How to Choose the Right Treatment Program for You and Your Family

0:00:13 William Moyers
Hello and welcome to Let's Talk, a podcast series produced by Hazelden Betty Ford. I'm William C. Moyers, your host. And today our topic is about how to find an organization or facility that is appropriate for you or a loved one who needs treatment for a substance use disorder. In 1989 when I was sick with addiction to alcohol and other drugs, and was locked in a psychiatric ward in New York City, my parents did not know where to find help. But a doctor told them about Hazelden. And based on Hazelden's reputation and the modality of treatment offered there, off to Hazelden I was sent. And so began my journey, my imperfect journey, on the long and winding road of recovery. Back then there was no Internet. And word of mouth or reputation counted a lot. Stigma too kept people from asking or talking about treatment options. Fortunately, it isn't like that anymore. Though certainly reputation or recommendation still does matter.

0:01:15 William Moyers
So, what to do when a plea for help turns into a need to find help? I'm joined by two colleagues whose expertise comes from their perspectives down in the trenches where people take that first step away from addiction and into treatment. Tessa Voss is the Executive Director of the Betty Ford Center in Rancho Mirage, California. In the past decade with this organization, Tessa's held many clinical and leadership positions at various sites. Cecelia Jayme is the Clinical Director at Hazelden Betty Ford in Center City, Minnesota. Cecelia has been integral to the growth and expansion of the programming at the Center City campus over the past 26 years. Including the Betty Ford Women's Recovery Center. Welcome to both of you for joining us today.

0:02:04 Cecelia Jayme
Thank you, William.

0:02:05 Tessa Voss
Great to be here.

0:02:06 William Moyers
And great to have such expertise and commitment, passion, that both of you bring. Not just to this podcast but to the mission at Hazelden Betty Ford. Cecelia, I'll start with you. What should somebody look for or focus on in considering a facility?

0:02:23 Cecelia Jayme
Well William, one of the things that we know in the United States is that there's over 23 million adults who would benefit from substance use disorder treatment. Unfortunately only about 25 percent of them ever actually arrive in treatment. Substance use disorder is a chronic disease. It impacts the mind. And so it seldom lives alone within that identified person's body. So the person suffering from substance use disorder—there is no one size fits all. So first and foremost, we wanna do the research to make sure that things are being addressed. Such as if I have medical illnesses along with my substance use disorder, some mental health aspects, and you really wanna know that the facility that you're going to is credentialed. That it has a good reputation. That its clinicians are well-educated and supervised. Much of what you talked about in terms of reputation is important. I'll just give an example. When we look at a privately researched study that was published in Very Well magazine recently, they identified the ten top treatment centers in the United States. And I think what they say in this research is that what they're looking for is that it's a treatment center that has the ability to address the various issues at various levels of care because not all patients are the same. They have their individualized issues.

0:04:24 William Moyers
[nods] Thank you. Tessa, why do credentials matter when it comes to clinical staff?

0:04:31 Tessa Voss
Credentials matter for a few reasons. One, it represents the training that someone's received to ensure that they know the best practices to treat substance use disorder, mental health, medical needs. And also, you know, we look at credentials also for our facility. So like Joint Commission accreditation is one that we use. We're Joint Commission accredited. And you can see that easily on a program's website. But that is important to know that there's other—there's a certain level of standards upheld. To ensure that people really get good quality treatment and meet high levels of standards.

0:05:20 William Moyers
Mmm-hmm. Tessa, what about the ASAM criteria? Can you just explain a little bit about what ASAM is and why those criteria matter?

0:05:27 Tessa Voss
Sure, I'd be happy to. Many people don't know that there are standard practices and criteria for establishing that someone has a substance use disorder, first of all. And then to assess whether and how they make progress. The ASAM criteria is also used to place people in the level of care that's right for them. It is six different dimensions related to the whole person. So, it can start with their withdrawal and if they're expected to experience withdrawal. Some people do and some people don't. And then in between, there's various different levels that someone might experience withdrawal. Then there's medical and mental health. And that includes things like co-occurring medical or mental health struggles that someone might have. Again someone also may not have those struggles. The ASAM criteria also include things like where someone is at in their change process. And so as humans, we all are in a series of change processes for different things that we're going through in our lives. And this relates specifically to them and their substance use disorder. We look at relapse potential and the risk of returning to use and what might happen if someone did return to use. And then lastly, recovery environment. And that includes what kind of support do they have in their personal life? Maybe someone has been in recovery for years, had a recurrence of symptoms, and is planning to go back into their recovery network. That's a very different clinical situation than someone who has never been in a program of recovery and a lot of their social and environmental experiences are around substance use.

0:07:06 William Moyers
Hmm. Cecelia, you and I have been around a long time. When I was a patient at Hazelden in 1989, all three of my counselors you probably knew who they were, were men who had been in recovery. When somebody's considering a treatment facility, should they be considering whether or not the counselor that their loved one or themselves are gonna be with is a person recovering? In other words, do people, do counselors, need to be in recovery anymore to be good counselors?

0:07:34 Cecelia Jayme
You know, I'm glad you asked that question. Because it's a very important point to make. This is a disease of the brain and it impacts organically and genetically features of our brain. It impacts features of our body, it impacts our spirit. So, it is imperative that we have a support system with other recovering people. But it is not important that the clinician is a recovering person. It's important that the clinician understands all aspects of your disease. So, while being in recovery can be supportive of a fellow in recovery, sharing experience, strength, and hope, but I'm gonna want a clinician, an expert, to help me identify changes needed, what's going on. I mean we're talking about a disease that may require not only abstinence or a reduction in substance use, but a disease that may need to have medication assistance. It may need to have medical assistance. And I want an expert to treat that disease.

0:09:04 William Moyers
Which is why those credentials are so important. If they have the personal experience, that might be the bonus, that certainly isn't gonna be a hindrance. But it's those clinical credentials that really make the difference. So Tessa, you were talking earlier about levels of care. Once upon a time, when you quote “went to treatment” [uses air quotes], you went to treatment and you packed a bag and all those other things. But, people don't need to consider—or when they're considering a facility or an organization to get professional help, they don't just consider packing a bag and going, right?

0:09:41 Tessa Voss
You're right, people start at various different levels of care. That could be residential like you're talking about. Packing a bag and spending some time away from home. In a really structured environment where there's a number of different staff and experts to help them. As well as living with a community in the residential setting. Some people need that and do start there. Others start at a day treatment level. Which is about 20 hours a week of treatment. Groups, individual sessions, and community. Others start in intensive outpatient. Which might be nine hours a week in groups and individual sessions.

0:10:16 William Moyers
Hmm. And Cecelia, another factors that families or individuals need to consider is the role that insurance plays. Not just in how much they're gonna cover in terms of a treatment experience, but whether they cover it at all. Can you talk a little bit about what people should consider there?

0:10:35 Cecelia Jayme
Actually, it is very important for people to think about their insurance coverage. Because different organizations are able to accept insurance from various places. So, coverage needs to be a part of your policy. You can't just assume that this will be covered at this place. So, I feel very fortunate that in working with Hazelden Betty Ford, we work within most of the large insurance companies. There's over 35 insurance companies and then all their subsidiaries that we do have contracts with. But, it is important that we recognize as with any hospital type of program that this is a chronic disease. And what that means is that there's no absolute start and end date to your recovery process, right? And you wanna use your resources to manage this disease over the course of a long period, a lifetime. So, we really—I encourage people to talk to their benefits providers and their insurance. I know that we have a resource here when people call in to ask about insurance to check that we're also involved with our patient care network so we can direct people in other areas. So, checking insurance is important because you're gonna need those resources over a long period of time. And insurance companies are invested in seeing you get well. So they're gonna invest in making sure that you're getting that treatment with your resources over the longest term possible.

0:12:27 William Moyers
[nods] Tessa, why is it important that a family or an individual consider the mental health component of a treatment center's continuum?

0:12:38 Tessa Voss
Definitely. You know, in years past, we really—people tried to in the addiction field tried to really parse out, you know, this is addiction treatment, rather than, you know, mental health. And when we know how this illness works, and we know how people are, we realize that it all needs to be treated together. In an integrated way. We are whole people and so you need the services available. If someone has substance use disorder as well as a mental health condition, they need to be treated at the same time in a way that really respects the whole person. And helps them set them up for long-term wellness.

0:13:20 William Moyers
Mmm-hmm. And Cecelia, what about culturally specific treatment options? And I say that not just in the context of culturally specific, but some of the other issues that people need to consider such as gender specific. Or, you know, in the case of the role that you play there, treatment for women. Can you talk about that?

0:13:41 Cecelia Jayme
You know, what we need to understand is that we have to be very aware. Because a person's culture and their identity is important. So if we're gonna work, you know, the best treatment for addiction is to include the whole self. And the family. That includes culture, that includes gender identity. So, an example being with women, we know that research has shown that in groups, therapeutic groups, women have a tendency to wait longer to take a turn when there's men in the group. Nobody knows if that's socialization or what that is, but we know that it takes longer for a woman to come forward. There are situations that men have had where they don't feel comfortable talking about that feeling and experience. So, we like to again individualize, there are co-ed treatment settings that work fabulous, you know? But there's other times where having that gender specific is important. And remembering that the gender is the gender that a person identifies, not the gender assigned to them by others. You know? And we need to honor that.

0:15:03 Cecelia Jayme
[continued]
Culturally, it's important as across the nation that we recognize that we wanna be inclusive. Right? And to be inclusive, we have to be open to experiencing things that we haven't experienced before. So, there may be culturally specific treatment centers and look into them if those feel like a better solution for you as an individual. Or it may be that you have a culturally sensitive organization and look into that. But, the bottom line is that substance use, substance abuse, has no identifiers. It will impact any and all, regardless of race, color, creed, gender. Right? So, it's important to recognize that there are specialized programs, there are specialized tracks. But make sure that that is the track that you feel you will heal in.

0:16:08 William Moyers
Great point. Tessa, I know you're sitting in the chair there in Rancho Mirage as the Executive Director of the Betty Ford Center, but you came there from Hazelden Betty Ford's adolescent facility in suburban Minneapolis. You've got a lot of experience in working with adolescents and their families. What should families consider as it relates to treatment options for a son or a daughter?

0:16:34 Tessa Voss
It's important to see what services are available also for family and children. In addition to services for the patient. Because we know that substance use disorder impacts the whole family. And there's a lot of resources for recovery for those in family or children looking for recovery and help themselves.

0:16:51 William Moyers
Thank you. And Cecelia, I'm gonna give you the last question before we close on this segment. But, there are people who express somewhat of an aversion to a Twelve Step approach. Because they construe it to be a religious-like facility. What is your response to people who are wary of or considering the religious applicability of Twelve Step treatment centers?

0:17:23 Cecelia Jayme
You know, thank you, William. My response to that is that we wanna meet people where they are. And, we want to be able to work with them from their perception. So, it isn't really that important to me whether or not you sign on to the Twelve Step per se program. It's really on my clinicians and that's why we want professionals. To help that individual find their individualized path. And so, you know, I love the Twelve Steps of recovery, I embrace them with my heart, but I also know there's many paths to recovery. This takes a long time. And we know how to help.

0:18:14 William Moyers
We know how to help. Cecelia Jayme and Tessa Voss, thank you so much for your commitment to women and men and families who begin their journeys in recovery through treatment. We're glad you were with us today.

0:18:25 Cecelia Jayme
[smiles] Thanks, William.

0:18:27 Tessa Voss
Thank you so much, William.

0:18:28 William Moyers
[to camera]
And thank you all for joining us today. On that note, remember that addiction to alcohol and other drugs doesn't discriminate. But treatment does work and recovery is possible. So, don't wait if you or a loved one needs help. Ask for help and do it now. I'm your host, William C. Moyers, I hope you'll join us for another edition of Let's Talk. See ya soon.