Addiction Treatment Programs

Florida drug bust

Florida Drug Bust

The Largest Drug Bust in Brevard County History

Known for the Kennedy Space Center and the quiet beaches, Brevard County is not usually the place for crime or drug busts, but recently this sleepy county made big news. After a six-month investigation, there was the largest drug bust in Brevard County history. 60 people have already been arrested and more than 100 people have warrants out for their arrest. Brevard County police found firearms, $100,000 in cash, and a combination of drugs including kilos of fentanyl, meth, and heroin. Brevard County Sherriff Wayne Ivey commented, “That is enough fentanyl to kill everyone in Brevard County.”1

Not only was this Brevard County drug bust spanning across the county, but the sheer enormity of the bust leads to suspicion that the illegal activity was reaching outside of Florida as well. The suspects involved in the drug operation range in age and gender, proving that drug abuse knowns no bounds. The three suspected leaders of the drug trafficking include Brand Huff, Jonathan Walker, and Megan Wilborn who were taken to Brevard County Jail with high bails. 1


divorcing an addict

Divorcing an Addict

It can be difficult to watch your significant other struggle with an addiction. It can be even harder when their addiction exacerbates the cracks that were already present in your relationship.

Unfortunately, addiction and divorce can often mix. As a South Florida detox center and behavioral health care providers, we see firsthand how substance abuse can ruin marriages.  If you are divorcing an addict, we have pulled together a list of what you should expect.

What to Expect with Drug Addiction and Divorce

Divorce can have different effects for different people, especially when you have the added layer of divorcing an addict. The whole process can seem overwhelming, but our behavioral health center wants you to be prepared for the whirlwind that is about to come.


holistic treatment approach

Holistic Treatment vs. Traditional Treatment

Like many other diseases, addiction can be treated through a variety of options and there are many factors that come into play when determining the best level of care.

Everyone will experience a unique journey through recovery and there are many benefits to holistic addiction treatment as well as a more traditional route.

The addiction experts at our drug rehab in Palm Beach explain the differences between holistic treatment and traditional treatment for any addiction that is present. There are numerous benefits for both options and through professional care you will be able to start over and fully recover from addiction. If you are in need of addiction treatment in Palm Beach, read on to understand the different approaches to treating this disease.


professional treatment for addiction

Why Professional Treatment is Needed for Addiction

While some people think that addiction is a moral failing, this is not the case. Addiction is a struggle that can be perceived as a disease, and the physiological manifestations of addiction reinforce this opinion.

Studies show that when someone is an addict, their brain has a deficit in the function of the prefrontal cortex – the region of the brain responsible for reasoning, reward, and more [1]. When someone is an addict or alcoholic, their prefrontal cortex does not understand how to properly respond to stress [1]. Many argue that this is a learning disorder more than a disease, in which a person’s mind and body have learned to count on substance abuse rather than other natural coping mechanisms. Whether you consider addiction to be a learning disorder, a disease, or an unfortunate circumstance, professional treatment for addiction is key. (more…)

photo of a judge gavel and law book from a courtroom next to illegal drug needles

Does Mandatory Addiction Treatment Work?

Drug and alcohol addiction treatment in the United States has evolved considerably in the last 50 years. Our nation has slowly moved away from the philosophy of incarcerating people with addictions to providing treatment. While it has been shown that treatment is much more successful in helping people with substance use disorders (SUDs) than punishment, the question of whether or not mandatory rehabilitation can be effective remains unanswered.

Many subscribe to the belief that an addicted individual must “hit rock bottom” before he or she can get better, thus making mandatory treatment inherently flawed. The “rock bottom” theory implies that a person must get to a certain low-point in his or her life (either professionally or personally) in order to make the decision to get help and be treatable. This theory would make mandatory treatment useless, because the addicted individual did not choose to get help. Others argue that a person with a drug or alcohol addiction is unlikely to voluntarily seek treatment and needs to be pushed into it, making mandatory rehab a viable option.

Boston Medical Center’s global analysis of mandatory drug treatment programs determined there was no evidence that these programs were effective.

The Boston Medical Center is the most recent group to offer its two cents. In June 2016, the organization conducted a global analysis of the efficacy of mandatory drug treatment programs and determined there was no evidence that these programs were effective.[1] In addition, the medical center found that these programs violate human rights principles laid out in the Covenant on Economic, Social and Cultural Rights, a U.N. treaty signed by 160 states.[2]

Not All Mandatory Treatment is the Same

For the purposes of the global analysis (which did not include drug courts in America), mandatory treatment was defined as, “Any form of drug treatment that is ordered, motivated, or supervised by the criminal justice system.” But within this broad definition lies differing degrees of severity:

  • Quasicompulsory: Person is offered a choice between incarceration and treatment.
  • Compulsory: Authorities mandate treatment without allowing the person the option to give consent, decline treatment or choose the type of treatment received.[3]

mandatory addiction treatment programMost mandatory drug treatment programs within the U.S. and around the world fall somewhere in between these two extremes. In this global analysis, mandatory detention was a part of many of the programs observed by the Boston Medical Center, where hundreds and even thousands of people are detained for periods ranging from a couple of months to multiple years. These facilities are run by police officers and members of the military, rather than by medical and addiction care professionals.

This is an oppressive form of addiction rehabilitation and is not allowed in the United States or in many other developed nations. Instead, our country has relied on drug courts as a diversionary programs since the late 1980s. The first drug court was established in Miami-Dade County, FL in 1989.[4] The program was created in response to growing frustrations over repeatedly seeing the same faces in court for non-violent drug offenses. As of June 30, 2014, there were 2,968 drug courts in the United States, with programs operating in every U.S. state and territory.[5]

Specifics about U.S. Drug Courts

mandatory addiction treatment planDrug courts combine drug treatment with the structure and authority of a judge and court system. The programs provide nonviolent people with substance abuse problems with intensive court supervision, mandatory drug testing, addiction treatment and other social services in an effort to keep them out of jail or prison. When faced with the alternative of incarceration, many happily choose drug courts. Ideally, these programs help participants break the cycle of substance abuse and addiction.

It’s important to note that these programs are optional. Drug offenders must agree to all of the program’s requirements and successfully meet all obligations in order to avoid jail, have their sentences lessened or have charges reduced or dismissed. While there could be some debate as to how ‘optional’ these programs are in reality, the fact that U.S. Congress has continuously supported its development is a sign that drug courts are considered to be effective.

Since their creation, drug courts have been evaluated on the following three types of analyses:

  • Cost Savings: The amount saved in comparison to what would’ve been spent with incarceration, adjudication (court trying and sentencing) or criminal victimization.
  • Impact: Whether or not drug courts improved the lives of drug offenders compared to those who were incarcerated. Recidivism rate, employment and future substance abuse are among the factors evaluated and compared.
  • Process or Operations: This type of analysis focuses on the program’s details, such as the number of participants, referrals to treatment and the number of individuals successfully graduating from the program.[6]

How Successful Have Drug Courts Been?

While it’s widely believed that drug courts are certainly an improvement over the incarceration-focused policies of the past, there is some debate about their effectiveness in reducing substance abuse. According to the National Association of Drug Court Professionals (NADCP), drug court programs have been wildly successful in America. Here are some of their supporting facts:

  • mandatory addiction treatment requirementsNationwide, 75 percent of drug court graduates remain arrest-free for at least two years following the program’s conclusion.


  • mandatory addiction treatment resourcesDrug courts reduce crime by as much as 45 percent, compared to other sentencing options (probation, jail or prison)


  • mandatory treatment for drug addictionDrug courts produce cost savings ranging from $3,000 – $13,000 per client. These savings reflect reduced prison cost, lower recidivism and reduced victimization.


  • mandatory addiction treatment methodsParents who are in family drug court are twice as likely to go to treatment and complete it.[7]

Despite these supporting facts and figures, there have been many criticisms of the programs, namely in the evaluations themselves. Since funding is often dependent on a drug court’s ability to demonstrate effectiveness, many argue that the programs’ operators may be inclined to only report positive results or create evaluation methodologies that will ignore negative outcomes.

For example, the majority of drug court evaluation programs have no comparison group, such as offenders who refused treatment. This means that any success numbers reported by drug courts lack the context to put them in proper perspective.

“Drug court programs do not have much interaction with participants following graduation — meaning there are no long-term success or failure rates to examine.”

Another criticism is that treatment outcomes are only reported for those who graduate the program, meaning that it is not a true measure of the program’s overall effectiveness. Additionally, much of the drug court data is based on the self-reporting of participants (who are obviously motivated to report no drug use), adding another flaw. Lastly, drug court programs do not have much interaction with participants following graduation, meaning there are no long-term success or failure rates to examine.

Addiction Treatment is a Must

Though opinions vary on the efficacy of drug courts and the validity of their success-rates, there is little argument that they are more effective than incarceration. Many researchers believe that despite criticisms of drug courts, they are one of the most effective tools for combating addiction available.[8] This is because after centuries of research and observation, it has been shown that you can’t incarcerate a person’s addictions away. Drug courts allow addicted individuals to remain employed and to be productive members of their household and society.

At Behavioral Health of the Palm Beaches, we firmly support a treatment over punishment approach to addiction rehab. We offer an intensive DUI rehab alternative program and professional intervention services to help give your loved one the push he or she needs into treatment.

While it would be great if people addicted to drugs and/or alcohol took it upon themselves to get treatment, there are many who need extra motivation. We believe that the only thing stronger than addiction is love. If there’s a person in your life who needs help defeating an addiction, show how much you love and care for him or her by calling one of our representatives at 888-432-2467 to learn more about our treatment options.



photo showing the words chronic diseases next to bottle of pills and drug needle

Where’s the chronic-care approach to this chronic disease?

Most of us know someone with a chronic disease. I think of my friend who has type 1 diabetes. He’s doing OK now, but he has been hospitalized on two occasions in the 25 years I’ve known him. After being discharged from the hospital, he had numerous outpatient appointments with his endocrinologist. The appointments became less frequent as his blood sugar stabilized. To this day, he monitors his blood sugar daily. My friend knows that he has to follow a daily plan to treat his disease. If he doesn’t, he could wind up in a hospital again or have to see his endocrinologist more often. In fact, this has happened on a few occasions.

My friend used to live in New York, and moved to Florida a few years ago. When he moved, he searched for and found another endocrinologist. He has regular checkups with his new


People Who Do Not Deserve to Have a Problem: Issues Related to High-End Care

Seaside Palm Beach opened the doors to “high-end” treatment for substance use disorders in 2009. I would like to share the experience of having been the first Director, and as a person who has maintained his involvement with Seaside to this day.

When Seaside opened it was the only substance use disorder treatment program in Florida describing itself as “high-end.” It’s possible that we were the only one on the east coast. The number of programs currently describing themselves as “high-end” has grown considerably in Palm Beach County alone.

It’s worth taking a moment to ask what exactly “high-end” care is. Although there is clearly no precise definition, adjectives used to describe this manner of care have included “executive” and “luxurious.” The term “high-end” connotes “expensive,” “wealthy,” “rich.” It may not be politically correct to openly use these adjectives, nevertheless, they exist.

Discussing the reasons for the exponential growth of high-end care is not the purpose of this article; discussing the lessons learned since 2009 is.

Seaside Palm Beach is one of four treatment facilities owned and operated by Behavioral Health of the Palm Beaches (BHOPB). BHOPB’s experience in providing quality residential care for substance use disorders dates back to 1996. In 2009 providing high-end care was new for us, but providing high-quality residential care wasn’t. Seaside was planned by people who had years of administrative and clinical experience with the provision of quality care. Even so, there were lessons to be learned along the way. Sharing knowledge acquired through experience and research with our professional community has always been an integral aspect of BHOPB’s mission.

Selecting and Preparing Staff

When staffing Seaside, we looked for the most highly qualified, credentialed, and experienced staff that we could find. We searched from within our organization and externally. It didn’t take long for us to see, and to recognize within ourselves, that we held attitudes that were negatively impacting the delivery of care.

We had staff providing services who made less money in a year than our residents made in a week or a month. In fact, residents whose income was dependent on investments sometimes had more income during their stay than the staff member did. Residents often owned homes in attractive locations around the world while a staff member may have been struggling with rent (p.s. we do pay staff well). I could go on.

Staff, who ordinarily would go the extra mile for a resident, didn’t. Negative remarks about residents could be overheard among staff. Staff whom had demonstrated remarkable empathy in the past all of a sudden became unable to demonstrate that essential quality. How could they? Residents were perceived to be people who did not deserve to have a problem.

Residents were being talked about as people who lacked “humility.” How do people with extreme wealth demonstrate humility?

Staff who had been trained to help residents look deeply into themselves, now had to look deeply into their own selves. It became obvious that residents coming from wealth had to be treated as a sub-culture (NAADAC, 2009). As F. Scott Fitzgerald allegedly remarked to Ernest Hemingway, “The rich are different than you and me.”

We needed to do cultural sensitivity training with current and perspective staff. No one can change until the need to change is recognized.

We did locate some staff who did come from wealth and made the choice to give back by helping others.

What do High-End Patients Look Like?

This may be a good time to mention that residents seeking treatment at Seaside were and are significantly older than residents at BHOPB’s other centers. The average age at Seaside is approximately forty-eight years. At BHOPB’s other facilities it ranges from early to mid-thirties. There are numerous reasons for this. The most obvious is that it often takes some time to accumulate wealth.

Seaside residents tend to be proud people. They do not respond well to confrontation, particularly when it comes from a staff member perceived to be very young. Maturity should be a sought after characteristic for on-site staff. 

Age and wealth are correlated factors. Wealth is likely to have enabled substance abusers to avoid the consequences of abuse.

It is also likely that wealthier residents have not been confronted in the workplace. They don’t get referred to management, they are management. Sometimes the wealthy substance abuser is simply too powerful to confront. Confrontation as a therapeutic tool needs to be used very carefully.

It is also likely that the Seaside resident comes from a sub-culture who could not possibly be addicted. After all, they don’t deserve to be. They feel the stigma more than any other sub-culture. “With everything you have, how could you let this happen?”

They are more likely to be referred for mental health care as opposed to care for a substance use disorder.

Want to know who else didn’t think that people from this culture could have a problem. We didn’t. I feel certain that there have been patients whom I’ve treated over the years whom I perceived to be not in need of intense services because of the privileged culture they came from. Possibly I recommended people from this culture to a lower level of care than was necessary.

We Are Products of the World We Live In

When we opened our doors in 2009 we did not expect residents coming to us who had more substance use related physical deterioration than we had previously seen. There were more frequent occurrences of high blood pressure, unstable blood sugar, impaired liver and pancreas functioning, and organicity than we had previously experienced. There were ambulatory problems, particularly among women.

Having to treat chronic pain as a co-occurring disorder was also more likely. Consequences like pancreatitis are painful. So are things like falls and neuropathy. The list is long.

Severe alcoholism often requires a longer period of withdrawal management.

Since the issues mentioned above are more likely to occur, lengths of stay for withdrawal management and treatment are likely to be longer. This was recognized by the American Society of Addiction Medicine (ASAM 2013) when their recommendations included five levels of withdrawal management.

It is important that expected lengths of stay be talked about at the outset.

As part of its pre-treatment assessment process BHOPB asks each patient, including Seaside patients, to complete the Millon Clinical Multiaxial Inventory-III (MCMI III). The resulting personality profile is used to help the therapist and the patient identify both problem areas and strengths to focus on during the course of treatment.

The initial three scales (Disclosure/Desirability/Debasement) can give the therapist some insight into how the patient presents for treatment. They are referred to as “validity” scales. Patients being treated at BHOPB represent a cross section of patients who have been presenting themselves for treatment since BHOPB’s opening in 1996. Wealth may well be represented in this randomly chosen sample of 100 patients being treated in 2010. If you look at the first three scales in Figure #1

BHOPB Patients


You will notice that “Disclosure,” and “Debasement” are high relative to “Desirability.” A reasonable hypothesis would be that BHOPB patients are self-debasing (low self-esteem, self loathing) and are willing to tell you about it. This pattern on the “validity” scales tends to falsely elevate scores on clinical scales. In other words, BHOPB patients may not be as impaired as their personality profiles would indicate. Whatever their issues are, the issues are probably complicated by low self-esteem.

A major goal of treatment would be to increase the patient’s self-esteem. Continued low self-esteem could be counted on to be a relapse issue.

Now look at Figure # 2. For Seaside patients, “Desirability” is elevated when compared to “Disclosure” and “Debasement.” This pattern is totally opposite that seen in Figure # 1.

Seaside Patients


This “validity scale” pattern is indicative of patients who are suppressing clinical issues. The remaining clinical scale scores will be artificially low. Therapists will have to pull teeth to get issues to work on from these patients.

This is not to say that Seaside patients are lying. They may be totally unaware of where to start.

Ironically, it’ easy for the therapist to follow them into the trap. At the end of a busy day it may seem delightful to have a patient without problems walk through the door.

Perhaps this is another argument for lengths of stay. It will take these patients a longer time just to scratch the surface.

Are “High-End” Patients More Narcissistic? If all you do is look at Figure # 2 you might conclude that they are. However, it’s probably worth stopping to think that the MCMI III was normed on a broad range of people, not just a “high-end” group of people. Are patients seeking “high-end” care using self-centeredness and grandiosity as a means of avoiding issues, or are they really that important?

These are not people who think they are God; people have been treating them that way. OK, that’s an exaggeration, but not by much.

Point is that a sense of self-centeredness and grandiosity may not be a means of avoiding issues for this population. It may be who they are.

In that case, it would not be an issue to work on.

What is Powerlessness and Unmanageability to this Group?

We’ve treated people at Seaside who have been pushed out of companies they may have started. When this occurs there’s usually a financial package, a golden parachute that goes along with the departure. Golden parachutes have ranged up to $40,000,000.

There are other times when there isn’t a severance, but the person is simply not involved in the company. Their name may remain on the door, but they are basically ignored and everyone knows it. However, the person is still receiving a very significant financial benefit.

Question becomes would a salaried therapist recognize this as powerlessness and unmanageability? A skilled, mature therapist who recognizes the downside of wealth would. It could be said that the head of a company has taken a bigger fall than a salaried person losing a job. Having spent time with a high-end population, I know this to be true.

There have been instances when relatively young people have sold companies and have looked forward to a life of leisure. They soon realize that playing golf goes only so far.

Of course people who have experienced wealth have also experienced powerlessness and unmanageability. Therapists need to be trained on where to look for it. They also have to be trained to empathize with a patient who has made more money than the therapist can imagine. This is not always possible, skilled therapists have to be selected.

Abandonment/Attachment Issues

There’s no evidence that high-end patients differ from more traditional patients seeking treatment for substance use disorders when it comes to abandonment issues/attachment issues. Having observed high-end patients for a considerable period of time I’ve come to believe that their abandonment/attachment issues are just different.

We’re used to seeing patients who have been abandoned by sexual abusers, substance abusing parents, parents who left the household, etc.

High-end patients may never have felt that they were abandoned by a parent. The parent was never available. They were brought up by a series of nannies some of whom they became attached to. Inevitably, that nanny was replaced.

As they got older it was a matter of moving from one boarding school to another.

It’s harder to identify abandonment/attachment issues when patients believe that the issues are not there. After all, everyone else they knew was brought up in a similar fashion.

So, a therapist should never conclude that abandonment/attachment issues don’t exist. Therapists need to learn where to look for them.

What Does High-End Recovery Look Like?

Traditionally, patients completing treatment for an addictive disease would be recommended to do 90 in 90: 90 12-step meetings in 90 days. It’s likely that they would be referred to a lower level of care such as intensive outpatient, and would likely be referred to a one on one therapist as well. This certainly doesn’t describe all discharge plans, but it’s close.

Sometimes there is resistance, but options are limited by financial issues, insurance coverage, ability to be given time to blend recovery and work.

Some people just don’t like the 12 step recovery process.

I know all of the arguments. I’m a person whose life has been saved by Alcoholics Anonymous (AA). However, I can understand the resistance.

We can’t push 12-step recovery down someone’s throat.

The problem is that there is no other form of support for recovery that is as available as 12-step recovery. It’s also free. “Free” is a wonderful thing, 12 step recovery is a wonderful thing, but what about people who have more options and more resources.

Some “high-end” patients might have a therapist or team of therapists available to them 24/7. Is this as good as 90 in 90? It may be, but it’s not free. In fact, it could be incredible.
I’m aware of a patient who traveled with a personal therapist and a nurse. Sober coaches and sober companions are really good sources of support.

Fact is that patients with wealth have more options than other people. I can only wish that all of these forms of support were available to everyone, but they’re not.

What happens on some occasions is that a wealthy patient is being case managed by a person who has resentments. It may be a person who is thinking “I got sober with AA, why can’t she?”

Summary and Conclusion

At Seaside, we\’re going on our 6th year of providing care to people who are frequently referred to as “high-end,” “executive” or exclusive in some way, shape or form. BHOPB’s mission has always included the sharing of experience, strength, and hope with our professional community. “High-End” programs seem to be popping up everywhere. So we are sharing what we have learned.

One thing is to pick and train staff very carefully. If a salaried staff person tells you that they don’t have resentments toward people with extreme wealth they’re either in denial or out right lying. It’s important to recognize it.

It is also important to look for staff who can relate to, or come from wealth themselves. Believe it or not they exist. Maturity should be a sort after quality when choosing staff.

High-end people come to us with patterns of denial, issues and character traits that are not all that different than our more traditional patients. They are just displayed differently and a trained therapist needs to know where to look.

The world is not fair or equitable. It\’s not the fault of the patient. It’s important to accept that people with resources may have a path to recovery that is different than those we’ve seen in the past. The objective should be to bring everyone up, not to bring a fortunate person down.

Most of all, these are people who deserve to be cared for. Addictive diseases do not discriminate. If anything, they hit a person with wealth much harder. Being able to avoid consequences is not always a good thing.

We are also treating people who are smart, creative, and often become passionate about recovery. Sometimes they are in a position to help others.

Mostly what I’ve learned, people are people.

Old Baseball on Wood

Treating Seniors for Addictive Diseases: It’s a Whole New Ballgame

In 2013 the American Society of Addiction Medicine (ASAM) designated “seniors” to be a special population. Since that happened a number of quality treatment programs have attempted to enhance the services they provide to senior patients. In my professional experience I have found that there is a lot to be considered when treating seniors for addictive diseases. To properly treat seniors for addiction, it takes a lot more than making a few adjustments to a rehab’s existing treatment program that is already being used to treat their younger patients.

Behavioral Health of the Palm Beaches (BHOPB) is one of the leading addiction treatment providers in the country today. We are proud to offer patients several paths to recovery, including gender-specific and highly individualized care. Seaside Palm Beach is the luxury rehab facility at Beahvioral Health of the Palm Beaches. I’ve been fortunate to be directly part of Seaside Palm Beach since its opening back in 2009, and I know that it was not specifically designed to provide senior care when we first opened.

However, highly individualized care is expensive, so it may not be surprising that Seaside has attracted an older population than most of BHOPB’s other facilities. Honestly, this was not anticipated when the doors were opened in 2009. Highly individualized care is very good care. It so happens that Seaside has been affordable to a more senior, successful and entrepreneurial group of people.

We didn’t anticipate the downside of achieving success. Successful people have been fairly good at avoiding consequences and are less likely to experience confrontation from colleagues, family and peers than their less successful counterparts. Seniors in need of addiction care generally have a longer history of substance abuse. It is not uncommon for us to treat patients who are baby boomers and have been using alcohol, benzodiazepines, and/or opiates for twenty to forty years.

Who is a Senior?

Our country’s population of seniors is growing significantly because of our baby boomer generation. There are 50 million people over age 65 in the United States, and people over 70 are the fastest-growing group in the nation (Vimont, 2015). Would this entire population meet the admission criteria for senior specific care? It’s unlikely. Age needs to be a factor, but far from the only factor. Other things need to be considered: substance use history, medical/neurological impact, and psychosocial factors.

It may sound reasonable to say that a person who is fifty-five years old would meet the admission criteria. However, there may be some fifty-five year old people who have used substances for a very short period of time. There may be forty-eight year old people who started using at the age of fifteen. The forty-eight year old may meet the criteria. The fifty-five year old may not. There are numerous factors that would need to be considered.

Withdrawal Management:

It would not take long to realize that traditional withdrawal management protocols are not likely to be effective when managing the withdrawal of a senior with a forty-year use history. In these cases withdrawal management protocols should be extended.

Perhaps that’s one of the reasons why ASAM designated seniors to be a special population. Traditional protocols need to change.

ASAM (2013) has described five levels of withdrawal management:

  1. 4.0 Medically Managed Inpatient
  2. 3.7 Medically Monitored Inpatient
  3. 3.2 Clinically  Managed Residential
  4. 2.0 Ambulatory extended on site monitoring
  5. 1.0 Ambulatory without extended on site monitoring

All five levels need to be considered when treating seniors.

Medical/Neurological Concerns:

With longer histories of substance abuse come more substance-related physical ailments. Seniors will bring more instances of chronic hypertension, diabetes, liver and pancreas damage and other ailments often associated with chronic substance use disorders. A treatment program for seniors will need to have the ability to provide or access a higher level of medical care than has been provided for younger populations.

Long histories of substance abuse may cause extensive brain damage. I’ve seen men and women arrive at Seaside who can be ambulatory only with the help of a wheelchair or walker. More senior women have fit this description than men. It is likely that chronic substance abuse has impacted their motor cortex. The only upside is that the motor cortex begins to heal quickly. Three to four weeks into recovery they get around just fine.

Other areas of the brain that have been damaged seem to take longer to heal.

Long histories of substance abuse can also cause severe memory loss, cognitive impairment (Korsakoff’s psychosis, Wernicke’s syndrome), and accelerated dementia. I have worked professionally with people having addictive diseases for almost thirty years;  it’s only been in the past five that I’ve encountered two senior gentlemen who could not be treated in the setting that I’m familiar with. In the afternoon they could not recall what took place in the morning.

Seniors may experience the worst consequences of addiction. It is truly sad to see people who have been bright, hard-working, successful and creative, and who have raised families and often made significant contributions to our culture be reduced so much in their later years.

I’ve witnessed cases of alcoholism that have been different from what I’ve seen before. I’m talking about a few people between the ages of fifty-eight and seventy-seven whom I believe truly could not stop drinking alcohol outside of a structured setting.

I have a patient who is ninety-two years old who is functioning well, which is another good argument for individualized care.

Length of Stay:

Sometimes our senior patients have unrealistic expectations about how long it will take them to get well. These estimates are likely to formed from observing younger people who are also in recovery. 

I think that families and patients who meet the criteria for admissions into any seniors’ program need to accept the reality that a longer stay will usuaully be needed then the average stay for younger patients.

Other Things to Consider:

Helping our senior patients maintain their dignity is of the utmost importance to us. Let’s not forget that seniors have not been enlightened to the fact that an addiction is a disease; even many younger people still have a hard time accepting it. So the time-honored technique of “confrontation” should be avoided (ASAM, 2013), especially if it going to be coming from a therapist half their age.

As much as possible, staff should be mature and experienced. Staff needs to be able to relate to senior issues such as isolation, changing role in the community, mortality and many other speicialized considerations.

Family treatment also needs to be different. It too needs to be provided by age-appropriate staff that is more likely to be dealing with adult children than spouses.

The whole point of this article is to say “give a lot of thought to the needs of seniors” before installing a program, It’s not a matter of a few adjustments, it’s a whole new ballgame.

A lot of of what we know about treating addictive diseases is based on people in their early to middle years—from the Baby Boomers generation when they were young. Those who have survived wars in Korea and Vietnam, as well as those who attended Woodstock are showing up on our doorsteps today for treatment as seniors. As addiction treatment professionals we need to do the right thing for them and by them.



Calendar Pages and Dates

If Addiction is a Chronic Disease, We Need a Chronic Care Model to Treat It

I have this friend of mine who has a chronic disease: type 1 diabetes. He’s doing OK now, but he’s been hospitalized on two occasions in the twenty-five years that I’ve known him. After being hospitalized, he had a lot of outpatient appointments with his endocrinologist. He had frequent check-ups. While the frequency of the appointments seems to have slowed down, he still checks his blood sugar daily. My friend knows that he has to follow a daily plan to treat his disease. If he doesn’t, he could wind up in a hospital again or have to see his endocrinologist more often. In fact, this has happened on a few occasions since I’ve known him.

My friend used to live in New York. He moved to Florida a few years ago. When he moved to Florida, he searched for and found another endocrinologist. He has regular check-ups with his new physician. All seems to be going well.

My wife suffers from a different chronic disease: hypertension. Her treatment routine is very similar to that of my friend with diabetes. She has frequent check-ups. She was hospitalized on one occasion. After we moved she found another physician to monitor her hypertension. All is well today.

Historically, patients going through residential care are being told that they have a chronic disease, but the disease has been treated like an acute occurrence; this is in the process of changing.

I have a chronic addictive disease. However, the course of my treatment has been much different. I was treated for 28 days in 1983 which was followed by fifteen weekly group counseling sessions. I haven’t seen a physician since nor has seeing a specialist of any kind been recommended.

When a person leaves the hospital after developing chronic heart disease, they have an appointment scheduled to see a cardiologist. That person will have a cardiologist on their medical team forever. How come I don’t have an addictionologist?

I know someone who had their appendix removed some time ago. His appendix was diseased, it was removed. It was over. This person has not seen an appendix specialist since nor has he had any further difficulties. It was an acute occurrence and was treated as such. It seems that addictive diseases have been treated more like an appendectomy, an acute occurrence, than like chronic diseases such as diabetes or hypertension.


We Need to Change How we Think, How we Talk and What we Do:

Patients Do Not “Complete” Treatment

It’s up to us to stop giving patients the impression that they’ve “completed” treatment after they’ve met the objectives of inpatient or residential care. Remaining abstinent from substance use while in a safe, secure environment is hardly completing treatment for a chronic disease. Yet, we’ve given that impression.

We’ve Had “Coin-Out” Ceremonies or “Graduations”

Perhaps something like a “commitment to recovery” celebration would work better. It would recognize that hard work has been done, but that their work is hardly complete. It’s only the beginning of a lifetime of recovery during which there will be many celebrations.

Let’s Stop Asking Patients: “How many times have you been in treatment?”

It’s like asking them: “How many acute episodes have you had?” It also conveys: “How many times have you failed?” No one has ever asked my diabetic friend: “How many times have you been in treatment?” No one asks because diabetes is recognized as a chronic disease. My friend wouldn’t even understand the question.

We Still Treat Patients Who Need a Higher Level of Care Like they Have No Experience with Recovery

People enter recovery when first diagnosed. It’s likely that coming back to a higher level of care was preceded by a period of not treating their chronic disease, but even that was an experience that a first-time patient is lacking. We tell patients that doing the same thing over and over and expecting different results is a good definition of insanity. Why do we do the same thing? It demeans us as professionals.

Discharge Planning Has Not Received the Attention It Deserves

A close friend remarked that “The single most important thing that we do in treatment (residential or inpatient) is discharge planning and we give it the least amount of attention.” Maybe it’s not the “least amount of attention,” but it isn’t given the attention it deserves.

There’s being in treatment, and then there’s the rest of your life. Which is more important?

A discharge plan is essentially an assessment of the patient’s performance in treatment: which treatment objectives were met, which ones were deferred, which ones need more work, which new issues, if any, have come up in treatment? The plan needs to address medical, emotional, motivational, relapse and recovery environment issues. The discharge plan needs to be the next provider’s starting point. It is also the document that gives the next professional their first impression of the treatment provider. First impressions are hard to change.

It is also a legal document. It has to make sense.

The next provider (next level of care) needs to be carefully determined.  Continued care recommendations vary. For the most part, they are individualized, but it’s hard to tell what criteria were used for the patient’s next placement. Actually, little clinical information is provided. In particular, there is very little discussed about a patient’s motivational level or recovery environment.

Discharge planners/case managers need more training and more involvement with the clinical team.  There is a need for a discharge summary that looks more like an assessment.

What Treatment Needs to Look Like

It’s actually quite simple: it needs to look like how we treat any other chronic disease. The intensity of care should always match the severity of symptoms. When I say that people in recovery need to be in treatment “forever” I clearly do not mean a continuously high level of care.

Personally, I see my dermatologist every three months, whether I feel like I need to or not. I have skin check-ups. There have been times when I developed a basil cell skin cancer. The intensity of treatment increased. As I got better the frequency of my check-ups came down.

What about “recovery check-ups?” (White, 2014) How about at least semi-annual addiction check-ups?

Who would do them? How about an Addictionologist? What’s that? It’s a physician who has been certified by the American Board of Addiction Medicine (ABAM). Before actually sitting for the exam offered by ABAM, the physician would have completed a residency in Addiction Medicine. There are approximately 3000 board certified Addictionologists in the U.S. The numbers are growing. If you are in recovery, find one! Let\’s call this “Medically Monitored Recovery.”

If we treat addiction like we treat any other chronic disease, this all begins to make sense. Anyone who is fortunate enough to have achieved long-term recovery will have experienced illnesses, prescribed medications, surgeries, anxiety, depression, pain, sleep disorders, loss, changes in recovery environment, etc.  How do people get through all of that and remain drug free? The answer is that many don’t. Recovery monitored by an ABAM/ASAM primary care physician could help many more people achieve long-term recovery.  

The faster we change how we talk, what we think and what we do, the faster shame will disappear from the treatment of addictive diseases.