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When Treatment Becomes Necessary

When Treatment Becomes Necessary

The late 80’s and early 90’s was an interesting time in treatment.  I cut my teeth as a newly certified alcohol and drug abuse counselor (CADAC) in a Houston based psychiatric/addiction hospital.  This small facility was an amazing place to learn about treatment.  Some of the best psychiatrists, psychologists and therapists worked there and all were treated as equals.  The nurses, techs and even a newbie addiction counselor like myself, were all on equal footing.  We all worked together for the good of the patients and the staff.

Treatment then was pre-managed care.  Patients could stay longer until managed cared was instituted.  It was night and day.  Were there elements that needed to change?  Yes, change was needed but it also came at a cost for the care of the patient.  As we all know, that is life and business.  Change happens.

Many years have come and gone and the CADAC’s became LCDC’s (Licensed Chemical Dependency Counselor).  I returned to school for a master’s degree in Clinical Psychology and then acquired my LPC.  Next, I launched into new territory by training to become an EAP (Equine Assisted Psychotherapist).

Throughout the years I have referred many adolescents and adult patients to treatment.  I have also made it my mission to visit treatment facilities for adults and therapeutic residential programs for adolescents.  These visits led to evaluating programs and their staff.  Referring a patient to a program is a huge responsibility.  Assisting patients and their families in such an endeavor comes with a big price not only financially, but emotionally.  The right treatment program can save lives and can be life changing.

Over the years, I learned new ways to evaluate the client and programs to assist in better placement options.  Here are a few recommendations I find important when considering a treatment facility or program:

  1. Least restrictive environment – Evaluating the teen or the adult and their family dynamic is vital.  What is the issue(s) with the teen or the adult?  How significant is the problem?  How are the parents or spouse, children or adult children handling this situation?  What outpatient strategies and resources have they used and how much have they used them?  When I meet with parents of adolescents, or with adults, these are only a few of the questions that I ask.  Referring to the least restrictive environment is optimal.  Sending a teen to a too high level of care can be detrimental.  Likewise, for adults what local outpatient programs or partial hospitalization programs, AA, NA, therapy, etc. have they tried?  Knowing when a patient is medically or psychologically in danger and getting them to higher level of care can be a life or death scenario.
  2. Knowing the resources – It is vital to know your local and state resources as well as national resources. Each year I spend time visiting programs.  I like to be able to tell clients I have visited the facility and met the staff.   Keep in mind that programs can go through changes.  There may be a big staff turnover.  This can be an indicator that good things are happening at a facility.  Staff turnover can also be an indicator of a facility facing some difficulties and this could mean your patient may be heading into a compromised environment for treatment.
  3. Location, Location – Some clients need to be near to home for a variety of reasons.  Some need to be anywhere but near their home base.  A patient who is enmeshed with their family or family with them will likely have a better outcome if they are placed further away from home.  This will enable the patient to face their issues on a deeper level with less family involvement.  Likewise, for the family member(s), distance can allow for them to get involved in their own recovery.
  4. Family Programming – Looking at the treatment facility’s program for the family is ever so important.  How do they incorporate the family?  What does their family week or family seminar(s) entail?  This may look very different in an adolescent program versus and adult program, since teens still live with their parents.
  5. Communication with the referent – Programs that communicate with the referring professional assist with continuity of care. Rather than starting from zero, a program that takes the extra time to talk with the clinician(s) that has been on the case is a sign of a good program.  Treatment only lasts for so long and the more collaboration at the front end can be a time saver.  Including treatment professionals’ experiences with the patient gives treatment staff more insight early in the process.  Plus, if the patient returns to the therapist, ongoing dialogue with the home therapist assists with continuity of care post-treatment.
  6. Addiction, Trauma, Dual Diagnosis – The more information we have about a patient, the better job we can do as clinicians about recommending the best resources. If addiction is the primary issue, what other symptoms or diagnoses is the patient is experiencing?  I have seen clients over the years that minimized trauma or losses they incurred.  The unresolved trauma may have be preventing the client from dealing with their addiction or other issues.  If the primary is anxiety or depression but the client is becoming more abusive with use of alcohol or other substances to manage their symptoms, a different type of facility may be necessary for diagnostic psychological testing and specialized treatment.   Knowing what a program treats is very important.  If a program says that they treat trauma, ask them what treatment modalities are used.
  7. Activities – Activities at the treatment facility are very important.  Some patients are more inclined to do indoor activities, but need the challenge that the outdoors can offer.  Stimulating the senses in a kinesthetic and sensory manner can increase the patient’s ability to address their issues on a deeper level than just talk therapy.  More research is becoming available about experiential therapies and the value they provide.  Some patients are more willing to go knowing they will be able to participate in fun activities.   I have seen many a teen or adult make assumptions about treatment.  The movie industry still tends to portray them as dingy lock up facilities.  Ropes courses, swimming, equine assisted psychotherapy, therapeutic horse-back riding, rock climbing, hiking, kayaking, gardening, biking are examples of activities offered at some treatment facilities and residential programs.  Other activities offered are art, dance, yoga, tai chi, karaoke, mindfulness and meditation are also offered.  I recently visited Lakeview  Health, an addiction treatment facility in Jacksonville, Florida.  Due to their unique location near the beach, they offer an extremely unique activity – surfing.  It was interesting to hear staff sharing how this modality had transformed some patients.  Some were very excited about it, others terrified of even trying.  Some valuable metaphors happened due to Lakeview using a local resource of water and waves.  It is vital that patients learn how to have fun again and do it sober.  Lakeview also offers equine assisted psychotherapy with one of the most experienced equine providers in the country.
  8. Aftercare and Follow up – These two modalities are tell-tale signs of differentiating a mediocre program versus an exceptional program.  I like programs that have a dedicated staff member(s) to assist patients and their loved ones with specific after care plans.  Also, how the program follows the patients after treatment is always of interest to me.  Some programs that I have referred to over the years offer aftercare in various states around the country.  As clinicians, we all know that these two areas are a must if patients and their loved ones are going to have the best opportunity to stay sober and continue to learn how to live sober and/or continue their recovery journey concerning their depression or anxiety or other diagnoses.

These eight recommendations are just a few of the important things to consider when assisting patients or their loved ones with finding the right treatment program.  Having been in this field since 1989, there are many more facilities in the U.S. and around the world that are offering help.  While this is great progress in the mental health field and offers more options, it also creates the challenge of choosing the best programs for our clients.   Providing our clients with several options also allows them to take responsibility and launch their own investigation of the programs recommended by an expert.  I hope these recommendations validate what you are already providing or that some of this information is new and will assist you in future recommendations.  After all, that is our primary goal as treatment providers, to help people find the help they need and to heal individuals and their families.

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