Since the introduction of residential treatment at Saint Luke Institute 17 years ago, a major paradigm for treatment has been the 12-step model. Any addictive process is a disorder of intimacy. Patients referred for treatment at our Institute come from years of living life  on  their  own,  victims of denial and minimization, "stuck" in persisting patterns of behaviors that clearly harm them and those around them. They come here angry at being intervened upon and feel that their "life is at an end". What we know is that life as they knew it is at an end. The addictive process first affects one spiritually, then emotionally, then physically. The healing process happens in the reverse order, one recovers physically and emotionally, and eventually spiritually, "seeking through prayer and meditation to improve our conscious contact with God." (Step 11)

The concept of "the holding environment" as defined by D.W. Winnicott (1965) refers to that constancy of care, the experience of being held, which the infant needs for healthy development. When patients arrive here they discover that they are desperate for a "holding environment" comprised of a healing community which cares about living life differently. No longer is life lived in solitary, quiet desperation - cut off from self, others, and God. Quite the opposite! One gradually finds consistency and strength in the 12 step promise that states, "We will suddenly realize that God is doing for us what we could not do for ourselves."

The Continuing Care Program at Saint Luke Institute is based on a rather simple premise: it makes little sense to make such a financial and personal investment and then expect that the person will "get it right the first time." We realize that the restructuring of one's life cannot take place in a six month in-patient treatment program. The pattern of isolation and secrecy has been long-standing. That "disorder of intimacy" mentioned above has to be the constant focus of the recovering person's life.

Appropriate intimacy, living with boundaries, is learned behavior. Here are some of the steps that experience has shown us are the important building blocks in learning this new behavior:

• Prior to the patient's discharge from treatment he/she prepares a continuing care contract which commits one to such things as 12 step meetings, ongoing therapy, spiritual direction, positive health measures, accountability to religious superiors, etc. In addition, the patient prepares a list of "budding signs", behaviors that the patient has identified as precursors to relapse. We share the belief that "if nothing changes, nothing changes".
  

• Additionally patients return for semi-annual workshops for a period of two to five years following in-patient treatment. We strive to replicate that "holding environment" through the development of local recovery support groups chosen by the patient in conjunction with the local authority person and the continuing care therapist.
  
• The patient forms this support group of 6 to 8 persons who are willing to offer honest feedback through observing and sharing with the patient behaviors that they believe are problematic to recovery.
  

• The continuing care therapist conducts a re-entry workshop - a training session for the support group about two months after the patient is settled back home.
  

• immediately after treatment,
  
• 2 ½ years after treatment,
  
• 5 years after treatment.