How to Choose the Right Outpatient Treatment Program

0:00:13 William Moyers
Thirty-three years ago, I was told to "go to treatment" to deal with my addiction to alcohol and other drugs. So I packed my bags, said good-bye to my friends and family, got on an airplane, and off I went from New York to Minnesota, the land of 10,000 lakes, and 10,000 treatment centers, including Hazelden. Where I spent five months at the start of my long and twisted road to recovery. All these years later, there are still some people who "go to treatment." But most don't. Or if they do, it's closer to where they live and work, usually they can drive there or take public transportation. And at the end of their treatment day, they go home to their families and sleep in their own beds. Best of all, they don't have to pack a bag or make an excuse for disappearing from the routine of their lives. Hello, everyone, and welcome to Let's Talk. Our podcast series from Hazelden Betty Ford. I'm your host, William C. Moyers, and today we talk treatment. Outpatient treatment and how to decide what program is best for you or a loved one. Joining me are three colleagues from Hazelden Betty Ford. All of them clinical experts on treatment. With an emphasis on outpatient services and recovery support. Samantha Pauley joins us from Oregon. Hello, Samantha.

0:01:30 Samantha Pauley
Hi, nice to see you. [smiles]

0:01:32 William Moyers
Nice to see you. Brian Couey joins us from California.

0:01:35 Brian Couey
Good to see you, William.

0:01:36 William Moyers
Hello, Brian. And Lydia Burr joins us from Minnesota. Hi, Lydia.

0:01:41 Lydia Burr
Hi! Nice to see you, thanks for having me.

0:01:44 William Moyers
And thanks to all three of you for bringing your expertise and your leadership to this really important conversation today. Lydia, I'll just start with you. Why outpatient treatment?

0:01:54 Lydia Burr
There are so many reasons why outpatient treatment might be the right fit for somebody. You know, we can talk about the opportunity for earlier intervention, maybe somebody's not at a place in their substance use where they really require residential care. You touched on some of it even in that introduction there. Maybe people can't uproot their lives, maybe they can't leave their families, maybe they don't want to detach from their communities. Maybe they have to maintain a job or there's childcare or caretaker responsibilities that they can't leave. And it just—outpatient can really make all the difference in terms of access to care and getting somebody's life back on the right track.

0:02:35 William Moyers
Brian, what are two or three things that a family or an individual should look for when considering a quality outpatient treatment provider?

0:02:47 Brian Couey
Well, that's a good question. For a regular consumer, it can be sort of tough to figure out, you know, who is a qualified provider when you're looking for care for someone that you love and you wanna get them to treatment. A couple of things come to mind. The first would be is the organization accredited with the Joint Commission or licensed by the state that they're in. So that's gonna give you some quality assurance and accountability. Relative to the quality of the programming that you're gonna experience. And do they take your form of reimbursement. Are they a match for you relative to your disposition and profile? So, is it a gender-specific program, is it a youth program? And you would also want to go with the reputation, right? So you wanna look at their website, you wanna see that you can identify the providers, what their credentials are and what their history is. And so there's a lot of bad actors out there. And you wanna just take some time to do your due diligence and to be able to look for the things that are gonna signal to you that you're going to a reputable and quality program.

0:03:54 William Moyers
Samantha, if we were doing this interview before the pandemic, and I'm interviewing you all in the summer of 2022, but if this was a couple of years ago, we wouldn't be considering the reality that virtual outpatient treatment is an option. Can you talk about how that works?

0:04:10 Samantha Pauley
Absolutely. Thanks, William, I appreciate that question. Because virtual is just part of our reality right now, right? I mean it came to us in folds because of the pandemic, but I think many of us as employees of the Hazelden Betty Ford Foundation but also because of our patient need for quality accessible healthcare, virtual platforms are just part of now what we do. So, you know, individuals can log in and attend their appointment, either individual or group, from the comfort of their own home. That allows them to access treatment much easier and quicker than they ever had before. Because they're not worrying about commute and childcare and some of the logistics that maybe were prohibitive of treatment before. The other side of the coin is that we as treatment providers also get to see them in their own homes, which allows us to kinda get a glimpse into their day-to-day reality. Which kind of unfolds treatment a little bit faster and in a more unique way that allows us to really kind of hone in on what recovery will look like for them while they're managing their families or, you know, going to and from work and just managing life.

0:05:27 William Moyers
Lydia, what is the role that insurance plays in an outpatient experience?

0:05:37 Lydia Burr
I think for most people, insurance plays a huge role in an outpatient experience. And it can be at times easier to get that reimbursement or that support from an insurance company. Because outpatient is less intensive. And requires less resources on their behalf. And it can also—people can be in outpatient for longer. You know, when we compare outpatient to say residential treatment setting, a residential treatment setting is usually pretty short. You know, 28 days at the most. But I would say the vast majority of people aren't actually even in residential for 28 days anymore. That's a thing of the past. And it gives people an opportunity to really extend their clinical touchpoints and engage for a longer length of time. Which third party payers like to see. Because what we have in common with insurance companies is that we both wanna see people get better and we wanna see them stay well. So it's really important to consider how long can I sort of stretch out my benefits and still have that support while I'm engaging in my everyday life and learning to manage some of the complications or barriers that come up and I can still have that clinical touchpoint to process through that. In a safe space and a safe environment, access to my peer fellowship. And then I can get up and go to work the next day. And insurance companies love seeing that and so do we.

0:07:03 William Moyers
Brian, how do we know that outpatient treatment is effective?

0:07:09 Brian Couey
Oh that's a really good question. So, we use evidence. And we use outcomes. Lydia touched on this a little bit and so did Sam and you. So the 28-day model is sort of a historic conventional model that really doesn't exist anymore. Outpatient treatment has advanced to the point of being just as effective as residential may have been for many of most people. And that's an artifact of more sophisticated clinical techniques, like cognitive therapy, and other evidence-based or informed practices that we use. Medication assistance, psychological, psychiatric, spiritual support. So when you combine all that in an outpatient setting, you're just gonna have a much more effective level of care than you've ever had before. So there's a good reason why it is as effective as it is and that's really because of advancements in the field of addiction treatment in medicine.

0:08:02 William Moyers
But what about, Samantha, the camaraderie or of course the fellowship, which is so critical to the therapeutic experience and the recovery aspiration? How do you do that in an outpatient setting?

0:08:19 Samantha Pauley
Yeah! That's such a great question because it is unique in an outpatient setting because they're obviously not living in the same milieu, environment, as their peers. But that's why group therapy is so critical. Group therapists are trained to create that interpersonal connection. And a lot of really strong bonds are built because that vulnerable experience of coming to group and processing day-to-day challenges that individuals are struggling with while working a recovery program. And that similarity, that same connection, is formed in an outpatient group setting. And that has a lot of impact to the shame reduction that we're looking for as well as then being able to also form chats and text threads and, you know, reinforcement that they can connect outside of the therapy room. So we're really looking at how do we bridge what's happening in a treatment setting into their communities, into their homes, and so we hear often stories of, you know, people and peers within the same group meeting up for coffee on the weekend. Or going to meetings together. And that's really what we're hoping for is that they take what they learn in treatment and apply it when they're quote unquote "not in treatment."

0:09:36 William Moyers
Lydia, I know at our St. Paul site you're not only a site leader there but you've been really a driver in terms of taking our model of care and making sure that it meets the needs of diverse populations, gender-specific populations, and all those other dynamics that are so critical to delivering care. Can somebody find individualized treatment in an outpatient dynamic?

0:10:07 Lydia Burr
I appreciate that callout, William. And I would take it a step further, right? I wouldn't say they can, I would say they must find that personalized and individualized care in an outpatient treatment setting. And it absolutely is possible to find that. It comes from a collaboration. Between the patient and sort of their story, they're the expert on their own story, and then the clinician and the clinical team coming in, and being experts on the disease that we treat, and a good course of treatment to treat the disease that this person is struggling with. And we layer on top all of those cultural considerations and all of those personal aspects of an individual story. So it's absolutely imperative that that happens. And I think a lot of what we're talking about kind of goes back to that question you had asked, Brian, earlier. Which is, you know, what should people be looking for. In an outpatient treatment setting. You know, we've talked about evidence-based practices. Is this treatment provider using evidence-based practices? Length of stay, you know, how long can I be engaged in care and maybe I'm looking for a six-week program, but maybe I need to be engaged for months and months. You know, maybe I need a gradual step-down in clinical intensity as I gain the ability to self-manage my own recovery. And, how is this program structured to help me create those relationships in group with my peers? So that I can take that with me outside of the treatment setting. How is this environment not causing me to be dependent on my counselor, but dependent on my peers and my fellowship? And how is this gonna—how is this program gonna individualize care for me? Those are all valid and important questions. For people to ask of their treatment provider when they're selecting a program.

0:11:56 William Moyers
Great point. So, on that note, Brian, I know you really can—although your expertise goes far beyond Hazelden Betty Ford, I know that for the benefit of this Let's Talk podcast, we're talking really about what we know in the context of Hazelden Betty Ford. But I wanna talk specifically about a recurrence of use or relapses as some people would call it. That happens, it's inevitable with some patients, because it is a chronic disease. But what happens to a patient in an outpatient setting who has a recurrence of use? Do they have to go to a residential treatment, do they get kicked out of the outpatient that they're in? How do we typically handle that, Brian?

0:12:35 Brian Couey
Yeah, a lot of layers to that question, right? So typically the word that's been used in relapse, which actually has moral connotations to it as being a lapsed Catholic or something to that effect. [grins] And the truth is, that people do have a recurrence of symptoms. And with any chronic disease model, they're going to potentially have multiple recurrences of symptoms, and so you would treat it like any other chronic, progressive illness. And you would try to intervene. And so you would want to make sure that they have the appropriate increases in structures and supports. Sometimes that means going to a higher level of care. And sometimes it just means enhancing their current service plan. Adding additional psychiatric, psychological supports, increased mutual aid support in attendance, or just another shot at, you know, trying again. So, we are an organization of second chances. [smiles] And third chances for people. So, I don't want to give the impression that, you know, somebody would be kicked out of a program simply because they became symptomatic again. We wanna look at that from a compassionate and person-centered perspective, which is, you know, we would want to intervene. And bring in any additional tools, sharpen up any tools that we might have, to help the person get on track. And start to get on the road to a self-directed recovery program.

0:13:56 William Moyers
And part of your emphasis there is on the fact that when somebody is considering a program, they wanna probably look for a program that has all those other aspects to it, should they be struggling in an outpatient. So that they can probably stay under that umbrella but go either to another level of care or get those additional services, right?

0:14:13 Brian Couey
Yeah, that's the beauty of our organization is that we have a continuum of care. And so, we can move people into more intensive levels of care very easily and we can put them into a more sort of long-term, aftercare supports, within the organization as well. Alumni, our Connections program. So that's what's so awesome about the Hazelden Betty Ford Foundation is that we do have all of these resources internally that we can leverage and utilize for the benefit of the consumer. [smiles]

0:14:46 William Moyers
We're just about out of time so Sam I'm gonna probably ask you what I think will be the last question. But, in considering an outpatient program—and I ask you this because I know you've got such a commitment to families as well, in terms of your experience and your passion, but does the family need to consider the services? Or how do they consider the services that they might need when considering outpatient for their loved one?

0:15:13 Samantha Pauley
Mmm-hmm. I'm so glad you asked that, William, because family and that system that supports the individual that is directly seeking treatment, is so critical to a lifelong and healthy recovery. So, at the Hazelden Betty Ford Foundation, we have a lot of family resources. Everything from a one-day pretty intensive educational program to family support groups to very topic-specific workshops that a family member can attend. And really that's about getting educated about the disease of addiction. Really understanding what it is like for their loved one that's going through treatment. And entering in early stages of recovery. But also, learning how to take care of themselves. Learning skills around boundary setting and communication and just general self-care so that as the whole family unit, however that's defined for an individual, starts to heal and starts to recover as a system. Each member is really starting to own their own recovery journey.

0:16:12 William Moyers
Well, thanks to you, Samantha Pauley, and Lydia Burr and Brian Couey for bringing your remarkable professional expertise and your passion to this issue today. I know that with this podcast we will help a lot of people take that first step towards their recovery road. So, thank you all for joining us today. [turns to camera] And thanks to all of you for tuning in to another edition of Let's Talk, our podcast series that comes to you from Hazelden Betty Ford. Remember, if you or a loved one are struggling, don't wait. Now is the time to ask for help. Now is the time to begin your journey in recovery, too. We'll see ya again. [smiles]