Industry Insider - December 2016

Nov/Dec 2016

Vol. 2 No. 6

Ethically Speaking: A Reminder from CCAPP pg. 9

Industry Trends: Tension Between Treatment Centers and Twelve Step Groups pg. 10

The Busiest National Recovery Month pg. 11

Doug Tieman Leads Caron’s Major Expansion, Academic Partnerships pg. 2

Dr. Deni Carise Leads New Initiatives from RCA pg. 5

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Nov/Dec 2016

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Letter from the Editor

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very September in the United States it is brought into focus how poignantly irrelevant it is if one believes that addiction is a disease, bad habit, moral failing or a lack of willpower. This is magnified by the news stories as heroin and other drugs ravage our country, but also by the more positive and conspicuous commitment to recovery on which a light is shone immediately after the summer months.

National Recovery Month began on September 1 and highlighted the reality that hope sparks healing and that lasting, positive change is being achieved by millions every day.

Many who contribute to these pages remind us that the opposite of addiction could often be identified as “connection,” and September showcases what is happening in the States to supplement that worldview.

But the Insider sees this every day; its mailbox is filled with examples of peer-run groups of individuals in recovery and/or the loved ones of those in recovery who provide countless hours of free and effective support to each other, not to mention those still struggling.

Beyond these worthy September celebrations, featured on page 11, we observe so many group treatments and mutual support meetings as the inherent mainstay of recovery efforts.

Astute observers of the history that brought us to this point include two public figures charged with leading forward-thinking organizations in this space, both headquartered in Pennsylvania, and they are featured in this issue.

Firstly, our cover story finds Doug Tieman of Caron Treatment Centers adapting a “strategic blueprint” to maximize the nonprofit’s extraordinary delivery of services for the next generation of suffering addicts on page 2.

I was privileged to be part of an audience in Florida where Mr. Tieman, the author of Flying over the Pigpen, put into perspective the point we have reached with unprecedented consumer access to care and public attention to our field that has not been seen before.

That has also been a recurrent theme in the stratospheric vault onto the national scene of Recovery Centers of America (RCA), led by the charismatic J. Brian O’Neill and inspiring Chief Clinical Officer Dr. Deni Carise, featured on page 5. For such a nascent

company, RCA has done an extraordinary job in forging partnerships with the most respected clinicians, researchers, and policy makers, and I was again privileged to spend time with them, many of whom contribute to Counselor.

Like Mr. Tieman, all were well aware of the suspicions aroused by pharmaceutical interests and medications such as methadone and buprenorphine, yet are articulate about how immense benefit can derive from them if used as a part of comprehensive care. So from the unlikely locations of Wernersville and King of Prussia in Pennsylvania, extraordinarily detailed plans of comprehensive care informed by science and expertise provide a compass for the full continuum of care across two of the most progressive organizations you'll find in our field.

This time last year we saw Facing Addiction, the once-in-a-lifetime event on the National Mall; its message was surely that it’s time we begin celebrating the redemption story from addiction with the same ferocity and repetition that we have told the addiction or relapse story.

Collectively, we have a responsibility to look at our own lives, be the change we want to see in the world, and help others in their journey of recovery. This year we didn’t need to galvanize the people with a concert to show, as so many centers do behind the scenes every day, that more connectivity and more love in our lives will go a long way to address this epidemic.

As Dr. Carise affirms—and Recovery Month shows the general public who may be unaware of it—parity, ACA, and now the CARA bill make this a serendipitous time to be delivering this care . . . and most importantly she repeats, because “this disease never has to be fatal!”

Let us keep finding the pathways to connect to each other so we can facilitate and highlight more of the amazing transformations that occur every day, not only in National Recovery Month, from addiction to recovery. n Sincerely,

Stephen Cooke Editor, Treatment & Recovery Industry Insider

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Caron’s Strategic Blueprint Includes Major Expansion, Academic Partnerships, “Doubling Down” in Florida and Pennsylvania Stephen Cooke

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aron Treatment Centers, one of America’s leading not-for-profit providers of residential addiction treatment, has delivered on the first year of its “strategic blueprint” continuing the precise focus of President and CEO Doug Tieman’s plan. In an extended interview with the Industry Insider, the author of Flying over the Pigpen described in rich detail how the company has “doubled down,” in his terms, on the Centers’ next generation of lifesaving addiction and behavioral health care treatment in Pennsylvania and Florida. This commitment to its established communities in the northeast and southeast regions will allow for increased accessibility to life-changing treatment services.

“Our new strategic plan, which our board identifies as a ‘blueprint,’ has clearly-defined goals of where we’re going,” said Tieman on a recent visit to Florida. “From a programmatic perspective, that has meant adding seniors in Pennsylvania, along with a health care professionals’ program, and an executive program in Grand View,” he added.

Caron’s Grand View Program provides addiction and behavioral health treatment for executive professionals, and the launch of these three unique offerings led to Caron’s highest census since 2010. “Our focus is on expanding our Pennsylvania and Florida facilities with a company-wide commitment to innovation, leading medical and technological tools, proven patient outcomes, and personalized behavioral health care solutions,” Tieman stated.

“The commitment to Florida shows a couple of things. It solidifies the presence at Renaissance and Ocean Drive, and is a logical extension from the Northeast,” continued Tieman.

“As a not-for-profit, philanthropy is so important that, with so many donors from the Northeast in Florida for the winter, it provides consistency,” he added.

An important element in that expansion has been the twenty-three additional beds of Caron’s $15 million Carole and Ray Neag Medical Center. Florida is under the stewardship of Bradley Sorte, who serves as the executive director of Caron Renaissance and Caron Ocean Drive in Boca Raton.

In 1959, Richard Caron, a recovering alcoholic, and his wife Catherine, opened Chit Chat Farms, renamed to honor its founders in 1983.

“Often you build it and ‘hope’ they come,” said Tieman after a productive alumni dinner in Houston, Texas. “The beauty of the Neag Center is that the strong programming was already in place to move into a striking new building,” Tieman added. “Very much at the heart of the blueprint is treatment for seniors and addiction, chronic pain, and brain health initiatives as well as overarching medical care. The neurofeedback program that has been run so successfully in Florida has been brought to Pennsylvania, charting a future course in state of the art brain imaging,” he added.

Tieman is a big believer in patient compliance, and that fits his vision for Caron: Caron has taken leadership roles in treating addiction in young adults and adolescents, sponsoring research, and the expansion of treatment for seniors endorses vision allied with a strategic blueprint—it’s about having the vision and taking the appropriate steps to implement that.

In Florida, the best “doubling down” so far has been with the introduction of the sober

dorm component reengaging students, under Jonathan Salzburg, who serves as the director of collegiate recovery services at Caron Renaissance, which is part of Caron Treatment Centers’ continuum of care.

When we look at Caron’s young adult program in Pennsylvania in the light of this disease that’s particularly affecting our young people, we see that one year later, 70 percent are still engaged with us clinically. Meanwhile, in Florida we’ve taken some of our capacity at Caron Renaissance and turned that into college dorm space and are currently looking at doubling our space across the state that is so important to us.

Within the area of outcomes, with which we’ve been involved for decades, our initiatives have added sophistication with our collaboration with the University of Pennsylvania. Three years ago we began My First Year of Recovery with biological follow-up rather than just self-reporting random urine drug screening and input from four other sources. The

Nov/Dec 2016

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benefit of solid academic follow-up from this collaboration has yielded impressive results.

Thirty percent were sober again at the end of the year following a relapse. It's a beneficial intervention before they run into problems.

With the families over 90 percent of them have proved cooperative, and 100 percent of Caron patients reported that their quality of life is good to very good (e.g., they don’t do things like drive to work drunk, etc.). We think that, in looking at a chronic illness, that compares favorably with other diseases.

The young adult follow-up is particularly significant as it’s important for us to be able to tell parents what the program looks like for those who stay in the Caron continuum of care; now we also look at those outside the Caron continuum and how they do.

Now using technology from a follow-up perspective we have the “passport” in Pennsylvania, where we put the entire treatment program on an iPad—their notes, medical records, lectures, treatment plans— such that when they leave, the entire aftercare plan is on it, plus another positive, the Trigger app, once they get out of treatment. From a chronic illness perspective, that’s beautiful.

Spiritual care continues to be pivotal in the foundation of what Caron does well. We’re good at that, evidence-based practices, and medicine. Spirituality is one of the universally glowing components of alumni interviews.

I was just in Houston with an alumnus who said that the defining piece for him was Father Bill’s Sunday service, as it made him realize how spiritually bankrupt he was. The key differentiator that’s important if we look at our strategic blueprint, is that we honor our past and are always looking forward in the new age of brain science.

With so much expansion, it is often forgotten that Caron is a not-for-profit, engaged in a $70 million capital campaign with $40 million raised so far. Outcomes and families provide a compass for Tieman to assess how these ambitious plans are progressing.

Tieman is particularly proud of the academic partnerships that Caron has forged recently, particularly in understanding the importance of training young doctors in strategies for curbing addiction. Southampton Hospital is partnering with Dr. Joseph Garbely, medical director at the Caron Treatment Centers in Wernersville, Pennsylvania. They will send a group of medical students and residents from the hospital to Caron

The key differentiator that’s important if we look at our strategic blueprint, is that we honor our past and are always looking forward in the new age of brain science.

Treatment Centers for the upcoming school year.

The need for education on this topic is acute.

“Unintentional overdose is now the number one cause of death among our youth, yet when we query American medical students whether they’ve had any education, the answer is rarely a ‘yes.’” Dr. Garbely stated.

Dr. Garbely further explained that in the past, doctors weren’t able to understand the differences between chronic and acute pain. “We’ve constantly been writing prescriptions for pain relievers instead of figuring out how to deal with chronic pain differently, and that’s something that’s of critical importance for Caron,” he stated.

Advanced research at Caron has provided better understanding of different kinds of pain.

“We have a chronic pain program at Caron, one of the few in the country. We don’t use opiates here, and we’ve been very successful in getting our patients’ pain under control and them off the dangerous medication they’ve been using,” said Dr. Garbely. “It all illustrates another core component of Caron’s full biopsychosocial approach, which addresses that addiction is not simply a medical problem. We have to deal with your mind, body, and spirit, and that’s not an easy process,” he added.

At the Caron Centers, the students and residents will learn about other options available for treating pain. “We teach them differently,” explained Dr. Garbely, “and they come out with a sort of epiphany of ‘I think I can do this—I can deal with pain differently,’ which is great.”

At the recent Moments of Change Foundations conference on Innovations in Integrated Treatment, Tieman delivered a rousing speech on the history, titled “Where is Addiction Treatment Heading in the New World of Health Care?” His presentation urged a full house to learn from the lessons of the past in a rousing plea for collaboration among centers. “If we are greedy, play outside the rules or think that competition is more important than collaboration, if we don’t have a united voice with visible spokespeople, there will indeed be a crash,” he said.

Since Tieman joined Caron, its revenue has grown more than tenfold, making it one of the largest not-for-profit residential addiction treatment centers in the nation. The strategic blueprint provides a fascinating progression on how an institution can achieve an enlightened future in that context. n

To hold on to a child struggling with addiction, you must finally let go.

Let us take it from here.

At Caron our comprehensive and innovative addiction treatment programs work to make families whole again. So when you have given all you have to give, let Caron take it from here. Reach out to us, and we’ll help you take the next step. caron.org/holdon

Nov/Dec 2016

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Recovery Centers of America Finds a Corridor to Address National Epidemic ENTER DR. CARISE

at the clinical helm of a full-service neighborhood model that allows patients to receive Brian O’Neill is a man on a mission. a full continuum of care close to home. Its O’Neill, who governs O’Neill model eviscerates the “flyaway model” that Properties Group in King of Prushas sustained some of the worst excesses of sia, Pennsylvania, has been doing addiction Florida treatment as covered in these pages interventions for three decades. But his current and, like its prominent lighthouse in Mays venture has catapulted him onto the national Landing, New Jersey, serves as a beacon of stage as the architect of a company that, without hope for those in the so-called “Amtrak corhyperbole, could transform the way treatment is ridor” between Massachusetts and Virginia delivered, geographically and otherwise, in the whose options have been underserved.

United States, with the rapid “I’m not a big fan of the ascent of Recovery Centers of flyaway model,” asserted America (RCA) throughout the Dr. Carise. “Fifty percent of Northeastern United States. people don’t show up for “For thirty-five years I’ve their first outpatient treatbeen doing interventions and ment,” she said of addicts helping people get treatment who fly to a recovery center for alcohol and drug abuse,” and then return home. “We O’Neill said at the real estate are bringing full service cenheadquarters in King of Prusters for addiction medicine to sia that still constitutes his our patients’ neighborhoods core business. “I’ve been so they can receive all levels doing it quietly,” he stated. and modalities of treatment There has been nothing in one place. We are worksedate about the trajectory of ing with insurance compaRCA’s footprint, transforming nies to streamline payment J. Brian O’Neill Dr. Deni Carise the way treatment is delivered methodologies. Our goal is in an industry in desperate need of change. Carise recently as she prepared for the open- to make substance abuse treatment as readThat dream has crystallized over the past year ing of another RCA facility. ily available and continuous as treatment for in RCA having raised $250 million with the It took some convincing by O’Neill over other chronic diseases, such as diabetes and expressed purpose of opening centers for ad- multiple breakfasts in the Philadelphia area, asthma,” she stated. diction medicine throughout the northeast. but Dr. Carise was ideally poised for a new RCA’s philosophy has been one of estabO’Neill’s team started with an acquisition challenge. “To engage with the most respect- lishing a full continuum of care in communities in Mays Landing, New Jersey, and to imple- ed scientists and clinicians in the world with where residents generally have had to resort to ment his transformative goals, O’Neill needed our advisory board . . . and to do it now, at receiving treatment far from home. Dr. Carise the talents and high visibility of a nationally a time when parity and ACA are working for reiterated her concern for the effectiveness of recognized expert in addiction treatment. He us, guided by science, is a unique platform the “flyaway model,” under which patients are has found this—fortified by an outstanding RCA has offered,” added Dr. Carise. She not able to build relationships in early recovscientific background in addition to the re- continued, “And to do that at a time when ery with people and organizations near where spect of the industry—with the appointment the opioid epidemic is decimating so many they live and work. Thus, neighborhood-based of Dr. Deni Carise as chief clinical officer at of our communities and parents are bury- campus locations are being actively developed RCA in November 2014. Dr. Carise will helm ing their children virtually every day made it to bring critical addiction treatment to comthe openings of an additional seven state-of- something I had to do.” munities in need. the-art locations in Westminster and Danvers, “I feel so strongly about the benefit of the Massachusetts; Earleville and Upper Marlboro, THE NEIGHBORHOOD MODEL neighborhood model, where patients can deCommitted to changing the way addiction velop sober relationships in their neighborhood Maryland; Washington, DC; Blackwood, New is treated in the United States, Dr. Carise is that continues with them in outpatient treatJersey; and Paoli, Pennsylvania by 2018.

Stephen Cooke

J.

An internationally-renowned researcher and clinician, Dr. Carise’s global experience included UN work with a twenty-country consortium of nations that asserted that they had no drug problem (and therefore there was no treatment until she brought her ideas there).

“To create treatment systems based on the best science to what would be the best clinical programs around—I never thought I’d have the chance to do that in my own country,” said Dr.

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ment and recovery support meetings as opposed to the more common ‘flyaway model,’” she explained.

The first incarnation of that vision came in the spring with the opening of Mays Landing, in an area near Atlantic City suffering devastating drug and alcohol problems. True to their model, the Mays Landing site offers detox, residential, intensive outpatient, and traditional outpatient as well as having three satellite outpatient programs in surrounding neighborhoods. “Lighthouse stands as our flag in the sand in New Jersey, offering new hope to families and individuals struggling with addiction,” said Dr. Carise. “As the first RCA-branded treatment center, we believed it was urgent to bring our unique neighborhood-based treatment model to a struggling state,” she added. Dr. Carise urged developers of new programs to offer high-quality services at multiple levels of care that can be sustainable from a business perspective.

The neighborhood-based centers for addiction medicine RCA is spearheading are based on the latest scientific research that indicates sustained recovery is more likely when patients stay connected to and supported by family and friends while building other, ongoing support networks.

Nationwide, over forty million Americans are affected by addiction to alcohol and other drugs, and opiate abuse is now unequivocally one of the fastest-growing epidemics in America, but that particular “corridor” houses many who, in the early years of this century, have been uprooted from communities and added to the stresses upon their recovery practices by receiving treatment far from home.

“When you do an intervention, it can take two hours or it can take two days,” asserted O’Neill from experience. “The problem is when somebody agrees to get treatment you can’t always find a [hospital] bed, or if you do it’s in California or Florida or in some rural part of Pennsylvania or it’s in a rundown facility. People can spend $25,000 or $30,000 a month and the treatment doesn’t work,” he said.

That model has already caught the attention of some of the most distinguished voices in the field. Dr. Andrea Barthwell, former deputy director for demand reduction in the Office of National Drug Control Policy (ONDCP) and CEO of Two Dreams Outer Banks, shared a stage with Dr. Carise in a panel discussion after the recent Heroin, Cape Cod USA film discussion at The Cape Cod Symposium on Addictive Disorders, and pointed out that the RCA business model follows ASAM placement criteria. “The model of planning regional, full-continuum centers where they are needed is a first step. It

will allow entry into an appropriate, accessible level of care for people in the community,” Dr. Barthwell stated.

Dr. Carise, who is shaping the innovative clinical program, related a personal experience of having a close friend, a seventy-year-old patient with mild dementia, receive inpatient care at a nationally renowned treatment program. The facility eventually discharged the man after twenty-eight days, scheduling him for continuing care at a day program located ninety minutes from his Philadelphia residence, paying scant attention to the fact that he no longer drove and could not access other convenient transportation. Without the transitional care tailored to his life circumstances, the man overdosed and died shortly after discharge.

“The residential to outpatient transition is a key breakpoint that RCA’s business model will eliminate,” said Dr. Carise.

“Patients who are treated well tend to get well sooner and stay well longer,” echoed O’Neill. “These are patients that people don’t want to deal with; a lot of the facilities are old and tired. Our facilities are brand new, and we treat our patients with extra-special customer care, in addition to clinical care. Our facilities are convenient and we’re building in neighborhoods, with neighborhood support,” he continued.

Many of Dr. Carise’s initiatives are modeled on her work recognizing that true comprehension of the vicissitudes of impaired physicians began to emerge only in the 1970s that led to the development of physician health programs (PHPs). The 10 to 15 percent prevalence of substance use disorders among physicians is similar to that in the general population, but the quality and intensity of treatment given to physicians may far exceed that available to other individuals with these disorders.

Treatment in these programs is probably the most comprehensive available for the disease likely to include a full continuum of care, longitudinal (one- to five-year) management, contracting for treatment and mutual help group (e.g., Alcoholics Anonymous) participation, frequent assessment, random testing for abused substances, and workplace surveillance. Its worth has not only provided a compass for Dr. Carise’s continuum, but has informed the veritable glitterati who assembled at her request in August.

Anyone stumbling into the Society Hill hotel on August 5, 2016 would have bumped into some of the world’s leading experts on substance abuse, treatment, and recovery. They met to provide insights and counsel from aca-

demia and medicine—“You don’t say ‘no’ to Dr. Deni,” said Dr. John Kelly, who flew down from Harvard for the day. The panel included some of the most widely acclaimed thought leaders in the field, including professionals from Harvard, Columbia, and Yale University, as well as the University of Pennsylvania and other esteemed institutions.

“It was a landmark panel illustrating RCA’s continued commitment to providing the highest level of evidence-based care for recovery,” said Dr. Carise. “Rarely has this level of expertise convened in one location with the singular purpose of reimagining treatment and recovery by establishing research-based best practices for clinical delivery,” she added.

The advisory panel will continue to provide her with newfound insights into the latest research and science on clinical, medical, and continuing care issues affecting the recovery of millions of Americans. “We are thrilled that our panel of experts agreed to attend and share their collective knowledge, and look forward to translating these findings into clinical practice at each of our centers for addiction medicine,” said Dr. Carise following the first such summit.

With decades of experience in hundreds of treatment programs from her NIH-, UN- and ONDCP-funded studies to consulting for the most celebrated centers in the land and roles as CCO for the likes of CRC and Phoenix House, Dr. Carise is uniquely poised to apply the best science and lessons learned to create a best in class system of care.

PLANS FOR RCA

In building facilities that provide everything from detox and residential services, to AA and NA meetings in cyber cafés, to partial hospitalization, intensive outpatient, and recovery check-ins, all delivered in facilities close to home, patients will have a gilded opportunity to stay sober. The breadth of RCA locations “will serve as centers of sobriety, treatment, spiritual life, and healthy sober living for individuals and their families,” the company said last year in announcing its plans, and those goals are now truly crystallizing for 2017 under the helm of Dr. Carise (RCA, 2016).

Last year, 22.7 million Americans met criteria for diagnosis of substance abuse or dependence, with only 2.5 million receiving treatment, and the figures Dr. Carise and her team have at their disposal have gone a long way to informing O’Neill’s northeastern tactics.

O’Neill said a few years back, when the economy was struggling and his real estate

Nov/Dec 2016 business faced significant challenges, he got the idea. In the simplest terms, that epiphany was to develop a national network of recovery treatment centers, compounded by his epiphany that treatment arrangements in the US were “terrible.” He said he grew up in what he identified as “the culture of addiction” himself, so believes himself adept at relating to what addicts are going through.

During the recession, O’Neill said he made a list of what he would like to do if his company survived. “I said I would be more prudent financially and that I would devote half my time to saving lives, and that meant attacking substance abuse,” and that led to the genesis of a four-hundred-page plan for the company he initially called Rehab Centers of America.

In an early meeting, Dr. Carise suggested they be the first group to focus on the recovery, not the addiction or the rehab. The newly named Recovery Centers of America was born, and even before funding was officially validated O’Neill was galvanized to assemble doctors and administrators to staff and run centers that did not exist yet.

Both O’Neill and Dr. Carise perceive an extra poignancy to some of the locations, with the Danvers location on the site of the former Hunt Hospital Institute for mental health. RCA gains credibility there with a longer and more comprehensive continuum of neighborhood care, including detox, inpatient, outpatient, and ongoing support services through its centers.

RCA’s Bracebridge Hall is just opening as RCA’s first de novo operational facility.

Situated in Earleville, Maryland, this location will be home to RCA’s executive treatment program. In addition to evidence-based substance use disorder therapies and a low resident-to-staff ratio, Bracebridge Hall clients and their families, often executives of prominence and distinction, will receive highly personalized and comprehensive treatment for addiction and overall health.

“The opiate epidemic in America has simply overwhelmed our country and our health care system,” Dr. Carise noted. “Patients who start with prescription painkillers soon have turned to cheap street-level heroin, creating an entirely new class of substance abuser that desperately needs help to overcome their disease and rebuild their lives,” she added.

Dr. Barthwell was reminded of the principle as demonstrated by the recent film Sully; “Airlines speak of seventy ‘souls’ on board, not seventy ‘seats.’ Too often lately when talking to providers of care they speak in terms of ‘beds’ in their system; the more the better for

the next round of financing. I don’t want the airlines to do a better job than us of knowing what is important; it’s not beds, it’s people— broken, wounded souls who need recovery.

Deni and her team are getting that right,” Dr. Barthwell explained.

But the experiences have added other strings to Dr. Carise’s bow. She is immersed in laborintensive certificates of need (CONs) and has developed a newfound advocacy in civil rights issues, courtesy of some of the curious civic opposition to RCA’s plans.

In just two years developing the programs, Dr. Carise has experienced numerous “NIMBY” experiences RCA has endured throughout its nascent processes of siting facilities. Illjudged and derogatory exclamations such as “How can you sleep knowing that something could happen to my little one because some horrible addict was high?” have become de rigueur in local public hearings that the company has attended.

But neither O’Neill nor Dr. Carise will remain silent in the face of such obfuscation: “There’s been an explosion of heroin and opioid addiction. Someone had to create a national treatment company on a scale that’s capable of dealing with the number of young people who are getting addicted to heroin and opioids,” stated O’Neill.

THE FUTURE OF RCA

Dr. Carise’s panel at the Cape Cod conference included Mike Duggan, founder of the celebrated Boston-based local intervention group Wicked Sober, another company RCA purchased when they decided to have a significant presence in Massachusetts. Wicked Sober will add to RCA’s New England Center for Addiction Medicine in Danvers, making it a true regional center of evidence-based addiction medicine and peer support. Duggan’s team will work with those struggling with problems all over New England, but will be located at the The New England Center for Addiction Medicine Danvers campus.

RCA acquired Wicked Sober to strengthen its community-based battle against addiction.

“It’s really important to get the entire community involved and contribute to change on a grassroots level,” says Brad Greenstein, CEO of RCA’s New England branch. “We’re hoping to partner with as many sectors as possible, and by teaming up with Wicked Sober, we can double our resources,” he explained.

That ambitious plan for Massachusetts and surrounding regions has its RCA genesis with a ninety-bed facility in Westminster and a 210-bed facility in Danvers, where

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Dr. Carise said RCA will maintain a one-toeight therapist-to-patient ratio and will operate dedicated floors for opioid-dependent young adults.

The universal respect with which Dr. Carise’s work has been greeted over two decades also gives her a voice in the national media, such as during this autumn when she was highly conspicuous in the media addressing the synthetic opioid that some dealers are adding to narcotics to give them an even more powerful—and completely deadly—kick; it only takes a couple of milligrams of carfentanil to knock out a two-thousand-pound African elephant, and the veterinarians who administer the drug use gloves and face masks to prevent exposure to it, because a dose the size of a grain of salt could kill a person and may be lethal even when absorbed through the skin.

As the state of Ohio recently witnessed, carfentanil is not for human consumption in any way. This does not stop drug dealers from adding a microscopic amount to heroin to give the drug an even more potent high, even though it’s often fatal, and Dr. Carise uses her esteemed national platform to speak out on these and other matters pertaining to the national epidemic. For now, Dr. Carise is focused on O’Neill’s company, expressed with his usual assertiveness rooted in personal experience and faith in his CCO: “We want to build a $5 billion company that can cure a million patients. There are twenty million Americans who need treatment who aren’t getting it right now. So, if we reach our goal, we’ll solve 5 percent of the problem,” he stated.

The giddy ambitions of this two-year-old company may progress to serve adolescents and the Medicaid population in the future, but for now, O’Neill is crafting a clearly-defined mission.

“Our facilities are convenient; we’re building in neighborhoods, as opposed to nationally. At first, people thought I was crazy, but now that we’ve gotten the $230 million investment, they know I’m for real,” he stated. The company’s stratospheric vault onto the American recovery stage will be rooted in collegiality with other treatment centers, even though Dr. Carise has seen some prominent ones oppose the establishment of and birthing of new RCA centers of excellence: “Look, it’s never been our time before, there are more than enough patients for everybody, and most importantly, this disease never has to be fatal!” n References Recovery Centers of America (RCA). (2016). The finest inpatient and outpatient drug and alcohol addiction treatment in the world. Retrieved from http://www.recoverycentersofamerica.com.

A sanctuary for hope and healing Recovery Centers of America offers serious addiction treatment. Our distinctive approach to treatment of chemical dependency and other mental health disorders employs an integrative methodology of evidence-based practices combining time-tested and research-supported techniques from several scientific and psychological disciplines.

Our goal is to help our patients achieve and sustain meaningful, lasting recovery.

RCA iPlan Individualized, comprehensive treatment

Neighborhood Model Centralized, community-based recovery campus

Affordability Accepting private pay and most major insurance.

Financial options available.

5-star Patient Experience Black car service, exceptional dining and luxury accommodations

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Š2016 Recovery Centers of America

Nov/Dec 2016

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Ethically Speaking David Skonezny, CADC-II, ICADC

M

y agency, Simple Recovery, hosted an ethics event the other day. The format was a presentation I put together and delivered on the state of ethics in our profession followed by a moderated Q&A session. There were over sixty people in attendance, standing room only for the venue, and while it was scheduled to end at 2:00 PM, I don’t think it broke up until closer to 3:00. Yeah, an hour late and although we fed the folks, only two attendees requested CEUs and yet just about everyone still stayed on.

I have done a couple of similar talks—I don’t hold back much and it always interests me to see the response from the audience.

There are a lot of nodding heads, but what I am normally looking for are the squirming bodies that ensures the humans inhabiting them are really uncomfortable. That’s when I know I’m hitting the right chords, and that the Boogie Man is being seen. There was a lot of squirming.

Among the people who attended were counselors, interventionists, marketers, therapists— virtually the gamut of our field. And it was not lost on me that those who were there, with the type of publicity the event merited, were among those operating well within the boundaries of ethical behavior. There likely wasn’t anyone near the margins, let alone outside of them.

It’s hard to say which topic was of the greatest concern, however the “pay for play” concept was certainly top of the list. You know, selling clients to facilities for money without regard for the clinical appropriateness? I like to call it “human trafficking,” and I think that’s a fair enough phrase. That’s what’s happening: the buying and selling of human life . . . the lives we serve and that hang in the balance of the work we do. People forget that part.

Among the most grievous of offenders are call centers. I tell a story of meeting with a call center that was just getting started a few years ago. I attended the Innovations conference in San Diego and they asked me for a meeting.

Reluctantly I agreed, and when we sat down to talk the owner of the company asked if I had any opinions of call centers. I did, and do, and told him I thought they are the epicenter of what’s wrong with our profession. He seemed to take offense and asked me why I would say such a thing. I responded by saying I was going to ask

a few questions. Here’s a paraphrased recap of part of that chat: Me: So, what’s your background in this field?

Him: Well, I built and sold a business focused on telemarketing extended warranties for automobiles.

Me: So you have no experience in recovery?

Him: Well no, but in looking around for how I could replicate what I do I settled on recovery as a good opportunity.

Me: So you’re not really qualified to be in this field. Anyway, the people you have answering the phones, they’re clinicians trained in crisis response and management, right?

Him: No, is that important?

Me: Considering that every person who calls is almost certainly in some type of crisis, it absolutely is. But nevermind that for a moment. The facility you are sending the calls to, surely you have vetted them to ensure they are clinically sound and ethically centered?

Him: Well, no, I assumed that since they are operating they are doing things the right way.

I’m not sure I did a good job of masking my disgust.

Here’s the problem: this company, and ones like it, are outspending the marketing and advertising budgets of the facilities that ought to be receiving these calls and disseminating them appropriately to those in the best position to help. In doing so they are doing a number of things, a couple of which I will point out.

First and foremost they are the frontline representatives of our profession to many in need and are making financial rather than clinical decisions on behalf of the caller. This cheats them out of the very best solution for their need. They also compromise the nature of organic client contact by aggregating inbound calls rather than generating calls based on specific clinical services. For their customers they adversely impact the essential function of developing and maintaining robust referral relationships. Our jobs and our ability to do these jobs most effectively revolve around community coordination, working with our colleagues and partners to create an environment in which clients get to where they need to go. If I rely on call centers, I don’t develop a professional re-

lationship with counselors in the manner that best serves those in need. And so my ability to help is severely curtailed.

Suffice it to say that call centers ought to scare you and the degree to which we allow ourselves to rely on them is the degree to which we voluntarily handicap the profession. That’s not why you came to work today.

What CCAPP intends to do is to set the standard for our field, from the clinical services we provide to the way we generate business to the manner in which we work together as professionals. We believe urgently in a process by which care is given and received and the environment in which this care is rendered. We are developing a code of conduct that will guide the actions of our program members. We’re going to hold to those standards and have sanctions for failing to do so, as we currently do with our individual members and credentialed counselors. Our goal is to be the standard bearer for professionals in the chemical dependency field and we are inviting you along for the journey.

We’re going to be better for you joining us, and you’ll be better for doing so.

I like to remind those I get the privilege to work with, talk to, and present in front of that we have made a decision to positively affect the lives of those we get to serve. Why did you get out of bed this morning? What drove you? What drives you to facilitate one more group, have one more one-on-one session? Why do you get on the phone and talk to the crying mom, terrified she’s going to lose her child, and offer her comfort and understanding? Why do you go out of your way to do the next thing that is going to help the dying addict?

We get to do this work, we get to stand in the gap with our clients, and we reap the rewards that never show up come payday. Let’s never lose sight of that fact, and let’s resolve to do it the right way. No big deal, just saving lives here . . . n David Skonezny, CADC-II, ICADC, came to the field of recovery with extensive business and marketing experience both domestically and internationally. He has worked as a counselor and case manager for two of Orange County’s most highly regarded treatment facilities before crossing paths with Simple Recovery.

He joined the Simple Recovery team initially as a case manager before advancing to his current position as COO.

10 Industry Insider

Nov/Dec 2016

Industry Trends Tension and Different Perceptions in the Recovery and Treatment Communities Michael Walsh, MS, CAP, BRI-I

Y

ou wouldn’t really expect there to be tension between the recovery and treatment communities, but there is.

I sincerely hope that this article, if nothing else, gets people discussing the topic and educating consumers—patients, clients, members—in order to ease the tension needlessly being felt in many communities.

Last week I was at a meeting of the Palm Beach County Substance Abuse Coalition at which treatment centers, the recovering community, and the public had been invited to share ideas, information, and concerns on a variety of issues.

One interesting item on the agenda was the input from a representative from Alcoholics Anonymous and Narcotics Anonymous discussing the issue of getting support from treatment centers.

There are two major issues I have identified over the last few years and I believe it’s time we as professionals bring them to light: financial support and Twelve Step etiquette.

The Seventh Step from AA states that “Every AA group ought to be fully self-supporting, declining outside contributions.” This is a longstanding tradition that has worked for self-help groups of all kinds for decades. I don’t feel that it is incumbent on the fellowships to address this issue. However, the professional community is certainly obligated to discuss, debate, and otherwise share opinions and information, especially as the lack of information and education surrounding “meeting etiquette” is a blight on our industry.

The proliferation of treatment centers and growing numbers of new attendees to meetings has been causing problems for clubhouses and meetings across our country, and I feel it is our responsibility to do more. Shouldn’t we teach people how to go to meetings? What meetings are and aren’t? What sponsorship is and how to pick a sponsor? Some would say that’s the job of the fellowship and I can see their point.

However, when we have an industry that is supported so heavily by meetings, there is a shared responsibility. Sending a van full of clients who have a few weeks of sobriety and an understanding of where they are going and what

should happen there is quite different from sending a van full of clients who are still detoxing and can’t tell the difference between group therapy and a meeting. It is irresponsible and should stop!

We have an independent contractor group leader at our facility who is a long-time member of a certain fellowship and also a retired doctor who does a lecture entitled “AA: What it is and What it isn’t.” We have some educational groups to discuss meeting attendance and etiquette. We also give each van driver a $20 bill to put in the basket to make sure our clients are respectful and courteous at meetings. Our staff attempts to carefully choose meetings so that we don’t overwhelm a small meeting with too many clients.

It just takes a little common sense. There is a charity golf tournament each year for the Club Oasis (a local Twelve Step clubhouse) and last year I sponsored a hole and a foursome. While playing in the tournament with a staff member and two alumni, one of the alumni commented that Harp was one of only two treatment centers that had sponsored the tournament. I found this disturbing to say the least.

I'd been hearing friends who were members of the club talk about the financial strain being experienced at the club with the influx of treatment center attendees who were in need of books but had no money, not contributing in any constructive way, and some long-time members of the club choosing to attend other smaller meetings. A suggestion was made to ban treatment centers from the club; not sure how much support that received, but the fact it was brought up tells me this is an issue!

Recently I wrote an e-mail to someone involved with the club expressing my desire to shed some light on this issue. Here is his response.

I think your initiative is long overdue. The treatment centers are certainly welcome to bring their clients to clubs like ours; that’s kind of our mission, right? But too often, as you know, there is little or no accountability of the clients once they are at the club/meeting. I think the techs that chaperone the clients need some training before they can explain proper etiquette to the clients.

These are the salient issues that I see: buses arriving late to meetings and disrupting the meeting when their clients enter the room, or worse, clients there on time but stay outside to smoke or whatever and enter the meeting late anyway; clients getting up and down continually during meetings; texting during meetings, although I know most treatment centers do not allow their clients to have phones; disregard for the facility (e.g., gum placed on walls and chairs, cigarettes flicked everywhere); and lack of financial support.

Sometimes the centers will bring in over twenty clients and not a single dollar goes into the basket. I realize it’s not the patients’ responsibility, but the centers need to step up to the plate and contribute. I know that HARP has been out in front of this issue. And this issue kills the smaller, church-basement-type meetings. A club like Oasis can absorb the lack of support, but the smaller meetings that provide coffee and donuts cannot.

As you know, this is all very touchy. The AA purist would say that money should never be an issue concerning outside parties (i.e., treatment centers). Seventh tradition, right? But the fact of the matter is whether it’s a small independent meeting or one that is held at clubs like The Triangle Club or Club Oasis, there is an inherent cost to putting on that meeting: rent, coffee, staffing, and so forth.

They aren’t asking a lot in my opinion; in fact they aren’t even officially asking, but I am because I feel as a recovering person who is also a treatment professional it is incumbent on me as a professional to bring light to this issue and offer solutions. After all, isn’t that what treatment and recovery teach us: personal responsibility? n Michael Walsh, MS, CAP, BRI-I, is currently executive director and COO at HARP Treatment Center on Singer Island, FL. Former president/CEO of The National Association of Addiction Treatment Providers (NAATP), he holds a master’s degree in substance abuse counseling and is a certified intervention professional. He has extensive knowledge, experience, and understanding of the treatment industry from preadmission through the intervention, admissions process, case management, referent relations, client services, and aftercare coordination for patients.

Nov/Dec 2016

Industry Insider 11

National Recovery Month Engages with More American Communities in 2016

By Stephen Cooke

N

ational Recovery Month is a national observance held every September to educate Americans that substance use treatment and mental health services can enable those with a mental and/or substance use disorder to live healthy and rewarding lives.

The United States is not the only nation to recognize National Recovery Month, and 2016 saw more events than ever before. Completing its twenty-seventh year, the celebration highlights how prevention and treatment of and recovery from mental and substance use disorders benefits individuals and our communities. This year’s theme was “Join the Voices for Recovery: Speak Up, Reach Out.” National Recovery Month celebrated the gains made by those in recovery in the manner in which health improvements are celebrated by those who are managing other health conditions such as hypertension, diabetes, asthma, and heart disease.

Recovery Month provides many forums in all fifty states to highlight the achievements of individuals who have reclaimed their lives in long-term recovery and honors the treatment and recovery service providers who make recovery possible.

Recovery Month began in 1989 as Treatment Works! Month, which honored the work of substance use treatment professionals in the field.

The observance evolved into National Alcohol and Drug Addiction Recovery Month in 1998, when it expanded to include celebrating the accomplishments of individuals in recovery from substance use disorders.

The observance evolved once again in 2011 to National Recovery Month (Recovery Month) to include all aspects of behavioral health. There are millions of Americans whose lives have been transformed through recovery. Since these successes often go unnoticed by the broader population, Recovery Month provides a platform for everyone to celebrate these accomplishments.

A “legislative bonus” for those participating in the thousands of events came at the end of September when Congress passed short-term funding to keep the federal government operational until December 8. The good news for the

addiction field is that additional funding not in current budgets was included for the Comprehensive Addiction and Recovery Act (CARA).

Usually in these short-term funding measures, only existing programs are extended. The addition of CARA funding is deemed by many to be a very good sign it will be continued when next year’s budget is passed.

A newer custom in National Recovery Month is the Presidential Proclamation defining recovery as a disease and reinforcing those messages.

President Obama delivered that message: Throughout this month, we celebrate the successes of all those who know the transformative power of recovery, and we renew our commitment to providing the support, care, and treatment that people need to forge a healthier life.

Substance use disorder, commonly known as addiction, is a disease of the brain, and many misconceptions surrounding it have contributed to harmful stigmas that can prevent individuals from seeking the treatment they need. By treating substance use disorders as seriously as other medical conditions, with an emphasis on prevention and treatment, people can recover, and that theme resonated in a motto of, “Join the Voices for Recovery: Our Families, Our Stories, Our Recovery!” (“Presidential proclamation,” 2016).

Focusing on the importance of family support throughout recovery, Recovery Month invited families, loved ones, and other individuals to share their stories and triumphs in fighting substance

use disorders to inspire others that may follow in their footsteps. Collegiate recovery is also at the forefront, well exemplified by the Penn collegiate community; Quaker Peer Recovery, the student recovery community at Penn, hosted diverse events such as the Philadelphia Recovery Walks, the Penn Spectrum Conference, and the #PennRecovery campaign to begin the fall semester engaging with over six hundred students and continuing to spread the word on campus.

It was also the first anniversary of Facing Addiction, which was born beneath the Washington Monument during National Recovery Month 2015. In that year, the organization, under the guidance of Founder Greg Williams, has: • •Organized over four hundred advocates for Advocacy Day on Capitol Hill to meet with representatives to talk about the addiction crisis • •Helped to advance and secure passage of CARA • •Formed the Action Committee with leaders from across the addiction spectrum and charged them with executing the Action Agenda • •Solicited over eleven thousand signatures on a letter thanking President Obama for his commitment to increase funding for treatment • •Hosted wellness rooms and the first-ever Educational Caucuses for Addiction Solutions at both national political conventions • •Was chosen by the United States Surgeon General as the cosponsor partner organization to launch and amplify the office’s first-ever report on addiction beginning in November and continuing for eighteen months With more exposure following the passage of CARA, the work continues; the observance of National Recovery Month 2016 reinforced the positive message that behavioral health is essential to overall health, prevention works, treatment is effective, and people can and do recover. n References

“Presidential proclamation – national alcohol and drug addiction recovery month, 2016.” (2016). Retrieved from https://www. whitehouse.gov/the-press-office/2016/08/31/presidentialproclamation-national-alcohol-and-drug-addiction-recovery