Too often when a patient with a substance use treatment history becomes a repeat visitor to treatment, programs do little to change up what the patient was exposed to in past experiences. The resulting care could be a precursor to failure, perpetuating a revolving door of relapse and recovery.
Behavioral Healthcare Executive spoke with leaders in two treatment organizations looking to establish a better path, by establishing dedicated programs for patients who have been in treatment in the past and need to regain their footing after a relapse. Each leader (with Recovery Centers of America and Stepping Stone Center for Recovery) suggests that the structure and content of programs targeting people who have relapsed needs to change, with an emphasis on shorter stays and a curriculum that matches how people process information today.
Importantly, they see a move in this direction as beneficial from both a business and clinical standpoint.
“Our field needs to rethink relapse,” says Scott Weisenberger, vice president of clinical services at Recovery Centers of America (RCA). “My belief is that the previous models we have used no longer work as well with today's younger opioid-dependent patients. This group represents our largest number of AMAs,” patients who leave treatment prematurely against medical advice.
RCA last month initiated a three-to-four week Promoting Recovery Through Intensive Support and Education (PRISE) program at the Northeast and Mid-Atlantic treatment organization's Devon, Pa., facility. Weisenberger says staff deliberately avoids using the term “relapse” when discussing the program with patients and families. “That connotes 'loser,'” he says.
The program targets individuals who have had at least three unsuccessful attempts at recovery—those could involve traditional treatment or participation in a 12-Step support group. Weisenberger explains that the treatment approach considers the shorter time frames in which individuals learn in today's world.
“We hand-selected the staff for this program, and we told them in terms of their work with patients to be excited about it,” he says. It may be as important for clinicians to entertain as it is to inform, in order to guarantee patient engagement.
The unit that houses PRISE within the sprawling Devon facility has capacity for 32 patients. “We had seven people clamoring to get in on the first day,” Weisenberger says of last month's launch.
The program requires staff buy-in for the treatment modalities used, most prominently Acceptance and Commitment Therapy, narrative therapy and positive psychology. A key tenet of positive psychology is community involvement, so patients engage in volunteer work while in the program. For example, they help with various roles at a human-services organization focusing on hunger, and they also have an opportunity to talk to adolescents who already find themselves in treatment.
“The words they say to young people matter, because you're making that same commitment to yourself,” says Weisenberger, referring to these patients' pledge not to repeat past mistakes.
He believes programs such as this will generate organizational benefits, as well as those for a facility's payment sources.
“Part of our staff goes to great pains to get days authorized, and then they see the patients leave,” he says. “It is to anybody's advantage, including insurance companies', to have a patient not relapse.”
Plans are for PRISE to be introduced next at the RCA facility in Mays Landing, N.J., Weisenberger says.
Relapse recovery at Stepping Stone
Jacksonville, Fla.-based Stepping Stone Center for Recovery last month launched its Relapse Recovery Program at the same time that it initiated a stabilization program for persons new to treatment. Both programs will offer relatively short stays of around 10 to 14 days. Between the two program, there is capacity to serve 29 individuals at any given time.
“The patient might not have interest in four-plus weeks, or the ability to do so based on the commitments in their life,” says Eric Kaplan, MD, corporate chief medical officer at Stepping Stone, which is owned by the parent company of Lakeview Health. “The goal is to get people back on track in a time-limited process.”
Of utmost importance in this effort, Kaplan says, is identifying why the patient has relapsed. Self-medicating an untreated mental health disorder often will surface as a cause, he says. “If you don't address and treat co-occurring psychiatric disorders, you're setting up for relapse,” he says.
Kaplan says the therapeutic approach in the Relapse Recovery Program emphasizes skill building, with case managers heavily involved in assisting patients in areas such as legal and vocational challenges. The program also embraces an expanded definition of medication-assisted treatment that covers any medication that reduces craving, reduces the intoxicating effects of substances or prolongs the duration of recovery, he says.
Neither the RCA program nor Stepping Stone's will limit participation to patients who have received treatment in those organizations in the past.
Stepping Stone's other new program, for individuals new to treatment, can be designed around two weekends so that a patient in theory could be away from work and family for only one full workweek. Dual disorders are a focus of that program as well, Kaplan says. Patients likely would move from that program to an intensive outpatient or other community-based level of care.
Kaplan says today's treatment programs need to be designed with numerous factors in mind, including patient needs, financial resources, and career and family obligations. “I believe that even in the managed care era we live in, there's a need for all types of programs,” he says. “There's still a need for the longer programs.”
However, “There's this large group of people with substance use disorders that have not been well served,” Kaplan adds. “They have an interest in treatment, but they only have a certain amount of time. They do not want simply a 'rinse and repeat' approach.”