Getting Help: Drug Addiction Series Part IV
What can a family expect when their child enters an outpatient recovery program? An interview with Michael Odom, director of Clinical Consultants.
-by Kim Hancey Duffy
In the Salt Lake Valley we have substance abuse treatment programs which focus on Native Americans, Asian Americans, Pacific Island Americans, immigrants and refugees, pregnant women, homeless people, Catholics, Mormons, people who work nights, gays and lesbians, adolescents, women with children, deaf people, veterans, criminals, the chronically mentally ill, and people who fit into none of these categories. There are outpatient programs which can occupy one hour a week of the patient's time, and others in which the patient lives in residence for weeks to months in settings resembling a clinic, or a high school, or grandma's house. There are apartments where recovering addicts live together and go out to work, school, or all-day treatment. Addicts can get treatment for any sort of substance in this valley, and it can cost anywhere from nothing to more than $15,000 a month.
For direction, many are turning to government-run agencies to have their substance abuse problem assessed (for little or no cost) after which they can be referred to an appropriate treatment program. The Salt Lake County Assessment and Referral (468-2009) and Assessment and Referral Services (532-1850) are two such agencies that can guide families before they plunk down thousands of dollars.
Many addicts choose an outpatient program for their first treatment because they can still work or attend school. Depending upon the level of intensity needed for the addiction, an outpatient program can run from one hour a week to more than 20 hours a week.
What can a family expect when their child enters an outpatient recovery program? To answer this question, we were referred to Michael Odom, administer of Clinical Consultants. Odom is a licensed substance abuse counselor (LSAC) who has worked in the addiction field for 25 years. He recently developed Clinical Consultants, which is a group of LSACs, social workers, psychologists and psychiatrists who serve 1,200 clients a month in six offices around northern Utah. He intentionally located outside Salt Lake City's center in order to serve neighborhoods – like the doc-in-a-box medical clinics which started popping up in neighborhoods 20 years ago.
Do you have a set program that you offer, of a certain number of hours a day or days per week?
Treatment is organized by the American Society of Addiction Medicine (ASAM) guidelines, and the services we offer match the client's needs most responsibly. That's a result of the assessment typically done by Assessment and Referral Services. They advise what level of care, frequency of care, types of services, and types of interventions that are needed, then we try to match the client to them. We begin at that level, and as the client progresses in treatment and begins to respond, we decrease the level of services. It's individually paced rather than relying on a formula.
It seems that most programs now tout evidence-based therapy. What therapies do you employ?
We use programs with cognitive restructuring, commonly referred to as "thinking errors," for clients who rationalize, or blame, or won't accept responsibility for their problems. We see that with many people who are substance-dependent – things are externalized, problems are blamed, and there is little owning of responsibility. The cognitive restructuring program approaches these kinds of thought disorders. We offer individual psychotherapy with one of our clinical social workers or psychologists and also a substance abuse therapy group where folks can identify high risk situations. This is where we provide the substance abuse education, health-related risks, and recovery information.
We also offer an intervention group which is rather unique. When we're seeing someone who relapses, we place them in a group where we begin to structure more of their time and help them identify some of the drivers that caused their relapse. It's an assignment-focused group, where we help the clients figure out what's really going on in their life. This allows us to help those who have stumbled, but continue them in treatment without some sort of punitive message – that they are bad, they used drugs, so we can't serve them anymore. It's kind of odd, the way some programs discharge their clients when they relapse. I understand they have to have some limits, but it kind of contradicts the concept of caring for someone in need. It's our opinion that this is the moment when we need to take out the tools. We don't cut them off.
In the cognitive behavior therapy you provide – is the aim to restructure the addict's brain by getting them to think differently?
Yes, that is the process. Identifying old, dysfunctional thoughts and attempting to replace that with healthy, productive thoughts. There is a lot of evidence to support this approach.
Is it hard to introduce the idea to a person that their thinking is damaging them? Don't you lose a lot of people?
No, it's not presented in that fashion. We tell them we're going to look at thought processes that contribute to their addiction. We pick an easy topic like blame. How does blame fit into their dependency? They can tell you. Each person has a long list.
Then there is rationalization. Take, for example, the client who gets a DUI, but then continues to smoke pot and drive. They say, "It doesn't matter anyway. Pot shouldn't be illegal. The world shouldn't be coming down on me just because I made some promises to a judge. I still smoke pot. Pot is okay." They redefine what promises mean, rather than looking at it like most folks would, which is that if you say you won't break the law, that includes smoking pot.
Sense of entitlement is another problem we need to address. One thing we see frequently is, "I've done real well for a month. I got out of my financial troubles but I'm not having any fun. No one appreciates what I've done. I got paid, it's my birthday – I am owed a good time! I didn't relapse, I planned to use drugs and have a good weekend."
What do you say to them – "how did that work out for you?"
Yes – "Now your probation officer wants to lock you up. How do you feel about that good time?" It's a sense of entitlement. They have their own definition of equality. These are some of the things that drive substance abuse.
How do you deal with shame?
Shame generally has to be approached in individual therapy. There is a lot of shame around the carnage that the addict has caused for their family. But luckily it's something that folks can recover from. They can go back to people and make amends. More importantly, given time, people can forgive them. Shame is overcome with trust – which has to be earned – and it takes a while.
Do you have programs for the families of the addicts?
Family therapy is an integral part of the program; it's not an add-on. Abuse or addiction problems exist throughout the family system; everybody has a contribution, and everybody suffers the consequences.
Do you find that families are generally willing to come to meetings?
Most are fairly resistant because they don't see it as their problem. And that's understandable, but at the same time there are dynamics between the members that they all need to understand. While an adult child's addiction is not necessarily the parent's responsibility, it helps everyone to understand what triggers them to use drugs.
How do you broach that subject with families? Some parents might take offense at the idea that they contribute to their 25-year-old's addiction.
That's one of the biggest difficulties with treatment. And when you look at all the research, involving the family is one of the most effective treatment interventions – but it's one of the least used. Most families would rather go to the ball game than to group with their child. Yet if their son had a flat tire Dad would pitch in – but because it's a drug problem, he's going to the ball game.
Do you see stigma lessening in families or in society at large? Is there more understanding of addiction as disease rather than a failing?
I don't. Politically, yes, we have seen a shift within the courts. But I think that most families don't see it as a disease.
Do you use drug therapy here?
We don't – we specialize in a drug-free treatment approach. There are other programs that offer medications. We're relatively new; we've only been in this location two years and we have yet to find a physician to work with. It's kind of difficult to find physicians who want to work with addicts.
Do you encourage your clients to go to Alcoholics Anonymous (AA) meetings?
Treatment is designed to be an intervention, a service that interrupts something that may have been going on for months or years. So in three months time we can't put a fix on all of that. We can't say, "You've been an addict for 20 years so we'll see you in outpatient for 20 years." What you're doing in treatment is selling a lifestyle. How do you create a lifestyle of recovery? Treatment is costly, so that's where AA and Narcotics Anonymous (NA) come in. It's a support system throughout the nation that is virtually free and offered seven days a week. The best likelihood of a client's long-term success is a long-term involvement with treatment. Whether that's treatment or AA – the longer some sort of treatment is delivered, the more likely they are to succeed.
Do you have groups that people can continue long-term?
Yes. In addition to trying to place patients with AA or NA after they've completed treatment with us, we offer them up to one year free access to weekly support groups. That way they're still connected with their therapists, their recovery network, they still have their foot in the door.
Kim Hancey Duffy is a freelance writer, and a member of Salt Lake City Mayor's Coalition on Alcohol, Tobacco and Other Drugs. Contact Clinical Consultants at 233-8670.