Rehab Evolution: Following the Science to Help More People

Let's Talk Addiction & Recovery Podcast
Four people working together

While a "cure" for alcohol and drug addiction remains elusive, clinicians are getting closer to understanding how to help more people successfully reclaim their lives from the chronic disease. John Driscoll, senior vice president of recovery services for the Hazelden Betty Ford Foundation, joins host William C. Moyers to discuss evidence-based rehab advancements and core elements of effective treatment designed to help patients learn how to successfully manage the symptoms of their disease.

Our model is really shifting and changing, not because it’s something that we’re doing internally, it’s because we’re following the science.

John Driscoll

0:00:16 William Moyers
Hello and welcome to Let's Talk a series of podcasts produced by the Hazelden Betty Ford Foundation on the issues related to addiction, treatment and recovery. I'm your host William Moyers. I'm the vice president of the public affairs and community relations for the organization and I've been with Hazelden Betty Ford for 23 years. But my personal interest stretches back almost 30 years ago when I was a patient at the organization. Today we're talking with John Driscoll. He's the senior vice president of recovery services for our organization which means he's got everything from soup to nuts when it comes to our treatment of patients both residential and outpatient. John, welcome to our program today.

0:01:00 John Driscoll
Thanks, William.

0:01:01 William Moyers
And thanks for being here with us. Tell me what—where does your interest come from in working in the addiction treatment field?

0:01:08 John Driscoll
Sure. You know my—my interest started when I was an undergraduate in college nearly 30 years ago. Working to try to help people feel better about their life circumstances. And my experience working with people with addiction actually started out in the inner city of Chicago where I worked with a population that was in need of a lot of different resources including treatment for drug and alcohol abuse. And it was there that I discovered the miracle of working with people that—that work a simple Twelve Step program even though the environment may not have been good. When they were able to commit, when they were able to work together, they became productive members of society again. They got employed, they got their children back, they got off of welfare, became really productive members of society and changed their life around. And so it's that hope that's always kept me in this industry. Watching people completely change their lives from where they are to where they wanna be. Really keeps me here today and that's what drives me.

0:02:17 William Moyers
Our topic today is the Hazelden Betty Ford model of care. And I note that your undergraduate was in Psychology. Tell us what is the role of Psychology in the treatment of addiction?

0:02:27 John Driscoll
Well you know it does play a big role in it. Addiction is a biopsychosocial disease. It's under the behavioral health category of health care. And in the psychology-psychological part of it is really there to help people, you know, start to believe that number one they do have a disease and that with proper treatment, it can be overcome. It may not be able to be cured right now, but it is something that we can live with and treat much like diabetes or hypertension. There's a way that we can have a successful life by treating it. And having that knowledge and having the tools needed to keep yourself engaged in the appropriate treatment, is—is extremely important in any of these chronic disease battles.

0:03:14 William Moyers
Minnesota is considered the birthplace of I guess modern professional addiction treatment in this country. And for many, many decades, the his—the history of the state when it came to addiction treatment was such that everything was known as the "Minnesota Model." Yet we're here today to talk about the Hazelden Betty Ford model of care. We used to be known as the Minnesota Model because we helped to start that. Now we're something different. Explain our history and how we have evolved into what we are today.

0:03:47 John Driscoll
Sure and that's a great question, William. You know we still have our roots based in the Minnesota Model of care but we have evolved from that. As you'd expect any other type of health care, Minnesota Model really came together in the mid-to-early 60's and—and really became something that people saw really worked, it was a good way to implement, and—and Dr. Dan Anderson, our former CEO and one of the f—the architects of the model, really went out and promulgated it across the entire world to say here's something that worked. Well one of the things Dr. Dan Anderson always said was this is not the end; this is simply the next chapter. And it was really left up to the next generations to continue to evolve. And that's where I really see our model now is really the evolution of the model with evidence-based practices, with better science, with better medications, just exactly the way Dr. Dan Anderson intended it to be.

0:04:48 William Moyers
So when somebody comes to Hazelden Betty Ford whether it's to our facility in Center City, Minnesota where we were birthed in 1949, or perhaps to one of our outpatient facilities in San Diego or in the West Metro of the Twin Cities or New York City, what should they expect in terms of how they're going to be treated literally by our organization?

0:05:10 John Driscoll
Well, one of the first two things that have really been in existence since 1949 is dignity and respect for individuals that suffer from this disease. You need to go back in history and—and remember what people thought of people that were alcoholics or drunkards. You know they were locking 'em away, they were shunning 'em, they were living in horrible conditions and situations. And—and one of the first things we brought back was really that these are individuals. These are human beings that need to be treated with dignity and respect. They're not bad people, they're sick people trying to get well. And—and that's the first tenet of what we do across any of our programs.

0:05:52 John Driscoll
The next aspect of it is really to help people understand what is addiction as a disease. And it truly is a brain disease. And—and what do we then do once we have this disease, how do we arrest it so it stops creating multiple sets of problems in our lives. And begin to help us on a road to recovery. So that we can live life to good purpose. So what you'll see and experience at any of our programs is number one that basis of dignity and respect, followed by education and therapy to help people understand and accept the fact that they have this incurable disease but not untreatable disease. And then we begin the process of being able to treat them. And just like any chronic disease, the ultimate goal is really self-management of that disease. It's not able to cure it. Now maybe someday, we're able to cure this disease, like other diseases that are out there that we're working on, but today we don't have that. Today we want people to be able to live life to good purpose with as little clinical interaction or—or—or necessary care as anybody else. If you think about diabetes, you know, people that suffer from diabetes you want them living in home, living with their families, working and living life to good purpose. You don't want them living in a hospital, you don't want them constantly going to that hospital for that care. Even though some people may have to have that. What you want is people to be living their life as free as they possibly can. While treating the—the symptoms and—and the issues of their disease as they live on.

0:07:32 William Moyers
So treatment at Hazelden Betty Ford is not an endpoint it's really actually the beginning of a lifelong day-to-day process.

0:07:42 John Driscoll
Absolutely. You know, addiction at—at its end can lead to death. It leads to alienation and isolation. And so, what treatment does and especially treatment at any of the Hazelden Betty Ford facilities and programs is meant to interrupt that course of the disease. Where if left unattended, could lead to isolation and/or death. What we wanna be able to do is to stop that, arrest the progression of the disease, and move people into recovery. So that they begin to do better in their life. Both from a physical standpoint, from a psychological standpoint, and even from a spiritual standpoint as well.

0:08:25 William Moyers
As we know, our model has evolved. It's morphed over the years but you can go to any of our facilities whether it's residential or outpatient and you'll still see hanging on the wall of every unit, of every place where addicts and alcoholics get together for their treatment experience, you'll see those Twelve Steps of Alcoholics Anonymous hanging there. Talk about the role that the Twelve Steps continues to play all these decades later in our program.

0:08:50 John Driscoll
Absolutely. You know and that's what I saw when I was in Chicago. Is these women that I worked with really working a Twelve Step model that turned their life into a better situation than what they were. And—and the Twelve Steps aren't clinical. They say it right in their bylaws; they're an individual helping another individual. And that's that long-term self-management of the disease, that's that self-help group, that's one alcoholic or addict talking to another to help their lives improve. And that's the ultimate goal, so that's where we wanna get people to be at. We wanna introduce that early on. We wanna show people what it is, we don't wanna scare 'em off, we want to give them good information and actually facts of what it means and help guide them in that direction. You go into from clinical management when you think of it you have a counselor or a clinician, and you've got therapy groups that are run by licensed therapist. That's in the clinical phase of this. When you're in the self-management stage of this, typically you see people with sponsors. These are non-clinical people, or people with a little more time managing their disease that can serve as guides. And then you see groups replaced with Twelve Step self-help groups. So they're not run by trained therapists, they're really run by other individuals that are in treatment. So we're really are trying to move people from clinical management to self-management of this disease. And—and our model enables us to meet them wherever they're at. So if—if they're at a point where they need intense residential care and physical, psychological stabilization, we can meet them there. If they've—they've had some incidents that's out of control but not so much that they—they need to—to move away from their home environment but can stay in the home and come to treatment, we'll meet them there and so on. Much like you—you'd expect with any other chronic disease. Let's meet the patient where they're at in their disease cycle and begin the process of them getting better.

0:10:53 William Moyers
Once upon a time for example when I was a patient at Hazelden in 1989 I had to come from New York out to Minnesota and go to a residential program. That—there wasn't another option. We were built as a residential model or as some would say an inpatient model where people came and slept and ate and got all of their experiences as in treatment in one place. But our organization and your responsibilities have morphed dramatically over the years to the point that today, we're not just a residential facility anymore. Talk about the options that people have. Should they seek treatment at Hazelden?

0:11:30 John Driscoll
Well let me talk a little bit about the "why."

0:11:33 William Moyers

0:11:33 John Driscoll
Why has it morphed like that? Why has it changed? And I'll tell ya it's really about outcomes for our patients. It's really about studying what really works. And we've known for a long time that a good residential model of care helps a lot of people get well. However, we also have studied and learned from the data that's out there from other scientists that the longer we can keep people engaged in services, the better their outcomes are. So for a long time Hazelden has published its Minnesota Model outcomes of about 55 to 58 percent of people that go through our residential program get better. And what we've been able to see is that the—if we can keep people engaged in services sometimes up to six months, on an outca—outpatient basis—not just in our residential sites, but keeping them engaged in services in their home communities in outpatients. You can see those outcomes improve greatly.

0:12:30 John Driscoll
Now there's more research that needs to be done on that, but some of the—the areas that have been studied such as health care professionals and—and pilots, show outcome rates around 85 percent. And that's what we want for all individuals around. So our model is really shifting and changing, not because it's something that we're doing internally, it's because we're following the science to say how do we help more people get better for a longer period of time. It's outcomes-based.

0:13:02 William Moyers
And of course the other big change that's occurred over the decades certainly has been our relationship and our—our healthy relationship with insurance companies. In the old days, most people who accessed our level of care did not have the ability to use their insurance. That's changed.

0:13:19 John Driscoll
That absolutely has changed. William you were on the front lines of this as part of your role in our organization so many years ago to really help us get addiction legitimized—it is a disease. And that battle has been won I'm very happy to say. To some extent to the work that you've done but many others in the field have really stepped up and—and done that. That really said addiction is a disease and should be treated the same as any other health care disease. That legislation that went through, the Parity Act, really allowed us to put our foot in—in the sand to say this is where we begin from here. And allowed us to have more relationships with third party payers. As we then moved on into the Affordable Care Act, where it was identified as an essential benefit.

0:14:07 William Moyers

0:14:07 John Driscoll
That it needed to be treated. So we had really three things happen there that really moved us along. Number one addiction was truly recognized as a chronic health care disease. Number two we identified it as an essential benefit. And number three, the Affordable Care Act said all Americans should be covered by health insurance. And so with a combination of that, it really for the first time ever in our history, enabled all Americans to suddenly have access to good quality health care for their addiction that was reimbursed through their—through their insurance company. And so, our organization first as Hazelden and then when we merged with the Betty Ford Center to become Hazelden Betty Ford, has really been marching down the route to be an in-network provider so that all Americans can access their own personal health care to access quality care for us. And our goal is twofold: help more people, help 'em better.

0:15:10 William Moyers
And so we'll end on a high note by I'm gonna ask you 'cause I know the answer to this but I'd like to hear it from you and our listeners and our viewers to also hear it. If you have health insurance and are struggling with addiction, the percentage of patients now who use their insurance to access our care is?

0:15:27 John Driscoll
It's actually 93 percent use their in-network insurance. A lot of times you hear in-network, out-net—out of network individuals. We've done a lot of work to be an in-network provider. Which people know reduces their expenses, it's a win for everybody. It wins—it's a win for the patient, it's a win for us as a provider, and it's a win for the insurance company because they know that their clients, the patients, are getting high-quality care and in an efficient and affordable manner.

0:15:56 William Moyers
There ya go! Then if you are somebody or are who is struggling with a substance use problem or have a family member and you've got insurance, there is hope and there is help and there is healing out there. All you need to do is to reach out and ask for help and the Hazelden Betty Ford Foundation is a place where we treat addiction and transform lives. John I wanna thank you for taking the time out of your very busy schedule as our senior vice president of recovery services you—you've got a lot of irons in the fire these days but thank you for being part of our Let's Talk Podcast today and thank you to our executive producer Lisa Stangl and great crew that makes these things possible, thank you to our viewers and our listeners for tuning in today and watching another edition of Let's Talk. I'm your host William Moyers and we'll see ya again.

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