Creating A Recovery Addiction Program
January 21, 2020
Welcome to Recovery Radio by Landmark Recovery with your host, Zach Crouch. In this program we’ll discuss the root causes and treatments of alcohol and substance addiction, speak with experts in related fields, and help navigate the road to recovery.
Now, here’s the host of Recovery Radio, Zach Crouch.
Zach: Hello. I’m Zach Crouch, host of the Recovery Radio podcast, your source for addiction recovery news and knowledge. If you know someone struggling with drugs or alcohol, Recovery Radio is here to help. We’re dedicated to providing you with the tools to help you or a loved one take the first step on the road to recovery.
Joining us on the show today is Michelle McGinnis. Michelle is a licensed Clinical Social Worker and the Chief Clinical Officer of Landmark Recovery. She’s been in the substance abuse industry for over ten years and has been critical in the creation of Landmark Recovery’s programming.
Michelle is a firm believer in evidence-based practices and this has allowed her to help individuals with whatever substance abuse problem they may be struggling with.
Michelle, I’ve known you for quite a while now and it’s good to have you on the show and actually have some time to talk.
Michelle: Yes. Thanks for having me, glad to be here.
Zach: If you don’t mind, tell the audience just a little bit about what is your background and education.
Michelle: Yes, absolutely. As you’ve already indicated, I’m a licensed Clinical Social Worker. I completed my Master’s for them at the Control Social Work at the University of Louisville and that was a Master’s in Social Work. Prior to that, I attended the University of Oregon. I was a double major in Psychology and Women Studies with a minor in Sociology so lots of behavioral help and people sciences.
Zach: Go, Ducks! Right?
Michelle: Yes, absolutely, also cards. Fully cheeky when they make use of it.
Zach: Yes. That’s the question. What team do you go for then?
Michelle: I’d say for basketball, University of Louisville. That’s the women’s basketball although I do like the men’s team as well. For Oregon, I would follow football if I followed football but I don’t do it very often.
Zach: Right. Got it.
Michelle: That’s my education. As far as my background, I have been working in substance abuse treatment in some capacity pretty much my entire career. I actually have over ten years’ experience. I’ve done pretty much every role that you can have. I’ve been a tech where I was caring for adolescents who are residents of treatment facilities. Most of them have substance abuse issues that brought them into residential treatment. I was a tech for a company that cared for adolescent girls.
I moved in to community health care while I was a private practitioner working with individuals. My team would specialize…we were treating trauma and substance abuse disorders. Mostly, I worked with the children who were removed from their home due to parental issues of some sort. The rest of it was related to substance abuse. My role is kind of work the trauma and help towards fulfilling reunification.
I’ve also worked on the other side of the treatment which is working for an MCO and utilization reveal and for kind of a large MCO.
Zach: When I first began at Landmark, there was really nothing. There was no clinical programming. There was no policies for seizures really. There was nothing, right? We were starting from the ground up. One of the big pieces that you pushed for in the beginning and materialized especially with our programming now, was based upon your time in working for an MCO as a UR person.
You saw some things that were just not really, I don’t know, savory is not the right word, but you didn’t care for it too much when you were doing reviews on these different treatments as you were called on and informed your decision to put in place the program that you did. Why do you think that was so important, working for the MCO’s and how it informed your views?
Michelle: I think I’ve had a lot of work experiences that I kind of landed in and wasn’t quite sure about I would get out of it. I would never have been in MCO thinking, “I’m burned out from patient care. I could use a nice break.” I learned, it was a huge education for me, in what practices are really helping people recover from drugs and then helping people through things they are going through their lives.
From the MCO end, we saw a lot of, I call up a provider that was providing residential treatment and I ask them, “Tell me about your treatment program.” They would describe to me what their treatment program was. It was, basically they put the patients in a van and then took them to AA meeting in their community for eight hours a day.
Michelle: What’s happening there is their affair but you’re just giving a ride to therapy. You’re just taking them to things they can get in the community. From the MCO’s whose members are really talented and knowledgeable ended up there was looking at what are the evidence-based practices. The insurance companies really want their members to get better.
Michelle: They want their members to live the best lives so that they have good outcomes, very outcome-driven. What the MCO’s look for are what are the treatment approaches that are deriving good outcomes.
Michelle: There wasn’t a lot of evidence to support that putting people in a van so that they can attend meetings was evidence, but wasn’t leading to good outcome because it wasn’t really giving them the tools they needed to work through, not just their substance abuse disorders but also the co-occurring issues that are contributing to life disruption and dysregulation.
For me, it was learning a lot. That’s what I’ve learned. Before I started working at an MCO, I really had very little knowledge of anything other than…that there were other mutual support groups out there. It’s something as simple as when you leave treatment and you attend meetings that are supportive of your recovery efforts. There are more than just 12 steps.
I was taught 12 steps earlier in my career and that’s kind of what I knew. In the MCO world, I learned that there are a ton of them. One that I was very drawn to because the outcomes were very positive was SMART Recovery and then dove into learning as much as I could about SMART Recovery and what it was built on which was evidence-based treatment models — MI, Key-to-key, RSAT. There are several more others than that but I couldn’t get focused on everything.
Michelle: I learned a lot about what was available as far as, not just treating patients while they’re in-patients, but what they needed to be…have long-term recovery and have the support necessary to change their lives long-term.
Zach: Sure, yes. You had a pretty unique experience in that regard just by working on both sides of the fence, so to speak. Is that something that people, particularly coming out of grad school who maybe get thrown into one of these other programs we’re talking about here, would you recommend or even consider those people to work for an MCO is to broaden their experience? Do you think that would be a really good thing for a lot of people?
Michelle: I think MCO’s, I think they get a lot of bad press for denials and things like that but they’re definitely innovators in looking at…it’s good for them if their patients have good outcome. Their reality is the more people that don’t use their insurance, the better it is for them, for the company. The outcome about it, if it’s for the right reasons because patients are getting better because they’re getting the right treatment at the right time with the right support then that benefits not just insurance companies but it benefits everyone so people get better.
Zach: Got it.
Michelle: Yes, you should learn a lot. You also have to be a lifelong learner to be looking for the learning opportunity. Not everyone at the MCO was a learner but I was and I was very intrigued by things I have heard about.
Zach: I think that, just from hearing you talk and knowing you for quite some time now, I think that one of those things, correct me if I’m wrong, it allowed you the opportunity to ask those questions that maybe you wouldn’t have known how to ask before without that experience.
Michelle: Absolutely. Oh, yes.
Zach: Yes, very cool.
Michelle: It’s not like I didn’t have missteps in my career but it’s always about asking questions, looking at outcomes. If I do something, what happens? What was the outcome? How will it affect my patient positively or negatively?
Michelle: If it’s positive, then keep doing that thing.
Zach: Absolutely. What brought you to choose a career in addiction treatment?
Michelle: Well, probably I’m going to sound like every single adult person that worked in the field. It was just a personal passion. It makes me try to relieve trauma and I knew very early on that I’ve wanted to work in trauma, wanted to help people who has this event happen in their life and were really dealing with it, struggling and get them to a better functioning place. I think trauma and substance abuse are just so intertwined that it just naturally led me in to substance abuse and treating substance abuse disorders.
I know the bigger question is what led me to be a therapist more so that coming in from trauma, substance abuse is a very natural pivot for me. I started off my career, my educational career as a part major, Fine Arts.
Michelle: I took Psychology as an elective during my first year of college. After that first class which I majored from, Art, from Fine Arts into Psychology, it just didn’t seem like, trying to maintain in writing movie scripts was as important as helping people change their lives and get better.
Zach: Got it. You’ve been in Landmark now for going on four years.
Zach: You’ve had a multitude of different roles during that time. I remember you and I, when we first got started, you were in there as I was, getting this place ready for the first patient to walk in. I remember you making beds. I remember us…
Zach: Yes and pressure-washing, etc. Shout-out to Matt Boyle who’s our COO who could probably use a little bit of training in pressure-washing a little bit. That’s beside the point. Tell us about your current role at Landmark. What is that? What does your day-to-day look like?
Michelle: My current role as Chief Clinical Officer which my primary responsibility in that role is to make sure that all Landmark facilities wherever they are, whatever state they are in that they stay licensed and they stay operational.
It’s kind of manage day-to-day compliance with our policies and procedures as well as all regulatory kind of rules and elements that are out there whether it be our state license, regulation or our accreditation to joint commissions, making sure that we’re always kind of continuously compliant so that we are able to operate without interruption. That’s kind of primary, so compliance officer-y sort of stuff.
The other side of that is managing our clinical content which means managing our clinical program, making sure that it is doing what it’s supposed to do which is making people kind of get the tools that they need to do better and make change in their life. It’s continually evaluating the quality of our program. You’ve seen outcome measures, those surveys and things like that and see the reaction in patients and how well the program is helping them.
Michelle: Part of maintaining our current program, adding and changing the program. I oversee our Clinical Program Committee which is a global committee here at Landmark where anyone from the facility level can be part of it.
We look at all of our lesson plans and evaluate how they’re going on the ground with the patients, look at…any therapist can, anyone really, can suggest a lesson plan that be rolled into our curriculum. I’m also responsible for like reviewing it to see if we want to roll it into our programming.
Another part of the current program is officers maintaining innovation so researching new or emerging interventions that are going to help people either with trauma, substance abuse or both and seeing if they’re appropriate for our program, so research and development.
Zach: Yes. That’s right along with our mission, vision, and values which is being a thought leader in this space and not really resting upon maybe even a tried-and-true method. We want to keep those in place, but continue to build upon the basis and foundation that you’ve helped create.
Zach: Just with regard to the compliance thing because I think that that’s really an important piece especially as somebody’s…other treatment facilities open up then are not compliant, there’s going to be a need for, I would just say, more Michelles, right, especially as we have pretty lots of growth area, growth plan in the future.
With that in mind, are you training people to help out with that piece? The compliance… grow and grow. What kind of person needs to be in that place? What’s the personality, or not even personality, but professional skill set of that person look like?
Michelle: I think I don’t really know the answer to that specifically. I mean, I would say someone who’s very knowledgeable of our program, not just our program but how our program currently meets our regulatory and accreditation standard and attention to detail. I mean is the detail necessary to this so someone who can make the connection between everything and remember them.
It’s a lot to keep track of. You have from state to state; regulations vary sometimes even just minutely, sometimes very dramatically. Our overall goal is we want to make sure that our operations and our compliance with regulatory standards, we operate in a way that’s best for Landmark, not necessarily we don’t operate to…we want it to flow well for our employees and our patients, but also make sure we’re on the right system and who isn’t too rigid in their thinking but then is also too rigid at the same time because you do have to be compliant.
It’s tricky. I don’t know. I don’t have a good answer for that. That’s a tricky question, Zach.
Zach: Well, I think that you’ve probably answered that. I think that one thing I would ask you is we’ve talked about disavowal back when we first started together. I was like, “This is amazing. How do you keep up with all this stuff,” right? You just said to me very succinctly, you said, “It’s all up in my head.” Is that the case still or is there a system that works for you that you’ve learned over the years? It’s like, “Man, I’ve got all these different things on my dashboard and this is how I manage all this.”
Michelle: Yes. I’m moving towards that. I think one thing that we’ve learned over nearly four years of operating Landmark is that you can’t store important things in someone’s brain.
Michelle: There are things that I remember and there are things that I know that are important. What we say from a company is “Write those things down. Develop a system around it so in the event that Michelle McGinnis is no longer here then we would still continue to operate and help people.” I can’t keep things in my brain. There have to be systems that are sustainable over time.
Michelle: It’s mostly kind of like the phase that we’re at right now. It’s like writing all that stuff down. I’m especially thinking of a funny story about compliance that as I’m working with lots of other professionals who have been in compliance and some elements and hearing their compliance stories compared to my compliance stories so it’s pretty funny. Who knew that there were funny stories about compliance, right, about the strike thing that you can create?
It comes with a lot of power being responsible for compliance for a company. If I read a regulation and I interpret it a certain way and I write a policy and a procedure because I read this in the regulation. That is now something that someone has to do on the ground, on the floor with the patient and if I got it wrong and they have to do too much.
Funny story. I was working with our Clinical Director in Oklahoma City. She had all these funny little tags hanging from, especially two things that were cracking me up, so she has these funny little tags hanging from every single plug, every plug like to a lamp, to a computer. Everything had this little paper tag that said, “Check. Substantiate.”
I said, “What on earth are these funny little tags on everything.” She says, “It’s joint commission standards.” I said, “What do you mean ‘it’s a joint commission standard’?” She’s like, “You have to tag every cord stating you checked it and that it’s not faulty and that it’s fine.” I said, “Oh, you have to check your equipment and how you choose to document it varies.”
She’s like, “Well, someone came up with a rule that you have to create these individual tags for every single electrical outlet. Someone made that up in the compliance department. Now I have to do it.”
It’s the same with copy. She has like, she came to the rule book facility with like, “You have to have copies of conversations and all.” Like, what do you mean? She said, “You have to have them for joint commission standards.”
Again, I think that, let’s talk about what’s this regulation, what standard is that is what you have to do. Ultimately, I agreed with her from an infection control standpoint. Were there much easier ways that help maintain infection control from a copy stand? It’s funny. If I make a policy, someone has to follow it somewhere so I have to make sure that it makes sense for us because we don’t want our staff doing silly things that are not necessarily what we have to do.
The trick is in the compliance. I read a reg. I read a standard. How do I have to execute that on the ground? Having the team around us, having the other executive team members and just having to see that from the facility itself, what do we need to be doing to meet the standard, not necessarily like what I think might be because I may be the crazy one, too. I’m just as bad as everyone else.
One of the joint commission standards is that you have to have a plan so if your power goes out you have to have a plan if you have medication that requires refrigeration. You have to have a plan what you’re going to do with it if it goes over four hours. After four hours, you have to have a plan.
Michelle: I come up with this very elaborate…you’ve got this plug in generator. After that plug in generator, you plug that refrigerator to the med refrigerator and you test this battery-powered generator every week to make sure it’s functional. I spoke to joint commission during my annual conference with them and they’re like, “Or you could have just written your policy that after four hours, we’ll discard the medication.” I was like, “Oh.” That would have been a lot easier.
Zach: Yes, but you wouldn’t know that unless you had written the policy and then sort of pressure-tested it against what the joint commission said would be kosher, right?
Michelle: Exactly. You kind of jump to what do they need you to do and sometimes you come up with very elaborate answers when it was as easy as, after four hours you just say, “Throw it out and order new medication.”
Michelle: Oh, that makes sense.
Zach: Focusing back on, and this is all well and good, focusing back on the treatment program that you built, what is the importance though of building a treatment program that really focuses on treating trauma?
Michelle: I’m going to make up this number. They also say that 85% are completely made up anyway. When you look at trying to separate…I think back in to the early days of substance abuse treatment and this idea of which came first, chicken or the egg. Coke, heroin disorders or substance abuse, which do you treat first? You think you have to treat them separately. First you have to treat the coke, heroin then you have to treat the substance abuse or you have to treat the substance abuse first then the coke, heroin.
Now, we’ve moved to the, as a field, we don’t have to separate them anymore because they’re not separated. They are combined. Coke, heroin, whether the trauma which would prevent depressive symptoms, anxious symptoms, dissociative symptoms, whatever they’re manifesting in, trauma and substance abuse, they go together. These things are intertwined. To try to separate them is just more work than it needs to be.
Majority of our patients, I’d say 98% of the patients walking through the door for any given substance abuse treatment program in the United States is walking in with trauma. Most of the time, they don’t know they have it. Most people don’t recognize their own trauma because they don’t believe what they went through has happened to someone else.
We do a lot of comparison with other people who say, “Oh, I wasn’t in combat. I didn’t have to carry…see my buddy die. I wasn’t physically abused as a child horrifically.” A lot of people jump to worst-case scenarios of being locked in a basement as that’s trauma.
Trauma is whatever trauma is. It’s anything that…an event that impacts us and then creates functionality, functional dysfunction for us. It doesn’t have to be severe as we think it is. We kind of hear the word “trauma,” we think combat. We think horrific car accident, surviving a plane crash, things like that, but the traumas can be much different than that.
One of the big things that we focus on at Landmark is if you can identify that you’ve experienced trauma, you at least know what direction you’re heading. My biggest take-away for patients is if they leave Landmark with one thing, they’re able to recognize “I have trauma. I might get three, so I have to treat that as well as my substance abuse.” They go together.
Michelle: I’m a huge, huge believer in learning to treat early or adverse childhood experiences or ACEs.
Michelle: Every patient who walks in to Landmark, whether they come in as in-patient or come in as out-patient program, they’re given an ACE screener to find out, to help them identify, “Oh my gosh. I did have trauma,” because what we know is that if you score a four or above on an ACE, you’re likely to have adverse experiences as an adult whether be it a physical symptom, I’m thinking like heart disease or diabetes, something physical or mental health, substance abuse disorder or a mental health disorder or both or all three.
You might have all three of them. It’s because of those ACEs. We don’t think about those ACEs as an adult because as an adult, “I wasn’t in a bad car accident. I wasn’t raped. I wasn’t in combat but I did grow up in a home that was unsafe.”
Zach: As you’re talking about this, I was thinking about those people. They come in and maybe they can identify, particularly those people that come in also that are…it’s like trying to pull teeth convincing them that someone, convincing someone that this was traumatic in any sense of the word from an observable outside perspective.
Maybe through their own, some people might call it traumatic bonding, trauma bonds, whatever it was that they had occur in their life that they are unwilling or unable to sort of identify that this was in fact a traumatic event for them. How do you work with those kinds of cases?
Michelle: I think that that’s where the group study comes in really handy especially tends to this male population that’s a bigger barrier because men are tough. You got to be tough. Everyone has adversity. This is what makes you tougher. Pull yourself up by your bootstraps and keep going.
Being in a group study and we have a group that’s specifically designed for learning that we’re about trauma, what it looks like and how do I identify it and seeing other men or other people in that group uncover their own trauma experiences and being able to identify, “Hey, this experience as a child could affect me today and it’s okay that that happened.”
It’s not necessarily, I don’t like the word “normal” but it shapes the way how I got here, so kind of helping them that it’s not about identifying trauma to see these as weaknesses, this area is to be blamed, but what is the contributing factors that go, “Everyone always asks me,” through the Landmark, “what’s the root of my addiction?”
Michelle: Most likely, trauma. Trauma.
Michelle: ACEs specifically…we’ve learned how to create emotional upset and this shapes how we respond to things. As we respond to things and those responses are using substances to cope with these upsets and those ACEs contribute to that drug addiction behavior long-term.
Zach: Is part of Landmark’s work, the childhood pieces especially is that unless you’re able to self-regulate at some level, you can’t work through some of this stuff because it just becomes so overwhelming once you begin to think about it, process it, whatever? How does Landmark help out with that?
Michelle: We are just starting to unpack trauma. We’re developing safety measures all around — buffering, kind of wrapping people in bubble wrap so that they don’t get hurt because the last thing you want to do is kind of start unpacking things that someone’s not emotionally equipped to be able to do.
We teach pretty simple, easy-to-use coping strategies and before we start diving in…one of the things…once patients start identifying, “Oh my gosh. This is trauma,” they sometimes want to like, dive head first. It’s like, “Whoa. You don’t even know how to tread walk.”
Zach: Iron shield. Right.
Michelle: Yes. We’re not there yet. It’s kind of helping them to see that tip of the iceberg and know that there’s more underneath where short-term program, the residential component, 35 days to start unpacking trauma is not quite…what we’re focusing on is identifying and then buffering, like, “Here are some strategies. Here are some things that you’re going to need to support the trauma work that you’re going to be kind of starting your journey on.”
We’re in the beginning and we’re getting them set up. We’re filling their backpack. As they go on this journey that their backpack is full of the supplies that they’re going to need to be able to navigate there safely.
Zach: It’s a great analogy. As the people come in to our treatment program and the residential piece, you bring up an interesting point about trauma and how…a lot of these people come in, a lot of the significant trauma in people’s lives has been caused by those people who were closest to them.
What people want to know in our program, how much contact do patients get to have with their loved ones during their in-patient stay? When and how are they able to connect with them? It’s kind of a three-part question I guess. Answer it as you like.
How do you advise a therapist or a clinician when it’s not best to include someone in the visitation?
Michelle: Family involvement could be on day one. If they’re accompanying their person to in-take, they would be present for a portion of the in-take process until our staff kind of determines, “Hey, it’s a good point that we separate ways, time for your loved one to enter treatment and now time for you to kind of go.” We let them say goodbye, have some closure so they’re involved.
Option on day one, on that first day when they come in. It also helps to gather some collateral information. The patient tells us what’s going on and we could have their family members tell them their perspective to see if things differ. That’s day one.
From there, we do restrict contact for the first 72 hours. Those first couple of days they are really very vulnerable. They are in a new environment. No matter how big and beautiful the environment is, it’s new. We have a limit so that that person that’s coming in builds connections to the program and other members of the program like other residents.
From there, the family can be involved really up to how much they want to be involved or how much that person wants them to be involved. Standard, we have visitation for one hour a week on the weekends and then they get a phone call that is made and facilitated by their primary therapist.
Not a whole lot of just open contact, the visitors are used to kind of unstructured contact. There’s regular visitation, phone call once a week and visitation once a week. Other than that, the family can be involved in different ways. On Saturdays, the family is invited to attend a, I’m going to call it a workshop.
Zach: Yes, I was going to say Family Day. Right?
Michelle: Yes, Family Day. It’s almost like a family workshop. The family can come in and they come in at 9:00 am. They’re going to be in a Family Psycho-Education Group which is facilitated by our alumni family therapist. It’s teaching the families without their person present while the person’s in treatment doing their own group therapy so that they’re not with their loved one.
It’s just family and support members attending the Psycho-Ed. They have topics that are focused on what that family member needs to know about addiction in general and about what their person’s going to do like how addiction was developed, what families look like in addiction, primary roles, genetics. After genetics, there’s a ton of education. It’s a two-hour day.
They go from that; they’re able to join their support person or their loved one. Actually, having the SMART Recovery meeting is onsite and then they go to a family process group. The family process group is a family psychotherapy group. It’s pretty intense. We call it Knee-to-Knee and that being able to kind of talk through how that person’s addiction has impacted the family members or support members.
It’s a pretty intense day where families are able to be involved for as long as they want. After that family group, they have that open invitation. There might be, if the therapist has determined that the family is going to be a big part of this person’s recovery environment then they may have individual family therapy throughout the week.
They might get like an hour session, that patient, family, and therapist. It varies from person to person and it would really depend on how healthy those loved ones and support will help that person’s recovery.
Zach: Sure. What are the benefits then of including loved ones in a patient’s treatment program?
Michelle: Reality. They’re going to leave. When I was in the MCO, we’re all doing reviews of facilities. One biggest inquiry I would ask about was the discharge plan. What’s the discharge plan? This person’s back in, they’re not in Landmark, what are they going to do when they leave here?
So many facilities would tell me back, “They’re going to go home with mom,” or “They’re going back home with their wife.” I’m like, “Okay. When has the family been involved to know when that person comes home what to do?” They’re like, “They’re not. They haven’t been to anything.” I’m like, “You’re sending that person home to an environment that has no idea what to do with that.”
Addiction is individual that there’s one person that substance uses with a family system problem. It’s not something that’s an isolation. The family members have been affected by this. The family members need to understand how to support someone in early recovery because support can look a lot different. I think we look at…oh, go ahead.
Zach: I was just going to say in terms of, I’m going to say, buy in, that family members that come through for instance our program, have in believing that, right, that this is a family disease, it’s a family process. Is it 50-50 or is it more like 80% believe it, are willing to do work or is it more 20% believe it? “No, you need to fix this person so then we can get our lives back together.”
Michelle: I probably need to query the therapists on the ground. I don’t know that. It’s tough though because we look at it as a family process. We look at the family system. I think it’s easy to want to say, “We’ll just fix this person,” but then we look at how the family system organizes around someone who’s an active user to help support them because we care about them.
I can’t tell you how many moms I’ve met who are loving their children to the point of making their children more sick, not on purpose but because they don’t know. They’re like, “Oh, you’re going to jump off this cliff. Let me get down to the bottom and catch you,” then they both get smashed.
Zach: Right. Right.
Michelle: Because we love our children. We want to take care of them but sometimes loving our children means setting limits and setting boundaries. There is the classic. You get on an airplane and they tell you, “I’m a mom. It’s my first time to get on an airplane. My instinct is just to ignore the flight attendant when they tell me, ‘if the air pressure drops and the cups come down, put yours on first. Secure your mask and then put it on your child.’ Huh. Yes, right. Like I’m going to put that on my head first and then I’m going to put mine on. I’m going to lose a few seconds and then we both die.” You have to take care of yourself.
With family members, I don’t think it’s about looking at who is teaching them. It’s not about blame. It doesn’t matter how the system got here. It got here. Now let’s fix it and part of fixing means we’re fixing our own issues as well as our family issues.
We can’t rush in to…most families want to come in and start working on their deep-rooted issues. I’m like, “Wait a second. None of you have the coping capacity to do this. Let’s get to the coping and work through your own issues then let’s work together as a family on the other stuff.”
Zach: We give all these people that come through our program this backpack full of tools. Yes, four times per month or four times during the course of a process treatment, the families come in to get their tools, hopefully during that time.
To be honest, that is really just a starting point for so many of these families coming through. They would do well to probably go off and in tandem with the person who is entering if they could, maybe even do like some sort of co-dependency workshop somewhere. That’s kind of an easy way to put it but I think that…
Michelle: Yes. They need their own person and they need to do their own work as well.
Zach: Yes. As we’re sort of winding down, there are a couple more questions. Tell us about a patient’s stay. How scheduled is a patient’s stay? What is the value, in your opinion, of structuring it that way?
Michelle: It is very scheduled. They are in a schedule effectively pretty much from the moment they wake up until they go to sleep. We have limited amounts of free time and that is purposeful. They came in to this program to get those tools and learn the things that they need to kind of embark on their recovery journey.
While free time is very important to that as well, we want to make sure that this person learns. A person in early recovery learns how to structure their own time. They don’t have to leave Landmark and have a Landmark program. That’s a lot. It’s an eight-hour work day. If we don’t have structured time, it’s easy to lose track of things. If we lose track of things, it’s easy to kind of fall back into old patterns and old behaviors.
The structure is one we have a lot of information to cram in. Those limited amount of days that we have so we kind of try to put in as much as we can in those days and then just to help, kind of keep people focused on the right spots. We have downtime.
We tend to go into our heads and drift off. Our heads are not always a great place in early recovery because of things like errors and thinking of cognitive distortions and dwelling on things we can’t change or dwelling on things we shouldn’t or feel like we need to change. Keeping them busy is a very important part of the recovery process.
Zach: Yes, yes.
Michelle: It helps them focus on what is important as well as start to learn tools to how to structure their life when they leave.
Zach: They would still be very active early on in the recovery process even though you’re free and clear of substances at that point.
Michelle: Yes. They’re not like in school or in classes all day. From about 9:00 am until about 4:00 is when you have your course therapy. There are therapy groups that are happening. That’s like the work day. That’s when they’re doing the hard work.
Prior to that, they’re doing work. Some work actively with our patient engagement specialist doing things like community building, things like fun activities that are not just like fun but devise, help bring back community culture together so that they learn how to build connections with others.
We have physical activities, a fitness center, being able to do fitness-related steps in learning about what do need to do to our bodies to kind of continue to feel good. The hard step of the day is from 9:00 to 4:00. That’s when they’re getting their therapy.
After that, there are things we do. We allow about an hour and a half scheduled. They get a lot of homework assignments — being able to work on homework assignments which could be structured journaling. It could be a worksheet that correlates with the learning topics for the day.
They’re kind of assisted in making sure that they have time to work on the things that are going to help stretch what they’ve learned, the concepts they’ve learned from group into actual application because we can learn a lot in group but if we don’t learn how to actually apply it, it’s going to be no good. You’ve got to be able to apply that, too.
Zach: Yes. I was just going to say one of the things, too, Michelle that was a big change I think for Landmark especially within the past three months or so is that there’s been a huge change in our clinical approach or programming particularly because our groups are now led by therapists. They’re not led by maybe entry-level positions folk. These are folks who are masters of a quality therapist. What went into the decision around creating that change?
Michelle: Outcomes. We want our patients to get better. We have seen some quality inconsistencies when non-Master’s level were kind of facilitating the groups. To help develop consistency across not just programs within one facility but across our facilities as a whole whether it be Boho compared to Indianapolis compared to Oklahoma City. Everyone was doing the same thing across the country and that meant everyone had to have the same educational level.
We’re taught in group dynamics. The patient gives a specialist two groups because the patients, they’re just not psychotherapy groups. Our entire model moved towards the emphasis is on psychotherapy groups. That is all facilitated by Master’s level clinicians.
Zach: Got it. Got it.
Michelle: It was the right decision for the patients.
Zach: Yes, absolutely. With that in mind, I think the people that lead in our in- and out-patient following their in-patient stay do quite well. How important do you think it is though for people that lead treatment in our in- and out-patient treatment and afterwards? Why is that so critical?
Michelle: Because it’s support, it’s structured support. The first 35 days especially if someone enters in detox, their brain is just a mess of…just the neurochemistry is not functional to the point that it needs to be at. In fact, the brain of someone who has been using substances for a period of time is that they’re dependent.
You finally see some kind of typical, normal, pre-use functioning in about a year. What drives that is going on those cognitive connections and what helps the brain heal are things like behavioral therapy, being involved in something that helps us make those neural connections again and restore the balance to our brain.
It’s important that that happens in a structured setting because left to our own devices, we’ll experience things like acute withdrawal that leads to periods of just…when you’re like being down in the dumps, we decide not to do our recovery efforts for that day and we’re not accountable to anyone. When you have accountability in your life, you’re more likely to do that thing.
If I’m trying to get well, like fitness and I have a personal trainer then that personal trainer is blowing me up to come and do my training that day, my possibility of outcome go up of getting to where I want to get, go up when I have an accountability partner.
Our patient programs, our accountability partners as well as teaching the tools that we need to hit that year-mark and that year-mark is when someone’s been able to have a sustainable behavior change and make it to a year, the likelihood of continued success goes up dramatically.
Zach: With that in mind, too, one thing I’ll say to the people listening is well, if you’re in your first year of recovery and you’re going through treatment, maybe you’re in an out-patient program, too, if you pair that with a weekly consistent activity where you’re doing something, let’s just say with other people in recovery, maybe you’re going to a coffee shop, you mentioned fitness, maybe you’re going to the gym with other people who are in recovery, you do that weekly with someone for an hour, your chances of staying sober and clean for that first year go up by 50 or 60%.
To your point, having that built-in partner, that person that can hold you accountable is critical.
Second to last question here, what are some common misconceptions about recovery treatment that you wish more people knew about?
Michelle: I don’t know. That’s a toughie. I mean, I think we’re getting to a better place and there’s been a lot more factual examples. Zach, I don’t know quite the answer to that.
Zach: I didn’t mean to insult you.
Zach: No, it’s all good. If I were to take a stab at it, it would be that this idea, especially given what we discussed prior to coming on the air, is that longer-term stays in treatment do not equal better outcomes because they do, right? By cutting some of the stays in half, how is that going to be helpful, right? Because I don’t think it will be. I think it will be harmful actually.
I think you’ll see a significant re-tread with people who come back to in-patient treatment. I think that another misconception is that well, you can just sort of try out this tried-and-true method that’s maybe worked for a subset of your population who have gone through your program and try it on everybody because it won’t work. You need to be innovative. You have to be innovative in order for this to be successful.
Michelle: Zach, thank you. I got to like a brain phase where I’m like what would be a misconception — there’s one model that fits everyone. I think growing up in substance abuse treatment, I saw the kind of people that were like, “Here’s what you need. You don’t need this and this and that. If you can’t recover from that then there’s something wrong with you.”
Yes, there are a lot of universal sayings but everyone is individual. The experiences we’ve been through are individual and they need to be taken into account. It’s not the kind of individualize yourself out of treatment although that does happen, but not everyone’s is going to benefit from the same approach.
Michelle: You can’t be afraid to try different things at the same time.
Zach: I was going to say that’s probably where the skill set of our clinicians who are the boots on the ground, so to speak. If they continue to build on their skill sets and recognize that each person who does come in, yes, there’s going to be some commonalities but each person really needs to be treated with, I would say, enough dignity and respect, too to be honored.
This person walking in, they might have told 50 other therapists before about their sexual abuse but this might be the opportunity for you to actually hear for the first time from them or for them to speak it that this is how it affected them, right?
Michelle: Right. Well, I think that’s one of the biggest things that we talk about at Landmark but I’ve absolutely changed that, is the first thing we do at Landmark, the first form of business we do at Landmark is we’re here to restore some of humanity and their sense of being a worthy human of recovery.
If you don’t feel like you’re deserving of recovery then your recovery efforts are not going to go well but when you feel that no matter what you’ve done, it doesn’t matter what you did prior to walking through the door.
When you walk through the door at Landmark Recovery, I don’t care who you are. You are a person who is deserving of a better life. That’s what we are there to teach them and help them act that.
Zach: With that in mind, what’s the most rewarding part of your job?
Michelle: The patients, seeing them get better. I recently had, someone reached out to me who was one of my patients, went back when I was seeing patients one-on-one in the early days of Landmark. That individual has just achieved three years sobriety. To see people get better and see them change their lives and go through that transformation…there’s nothing, nothing that’s better than that.
Zach: It’s good stuff. Any last thoughts, Michelle?
Michelle: No, no. I could probably keep on talking about this stuff forever so it’s probably best you cut me off.
Zach: Well, thank you. I appreciate you coming on with us today.
I hope all of you listening have enjoyed our podcast. If you know someone struggling with an addiction and are searching for answers, subscribe and tune in to Recovery Radio each week for the most up-to-date information from leading experts. You can listen to Recovery Radio wherever you get your podcast.
Before I sign off, if you’re looking for in-patient or out-patient drug or alcohol rehab, visit landmarkrecovery.com to learn about their substance abuse programs that are saving lives and empowering families.
Until next week, I’m Zach Crouch with Recovery Radio wishing you well.