Canada Drug Rehab

By Daniel Jordan
General Manager
Sunshine Coast Health Center

One of the benefits of residential treatment is the many opportunities that clinical staff have to get acquainted with clients. Having a laugh over lunch, chatting during breaks, and working through issues in structured group and individual therapy allows our clinical staff to learn a lot about the clients they serve. Getting to know our clients so intimately also affords a greater appreciation of the complexities and challenges inherent in addiction and it’s treatment.

A few months back, the clinical team at Sunshine Coast Health Center took an informal poll and found that approximately 3 out of 5 clients were, prior to treatment, acting out sexually. Interestingly, clients rarely, if ever, made any mention of sex addiction on their admission form. Instead, clients come forward after concluding during treatment that their acting out sexually seemed to have a lot in common with their addiction to substances. While we know that individuals with one addiction often have multiple, or concurrent, addictions we underestimated it’s prevalence. As a result, steps were taken to enhance the skills of the clinical staff to treat sex addiction, culminating in a 2-day on-site workshop September 17 & 18,  2009. * Hosted by sex addiction expert Robert Weiss, this event marks an important first step in expanding our program to include process addictions such as gambling, sex, eating disorders, and online gaming.

However, while training staff on process addictions is a step in the right direction, we know that implementation is another matter entirely. Therefore, as a program more accustomed to treating drug addiction and alcoholism, Sunshine Coast Health Center is proceeding with caution,  carefully weighing the costs, benefits, and challenges of treating process addictions. An important first step is, I believe, looking at how we, as a treatment center, define addiction.

(*) Note: for more information on the 2-day sex addiction workshop see our promotional flyer.

DEFINING ADDICTION

Addiction is a complex condition that can be defined by it’s etiology, by it’s symptoms, and by its scope.

Defining Addiction by Etiology

In my last article, We Were Powerless Over Our Addiction: Why Step One is So Controversial, I alluded to competing theories on the causes of addiction. Often times, people will define addiction by its etiology, for example, “addiction is a brain disease” or “addiction is a psychological maladjustment or negative coping skill”, etc. However, as important as the origins of addiction may be, this blog article is not about etiology.

Defining Addiction by Symptom Severity

Addiction can also be understood by the severity of its associated symptoms. For example, previous blog articles have introduced the 3 Cs: a self-test that people can use to help figure out whether or not someone has crossed the blurry line between misuse and addiction. To review, we distinguish addiction from a bad habit based on the 3 Cs. This simple test can be applied to any substance or activity:

C#1 - Compulsion - obsessive thinking about, and planning around, a substance or activity so that an individual has regular, convenient access. Compulsion is what happens during the abstinence stage of the cycle.

C#2 - Control - an inability to control the amount of time engaged in an unhealthy activity, or the amount consumed of a harmful substance, once initiated. Control is what happens during the active stage of the cycle.

C#3 - Consequences - repeated engagement in an unhealthy activity or harmful substance despite negative consequences. Often times the Consequences stage is motivation enough to return back to the abstinence, or compulsion, stage.

If a person is observed exhibiting behaviour described in C#1 and C#2 but not C#3, chances are then they are probably still just at the abuse stage. Most abusers will stop or cut back once they experience one or two negative consequences such as a DUI charge, failing grades, or problems at home. Therefore, C#3, consequences, is what distinguishes addiction. Another way of explaining consequences is that addiction is, by it’s very nature, a state of chronic relapse.

However, while it’s important to distinguish addiction from abuse, this blog article is really about how we define the scope of addiction, or the different types of substances and activities normally associated with addiction.

(*) Note: For more information see The 3 Cs of Addiction Test: Are You Addicted?

Defining Addiction by Scope

It was not that long ago that the term “alcoholism” was the predominant term used in addiction treatment circles. According to Hazelden Foundation, one of the first residential treatment programs in North America, it wasn’t until 1958 that their clinical staff recommended using a new term, “chemical dependency,” to replace ”alcoholism” to better reflect the growing trend of marijuana, cocaine, and heroin misuse in the United States. *

Fifty years later, it’s not just illicit drugs but prescription drugs and it’s not just substances but activities, or “processes” such as gambling, sex, online gaming, and eating disorders. However, while the term “addiction” is now in common use (more so than “chemical dependency”), the vast majority of residential addiction treatment centers in North America still focus almost exclusively on drugs and alcohol. Admittedly, our own website and printed literature reflects that we, too, are first and foremost a chemical dependency treatment program. Why, then, has the addiction treatment industry been reluctant to include process addictions?

(*) Source: Hazelden History

THE CHALLENGE OF TREATING PROCESS ADDICTIONS

As mentioned earlier, Sunshine Coast Health Center is in the initial stages of reorganizing our treatment program to include process addictions. During this transition, however, we recognize the challenges involved.

Challenge #1: Lack of Evidence-Based Treatment for Certain Process Addictions

Until recently, the vast majority of addiction research and program development has focused on chemical dependency. In his landmark book first published in 1983, Out of the Shadows: Understanding Sexual Addiction, author Patrick Carnes became one of the first to link unhealthy sexual behaviour to addiction. Twenty-five years later, pornography, particularly online porn, has become a multi-billion dollar industry.

Furthermore, although gambling addiction has been recognized for a long time, very little research has surfaced for the treatment of gambling addiction. This is somewhat puzzling considering the growing dependence of provincial governments on gambling revenues.

Challenge #2: Lack of Consensus on Whether Certain Processes Are Addictions

Another consideration for addiction treatment providers is the lack of consensus about whether anything that is vital to the survival of the human race, such as sex and food, could be considered addiction. For example, sexology proponents argue that much of what is considered sexual addiction is normal sexual behaviour, essential for healthy sexual development and the survival of our species. Other experts believe that sexual addiction is actually a mental illness commonly referred to as obsessive compulsive disorder and refer to it, not as an addiction, but as sexual compulsivity.

Challenge #3: Lack of Medical Care to Treat Eating Disorders

While individuals struggling with eating disorders have had access to specialized treatment, these programs are scarce and are typically government outpatient programs or private residential programs in the US. A reason for the paucity of programs is the long-term medical intensity required to treat moderate to severe eating disorders, particularly anorexia and bulimia nervosa. Eating disorders can be life threatening and require medical monitoring and procedures not typically offered in residential alcohol and drug rehabilitation programs.

Challenge #4: Impact on the Peer Group

Another concern of programs that specialize in chemical dependency treatment is the impact that individuals with other addictions will have on the peer group. While it is quite common for individuals with drug or alcohol addiction to have concurrent gambling, sex addiction, or, to a lesser extent, eating disorders, there is a prevailing notion that people who are exclusively processed-addicted may not be compatible with the dominant, chemically-dependent peer group.

Some treatment centers address this concern by creating separate tracks for process addictions. In other words, someone with a sex addiction will be placed in a group separate from those with chemical dependency and will have their own group therapist. However, the problem then becomes costs associated with extra staff, creating a sense of separation in the peer group, and adverse group dynamics associated with insufficient group size.

Then there is the challenge to the peer group of having an individual whose sexual behaviour crosses over into sexual offending such as pedophilia, compulsive masturbation, incest, and rape. Incidentally, sexual offenders will be a major topic in our September workshop.

Challenge #5: Lack of Clearly Negative Consequences for Some Process Addictions

Unlike chemical dependency, gambling, or eating disorders, individuals with sex addiction or online gaming addiction show symptoms that may seem less harmful. Therefore, the perceived need for treatment may not be as obvious. * 

(*) Note: For addition information on the negative consequences of online gaming see Ambivalence is Fertile Ground for the Growing Popularity of Online Gaming.

Challenge #6: Apparent Lack of Demand

For all of the publicity that certain process addictions have been getting recently, most residential treatment centers do not receive a lot of calls for gambling, sex addiction, or online gaming. This apparent lack of demand may be attributable to the more benign effects of certain process addictions (see Challenge #5 above), the lack of available funding for individuals with gambling addiction, the lack of perceived similarity between process addictions and chemical dependency, or the greater stigma attached to sex addiction.

Challenge #7: Training Clinical Staff

Addiction, particularly process addiction, is rarely taught in graduate or medical school. Professional development workshops rarely offer courses in process addictions. Training, therefore often requires that staff travel to the United States or that a presenter be brought up for training on site. Sunshine Coast Health Center chose the latter because all of our clinical staff needs training, not just one or two counsellors. Any way you slice it, it’s expensive and is tricky to schedule in a 24/7 residential program like ours.

Sunshine Coast Health Center is also interested in training the staff of gambling addiction, however, we have been unable to find an expert in this field. WIth regard to eating disorders, management is unsure if the  demand for men’s eating disorder treatment is sufficient to justify the costs associated with specialized staff training (not to mention the possibility that additional medical staffing or equipment may be required).

Challenge #8: Establishing Clear Admission Criteria

Before we begin to admit clients who have a process addiction without concurrent chemical dependency, clear admission criteria must be established. For example, where do we draw the line on the severity of a process addiction? The challenge of sex addiction that has crossed over into sexual offending is a good example. Fortunately, this aspect of sex addiction and its treatment will be addressed in the upcoming Robert Weiss workshop.

Challenge #9: Tailoring the Program to Address the Unique Aspects of Other Addictions

Part of treating other addictions is to first differentiate their unique aspects then to integrate new treatment techniques or knowledge into a program that embraces these differences but includes the effective components of previous modalities.

Fortunately, for Sunshine Coast Health Center, our smaller size and favourable counsellor-to-client ratio allow us to provide a higher degree of individualized treatment than what’s possible in larger facilities.

WHY SUNSHINE COAST HEALTH CENTER REMAINS COMMITTED TO TREATING PROCESS ADDICTIONS

With all of the challenges present in integrating other addictions into chemical dependency treatment, one could be excused for maintaining the status quo. However, Sunshine Coast Health Center is committed to expanding our treatment of addiction to include process addictions. If one considers the needs of the addicted client, there are a number of good reasons for making the change.

Reason #1: Risk of Drug or Alcohol Relapse

Clients who abstain from drugs or alcohol but continue to participate in process addictions run the risk of eventually relapsing back to their drug of choice.

Reason #2: Living Out of Integrity

Clients who abstain from their drug of choice may be considered by some programs to be a treatment success. However, at Sunshine Coast, abstinence is only part of what is considered true recovery. The clinical program at Sunshine Coast emphasizes personal integrity, being true to one’s sense of self. Shifting to another addiction precludes developing inner strength and authentic connectedness to others, particularly family.

As Geoff Thompson, Sunshine Coast Program Director, often tells clients, “it’s not in the bottle.” Including individuals with process addictions in the peer group will help chemically depend clients understand that, even in the absence of drugs or alcohol, individuals can still have addictions. Process-addicted clients, therefore, are living proof that drugs and alcohol do not have some sort of magical, addictive property.

Reason #3: Reducing Client Shame Associated with Their Addiction

By identifying with individuals that have different addictions but find themselves in similar circumstances, clients may come to see that addiction manifests itself in many ways in our society.

A few months back a therapist explained her philosophy of addiction. To summarize her approach, she explained that “all human beings are in recovery from something.” Our talk has stuck with me because I see how all human beings have moments of insanity as defined by Albert Einstein: doing the same thing over and over again and expecting different results.

As Christina Grof writes in her book, The Thirst for Wholeness, “By recognizing that as human beings, we share the common dilemma of attachment, but to different degrees, we open the way for understanding and compassion toward ourselves and others. We can even discover a sense of relief and liberation as we recognize the reality of our mutual dilemma.” The AA spiritual principle of surrender is closely linked to addiction and attachment. Just as recovery from addiction is made easier by surrender, so freedom from attachments also requires surrender.

CONCLUSION

As mentioned in this article, Sunshine Coast is hosting a 2-day workshop hosted by sex addiction expert, Robert Weiss of the Sexual Recovery Institute based in Los Angeles. Out of this training, we hope to make some important distinctions between sex addiction and chemical dependency, as well as the difference between a sex addict and a sexual offender. It promises to be an engaging two days.

As part of our new program at Sunshine Coast Health Center, the idea that addiction is strictly a substance-related phenomenon is coming under scrutiny. Clients with multiple addictions require treatment that recognizes the complexity of their predicament. However, just as mental health issues can complicate treatment, treating multiple addictions at the same time is the best approach to take, despite the additional challenges to staff and program. For the time being, clinical staff believes that treating both chemical dependency and process addictions with clear, thoughtful admission criteria, will mean better treatment and, thus, better outcomes for the clients we serve.

Yesterday, Oprah Winfrey dedicated a segment on her TV show to severely obese children. A 14-year-old girl interviewed in the middle of a food binge confessed that “once she starts she cannot stop.” She went on to say that when she starts to feel down about herself, she eats. I know more than a few kids that find the same sort of relief through online gaming. Hopefully, other private and government addiction programs will also consider expanding their notion of addiction to include process addictions. Now, more than ever, it’s clear that addiction is more than just a ’skid-row’ phenomenon.

By Daniel Jordan
General Manager
Sunshine Coast Health Center

In Part 1 of this article I highlighted the importance of designing a clinical brochure that is current, user-friendly, and comprehensive. Originally, I had planned to jump right in and explain our “integrated approach” to addiction treatment. However, as I was preparing for Part 2 I realized that exploring the complexity of residential addiction treatment is a necessary first step before attempting to explain our unique method of treatment.

Complexity #1: The Living Vs. Non-Living Universe

This may seem obvious but living entities are much more complex than inorganic objects. Neuroscientists point out that there are more synapses in the brain than stars in the galaxy and that the brain is the most complex device in the known universe. * The interesting part, however, is how we approach problems associated with living vs. non-living objects. In his book, Guide for the Perplexed, economist E.F. Schumacher argues that there are two types of problems in the world: (1) convergent and (2) divergent. 

Convergent problems are ones in which attempted solutions gradually focus on one solution or answer. Of primary importance is that convergent problems are those where that all tend to point to the non-living universe. Take, for example, the problem of manned flight. In the early days of aviation, there were many different contraptions that inventors hoped would become the first successful flying machine. Perhaps you have seen the old movie footage of planes with 4 sets of wings, or wings that would flap up and down, etc. Finally, after a lot of trial and error, Orville and Wilbur Wright made the world’s first flight in a powered, heavier-than-air machine on December 17, 1903 near Kitty Hawk, North Carolina. 100 years later, aeronautical engineers continue to improve on the Wright Brother’s original design, however, all manufacturers such as Boeing, Bombardier, or Airbus, build planes that follow remarkably similar design principles. The same is true for automobiles, cell phones, and portable computers.

Divergent problems are ones which we must find multiple solutions to a single problem and are typically found when we are dealing with living organisms, particularly human beings. For example, if you are trying to solve the problem of HIV/AIDS, handing out condoms or clean needles may be a start but it’s not going to completely solve the problem. Another agency may start a 24 hour help line and this may help as well. But these are just 2 of many possible solutions. The ongoing search for a cure to cancer, which is basically a living organism within a larger living organism (us), is another good example.  

(*) Source: Nuts, bolts of who we are, Princeton Weekly Bulletin, May 1, 2000.

Complexity #2: Chronic Conditions Vs. Acute Conditions

While many people may consider addiction a chronic condition *, the truth is that addiction has a lot more in common with diabetes, high blood pressure, and arthritis than it does with acute medical conditions such as a broken leg or appendicitis. This misconception is clearly evident whenever scientists claim to have found the gene responsible for alcoholism or pharmaceutical companies promote a new drug as the cure for addiction.

Even residential alcohol and drug treatment centers that should know better typically operate like hospital emergency wards, throwing everything they have at the client during primary treatment and leaving precious few resources for follow-up or relapse.

(*) Note: for more information on the chronic nature of addiction refer to William White’s articles on bhrm.org .

Complexity #3: Addiction Impacts All Life Domains

Unlike many medical conditions, addiction cannot be treated by localising the problem to a particular part of the body and then treating it. Addiction is a Biopsychosocial condition that impacts all life domains - biological, psychological, social and spiritual. For example, all may be well with a client while he is in the safe confines of residential treatment, however, what happens when he gets home where the same job, family, and old haunts await his return? Furthermore, most addictions impact negatively on the body (liver damaged by alcohol, tooth enamel destroyed by crystal meth or crack cocaine, etc.). Psychotherapy can be particularly challenging if a client is also suffering from cognitive impairment, or mental illness.

Not only does addiction require a diverse team of professionals to be involved in treatment, it means that often treatment often has to be applied concurrently, and that the discharge plan must include community resources that also embrace the Biopsychosocial nature of addiction.

Complexity #4: Addiction Defies Simple Definitions

The origins of addiction have been a source of lively debate for hundreds of years. Is it a learned behaviour or is it a disease? Is addiction a choice or is it a genetic predisposition? Is addiction caused by developmental factors or do some people have addictive personalities? Are addicts created by eating a diet deficient in certain nutrients? Or is addiction a response to feeling disconnected from the world?

As Ken Wilber in his book Integral Psychology states, “The great problem with psychology as it has historically unfolded is that, for the most part, different schools of psychology have often taken one of those aspects of the extraordinarily rich and multifaceted phenomenon of consciousness and announced that it is the only aspect worth studying (or even that it is the only aspect that actually exists).” Dr. David Burns, author of Feeling Good: The New Mood Therapy, calls it the “schools over tools” approach. This tendency towards over-simplification, commonly referred to as reductionism, is alive and well in the treatment of addiction. This is most unfortunate since addiction is a complex condition that impacts all aspects of health and lifestyle.  

Now combine debate among competing schools in psychology with the medical community and you begin to see why the matter of deciding on effective treatment for addiction is far from settled.

Complexity #5: Addiction Requires More Than Mere Abstinence

Even the goal of addiction treatment is a topic of lively debate. Some will reason that if only the addict will stop using his/her drug or process of choice (gambling, online porn, etc.) then the problems associated with addiction will go away. Unfortunately, just as health is more than the absence of disease, recovery requires a fundamental shift that impacts all life domains mentioned in Complexity #3.

At Sunshine Coast Health Center, we believe that abstinence is a by-product, not a goal of alcohol and drug rehabilitation. When an individual discovers his true calling and begins the process of living a life of purpose, we believe that ’external’ solutions and unhealthy attachments will be discarded in favour of being true to one’s self.

Complexity #6: Not Everyone With an Addiction is Motivated to Quit

Another point to ponder is that people with addictions actually need a reason to stop. Having something to lose (health, marriage, career) may work for a brief period of time but, long term, a fundamental shift or transformation is often required for abstinence to become permanent. Unlike most disorders or medical conditions, addiction produces a positive benefit for the individual such as dissociation (numbing out) or escaping from, what Narcotics Anonymous calls, the ”meaningless, monotonous, and boring” life of an addict.

Complexity #7: Primary Residential Treatment Vs. Outpatient Treatment

The last point to make on complexity is that residential addiction treatment, is more than just counselling with room and board thrown in for good measure. Social skills associated with the give and take of living 24/7 with a peer group is an issue for residential treatment while the same can’t be said for outpatient.

Furthermore, group therapy, commonplace in residential treatment, is rarely provided in most outpatient settings. Group therapy is, by nature, a dynamic process that can have remarkable therapeutic effect in the hands of a skilled psychotherapist.

Complexity #8: Addiction is More Than Just Drugs and Alcohol

Cross-addiction (having more than one addiction) is a common occurence for individuals who struggle with drugs or alcohol. Sunshine Coast recognizes this tendency and is redesigning its program to expand the definition of addiction to include process addictions such as gambling, gaming, sex, even eating disorders.

Conclusion

Addiction is a complex condition that requires an equally complex approach to treatment. Sunshine Coast Health Center recognizes these challenges and has been continually finding new ways to enhance program effectiveness. in Part 3 of The Challenge of Writing a Clinical Brochure, I will examine how other individuals and groups are integrating their approach to address complex problems.

By Daniel Jordan
General Manager
Sunshine Coast Health Center

If there has been one thing that has been a constant at Sunshine Coast Health Center, it’s change. Changes at our residential addiction treatment center tend to occur under four broad categories: (1) program, (2) staffing, (3) services, and (4) facility. Since one of my responsibilities is marketing, it dawned on me that the corporate brochure that we created in the spring of 2007 was due for an overhaul. So, back in March, a new pamphlet was produced that showed our newly-expanded drug rehab center (new building, new indoor exercise pool, expanded fitness center, landscaping, etc.) and enhanced services (mental health services, on-site fitness, off-site recreation). However, after inserting all the new photos that highlighted our facility and campus, there really wasn’t much space left to detail how the clinical program has changed.

So, since the spring, we have been working on creating a brochure that provides additional information that is primarily clinical in nature. Having committed to this project, however, I soon realized that creating a clinical brochure that is comprehensive, user-friendly, and current is a big job!

The Challenge of Being User-Friendly, Current, and Comprehensive

In many ways, this reminds me of the work leading up to our publishing of the 1st edition of the British Columbia Alcohol & Drug Services Directory last November. It was the first time in 8 years that anyone had published anything similar to a directory of this nature (the last Kaiser Directory was published in 2001). I had found a number of BC addiction directories but all of them had one problem or the other. For example, either the information was outdated (again, the Kaiser Directory, many addiction directories found online), or was not presented in a user-friendly fashion (the Red Book in BC has quite a few listings but suffers from excessive categories and bulk), or was not comprehensive (no addiction listings felt that private practice therapists that worked with addicts or 12-Step meetings were worth listing). So, the challenge then became to integrate all of the available information into a publication that was better than the sum of its parts. Based on feedback we have had from many health professionals across BC, it seems as though we have succeeded in our objective. But while I thought the directory was a challenge, it seems as though creating a clinical brochure is a much more difficult task. After five months of internet research and countless visits to libraries, and used bookstores, I figure it’s time to start putting it all together, and what better place to start than our blog?

Challenge #1: Being User-Friendly

When it comes to having a user-friendly clinical brochure a logical presentation of content is necessary. However, a clinical program can’t be arranged in a simple, linear fashion like a novel or historical account. Instead, a framework needs to be designed so that all of the pieces are arranged in such a way that makes sense.

Finding material to aid in the development of a framework has been interesting, to say the least. Philosopher Ken Wilber has been instrumental in creating integral models that embrace the human condition from a subjective (”I” and “We”), objective (organism and environment), and structural (mind, body, soul, spirit) perspective. Ervin Laszlo, a pioneer in systems thinking; Roger Martin, author of The Opposable Mind; and economist E.F. Schumacher have all written on designing models that help explain complex systems. However, incorporating a system so that the system itself does not become the focus of the brochure is going to test the limits of being user-friendly.

Another aspect of being user-friendly is avoiding jargon that is so prevalent in health sciences and philosophy. Relapse Prevention expert Terence T. Gorski once pointed out to me that it’s often a question of languaging: communication can break down when we fail to understand that different words are used to represent the same thing. For example, one clinician may use the term resistance while another uses the term denial to represent the inability or unwillingness of a client to make healthy changes. So, a user-friendly clinical brochure must be presented in a way that doesn’t just assume familiarity with terminology commonly associated with alcohol and drug treatment.

Challenge #2: Being Current

Sunshine Coast Health Center is an evolving entity and that is by design. However, when creating a clinical brochure, information about staffing, programs, and services must be presented in a way that can embrace these changes without becoming outdated. For example, we may decide to change out an adjunct therapy (massage, relaxation, ozone, etc.) based on published research, client feedback, or staff turnover. However, such changes to the clinical program at the programming level does not automatically mean that the program, for example, no longer addresses the physical aspects of addiction. 

Highlighting qualifications of staff must also be presented in general terms (such as all counsellors requiring a minimum of a master’s degree) rather than focusing on particular techniques (Cognitive-Behavioral Therapy, Motivational Interviewing, etc.) that individual counsellors possess.

Challenge #3: Being Comprehensive

Addiction is a complex condition that defies a simple solution. While it’s somewhat straightforward to simply provide a list of programs and services, explaining why clinical elements have been included and how all of the clinical elements work together (our philosophy) is another story. A drug treatment program is far more than just it’s ‘bits and pieces’. Furthermore, a good clinical brochure should be able to demonstrate that its programming is supported by evidence-based research if it expects to be supported by the health professional community it needs to remain viable. And then there’s the addiction treatment-specific issues that always come up such as ‘how do you deal with disruptive clients?’, or ‘what happens when a client has a relapse?’. Answers to these policy questions often reveals a lot about a program’s philosophy.

Conclusion

Explaining how our program has integrated all of its clinical elements in a user-friendly, current, and comprehensive fashion is proving to be more challenging than originally anticipated. In Part II of this series, I will expand on why our program, based on our unique integrated approach to addiction treatment, is particularly challenging to summarize in a clinical brochure.

By Daniel Jordan, General Manager
Sunshine Coast Health Center

For the past few weeks, I have been putting together a new corporate brochure that highlights the main features of our program, facility, and staff. We still have some of the old brochures left but since we added a whole new wing and swimming pool to the building and landscaped the yard, the brochures didn’t really put our best foot forward. More than just the physical changes to our facility, however, a new brochure was also necessary to reflect that we are now staffed with a psychiatrist, masters level therapists, and a kinesiologist.

Most of these changes to the corporate brochure were pretty straightforward and it didn’t hurt that we had some great new photos to enhance the presentation. However, when it came to changing the “Our Philosophy” section, that took some work. For those of you who have ever had to figure out your company’s philosophy or mission statement, you will know that it is no easy task. It’s actually a very personal experience since your company philosophy is really meant to tell the world what you value as a human being and why you are in your chosen profession.

OUR PHILOSOPHY at Sunshine Coast Health Center

So, after some soul searching and a lot of discussion with staff and various stakeholders, this is OUR PHILOSOPHY:

At Sunshine Coast Health Center, we believe that it is not enough simply to treat the ‘addiction.’ Instead, a client’s experience with us facilitates ongoing personal transformation, the goal being healthy, thoughtful men who are inspired to live with a renewed sense of vitality and purpose. Our therapy program prepares clients and their families for a deeper, more fulfilling life.

Sunshine Coast Health Center focuses on providing the most effective, evidence-based treatment, exceeding expectations by paying close attention to four key therapeutic principles:

Respect: We treat others as we would wish to be treated. This respect is the foundation of our program and pervades everything we do, how we conduct ourselves and how we interact with each other.

Gratitude: We feel privileged that clients and their families put their trust in us.

Empathy: We support our clients through the good times and the bad, free from judgment.

Humility: No matter how proficient we are at treating addiction, we know that the client is always the expert in his own recovery.

OUR PHILOSOPHY Now Reflects Our Values

Basically, our corporate philosophy now reflects the values of ownership. Respect, humility, gratitude, and empathy rose to the top in terms of importance. This process of prioritizing virtues was actually quite fascinating. For example, why not courage? How about creativity? In the end, it came down to the most salient values we share in common with our clients. In other words, any value that staff and management practice on a daily basis will also benefit our clients, but some more than others.

The Biggest Change Reflected in OUR PHILOSOPHY: Our Approach to the Client

One of the biggest changes we made in our philosophy was our approach to the client. This change is especially notable in the first sentence (see above). Nowadays, we don’t actually treat ‘addiction’ or an ‘addict.’ We treat a unique human being who happens to suffer from addiction. This is no small change. Treating an ‘addict’ or an ‘addiction’ can be an extremely dehumanizing process where, by virtue of being addicted, treatment programs can mistakenly assume that their clients suffer from;

-Narcissism
-Denial
-Addictive personality

or is a liar and a manipulator, is incapable of making any healthy choices, etc., etc.
 
The Inclusion of ‘Personal Transformation’ in Our Philosophy

Personal transformation is a term we have intentionally included in our corporate philosophy. From my experience, most treatment centers don’t spend a lot of time talking about transformation since it is more spiritual than psychological in nature. However, ownership at Sunshine Coast has always had an interest in the idea of enlightment, even going so far (in our own imperfect way) as making it a way of life. Since getting involved in addiction treatment, ownership has been inspired to pay more attention to self-development and spirituality. After all, the process of recovery for our clients often needs to be a total, rather than incremental, shift.

Conclusion

So there you have it. Admittedly, it’s nice to be able to move on to other projects now that the new corporate brochure is finally going to print. In the short term, we can hand out some nice new shiny brochures but I’m sure that we will be back making a new version in another few years. I have a feeling, however, that the OUR PHILOSOPHY section may not change so fast. I guess time will tell.

By Cathy Patterson-Sterling, MA, RCC

Director of Family Services, Sunshine Coast Health Center

Research and studies show that the impact of addiction on men and women can be different for both genders. Here are some differences at a glance

Men:

• are more likely to have a drug abuse or alcohol abuse problem than women
• have much higher rates of chemical dependence than women for all ages except the 12 to 17 year age group
• tend to higher rates of “social drinking” when compared to women
• tend to start using cocaine recreationally as a way to bond with other men. Women, on the other hand, typically initiate recreational cocaine use as a way to bond with the men in their lives

Women:

• tend to proceed more rapidly to drug dependence compared to men
• tend to have higher rates of “social smoking” when compared to men 
• are more vulnerable to HIV/AIDS through injection drug use when compared to men. Approximately two thirds of AIDS cases among women result from injection drug use. AIDS is now the fourth leading cause of death among women 15 to 44 years
• tend to begin abusing drugs at a later age than their male counterparts
• who have been treated for drug addiction have a higher incidence of childhood sexual when compared to men. Studies indicate that up to 70% of women in drug abuse treatment reports have histories of physical and sexual abuse with victimization beginning before the age of 11
• who have been treated for drug addiction have a higher rate of disordered eating when compared to men. For example, as many as 55% of bulimic patients are reported to have drug and alcohol use problems.Overall, 15-40% of females with drug abuse or alcohol problems have been reported to have eating disorder syndromes, usually involving binge eating
• have higher rates of co-existing substance abuse disorders and other psychiatric disorders compared to men. Data from a study on female crime victims, for example, indicate that those suffering from post-traumatic stress disorder (PTSD) were 17 times more likely to have major drug abuse problems than non-victims

Women who seek addiction treatment are in need of female-sensitive services for a wide range of medical problems, mental disorders, and psychosocial problems. Furthermore, there is a stronger likelihood that women with addictions have been victimized earlier in life so this means that they have special psychological and psychiatric needs. For this reason, non-punitive and non-coercive treatment facilities are recommended for female populations.

One can conclude from the information above that women have very specific treatment needs especially considering that their cocaine addictions may start out as attempts to connect intimately in relationships and that women also have a higher incidence of medical and co-existing mental health issues compared to men. With the above differences in mind, one can also make a strong case for gender-specific treatment in which men’s drug and alcohol programs are designed for men’s needs and the same is provided for women with their exclusive issues. 

If gender-specific treatment is the gold standard, then the question remains as to why so many men and women remain in co-ed treatment settings. Is this simply a case of economics - ensuring as many admissions as possible? Or does co-ed treatment have some special redeeming qualities in terms of care for clients? The writer will leave it to the reader to ponder such controversial questions.

References

www.alcoholaddiction.org - “Men vs. Women in Substance Abuse” - April 13, 2008
www.4therapy.com - “Women Often Experience Addiction Differently Than Men”

Stepanie S. Covington Ph.D., LCSW - Center for Gender and Justice

By Daniel Jordan
General Manager 

Every month or so when I am heading down Granville Street in Vancouver I will stop by the Salvation Army Thrift Store located in the Marpole District. As I have mentioned in previous blog posts, I am a used book nut and am always on the search for interesting self-help or psychology books. This past week I came across a book titled, “Leadership Secrets of the Salvation Army,” written by former National Commander, Robert A. Watson. 

I have known for some time that Salvation Army is also the oldest drug rehabilitation treatment provider in the world thanks to their network of Harbour Light rehabilitation centers. So what can a charity like Salvation Army teach a private addiction treatment center? Lots, as I was to learn:

Lesson #1 - Combine Seemingly Incompatible Corporate Values Into A New, Superior Synthesis

The Salvation Army is part evangelical, part Good Samaritan as exemplified by their mission:

“The Salvation Army, an international movement, is an evangelical part of the universal Christian Church. Its message is based on the bible. Its ministry is motivated by the love of God. Its mission is to preach the gospel of Jesus Christ and to meet human needs in His name without discrimination.”

In other words, Salvation Army has managed to combine religion and social work in a way that reminds me of what Roger Martin called in his book, The Opposable Mind, integrative thinking, or “the ability to hold two opposing ideas without panicking or settling for one or the other idea.” The result of this is a “synthesis that contains elements of the opposing ideas but is superior to each. (page 15).” The opposing ideas in this instance are religion and social work. In the mid-1800s, neither the Church nor government wanted any part of East London where disease, drunkenness, and child abuse were rampant. By distancing the Army’s work from the limitations of both church and state, its founder William Booth was able to create a uniquely powerful charity committed to service without discrimination.

Lesson #2 - Help Employees and Clients Connect to a Sense of Meaning and Purpose

People often talk about their work lives, their family lives, and their spiritual lives as if they are distinct sectors they must somehow keep in balance. Robert Watson points out that human beings cannot be one person at work, another with friends and family, yet another in their spirituality. We are, each of us, one person.

Mr. Watson suggests that a way to pull these “fragments” of our lives together is by finding a meaningful, transcendent purpose. Salvation Army encourages its employees strive for a healthy reintegration of work, friends, and family and a connection to principles that give meaning to life. Salvation Army is quite candid about the modest financial compensation they provide employees, explaining that life is more than personal gain - salaries, perqs, bonuses, and fancy titles - or corporate objectives - earnings, dividends, or market share. Mr. Watson suggests that Salvation Army provides its employees something much more important: meaningful engagement in challenging arenas and soul-satisfying service of people in need.

When clients come to Salvation Army for help, they often have addiction or relationship problems. While Salvation Army is committed to help their clients face and overcome these problems, the “real secret of success” is by helping clients connect with purpose and integrating their hearts, minds, and souls with this spiritual connection. Many of the clients that get help at Salvation Army are far from the stereotypical homeless and helpless. A lack of purpose can be an issue for those who have attained professional achievement and material success.

Lesson #3 - Help Clients by Offering a Variety of Services

Clients with addictions rarely come with just an addiction problem. Many also have a need for housing, job training, life-skills counselling, transportation, and clothing. For single parents comes the need for daycare, after-school recreation, health-care counselling, and parenting instruction. Each of these hurdles can be an insurmountable barrier for the person in recovery. Salvation Army provides all of these through their various businesses.

Lesson #4 - Five Criteria of Effectiveness

Peter F. Drucker, perhaps the world’s most famous management authority, calls the Salvation Army “by far the most effective organization in the U.S.” This is based on what Mr. Drucker calls the five criteria of effectiveness:

1. Clarity of Mission - the dual mission of “salvation and service” has not changed since its inception in 1850. This is the anchor that has allowed Salvation Army to expand from 8 people with no assets when they arrived in America in 1880 to an organization with an annual budget exceeding $2 billion and a work force of officers , employees, and volunteers approaching 3.4 million people. Mr. Watson explains that this laser-like focus on mission has benefits on both the revenue and cost side of the income statement: (1) donor support (public donations are often double that of runners-up like YMCA and Red Cross) and (2) employee and volunteer devotion whose faith in the mission makes low pay and long volunteer hours worthwhile.
2. Ability to Innovate - Peter Drucker referred to the Salvation Army not so much as a charity but as venture capitalists. What he meant by this is that the investments Salvation Army makes in people get huge returns. By awakening an awareness in clients to their ”divine purpose” what often follows is an acknowledgment to serve others, often in new arenas. For example, Salvation Army services include  retail (over 1,600 thrift stores), housing providers (65,000 beds spread across the US), and social service specialists (ranging from disaster relief, long-term drug and alcohol rehabilitation, correctional counselling services, summer camps for kids, day care, community recreation programs, medical services, job training and placement, missing persons services, etc. This innovation is also done with a minimum of management involvement: a core management group of 5,000 oversees a work force of 3.4 million people.
3. Measurable Results - Salvation Army embraces the idea of accountability with specific, measurable, achievable, and mission-related goals. Outcomes are tracked for clients in their residential drug and alcohol programs as well as those in the pre-release transition programs for federal prison inmates. Every New Year’s Eve, Salvation Army holds open meeting Victory Reports on the year’s achievements and new program announcements for the coming year.
4. Dedication - volunteers and paid staff are inspired by the dedication modeled by Salvation Army officers. These officers are trained not as managers and counselors, but as ordained ministers. Officers sign a covenant, renouncing alcohol, drugs, and tobacco. To avoid the stress of competing careers on officer families, both spouses must be officers. The covenant of an officer is life-long (in  the year 2000, over 30 percent of the 5,326 member officer group was retired).
5. Putting Money to Maximum Use - of every dollar Salvation Army receives, at least 83 cents goes directly to services to people. At National Headquarters in Alexandria, Virginia, a staff of less than 100 oversee operations in four regional territories that extend from Maine to Florida to California to Alaska and the Pacific Islands.

Conclusion

Sunshine Coast Health Center, as a private treatment facility, will never be able to secure nor want the dedication demonstrated by Salvation Army officers nor will we ever have much of a volunteer work force or be able to pay our staff less in exchange for a commitment to public service. However, many other concepts such as clarity of mission, ability to innovate, and measurable results are certainly doable and worthy goals. I have read countless books stressing the importance of having a mission statement but this book was one of the first to explain that it is critical in today’s world of constant change. Furthermore, having a mission statement that has an overarching sense of meaning and purpose that extends to staff, clients and the community appears to be key in explaining Salvation Army’s longevity.

Additional Readings or Viewings

4 Questions for Roger Martin - a YouTube video

Commissioner Francis Speaks About Sally Ann Services in Canada - a video

Watch Hollywood movies, such as 28 Days with Sandra Bullock, or television talk shows, such as Oprah, and you might get the idea that the typical treatment program is well designed and effective.

You might think this until you read William Miller, one of the acknowledged gurus in the field. Miller commented in 2007: “What is actually being done in most addiction treatment programs? The truth is that no one really knows, including the administrators and supervisors of those programs.”

How this happened is a fascinating story. In 1949 several recovering alcoholics and community-spirited volunteers opened Hazelden, a treatment center for alcoholics in Minnesota. They really had no idea what they were doing. The healthcare profession was at a loss with what to do with ‘hopeless’ inebriates. But the Hazelden founders did know about Bill Wilson, who created a self-help program called the twelve steps. Since Wilson was having more success than the professionals, they gratefully borrowed the steps and tacked on medical, psychological, and religious components.

By the 1960s, Hazelden’s program would be known as the Minnesota Model, by far the most popular treatment for addiction. Various centers modified the model, and these are now known as “12-step based” treatment. Our best estimates from the US tell us that about 95 percent of all treatment facilities are 12-step based.

A typical counsellor was a recovering addict who attended a 12-step based treatment program, followed by membership in Alcoholics Anonymous or Narcotics Anonymous.

With so many facilities offering 12-step based treatment, rather odd ideas about addiction and recovery became the paradigm. For example, treatment providers relied heavily on the ideas of psychiatrist Harry Tiebout. Tiebout was trained in Sigmund Freud’s psychoanalysis, described himself as a “side-line observer” of Alcoholics Anonymous, and even treated Bill Wilson. Based on this experience, he declared in 1944 that the “so-called typical alcoholic is a narcissistic egocentric core, dominated by feelings of omnipotence, intent on maintaining at all costs its inner integrity.” Tiebout’s ideas were so influential that even Alcoholics Anonymous published his work.

Although modern psychology has advanced tremendously since Freud, disciples of 12-step based treatments continue to stick with this early psychology. Even today, they design programs around concepts that even neo-Freudian psychology has long since dismissed.

Second, counsellors generally believed there was no need to keep up on theory and research. Few counsellors had university degrees, much less training in statistical analysis or research methods. Many had no training whatsoever. Pouring through research articles was neither a priority nor even encouraged. Although the situation today is changing, it remains much the same 60 years later.

Third, the counseling style was confrontational because the counsellor had to break through the addict’s ‘denial’ (one of Freud’s ideas). The addict left to his own devices was a disaster, because, as Tiebout had said, the alcoholic would maintain his egocentric integrity at all costs. This form of counseling continues today, despite the overwhelming evidence that confrontation does not work and can harm clients.

Fourth, if clients did not do exactly what their counsellors told them to do, they were inevitably discharged. Such clients were judged “not ready” for treatment and had to do “more research” before they were serious. Studies of current programs continue to show discharge rates as high as 80 percent, with an average of 40 percent.

Fifth, counsellors developed the idea that only someone who had personal experience with addiction could counsel addicts. The continuing pervasiveness of this idea today is remarkable, considering that every study done on this issue has shown that it is simply not true.

One of the strangest of ideas was that almost no one thought it important to study how successful their treatment was. Staggering sums were being spent on treatment, and no one had a clue if it even worked. As we now know, it wasn’t very good. Even today, most counsellors and program supervisors have never bothered to study what they do and how successful they are. This explains, of course, Miller’s observation that “no one really knows what is actually being done in most treatment programs.”

Despite this bleak picture, there is much hope. Research-based treatments, such as Alan Marlatt’s relapse prevention programs and William Miller’s motivational therapy, are showing better results than we’ve ever seen. Faced with overwhelming pressure to update its program, even Hazelden has distanced itself from the past and begun publishing quality research. 

This is all good news. Still, it is one more strange thing about treatment that most counselors and their supervisors refuse to take a long, hard look at what they are doing.

About the Author

Geoff Thompson, MA, is the Program Director at Sunshine Coast Health Center, a private addiction treatment facility for adult men. His book, A Long Night’s Journey into Day, explores Eugene O’Neill’s life to uncover the truth of addiction and recovery.

By Geoff Thompson - MA, CCC

As part of the new programming at Sunshine Coast Health Center in Powell River, Melanie Alsager, the Center’s Administrator, is opening its doors to public scrutiny. Unlike most managers of treatment facilities, she believes that what Sunshine Coast does, why it does it, and how well it does it should be transparent.

Ken Hart of the University of Windsor, one of Canada’s experts in the field, has already accepted Ms. Alsager’s invitation to study its program. 

Sunshine Coast will be the first private treatment centre in Canada to be transparent. If this sounds odd, it is. Imagine the public outcry if the local hospital just did what it wanted to without having to answer to regulatory bodies or patients. But one of the more peculiar things in the treatment of addictions is its secrecy.

Public scrutiny scares most facility managers because it means inviting professional researchers in to take an in-depth look at how successful they are.

A handful of private facilities have offered the invitation, with embarrassing consequences. Renascent in Ontario advertised an “independent study,” which concluded “60% have stayed clean and sober two years post-treatment.” Phoenix House in New York City declared publicly that 80 percent of its clients stayed sober for at least five years.

These public declarations are invitations to researchers, who promptly proceeded to report, equally publicly, that the studies were flawed. In fact, there were even suggestions of deliberate deception. The experts didn’t bother dissecting the Renascent figures after they realized that the methodology was substandard. They simply embarrassed the centre on television.

After researchers got their hands on the Phoenix data, the successful outcomes plummeted from 80 percent to 16 percent. Even 16 percent after five years is high, according to scholarly research, until one recognizes that the Phoenix programs are 18 and 24 months long. Thus, only the most motivated clients enter the facility.

Small wonder that managers of  treatment  facilities steer clear of researchers. Renascent and Phoenix were hard lessons.

Still, many continue to publish rates that are wildly more successful than any published in scholarly research. A taxpayer-subsidized program in BC’s Lower Mainland advertised a 90 percent success rate, though its annual report dropped the figure to 66 percent. I suspect that I’m one of very few who even paid attention to the numbers. Most researchers wouldn’t waste their time. It was obvious that the study’s design and methodology were weak, and it lacked sufficient data. Most damning, it conveniently omitted those who did not complete the program, which was rather significant since the attrition rate was 60 percent.

But regardless of Renascent, Phoenix, and the rest, researchers have known for years the outcomes of mainstream treatments. In the old days, we used to measure them by abstinence. Success meant never using substances; failure meant any use of a substance.

Under this now dated way of thinking, success rates were as follows:

• Up to a year (clients are usually followed only for three months): about 25 percent abstain
• At four years after treatment, the figure drops to 7 percent
• At seven years, the figure is 5 percent.

But measuring success by abstinence has not been done for a generation. The new method is to examine various life areas before treatment and after treatment. Typically, researchers want to know if there are improvements in physical health, family relationships, ability to work or attend school, emotional and mental stability, and criminal involvement. Drug use is used as one more indicator.

Successful treatment means a statistically significant improvement in these life areas. Generally, of those attending mainstream programs, one-third improve, one-third stay the same, and one-third deteriorate. In the very best researched-based programs, with clients who are motivated and have lots of support, about half will significantly improve. 

Professor Hart will soon be studying Sunshine Coast, and both he and Ms. Alsager are excited.  Preliminary discussions with several universities, including one in the US, have indicated that many are eager to see the results. And why wouldn’t they be excited? With only a handful of centers in North America willing to invite researchers in, Ms. Alsager’s belief in transparency is welcome news to them.

About the Author

Geoff Thompson, MA, is the Program Director at Sunshine Coast Health Center, a private addiction treatment facility for adult men. His book, A Long Night’s Journey into Day, explores Eugene O’Neill’s life to uncover the truth of addiction and recovery.

1. our treatment program is becoming increasingly evidence-based
2. counsellors are now masters level therapists
3. free weekend refresher stays for alumni
4. flexible, more affordable relapse prevention services for alumni
5. enhanced family and couples services with the full-time appointment of Cathy Patterson-Sterling as Director of Family Services
6. enhanced biopsychosocial services (physical assessments, personal fitness programs, etc.) with the full-time hiring of Kye Taylor, kinesiologist
7. enhanced alumni services with the full-time appointment of Darren Nivens as Alumni Coordinator
8. a new wing complete with additional space for group activities (lounge, group therapy), accommodation (8 new bedrooms upstairs), and recreation (including the opening of an indoor lap pool in November)
9. a newly-landscaped campus

Item 4 from this list is worth special mention: flexible, more affordable alumni services.

More Options for Alumni Means Long-Term Value For Families

A few months back, Daniel Jordan (Sunshine Coast General Manager) and I talked about making lifetime commitments to our clients.   This commitment involves a multitude of free support services including online and telephone counseling, family programming and weekend visits.  We know that any client who continues to work with us can find the answers he needs to maintain abstinence, healthy relationships, and improved quality of life.

One way that I felt we could improve our offerings was to offer a more flexible relapse stabilization program. Typically, private treatment centers require their relapsing clients to return for another full treatment stay – often 42 days or longer. However, at Sunshine Coast, we find that returning clients often have the basics and their needs are more specific so a shorter stay is often sufficient. Furthermore, the additional expense of a second 42-day stay can create unnecessary hardship when a short-term follow-up could have sufficed.

At Sunshine Coast, we have offered a shorter 30 day program for our alumni at a reduced rate for more than 2 years. In the fall of 2007 we added a 7 day rapid stabilization for clients who had a short relapse so that they could quickly get back to their families and careers. Many of our alumni take advantage of these relapse prevention services and can refocus their recovery for less than half the price of what it would cost at other centers. 

It’s this commitment to a lifetime of care with very inexpensive and short relapse program opportunities that creates real value for our clientele.  Families can now access shorter, more affordable treatment that has a length of stay appropriate for the individual needs of the client.

Many of our alumni have successfully bounced back from a short relapse with little more than a week or two of relapse prevention work. These alumni seem to know when they have had enough time in the center and when additional therapy has met their personal recovery goals.  It is this trust that they know themselves and their recovery needs that increases their confidence in their recovery work and enables them to move forward with fewer, less intensive, and shorter-duration relapses.
 
Conclusion

In these economically uncertain times, we at Sunshine Coast are committed to increasing value when it comes to residential drug and alcohol treatment. That means not only making treatment more effective, it also means providing flexible and affordable “refresher” programs for alumni. In the end, it is a treatment center’s long-term commitment to clients and their family members which separates real value from a quick sale.

About the Author

Melanie Alsager is the Administrator of Sunshine Coast Health Center and oversees administration, operations and clinical programming.

In this video, Program Director Geoff Thompson describes what happens to clients in the weeks following their discharge from medical detox at Sunshine Coast Health Center. Clients in early addiction treatment can offen feel nervous yet enthusiastic about starting treatment while, at the same time, trying to deal with the shame and guilt of their past. Geoff also describes some of the features of the treatment program at Sunshine Coast such as group therapy, psychiatric services, recreation, etc.