May 28, 2016 by Robert Freitas, ASW — Leave a comment
Obviously substance use disorders is a highly prevalent and expensive public health problem in the United States and in other industrialized countries all over the world. The United States Department of Health and Human Services (USDHHS, 2012) estimates 22.2 million Americans 12 years and older meet the criteria for a formal substance use disorder. Unfortunately, of those struggling with addiction only approximately 1.5 million (0.6%) Americans have reported being treated for drug addiction in the past year. Not only are people dying in staggering numbers, but we are shelling out billions (over $600 billion) to combat this epidemic. Something is definitely not working efficiently and we are in desperate need of alternative approaches to treat people effectively. One of the newest and fastest growing approaches is the live-in, recovery coaching models of care. At Tailored Transitions, we would argue that this innovative practice, when done properly, has some excellent benefits that are leading to successful outcomes and long-term recovery. Some of those are as follows:
- CLIENT-CENTERED APPROACH
The client-centered approach originated with the humanistic psychologist Carl Rogers in the 1940’s and 1950’s. Rogers was regarded as one of the most influential thinkers of the 20th century and affirmed that people are inherently good and have an actualizing tendency to reach for their potential. The client-centered approach is a non-directive form of interaction in which the client drives the treatment based on their intrinsic desire for self-actualization. Both therapists and recovery coaches alike are moving toward a client-driven treatment plan with client-driven goals and action plans. This is now accepted as a best-practice by most clinicians working in recovery and mental health. It requires that the therapist, counselor or recovery coach remain empathetic, non-judgmental, accepting, genuine and collaborate with the client with unconditional positive regard. Through a live-in model of care, clinicians are able to see the client in every facet of their life. They see them at home, work and in the community. They see them engaging in interpersonal relationships. They see them in their natural environment on good days, and bad. This allows them to show acceptance of the client’s mood, behaviors, and emotions in a way that is not available in an inpatient rehab or intensive outpatient program. Not to say that clinicians cannot, or do not remain client-centered in those settings, but obviously doing this in a person-in-environment approach has additional therapeutic benefits.
- MEET THE CLIENT WHERE THEY ARE AT
This is a phrase so over-used in mental health and treatment. However, it is still regarded as a “best practices” approach to recovery and therapy. Many times it is referred to in relation to the Transtheoretical (TTM) or Stages of Change Model (Prochaska & DiClemente, 1983). According to this modality, a person falls within one of six stages. It is our job to coach them, cheer them and guide them through the stages. However, we must accept where they are in this process. We must accept where they are when they enter treatment. We must accept what their goals are and what they wish to achieve. It’s not our job to decide this for them, but rather to “meet them where they are at” in their process and help them make thoughtful decisions about how to get where they want to be. This is a practice implemented in therapy, IOP’s and inpatient rehabs. However, they are limited to the extent that they are able to meet the client where they are at. They have removed the client from their natural environment. Through a live-in, PIE approach clinicians are able to literally meet the client where they are at in every sense of the phrase. We go to them, and stay with them 24/7 for the duration of services. We meet them where they are at physically, mentally, emotionally & spiritually in every moment throughout every day. We meet them through a client-centered, strength-based approach and gently coach them in the direction of self-actualization in a way virtually impossible through traditional methods of treatment, therapy and recovery.
- HOLISTIC APPROACH
For many reasons a holistic approach to recovery is regarded in the profession as a best practice. It has many definitions and is usually referred to in relation to treating multiple facets of a person’s ailment (i.e. mind, body & spirit). It affirms that a problem (such as drug use) cannot, and should not, be treated as separate, but rather, must be viewed in relation to the person as a whole. For example, it is commonly understood that to sustain long-term recovery you must not merely focus on just the substance use, but the co-occurring issues that lead to the desire to alter one’s state.
“Characterized by comprehension of the parts of something as intimately interconnected and explicable only by reference to the whole.”
“Characterized by the treatment of the whole person, taking into account mental and social factors, rather than just the physical symptoms of a disease.”
Through a live-in approach, clinicians are in an optimal position to treat the person as a whole and implement holistic practices that focus on a variety of signs and symptoms impacting a person’s overall wellness. Live-in counselors, therapists and coaches can work toward assisting the client develop and utilize tools that improve physical health (i.e. nutritional & fitness), mental and emotional regulation (i.e. self-soothing techniques, cognitive reframing, etc.), and spirituality. Furthermore, when approached through a ecological systems theory the live-in model can start addressing not only the client as a whole, but micro, mezzo and macro systems impacting the individual. For example, the assigned therapist/coach can collaborate to address family issues or interpersonal relationships at work on a mezzo level.
- TREATING THE WHOLE FAMILY
For those well-versed in addiction, or those that have been directly impacted by substance use, it is common knowledge that it is not just the addict suffering, but the entire family. Co-dependency, unmanageability, legal/financial matters, interpersonal relationships, anger, fear, confusion, sadness and health issues plague the entire family unit. The family unit is in need of coping skills to adequately walk through the storm without relapsing on behaviors. Traditional rehabs and IOP’s incorporate family sessions into their treatment plans to address these issues. Similarly, live-in models of care serve the entire family when done correctly.
Recovery starts and ends at home!
The live-in approach to recovery and wellness allows the staff insight into the family’s presenting problems and supports them in their home as conflicts arise. Each family member will have unique challenges that call for a tailored action plan or linkage to resources to recover. Live-in recovery programs allow staff to be there moment-to-moment to assist them implement tools or conduct sessions as problems arise. Developing connections among family and maintaining peace and serenity in the home is essential for recovery starts and ends at home.
- 24 HOUR, MOMENT-TO-MOMENT PERSON-IN-ENVIRONMENT CARE
Inpatient rehabs also offer 24 hour, moment-to-moment care which can be beneficial under certain circumstances. However, the live-in approach to treatment/recovery offers a person-in-environment (PIE) value that will not be available in a rehab environment. Person-in-environment PIE is based on a model developed by social workers in attempts to move away from the dual construct of either being completely person-focused or environment-focused. PIE bridges the gap and examines the interaction between the person and his/her environment while specifically addressing problems and highlighting strengths in categories such as:
- Social Roles in Relationships with Others
- Social Environment
- Mental Health
- Physical Health
There is no better way to address the interaction between a person and his/her environment then by stepping into that environment. This gives the assigned clinician a unique insight into the interplay between the two constructs which gives them the ability to gain more thorough and accurate assessment information. A more accurate and thorough assessment will lead to a treatment plan that is more individualized or tailored to the client’s needs. Live-in, 24 hour care in a person’s environment gives the client access to strategies, interventions and support as stressors, triggers and cravings arise moment-to-moment in their everyday lives. Rehabs may educate clients on tools during their inpatient stay, but they are not with them when they need to use them after they are back at home. This is a problem because all it takes is one moment for a relapse to occur in early recovery.
- LICENSED, CERTIFIED & COMPETENT STAFF
It should be noted that this author is a member and avid supporter of traditional 12 step communities. A sponsor and support group developed in programs such as AA/NA are extremely valuable for many people (including myself). However, within the literature and meetings you will hear it stated that some people need outside help. A sponsor is not a licensed therapist, certified recovery coach, drug and alcohol counselor, psychologist, or psychiatrist. Although life experience is a valuable asset, it does not give one the formal education necessary to support someone with mental health or co-occurring disorders. A reputable live-in recovery coach company such as Tailored Transitions provides certified, licensed and competent staff to address clinical needs that may be impacting the likelihood of success. A person’s treatment plan should include trained staff with the credentials to treat the client based on the level of severity of the presenting symptoms. In many cases, this may mean assigning a therapist to act as a clinical recovery coach or having a therapist work in collaboration with a licensed mental health clinician. It is important to ask the company who’s services you wish to obtain if their staff is licensed, certified AND if they are acting under clinical supervision to assure best practices and the highest level of clinical care. There are evidenced-based practices (EBP’s) that have been proven to effective in treating substance use and related disorders. Therapeutic modalities that are tailored to a person’s presenting problem can only be offered by those working within the scope of their practice. The live-in approach allows the staff the ability to extend evidenced-based interventions outside of the therapy session or inpatient facility and into a person’s natural environment. As soon as insurance companies recognize this, the benefits of this model of care can be more readily available to a wider population of people in need.
Although live-in recovery models of treatment can be used in lieu of traditional approaches, they can also be used in collaboration with them as pre-care or aftercare programs. There needs to be a variety of individualized programs to meet the needs of the clients. We cannot expect to remove one from their environment and then return them to that environment without the support they need to walk through the most challenging process of their lives. As mentioned, there are many benefits to stepping into the real life situations faced by individuals in the grips of addiction. It allows for a more realistic and higher quality of care which increases the likelihood of successful outcomes. Through this model of care, multifaceted issues can be addressed including biopsychosocial presenting problems and systemic issues. There are added benefits to the clinician, as well as the client and their families. Addiction can feel like being lost in the dark. Through a live-in approach, clinicians are able to act as a beacon, lighting up a path to limitless horizons and potentiality.
Robert Freitas, MSW is the founder & CEO of Tailored Transitions, a member of the Board of Directors for the International Association of Addictions Professionals (IAAP), and a therapist registered with the California Board of Behavioral Sciences. He is graduate from the University of Southern California (USC) and holds a Master’s in Social Work with a concentration in mental health. Robert is a passionate member of the recovery community who is dedicated to supporting those struggling with addiction and co-occurring disorders through an integrated approach. He is leading the paradigm shift in treatment through his clinical coaching model which combines recovery coaching with therapeutic modalities.