Sierra Tucson utilizes many different types of therapeutic modalities to access underlying issues. Every person is different and responds differently to various types of therapy. Each modality is designed to unearth vital information from different angles and pathways into one's self. The varied dynamic approaches available at Sierra Tucson provide rich resources to help access these issues and enrich the treatment experience, heightening the chances of one's recovery.

Cognitive-Behavioral Therapy

Cognitive-Behavioral Therapy (CBT) came about in the 1950s and 1960s to concentrate on a person’s problem behaviors and thoughts. The major philosophical assumption of CBT is that by changing individuals’ thinking, their belief system, and, in turn, their behavior is changed.

Although many people have the misperception that CBT is all head work, emotions are a critical piece in helping people deal with their thoughts, attitudes, and beliefs about themselves and the world around them and the behaviors that follow. Sierra Tucson utilizes CBT in conjunction with other therapies that best meet the needs of each patient.

Continuing Care

Sierra Tucson believes that inpatient treatment is the beginning—not the end—of the recovery process for individuals. Because of this, there is a strong belief and focus on continuing care during the treatment process.

Preparation for continuing care begins upon admission in the assessment phase of treatment and continues until discharge, at which time the patient has a clearly defined, individualized written plan for ongoing recovery.

The entire treatment team is responsible for the relapse prevention and continuing care planning, with team members having specialized focus. Patients attend Relapse Prevention Groups regularly, with specific meetings dedicated to continuing care each week. This prompts patients to delve into the meaning and importance of continuing care and think about what their discharge plan might look like. They learn about the various options available, including resources at home, extended care, transitional living, and intensive outpatient programs. Patients then begin to outline individual needs and goals that integrate 12-Step meetings and other sources for continued recovery in family/primary relationships, spirituality, social/recreational, medical/physical/fitness/nutrition, vocational/educational, financial, or legal areas.

The unit therapist works with the patient weekly on an individual basis to better hone and define the patient’s understanding of his/her disease process, coping skills, and support systems necessary for prevention of relapse. With input from the patient’s referring professional, family, and the Sierra Tucson treatment team, the patient is given recommendations for continuing care needs post-hospitalization. Patients who discharge on medications will have a follow-up appointment with a psychiatrist for continued evaluation. Patients will make appointments for follow-up care before discharge, in order to ensure continuity of care.

During treatment, a Discharge Group assists patients in completing their continuing care plan, and a Going Home Group provides support and strength for those discharging in the immediate future. The continuing care coordinator and the alumni coordinator ensure that each individual is aware of the many resources available for sustained recovery. Alumni contacts are given, where applicable, to ease the transition for patients returning to their home environment.

Sierra Tucson considers the Continuing Care Plan to be one of the most important tools that a patient takes with him/her. Through collaboration of the patient, the treatment team, the referring professional, and family members, each individual leaves treatment with a solid plan for continued success on the path to recovery.

The alumni coordinator, with each patient’s consent, follows up with a telephone call at 1 week, 1 month, 6 months, and 1 year to provide support and resources. To further encourage our alumni, Sierra Tucson helps facilitate alumni support groups and offers workshops, alumni dinners, and an annual Alumni Reunion. Sierra Tucson also provides a biweekly Alumni eNews called Beyond the Miracle and publishes the Afterwords Alumni Newsletter three times per year to provide continued strength and hope.

Experiential Therapy

Experiential therapy was developed during the early 1970s. This type of therapy helps individuals experience the issues they are dealing with through acting them out, role-playing, guided imagery, projecting, and the use of props. By physically, emotionally, and mentally expressing one’s self, individuals are assisted in unlocking hidden issues and in working through them. Sierra Tucson utilizes experiential therapy as a significant component in treatment. Psychodrama, group process, sculpting, the Challenge Course, Climbing Wall, and Equine-Assisted Therapy are all types of experiential therapy.

Eye Movement Desensitization and Reprocessing (EMDR)

Eye Movement Desensitization and Reprocessing (EMDR), developed in 1987 by Dr. Francine Shapiro, has shown to be useful in assisting patients in resolving traumatic experiences and is an integral part of the Program for Sexual and Trauma Recovery (PSTR) at Sierra Tucson. Dr. Shapiro, a psychologist in the San Francisco area, initially used EMDR to help Vietnam War veterans process the extreme trauma they had experienced. Since the development of EMDR, countless clinicians worldwide have been trained in this method. It has been used to treat patients with a variety of disorders including phobias, depression, and anxiety, but has been most widely used with posttraumatic stress disorder (PTSD). EMDR is currently recommended by the American Psychological Association and leading authorities on trauma resolution.

When an individual is emotionally overwhelmed from a traumatic event, the brain cannot process information as it normally does, and the emotion becomes “stuck.” The act of remembering triggers the “fight or flight” response. The resulting memories of sights, sounds, smells, thoughts, and emotions can feel as intense as when the traumatic event actually occurred. Such upsetting memories can have a profoundly negative impact on the way an individual sees the world and relates to self as well as others.

EMDR is utilized to change an individual’s emotional response from dysfunctional to healthy by allowing access to adult coping skills and resources to use later in life. The technique utilizes bilateral auditory, visual, and tactile stimulation (also known as Dual Attention Stimulation, or DAS) while thinking about a traumatic memory. As the individual remembers the event and associated memories while continuing with DAS, he or she can resolve troubling emotions and cognitively reframe negative belief systems associated with the trauma. Subsequently, patients often report that symptoms associated with PTSD such as nightmares, flashbacks, panic reactions, and even suicidal ideation are greatly diminished and sometimes absent entirely after only one to three sessions.

EMDR is ordered for the patient when clinically appropriate. Although EMDR is successfully used on an outpatient basis, the safety of the inpatient setting allows individuals to focus on their therapeutic work without the distractions of ordinary daily responsibilities. Occasionally, too, a patient can experience between-session disturbances that make inpatient treatment a desirable scenario. The patient can take the best advantage of time in treatment and the opportunity to experience EMDR as part of a specialized therapeutic focus to find relief from the debilitating symptoms of posttraumatic stress disorder.

Grief/Spirituality

Recovery from dependencies and other self-defeating behaviors involves recognizing that grieving, i.e., that process by which all humans adjust to loss and change, has been a significant and frequently under-acknowledged dynamic in our lives.

Sierra Tucson's staff educate patients in the normal and natural process that leads to resolution of loss. Patients learn how this process has been interrupted by the use of mood-altering substances, compulsive behaviors, trauma, or dysfunctional family roles. Patients are guided into the grief that has been inhibited, thereby allowing the process of healing to occur naturally. Outcomes of grief work frequently include increased self-esteem, reduction in reported depression and self-harm, and dramatic emergence of energy for life and the tasks of recovery. Emotional access is further encouraged as the bridge to personal spiritual discovery. We believe that the ability to identify, experience, and express all emotions appropriately is the conduit to authenticity, values clarification, and passionate connections with self and others.

Grief and spirituality therapists co-facilitate grief work in Process Groups and lead Specialty Grief Groups for patients with unresolved losses. Patients may be assigned to individual grief/spiritual consultations. Spirituality is enhanced through 12-Step meetings and Step work, nondenominational services, walking the labyrinth, talking circles, yoga, and meditation. Patients are encouraged to explore their spirit in the transformative desert setting—with music, art, physical movement, and Equine-Assisted Therapy.

Individual Therapy

Individual therapy is comprised of individual time with the unit therapist, physician or medical provider, or specialty or evening/weekend therapists. Sierra Tucson mostly utilizes group work, but patients have one-on-one time scheduled throughout their treatment stay to process issues and discuss treatment plans.

Medication

The appropriate use of medications for individuals suffering from severe depression, bipolar disorder, panic disorder, or other disorders can be extremely helpful in furthering recovery. This is a process of balance, because the inappropriate use of medications can be a major cause of relapse and suffering. The challenge we face, especially in those who are recovering from a chemical dependency, is to identify those who will truly benefit from medication and those who will not.

All patients admitted to Sierra Tucson will have their medication needs thoroughly evaluated. This includes assessment of the medications patients are taking prior to admission to Sierra Tucson as well as the need for medications during their hospitalization. We often will discontinue all medications, if it is felt to be safe, to allow the patient a “drug washout.” This can often be extremely enlightening when done in a controlled setting, since many patients have problems that were caused by medications rather than relieved by them.

The medical and psychiatric staff at Sierra Tucson are experts, trained in the management of medications for use in psychiatric illness and chemical dependency. A thorough evaluation is given prior to prescribing any medication. We also talk with patients before a prescription is considered to discover their perspective on medications. Prescribing medications to a patient who is not willing to take them only invites non-compliance and failure. We offer educational sessions on medications in several of our didactic lectures. A weekly mental health lecture also discusses the appropriate use of medications by any individual with a mental illness or a chemical dependency problem. Patients are educated about what medications may or may not be helpful. We also provide referrals to sources of information that can answer questions about specific issues.

In the past, patients have been advised that, “In recovery, all drugs are bad and should be avoided.” Although the intent of this message was valid, today it is neither practical nor helpful. Patients will be making decisions on a regular basis with issues regarding medications. Individuals need a process by which they can sort out the good medications (helpful and necessary) from the bad, as well as an environment that continually supports them.

Nutrition

Sierra Tucson believes in a holistic approach to treating addictions and mental/behavioral disorders. Part of this approach includes healthy nutrition. People in need of treatment tend to have unhealthy eating habits and may be nutritionally deprived. We believe that in order to think clearly, work effectively, and have enough energy to get through the day, everyone needs to be properly nourished.

Carbohydrates are used as your main energy source. If you don’t consume enough “carbs,” you won’t be fueling your brain to help you think clearly. Protein is needed to repair any damage that your body has sustained. Fat is important at meals for being physically satisfied after eating and is also required for proper brain functioning. The meals at Sierra Tucson are high in complex carbohydrates and fiber and are low in fat and sodium to provide the nourishment your body and brain need.

A vegetarian entrée and at least one non-vegetarian entrée are provided for both lunch and dinner. We strive to offer the freshest seafood, USDA Choice meats, and fresh poultry, as well as locally grown produce.

Low-fat desserts are served twice a week. To limit the amount of simple carbohydrates, sugar is used sparingly in some foods, beverages, and desserts. If you have special dietary needs, i.e., Kosher or vegetarian, the kitchen staff will do everything possible to accommodate your needs.
When at a meal, staff strongly encourage individuals to listen to body cues of hunger and fullness. By doing this, you will eat what your body and brain need for nourishment. If you have an eating disorder or think you may have one, it may be difficult to listen to these cues. By working with a dietitian, you will begin to learn how to listen. Eating at regular times throughout the day will improve nourishment and will prevent mood swings and irritability that may result from erratic blood sugar.

Sierra Tucson’s meals are based on the American Diabetes Association Exchange Lists, which are used to teach what food groups are found in specific foods.

Psycho-Educational

Psycho-educational instruction is a process of imparting knowledge about diseases, therapies, medications, communication styles, etc. through participative lecture. This educational method is used in conjunction with all programs at Sierra Tucson.

Twelve-Step Philosophy

The 12-Step philosophy is utilized as a basis for the treatment programs at Sierra Tucson, and individuals are encouraged to use the 12-Step principles in their recovery. Research has shown that the quality of recovery from all addictive and mental health disorders is enhanced by the many components of the 12-Step Programs, such as mutual support, honesty, accountability, acceptance, and spirituality.

The 12 Steps and the 12 Traditions of Alcoholics Anonymous have been effectively adopted by other self-help organizations.

The 12 Steps
(Adapted from the Big Book of Alcoholics Anonymous)

1. We admitted we were powerless over ****—that our lives had become unmanageable.



2. Came to believe that a Power greater than ourselves could restore us to sanity.



3. Made a decision to turn our will and our lives over to the care of God, as we understood Him.



4. Made a searching and fearless moral inventory of ourselves.



5. Admitted to God, to ourselves, and to another human being the exact nature of our wrongs.



6. Were entirely ready to have God remove all these defects of character.



7. Humbly asked Him to remove our shortcomings.



8. Made a list of all persons we had harmed and became willing to make amends to them all.



9. Made direct amends to such people wherever possible, except when to do so would injure them or others.



10. Continued to take personal inventory and when we were wrong, promptly admitted it.



11. Sought through prayer and meditation to improve our conscious contact with God, as we understood Him, praying only for knowledge of His will for us and the power to carry that out.



12. Having had a spiritual awakening as the result of these Steps, we tried to carry this message to others and to practice these principles in all our affairs.

1. Our common welfare should come first; personal recovery depends upon AA unity.



2. For our group purpose there is but one ultimate authority—a loving God as He may express Himself in our group conscience. Our leaders are but trusted servants; they do not govern.



3. The only requirement for AA membership is a desire to stop drinking.



4. Each group should be autonomous except in matters affecting other groups or AA as a whole.



5. Each group has but one primary purpose—to carry its message to the alcoholic who still suffers.



6. An AA group ought never endorse, finance, or lend the AA name to any related facility or outside enterprise, lest problems of money, property, and prestige divert us from our primary purpose.


7. Every AA group ought to be fully self-supporting, declining outside contributions.



8. Alcoholics Anonymous should remain forever nonprofessional, but our service centers may employ special workers.



9. AA, as such, ought never be organized; but we may create service boards or committees directly responsible to those they serve.



10. Alcoholics Anonymous has no opinion on outside issues; hence the AA name ought never be drawn into public controversy.



11. Our public relations policy is based on attraction rather than promotion; we need always maintain personal anonymity at the level of press, radio, and films.



12. Anonymity is the spiritual foundation of all our traditions, ever reminding us to place principles before personalities.