Choosing an Addiction Treatment Facility

By Mary H. Beck and Lori Fiester


Choosing an addiction treatment facility for your clients is not simple. There are for-profit and non-profit centers. Certain treatment centers boast a lower cost, whereas others pride themselves in being on the higher end of the spectrum. Some subscribe to the 12-Step Program, but others do not. Many even advertise spas, horses and pools. Some are near the ocean, while others are located on ranches overlooking beautiful countryside. The distinctions could go on.
While it is easy to get caught up in the various amenities a rehab facility claims, it is vital not to lose sight of the ultimate purpose and goal of seeking help: To find the most effective addiction treatment for employees so that they may live healthy, happy, and productive lives.

Cost Important, but not Only Consideration
In addition to finding a clinical match for an employee, cost is a critical factor to consider when choosing a treatment center. Does the center take the client’s insurance? What is the cost per month? Do they accept payment plans? How much money is needed upfront? Unfortunately, many people choose medical and behavioral healthcare based on the answers to these questions, versus what is most effective and in the employee’s best interests.
To increase an employee’s odds of success in treatment, it’s important to grasp all of the factors that can be expected to work for this individual, as opposed to cost-related reasons alone. With enough understanding and research, EA professionals can, in order of importance:
* Locate treatment programs that meet the employee’s clinical needs.
* Consider how affordable a program is for the employee given his or her resources.
* Consider the center’s amenities.

Key Facets of Addiction Treatment
This article seeks to explore key facets of effective addiction treatment so EA professionals can feel confident in their recommendations. The discussion is applicable to all levels of treatment, from early intervention through inpatient care. These facets include:
* Methods of treatment;
* Diagnoses;
* Levels of care;
* Origins of addiction;
* Impact on family; and the
* Effect on work.

Each of these facets need to be considered when evaluating an employee’s treatment needs.

Methods of Treatment
Dynamic treatment is the current focus for treating chronic diseases, including addiction. Also known as adaptive interventions or multi-stage treatment strategies, this method continuously evaluates a person’s progress and adjusts treatment based on this information.
Historically, addiction treatment has used a “one-size-fits-all,” linear approach with a single goal: recovery. This approach leaves little room to individualize a client’s service plan and does not include regularly measuring progress and adapting the plan as appropriate.
“One-size-fits-all” plans also do not take into account other life issues that may occur while a person is in treatment, such as the death of a loved one, separation/divorce, financial challenges, etc. The National Institutes of Health state that the best programs provide a combination of therapies and other services that take into consideration age, gender, race, culture, sexual orientation, pregnancy, parenting, trauma and co-occurring mental health disorders.
There are several reasons for clinicians to advocate for dynamic treatment in both outpatient and residential settings. Namely, people respond differently to various therapies. In early treatment, co-morbid conditions may become more apparent. People possess different coping skills and have varying levels of support. The potential for relapse also needs to be considered with appropriate strategies employed.
It is critical for treatment to be specific enough to be tailored to individual needs and dynamic enough to adapt as challenges arise or when progress is made.
Traditional treatment methods focus on:

* Detoxification;
* Behavioral therapies;
* Life skills;
* Psychoeducation and peer support through the 12 Steps; and
* Family weeks or weekends for those 13 or older.

However, the more novel yet effective programs:

* Use a range of therapeutic approaches;
* Provide multiple levels of care;
* Treat co-occurring mental health disorders;
* Address the underlying issues related to a person’s addiction;
* Involve the entire family – including children – in a client’s treatment;
* Explore a client’s performance at work; and
* Examine legal and financial issues resulting from the client’s addiction.

As an employee assistance professional, how can you determine what “fits” for your employee?

Diagnoses
The first step when seeking treatment is to provide the employee with an opportunity for a thorough diagnostic assessment that includes: mental health, physical health, substance use, eating disorders, other compulsive behaviors (e.g. gambling, sexual, Internet), trauma experiences, any involvement in the criminal justice system, and the occupational, educational, and financial aspects of a person’s life.
If this is not a service offered through an EAP, outpatient treatment centers and behavioral health agencies often provide these assessments as a stand-alone service.

Levels of Care
The levels of care related to substance abuse, addiction and mental health-related issues, as defined under criteria set by the American Society of Addiction Medicine (ASAM), include:
* Early intervention;
* Outpatient;
* Intensive outpatient;
* Partial hospitalization;
* Intensive and supportive residential; and
* Medically Managed Inpatient.

The following six factors are used to determine the level of care that a client needs:

* Acute intoxication and/or withdrawal potential;
* Biomedical conditions and complications;
* Behavioral, emotional or cognitive conditions and complications;
* Readiness to change;
* Relapse, continued use or continued problem potential; and
* Recovery/living environment.

Based on a comprehensive assessment, the EA professional can identify which criteria match the client and make a list of the other applicable factors that may influence the treatment recommendation. For example, if a 60-year-old Hispanic male employee is diagnosed as having a substance abuse disorder co-occurring with major depression, the clinician would choose a different program than they would for a 30-year-old, Caucasian female with a significant trauma history who lives with a drug user.

Origins of Addiction
While the genetic predisposition to addiction is well documented, other factors are emerging that contribute to engagement in compulsive behaviors. Unresolved emotional trauma and family dynamics are two of these factors.
While traditional treatment has shown success in reducing a client’s substance use in treatment and early recovery, if trauma and family dynamics are not addressed during the treatment process, the likelihood of relapse increases significantly.
Recent research by Lisa Miller, Ph.D., Director of Clinical Psychology at Columbia University and the Spirituality Mind Body Institute, has indicated a clear link in children and adolescents between spirituality and substance use as well as depression. Therefore, exploring spirituality in treatment and recovery adds great value and produces stronger outcomes.

Impact on Family
The involvement of family in treatment is unique to each client and needs to be carefully considered and planned. Many treatment centers offer a “family week” which lasts an average of 3-5 days. Family members receive psychoeducation and sometimes therapy is incorporated during the week. Otherwise, the family is often left out of the treatment equation.
While this approach provides a basic foundation for families, it does not fully prepare them for life after treatment. Programs that find ways to ensure that all family members, regardless of age, are involved in their loved one’s treatment, from admission through discharge, are more effective. This may mean actively participating in family therapy at the treatment center, the family engaging in multi-family group therapy where they live, and/or each member receiving his or her own services.
Judith Landau and James Garrett of Linking Human Systems, LLC report that, “Alcoholism affects the family, and the family can positively affect recovery from alcoholism. Applying engagement and treatment methods for alcoholism based on this concept has been shown to improve treatment engagement, retention and outcome.”

Effect on Work
Naturally, if an individual is being referred for treatment by his or her employee assistance provider, it is vital to ensure that the treatment center will explore how the employee’s addiction is affecting his or her job performance. These issues also can be motivators to seek treatment and need to be addressed in the therapeutic process. For example, drug or alcohol use may have caused someone to neglect work responsibilities, develop a negative relationship with supervisors and co-workers, or regularly miss work.

Discharge and Aftercare
The most effective treatment programs believe in a step-down and step-up approach to treatment. As clients successfully complete a specific level of care, they move down to the next level. For example, when a client finishes residential treatment, he or she would enter intensive outpatient. When they complete this level, they would receive general outpatient services and begin attending aftercare groups once per week.
This process is vital to a client’s continued recovery. “Research shows that those who actively engage in continuing care after treatment are more likely to remain abstinent” (Hazelden, 2011). If a person relapses, the approach calls for the client to move back up at least one level of care, ensuring enough structure and support to return to, and maintain, the client’s recovery.
Returning to work after discharge from treatment can be a scary and stressful experience. It is important to ask the treatment center about its practice for communicating with the source of the referral. The EA practitioner is part of the treatment team (if appropriate consents are signed) and needs to have up-to-date information regarding discharge and aftercare plans.
Such plans are helpful to all involved: employee, employer, and EA professional. Knowing that there is a team assisting them through this process can ease employees’ fears. Employers also benefit as their employee integrates more easily back into the workplace.

Summary
Choosing addiction treatment can be a bit overwhelming. Evaluating exactly what form of treatment works best with the individual is of utmost importance in gaining long-term sobriety from alcohol or other drugs.
The employer also will believe more strongly in the investment made in their employee’s health and well-being. Ultimately, it is up to therapists, employee assistance providers, and human resources representatives to find the most effective addiction treatment for employees.

Mary H. Beck, LMSW, CAI, is the Chief Operations Officer with The Council on Recovery. Lori Fiester, LCSW, BRI II, CAI, is the Director of Treatment Services with The Council on Recovery.

References

Galanter, M. (1993). Network therapy for alcohol and drug abuse. New York: Basic Books.

Hazelden Foundation (2011). Hazelden Connection.

Landau, J. et al, (2004). Outcomes with ARISE approach to engaging reluctant drug- and alcohol-dependent individuals in treatment. American Journal of Drug & Alcohol Abuse, 30 (4), 711-748.

Mee-Lee, David, MD ASAM Criteria: Treatment Criteria for Addiction, Substance-Related and Co-Occurring Conditions.

Miller. Lisa, Ph.D. (2015). The Spiritual Child. New York: St. Martin’s Press.

Stanton, M. D., & Shadish, W. R. (1997). Outcome, attrition and family/couples treatment for drug abuse: A meta-analysis and review of the controlled, comparative studies. Psychological Bulletin, 122 (2), 170-191.