Happiness Isn’t Brain Surgery Finding the Right Treatment Services

hi everybody and today we’re going to be talking about individualizing treatment the first thing that’s really important to understand when you’re talking about or thinking about getting into treatment is the fact that there are a lot of different types of treatment residential is the one people generally think about and that tends to be 30 days to 90 days sometimes a little bit more PHP is a level of treatment that offers people basically six hours of day of treatment five days a week but there’s still no treatment on the weekend for most PHP programs IOP is even less restrictive that’s nine to fifteen hours of treatment a week so you’re getting a lot of intensive treatment but outside of those nine to fifteen hours you’re back in your environment whatever that environment is so if it’s not a safe environment if it’s not a healthy and helpful environment IOP might not be the best choice and there are things you can do like living in a sober-living house or a halfway house depending on what it’s called where you’re at that can help so you can use a lower level of care and be in a safe environment and still get to work and do all that kind of stuff that you you feel you need to do outpatient treatment is once a week you’re seeing a therapist and it’s either for group or for individual but it’s only once a week so you’ve got anywhere from 60 minutes to 120 minutes of treatment and that’s it and you don’t have generally contact with your therapist in between so you need to add other things such as support groups coaches sponsors to fill in the gaps because most of the time people who are in outpatient treatment need a little bit more support than once a week coaching and early intervention these are services that if you think you’re starting to have a problem you can access but for a lot of people these are things that they’ll access once they leave residential PHP or IOP and a coach and early interventionist and support groups there all there to help you maintain games they’re not going to diagnose or treat anything they’re going to help you look at your relapse prevention plan they’re going to help you look at your goals they’re going to help you look and you look at the skills that you learned and use those in order to maintain your gains in long-term recovery so it’s important to look and see you ask yourself what kind of environment do I have how much structure do I need from outside how much structure can I provide to myself and you know what kind of support do I need do I need support 24/7 365 do I just need someone like a coach or sponsor that I can call when I’m having a bad moment but I can do IOP or or PHP and that’s going to be a very individual decision what I would tell you is to really consider and it doesn’t matter if you’ve got depression and anxiety or substance abuse or whatever issue you’re dealing with what I would tell you is look at the places that you spend the most time and that’s generally home and work or one or the other or both and figure out is that a safe environment if it’s not safe if it’s not conducive to your recovery then you may want to look at something that gets you out of the house more now the good thing about some support groups is you can access what they call club houses which are available to most people that are in the support group I mean just about every town I’ve ever lived in there’s been at least one 12-step meeting that’s pretty much 24/7 365 you can always go there but it’s important to know what your resources are so you can sort of start building your own program and your program can adjust based on your needs maybe when you first get out of treatment you’re doing really well and you don’t need as much structure but then something happened you lose your job the bottom falls out I don’t know and you start hitting a rough patch and you’re struggling to maintain the games that you made in treatment well this is when you may need to up your access to support groups or your coach or your sponsor in order to keep going because your situations changed is not that you’re failing it’s that life has thrown you a curve ball the other thing to consider when looking at treatment and a lot of people think that treatment is one-size-fits-all and it is so not even if you know the facility I used to work in we had 84 beds and we had 84 different very unique individuals with very unique situations so it’s important to understand what it is that you need what are your presenting issues do you have and mood issues or like anger anxiety and depression bipolar disorder trauma is self-explanatory substance abuse and I separated that from behavioral addictions and eating disorders for a reason because a lot of substance abuse facilities treat substance abuse but they don’t give much attention at all to compensatory behaviors such as sex addiction gambling eating issues other things that people may start engaging in in order to sort of substitute for their addiction of choice so if you have a quote straight up substance abuse issue great there are a lot of programs out there that can address that if you know maybe you’ve gone to treatment before or you just know yourself that once you remove your substance of choice you’re going to drop back into other compensatory mechanisms such as the ones I just mentioned that is important to make sure that that agency or that facility is capable of addressing those issues sex addiction gambling and and the environment is safe so just be aware of how you react when you can’t access your substance of choice or when things start to get really unpleasant and uncomfortable and I put eating disorders in their own separate category because they are a compensatory behavior they are used in a way to escape from stress and negative emotional states and yadda-yadda true however eating disorder treatment is unique because everybody has to eat and most programs you know you have a cafeteria you’ve got a dietician who sets up a one-size-fits-all menu if you’ve got somebody with an eating disorder this isn’t going to work if you’ve got somebody with bulimia there needs to be specific intervention set up for that person so after the meal that that person is not purging so if you know you’ve got an eating disorder know that that is sort of a relapse warning sign that’s going to keep you from fully addressing some of your other issues especially addiction issues if that is one of your compensatory behaviors you need to address all of your issues kind of at the same time not take away one and substitute it with another so make sure that you know yourself and you do you lived in your own skin it’s not we don’t do anything miraculous as clinicians to figure out where you should be placed or what should be going on a good clinician will ask you what works what doesn’t work and we’ll start from there now as far as duration some people will do well in programs there are 30 days most people don’t thirty days is pretty much an extended detox if we’re talking about substance abuse if you’re talking about mental health issues than thirty days may be enough but you want to look at what is the duration of the program given your experience with your situation is that enough is that going to meet your needs and you may have to go to a 30-day program but then where are you going to go from there which is what we call step-down and it breaks my heart when I see people go through 30 days of residential and do really really well and then we discharge them to support groups so they go from a completely structured environment to really no structure at all and that is setting people up for failure in my opinion and I’ve seen it happen over and over again step-down is really necessary we want to see people step down to IOP from residential so they’re still coming in every single day touching base maybe not for three months maybe just for a month make sure those skills that you’ve learned in the games that you’ve gotten in treatment are solidified when you’re out there dealing with life on life’s terms because residential kind of protects you from a lot of stuff in the outside world so step down to IOP or intensive outpatient of some sort for maybe 30 days and then maybe step down to support groups or preferably counseling but support groups with a good sponsor or with a recovery coach can do just as well it’s not better for some people knowing what you need how often do you need contact how much oversight do you need help with because you know we know ourselves we know that when we start to get stressed we know how likely we are to reach out and ask for help and how often we may need it initially so it’s not a weakness it’s actually a strength to know what you need initially in order to keep going and keep your progress moving forward people also need wraparound services if we discharge someone and speaking as a clinician I used to see this a lot we would have somebody in be great in residential for 30 days and the last three days of treatment they’re scrambling to try to figure out where they’re going to live and you know if they’re getting their kids back maybe somebody’s been keeping their kids how they’re going to find child care transportation to and from groups and work and probation then it starts getting really really stressful really really fast and we’re going to talk about this a little bit later but discharge planning is supposed to start at admission and I’m going to say that over and over again because it’s so important you don’t want to wait till the last three days of treatment to try to figure out well crap what am I going to do so you need housing you need to know where you’re going to go that’s going to be safe you need child care if you’ve got children and you’re going to be working transportation or access to basic services maybe you live in a city where you can walk to the grocery store and you can walk to the doctor and there’s a bus system and that’s great but if you live in a more rural area you’ve got to figure out how you’re going to get around because you need to and that could be calling people for rides but who are you going to call you don’t want to wait to the last minute when you’ve got no food in your fridge and you’re out of medication and you’re trying to call six buddies trying to find somebody who can tote you up to the store Medical and you you hear me preach about this over and over and over again if your body is not healthy your mood and your mind cannot be healthy so you need to make sure that you have access to prescriptions get on patient assistance programs find low cross prescriptions if you have medications you’re on and make sure you have access to a doctor so it’s not like well you know I’d like to get back on my meds but I can’t afford to see a doctor make sure your therapists or the program sets you up with some sort of medical services so you can get your needs met same thing with dental if you’ve got abscesses if you’ve got infections if you’ve got junk going on in here it’s going to keep you sick you need to address that because it can quickly become a physical issue but if you’ve got stuff going on in your mouth if you’ve got loss of teeth or rotting or anything like that for a lot of people that affects their self-esteem and we want you to go out there and be successful we want you to hold yourself head up and and smile and if you’re afraid to smile at other people or you’re self-conscious that’s going to negatively impact you Dental is just as important as medical and then employment and my brief little speech on employment is once you get a job go to your Workforce Development Board they’ll help you find work they’ll help you find places to go for jobs they’ll help you write resume get all ready for it once you secure a job if you are a hard to employ person because you don’t have a good employment history you have criminal convictions there’s a whole laundry list of things there is a federal bonding program that the employer can apply for which they quickly gets you a bond for six months so the employers not liable for anything should you be make a mistake when you’re working for them or quit or whatever it basically just gives the employer peace of mind so they’re willing to take a chance on you because there’s no risk to them so it’s the federal bonding program and it’s available through your local Workforce Development Board the other thing you need to know is what works for you I know I said that already but it’s so vital if you’ve been on every antidepressant that they’ve made and they haven’t worked for you you probably don’t want to start trying those again because you know that doesn’t work so you need to look at something different if you know that suboxone works for you and I know that’s a hot-button issue it works great for some people it works really lousy for others you need to know what works for you and do that do what works do you do well in groups not everybody does I am NOT an auditory learner if I can’t write something down if I can’t interact with people if I’m just sitting there listening to someone Yammer on I’m not going to get much of anything out of it so what do you need in groups if you have to be in one how can you make them work for you how do you feel about twelve steps some people love them not so much others just know what you need what you’re willing to embrace because if you’re going into it going well this isn’t for me then you’re not going to benefit from it do you need intensive individual some people have a lot of trauma issues that they’re not wanting to air in a group of sorts and that’s totally you know whatever it’s awesome if you know that that’s what you need and you’re willing to work on that stuff because it’s not comfortable and it’s not healthy in most cases to be sharing great details of your trauma in a group setting so if you need intensive individual make sure that you can either get it at that facility or they’ll refer you out to someone who can handle those needs and provide services including if you’re interested in EMDR or something else to help you handle trauma if you are a special population for example a veteran know what kinds of services are available that are specialized for veterans because those are your needs you need to make sure that you have specialized services to meet any unique needs that you might have know your rights and this is one I am one of those people who loves to write manuals and crosswalks and I am kind of rigid and anal retentive when it comes to making sure that programs are doing what we say we’re going to do so if we tell somebody like blue cross we’re going to run a residential program we’ll take your clients in and provide residential services then I am darn sure going to make sure we’re providing all of the services that Blue Cross says we have to provide at that level of care many facilities don’t do this and it’s important to know you’re right so you can say my insurance company says I need to have access to this service and you need to make it happen how do you do that well you can google the level of care guidelines by putting in the insurance company name and the level of service so for example if I was looking on Cigna insurance and I wanted to know what they required in residential substance abuse treatment I would Google level of care guidelines Cigna residential substance abuse and it would give me a document and it’s all right there and playing it plain English there’s no legalese it’s pretty straightforward going through the common the bigger insurance companies some common requirements and if you’ve been in treatment you’re probably going to go through some of these and at least one of them you’re going to go I didn’t get that that’s not that’s important that’s not okay if you’re not getting your what you’re entitled to medical exam within 24 hours of admission or within a week prior to admission where I used to work we require people to have a medical exam before coming in that’s you know reasonable face to face assessment by a board-certified position within 24 to 72 hours of admission depending on the insurance company if you’ve been in residential treatment before how many times have you ever actually seen the doc within 24 hours a face to face assessment with the individual and the family within 72 hours of admission by a licensed clinician not a tech not somebody who’s working towards licensure but somebody who actually has a license they’re licensed by the state as a social worker Marriage and Family Therapist addictions counselor or mental health counselor and that is supposed to be completed within three days of admission not three business days three days the admission process includes discharge planning why is that and I said that earlier well for two reasons number one you don’t want to wait to the last day and go oh crap I’ve got to find somewhere to live you’re not going to have enough time and it’s going to end up being slipshod which is going to impair your chances of having successful recovery the other reason and not on what I like to think about but the reality is some people leave treatment early and I want to know that when you walk out of this facility even if you’re walking out AMA you have resources you know where you can go to find housing to find medication to get dental services whatever else you need you have your Linkedin somehow so you’re not just walking out there going well I’m no better off than I was six days ago so discharge planning has to begin at admission family therapy is required unless it’s clinically contraindicated now family can be loosely defined may be your blood relatives and you don’t get along anymore but you’ve got your marriage and have children or you know whatever whoever you call your family your support system it’s supposed to be involved in treatment on a weekly basis by just about every insurance company unless it’s clinically contraindicated for example maybe your same way of origin you’re one of the parents was abusive to you and it’s not a good mesh to try to get back into good graces with them or whatever totally understandable but you need to have a support system involved so it’s not just you in treatment you’ve got somebody to welcome you with open arms when you leave a nurse is supposed to be on site not available on site 24/7 365 preliminary treatment plan should be given to the patient given to you within 48 hours and this is one that says ok been over the next week these are the things that you’re going to do or this is what we’re going to look at starting to address this is preliminary within five days you can not five business days five days the treatment plan comprehensive treatment plan that covers whatever you’re going to do throughout treatment there it should be in your hand you need to get a copy and in most cases you’re supposed to have weekly psychiatric and/or treatment plan reassessment so you’re supposed to go in and talk to your therapist go over your treatment plan go this is working making good progress here this ain’t working for me I need a referral here and you both are supposed to sign off on it so please know these things these are just the ones that are kind of the burrs under my saddle but there are a lot of other requirements such as how many hours of Group per day and how many times you’re supposed to meet with your individual therapists per week and stuff like that so please be willing and be able to reach out to and find out what the level of care guidelines are for your insurance company if you don’t know or if you’re struggling with it send me a message and I’m more than happy to help you facebook.com slash dr period snipes i am more than happy to help you try to figure out what you’re entitled to so some clues I’ve worked in the industry for 20 years and I’ve seen a lot of people come through treatment if you’ve been through the program more than once ask yourself what do I need that I’m not getting here I’ve had people come through the same program 10 12 17 times and they were had gone through so much they knew how to teach the group’s better than most of my staff did that’s not what we want because if there’s if they know all that stuff and they’re still relaxing then clearly our program is not meeting their needs it’s not that we’re not doing a good job it means that we are not the right fit for that person so pay attention you may get a lot of great stuff from one program and you may go back through and get some more great stuff but generally after twice you’re you’ve gotten everything you’re going to get so you need to figure out what else is it that you need you can do this by examining your strengths to know what you need to be happy healthy and sober so again looking and saying alright where do I keep tripping up with one of my clients and and he’s finally achieved long-term recovery but whenever he would start to get into relationships it was a down hill he’d get into a relationship he’d fall in love in three days the relationship would end and he relapse pretty predictable then he’d be back in detox and online on my wing again so we were not providing we were not able to provide the level of services he needed to help him really address his interpersonal issues his fear of abandonment his childhood trauma issues so the last time he came through we altered the treatment plan in order to set him up with one of our trauma focused therapists and he did a lot of intensive work there and you know it seemed to work so it’s important to know what you need and know what is your stumbling block so you can tell the therapist this is what I still need help on examine your relapse triggers to know what still needs to be addressed if you relapse when you get angry or you get stressed out well that’s kind of vague I can’t help with that what makes you angry and what gets you stressed out then we can start hammering down and figuring out what to address but a good clinician will ask those questions so if you’ve been through a treatment program a couple of times you’re probably not going to see the same assessment person anytime you go in so make sure to let them know I’ve been here I’ve done this this is what I got out of it this is what I still need and finally I see a lot of people posting on Facebook and mainly Facebook that they’re looking for a facility that takes such-and-such insurance or that addresses such-and-such issue there is especially for residential now you can find IOP PHP and outpatient programs on here but not all of them are in this almost every residential program is on the samsu treatment locator so you go to this website and I’ll bring it down here for you and you put in we’re just going to search my area nashville tennessee and go so there’s a bunch of facilities in nashville tennessee but i want to look for facilities that treat substance abuse and accept Medicaid and deal with veterans so that narrowed it down to let’s see one which would be probably Vanderbilt Health System so you can see what we’ve managed to narrow our search down to and then you can start going from there go to the website find the information on who to contact they’ve got the admissions contact information there and let’s see Medicaid veterans take out veterans just do Medicaid so here we have a few few more I’ve got 75 facilities will look at United neighborhood health services click on there then we you can find out how to go to their facility how to get enrolled who qualifies etc sometimes you got to play around a little bit and figure to figure out what’s going to meet your needs and make a list of the ones that most closely meet your needs because you might not find something something that totally meets your needs if payments an issue call the facility sometimes they have scholarship beds sometimes they have sliding-scale payment plans sometimes they’ll work with you and allow you to make payments over the course of three or four years so remember that treatment needs differ for each individual person and good treatment programs are going to individualize treatment for you not make you feel like a number that you’re just another one of the 84 butts in seats know your strengths know what works for you because that’s what you want to build on and if people are trying to tell you forget all that stuff you’re going to learn this whole new program they’re not individualizing treatment they’re trying to put you into kind of a neat little package know your rights regarding the types of services you’re supposed to be getting so you can ask for those if you’re not getting them and remember that not all programs can meet everybody’s needs that’s just the nature of the beast that’s why there are so many programs out there so be willing to explore a little bit and when possible interview programs that you’re interested in call ahead ask them about their program maybe even go visit the facility if you’ve got that kind of time I mean obviously if you are looking for a detox facility you may not have that luxury but if you’ve got that kind of time or while you’re in detox start looking at what facilities are available and figuring out which one is going to be the best fit for you if you liked our podcast you can subscribe on your favorite podcast app you can join our Facebook group at Doc Snipes comm slash Facebook and that is another great place to reach out to me if you have any questions about how to access level of care guidelines or anything with individualizing treatment you can subscribe to our youtube channel at youtube.com slash all CEUs education or join our community and access additional resources at Doc Snipes com

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