I am just leaving for the UKESAD conference in England. I am co-presenting on the subject of the future of residential treatment. Many of you have communicated with me directly on the subject. Thanks.
I think we can be fairly sure they will exist but will there more beds or less. I also wonder if there might be changes over the next few years in terms of client populations and treatment approaches.
As a non clinician, I would suggest that for goverment funded programs the beds should be reserved for the most acute cases. I mean by acute those with concurrent disorders or lack of social and financial supports.
Another question is the future of the private pay for service residential programs. One American commentor has suggested that they are getting too expensive.
What does your crystal ball say?
I have set this blog up for you to share and discuss the issues. So please let me know what subject matters you want to address.
Jeff
May 11, 2009 at 9:10 pm |
Jeff good question. Private is so expensive, I don’t know anyone who is on the streets that can come up with $10,000 immediately. Yes, I know they may have spent that on their drug of choice, and I know they would crawl over broken glass on their knees to get their drug of choice, BUT, when someone actually cries out for help there are little resources to send them to. Some places want a minimum of 30 days sobriety, others want the person to not be on medication of any kind, there are long waiting lists, some can only attend treatment if it is through a health authority, etc. My point is, there are so many obstacles to someone getting immediate help, fees being only one part of it. If we cannot accommodate the person in the window of the moment, we may lose them forever.
May 11, 2009 at 9:40 pm |
When I consider the future of treatment, I wish I did have a crystal ball. I certainly agree with Rosemary regarding the numerous obstacles faced by those seeking treatment, but really don’t know what direction to look to begin tearing the obstacles down. If I were asked what I might like to see in the future, I guess it would be the removal of the current obstacles, clean time requirements, and waiting times (as mentioned by Rosemary) being two of the first to go. The next item up for renewal might be the current “one size fits all” mandate held by many centres. Flexibility in what we do for each unique individual, fueled by the understanding that a gay meth addict in Toronto, a sex trade worker addicted to crack and an alcoholic from the suburbs have very different first person experiences and very different issues to deal with after treatment is complete. Too often I have heard that “the drug doesn’t matter”, or that “addiction knows no boundaries” and “when it come to addition, everyone is the same, regardless of class, education etc etc.” Everyone is different, and our programs need to reflect that And please, I am not saying that this is the case everywhere, but having worked in both residential and withdrawal management sectors, and having once been a client in both, it is the case in many.
For the time being, as no one can really see the future, we continue to try to tear the obstacles down, chipping away at stigma, trying with all of our might to get funding for just one more bed, and working, each of us, to do our best with the system we have while trying our hardest to make the changes we need for greater success in the future.
May 11, 2009 at 10:18 pm |
As long as addiction is around we will need rehab facilities and although in-patient is the most expensive it seems to, when coupled with good follow up and aftercare, work the best. Part of our job is to continue the education of the public and the polititicians. people need to understand that treating addiciton is like treating cancer or diabetes, it is a health problem and treatement pays off. Treating addiction saves society money.
May 12, 2009 at 12:10 pm |
Rand, I think you point out a central challenge for our field. I agree that we need to do a much better job at getting our message across to other health professionals, governments and the general public.
Jeff
May 12, 2009 at 12:11 pm |
I’m reading Lawrence and Rand and sharing their experiences, agree with them. Yes residential is expensive and can not be all things to all clients yet serves those who are knocking on the last door of the street. Our trouble as service providers does not stem from the fact that we do unproductive work. Each service has value to those who are afflicted and given the massive social costs of addiction, should be supported by governments (and I don’t mean the usual lip service). Our struggles surround funding. How can we try with all our might to get just one more bed when the ones we have are bound to close. How can we expect our funders to have an understanding ear when their agenda is one sided. Integration is a must and welcomed but to water down the addicitons side of addictions/mental health in our residential centres is a big mistake.
May 12, 2009 at 12:28 pm |
There a couple of points I want to comment on. First of all it is related to the language we use when speaking of treatment. “REHAB” is a term that makes me cringe…I believe the term stands for rehabilitation…which is more related to behaviour and physical wellness….If all those suffering at one point had everything they needed cognitively, emotionally and spiritually there may not be any souls suffering for substance abuse and other addictions. So, the term ‘rehab’ is contrary to our thinking around why people become addicted. Rehab implies that people had at one time what they needed to function….and we all know that the suffering comes from lack of self awareness, related to our cognitive, emotional and/or spiritual well being. Thanks Jeff, I have been wanting to say that for a long time…but no forum until now.
Second point is that there are far too many clients clamouring to get into our scare residential treatment beds because they are seeking temporary shelter. There needs to be appropriate transition supportive housing in place for those that require it…. not all clients need intensive residential treatment. So, until we have an appropriate continuum in place our resources will continue to be inappropriately used. Then this will result in the outcomes for our residential treatment services being skewed…. perhaps showing little positive change (as those that are using them don’t require them for ‘treatment’)…then they will be closed because “they are not effective.
I wish my crystal ball showed a rosier future.
May 12, 2009 at 1:56 pm |
Thanks Michael. I think having this Blog is important to discuss the issues and air our different opinions. That is why I set it up. But what we need is getting the word out that the resource exists.
The term Rehab is of course used in the USA and the UK far more than it is in Canada. But, I personally agree with your point.
Jeff
May 12, 2009 at 1:52 pm |
It looks like the government is trying to get rid of inpatient care period. They seem to believe that out patient care is the way to go.This seems to be based on the medical system whereby ill people prefer to recover in their own home where they have their own support system to care for them. For someone who has a physical ailment like a broken arm or is recovering from surgery this is valid approach and is supported by the research.
With addiction as some have already pointed out a lot of our clients either don’t have homes or don’t have proper support systems, or their environment is not conducive to their recovery. Not everyone requires in patient service just like not everyone needs surgery to remove cancer.
The problem we are facing right now is our continuum of care being underfunded, undermanned and overtaxed. Right now it is almost impossible for a client to go directly to treatment from a withdrawal management centre, and then from treatment to a longer term program if needed.
Studies show that if a client can stay clean for the first year their chances of staying clean improve by a lot but with the system we have in place the approach is more about getting the client through the system as cheaply as possible rather than trying to help them.
While inpatient care is more expensive in the short term, it is more effective in the long term. I work in a WMC located in a shelter and the majority of our clients have very few resources, and are caught in the revolving door, in and out of WMC and waiting for months to get into treatment and the only support most of them have is 12 step meetings and call in lines (as most of the outpatient services are also overbooked and undermanned). Which is cheaper, putting a client through 1 year of treatment (even two or three times) or having them come to your facilty over 1500 times in the past 20 years? And I’m sure our centre is not the only one with client’s like that.
Many of our clients are very motivated but become extremely discouraged when they leave us after 3 to 7 days knowing they are back in their old environment with very little support, knowledge, and tools to stay clean until they go to treatment in 6 to 10 weeks.
What I would like to see is more inpatient beds in all areas, longer programs (7days in WMC is not enough nor is 21 days in treatment) and more transition beds or day programs for those that are waiting to get into treatment.
May 13, 2009 at 9:20 pm |
The issue I have with residential treatment in this country is that the modality of treatment is dominated by the 12 step philosphy. I believe in the 12 step program but to make it a condition of graduation of a program is ludicrous. Centres that make the 12 step program their core programming are charging for programming that can be obtained through the community. Most clients have no concept of a step 4 and 5 when they are completed in a treatment centre, they jump through the hoop to complete the program.
Treatment centres need to be focused on the science of addiction and quality aftercare which could include the 12 step programs as support. However core programming needs to based on evidence based information and therapies such as CBT.
The cost of these centres is also getting out of hand. The clients who can afford the costs are usually referred by EAP, government or military funding and they are referred to the quality centres. The rest go to the publically funded centres which offer a far lower quality of care. This is unfair to those who do not have these benefits. Treatment needs to be equal and accessible to all. The cost of addiction to our society is staggering. Politicans do not appear to get it and they are not likely to have the will, as the addicted do not usually vote.
June 1, 2009 at 8:23 pm |
Residential beds are an important component in the continuum of addiction treatment. Contrary to popular opinion there are government funded beds available. Contact the office at the Newport Treatment Program 905 8344501 ext 32500. We are an 18 day inpatient program addressing all substance use concerns including tobacco in a concomitant way. Tobacco is the first addiction and the one that will kill you. Given that we are an abstinence based program ( but you can and should use your medically prescribed medications including methadone and we will treat your tobacco addiction with accupuncture and NRT) So come spend a treatment cycle with us and see how much better you feel. We will ensure you are hooked up with aftercare supports. If you need a withdrawal management bed we will get you in to ours.
July 21, 2009 at 3:08 pm |
first of all i love this forum and believe that advertising a Treatment Program as Norma has done is inappropriate for this forum. I am in agreeance with the others that the lack of funding is causing our country to fail. When are we going to educate the Physicians to recognize an addiction and go through our health system to assist a patient. The amount of $$$$$$ that are asked from these Rehab Centers(sorry Micheal for using the word Rehab) is outrageous. When our country realizes that most times the addicted are a product of our government, our country standards for the poor and oppressed and our so called Health Care system, then and only then can they actually address the problem in a productive way. Currently their choice (Gov’t) is to keep these people on the streets, to not assist them to turn them away as they done to the numerous Mental Health Facilities until they either commit suicide or get killed over a 5 piece.
July 24, 2009 at 5:13 am |
I just need to say that your comment about the cost is so real. We pay athletes millions of dollars a year and don’t care about the most vulnerable of society. It is a shame.