Drug Rehab Center

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.

By Daniel Jordan

I received an email the other day from a women’s-only drug treatment center in the United States. As I read the article entitled, “Women Find Success at Female-Only Addiction Treatment Programs,” it reminded me that when people talk about the need for gender-specific treatment what they are really referring to is all-female treatment. Rarely, if ever, do I read an article pointing out the advantages of male-only treatment. 

After nearly five years serving an exclusively male clientele, I see the need to expand the definition of gender-specific treatment to include men. “Traditional” addiction treatment, often provided in a co-ed setting, has not done a good job of addressing the unique needs and characteristics of its clientele, often to the detriment of both sexes.

The Forces Behind the Womens-Only Treatment Movement

In her article, “Helping Women Recover: A Comprehensive Integrated Treatment Model,” Dr. Stephanie S. Covington, a leading advocate for womens-only treatment, writes a brief but telling history of the treatment of women’s addictions. Describing how women were essentially “invisible” in the field of addiction recovery until the late 1960s, Dr. Covington attributes this to “strong social taboos” against women who used drugs and alcohol to excess.

Internal Forces for Change

For many years, a small but vocal group of treatment industry insiders has expressed concern about the male-dominated origins of traditional addiction treatment. Much of their concern hinges on the two “cornerstones” of traditional addiction treatment programs in the United States: (1) the Alcoholics Anonymous (AA) movement of the 1930s and (2) the pioneering work of addiction researcher E. Morton Jellinek in the 1940s. The concern with Alcoholics Anonymous is its founding by Bill W., Dr. Bob and other men working with a mutual support group of mostly men, particularly in the early days of AA. Similarly, the concern with Dr. Jellinek was how he based his influential research on a population that was almost exclusively male. As a result, according to Dr. Covington, traditional treatment has always consisted of programs made “by men, for men.”

Furthermore, advocates for change have observed how traditional, co-ed treatment has made it difficult for women to discuss sensitive issues such as sexual abuse, parenting, and eating disorders. Brenda Iliff, Clinical Director at Hazelden Foundation, describes the treatment experience for women when Hazelden was still co-ed: “women tended to sidestep many issues when in the presence of men.” In some cases, she and other professionals would actually discourage women from talking about certain topics with male clients. “Most women will hesitate to talk about trauma issues in front of men, or about areas where they have failed as a parent,” Iliff says. “We even had women who wouldn’t eat in front of men because of issues surrounding body image. *” This behaviour, while no longer an issue at Hazelden since the opening of its Womens Recovery Center in 2006, continues today in other treatment centers with co-ed environments.

(*) Source: Celebrating Women’s Differences (March, 2007) Addiction Professional Magazine.

External Forces

Coinciding with the feminist movement, Dr. Covington points out that “taboo subjects” such as incest, domestic violence and addiction were openly discussed by health professionals and the general public for the first time in the 1960s and 70s.  In 1976, the U.S. Congress responded to pressure from feminist organizations and treatment advocacy groups by funding specialized women’s treatment for the first time.

Since those early days, treatment centers with specialized programs for women now exist all over North America. While the author could not locate data showing the actual number of female-only treatment programs, statistics from the National Survey of Substance Abuse Treatment Services show that among the 13,771 addiction treatment facilities (outpatient, residential, hospital inpatient) in the United States surveyed in 2006, 32 % of these programs offered at least one special program or group for adult women while 14.2 % had a similar option for pregnant or postpartum women.

How Male-Only Treatment Can Enhance Spirituality in an Addiction Treatment Setting

While traditional treatment does not necessarily encourage discussion on gender-specific issues, it does address the critical issue of spirituality in recovery. However, in a co-ed environment, the ability of clients to experience spirituality is hindered by the presence of a mixed-sex peer group. At Sunshine Coast Health Center, the opportunity for our male clients to connect to their spiritual selves seems to coincide with their reconnection with, what author Herb Goldberg * describes as, the “Lost Art of Buddyship:” the experience of having a sharing, caring, and loving relationship with another man. For many of our male clientele, the last time they have had a true “buddy” may go back to grade school. Thus, in a male-specific treatment center the experience of having a “higher power” is fostered by a setting that encourages fellowship.

(*) Source: The Hazards of Being Male: Surving the Myth of Masculine Privilege (1976) Herb Goldberg, Ph.D.

How Male-Only Treatment Can Enhance Programming

While Dr. Covington’s description of traditional treatment being a “program designed by men for men” may be true, one cannot simply conclude that male-specific issues have always been part of the curriculum in traditional treatment. Assigned reading typical of traditional treatment programs - the Big Book, Came to Believe, Living Sober, the Twelve Steps and Twelve Traditions, etc. – makes little mention of the unique challenges of being a man in the modern world.

Within a treatment environment that encourages self-disclosure, women in female-only treatment programs have, to varying degrees, enhanced their programs by addressing issues not considered appropriate for co-ed treatment. The Center for Substance Abuse Treatment (CSAT) has identified 17 essential issues (1) for women in substance misuse treatment, seven of which include:

1. an attachment to unhealthy interpersonal relationships
2. interpersonal violence, including incest, rape, battering, and other abuse
3. eating disorders
4. sexuality, including sexual functioning and sexual orientation (2)
5. parenting
6. appearance, overall health and hygiene
7. child care and custody

Men in gender-specific settings can also benefit from an open discussion on many (though not always the same) subjects considered “taboo” in co-ed treatment. While The Center for Substance Abuse Treatment (CSAT) has provided, as shown above, a list of  essential issues for women in substance misuse treatment, no such “official,” research-supported list for men in substance misuse treatment could be located by the author. The closest thing to a list was found in a book written by staff at Hanley Center, a male-only residential treatment center located in Florida. Titled Men’s Healing: A Toolbox for Life, authors Alam Lyme, David Powell, and Stephen Andrew identify five areas to help men understand the how and why of their behaviour, including:

1. father/son relationships
2. anger and aggression
3. emotional isolation
4. spiritual disconnection
5. sexual issues

(1) Source: Center for Substance Abuse Treatment (1994) Practical Approaches in the treatment of women who abuse alcohol and other drugs. Department of Health and Human Services, Public Health Service.

(2) Note: for more information on female sexuality and addiction see Women, Addiction and Sexuality by Stephanie S. Covington, Ph.D.

Conclusion 

Ten years ago, in a NIDA article entitled “Gender Matters in Drug Abuse Research,” then NIDA Director Dr. Alan I. Leshner stated, “Evidence from NIDA’s gender-related research indicates that prevention and treatment strategies that address gender differences can be more effective than one-size-fits-all approaches in preventing drug abuse and relapse following treatment.” Without a movement to call their own and a lack of advocacy from treatment insiders, gender-specific treatment for men has not kept up with treatment for women. Perhaps the need for male-only treatment will be part of a larger, more powerful movement advocating for individualized therapy that is more focused on the unique characteristics of the client. One can only hope.

About the Author

Daniel Jordan is the General Manager of Sunshine Coast Health Center and hopes that these postings will help  take away some of the mystery often associated with addiction and its treatment.

Printed Resources – Men as a Special Population

For more resources related to men with addictions see the Special Population section of the Sunshine Coast Health Center website.

I Don’t Want to Talk About It: Overcome the Secret Legacy of Male Depression (2000) discusses how men attempting to escape depression fuel many of the problems we think of as typically male – difficulty with intimacy, workaholism, alcoholism, abusive behavior, and rage. Terence Real.

Men’s Healing: A Toolbox for Life (2008) is a book written about male-only treatment for addiction and the unique needs of men with addictions. Alan Lyme, David J. Powell, Stephen Andrew.

Message in a Bottle: Stories of Men and Addiction (1997) shares the stories of alcoholics whom he helped treat, detailing how traditional treatments for addiction fail to meet the needs of men. Jefferson A. Singer.

Touchstones: A Book of Daily Meditations for Men (1986) begin with quotations from sources as varied as William Shakespeare, Wendell Berry, Michael Spinks, and Woody Allen and conclude with affirmations that underscore the lessons of intimacy, integrity, and spirituality. David Spohn.

Wisdom to Know: More Daily Meditations for Men (2005) serves as a practical and spiritual compass for men making their way along the often-tumultuous recovery journey. Hazelden Foundation.

Printed Resources – Women as a Special Population

For more resources related to women with addictions see the Special Population section of the Sunshine Coast Health Center website.

Best Practices: Treatment and Rehabilitation for Women with Substance Use Problems contains a selected bibliography of women-specific addiction information. Health Canada.

The Fight Within: A Story of Women in Recovery (2005) relays the human side of addiction and its consequences. Using narrative as a counseling tool, female clients collaborate with a group facilitator to process their own stories, which appear as a collection of writings. Norma Miller.

Goodbye Hangovers, Hello Life: Self-Help for Women (2003) the founder of Women for Sobriety explains the self-help system she devised to cure herself of alcoholism and discusses the special problems of the woman alcoholic. Jean Kirkpatrick.

The Handbook of Addiction Treatment for Women (2002) offers a historical context on the issue of women and addiction, examines the myriad challenges of the female addict, and includes recommendations for choosing a course of treatment. Shulamith Lala Ashenberg, Stephanie Brown.

Highs and Lows: Canadian Perspectives on Women and Substance Use (December 2007) Centre for Addiction Mental Health ISBN 978-0-88868-534-6.

A Place Called Self: Women, Sobriety, and Radical Transformation (2004) helps readers unravel painful truths and confusing feelings in their newfound sobriety. Stephanie Brown, Yvonne Pearson.

Recovering Women: Feminisms and the Representation of Addiction (2000) analyzes women’s addiction and recovery from a feminist perspective. Melissa Pearl Friedling.

Social and Behavioral Aspects of Female Alcoholism: An Annotated Bibliography (1980) includes 488 annotated references to journal articles about the social and behavioral aspects of female alcoholism divided into 9 subject categories. Paul H. Chalfant, Brent S. Roper.

Substance and Shadow: Women and Addiction in the United States (1999) Stephen R. Kandall

Substance Use Among Women: A Reference and Resource Guide is a compilation of theoretical, empirical, and clinical knowledge concerning key topics associated with substance use among women. Ann M. Pagliaro, Louis A. Pagliaro.

Substance Use Among Women in the United States (1997) Office of Applied Studies, Substance Abuse and Mental Health Services Administration (SAMHSA).

A Woman’s Spirit: More Meditations for Women (1994) is a collection of wise, compassionate daily meditations for women now living a sober life and seeking spiritual fulfillment. James Jennings, Karen Casey.

Women and Alcohol: Contemporary and Historical Perspectives (1997) records the widespread and persisting ambivalence or hostility in many cultures towards the relation of women with alcohol by reference to religious and social pressures, gender roles and stereotypes. Moira Plant.

A Woman’s Way through the Twelve Steps (2000) is a workbook designed to help a woman find her own path through the twelve steps. Stephanie S. Covington. 

Women, Sex & Addiction: A search for love & power (1989) shows women how they can learn to experience their sexuality as a source of love and positive power and sex as an expression that honors the soul as well as the body. Charlotte David-Kasl.

Women Under the Influence (2006) documents the physical and emotional effects of substance abuse in girls and women and explores the role of advertising and entertainment industries in popularizing various substances of abuse. Joseph A. Califano.

By Daniel Jordan

We get a lot of calls from family members looking for help for their loved ones and, occassionally, we are asked whether it is possible to lock someone up to keep them from their drug of choice. To spouses, parents, and siblings in distress, it must be hard to imagine that anything less than prison could keep their family members from drinking or getting high. We do explain to family members, however, that there are other ways to keep individuals in treatment and, almost as importantly, prepare them to live productive, fulfilling lives in recovery. 

I have observed over the years that clients, for the most part, adapt quickly to their new environment. And just because their home life is in disarray doesn’t preclude them from pointing out our faults as an alcohol and drug treatment center. Any time a client has a complaint or suggestion, we pay attention and, if the client has a valid point, we make a change *. After 4 and a half years in operation, all of these suggestions (and a “few” of our own) have created a program and facility that, we believe, is efficient, responsive, and organized.  Invariably, clients benefit from having a well-structured program. The protective “bubble” that exists in residential drug treatment is, however, a double-edged sword that has both pros and cons for the client.

Structure Benefits the Client

One of the main reasons why individuals choose residential over outpatient treatment is because of the amount of structure present in residential treatment. When clients first arrive, they frequently report not having slept for days (especially the crack cocaine users) and can’t remember the last time they have sat down for a proper meal. If basic life essentials like sleep and food can take a back seat to drugs, then it’s easy to understand why showing up for an outpatient session at a clinic across town can be a monumental, if not impossible, undertaking.

While some clients may grumble about all of the rules and restrictions of residential treatment, most seem to understand the need for structure and slowly begin to rebuild their lives due, in part, to putting structure into their own daily routine.

Structure Also Benefits the Treatment Provider

Like any business, staff and management of treatment centers also benefit from structure. Structure provides some sense of predictabilty for staff which is so important when working with clients who go through many highs and lows during the course of treatment. Management loves structure because it makes it possible to plan for the future rather than lurching day to day, from one crisis to the next.

Structure, however, has its limitations and may even be detrimental to the client if taken to the extreme.

The Disadvantages of Living in the “Bubble”

As our clients know from personal experience, too much of a good thing is usually a bad thing. So it goes with structure as it can create an artificial sense of security – a protective “bubble” of sorts- that can collapse when tested by the trials and tribulations of real life.

My colleague (and sister), Melanie Alsager, told me once how life was like as a teenager attending a private boarding school on Vancouver Island. A wake-up bell  would tell Melanie and her classmates when it was time for breakfast and another bell would tell them it was time for class. Another bell would ring to signal the end of class while another would announce lunch time. This would continue right through to “prep” at 9:30 PM. Furthermore, staff would mill about checking to make sure that homework was done and assignments handed in on time. At the time, Melanie and her classmates would grumble a bit but eventually got used to it.

The problem with this environment, however, did not appear until these boarding school graduates went on to university where there were no bells and no instructors to check up on them. In this new environment of independence, many of the boarding school’s “star” pupils were either put on academic probation or dropped out from college altogether.

The Importance of Empowering the Client

So, the life experiences and personal philosophy of ownership, suggestions from staff who have worked at other facilities, and feedback from clients have all culminated in our current approach where the extent of program structure has been tempered by the need to empower clients and help them find the resilience to face the inevitable challenges awaiting them back home.

Relaxing the Rules of Treatment to Empower Clients

Over time, many of our rules have changed as we have come to appreciate the importance of having clients experience “teachable moments” during treatment rather than after they go home. Examples of these rule changes include:

1. giving clients day or weekend passes
2. allowing clients to go down to the beach or the fitness center without a buddy or staff member
3. taking clients to convenience stores for extras (cigarettes, pop, chips, etc.) that also stock liquor
4. showing movies with scenes of drinking or drug use

Each of these rule changes were carefully considered and implemented with certain precautions. For example, clients on day or weekend passes need to be accompanied by an approved companion and are drug-tested when they return. Movies are pre-screened and a clinical staff member checks in with clients for a discussion session at the conclusion of a show.

Conclusion

The more proficient staff and management get at running an alcohol and drug rehabilitation program, the less the treatment environment resembles what awaits clients back home. Relaxing the rules is just one of the ways Sunshine Coast Health Center has tried to make for a smoother transition to life after recovery.

Admittedly, this is a contentious issue in the tradition-bound world of private addiction treatment. We understand the criticism that being too flexible with clients or exposing them to triggers can endanger clients and their early recovery. We are sensitive to these concerns and have built in provisions to minimize these risks.

In the end, however, life after treatment will always be infinitely more challenging than treatment itself. Far better, we believe, for clients to be exposed to some of these risks where they can be processed with the help of a counsellor than to give clients a false sense of security by postponing the inevitable.

About the Author

Daniel Jordan is the General Manager of Sunshine Coast Health Center. His posts in “Life in the Drug Rehab Business” are designed to lower the veil on the secretive world of addiction treatment. By being transparent, Daniel believes that Sunshine Coast can help lower the stigma attached addiction and, at the same time, raise the standard of today’s addiction treatment programs. 

(*) Note: the clinical debate over where to draw the line with complaining clients will be the subject of a future blog posting.

“Blessed are the poor in spirit: for theirs is the kingdom of heaven” ~ Matthew 5:3

Introduction

The Holy Bible considers being ‘poor in spirit,’ or humble, one of the most important requirements of those who want to be close to God. Alcoholics Anonymous considers humility a critical part of staying sober: “…the attainment of greater humility is the foundation principle of each of AA’s Twelve Steps. For without some degree of humility, no alcoholic can stay sober at all (page 70, 12 Steps and 12 Traditions ).”

At Sunshine Coast Health Center, much of the clinical work we do is designed to illicit motivation in the client. Often misunderstood, humility plays an important role in fostering motivation. However, over the past few years, we have distanced ourselves from using confrontation as a means of evoking humility and motivation in clients. It is a classic example of when the ends don’t justify the means.

Our Policy on Working with Clients

As detailed in previous postings, Sunshine Coast Health Center is committed to treating clients with the highest personal regard. Our approach to clients is based on the empathic, client-centred approach of psychologist Carl Rogers . True to the spirit of Rogerian therapy, we believe that clients are capable human beings and that the role of the counsellor is to partner with the client to achieve positive change.

Having a detailed client policy and clear corporate philosophy, however, has not stopped staff from occasionally resorting to confrontation.

The Fallout of Confrontation

The use of confrontation typically involves the use of shame, guilt, and humiliation to evoke humility or motivation in a client. These are powerful emotions which we have observed can immediately, and negatively, play out in a client’s behaviour.

While confrontation can hurt the peer group and the client’s relationship with all staff members, the most detrimental impact is the impact on the therapeutic relationship (*) between the client and his counsellor. Basically, confrontation often leaves the therapeutic relationship in tatters. The counsellor who confronted the client would be blissfully unaware of the problem they created since the fall-out from these confrontations would often play out in the evenings or weekends. Front-line staff (cooks, aides, drivers) and the rest of the peer group would become innocent bystanders of the confrontation’s aftermath. Senior clinical staff would be called in to clean up and help the client process the residual hurt and anger.

(*) Note: Scott Miller has some excellent data on the critical importance of creating and maintaining the therapeutic relationship in his article, “What Works” in Therapy?

Rationale for the Use of Confrontation in Addiction Treatment

One of the patterns we noticed with counsellors that would confront clients was how they would often resort to confrontation late in the day. We concluded that counsellors were resorting to confrontation not for therapeutic effect but simply because they were tired.  When we looked into what started the confrontation, it turned out that, more often than not, a client was seeking permission to go to town for personal supplies or for a day pass to spend time with a visiting family member.

When senior clinical management would ask counsellors why they resorted to confrontation it would often turn out that it was part of their training or, if the counsellor was in recovery, one of the methods used that, they believed, got them clean and sober. Rarely, if ever, would a counsellor point to research proving the efficacy of confrontation.

More often than not, however, the real objective of confrontation is not to evoke humility or motivation but, rather, client compliance.  While client compliance has short-term benefits such as minimizing disruption during treatment, the long-term clinical benefits of achieving client compliance have never been proven (*).

Another reason pointed out by counsellors for the use of confrontation came down to “tough love” which counsellors hope is interpreted by the client as saying “I care enough about you to tell you what you don’t want to hear. This is not easy for me to say but others around you have been afraid to tell you this so I will.”

Finally, for decades clinicians working in addiction treatment have been under the false notion that you can tear a client down, then build him/her back up after creating a foundation of positive attributes such as humility, gratitude, etc. This tactic, popularized by Synanon (*) in the 1970s, continues today (albeit, informally) in alcohol and drug treatment centers across North America.

(*) Note: for an excellent historical review of Synanon and other confrontation proponents as well as information on the lack of clinical trials showing the efficacy of confrontational counselling read Confrontation in Addiction Treatment.

Practical Solutions at Sunshine Coast to Lower the Incidence of Confrontational Counselling

While clearly explaining and reminding staff of our client-centred philosophy has certainly helped lower the use of confrontation by staff, it was not enough to dispel its use entirely. So other practices were incorporated to help reduce the need for direct confrontation. For example, Sunshine Coast has always had a weekly group exercise called Community where clients have the opportunity to express their concerns and suggestions. Since all staff and clients attend Community, solutions can often be found that would otherwise require a one-on-one, potentially confrontational, dialog between client and counsellor.

A second change Sunshine Coast decided to make was to offload the responsibility of approving client requests from counsellors to the Site Manager and Program Director. While we recognized that there was a clinical consideration in even the most mundane requests (e.g. permission to buy a pair of shoes at Wal-Mart in town), putting a counsellor on the spot to deny these requests was, in the end, deemed too costly when it came to the impact on the therapeutic relationship.

Finally, last winter Sunshine Coast Health Center added a Client Advocate to the staff roster. This volunteer, non-paid position was created to provide clients with a direct communication channel to ownership for clients that felt they weren’t being heard by operational, medical, or clinical staff.

Conclusion

These programming, procedural and staffing changes have made a positive impact by reducing the need for confrontation by staff. Current incidents of confrontation can be chalked up to staff fatigue, force of habit, personal philosophy, and personal difficulties spilling over to work. Resolving these staff issues while continuing to focus on the needs of clients is a fact of life for anyone engaged in running an alcohol and drug rehabilitation program.

In the last posting, I mentioned that we made a huge shift in policy when we decided to start treating clients at our addiction treatment center with the highest personal regard. The article highlighted several long-held beliefs in drug rehabilitation circles that, at a fundamental level, appear to get in the way of staff treating clients with respect.

Why Power and Control is Important to Staff: Predictability

I have since concluded that when we ask staff to treat clients with the highest personal regard we are also asking them to give up power and control. This is not easy in the sometimes unpredictable, chaotic world of alcohol and drug treatment. Anyone who has worked in the field of chemical dependency knows that clients often lack motivation, can be self-centered, and opinionated. Sometimes our patience is sorely tested when clients bend the rules to suit their purposes. Treatment is also a roller coaster of highs and lows where some clients make profound shifts in their lives while others leave early or relapse on the flight home. It is little wonder that working at a drug rehab center is not everyone’s cup of tea.

We have found that, for the most part, staff does a remarkable job of working through these challenges that can and do occur on a daily basis. Considering their working environment, however, It is not surprising that people who work in the field of addictions treatment cherish predictability. While change in any organization is often greeted with trepidation, this is particularly so in drug rehab programs (*). At Sunshine Coast, we have tried to make change part of our corporate culture. After all, we are asking clients to make some important, difficult changes so the least we can do is lead by example.

(*) Note: compared to other specialties in health care, addiction treatment has often been criticized for a reluctance to embrace clinical innovations.

Kicking Clients Out of Treatment: The Ultimate Trump Card

One policy that best exemplifies the need for ending the power struggle between clients and staff is discharging clients early. The threat of kicking clients out is the ultimate trump card for staff that is looking for an effective way to enforce the rules or attain client compliance. While Sunshine Coast doesn’t entirely rule out early discharge of clients, it is only used as a last resort. Staff whose first response to conflict with a client is to kick them out are asked to examine other options or brush up on their clinical skills.

Furthermore, staff members no longer have the final say in kicking a client out of treatment. Instead, a staff member is expected to discuss the situation with the Program Director who, in turn, consults with ownership so that the entire organization is in agreement and prepared to deal with the fallout from family members or referring partners.

Kicking clients out of treatment is a topic in its own right which I will cover in a future posting. For now, read Bill White’s article – It’s Time to Stop Kicking People out of Addiction Treatment.

The Benefits of Ending the Power Struggle

At Sunshine Coast Health Center, clients have, for the most part, responded positively to having a greater say in their treatment by:

1. assuming more responsibility for their own recovery
2. being more creative in finding ways to achieve and maintain sobriety
3. forming closer ties with other clients and less reliance on staff for direction and support while in treatment
4. adapting quicker and more effectively to the “real world” back home

Furthermore, lower staffing costs for non-therapeutic tasks such as client supervision also means a benefit to the company’s bottom line.

Conclusion

Treating clients with respect means more than simply being polite and courteous. It also requires that we give up power and control. It has been said that if you give up too much control to clients you end up, as the old saying goes, having “the inmates running the asylum.” While there is always a risk that some clients will abuse this freedom, our experience has been that most clients appreciate being treated like adults and learn to appreciate another old saying – “with freedom comes responsibility.”

Daniel Jordan is the General Manager of Sunshine Coast Health Center. His posts in “Life in the Drug Rehab Business” are designed to lower the veil on the secretive world of addiction treatment. By being transparent, Daniel believes that Sunshine Coast can help lead the way to a lowering of the stigma attached addiction and, at the same time, raise the standard of today’s addiction treatment programs. 

A few days ago, I wrote about how our policy concerning re-admitting clients who relapse after completing our drug rehab program has changed over the years. Today’s article is another matter of policy: how we treat clients. It has been, by far, our most challenging change in policy since opening in March, 2004.

Interestingly, the reasons for this are somewhat unique to the field of addiction treatment and are based on some long-held beliefs such as:

1. Clients are not Customers – Yes, clients pay to be in addiction treatment but many drug rehabs are concerned that standard customer service procedures feed the addict’s boundless ego and sense of entitlement
2. Clients are in Denial – many drug treatment centers feel that clients who don’t think they have a problem can’t be part of the solution. The result is a top-down authoritarian approach (I know what’s best for you).
3. Clients can’t be Trusted – whether it’s clients sneaking off campus, getting high, or having sex, most treatment centers believe that clients must be monitored at all times in order to minimize the need to kick clients out for such offences.

So when ownership at Sunshine Coast Health Center implemented a new policy of treating the client with the highest personal regard, it was not aware of just how entrenched these beliefs were for professionals who work in addiction treatment.

If this policy was just about being polite and courteous then it would have no big deal. What we have found that treating clients with respect is not just another policy, it is the policy.

Isadore Sharp, founder of the internationally-acclaimed Four Seasons Hotel chain, calls it the Golden Rule – treat all others—customers, employees, partners, suppliers—as we ourselves would want to be treated. Mr. Sharp calls it the cornerstone of the Four Seasons corporate culture.

If hotels can live by the Golden Rule, I say so can treatment centers.

Stay tuned for more posts on this critical topic.

Daniel Jordan is the General Manager of Sunshine Coast Health Center. His posts in “Life in the Drug Rehab Business” are designed to lower the veil on the secretive world of addiction treatment. By being transparent, Daniel believes that Sunshine Coast can help lead the way to a lowering of the stigma attached addiction and, at the same time, raise the standard of today’s addiction treatment programs. 

At Sunshine Coast Health Center, we welcome back clients who have had a relapse with open arms. When I say ‘open arms’ I mean that we no longer worry about how many times they have relapsed. A few years back we did worry about how many times clients relapsed before we would refer them to another program. Why?

Perhaps it was because we were worried about the impact a multiple-relapsing client would have on clients who were in the program for the first time. For example, perhaps clients might doubt the program (‘Gee, I guess this program’s no good if alumni keep coming back’) or doubt themselves (‘If he can’t stay clean and sober, how can I?’).  

Also, it would hurt our ‘success rate’ to keep re-admitting a chronic relapser.

Another concern we had was that we would be unable to teach the client anything new if they kept coming back.

I still recall having a staff meeting where we tried to assign a number of relapses a client could have before we would no longer accept them back. Eventually, we came up with a number but it never became policy.

Fortunately, as we have grown as an alcohol and drug treatment center our policy on relapsing clients has also ‘grown up.’ It is now based more on the needs of the client and less on what’s best for Sunshine Coast. In the end, it became clear to us that if we:

1. claim to offer individualized treatment, then the relapsing client should always receive a fresh, effective treatment plan that builds upon previous treatment episodes;
2. believe that addiction is a chronic condition then there is no better way to drive this message home to clients than to have them meet program alumni who have relapsed;
3. say we are “Partners in Recovery” there should be no arbitrary deadline when support is no longer provided;
4. want to reduce our relapse rates, there is no better way than to work with chronic relapsers .

So, when it comes to the ‘r’ word, at Sunshine Coast we decided to pull our collective heads out of the sand and acknowledge that, yes, our clients do relapse. If they weren’t, there would be a line-up from Powell River to Vancouver of people from all corners of the globe waiting for their turn.

One final note: Sunshine Coast now has relapse prevention programs that have been implemented in consultation with Terence T. Gorski, Stephen Grinstead, and CENAPS Corporation. By October 2008, Sunshine Coast Health Center hopes to be the first Gorski-CENAPS Certified Relapse Prevention Center in Canada.

Daniel Jordan is the General Manager of Sunshine Coast Health Center. His posts in “Life in the Drug Rehab Business” are designed to lower the veil on the secretive world of addiction treatment. By being transparent, Daniel believes that Sunshine Coast can help lead the way to a lowering of the stigma attached addiction and, at the same time, raise the standard of today’s addiction treatment programs.