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JimSBy Jim Seckman, MAC, CACII, CCS
CEO, MARR, Inc.

We keep doing the same thing over and over again expecting different results.

There is a trend, driven primarily by insurance companies and profiteers, supported by language in the Affordable Care Act, to shorten the length of stay of substance use disorder treatment. In other words: spend less money by cutting treatment down to about 30 days.

Also, because our field is returning to insurance-based treatment, there is a trend toward increasingly individualized modalities, due to the fact that it is the individual who pays the premiums.

Didn’t we learn our lesson well enough with the 28-day model? Didn’t we learn from experience and research that time is one of the most important ingredients of treatment and early recovery? Haven’t we learned that substance use is an isolating disease and that recovery only takes places within a community? Apparently not.

What has evolved in both medicine and substance use disorder treatment is that the rising costs of care, associated with new treatment protocols, regulations and standards of accreditation and licensing bodies, are forcing programs to reevaluate their structures and make changes just to endure the crisis. This does not translate into better treatment. It merely means that programs are trying to survive.

Because of these rising costs, insurance has seemingly become indispensible for average-income individuals and families who could not afford the price tags of many programs otherwise. This is creating a profit-driven system.

But the desire for profits is driving treatment backwards.

When the language of finance begins to replace the language of recovery, we lose the primary healing power of treatment: a longer length of stay within a supportive, structured community.

Research and evidence have consistently pointed to a long-term model as being an effective form of treatment. And, that relationships are the primary healing agent. Both of these are core values of MARR: creating a healthy and safe environment for clients to have time to grow stable relationships.

Our clients isolate. They move away from connections with others towards a primary connection with the using object/ritual. One of our tasks is to help them move into healthy and appropriate relationships with others. Research has shown that the therapeutic relationship is one of the most important aspects of successful recovery. At MARR, we believe it is more important than the approach or technique that the counselor uses.

Restoration of relationships is paramount.

The therapeutic relationship may be the first authentic and healthy relationship that many persons with a substance use disorder have ever experienced. Both the counselor and the recovery community provide the basis for directing the individual to the fullness of life-giving recovery. We are increasingly confronted by clientele who have no idea what a community is supposed to look like, much less what it means to be an accepted member of that community.

Thirty days of individualized treatment simply will not work.

The current focus on short lengths of stay may be necessary for cost reduction. It does, however, completely strip away the research-proven time needed for a person to heal. The healing takes place within the context of a community that does not condemn the person but calls her or him to restoration. The therapeutic community brings together the work of healing and relationship without overlooking the individual journey.

When I am known, fully and honestly, with my problems, pains, and good qualities, then true acceptance and healing take place. And therein lies the essence of recovery: When we are known by others, then we can ask for help and be accepted. This is how the miracle of change occurs.

The meaninglessness of substance use is given purpose within the context of community.

The therapeutic community then becomes the primary agent of change. In MARR’s therapeutic community, we ask clients to be willing to live in a small gender-specific community of 8-10 female or male clients who, by living and working together in treatment, learn how to be responsible, cooperate, support each other, and hold each other accountable for their actions and commitment to recovery. The clients take small steps at first: Planning, shopping for, and eating meals together; performing daily and weekly chores; participating in recovery devotional time; sitting in groups together; and enjoying recreational time as a community. This willingness leads to hope, which leads to faith, which leads to the opportunity for a new way of living. This is impossible for someone who is in active substance use.

Substance use and community are both universal human experiences. The interesting truth is that they cannot coexist: one will separate us from the other.

Treatment must focus on the formation of therapeutic community with a sufficient amount of time to learn how to live and be in recovery. At MARR, we provide both: the therapeutic community and the time necessary for each person to find healing and recovery and to learn to live life on life’s terms.


Carry the Message:
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5 Comments

  • Sally Dodge says:

    You have 100% agreement here. I have one son with dual dx of paranoid schizophrenia and substance abuse. Mostly he’s hospitalized for detox and 3-4 days later released and set up for o/P program…30 days sounds like a good start for him which has never happened, I’ve said he needs 9 mo to year. He’s been battling his disease for over 20 years now – he’s about to turn 42. He’s also had health problems with testicle cancer in 2002, which was cured, but then has rare side effect called teratoma where tumors start growing and have to be removed. His SA is combination of both drugs and alcohol. I’ve prayed to find a program that can work. He has Medicare and Medicaid.

    • Jim Seckman, CEO says:

      Sally,

      Thank you so much for responding to the article. Yes, the situation you and your son are in is one of the most difficult to try to find treatment. The schizophrenia and the SA are difficult enough just by themselves. But, put both of them together and it doesn’t just double the difficulty, it quadruples it. I worked at Emory Hospital on their dual diagnosis unit and we noticed that there is a type of “double denial” that manifests. While denial is always a symptom of SA, the person will also have denial around the severity of their mental illness. And,working on one denial does not necessarily help the other. Also, at times the person may enhance their mental illness (or try to self-medicate) through the SA. Plus, the person may feel like this is the only way for them to fit into the crowd or have relationships. In order for treatment to succeed, there must be stability in both the SA and the schizophrenia. It really is a specialized type of treatment that not many facilities are able to do anymore. But, you are absolutely right, your son needs some type of long-term treatment in order to consolidate his recovery and build some time because people in his situation have very poor impulse control and relapse at a much higher rate than the rest of the population.
      While we don’t treat dual diagnosis here at MARR, you are certainly welcome to call our Assessment Line at 678-805-5131 to talk with someone and perhaps get some ideas about referrals.
      We will often refer clients in your specific situation to a facility called Skyland Trail here in Atlanta (404-483-0646) or Pasadena Villa in TN (877-845-5235), or Lifeskills in FL (865-660-0837). While these can, unfortunately, tend to be pretty expensive they might have some ideas about dual diagnosis referrals for residential treatment.

  • You are right on the mark. Please put me on your mailing list. Keep up the great work. Thanks for all that you do.
    Recovery is Real,
    Cris…

  • James W. Jackson says:

    I thank God every day for my experience at MARR, and for the friendships that have been given to me. It has truly saved my life.

  • Thank you Jim for being honest about this subject. I’ve worked in this field for over twenty years and watched it change directions many times. I agree with you regarding relationships bring one of the keys to success.

    I currently work in a six week TC and wish it could be a little longer. I appreciate MARR and have referred people to you guys over the years.

    MARR has always been a role model for other programs. Keep up the good work.

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