Jillian, a recovering addict from Vermont, had just completed a residential treatment program at an exclusive facility in California — her third such facility in as many years. Once again having completed an exceptional private program, she was excited yet anxious about leaving. Thousands of miles from home and without the structure provided her in a residential setting, she was found unconscious in a California beach town hotel room within days of discharge, barely surviving another relapse.

Early and chronic relapse among clients in early recovery is a reality and constant source of frustration for those in the addiction treatment community. Traditional tools, such as residential treatment, extended care, attendance at 12-step meetings and a strong connection to a sponsor and others in recovery have been and continue to be the backbone of successful recovery. Unfortunately and too often, those new to recovery fail to successfully make the transition from a structured residential program, with its relatively controlled environment, to their everyday lives, often resulting in relapse soon after discharge.

Why some people relapse and others do not is a source of endless discussion. Leaders in the field, such as Terence Gorski, have done groundbreaking work in identifying causes, developing strategies for prevention, and renewing a commitment to recovery in the event of relapse. Still, there is the chronic relapser. Despite being armed with all the facts, tools, information and resources the treatment community can provide, this person cannot or will not maintain a commitment to recovery in the absence of a structured environment, and eventually reverts to old behavior. Longer residential care can help, but that same individual is often unwilling to remain in treatment, therefore, he or she is discharged, reentering a world full of the same stressors, triggers and situations.

The strong support network built in treatment is not utilized, the client’s commitment and willingness dissipate, and for these individuals it is not a question of if they will relapse, but when. For these people and the treatment professionals who work with them, a new concept is emerging — one that has been shown to provide a valuable link from being in treatment to living in recovery. “The concept of a person in established recovery helping one in early recovery is clearly not a new concept and is a tenet of the 12-step philosophy,” states Nanette Zumwalt, Director of Private Staffing, Hired Power Inc. According to Zumwalt, a personal recovery assistant program serves as a professional extension of treatment — a link in the chain of the continuum of care.

Zumwalt further explains that this type of service — which originated primarily among clients in the entertainment industry — was, until recently, only available through an informal network that was loosely structured, without the benefit of background checks, bonding or insurance. The personal recovery assistant is there to “bring structure, professionalism and accountability to this concept; to provide a real tool for the treatment professional in dealing with the difficult, chronically relapsing client,” said Zumwalt. “This service brings greater security to the client in whose home the personal recovery assistant will be, and to the treatment professional or facility who uses or recommends the service.”

Personal Recovery Assistants (PRA) are either personally active in recovery with a minimum of five consecutive years and/or have professional experience in the addiction treatment field. A PRA is provided to an individual to reinforce the foundation gained in a structured treatment environment. The PRA returns with the client to their natural environment (i.e. goes home with them and moves in for a designated period of time). There, the PRA mentors, guides and supports the client as they navigate that precarious time, between leaving treatment and establishing a healthy routine as a recovering person — a time when relapse is most likely to occur.

Upon leaving a traditional treatment setting, clients are given a written treatment plan to follow, which may include therapeutic appointments, outpatient programs, 12-step meetings, acquiring a sponsor, exercise regimes, and nutritional guidelines. A PRA helps the client take the skills and tools learned in treatment and apply them to the process of living in recovery, by establishing a daily routine that includes physically accompanying a client to appointments, meetings, exercise, activities, and daily living chores. In addition, clients must return to their everyday responsibilities — family, career, and community. Clients in early recovery are often emotionally fragile, and may experience feelings of isolation and loneliness. Also, their addiction may have engendered anger, bitterness, and distrust, which they may encounter upon returning home. A PRA can be an ally and buffer during this delicate time.

While PRAs are not for every client, they can help strengthen the bridge between treatment and successful recovery. John Southworth, the founder of Southworth Associates, agrees, “These individuals are quickly becoming an essential part of the treatment team, especially in the beginning.”

According to Southworth, “Once the decision has been made to seek treatment, the risk of relapse or changing one’s mind is very high. These assistants can provide that extra support that is needed.” Businessmen, accompanied by a trusted PRA, have successfully attended conferences, replete with cocktail parties, hospitality suites and customer dinners. Family members have rejoined homes and performers have taken their newly clean and sober acts on the road.

PRAs undergo personality profiling, drug testing, criminal, background and DMV checks, CPR/ First Aid certification, citizenship status, and social security number verification. One such agency, Hired Power, Inc. requires its PRAs to participate in an extensive training, professional development, and certification process, including seminars on various addiction and mental health issues, as well as coursework in Relapse Prevention by Terence Gorski. In addition, each PRA must sign a comprehensive code of ethics, including client confidentiality and anonymity. Other organizations or agencies may have different criteria.

For treatment professionals who are working with the chronically relapsing client, battling to break that deadly cycle, the intensive, individualized service of a the chronically relapsing client, battling to break that deadly cycle, the intensive, individualized service of a personal recovery assistant is simply another tool — one that could result in improved success rates and better outcomes.

Stephen Creagh Uys is the California-based creative director of Conduit International, an advertising agency dedicated to an ethically responsible or non-profit client base. He is the author of the internationally acclaimed novel on alcoholism, The Last Generation of Chainsmokers. He can be contacted at This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

References
Terence Gorski, founder of CENAPS, noted expert and author on relapse prevention.
John Southworth, NAADAC and ICRC certified counselor who served as director of the Physician Recovery Network. Founder of Southworth Associates, a counseling and intervention services provider.

This article is published in Counselor,The Magazine for Addiction Professionals, August 2005, v.6, n.4, pp.49-50.

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