What Can You Expect to Happen during the Treatment Process?

0:00:13 William Moyers
Hello! And welcome to Let's Talk, a podcast series produced by Hazelden Betty Ford. I'm William C. Moyers, your host. And today our topic is about what you or your loved one or your employee or your friend can expect when entering treatment for a substance use disorder. I'm joined by two colleagues whose expertise comes from their perspectives down in the trenches. Where people take that first step away from addiction and into treatment. Tessa Voss is the Executive Director of the Betty Ford Center in Rancho Mirage, California. In the past decade with this organization, Tessa has held many clinical and leadership positions at various sites. Cecelia Jayme is the Clinical Director of Hazelden Betty Ford in Center City, Minnesota. Cecelia has been integral to the growth and expansion of the programming and Center City campus over the past 26 years. Including, the Betty Ford Women's Recovery Center. Welcome, Tessa, welcome, Cecelia, to our program today.

0:01:16 Cecelia Jayme
Thank you, William.

0:01:17 Tessa Voss
Hi, William!

0:01:18 William Moyers
Hello! And Cecelia, I'm gonna start with you. You know, when we talk about taking that first step "into" treatment [uses air quotes], there are different steps to take into treatment—what are the various steps that people take into treatment?

0:01:31 Cecelia Jayme
So, stepping into treatment starts before the actual process. But, basically what we see is that something occurs in which the identified substance use disordered person is at a vulnerable state that they're willing now to seek help, right? So, that may not—that may be a small window of time. To take an opportunity to access treatment. So what I encourage families and employers and friends to do is to kinda do some of the pre-work to find out does this person have insurance and where would a treatment center be? And how difficult would it be to move from identified asking for help or needing help to being willing to move into help? So, you know again, I don't wanna say that it's a family's responsibility or employer's responsibility to make sure that when the moment comes. But if the family and the community wants to be supportive to be forewarned and prepared is the primary step. Most people who will arrive into that assessment process to determine the level of care they're gonna need are in some kind of crisis point. Whether that be with work, with legals, with family. And most often a deep spiritual need. And desire. So, we wanna be ready for that person as best we can when that moment comes that they're willing to step forward.

0:03:20 William Moyers
And Tessa, who is it that actually determines the level of treatment that somebody is going to need to get on that road of recovery?

0:03:30 Tessa Voss
Definitely. That's usually done in the assessment process. Each program has a different maybe structure for how they conduct their assessment. But it's really a session where the clinician assesses where someone is at in various dimensions. Where are they related to their medical situation? Do they need to go to the ER right now, or are they fairly medically stable? They might assess their mental health. And, you know, the severity of their mental health struggles as well as various other factors related to their substance use. And from there, they would make a recommendation for the right level of care to place them into. Based on that person's individual needs.

0:04:19 William Moyers
Mmm-hmm. And so some people who are going to come into treatment or step into treatment are gonna come into residential treatment, and then there's intensive outpatient, and there's also virtual treatment. So the experience of going to treatment is gonna be different based on the individual's needs, is that correct, Tessa?

0:04:37 Tessa Voss
That's correct. And I think that's something that most people don't really know or understand. And so I'm glad we can share that here. That it'll look differently for each person and really the point of that is to meet their own individual needs and their goals.

0:04:51 William Moyers
Mmm-hmm. Cecelia, you're joining us today from our main campus in Center City, Minnesota. Where we have lots of programming but residential treatment is a big part of what we do there. Talk for just a moment about what happens when somebody comes into a residential setting. What's the treatment regimen like, the daily regimen?

0:05:10 Cecelia Jayme
So when they first walk in the door, they're greeted and welcomed by our Admissions and front-end staff who will, you know, help to make not only the identified patient but those support people who bring them, comfortable. They'll go through an assessment process where a level of care will be finalized or determined for them. So, oftentimes the level of care will begin with that medical detox. They'll go into our medical services unit so that they're observed and treated for acute withdrawal. Once they're stabilized in that acute withdrawal and they're able then to do ambulatory withdrawal, we can transition them down onto the treatment unit. So each treatment unit is basically a small community, average size of about 22 people who live in that community. And each of those 22 are in the same mindset of seeking recovery, learning about their disease, processing. So they all have the same goal but they're at different spaces along the path to meeting that goal. The whole overall arching thing is the fellowship. So we know that with people suffering with substance use disorder and mental health issues, and even chronic medical issues, such as diabetes, that fellowship, a community of support, is the primary long-term benefit resource they're gonna have.

0:06:50 Cecelia Jayme
[continued]
So they begin learning that from the onset. Each person will be assessed with particular needs. So that individual will have group therapy with the other substance use disordered patients. He may have mental health group, so they would be meeting with a mental health clinician as well as some peers with identified similar issues. They'll be having individual counseling sessions, they'll be having individual therapy, they'll be meeting with the medical staff and we have ongoing, you know, you wanna make sure that you're keeping track of people in an ongoing matter medically. Because as we heal, our bodies change. And we start to feel things we haven't felt for a long time. So I mean the whole process initially can seem a little bit overwhelming. When a person first arrives. Because it's usually the first time they've ever been in something like this. There's no concrete answer to 'It's gonna be this and this and this and this,' you know? So it's really about knowing that that person needs love and support. Especially in those early days. And what is phenomenal about that fellowship of other recovering people is that they know that. And they surround and support that person as they transition into this treatment milieu. But this is just like oh maybe the emergency room of recovery. When you're walking into residential. 'Cause this is where we get stabilized, this is where we get strong enough, to do the work that we'll be able to do in the next levels of care.

0:08:45 William Moyers
Tessa, Cecelia talked about some of those dynamics that a patient will experience when they're in residential treatment. The group therapy and fellowship. But certainly the relationship between a patient and the patient's clinician or counselor is important. What role does the counselor play in treatment?

0:09:06 Tessa Voss
Definitely. It looks different at each program. So I can't—you know I can speak for what it looks like here at Hazelden Betty Ford Foundation. And I think many programs have a similar structure. But basically the counselor—there's a main primary addiction counselor that helps case manage that person's care to ensure they're getting the medical needs addressed. That they're getting the mental health support, help providing documentation to the insurance company for example for review. Advocating for their care and identifying with the patient what their goals are and how do we help them meet those goals. And building that key therapeutic relationship. They see them regularly in individual and group sessions. I know there's a lot of times patients come here and expect to meet with their counselor every day. Twice a day. Maybe three times. [smiles] 'Cause they love their counselor. And they want to spend that time with them and find it really helpful. And, there's a lot of benefit also from the group therapy. Which is where they'll spend most of their time. And because in the group therapy sessions, they can practice different skills. They can learn from others, they can teach others, they can practice interpersonal assertiveness and you know various different skills in that group setting. So they'll see their counselor there in addition to the individual sessions.

0:10:37 William Moyers
Cecelia, but people who are in treatment in a residential setting, there is also the dynamic as you mentioned about the fellowship but there's also the dynamic of recovery that's already happening. Can you talk about that?

0:10:53 Cecelia Jayme
So, the recovery that's already happening is in that you have to build a person's recovery plan to encompass the greater network, right? So, we have—and most facilities do—an alumni base that share their experience, strength, and hope. For example, in Center City there's an evening lecture that is always provided by somebody who has experience, strength, and hope in recovery. Rather than a clinician. That gives people the wherewithal to say, you know, 'I can do this.' This is not the end of the world. And it always amazes me—and I think Tessa and I have talked about this before—how people are so surprised how kind everyone is. Because I think if you practice what you teach, which is the principles behind those Twelve Step programs, the honesty, the respect, the integrity, the inclusion, when you practice those principles as we do, that also provides that sense of 'this is what this can look like for me.'

0:12:09 William Moyers
Yes. This is what it can look like for me. And that's so important—people when they discharge from treatment or go to Step Down, they've gotta continue to work on their own recoveries the way that works for them. So, that's a good reminder. We only have a few minutes left and there's a couple of myths or misnomers that I want us to address here. Recognizing that regulations and rules are gonna be different for treatment facilities. There is no one-size-shoe-fits-all. But let's talk a little bit about some specifics. And Tessa, I'll come to you first. Are patients—can they still smoke if they go into treatment?

0:12:45 Tessa Voss
At our facility in our adult facilities we do have smoking. We have specific smoking areas. But I know there is a lot of investment in the broader community about how do we really treat nicotine addiction, how do we help people with their nicotine use disorder—

0:13:02 William Moyers
Mmm-hmm.

0:13:03 Tessa Voss
—Differently than we have in the past. And so, I think it's an important question. Because it's a fatal illness. The nicotine use disorder. And so it's important for us to keep thinking about and talking about.

0:13:15 William Moyers
Cecelia, what about cell phones? They're ubiquitous in society and unfortunately it seems like they have a presence in treatment. Are patients allowed to use or keep their cell phones?

0:13:30 Cecelia Jayme
We're moving closer to opening that up in a broader way. But what the reality is in this current world that we live in is that the cell phone is very much an integral part of everybody's life. There's very few people who don't have a cell phone. Some still have flip phones, but mostly everybody has a cell phone, right? And there's all kinds of access to many things on that cell phone. So we wanna move toward helping people learn to utilize these devices to support their recovery, rather than to support their addiction. And the only way we can do that is to bring 'em into the milieu to have that practice, to be able to work with them as they're working with those—that technology. So, right now, some treatment centers do allow phones, others do not. It depends on level of care in some situations. But as basically a field, we need to look at how do we help people learn to use these responsibly to support their recovery.

0:14:41 William Moyers
And Cecelia, I'll stick with you for just a moment before I go back to Tessa for the last question. But this has always sort of hovered around Hazelden Betty Ford's reputation, particularly Hazelden in Center City. But what about caffeinated coffee? [smiles]

0:14:56 Cecelia Jayme
Well, there is medical concern for drinking excessive amounts of coffee. We have a coffee shop here onsite where you can purchase special coffees. But we put a limit on how much caffeine can be. So, sometimes you'll see maybe a stimulant disordered person or somebody who just wants to go get like a hundred shots of coffee. Which is their way of substituting for stimulants. And we have a limit on that. And we address it clinically. So, you know, as far as having caffeinated coffee, each person needs to look at what's best for their own health. But if they're abusing, that's another substance of abuse. When that's being abused, we have to address it. Because it's starting on the slippery slope to relapse. If we don't.

0:15:55 William Moyers
Tessa, the final question to you when we talk about people what they should experience when they go to treatment particularly residential treatment, what is the dynamic around family engagement? And why is that important in the treatment experience?

0:16:10 Tessa Voss
It's really important. To include support people in a person's treatment. We are—we rely on our community for our wellness and wellbeing just as human beings. And so, when someone is going through a serious medical illness like substance use disorder, they need support. Family looks different to every person. And so, that could be a friend or a work colleague. It could be a relative, you know, it looks different. And they can be included in various different ways. They might be really connecting with a counselor as well. You know, talking about care and how to help the patient coordinate care. Or they could just come to a family program. Or they're getting their own help for their own mental health and wellbeing. And so there's many ways family and loved ones can be involved. And it just is important that they are. [smiles]

0:17:07 William Moyers
Indeed. Because as we know, addiction is an illness that affects not just the person who has it but the entire family, and recovery should be to the benefit of not just the alcoholic or the addict, but the entire family. So thanks to both of you for what you're doing to help individuals and families heal with addiction. Tessa Voss, coming to us from Rancho Mirage, at the Betty Ford Center. And Cecelia Jayme coming to us from Center City, Minnesota. Thanks for all you do for all of us. [Tessa and Cecelia smile.]

0:17:36 William Moyers
[to camera]
And thanks to all of you for joining us. On the note, in the spirit of what Tessa and Cecelia were just talking about, remember that addiction to alcohol and other drugs does not discriminate but treatment does work and recovery is possible. So, if you or a loved one are struggling, don't wait. It's okay to ask for help. It's important that you ask for help now. I'm your host, William C. Moyers, I hope you will join us again for another edition of Let's Talk. See ya soon. [smiles]