After 12 years of the working in the field of addictions, I’ve come to the conclusion there are two different things taking place. There is the business of recovery and the business of relapse. Which business are you in? Which business do you want for you or your loved one?
The business of RELAPSE looks like this:
A) It’s massive, the bed count that is… Addiction is a disease of separation, it’s a disease of isolation and one that quiets the individual. There’s false pride involved and the disease doesn’t want you to reach out for help. When facilities start to eclipse 100+ beds how can someone not slip through the cracks? How can someone be vulnerable and open in a community of 100+ strangers?
As an addict I want to blend in, I’m a chameleon and I can be whatever you want me to be. This becomes so much easier when more people are around. How does someone get the individual attention they so so desperately need with so many patients passing through?
B) The outreach team or call center always tries to place you in the treatment center they represent first. Addiction often comes with co-occurring disorders, sexual issues and many others factors that should be determined before the patient is accepted. A pulse and a PPO should not be the only factors in determining whether a patient is right for a particular facility. The outreach team and the call center should place people in accordance with those co-occurring disorder, in other words when they run across a female patient that has sexual promiscuity issues she shouldn’t be accepted into a mixed gender facility, the same goes for mental health issues, eating disorders etc.
C) The treatment center has back door handshakes, side deals and is closed to referring out appropriately. Treatment center XYZ only refers to XYZ aftercare facility because they know XYZ aftercare facility will refer them a certain amount of patients per month, will refer the patient back when they relapse and or they share services such as own a lab together or they rent/lease property together. This is a large part of what has happened in south Florida, you’d be astounded if I told you some of the partnerships I know of and how they work.
D) Levels of care are dictated by insurance. A patient is only to be given a certain amount of days in each level of care by the insurance company. The patient is then dropped to a lower level of care by the treatment center despite what their therapist and or clinical team believes the patient needs because not as much money is being collected.
E) The clinical team is under qualified. Doctors, LMHC’s and Psychologists are signing charts for groups being ran by someone who may be well-intentioned but can often times have little more than a GED.
F) There’s no 12-step immersion program. I don’t mean this bullshit you read about the “twelve step model doesn’t work”. I mean a program that literally immerses patients in the twelve steps through the Book word for word line by line. Not a program that “Takes patients to outside meetings or has meetings brought in”. I said it. After a dozen years working in this field my experience is men and women who work all 12 steps continue to take other people thru them, have a sponsor, hit a couple of regular meetings regularly, take an inventory and have a higher power in their life are sober, while almost everyone else is not. Do the 12 steps work for everyone? No, not everyone can grasp a manner of living which demands such rigorous honesty but, my experience is for most people they do work.
All of these factors and more make for a poor quality treatment episode and almost always add up to a relapse. Most facilities as described above, thoughts are “The best client is a repeat client”… That’s a true statement when you’re selling cars not when you’re dealing with the number one killer in the United States of people under the age of 50.
The Business of RECOVERY looks like this:
A) It’s under 60 beds. Groups are effective because the therapist to patient ratio is well-balanced, groups are often ran with no more than 12 people per group. Often times groups can be separated by gender and or sexual orientation several times throughout the week. Patients get to know one another and or their therapist in a smaller group and will find it harder to “chameleon” or just blend in and they will confronted on underlying causes and conditions. Patients don’t go unnoticed and are not treated as a number.
B) Both the outreach team and the call center places patients appropriately because they understand they cannot treat everyone who knocks on their door for help. They are well versed and educated in mental health disorders and do a lengthy pre assessment to determine whether they can truly help the individual looking for treatment and if they are not they can make an educated referral based on the client’s needs not based on a reciprocal relationship founded in profit or the “swapping of bodies”.
C) The facility is transparent about relationships, and why they work with other facilities. When a patient is referred out to another facility whether it’s because of a therapeutic discharge or whether they couldn’t take the patient to begin with it is never for monetary gain, but rather because it is the best fit for the patient. I’ve seen people discharge patients because they we promiscuous with the opposite sex only to refer them to a mixed gender facility again… SHADY.
D) Levels of care are always determined by the clinical team. No matter what the insurance is paying, if the clinical team knows the patient is not ready to step down, then they stay in a higher level of care. Someone’s life should never, ever be determined by a stranger at an insurance company trying to save their corporation a few thousand dollars.
E) There is a full 12 step immersion program. As previously mentioned, everyone I know who is sober was at bare minimum introduced to the 12 steps. There’s this common delusion going around the medical community that 12 steps programs don’t work. This delusion is based on treatment programs that drive their patients to meetings, which are absolutely NOT the program of recovery. The meetings are the fellowship of people in recovery, the program is found in the literature. Most patients I work with and mind you several of them have been to over 6-7 rehabs HAVE NEVER WORKED THE STEPS or even heard of the program of recovery in the meetings or in rehab!
I could add to this article all day. This is just a few of the glaring issues that stick out. I hope families and those that suffer from addiction find it useful.