This interview with Peter Asmuth of Serenity Lane Rehab Center covers the topics of the best duration of treatment, family participation, and the difficulty of acquring insurance for patients undergoing treatment.
Peter Asmuth is the Executive Director of Serenity Lane Rehab Center in Eugene Oregon.
All Treatment: How does Serenity Lane determine if someone should start a residential treatment program or if they should engage in some form of outpatient care?
Peter Asmuth: We do an ASAM (American Society of Addiction Medicine) criteria assessment. Variables include the drug of choice, length of use, amount of use, combination of drugs, profession, prior treatment experiences, etc.
All Treatment: Why does profession have anything to do with it?
Peter Asmuth: Access and/or potential harm. For example, medical professionals or nurses taking Fentanyl or morphine from patients, a.k.a. diverting; or pharmacists or CMAs who have access to pure pharmaceuticals.
All Treatment: In those cases, would residential be the best?
Peter Asmuth: Yes, absolutely, plus the potential for harm to themselves or others. About 50 percent of the people who walk through our doors come to residential. Fifty percent go right into outpatient in the community where they are assessed.
All Treatment: What do patients need to know about long- term recovery?
Peter Asmuth: National studies have shown over and over that the length of time in treatment is directly proportional to the probability of long-term recovery. Serenity Lane, when founded in 1973, was a one year program. You don't get sick in a day. You're not going to get better in a day, and that's been our model ever since.
When you go to treatment, you want to look for a program that allows support for up to a year. For example, in our program, if you go to residential (50 percent of our patients just do outpatient), then outpatient, and then Recovery Support, (which meets once a week for an hour-and-a-half for up to a year), you have participated in one year of treatment. You can also choose to do a second year of Recovery Support.
We actually don't charge for Recovery Support. However, you must have gone through one of our outpatient programs to be eligible for it. This supports the understanding that the longer you're involved in treatment is directly proportional to the probability of long term recovery.
All Treatment: I think you've just answered the next question, how can patients improve the likelihood of a successful long term recovery?
Peter Asmuth: On our website, we have several outcome studies. From a pure research perspective, they have holes in them, but we're not necessarily interested in publishing our work per se as much as finding out what works. When we've done surveys, we've discovered the same thing other studies have shown, that the longer you're in treatment, the higher the probability of success. The one year involvement seems to be the magic number of being your highest probability for success. Our studies have shown that people that do complete the full year achieve very high success rates of sobriety and recovery.
All Treatment: What defines high success rates?
Peter Asmuth: Over 70 percent.
All Treatment: What role do family and friends play in recovery?
Peter Asmuth: Critical. It's a must. We have family programming in all of our programs. It's a value added service. We really encourage the patient to have their family involved. For example, our family programming occurs on the weekends because as demographics have changed, we've found that the traditional five day programming for families, Monday through Friday, as a part of the residential programming was becoming more difficult for people to attend. We moved it to segments on weekends. The family comes on Saturday and Sunday for two weekends while the patient is in residential treatment.
All Treatment: Of your residential patients, what percentage of them has family members who come for those weekends?
Peter Asmuth: Over 50 percent have family members come to family programming.
All Treatment: What is the correlation between the patients whose families come for those weekends and their long term success versus the patients whose families don't come?
Peter Asmuth: Direct correlation. Internal studies have shown that if you have family participate, you have a higher probability of success of completion.
All Treatment: Participate means they attend those weekend sessions?
Peter Asmuth: Yes. The point is that the patient is engaged in residential treatment and is in a protective environment. They're going to be going back home to the same environment that they left and it takes support to get through the early phases of recovery. If the family isn't on board or understanding of the dynamics and/or doing their own healing processes, then there are a lot of dynamics that are not conducive to getting into recovery. We feel it's critical. We can't force it, but we really encourage it.
All Treatment: Are there different phases or stages of the recovery process that each of your patients pass through?
Peter Asmuth: Absolutely. We talk about stabilization, education, and then recovery. What we're looking at initially is getting people stabilized and being abstinent. We also equip them with understanding tools they can use to maintain simply being abstinent. That's the first goal.
The primary objective is abstinence. We're twelve step oriented so we're an abstinence based program and we don't believe in substitution. We don't believe in harm reduction, so if you're chemically dependent, you need to abstain from all mood altering chemicals.
There's a lot of education that goes on in that regard. Lectures are an important part of the process. Along with education is the process of acceptance of self as chemically dependent. There is an internal paradigm shift that needs to take place so that the person understands that their relationship to substances is different than other people and that's what makes them unique in terms of being chemically dependent. I can't tell someone they're chemically dependent. Only they can come to an internal awareness and acceptance of that.
Our initial phase of treatment is to get them stabilized, get them the tools to understand the addiction, and hopefully to have that paradigm shift. Then the balance of treatment, or the recovery support phase, is really about learning to live life on life's terms and giving them the skills and tools to deal with the challenges (which everyone experiences) of everyday life that they encounter. Previously, when they opened their "life skills toolbox", they only had one tool, their drug of choice. Whether they were happy, sad, disappointed, frustrated, or angry; whatever the situation in life they were facing, the only coping tool that they had was their substance and now you've taken that away. Now when they open their life toolbox, what do they have to draw on to deal with life? You can only learn those tools as you experience those situations over time. One of the reasons we talk about staying in treatment for a year is that when you encounter new situations, you can come back and get the support of others who are going through it or have recently gone through it who can give you suggestions, insights, ideas, and "new tools".
That's also why we really support twelve step programs because in those meetings you learn how others who've been on the recovery journey, who didn't have life skills before because they just had their drug, have learned how to cope and how to get through situations chemically free.
All Treatment: If it's an inpatient facility and the individual is a residential patient, stabilization would be equated to detox just to get them physically abstinent?
Peter Asmuth: Yes, in our programming, everyone is admitted to the hospital unit for a minimum of 24 hours. There are a couple reasons for that. Number one is that our philosophy is this is a medical disease and for that reason, they're also all patients. They're not clients. What we do is a physical workup to make sure that whatever extent the disease has impacted them, we're aware of what impact there has been. We're also able to detox appropriately based on the type of drugs that they've been using.
Lastly, the importance of the hospital unit is that it is the first experience or opportunity that the patient has to really be treated with the dignity and respect that they may not have been experiencing lately in their life. When folks come to treatment, it usually isn't because things are going well in their life! There's usually a lot of crisis and chaos associated with it. The other thing we're doing in the hospital unit is really enveloping the individual with hope, compassion, and dignity. We are attending to them and letting them know their value as a person. It's the beginning stage of acceptance of self. So that's one component. The physical realities of the disease are another component of the hospital unit. The third component, and as important, is that it is a voluntary program. All our patients are here of their own free will. We have a responsibility to the patient population to make sure that everyone coming into that patient population is appropriate; physically, mentally, and psychiatrically. One of the other things we're doing is that we are 24 hours "eyes on" with our nursing staff and our physicians to make sure this person's right to be introduced into the residential community for the other patients' safety as well. This is another dimension of why we insist everyone has to go into the hospital unit for 24 hours. We have some pushback on that from insurers and others who claim there is no medical reason for it. We say there is and we're very firm about it.
All Treatment: What are the costs associated with ongoing recovery and does insurance typically cover those costs?
Peter Asmuth: Each company really is different. Some cover literally 100 percent. Others go through a process of what's called "utilization review" and/or "medical necessity". It's very challenging to help the public understand the nuances of this process. We assess and determine level of care based on ASAM criteria.
Insurers are not required to follow any universal set of criteria when it comes to justifying medical necessity. They can determine their own criteria. They do have to allow you to see it, but they can determine their own criteria.
The challenge that comes into play is that companies will say in the patients' benefit book that you have 100 percent coverage for chemical dependency, but when it comes to utilization review and we convey the medical criteria for which we say they need residential treatment, they will say, "That doesn't meet our standard of medical necessity and therefore, we're not going to pay for it,". All of a sudden, we're in this position between the patient and the insurer and it's a very difficult position to be in. There are some insurers that are wonderful to work with, understand the disease, and access to benefits for the people that are paying for it is no problem. For other insurers, it is an extremely arduous and difficult process.
What we try to do, even if your benefit says 100 percent in your benefits book, is to estimate your coverage based on our historical reality. We might say, "No, they're only going to authorize seven days and then they're going to say you're supposed to go to a lower level of care." We don't do seven day programming. It's 21 or 28 and either you're here for that or you're not coming in. We base the patient's expected balance based on our experience with each individual insurer.
All Treatment: It would seem that some insurance companies understand that if they deal with the disease now, it'll save them a lot more in medical expenses later and others don't.
Peter Asmuth: That's right. The other interesting thing is when you look at best practices, who are the national companies? Who are the major national treatment centers? Betty Ford, Sierra Tucson, Hazelden. What's their length of programming? It's 28 days. When you can afford the best programs with the best probability of success, what's the model? Anything less than that is compromising the probability of success. It's like a heart surgeon clearing one of the arteries and leaving the other artery still clogged to wait and see whether or not their patient survives.
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