Interview: Serenity Lane Rehab Center Oregon
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.
Go back to Oregon interviews.
All Treatment does not provide medical advice, diagnosis or treatment. See additional information.
