We explore a few topics we frequently discuss with families during those first initial phone calls to our addiction treatment center.

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Peaks Recovery Centers here in colorado
springs colorado and i’m joined today by
my two fellow colleagues
jason friesema one of the therapists in
our program and
additionally clint nicholson also a
therapist within our programming
so hopefully to bring your two brilliant
clinical minds together to help answer
some of these questions that i have
top of mind today so thanks for being
here
glad to be thank you for having us yeah
yeah
we all know i forced you guys to be here
you can do that yeah give the capacity
as the chief executive officer
okay yeah all right i feel good about
this stuff so far it’s good
yeah so recently i’ve had the
opportunity to
join the admissions department to
support them as we’ve built additional
team members or added team members
to the team in that regard and so i’ve
been able to engage in front-end phone
calls coming into peak’s recovery
centers and
one of the things that um i’m just
fascinated by and answering these phone
calls is that the phone calls aren’t
generally addressing
major issues on the forefront of
treatment you know that my son’s
suffering from addiction or these sorts
of things it’s
it’s often i’m looking for treatment
that lasts for 90 days or 60 days or 45
days or
that doesn’t mean a whole lot in my
experience in working in addiction
treatment and
sort of just curious from that clinical
lens what that means to you all or
maybe what is trying to be expressed in
that moment
okay good question i mean i might i
suspect people are trying to express
that they’re desperate for help and as
much help as they can get
and certainly in addiction treatment i
think it’s been
pretty well demonstrated that the longer
somebody is in
some form of care some level of care
the more likely they are to remain sober
for the long term now that doesn’t mean
that people need to be in say a detox
level of care
for 60 days or 90 days or even
residential level of care but
i do i do think i think what parents are
asking for is like this is i think
they’re saying this is really bad
and we need a lot of help that’s my
guess
i i agree with that i also think it
speaks to the um
the sort of lack of understanding and
knowledge about what actual addiction
treatment is
you know these ideas that you know the
fact that they’re hanging on to time
frame rather than to a con
to content or to actual programming just
i think it does it comes from a place of
fear but it also comes from a place of
just not understanding and a sort of
lack of education generally speaking
about what
what we do in addiction treatment and
what that actual
sort of programming looks like for their
loved one so i think it kind of speaks
to both of those sides
yeah well i think brandon we’ve talked
before like the 28 day model
it’s not like that was a clinically
based
length of stay for residential care that
was fairly arbitrary
designation for a treatment episode if
you will
and certainly i think it’s becoming
increasingly common knowledge that
just going somewhere for 28 days and
then going back out to the same
environment that
doesn’t tend to work very well however
um allowing somebody to kind of
start at a high level of care and then
work their way down to lowers levels of
care
usually can provide kind of a longer
length of
support and accountability for
individuals
i mean i think that’s those steps of
care though like that’s we have access
to that information and that knowledge
because we’re part of the industry
i think for families though it’s just
this yeah we know that 28 days doesn’t
work so well that means
you know if it’s 90 days you know where
there’s that much more opportunity for
whatever is going on to work but there’s
still this idea of i will send my loved
one off to this sort of
this this magical space where they will
get healed and they will come back
the person that i remember them or the
person that i want them to be or the
person that
they want to be the reality is that
that’s just that’s not what the process
looks like you know there is this sort
of um uh
these these sort of levels of intensity
and this sort of gradual
building back into the community that a
person has to go through while they’re
in
the treatment process and the reality is
that 28 days
that’s really just a pretty long detox
right like it but it’s
the recovery hasn’t even truly begun at
that point it’s really
um at that point it’s just a matter of
i’m not using
substances in this moment but i haven’t
actually started a recovery program
yeah and certainly in our experiences
working
within addiction treatment you know one
of the things that comes to the phone
next is this
array or a history of of this array of
diagnoses
my son or daughter suffers from severe
alcoholism and major depressive disorder
and
type 2 by you know bipolar disorder um
the nature of addiction is itself is
quite complex but then it has all of
these mental health components alongside
of it so what can we tell families
you know maybe about the order are we
starting with substance use disorder
first those craving states first before
we can even peel into depressive states
um or working on those mental health
states but what can we tell families in
that regard
about the order of that process and the
most efficacious approach to
you know sort of calming those diagnoses
concerns
over what is a fairly short episode
within treatment
so for example one of the things i think
we’ve talked about at least at some
point
you know cognitive behavioral therapy as
a practice in the direction
of curing a major depressive episode
and the evidence of it it can actually
do a lot of good over a period of three
to four months
but johnny’s only interested in
treatment for 30 days
and we need three to four months just
for the major depressive disorder but he
has this severe addiction on top of it
um it seems wildly inappropriate to
think that we can resolve all of that
within these limited time frames even a
so where do we start
i mean that’s a great question and
obviously
there there tends to be at times with a
fair amount of people
there needs to be some sort of medical
evaluation and intervention
uh with with medication
i am always a little bit suspect when
people walk in with
not suspect that’s the wrong word but
when people walk in with kind of a
laundry list of
diagnoses you know to me as a
as a counselor and just how my brain
works i kind of set that aside and then
i just try to meet the person where they
are
and and often times
sets if you will are adjusted even just
weeks into a treatment episode because
either new things emerge
or the the mood dysregulation was
in a large part due to the substance
misuse
and or vice versa or
other issues that begin to pop up now
that the the effects from the drugs
are wearing off and and you know really
i think i i think your question too is
like how do we address
these things with families other and i
think it’s
learning about an entire client or per
person i want to say actually learning
who they are
and what is driving the addiction and
mental health stuff with
with the background of our clinical
knowledge that some of these things are
probably going to require medication
some of these things can be dealt with
in therapy and then some of these things
some of these symptoms and traits
might even resolve themselves just with
some sobriety and healthy nutrition and
and good sleep hygiene
well i’m going to take this a slightly
different direction
i think we do yes we do yes i think the
idea
of um as of substance abuse
um or addiction somehow being different
than a mental health diagnosis is the
first fallacy yeah so really actually
starting there and
explaining to families that you know
addiction is a mental health diagnosis
like
they are one and the same to be able to
to say that we’re going to start working
on this one but not this one
is not actually real like you’re the
whole person is what we start with like
like jason mentioned you’re gonna meet
the person where they are and then
that’s where we just
that’s how that’s where we know we’re
going to go um so
really i think educating uh you know
families in particular as far as like
look there is no real
difference between these two types of
treatment and i think the industry
is kind of uh over time has sort of
wisened up to that that the
the way that we treat um besides
pharmacologically the way that we treat
addiction from a behavioral health
component and the way that we treat
mental health from a
behavioral health component are really
similar there’s not
nearly as much distinction as we thought
at the same time
it doesn’t change the fact that in 28
days we’re only going to be able to get
so far
in 90 days we’re only going to be able
to get so far and i think it actually
helps to
frame in um in a more realistic pers
um more realistic terms this idea that
you
just like you can’t cure or get rid of
depression in 90 days
the same is true for addiction so i
actually think by drawing those two
more closely together it helps to sort
of get rid of some of the
i don’t know the myths that have come up
regarding
what addiction is what addiction
treatment look like looks like the time
frames that that exists in
so well i think to your point in in
those first few weeks or even couple
months
i think a fair amount of the work is
about
helping people get some symptom relief
and then
truthfully i’ll just be the the
therapist here
like give them some hope that like
things are progressing
and there’s a way to keep progressing
and there’s there’s a way to continue to
experience greater relief and greater
adjustment to life and and more and more
ability
to function or
more ability to connect with others or
or more ability to
well just feel comfortable in one’s own
skin and so i just
i think it’s such a it’s such a process
and and
and these diagnosis sets in and
diagnosis sets aren’t even perfect like
they’re
they’re the best description we have and
there’s overlap
and there’s uh differential diagnosis
and how do we
distinguish all of that and that in good
diagnostic
work is important
but it isn’t um complete
it’s not a complete picture of a person
absolutely
yeah so you know for the sake of
uh time for this show maybe we can only
cover three bullet points today but one
of the
major things that i you know heard a lot
in my time being back on the admissions
line was that
you know johnny or sally’s past
treatment episode it didn’t work
um and the frustration about that
and it seems like behind the veil
there’s you know some sort of excusatory
lens going on
for a different episode but at the same
time what do you hear as clinicians when
you hear
you know the clients now in front of you
you know for the first time walking you
through sort of
what has brought them to peak’s recovery
and then they say something like the
last treatment center
didn’t work for me yeah and i think
i used to really maintain a very similar
mindset to that and i
the more i do this work the more i
really sense that what is didn’t work
what does that mean
actually a lot of people who have been
to six seven eight treatment they
actually have a lot of knowledge
right they actually i
sometimes even joke that they could
probably even facilitate groups or do an
education
on something and oftentimes i’ll ask
them to do that
so it isn’t like it it didn’t work like
there’s some knowledge in there but
there’s there’s just a component either
missing
um because that’s a little bit of maybe
even some shaming talk that something
didn’t work i i’ve never seen somebody
that’s gone through a couple rehabs that
can’t at least
have a little that hope that i was just
talking about that that’s like okay i
got i
got some traction but something fell
apart or like i just need a little more
help
to figure out what happened
yeah i i agree with part of what you
said as far as
what i hear is there’s a an expectation
that wasn’t met not that a treatment
didn’t work but there was an expectation
that wasn’t met
in treatment um again i think that
there’s this idea that the treatment is
the
is the actual recovery like the actual
programming is what’s going
to bring the change and it’s not like
the
it’s just um it’s the spark right that’s
all it is but if there’s no kindling
there then it’s there’s no fire who’s
gonna start
you know and we end up uh and then i
guess you just need to blowing a lot of
smoke right so
i think that with clients who have done
have been through this process over and
over again and
with families who have this idea or this
perception of things not working
a great place to start is what is your
expectation for treatment
and us being really clear about what we
are offering and what we are doing and
what
what these outcomes are actually going
to look like
rather than sort of i don’t know kind of
feeding into this idea that
again we’re going to be able to sprinkle
some magic recovery powder
and and people will leave ready to go
you know
right yeah and so you know for me in
closing it’s a it’s a reality that we
have to have this time extension within
treatment it takes a long time to quell
those craving states i think the
you know studies point out a 50
reduction in relapse after year one
in uh 85 chance of success after year
two
and by year five i think it’s less than
five percent chance that you’re
relapsing in the process so
but we don’t have five years in
addiction treatment nor is you know
united healthcare as a
as a payer gonna pay for things like
that and so there’s a lot of challenges
to get from day one today
you know to year five in that regard so
to me it sounds like
one of the most important features of
addiction treatment for anybody who
calls and says 30 60 90 days whatsoever
it’s not just about day 90 it’s on what
is now taking place on day 91
has to have this intentionality about it
but at the same time it’s complex
because it feels that
patients pull the you know the parachute
core day 30 and feel like they got it
and then don’t do any of the work
thereafter
so you know kind of in closing here what
can we you know maybe insist upon or
share with families about
uh about these time frames and to really
put intentionality into thinking about
this in much
longer terms and then creating
expectations
about what we can do in 30 days but what
the expectation will look like you know
a couple years from now
so what sorry what do we tell them in
that regard how do we yeah how do we
frame that to families
exactly
i think well a learning how to set
measured expectations uh
um and to me some of that language too
is around how do we
how do we help families well meet
meet their loved one where they are too
and
and then to me you know it’s it’s our
job at peaks it’s our job to provide our
care
and then all the time when i’m meeting
with clients i’m thinking about what
how do i help empower our case
management team to make sure that
as the client transitions from one
system and into the next system that
that’s seamless
and uh robust enough to
to help people maintain their uh
sobriety from substances and
any big relapses in mental health so i
think just helping to cast a vision of
the next couple
steps and that it’s going to take work
like this doesn’t
it just doesn’t go away uh even with
sobriety like this
this does have take some work
yeah i think i actually speak to
something that you had mentioned a
little bit earlier jason this idea of
the tiered levels of care and
and actually educating families on what
that is you know that recovery is a
process
you know treatment is a process and this
is what the process looks like and at
this moment you’re
here in the process and after after
you’re done with our program which is
this 30-45 day program then you will be
here in the pro in the process and then
after that you’ll be here in the process
so really
um breaking it down into realistic terms
into
and what the reality of recovery looks
like you know that it’s not
um you know it’s not just hope right
there’s a combination of hope
and uh life skills and behavior and
community and
um and there’s all of these different
levels of intensity and
so really uh really driving that home
that this is
especially when they’re at peaks they’re
at the beginning of the process
not at the end of the process and i
think a lot of families are so exhausted
by the time they even get to the
starting
uh get to the starting line that they’re
just praying that it’s the end but
being able for us to really educate and
provide them with the level of support
that says hey no you we’re actually at
the beginning you know so but we
we’re to tell you we’re going to help
you see what that
end looks like and we’re going to help
your loved one get to that process
but right now this is where we are
absolutely well for a first time show
here i feel like that was
a rather successful discussion certainly
entry level and i’m sure we could expand
on this for hours but i appreciate
everybody joining us today
and it’s our intention moving forward
out of this beta phase to
really explore topics and ideas within
addiction treatment and bring that
education to families
and their loved ones as they you know
seek addiction treatment or mental
health services and so
on behalf of peaks recovery centers and
my colleagues here clinton and jason
wish you all well and signing off