Alcoholism and drug addiction are chronic and fatal diseases that require a continuum of care to help the client fully recover physically, mentally and emotionally, behaviorally and spiritually. It is a common myth that detox alone, or, detox and a 30-day inpatient treatment stay sufficiently rehabilitates the client to never drink or use again. In such cases, it is easy to say that treatment did not work for the client who subsequently relapses post discharge. It is all too easy to say that the client did not follow discharge instructions and therefore relapsed. But the truth remains that recovery starts in treatment and continues with support, accountability and responsibility.
The 5-year Continuum of Care model is the gold standard in treating professionals such as physicians, attorneys and airline pilots. Among this population, the long-term recovery rates are approximately 82%. Whilst it may be easy to say that these professionals are highly motivated to remain sober because they could lose their license if they relapse, the fact remains that this model has merit and should be considered for all clients who enter into treatment.
The 5-Year Continuum of Care
The 5-year model has multiple components provided by multiple agencies. It often starts with a professional intervention followed by inpatient detox and residential treatment. Either during or discharge from the residential facility monitoring and coaching services begin that support the client and their family members through the continuum of care. The 5-year continuum model normally includes outpatient care wherein clinical and medical services are provided for the client’s on-going recovery needs. The outpatient level of care requires safe and supportive housing, which may include sober living, or, living at home with supportive family members. Following outpatient treatment, the client continues with monitoring and coaching and a continuing care plan that may include psychiatric care, counseling services and participation in a 12-Step or other self-help programs, for as long as necessary to achieve lasting sobriety.
Services Included in Monitoring and Coaching
The old adage: “Whatever is measured improves” applies here. Monitoring and coaching add accountability and measurable quality to continuous client care, which is part of the reason for the 82% success rate among professionals.
Monitoring and coaching include regular reporting to the client’s licensing board whose power to revoke one’s license is a great motivating factor for the individual to remain in recovery. For non-professionals, consequences of non-compliance should be as equivalent as possible to losing one’s professional license.
- A typical monitoring program includes:
- Regular and continuous contact with the client wherein the individual self-reports their compliance with the terms and conditions of the monitoring contract, with subsequent validation by the monitoring agency of the client’s self-report.
- The parties of the monitoring contract include the client, the monitoring company and the board (in the case of a non-licensed individual, the board may be the client’s family, employer and/or a probation officer).
- Monitoring agreements typically include:
- The frequency of 12-Step meeting attendance and meeting with a sponsor,
- Random alcohol and drug testing,
- On-going substance abuse and mental health counseling, addiction medicine and psychiatric care,
- Medication compliance.
- Those who receive reports from the monitoring company might include:
- The family,
- An attorney,
- A probation officer,
- An employer,
- An EAP company.
- Consequences of breaking the contract, or a relapse, should be on par, as much as possible, of losing one’s professional license. This may mean:
- Losing a job,
- Losing financial support,
- Divorce, losing the right to live at home, loss of a job, incarceration (if the client is on probation),
- Anything or any event that might motivate the client to be compliant with the monitoring contract and avoid the consequences of relapse.
Coaching goes hand-in-hand with monitoring. It services the often-neglected gap between clinical care and 12-Step sponsorship. Coaching may be weekly communication in the beginning and then gradually decrease in frequency over time.
Coaching typically includes:
- Providing encouragement to the client and their family,
- Helping and supporting the client with recovery goals such as:
- Returning home, work and/or school
- Debt repayment plans,
- Living within a budget,
- Maintaining fitness,
- Participation in a 12-Step or other self-help program.
- Acting as a sounding board when the client needs an objective point of view in making important decisions,
- Assisting the client in finding and using resources to support their recovery.
Coaching if often provided by telephone, but may also be in person if the coach and client live in the same vicinity. The monitoring company sometimes provides coaching, or an independent coaching service may provide coaching.
Benefits of Monitoring and Coaching
Benefits of monitoring and coaching include:
- Improved self-esteem that comes from long-term recovery for both the client and family members,
- Reducing the family’s anxiety about relapse,
- Restoration of relationships, whether family, social and/or business relationships,
- Improved physical, mental and spiritual health,
- Reduction in legal problems. (One does not get a DUI when one is sober.)
- Improved financial conditions from:
- Gainful employment,
- Elimination of fees for detox and residential treatment if the client remains sober,
- Elimination DUI defense attorney fees,
- Eliminating destruction of property, such as a car, due to intoxication.
Costs for Monitoring and Coaching
Monitoring costs vary upon the circumstances and the components of the service. It may range from a few thousand to many thousands of dollars annually; however, fees vary depending upon services provided and the individual who interacts with the parties involved. For instance, a monitor or a coach may be a licensed therapist, in which case the fees may be higher than a non-licensed therapist. The client’s residential treatment center may sponsor the service, with negotiated rates for the monitoring and/or coaching agency. In most cases, the treatment center will provide the client and their family with multiple monitoring and coaching resources.
The disease of addiction is chronic and fatal. The 5-Year Continuum of Care model has been proven to help recovering individuals achieve long-term recovery. The benefits far outweigh the costs. With a history of success, why would anyone who wants to remain sober not choose this model?