Use of milieu as a problem-solving strategy in addiction treatment

Addicted clients begin their recovery through detoxification and treatment in a structured inpatient unit. The focus of treatment is most appropriately on learning new, more constructive ways for solving problems. Everyday living skills can best be learned in a therapeutic milieu where interactions in the here-and-now are examined and opportunities are present for practicing problem-solving skills. A therapeutic milieu can be designed and initiated through efforts of the nursing staff and members of other disciplines. It is a group treatment approach emphasizing active participation in structured activities, decision-making by consensus involving all members of the community, and a reward and restriction system based on the appropriateness of client behaviors. Certain problem behaviors of addicted clients can be addressed through confrontation and group pressure; to be expected are problems with manipulation, avoidance, aggression, impulsiveness, and grandiose denial. Staff members who work in a therapeutic milieu approach to treatment of addicted clients share certain concerns. Strategies need to be developed for dealing with manipulative attempts at splitting the staff into opposing forces, clarifying roles, enforcing unit policies, and lessening feelings of hopelessness when clients fail to achieve sobriety. A cohesive staff who work at trusting each other in an atmosphere of open communication and equitable conflict resolution are best able to support each other while addressing common concerns. While treatment in a therapeutic milieu is an effective beginning in the process of recovery, it must be remembered that it is only a beginning in the long, slow process of rehabilitation. And during that process, there are likely to be relapses, which can be used as learning tools in the development of improved problem-solving skills.