David Nesenoff, DDiv, frequently told audiences at his motivational speaking engagements that everything they do in life involves selling the idea to another. Now as CEO of an addiction treatment center near Orlando, Fla., Nesenoff and his staff are selling the concept of a 10-day residential stay to a high-income population traditionally resistant to spending 30 days in a facility.
“When it comes to executives and hard workers, their time is their money,” Nesenoff, director of Tikvah Lake Recovery in Sebring, tells Behavioral Healthcare Executive. “Even when they know they need treatment, they can give you every excuse for not getting in the front door.” Sometimes the prospective patient casts that reluctance in the most altruistic terms, Nesenoff says, such as when a CEO might say that leaving the company for a month will put his/her employees' livelihood in jeopardy.
Nesenoff presides over what he and his staff believe is the country's first formalized 10-day residential program. The luxury facility, which is self-pay only after having stopped taking insurance, offers the same curriculum and hours of therapy from its 30-day program in the 10-day format, Nesenoff says. He says of the patients who prefer the 10-day stay, “They prepare well,” so they will tackle a more packed treatment schedule in the same way that they would take on a difficult task in their work life.
For these individuals, a 10-day stay resonates in the way a 10-day work retreat or family vacation would be seen as acceptable in the business world, Nesenoff says, so it is more likely they will accept that over a 30-day stay. Stays in excess of 10 days are still offered as well at Tikvah Lake Recovery, a center that has been open for three years.
“People out there are going to say, '10 days is not nearly enough time,'” Nesenoff says. “But 30 days isn't either. Any number is a ridiculous number.”
Thirty days is an insurance construct, not some magic number, he says. Continuing care, and adjustments to patients' lives outside of treatment, will be essential for every patient regardless of his/her residential length of stay, he says.
Evolution in thinking
Nesenoff says the idea of a 10-day program evolved as the treatment center began working with patients. Tikvah Lake Recovery was established along several initial guiding principles, he says:
No one should get lost in the mix at a treatment center, so the facility is licensed for a maximum of six beds and takes only a few patients at a time.
Individual therapy is preferred over group therapy. This especially resonates with a high-earning client population that values its privacy.
Treatment is best delivered in a non-hospital, inviting atmosphere, which certainly applies to Tikvah Lake Recovery's 15,000-square-foot lakefront mansion. Nesenoff and his wife live in the house as well.
Nesenoff wanted to be far enough from treatment hotbed areas such as South Florida, which can present their own potential distractions for patients. “This is remote enough but close enough to a major airport,” he says.
Unlike programs that tightly restrict patients' access to technology while in treatment, Tikvah Lake Recovery staff prefers to help train patients in how to balance the pressure to stay in contact with the need to work on personal recovery. Phone and computer use are thus allowed, but not during therapy sessions or meal times.
Nesenoff says most of the center's patients have ranged in age from the late 20s to the mid-50s. These are people who are very involved in both work and family life, and even for the highest achievers the pressures sometimes can be greater in their personal lives.
Despite all the attention to opioids nationally, for this population “alcohol is still king,” Nesenoff says. The noon cocktail might no longer be common in the corporate world, but alcohol-fueled socializing in the evening remains, he says.
Nesenoff says the center stopped taking insurance in part because it no longer wanted to wrestle with insurers that wanted to end a patient's coverage after just a few days of sobriety. Also, the self-pay structure tends to work better for executives and other well-known figures who are attracted to the treatment program but want to maintain their privacy, he says.