New "Therapeutic Community" Models Offer Hope to Severely Addicted

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 to treat.

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.

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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