Residential Addiction Treatment in Kentucky… a call for change.

1. Residential Addiction Treatment in Kentucky… a call for change. Martin C. Wesley Ph.D., LPCC, MAC Lindsey Wilson College

2. Agenda • Introduction… define terms • Look at Example Agencies in KY • Summary • Discussion and Q & A

3. Principles of Drug Addiction Treatment: A Research Based Guide Principles of Effective Treatment • 13 principles • First Principle - No single treatment is appropriate for all individuals. Matching treatment settings, interventions, and services to each individual's particular problems and needs is critical to his or her ultimate success in returning to productive functioning in the family, workplace, and society.

4. Patient Placement Criteria, 2nd Ed. RevisedASAM PPC-2R Placement Criteria • Level System – The patient is placed in the appropriate level based on several dimensions based on diagnosis and assessment • Level 0.5 Education • Level I Outpatient • Level II Intensive OP/Partial Hospital • Level III Residential • Level IV Medically Managed Inpatient

5. ASAM Criteria Cont. • In my experience very few use the ASAM criteria and most KY regions consider “treatment” to be at the residential level. • Most accept individuals into residential treatment without assessment to place in lower levels • Assessment is based more on Judge’s decisions than the therapist assessment. • 3rd Party Insurance will often pay for Level 1, 2 or 4 but not 3

6. Kentucky Agencies • State Operated Facility - Volta • Community Mental Health • Para-governmental agency – tax dollars • Monopoly for indigent • Private Treatment Centers • Recovery Homes – Transitional living • Recovery Kentucky • Drug Courts • We will look at examples throughout this presentation

10. Addiction Models • There are several models/theories to view addiction and unique education and treatments that coincide with each model • Two primary divisions • Disease Model • Spiritual Disease Model of AA • Medical Model • Social Learning / Strengths Model

11. Addiction Models Disease Models Social Learning / Strenghts Model The client has many strengths and these can help the client recover completely Disorder primarily based on environment Client is not powerless and is empowered by model – Professional Therapist is helper, coach and expert • The client is sick or diseased for life • Primarily genetic/heredity disease • Client is Powerless – peers, peer counselors and/or the medical doctor are the experts

12. Addiction Models Disease Model Treatment Social Learning / Strengths Model Choice – the client guides the treatment – goal directed Plethora of Behavioral Therapies among other therapies including medications Education Social Support is encouraged Spirituality is potentially explored not compulsory • Admission (not acknowledgment) of problem and powerlessness • Spiritual transformation through giving life to HP • Indoctrination • 12 step groups for life • MM – pharmacological therapy

13. Recovery Dynamics • About The Recovery Dynamics ProgramRecovery Dynamics is a comprehensive program of instructional and self-help materials for counselors and individuals. The program is completely faithful to the original 12 steps of Alcoholics Anonymous. • At the core of Recovery Dynamics is a clear, concise, and correctly-sequenced explanation of the 12 Steps - uniquely presented in a goal-oriented format that guides each individual to an understanding of the problem, the solution, and the plan of action that leads to recovery. • Why This Program?The 12-step fellowships have proven to be a highly effective means of self-help. Yet in the earliest stages of recovery, some are unwilling or unable to get help from a 12-step program and seek formal treatment.Most formal treatment programs are effective at helping people, temporarily. The problem occurs when individuals leave the controlled environment of the treatment facility. Still in need of help, they turn to a 12-step fellowship. But the program practiced there may be completely different from the one they relied on in treatment. In fact, it may be completely contradictory. The result is a far greater chance of relapse. Recovery Dynamics helps people get clean and sober by teaching a proven program that is readily available to them for continuing support after they leave a facility. No new theories. No changes in direction. Continuing recovery through the 12 steps, pure and simple 

14. Big Book Studies or Step Studies • Almost identical to a Bible study for Christians • Peer and/or counselors will search for inspirational truths found in the Big Book of Alcoholics Anonymous or the Basic Text of Narcotics Anonymous

15. Indoctrination vs. Education Indoctrination Education one stands outside the body of accumulated knowledge to analyze it open and unbiased inquiry and critical inspection the freedom to explore the wealth of knowledge available • one stands within a body of knowledge and absorbs its teachings • teaching someone to accept information uncritically • teach systematically partisan, opinionated, or biased ideas

16. State Law KAR 908: 370 • Section 12. Residential Treatment Programs. •       (g) Orientation to self-help groups specific to addiction recovery shall be provided to each client. • (l) A client shall receive forty (40) hours of structured activities weekly including alcohol and other drug abuse education; individual, group or family counseling; self-help group meetings and recreation. Ten (10) of the forty (40) hours of structured weekly activities shall be counseling services. • (o) A client shall be provided an opportunity to meet with a self-help group and other outside service providers. • Section 13. Residential Transitional Living Program. •       (d) Orientation to self-help groups specific to addiction recovery shall be provided to each client. •      (e) A client shall be provided an opportunity to meet with a self-help group and other outside service providers. • (e) A progress note shall be recorded weekly in a summary note documenting the client’s progress in: •            4. Participation in self-help groups; •       Section 14. Outpatient Program. • (6) Education shall be provided to each client on the effects of alcohol and other drug abuse, the disease and recovery from alcohol and other drug dependency, consistent with the client’s treatment plan. •       (7) A referral to self-help groups specific to addiction recovery shall be provided to each client.

17. Examples of Kentucky Programs

18. Volta – Kentucky State Program • Mandatory 12-step program • On the grounds of Western State Hospital • Run by ex-military and recovering Director • Hires only counselors in recovery and committed to the 12 steps of AA • Have 12-step meetings at the facility from the community – Limits confidentiality

19. Lincoln Trail Behavioral Health • Inpatient facility for Treatment • Over $14,000 for 21-day stay • The philosophy of the Adult Chemical Dependency Program centers on the Recovery Dynamics Model. The Recovery Dynamics Model enables counselors to have a broader and deeper understanding of the Alcoholics Anonymous plan of recovery and to be able to present the program to individuals clearly and effectively. This model is a clear and concise explanation of the 12 Step Program. • The philosophy of the Adolescent Chemical Dependency Program centers on the Recovery Dynamics Model. The Recovery Dynamics Model enables counselors to have a broader and deeper understanding of the Alcoholics Anonymous plan of recovery and to be able to present the program to individuals clearly and effectively.

20. Guesthouse Inc. • Not licensed as residential facility but operating as such. • They use the Questhouse Model and the Twelve Steps of Alcoholics Anonymous • “A Gentle Spiritual Retreat for Recovery from Addictive Diseases” • They believe, and their care is based on the belief that . . . Addiction is not a moral weakness! Addiction is not a sign of weak will! Addiction is not a mental illness! Addiction is not a bad habit! Addiction is not a result of stress! Addiction is not a temporary loss of control! Addiction is a chronic, progressive, incurable, and often fatal condition characterized by loss of control over alcohol or other drugs.

21. StepWorks Addiction Resources • Alcohol and Drug Addiction is a chronic, relapsing, potentially fatal brain disease that takes control of your mind, your body, your finances and your life... • CHRONIC: Addiction is a treatable, but non-curable disease. With appropriate therapy, continued support through a group like AA/NA, and (in some cases) medications, you can live a fairly normal life. The disease does require that you make certain changes or you will be at increased risk of relapse and fatal complications. • RELAPSING: Addiction is a relapsing disease. That is, falling back to old patterns of use is the norm - not the exception. There are signs that a relapse is about to happen. With education and experience, you and your loved ones can learn to recognize these signs and take action. A relapse is not a reason to lose hope, but rather a sign to work harder on your program of sobriety. • FATAL: Addiction can be a fatal illness. Untreated, people with addictions die sooner and have more medical problems than those people without addictions. Regardless of the substance abused, you are at higher risk of dying. Some die from the substance itself (heroin, alcohol). Others die from complications such as cirrhosis, hepatitis, HIV. Others die from crime. Some even die from a broken heart. • CONTROL: Addiction can take absolute control of your life. Because of this, you will need help controlling your addiction. You cannot do it alone. Again, you cannot do it alone. You need others to help you. This is often hard to accept. Step One (of the AA 12 steps) starts "I realize that I am powerless...)

22. The Bridge • Unlicensed Facility • Mandatory 12-step program • a program of recovery from unhealthy dependencies geared to the needs of young people reared in conservative religious families who had become alienated from family, church, and God for various reasons, including substance abuse.

23. Community Care Agencies in KY • Communicare Recovery Center • Park Place Recovery Center • Schwartz Center • Chrysalis House • Crossroads • Pathways • And Many, Many More • Toured many facilities in past • All have Heavy AA treatment focus

24. Recovery Kentucky • State Sponsored • Unlicensed facilities • Peer support driven • Dual Purpose of Drug Abuse Services and combat Homelessness • Modeled after Hope Center in Lexington and Healing Place in Louisville • Mandatory 12-step involvement • Recovery Dynamics Materials

25. The Healing Place • The recovery program consists of 67 men's program beds and 35 women's beds. This part of the program has three components.Information: Clients read and study the AA text, commonly referred to as the Big Book, from which the Twelve Steps are taken. They learn how to apply the Twelve Steps in their lives by studying the Big Book and a curriculum called Recovery Dynamics that breaks the Steps down into their simplest form. This curriculum consists of 28 classes and 32 written assignments. All clients are assisted through Phase by Peer Mentors*

26. Drug Courts of Kentucky • Drug Court attempts to integrate drug treatment services with justice system case processing. • Most drug courts require 12 step group attendance almost every day. This compulsory attendance must be proved and require them to get signatures • Their attendance is not welcomed by many 12 step groups because they are filled with people who do not want to be there & are only trying to avoid incarceration. • Many groups become very unhealthy • 13 stepping is very common

27. Recovery Homes • Shepherds' House • attend 30 Alcoholic or Narcotics Anonymous meetings in the first 30 days, then a minimum of 5 AA/NA meetings per week thereafter, obtain a sponsor, and adhere to all other rules and guidelines of the program. • Friend of Bill’s • [The owner] felt that a living environment that respected the client as an individual and strongly encouraged a 12 step program in Alcoholics Anonymous or Narcotics Anonymous was the best course of action.

28. Review and Discussion

29. State Run and Community Mental Health • Community Mental Health • Para-governmental agency – tax dollars • Monopoly for indigent • All are Requiring a religious/spiritual program of recovery for their regional area with no options • Requiring a religious/spiritual model of recovery to be used by counselors • No separation of Church and State • NO OPTIONS OR CHOICE for treatment

30. Private Institutions • Private agencies do not need to offer choice • All the private agencies in Kentucky subscribe to AA Disease Model of AA • No choice for anyone who seeks out service other than that of the Disease model and working through the 12 steps of AA • Individuals would need to leave the state and it would still be difficult to find. • NO OPTIONS OR CHOICE IN TREATMENT

31. The Reality for the Professional Therapist • Requiring therapists to espouse a religious/spiritual model of recovery that could violate their own religious views • Professional therapists are often viewed as stepchildren to their peer counselors counterparts (most CADCs) with very little education, if any. • Over half the current counselors with a CADC were grandfathered in without education or testing requirements • Past drug use is often seen as a greater credential than years of disciplined education and supervision

32. Professional Therapist Cont. • Professional Counselors often feel they are being forced to violate their own ethical code to have compulsory indoctrination of Spiritual and religious principles required by their program • Professional Counselors in this field often become very discouraged and leave the field for mental health because they are more respected and feel they are not discriminated against. • NO OPTIONS OR CHOICE IN TREATMENT

33. Suggestions for Change • Education – My mission is to educate new counselors to the field and create a vision for choice and client options • Call for Change in the field and question the status quo • Someday a lawsuit will change the field

34. Discussion and Q & A