Care that never quits

I spent a little more time with Jim Contopulos’ video memorial for his son and an interview he did will Bill White. There’s a lot to all of this, but a couple of things stuck with me.

In the interview, he discussed being a scared parent and seeking to buy recovery:

Yes. At the age of 15 we placed Nick in his first of many, long term residential treatment centers. This was the beginning of many years of cycling ˜in and out’ of residential treatment centers throughout the country. In the beginning, we felt, perhaps, that we could “buy” recovery. We were desperate to save his life and have our son return to us. Like many desperate and well meaning’ loved ones, we fell prey to what I call the 30/60/90 day false promises.

It took us and Nick, many years and many efforts to realize that recovery can not be purchased. Many times, we witnessed Nick’s hard work of recovery and recovery’s reward of self respect, only to experience the devastation of this relentless, chronic, terminal disease. Once we realized that “recovery could not be purchased” we continued to support Nick in his own efforts to find recovery at the many free recovery locations such as Salvation Army.

This is a message every responsible treatment program needs to hear. Families are desperate to save their loved one and they are looking to purchase something we can’t promise. It drives home the importance of providing good care and communicating the limitations of treatment. I’ve been using an obesity analogy more and more. That going to residential treatment is a lot like going to a residential weight loss program. The patient is going to get lots of structure, support, information and skills that will help them lose weight. If everything goes well, they’ll come out looking great, feeling strong, proud and motivated. BUT, we all know that what happens in the weeks and months after the program is going to be critical.

This is why it’s important for us to use approaches that:

  • help patients construct personal narratives and identities around recovery rather than pathology;
  • emphasize long term monitoring, support and early re-intervention;
  • build social support for long-term change (social anchors too!);
  • address structural/environmental factors like exposure to temptation and access to good food and exercise equipment; and
  • help the patient examine the roles of other lifestyle factors, like employment.

The other thing that leapt out at me was this passage from the video:

Slowly Nick, very slowly we came to understand that there is no formula for recovery. Looking back now we recognize the common ingredients of communities that affect a true change, for not only sobriety but long-term recovery. We need more. Communities and see the addict and the mentally ill the patients not problems; facilities that are able to treat these diseases concurrently; communities that are built upon humanity not humiliation; that encourage mutual respect, meaningful work and purpose; communities that afford the individual with the necessary time in order to restructure long-held habits; communities that encourage honesty and openness; communities to see beyond addictive actions labeled as bad and envision the value of the individual–the value in his recovery. We need to grow communities to become a culture of inclusiveness and helping. Nick as you know community such as these are extremely rare, but i hope for a better day. A day seeded by the pain and loss of losing such beautiful boys as yourself a day when the words of a cancer treatment facilities–care that never quits–becomes the words of those who care for the addicted and the mentally ill.

What a beautiful and thoughtful description of the role of community and vision of support for long-term recovery from a chronic illness.


The Senate's side of the Capitol Building in DC.
The Senate’s side of the Capitol Building in DC. (Photo credit: Wikipedia)

From the United States Senate Caucus on International Narcotics Control:

11. Finding: Traditionally, U.S. Presidents – through ONDCP – have divided drug demand reduction into two main categories: prevention and treatment. However, the Obama Administration has added a third area: recovery. For the first time ever, in its 2010 National Drug Control Strategy, ONDCP focused on the need to invest in recovery. Treatment for drug abusers usually takes place during a fixed period of time. However, recovery is a lifelong process.

Recommendation: The private sector should foster the development of businesses that positively affect the lives of people in  recovery by increasing employment opportunities for them.

12. Finding: Residential treatment is a commonly used form of treatment. However, many states are facing a shortage of residential treatment beds. The shortage of beds is especially true for women with children seeking treatment. Last year, there were only 80 family-based treatment programs in the United States. Many of these programs have limits on the age of children women can bring with them as they receive treatment, further limiting access to care for women with children. The federal government does not have a precise measure for determining the shortage of residential drug treatment spaces.

SAMHSA administers a survey – the National Survey on Substance Abuse Treatment Services – of specialty treatment facilities, including residential facilities. This survey includes questions to determine the proportion of facilities that offer residential services and the number of beds available in such facilities. However, the survey is not able to provide an estimate of the demand for these beds. Most facilities do not track and record such information.

Recommendation: Across the country, there needs to be real time reporting on the demand for beds in residential treatment. There also needs to be a more rapid response in areas with bed shortages to ensure treatment is available when individuals request it.

13. Finding: Residential treatment programs are costly which often leads to individuals not receiving long enough treatment to stop their substance abuse dependency. Some residential treatment programs, such as the Delancey Street Foundation, are self-funded. The Delancey Street Foundation sustains itself by the work of residents who live on the premises and complete work in areas such as catering, holiday decor and moving services.

Recommendation: In the current difficult fiscal climate, residential treatment programs should look to the Delancey Street Foundation as a possible funding model that is self-sustaining without relying on federal,  state and local funds.

Sound familiar?

[Thanks Matt]