Substance Abuse Treatment Modalities: Literature Review

Recreational Therapy

The classification study adopted the following definition for recreation therapy: "activities integrated into the treatment curriculum that are specific to the purpose of improving the client's ability to use his/her leisure time in a more productive and enjoyable manner". B.F. Skinner (1978) made the distinction between positive and negative reinforcement to explain the link between behavioural processes and leisure:

Positive reinforcement as the term implies, is strengthening ... and it is free of the effects of negative reinforcement and punishment, such as anxiety and fear. Positively reinforced Behavior is active participation in life, free of boredom and depression. When our Behavior is positively reinforced we say we enjoy what we are doing; we call ourselves happy.

The goal of recreational therapy is to increase positive reinforcement for behaviours that occur during an individual's daily life (i.e. amounting essentially to balancing "work and play" or the "ups and downs" of day to day life). Focusing on positive reinforcement for behaviours allows the therapist to reduce the stressors associated with substance abuse. Alan Marlatt (1985) has noted that a balanced lifestyle is characterized by a relative degree of balance in the individual's daily activities between sources of stress and one's resources for coping with stress.

This type of therapy is currently employed as a central component in the Offender Substance Abuse Pre-Release Program (OSAPP) and the Community Correctional Brief Treatment, Relapse Prevention and Maintenance Program (Choices). Dr. Marlatt's clinical observations led him to conclude that the degree of balance in a person's daily lifestyle had a significant impact on the desire for indulgence or immediate gratification. OSAPP and Choices work with offenders in establishing the balance between those activities perceived as external demands (shoulds), and those perceived as pleasures or self-fulfilment (wants). Creating an imbalance in either areas (shoulds/wants) increases the risk for a possible slip or relapse.

When the "shoulds" in life weigh a lot more than the "wants" the person often develops a sense of self deprivation or feeling sorry for themselves. They feel stressed out, under pressure, and feel they owe themselves something: that they deserve a reward. When the reward is alcohol or drugs for the person who is committed to abstinence, or getting drunk for the person committed to moderation, a dangerous situation arises. Therefore, balancing lifestyle is important for maintaining treatment goals and avoiding high-risk situations.

OSAPP and Choices participants run through a series of "hand on" exercises with the facilitator whereby they identify their "shoulds" and "wants" on a series of worksheets. These identified areas are built into each offender's slip/relapse prevention plan so that areas of change are identified. These areas of change can be explored further during the maintenance groups to ensure a healthy lifestyle balance. Participants are also asked to conduct problem solving in order to detail the steps that are necessary to bring about the targeted changes in their day to day lives.

There is not a great deal of empirical evaluation measuring the impact of recreation training on substance abuse. In recent years, researchers (Dilorenzo, Prue, and Scott, 1987) have speculated that the traditional conceptualization of addiction as a physiologically based problem has led to less interest in investigating this topic empirically. Nevertheless, evidence on male heavy social drinkers has demonstrated that recreational training does contribute to a reduction of alcohol use (Marlatt, 1985).

References for Recreational Therapy:

DiLorenzo, T., Prue, D., & Scott, R. (1987), “A Conceptual Critique of Leisure Assessment and Therapy: An Added Dimension to Behavioral Medicine and Substance Abuse Treatment” Clinical Psychology Review, 7, 597-609.

Marlat, A., & Gorden, J. (1985), Relapse Prevention. New York: Guilford Press.