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The addiction treatment industry is failing. The current system faces challenges in providing care that successfully supports long term recovery for individuals suffering from mental health and addiction issues. According to UCLA addiction expert Adi Jaffe, just twenty five percent of people who seek treatment are still sober one year after completing a 30-day program. That means 75% of those receiving treatment are back to using within a year of completing treatment.* For a fatal disease, this is unacceptable.

There is a solution.

Seeking to increase standards, In January 2015 we met with leadership at The Joint Commission to establish standard practices for supporting long term recovery.  By March 2016 this was completed, as we established a Joint Commission accreditation for intervention and case management (long term recovery support) services.  Next we went to Washington DC to meet with major payer representatives of insurance companies to help establish ethical business practices and goals for our industry. In our discussions, we talked about addiction treatment programs proven to provide sustained recovery approaching 80% over five years. These programs, which require case management type services, have been in existence for over thirty years. These programs clearly demonstrate the critical components to laying a foundation for a long-term, meaningful recovery.

In July of 2016, we began discussions with one of the Big Four Accounting Firms assessments ethical assessments for our industry. On behalf of ICOTP and it’s members, one of the Big Four Accounting Firms will conduct a quality assessment to review whether applicants’ operations achieve the ICOTP standards. This is an effort to establish ethical standards for the industry and assure the reputation of treatment providers willing to be audited.  We are committed to working with the payer community to provide quality care, transparent business practices, and measurable outcomes. We are committed to following our patients over a five-year period. To read of other programs and studies with long term recovery as a standard practice, please check out the program highlights below.

*http://newsroom.ucla.edu/releases/people-can-overcome-their-addictions-170880

 

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HIMS for Pilots

An industry wide effort to help maintain the safety of airline transportation, the Human Intervention Motivational study is a occupational substance abuse treatment program specific to commercial pilots the coordinates the identification, treatment and return to work process for affected aviators.*

The program has several components and lasts a minimum of 10 years. If there is a relapse, the pilot remains in the program for the life of the licensure. For those that elect to participate, 92% of participants are still sober after 10 years.

Components:

  • Intervention – (ROCK BOTTOM / Motivation)
  • Evaluation / Treatment Planning
  • Detoxification
  • Inpatient Treatment (Typically 90 day minimum)
  • Intensive Outpatient Treatment (IOP)
  • Sober Living/Transitional Living (optional)
  • Continuous Random Drug Testing
  • Continuous Peer Group Support – 12 Steps
  • Case Manager – Recovery Advocate

*www.himsprogram.com

 

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Physician Health Programs

Most states utilize a program for impaired professionals, including doctors. When a doctor is identified as impaired, a similar process for treatment and care is put in to place to help support a safe and sober return to work. Public safety is an utmost concern. The program is administered at a state level and unlike the HIMS program; there may be variations from state to state. In California, the program was initially three years in length but was increased to five years.

A study of 16 different Physician Health Care Programs was conducted by Dr. Greg Skipper. He found that of the roughly 900 participants who choose the program, 79% were still abstinent and in recovery after 5 years. *

Components:

  • Intervention – (ROCK BOTTOM / Motivation)
  • Evaluation / Treatment Planning
  • Detoxification
  • Inpatient Treatment (Typically 90 day minimum)
  • Intensive Outpatient Treatment (IOP)
  • Sober Living/Transitional Living (optional)
  • Continuous Random Drug Testing
  • Continuous Peer Group Support – 12 Steps
  • Case Manager – Recovery Advocate

*Dr. G.E. Skipper and R.L. DuPont. The Physicians Health Program

 

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Drug Courts

When an individual is faced with a felony from a drug or alcohol related offense, courts will often give that person an option to participate in a diversion program. Diversion programs for the court are typically 18-24 months in length.

Several Court Diversion programs have had remarkable success in helping participants remain sober.

The Brooklyn Treatment Court which is one to two years in length sees 65% of the participants still sober after two years.

In Hawaii, the HOPE program found 72% of the participants less likely to use drugs after involvement in the program*

Components:

  • Intervention – (ROCK BOTTOM / Motivation)
  • Evaluation / Treatment Planning
  • Detoxification
  • Inpatient Treatment (Typically 90 day minimum)
  • Intensive Outpatient Treatment (IOP)
  • Sober Living/Transitional Living (optional)
  • Continuous Random Drug Testing
  • Continuous Peer Group Support – 12 Steps
  • Case Manager – Recovery Advocate – Probation Officer

http://www.courtinnovation.org/search-results/Brooklyn%20Treatment%20Court

 

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Intervention

The TV show “Intervention” premiered in 2006.  The show highlights the intervention process and provides intervention services and treatment for individuals and their families who participate in the show.  It is not unusual for the show to receive over 10,000 submissions each year to appear on the show be families who are desperate to have an opportunity to save their loved ones.

As of September 2015, the show conducted 276 interventions.  Of those, only six refused treatment.  The show has surveyed all those individuals who said yes.  Of the 270 who went to treatment, 55% report remaining clean and sober. *

Components:

  • Intervention – (ROCK BOTTOM / Motivation)
  • Evaluation / Treatment Planning
  • Detoxification
  • Inpatient Treatment (Typically 90 day minimum)
  • 12 Step / Peer Support

Missing Components:

  • Intensive Outpatient Treatment
  • Sober Living/Transitional Living (optional)
  • Continuous Random Drug Testing
  • Case Manager – RAP

*www.businessinsider.com

 

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What Can Be Done?

According to the National Institute of Drug Abuse, long term treatment of a minimum of 90 days is what is most effective.
The numbers don’t lie. Long term treatment works. So why don’t insurance companies want to pay for it?

We don’t know.

In the long run it would save them money.

As we’ve shown, the patient who goes to treatment for 30 days will most likely fail. That failure can lead to multiple readmits, sometimes within the span of a few short months. All of that adds up to a large expense for both patients and insurance companies. Wouldn’t it be cheaper to pay once for long term care and not have to pay again?

We think so.

 

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The Disease Model

We believe addiction should be treated like any other disease.

Here are the steps to treat cancer:

  1. Diagnosis
  2. Treatment: Surgery/Chemotherapy/Radiation
  3. Monitoring
    1. For the first 3 years, patients get check-ups every 3 to 4 months
    2. From 3 to 5 years, patient check-ups are reduced to once or twice a year
  1. Aftercare

With cancer officially in remission, monitoring is still important to make sure it is caught should it come back.

At 5 years, patients are considered in remission and having survived cancer.

With cancer, insurance companies are covering every step of treatment.

 

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The 5-Year Plan

We have developed a plan we believe will lead to long-term success.

  1. Intervention – A trained interventionist will meet with the addict’s family to discuss their concerns. The interventionist then helps the addict get into treatment.   Patients are not motivated without hitting ROCK BOTTOM and this is what the intervention process helps families accomplish.
  2. Evaluation / Treatment Placement – The interventionist will work to find a treatment center that will meet all of the addict’s needs.
  3. Detox – Detox is a place the addicts can rid their bodies of most of the chemicals and get rest. Treatment cannot begin until this step is completed.
  4. Inpatient treatment – At this point, the addict may still not admit to having a problem. IP’s usually last 28 -30 because that’s all the insurance will cover. 90 days is the ideal, but rarely covered.
  5. IOP –Intensive Outpatient is the next step after IP treatment. It’s often where patients will hit their 90 days, IF their insurance is good. It offers continued support and therapy.
  6. Sober Living – Sober living provides the patient a safe and structured place to stay as they adjust to the world sober. We have found the longer people stay in sober living, the longer they are successful.
  7. Recovery Advocate Program (R.A.P.) – A long term supportive program modeled after diversion and impaired professional programs.
  8. Random Drug Testing– Random drug testing is essential to continued sobriety. All of the successful long-term programs utilize random drug testing to ensure abstinence.
  9. 12-step/ Peer Support – 12 Step group participation and peer support are critical to the development of new patters of behavior. Mandatory participation in 12 step is a hallmark of most diversion programs.

 

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What we want to see covered

Recovery Advocate Program (R.A.P.)

The Recovery Advocate Program is modeled after the programs that show success in helping those suffering from addiction establish and maintain long term recovery.  For at least a year – and up to 5 years – the Recovery Advocate works with the client, the client’s family, and treatment professional to develop, implement, and most importantly, to ensure the client is keeping compliant with treatment plan.

A detailed Behavioral Contract is established with the input of the client, treatment provider, treatment team and Recovery Advocate.  It is designed to clearly lay out guidelines as to what is expected in the upcoming year.  This contract can extend up to 5 years.  The guidelines will also help to establish healthy behaviors and the consequences if the client or family become non compliant with any aspect of the agreement.

The Recovery Advocate remains in close contact with the addict to provide support and family consequences. They also educate and support the families in enabling recovery and not the addiction. They work with every member of the client’s treatment team, including the client’s sponsor and therapist.  By giving the addict clear guidelines and ongoing structured support, the recovery process has a greater chance of taking hold and resulting in long term sobriety.

Sober Living

A safe sober environment is essential to recovery.

Most addicts and alcoholics come from chaos. Their lives have become unmanageable. It’s why many seek help in the first place.

Sober living gives people in early recovery a chance to get their lives back in order.

Residents at sober living are surrounded by people who want sobriety, just like them. They don’t have to worry about finding a place to sleep or a roof over their heads. It provides them the accountability that was lacking when they were using.

We believe people new in sobriety want to get their lives back. They want to be productive, contributing members of society. Sober living teaches them how to do that.

Most treatment plans do not consider Sober Living a form of treatment and it is not covered.

Sober living keeps addicts on track by providing structure and accountability. Without it, addicts and alcoholics face grave challenges to maintain their recovery. 

Interventions

Everyone needs some form of intervention or major crises in order to change.

Interventionists facilitate earlier entrance into treatment.  It is rare for a person to seek treatment on their own.  This is one reason why only 10% of those needing treatment in this country receive it contributing to 144 deaths per day nationwide.  Most are preventable.

Intervention programs are typically very successful at motivating clients to seek treatment.  Upwards of  98% of people intervened on seek treatment.  Interventionists are trained to work with family and friends to smash through the addict’s rigid denial and defense mechanisms and break through to reality, thereby leading the way to start the recovery process.

The intervention is not only for the patient, the most important part of the intervention is the role in changing family behaviors to support and enable recovery instead of addiction.

Some families members need treatment themselves since they are face many challenges due to the codependency that is a hallmark of addiction.  Some families are just as addicted to the chaos and reacting instead of responding.  During the process of an intervention we help the family create a family contract and educate them on what is supporting addiction and what is supporting recovery.  Different from what treatment centers provide we teach families how to get help for themselves, not just help for the addict.

The following line are studies that show the increase of success when the family is involved and learns to support the process.

http://www.springerlink.com/content/nph8q84375164x11/

http://www.tandfonline.com/doi/abs/10.1300/J160v02n01_05

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2791374/

Intensive Family Programs

Families play an important part in success or failure of the recovery process.

Addiction is a family disease. It’s hard to find any family anywhere not touched by it. Addicts and alcoholics leave a path of wreckage behind them. They are taught in recovery how to clean it up. Family members are usually not so lucky.

Broken and resentful families can be healed. They can’t do it by themselves. They need help too. Intensive therapy can teach them to take care of themselves. It can teach boundaries within the family.

A common question that many in the field hear from families is, “What can I do to help?”  Intensive Family programs provide that education and support so they are able to effectively

Random Drug Testing

Unscrupulous providers have been taking advantage of the insurance companies. They have been charging outrageous amounts of money for a simple drug test.

Random drug testing is a key component to getting and keeping someone sober. It shouldn’t cost insurance companies an arm and a leg to provide this service. For example, PHP’s are able to provide random drug screens for $50-100 per test, far less than the tens of thousands per year charged to insurance today.

THAT IS THE WAY IT SHOULD BE.

This issue is dividing the treatment industry. We want to make it very clear which side we are on.

We want to work with insurance providers to determine a fair price industry wide.

We want to send a message to providers taking advantage of insurance companies that it has to stop.  Now!

http://icotp.com/agenda-for-payers-conference/