered a low incidence population, deaf people
are often geographically isolated from one another. Ninety
percent of all deaf people are born to hearing parents and
are often the only deaf person in the family. As a result,
"Deaf Schools" (state run residential schools for
deaf children) become the cultural center and the place where
children learn ASL and traditions of the Deaf Community (Padden,
1980).
The following quote sums up the difficulties
deaf and hard of hearing persons face once alcohol or other
drug problems are identified.
"Large numbers of deaf alcoholics have
been forced to struggle without the help of community
agencies. Even within the alcoholism agencies, barriers
to treatment exist because the programs have been designed
for verbal, hearing clients. Counselors do not understand
the psychosocial aspects of deafness or the specific forms
of denial that occur, and they do not possess manual communication
skills. Agency budgets do not traditionally include funds
for sign language interpreters....It is the encounter
with confusion and ambivalence found in these situations
that have caused deaf alcoholics to avoid agencies, increasing
their frustration (and their denial) about being different"
(Rendon, 1992).
A Model Program
The Minnesota Chemical Dependency Program for
Deaf and Hard of Hearing Individuals (MCDPDHHI) is a specialized
program designed to meet the communication and cultural needs
of deaf and hard of hearing persons in chemical dependency
treatment. The Program is the recipient of a critical populations
grant from the Center for Substance Abuse Treatment (previously
the Office for Treatment Improvement). The Program was awarded
the initial grant funds in September, 1990, and was awarded
two additional years of continuation funds in September, 1993.
The grant funds enable Program staff to provide outreach and
training, to modify and develop materials as well as to provide
treatment to deaf and hard of hearing persons.
The MCDPDHHI is comprised of a highly trained
staff who provide a full range of treatment services. The
treatment team includes a medical director, a program director,
certified chemical dependency counselors, interpreters, an
outreach counselor, a family counselor, a licensed teacher
of the deaf, a chaplain, an occupational therapist, a recreational
therapist, nurses, a case manager, unit assistants and a program
secretary. Staff are fluent in sign language as well as knowledgeable
about and sensitive to Deaf Culture. Program offerings include
individual and group therapy, school programming, lectures,
occupational therapy, spirituality group, recreational therapy,
grief group, mens/womens groups, participation
in Twelve Step groups, comprehensive assessment services and
aftercare planning. As a part of a major metropolitan medical
center, the Program also offers a full range of physical and
mental health services.
The Program operates on a Twelve Step philosophy
and offers patients the opportunity to attend Alcoholics Anonymous,
Narcotics Anonymous or other Twelve Step meetings within the
hospital as well as in the community. Some meetings are interpreted
for deaf people; others consist of all deaf members. Treatment
approaches are modified to respect the linguistic and cultural
needs of the patients. For example, patients are encouraged
to use drawing, role play and communication in sign language
as opposed to written work to complete Step assignments. Written
materials used in the Program are modified and video materials
are presented with sign, voice and captions. TTYs (which
allow deaf people to communicate on the phone), assistive
listening devices and decoders for the television are among
the special equipment provided for patients. A Clinical Approaches
Manual has been developed by the Program. This manual describes
treatment approaches, philosophy, task rationale, step assignments
and educational topics used with deaf and hard of hearing
clients in treatment. This manual is intended to assist other
service providers who want to replicate the Minnesota Program.
Information from the manual is shared in later sections of
this paper.
Program staff give top priority to viewing each
client as unique and strive to meet treatment needs in an
individualized, therapeutic manner. Attention is given to
client diversity with respect to ethnic background, education,
socialization, cultural identity, family history and mental
health status. In addition, staff members recognize variation
in deaf and hard of hearing clients in their degree of hearing
loss, their functioning ability, their communication preferences
and their drug use experiences. These factors corroborate
the benefits of a flexible approach. The Program recognizes
the importance of all clinical staff being knowledgeable about
a variety of communication methods and being fluent in American
Sign Language. Effective communication is viewed as the most
essential tool in providing quality treatment services.
Phases of Treatment--Phase I, Evaluation
The Minnesota Chemical Dependency Program for
Deaf and Hard of Hearing Individuals encompasses three phases.
Phase I is the evaluation phase of the program. During Phase
I, various assessments are used to gain an understanding of
the individual client and his/her use of mood altering chemicals.
Typically, assessments include medical background, social
history, chemical use history, a clinical assessment and a
communication assessment. The communication assessment is
an important tool which profiles a clients communication
preferences and needs. The results of this assessment allow
treatment staff to present information and provide support
using the clients own preferred method of communication.
During Phase I, clients also complete a drug chart assignment
in which they detail the different drugs they have used, a
description of their last use and examples of consequences
of their use in major life areas such as physical health,
legal, family, social, work/school and financial. With few
exceptions, drug chart work, and many other assignments are
done through drawing. The use of drawing removes the barrier
created for many deaf and hard of hearing people by the English
language. It also seems to encourage the client to be more
in touch with his/her experiences and thus, more in touch
with the feelings connected to those experiences.
A copy of a sample drug chart assignment can
be found in Appendix I of this paper. When the client has
completed the drug chart assignment, he/she is asked to present
the work in a group of peers. Peers and staff provide feedback
for the client. Upon completion of Phase I, appropriate clients
(those diagnosed as chemically dependent using DSM IV criteria)
are referred to Phase II, treatment.
Phase II--Primary Treatment
Phase II is the primary treatment phase in which
clients receive education about the Twelve Steps and complete
Step work assignments. Ideally, clients will complete Steps
One through Five while in primary treatment. However, the
emphasis is for clients to integrate the concepts of the Steps
into their recovery as opposed to completing the assignments.
Step work assignments are modified to meet the needs of the
individual client, completed by clients (often through drawing
of pictures) and presented in therapeutic groups with staff
and peers. Most often, clients present their work using American
Sign Language. Task rationale for various portions of step
assignments help to identify the objectives of each assignment
and help to determine if the client has met the objective.
The goal of Step One is to help individuals
identify the aspects of powerlessness and unmanageability
in their lives and to get in touch with their feelings. Giving
examples of how their use of alcohol or other drugs has hurt
others as well as themselves help to personalize the powerlessness
and unmanageability of their own addiction. It is also during
Step One that a client confronts his/her denial. Following
the Alcoholics Anonymous philosophy, the client is asked to
admit that drugs/alcohol are more powerful than they are,
and that they cannot manage their lives any more. This helps
to establish a foundation on which to build a sober life through
the subsequent steps.
A typical Step One (see Appendix II) helps the
client to understand the significance of the problem with
alcohol and drugs. Again, much of the work is done through
the medium of drawing and presented in the clients preferred
mode of communication to a group of peers and staff. After
the work has been presented, self-related feedback from peers
helps the client develop a sense that he/she is not alone,
that others have had similar experiences. The clients
work is accepted when he/she is able to demonstrate an understanding
of the concepts of unmanageability, powerlessness and the
effects on self and others. For clients who have not completely
understood the concepts, additional assignment(s) may be given
to help supply the missing information or understanding. Most
of the Step One assignments are very similar in the tasks
given to clients. Typical modifications of this assignment
would involve breaking the assignment down into smaller parts,
limiting the scope of the assignment to a period of relapse
or expecting a lesser number of examples in each task.
Step Two assignments (as well as assignments
for the subsequent steps) tend to be more individualized for
each client. A sample Step Two assignment may be found in
Appendix III of this paper. With the exception of receiving
the Step prep and viewing the ASL video about the Step, the
assignment is developed by the staff team to meet the individual
needs of the client. A list of potential tasks (contained
in the Clinical Approaches Manual) provides options for creating
the assignment. Again, clients complete the assignment and
present it in group, as previously described. The goal of
the Step Two assignment is to allow clients to develop a sense
of hope. The assignment helps the client realize that he/she
is not alone, that there is a power to sustain him/her in
recovery. Since many clients often have had negative or confusing
experiences with the concept of God/religion, they are encouraged
in Step Two to identify their own Higher power as someone
or something--not necessarily God--which they believe to be
greater than themselves. Many clients identify their sponsors
or an AA/NA group as their Higher Power. Asking for and accepting
help are vital parts of acknowledging and accepting a Higher
Power.
Step Three is individualized in the same manner
as described above for Step Two. In this Step, the emphasis
is on action--safe places the clients can go for sober support,
people who can help the client stay sober, and so on. In this
step, clients are also asked to begin developing their understanding
of Higher Power. The Serenity Prayer (below) is often used
as part of the assigned work of Step Three. In the treatment
setting, it is used to close each therapeutic group session.
Clients are encouraged to use the Serenity Prayer as a tool
for coping with everyday stresses of living as well as with
efforts to maintain sobriety.
The Serenity Prayer
God, grant me the serenity
to accept the things I cannot change,
the courage to change the things I can
and the wisdom to know the difference.
As with Step Two, the Clinical Approaches Manual
presents a number of tasks which may be used in creating a
Step Three assignment. A sample Step Three is included in
Appendix IV.
The Clinical Approaches Manual goes on to describe
philosophy, task rationale and assignments for each of the
steps through Step Twelve as well as other information about
the approaches and assignments used at the Minnesota Chemical
Dependency Program for Deaf and Hard of Hearing Individuals.
The manual also includes examples of client work. A sampling
of other sections of the manual, a Behavior Contract, and
Family Week Assignment is included in Appendices V and VI.
In addition to step work and group/individual
counseling, clients are educated and supported through lectures,
educational programs and other activities mentioned above.
While chemical dependency is the primary area of concern,
additional problem areas, such as ineffective coping skills
and grief/loss issues, receive attention in programming. Throughout
the treatment stay, clients are provided with education related
to health concerns commonly associated with substance abuse.
Educational lecture topics include HIV/AIDS, sexually transmitted
diseases, physical effects of mood altering chemicals, birth
control and various types of abuse. Medical testing and consultation
is available to all clients.
Beginning in Phase I and continuing throughout
the clients stay, involvement in Twelve Step meetings
is provided as well as education about the programs of Alcoholics
Anonymous, Narcotics Anonymous and other Twelve Step groups.
A family week experience is provided for clients and their
families as appropriate whenever possible. Often, family members
are not fluent in sign language and for the first time, through
the use of an interpreter, the family explores a variety of
issues. If family members are unable to attend, materials
and phone contact with staff is available to all family members.
An educational component helps school aged clients maintain
their schooling while in treatment. The Program staff includes
a licensed teacher of deaf and hard of hearing students.
Phase III includes an optional extended care
program for those clients who need additional support in transitioning
back into the community and an aftercare component. For clients
who come from other states, staff members attempt to set up
a comprehensive aftercare program in the clients home
area, offering education and support to service providers
there. For local clients, the Program offers individual aftercare
sessions as well as an aftercare group and connects clients
to other local resources such as Twelve Step meetings, a Relapse
Prevention group, therapists fluent in American Sign Language,
an interpreter referral center, vocational assistance, halfway
houses, sober houses and other sources of assistance and support.
Networking with other service providers both locally and nationally
is an important activity related to aftercare. Aftercare for
clients residing in states other than Minnesota continues
to be a challenge. There are limited Twelve Step meetings
that currently provide interpreters in major metropolitan
areas, let alone rural communities. Shortages of professionals
trained to work in this area exist on a national basis. Developing
an aftercare plan for out of state clients might be compared
to putting together a puzzle--sometimes with many of the pieces
missing.
The MCDPDHHI has developed a Clinical Approaches
Manual which describes the philosophy and application of the
specialized approaches developed in five and one half years
of providing substance abuse treatment services to deaf and
hard of hearing persons. The philosophy is based on the Twelve
Step program of Alcoholics Anonymous. The manual includes
instructions for Step work, assignment sheets, examples of
client work, behavior management practices, and all other
aspects of the Program. Within the approaches developed by
the Program, the principles and concepts of the Twelve Steps
are taught and reinforced in a way that has been accessible
for deaf and hard of hearing clients. A videotape explaining
each of the Twelve Steps in American Sign Language (with voice
and captions) accompanies the Manual. In the approaches described,
clients come to recognize that they are powerless over alcohol
and/or other drugs and that their drug use has caused their
lives to become unmanageable. Each client explores for him/herself
what the impact of that use has been. Upon reaching an understanding
of these concepts of powerless and unmanageability, clients
are assisted in seeing that there is hope for changing their
lives and resources for doing so. Through the Program, clients
acquire information and skills to make different choices in
their lives, including the choice of sobriety. The use of
the Twelve Step approach helps to prepare clients to access
the most readily available source of support in the form of
Alcoholics Anonymous groups.
The Program also has developed a number of other
specialized materials including Choices curriculum (which
provides instruction in decision making and choices); Relapse
Prevention Manual; and a prevention videotape entitled "Dreams
of Denial". These materials begin to address some of
the gaps in the continuum of substance abuse services in the
areas of prevention and aftercare.
The MCDPDHHI offers comprehensive outreach and
training services to schools, communities and professionals
in all aspects of substance abuse from prevention/education
through treatment and aftercare. In addition, a grant from
the Office of Special Education and Rehabilitation Services
allows the Program to sponsor quarterly intensive trainings
which cover assessment, treatment approaches, dual diagnosis,
family issues and other topics. Professionals in education,
treatment and rehabilitation come from around the country
to attend these trainings. Staff members are available to
meet with deaf and hard of hearing school students on a one
time or ongoing basis. School services include prevention
programs such as D.A.R.E. (Drug Abuse Resistance Education)
specially modified for deaf and hard of hearing students,
educational groups for students at risk, drug/alcohol awareness
activities and consultation with school staff, and individual
student assessment.
References
Boros, A. (1981). Activating solutions to
alcoholism among the hearing impaired. In A. J. Schecter,
(Ed.), Drug Dependence and Alcoholism: Social and Behavioral
Issues. New York: Plenum Press.
Berman, H. (1990). Chemical dependency assessment
in a deaf population. Proceedings of the Substance Abuse
and Recovery: Empowerment of Deaf Persons (pp. 37-53).
Washington, D.C.: College for Continuing Education, Gallaudet
University.
Isaacs, M., Buckley, G., & Martin, D.
(1979). Patterns of drinking among the Deaf. American
Journal of Drug and Alcohol Abuse. 6(4), 463-476.
Johnson, S., & Lock, R. (1981). A descriptive
study of drug use among the hearing impaired in a senior
high school for the hearing impaired. Drug Dependency
and Alcoholism: Social and Behavioral Issues. Schecter,
E. J. (Ed.) .
Lane, K. E. (1985, April). Substance abuse
among the deaf population: An overview of current strategies,
programs and barriers to recovery. Journal of American
Deafness and Rehabilitation Association. 22(4),
79-85.
McCrone, W. P. (1982). Serving the deaf substance
abuser. Journal of Psychoactive Drugs. 14(3),
199-203.
Moore, D. (1991). Substance misuse: A review.
The International Journal of the Addictions. 26(1),
65-90.
Miller, B. G. (1990, May/June). Empowerment:
Treatment approaches for the deaf and chemically dependent.
The Counselor. 24-36.
Padden, C. (1980). The Deaf Community and
the culture of deaf people. In C. Baker & R. Battison
(Eds.), Sign Language and the Deaf Community. Linstok
Press, Silver Spring, MD. (pp. 89-103).
Rendon, M. E. (1992). Deaf Culture and alcohol
and substance abuse. Journal of Substance Abuse Treatment,
9, 103-110.
Sabin, M. O. Responses of deaf high school
students to an attitudes toward alcohol scale: A national
survey. American Annals of the Deaf, 133(3),
199-203.
Stokoe, W., & Battison, R. (1991). Sign
language, mental health and satisfactory interaction. In
Stein, L., Minder, E. & Jabeley (Eds.). Deafness
and Mental Health. Grune & Stratton, New York.
Whitehouse, A., Sherman, R., & Kozlowski,
K. (1991). The needs of deaf substance abusers in Illinois.
American Journal of Drug and Alcohol Abuse, 17(1),
103-113.
Appendix I
Drug Chart Sample
Drug Chart Assignment
SAMPLE
Do all work in the order written. Get staff
to sign before doing the next part.
Staff Initials/Date
1. Name all drugs you have used. ____________
2. Tell the last time you used. What? When?
____________
How much?
3. When I am high or drunk, bad things happen.
These things are called consequences.
Draw 7 pictures of body consequences. ____________
Draw 7 pictures of money consequences. ____________
Draw 7 pictures of family consequences. ____________
Draw 7 pictures of legal consequences. ____________
Draw 7 pictures of job/school consequences.
____________
Draw 7 pictures of social consequences. ____________
4. Present your work in group.
Drug chart is due on: September 18
Appendix II
Step One Sample Assignment
STEP ONE ASSIGNMENT
SAMPLE
Step One tells us: We admitted we were powerless
over drugs and alcohol and that our lives had become unmanageable.
Do work in the order written. Get staff to sign
before doing the next part.
Staff Initials/Date
1. Watch ASL videotape on Step One. ____________
2. Draw 10 pictures of unmanageable from drug/alcohol
use.____________
3. Draw 10 pictures of powerless with drugs
and alcohol.____________
Draw 1 picture of how powerless feels. ____________
4. Draw 8 examples of how my drug/alcohol use
has caused problems for other people.____________
5. Draw/write examples of how using alcohol/drug
has caused problems for me.____________
6. 2 1:1's with peers ____________
7. 2 1:1's with staff ____________
8. Present Step One work in group.
Step One is due on September 25
Appendix III
Step Two Sample Assignment
Step Two Assignment
SAMPLE
Step Two tells us: Came to believe that a
Power greater than ourselves could restore us to sanity.
Do work in the order written. Get staff to sign
before doing the next part.
Staff Initials/Date
1. Meet with the Chaplain for Step Two prep.
____________
2. Watch ASL videotape on Step Two. ____________
3. Draw 10 pictures of time people helped you.
____________
4. Tell 15 ways you are similar to your peers
in treatment.____________
5. Draw 10 places you can go to get support
in recovery.____________
6. List 10 people who can help you stay sober.
____________
7. Tell 15 things you like about yourself. ____________
8. 2 1:1's with peers ____________
9. 2 1:1 with staff ____________
Present Step Two in group.
Step Two is due on October 3
Appendix IV
Step Three Sample Assignment
Step Three Assignment
SAMPLE
Step Three tells us: Made a decision to turn
our will and our lives over to the care of God as we understood
Him.
Do work in the order written. Get staff to sign
before doing the next task.
Staff Initials/Date
1. Meet with Chaplain for Step Three prep. ____________
2. Watch ASL videotape on Step Three ____________
3. Draw or write about who is your Higher Power.
____________
4. Tell how you communicate with your Higher
Power. ____________
5. From the Serenity Prayer draw or write about
things I cannot change and things I can change.____________
6. Tell 10 things you are willing to give up
for your sobriety.____________
7. Why is trust important in your recovery?
____________
8. If you choose to trust people in recovery,
how can it help you?____________
2 1:1's with peers ____________
2 1:1's with staff. ____________
Present Step Three in group.
Step Three is due on October 10
Appendix V
Sample Behavior Contract
Behavior Contract
SAMPLE
Your behavior has become a concern on the unit.
The purpose of this contract is to help you change your behavior.
If you have any questions about this contract, please ask
a staff member.
Specific Behavior Concerns:
1. Not completing work on time. Drug Chart and
Step One assignments were both late.
2. Not asking for an extension on assignments.
3. Late for groups.
Expected Changes:
1. Complete all assignments on time.
2. If you need extra time to complete your work,
ask staff for an extension before your work is due.
3. Come to all groups on time.
______________________________
Client Signature
______________________________
Staff Signature
Appendix VI
Family Week Assignment
Family Week Assignment
SAMPLE
Please complete this assignment before Family
Week starts. Bring your work with you to all family groups.
What secrets related to using alcohol and
drugs do you need to tell your family?
What behaviors do you use with your family
to get what you want. Be specific.
What feelings do you have about your deafness
that you have not talked about with your family?
What feelings about your deafness do you
cover up by using alcohol or other drugs?
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