Leaders in Modern Addiction Treatment

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1 Issue Date: April 2010 Cover story Remembering history, creating history NAATP's new generation points to the future of addiction treatment by Brian Albright Over the past several decades, the field of addiction treatment has gone through numerous changes, from the development of the Minnesota Model of treatment nearly 60 years ago to the use of experiential therapies and advancements in neurological or pharmacological treatments today. As the founders of modern addiction treatment leave the field and a new generation of leaders emerges, treatment professionals are looking for ways to move the industry forward while still honoring those early pioneers. Many of these new leaders have had first-hand experience in recovery and their treatment experiences inspired them to help others. But while they are steeped in traditional approaches to addiction treatment, they have also embraced new ways to expand treatment options and make treatment available to more people who need it. This next group of leaders is coming out of a traditional treatment background, but they are going to provide leadership in expanding our approach to treating addiction, says Ron Hunsicker, president and CEO* of the National Association of Addiction Treatment Providers (NAATP). They have all of this history to build on, and they can now take that knowledge to help create the next level in our field. An open container One of those new leaders is Bob Ferguson, founder and director of the Jaywalker Lodge in Carbondale, Colo., who began his career at ground zero of the modern addiction treatment field: the storied Hazelden clinic in Center City, Minn., where the Minnesota Model was originally developed. Bob Ferguson, founder and director of the Jaywalker Lodge Ferguson, formerly a New York City journalist, first came to Hazelden in 1992 as a patient after two failed attempts at getting sober. He stayed on in the St. Paul sober community, eventually working at Hazelden himself in continuing care and alumni relations for six years.

2 Without formal or clinical training in treatment, I really came through my own recovery story, framed by my Hazelden and St. Paul experiences, Ferguson says. My roots in the field are really my own sober roots and in the Minnesota Model of care. He later worked at the Crossroads program in Antigua (founded by guitarist Eric Clapton), followed by Promises Malibu, which showed Ferguson the value of establishing a bridge with local Alcoholics Anonymous programs. He founded Jaywalker in 2005 in order to take the basic principles of the Minnesota Model and combine them in a more open residential treatment setting that emphasized community interaction and recovery. The 120-day program is based around what Ferguson calls an open treatment container that focuses on interacting with the community in recovery within the facility as well as the community at large. That is counter to how you are seeing treatment centers marketed on the Internet, Ferguson says. We believe the safety and welfare of the group as a whole supersedes the wants and needs of individuals. Jaywalker Lodge in Carbondale, Colo. Patients attend 12-Step meetings across the region, participate in wilderness activities, and do service work as well-everything from helping flood victims in Iowa to assisting with the construction of new buildings on Native American Indian reservations. You have a higher risk and higher reward proposition, Ferguson says. It's not right for every client, but if you catch somebody in the right point in recovery, then I say get them out of the closed campus or institutional setting and focus on initiating life in recovery. Now with 34 beds, Jaywalker has developed a reputation for providing effective treatment for men with a history of relapse, and also helped foster a vibrant aftercare community, which Ferguson believes is an increasingly important part of any addiction treatment program. A clinic reborn Dwayne Beason, president and CEO of St. Christopher's Addiction Wellness Center in Baton Rouge, La., is not only playing a role in the future of addiction treatment, he actually helped revive part of its past when he re-opened St. Christopher's in 1998.

3 Dwayne Beason, president and CEO of St. Christopher's Addiction Wellness Center Beason's introduction to St. Christopher's came when he went through treatment himself in 1988 and was referred to the halfway house. The facility closed while Beason was working at a local hospital, but after attending a wedding where he was able to count at least ten men who had gone through the facility and were still sober nearly a decade later, he made it his mission to re-open St. Christopher's. By the time he achieved that goal, though, treatment had changed considerably. St. Christopher's Addiction Wellness Center in Baton Rouge, La. Managed care had stepped in, Beason says. When I was in treatment, you went through a program and then to a halfway house. When I reopened St. Christopher's, most of our referrals were from failed outpatient experiences. There were a lot of retreads. A lot of the focus had gotten lost. St. Christopher's takes an integrated 12-Step approach that includes intensive therapy (both individual and family) and a focus on shame reduction. The clinic provides both inpatient and outpatient services, operates a recovery home program, and has an active alumni program. Beason has also worked tirelessly to keep treatment affordable. When managed care started cutting their benefits, it impacted success rates, he says. We brought St. Christopher's back to provide treatment regardless of what the insurance companies are doing, and to provide services in a way that we feel are going to provide a long-term recovery for our patients.

4 Striving for excellence In addition to being part of the next generation of treatment providers, Jamison Monroe, Jr. is also helping to treat the next generation of recovering addicts as CEO and founder of Newport Academy, a youth treatment center in Orange, Calif. Jamison Monroe, Jr., CEO and founder of Newport Academy Like Ferguson and Beason, Monroe went through rehab as a youngster, finally achieving sobriety after receiving comprehensive treatment at a center that focused on family involvement. Within three months of being sober, he was working at a 52-bed facility in Laguna Beach and was quickly promoted to a management position. He later assisted a friend in opening an adult treatment center in San Juan Capistrano. By that point, Monroe was already laying the groundwork for Newport Academy, which he envisioned as a center of excellence for adolescent substance abuse. The facility opened its doors in I'm a big believer in surrounding yourself with people that are the best at what they do, Monroe says. I had a vision of creating a center of excellence that offered the best treatment available to adolescents and their families. Newport Academy in Orange, Calif. Monroe feels his roots in the field lie in his focus on treating the underlying causes of addiction. I don't want to call it holistic, because that word is too broad and overused, Monroe says. The

5 kids we see these days, 90 percent of them have some form of psycho-social trauma that needs dealt with in ways other than just telling their sponsor. Newport includes a team of clinically-trained therapists to help residents work through those issues. Families have to be involved on a weekly basis. Newport also follows a 12-Step approach in addition to incorporating evidence-based experiential therapies, like equine, art, and dance therapies, as well as yoga, Tai-Chi, and mixed martial arts. These are things that are going to be stimulating for teenagers, Monroe says. The facility is also fairly small with a high staff-to-resident ratio. We have two programs, one for girls and one for boys, and we only have six kids in each program with more than 50 staff members for those 12 kids, Monroe says. No one has a cookie-cutter treatment plan. The team meets twice a week and we're always adding to or changing the treatment plans if need be. Mentors provide guidance In addition to their background in recovery, Ferguson, Monroe, and Beason share a great respect for the treatment professionals who have mentored them in their own careers. For Monroe, two women have influenced his approach to treatment and continue to provide guidance now that the center is up and running-ann Premazon, a 30-year veteran of the field, who currently serves as CEO of Premazon Internet Business Consulting ( and Barbara Woods, another long-time mental health professional who currently serves as the national director of business development at Casa Palmera in Del Mar, Calif. Ann really pointed me in the right direction from day one, and Barbara took me under her wing from our first meeting, Monroe says. Without both of these amazing women I would not be where I am today. Monroe also has the advantage of working closely with two mentors on his own staff: Dr. David Smith, the founder of the Haight Ashbury Free Clinics of San Francisco, and executive director and co-founder Scott Sowle, who has more than two decades of experience in the field. Beason has also been able to continue working with one of his mentors at St. Christopher's. In his case, that mentor is Bill Hite, who serves as St. Christopher's director of referent relations. Bill is one of the few people in this area that I know that has not only run a program, he's done his own work in the field, Beason says. Ferguson identifies John Curtiss, director of the halfway house at Hazelden and the man who first hired him, as my own personal hero. Curtiss went on to develop his own program called The Retreat in Minnesota that Ferguson used to model his program at Jaywalker. It provides a complete spiritual immersion in the 12-Step community, but keeps costs at a minimum by using volunteers from the AA community, Ferguson says. Ferguson also points to Mike Schiks, former head of Hazelden's recovery services and now CEO at Project Turnabout in Granite Falls, Minn., as well as Velvet Mangan of Safe Harbor for

6 Women. Velvet understands the residential treatment container at a level that I can only hope to replicate, Ferguson says. She creates this incredibly safe space for women so that they can begin to heal, and that's how Jaywalker is positioned for men. A bridge to the future As for the future of addiction treatment, all three agree that the trend toward longer lengths of stay and more robust aftercare services will continue. Treatment today is more about starting life in recovery, not just stopping addiction, Ferguson says. The physical treatment settings are different, the counseling strategies are different, the community interactions are different, and what success looks like after treatment changes, too. The real question is how to manage a lengthening continuum of care in a way that makes services affordable, he adds. In the short term, those financial issues are a key concern for both patients and providers, particularly for private-pay facilities. Despite opening his facility in the midst of the worst economic downturn since the Great Depression, Monroe reports that Newport is doing fairly well. If you create something that has great value, people are going to find it, Monroe says. There is hard work and there are challenges with every startup, and I'm sure the economy has affected us, but so far we're on track. Tightening credit markets, though, have made it tough for families to afford treatment, particularly if extended care is necessary. In the past they could borrow money to get treatment for those loved ones, Beason says. Now they aren't able to put their hands on those resources, or it takes them several months to do so, or in some cases they're scared to spend the money because they aren't sure the person is really ready for treatment. So not only does the patient show up a little bit sicker, the whole family really needs a life preserver. Ferguson says Jaywalker has been doing fairly well despite the economy, but adds that his staff works hard to help patients find affordable treatment, even if it's not at their facility. We stay engaged and make referrals to partners and colleagues who provide services that work better with insurance, Ferguson says. We think matching the right patient to the right program can be a cost-independent exercise. Despite those challenges, there is plenty to be excited about when it comes to innovative treatment approaches. Beason sees post-care monitoring as having great potential. Some of the highest success rates in addiction treatment are among professionals like doctors or lawyers, where they are monitored in

7 order to maintain their licenses, Beason says. We've established aftercare monitoring that has been very effective. For instance, if the patient is a pill addict and drug seeker, he is asked to write letters to his doctors, pharmacists, and dentists disclosing his problems. They also agree to attend aftercare and 12-Step meetings, and to call in regularly to see if they need a random drug screen. Beason, Ferguson, and Monroe also see the industry focusing more on treating the underlying causes of chemical addiction rather than simply focusing on abstinence. We see a lot of dual-diagnosis kids coming in with missed diagnoses because they haven't been observed for an extended period of time, Monroe says. We also have to do a better job of screening for other addictions that can lead people back to chemical addictions, like gambling or cyber sex, Beason says. If you don't screen, those problems never get dealt with. There are other treatment areas that are in the nascent stages within the industry, such as genderspecific treatment programs, online counseling, and the integration of pharmacology with spiritual- and abstinence-based programs. Monroe has been investigating brain imaging and biofeedback, for instance, and Ferguson has looked at the possible benefits of concentrating on smoking cessation in conjunction with addiction treatment. *On March 31, Hunsicker was suspended by the NAATP board pending an investigation by the Pennsylvania Attorney General's office. See for the latest updates on this story.