What Happens in Outpatient Treatment? Am I a Good Fit?

0:00:13 William Moyers
A lot has changed since I first experienced treatment for addiction to alcohol and other drugs. It was 1989 and back then treatment was pretty much the same. I lived with a bunch of other men who had traveled from far and wide to get help. Our days on the unit were chalk-full of lecture and group and one-on-one sessions with counselors. Some quiet meditation and exercise time. And three square meals a day. For some people, treatment is still like that. But not for most. As we will discuss in this edition of Let's Talk. The podcast series produced for you by Hazelden Betty Ford. I'm your host, William C. Moyers. And joining me, three colleagues who are leaders at Hazelden Betty Ford. Lydia Burr, who joins us from Minnesota. Hello, Lydia!

0:00:58 Lydia Burr
Hi, nice to see you!

0:00:59 William Moyers
Good to see you, too. Samantha Pauley who comes to us today from Oregon. Hey, Sam!

0:01:03 Samantha Pauley
Hi! Good to see you.

0:01:05 William Moyers
Likewise. And Brian Couey who comes to us from California. Hello, Brian.

0:01:10 Brian Couey
Hi, good to see you, William.

0:01:11 William Moyers
Thanks for being with us. And we're gonna talk today about the outpatient experience. Samantha, starting with you, what is outpatient treatment?

0:01:20 Samantha Pauley
That's a great question. And a good way to kick us off. So outpatient treatment really allows for an individual to enter into treatment or continue post a residential treatment stay. And allows them to live in their home, often times maintain or return to employment, and/or school. And it offers some flexibility. So that they can come into treatment, they usually attend anywhere from three hours of group programming per day, and then upwards of four times per week. So there's just some flexibility. And then there's also some individual sessions either with their counselor, sometimes there's a mental health professional or a psychiatrist involved in their care. So it's a home that allows them to come in, get the services and treatment that they need, but also then live in the community and kind of return to life.

0:02:18 William Moyers
Lydia, who is typically a candidate for outpatient treatment?

0:02:24 Lydia Burr
There's a lot of different ways to answer that question. Which makes it a good one. Somebody who is a good candidate for outpatient treatment may be somebody who has recently completed a residential treatment and is looking to continue their care on an outpatient basis. That's one person who might be a really good candidate. Another person who might be a really good candidate is somebody who's maybe just not as progressed in their substance use to necessitate like a residential, you know, completely detaching from their home life type of situation. Maybe it's an earlier intervention. And then, there are also those people who just simply can't you know completely detach from their home life. Maybe they really must continue working or they have caretaker responsibilities. Or there's a lack of access to sort of a residential treatment setting in their area. And, you know, outpatient can be a really, really good option. For any of those people. Or, some of those people fit into more than one of those buckets. You know? And that's what is sort of the beauty of it, the beauty of outpatient. Is its flexibility and its ability to meet a lot of different types of needs.

0:03:33 William Moyers
Brian, how does insurance—and we know how vital insurance is to expanding access to care. Whether that's residential, day treatment, or outpatient. What role does insurance play in the outpatient experience for somebody?

0:03:52 Brian Couey
Well, you know, I think one of the roles that they plays as a partner for us. So, they want value-based care from us, they want us to have good outcomes, they want to make sure that their members get quality care and don't end up in emergency departments after the care or re-admitting to treatments too frequently. So we try to be good partners for them. And we try to make sure that we get the correct level of care for people. And we work with insurance as partners to make sure that their members get the appropriate level of care, the quality of care, that they need. And the kind of outcomes that they're looking for.

0:04:28 William Moyers
Sam, how do you as a clinician, and this is a question for all of you, how do you determine if somebody is making progress in outpatient or maybe they need to go somewhere else. How do you decide that?

0:04:41 Samantha Pauley
Yeah, that's a great question. Because progress can look different for different people, right? Because of the way they are maybe entering in treatment, like what Lydia was talking about. But it's also really based on their individual goals. What are they looking for from an outpatient treatment experience? So, our clinicians at the Hazelden Betty Ford Foundation are really well-trained in thorough assessments and identifying patients' specific goals. And then walking a patient through the journey of treatment by measuring how they're moving towards those goals. We use objective measures. So measurement-based treatment is also a way that we can measure progress towards either symptom reduction for their anxiety, their depression, craving scales are monitored, and this objective feedback allows clinicians to kind of understand what's going on for an individual while they're actually not in direct services. So these individuals are completing these assessments while they're at home or over the weekend. And then it provides us back some data that we can have really rich, thorough discussions on what they're doing. And how can we help support them. That's one way that we can measure success through treatment.

0:05:54 Samantha Pauley
[continued]
Also related to just how are they integrating their recovery into their day-to-day lives? Are they going to meetings, are they connecting with their sponsors, are they connecting with other peers in recovery is another good way we can identify that they're starting to fold recovery into their day-to-day experience.

0:06:12 William Moyers
And you talked about that connection, intimate connection with other peers, Lydia is that really possible, an outpatient treatment for peers or fellow patients to make that connection? Considering that they're not gonna be together most of the day?

0:06:29 Lydia Burr
It's possible. It's practically inevitable. [chuckles along with Moyers] That's going to happen because, you know, whenever you get a lot of people together in a room, in a circle, to discuss what's really—what they're really struggling with. When you have that emotional exchange, bonds are made, you know, strong bonds are made. And that speaks to the importance of group therapy. But it also speaks to the effectiveness of mutual support, groups and meetings, that people are going to in addition to their outpatient treatments. So, to ask you know is it possible in outpatient treatment, I would only point to the mutual support groups that have been going for generations. That prove that it's possible to create these bonds and then to sustain them. Even outside of that room. As part of a really important recovery network. That's where we get the people that we call in the middle of the night when we're really struggling or because, you know, when something happened on a day where we don't have group, the text chains, the emails, the phone calls. The meeting for coffee. The meeting after the meeting. The meeting before the meeting or even the meeting during the meeting when we're on break and everybody goes out and just continues talking. Outside for a minute and then comes back in. All of that is really the magic of outpatient. It's a fantastic thing to see.

0:07:50 William Moyers
And just to follow on that but giving it to Brian here for a minute. So, the dynamic of the group is constantly shifting. It's always moving because you don't stay in the same outpatient—I mean people aren't in there for the same lengths of time, right, Brian?

0:08:04 Brian Couey
Yeah, I mean you're certainly going to get some rotation for people that are matriculating through the program. One of the things that is actually beneficial with that is that people who have developed some stability in their recovery and are thriving can mentor and act as anchors for people who are new and coming in. So, there's a difference between hearing about someone who's getting better and seeing a person who's getting better right in front of you in your own group, so that's one of the great things is that you can see people who are a little farther along the line developmentally in their recovery in your group. And you can use that as motivation and as a way to aspire to where you'd like to be in a couple weeks or months.

0:08:47 William Moyers
Mmm. Sam, is outpatient treatment appropriate for people who are struggling with a co-occurring disorder?

0:08:55 Samantha Pauley
Absolutely. Yeah. I would say that oftentimes outpatient treatment can be even more appropriate for someone that's struggling with co-occurring. Because it allows for the flexibility for an individual to attend a variety of different services with different treatment providers to really get the comprehensive care that they need. That's not to say that residential treatment with this whole dynamic, multi-disciplinary team, isn't also beneficial. But this really allows for some specific, individualized treatment to occur. Where we can pull in different specialties, providers, to really get the care that an individual needs.

0:09:34 William Moyers
So Lydia, we know how critical spirituality can be in the recovery process. And it's easier to find it on a campus or when you're around for a long time, but how do you find spirituality in an outpatient experience?

0:09:50 Lydia Burr
Yeah that's a really good question, William, thank you. You know, when we're talking about the Twelve Steps and the spirituality of the Twelve Steps, a lot of times I see it start sort of with the fellowship of the group. You know, the beauty of the Twelve Steps is that it can be changed and formed and personalized for people. Whatever their disposition. Maybe it's not a religious program, it's a spiritual one. So, for example, you know, the four of us here are creating something bigger together than any one of us would be if we were doing this alone. I'm learning from all of you and hopefully you're learning from me, and we're creating something bigger than we would if I were sitting in this office alone. And that being said, I do think it's also important to acknowledge the fact that the Twelve Step program of recovery is one pathway. To a life of recovery. But it is one. And there are several. And at Hazelden Betty Ford, we recognize that and we really want there to be a place for everyone. In our walls or virtually. So, while we can talk about the spirituality of the Twelve Step program, I think it's just also to give credit to the fact that some people may not ascribe to the Twelve Steps, and that's absolutely okay.

0:11:03 William Moyers
And Brian, people can find outpatient access in their communities. And that's actually a really important component of an outpatient program, right? Is that it's in the community.

0:11:17 Brian Couey
That can be an advantage, right, this proximity to where you're receiving services. But what's really been just an astounding sort of outcome for us is how we can access people through virtual platforms and programming. So, you might be somebody who lives in a rural area, California or Minnesota or Oregon, and you don't have a quality treatment center anywhere near you. And so what do you do? And so now, we can provide access to care for people who before may not have had any options for themselves and would have been sort of hung out to dry. Were it not for technology and the ability to provide quality programs through digital service platforms.

0:12:03 William Moyers
Sam, I know you have a real passion for families as well. Not that anybody else doesn't, but I know that's been a big part of your career. Are people who are in an outpatient program, should they expect that there'll be a family dynamic in their outpatient treatment?

0:12:22 Samantha Pauley
Well, William, I would hope so. I mean personally as a Family Therapist, I would hope that family involvement is a part of any core outpatient treatment. Certainly it is for the Hazelden Betty Ford Foundation. Where our clinicians are bringing family members into the dialogue, they're working through, you know, challenges that are happening within the home with the patient or with the loved one that's receiving treatment. But we also offer a really robust system of services for the family members for themselves. So that they also understand what is treatment, what is my loved one going through, how can I support them and support them differently than maybe they've been attempting to up until this point? So really for us, treating that whole family system is pretty critical in order to help that long-term recovery take hold.

0:13:13 William Moyers
We have just a couple of minutes left so I wanna ask each of you in our final question the same question. Just to get your expertise. Lydia, if there's one thing that you want our viewers to know about the outpatient experience, what is it from your perspective, Lydia?

0:13:34 Lydia Burr
It works. I want people to know that it works. And it works well. And I want people to know anybody who's watching this that there is hope, there's hope for recovery, there's hope for you, or your loved one. And that—and that it works. And it's magical. It's a wonderful thing.

0:13:58 William Moyers
Brian?

0:14:00 Brian Couey
Well the file that comes online for me is that it's a partnership. And there's an old saying in AA, 'it works if you work it.' Right? So, I want to just encourage people to avoid the idea that you just wanna come in and do your time. You know, it's gonna take some work and we're gonna work just as hard as you do at it. And if you put in some effort to the program, along with our support, you're gonna really be successful. And so that's what I would say is important to understand. You know, with any medical illness that you're getting treatment for, you gotta put in some work. If you don't go to your chemotherapy appointments, you're not gonna cure your cancer. Right? So, that would be my message.

0:14:48 William Moyers
Thank you, Brian. And Sam, you get the advantage of the last word but unfortunately you gotta follow these two experts or colleagues.

0:14:53 Samantha Pauley
[laughs] I know, right?

0:14:53 William Moyers
And so they've covered a lot of that right now. But what would you like our viewers and our listeners to know from your perspective about outpatient treatment?

0:15:01 Samantha Pauley
Yeah, Lydia and Brian are certainly tough acts to follow. But one of the things that I would offer and add to that is that you don't have to wait. Outpatient treatment allows people to kind of enter in much earlier in their disease progression. And we offer a range of services that allows someone to, you know, come in one time per week upwards of again four times per week. We can intervene on the progression of this disease much, much earlier. And hopefully prevent kind of the wake of chaos that sometimes will happen if someone has to wait until they get into residential treatment or, you know, medical detox. So, I think what Lydia said in terms of that there's hope, I would wanna offer that there's hope much earlier for individuals. And they don't have to wait until their disease really takes hold of their life. [nods, smiles]

0:15:50 William Moyers
Samantha Pauley, Brian Couey, Lydia Burr, thank you for bringing your messages of hope to our audience today. And thanks for reminding us that it works if we work it, but we have to work it. And you all are helping us to work it one day at a time. Thanks for being with us today. [turns to camera] And thanks to you all for tuning in for another edition of our Let's Talk podcast. 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]