New "Therapeutic Community" Models Offer Hope to Severely
In today's health care climate, everyone wants to control costs
while maintaining quality. Medical advances have made it common
for open-heart patients to go home within four or five days. Many
moms deliver their babies and are released in a day or two. Back
surgery patients are sent home in a week. While some people develop
complications when they go home too soon, others heal more quickly
in familiar surroundings. Either way, just because you're out of
the hospital doesn't mean you donít need assistance. Patients sent
home early assume more responsibility for their recovery.
Alcohol and drug treatment centers are affected by this trend.
People come to us physically and emotionally unstable, most with
a decade or more of alcohol and other drug abuse behind them. Many
patients are severely addicted to very powerful drugs. These substances
have become the center of their life, causing significant changes
in brain and body chemistry. Yet regardless of the length of their
addiction or its severity, our challenge is the same: get these
folks stabilized. Show them how the disease affects them and how
itís treated effectively. Get them to face themselves honestly,
set up structures for continued support, and discharge them. And
do it all within 10-21 days.
Surprisingly, this process actually works quite well, when patients
learn to accept responsibility for their recovery during and after
residential treatment. This combination has helped more than two
thirds of Serenity Lane's patients stay clean and sober for three
years or longer after treatment. Other programs report similar results.
Still, there is a group of addicts for whom 10 to 21-day stays don't
work. Often, their "drug of choice" is heroin, methamphetamine,
tranquilizers or severe alcohol abuse. They have gone through treatment
before and relapsed. For these patients, treatment centers and insurance
companies have begun to offer a longer-term approach ñ 30-90 days
of residential care beyond "primary" treatment. While centers use
different names to describe these programs, they are generally based
on a "therapeutic community" concept that combines a highly structured
daily regimen, increasing levels of service to others, participation
in 12-step recovery, and accountability for both behavior and attitudes.
According to Ron Weller, Director of ExSL,
Serenity Lane's long-term treatment program, the therapeutic community
is composed of 12-16 patients living in the treatment center for
2-3 months. Under professional supervision, they interact with each
other, with shorter-stay patients, and with people who have established
long periods of successful sobriety.
Weller says a "oneness of purpose" characterizes the effort."Long-term
recovery from this kind of addiction is much more than just abstinence,"
he says. "It requires a total change in lifestyle, and it is pretty
much impossible without a group held together by a lot of trust."
Weller explains that the program helps eliminate the kinds of self-centered,
anti-social behavior so common in addicts and alcoholics. "There
is confrontation," he says, "but it's done with compassion, often
by people who have experienced severe addiction themselves." While
quick to say that the programs are essentially upbeat, Weller reinforces
the idea of solid, sometimes painful self-appraisal: "There's no
time left for self-deception," he says. "Lives are on the line."
The program's daily schedule is full, with group therapy, meditation,
training in life skills and one-on-one counseling.
Weller says that while these programs are still too new to know
exactly how much they improve success rates (Serenity Lane's extended
care program, known as "ExSL," is only
about 18 months old), initial results are promising. Of 16 severely
addicted people who have completed ExSL,
75 percent are still clean and sober. Weller says that three of
the four who relapsed were long-time heroin addicts, among the hardest
As might be expected, these kinds of residential programs, complete
with 24-hour-a-day clinical supervision, are not inexpensive. But
compared to the cost of a 14-day inpatient stay with full medical
services, it only takes one or two relapses to make a successful
longer stay more cost-effective. Weller notes that insurance companies
are beginning to take notice. "Today," he says, "treatment programs
know full well that they have to work within managed care guidelines
and keep inpatient stays short wherever they can. Still, everyone
involved is sick and tired of patients going through primary care,
the most difficult and expensive stage, five, six or more times.
Once it is established that the dependency is that serious, extended
treatment is actually far less expensive." There's no question that
everyone involved in treatment for chemical dependency wants to
contain costs while maintaining quality. The emergence of extended
care programs reflects this reality, as well as a growing understanding
that the greater the severity of the addiction, the longer it generally
takes to heal. Addiction is also an exceptionally patient disease,
one reason why we see a direct rise in relapse rates as days in
residential reatment fall. Without a disciplined, structured and
monitored program during treatment and well beyond, relapse is more
likely. It's not hard to see that it ís better to keep severely
addicted patients in the therapeutic setting long enough to put
that structure in place. They can then make lasting changes in the
way they think and interact in their world, and increase their chances
of staying clean and sober.
Faced with years of drug and alcohol abuse, it is difficult for
addicts and the people who care about them to know where to turn.
Understanding the realities of treatment in the face of these kinds
of myths is critical to determining how best to address the problem.
The previous article, written by Jerry Gjesvold, was first published
in the Register Guard newspaper, Eugene, Oregon as part of "Straight
Stuff" a monthly newspaper column about substance abuse and related
topics. © Serenity Lane, Inc. 1997
The opinions expressed in this column are those of the writer