Addiction help: goodbye to the 28-day inpatient program?
The medication that kept Phyllis free from headaches for 12 years eventually forced her to deal with another pain in her life--the anguish of addiction.
When her employer suggested in January that she get help for a drug addiction drug addiction
or chemical dependency
Physical and/or psychological dependency on a psychoactive (mind-altering) substance (e.g., alcohol, narcotics, nicotine), defined as continued use despite knowing that the substance causes harm. , she agreed, and is in continuing care continuing care
a professional convention that a veterinarian who is treating an animal is obliged to continue treating that case unless an arrangement is made with its custodian to transfer the care to another practitioner or to a specialist. at the Aurora Chemical Dependency chemical dependency
A physical and psychological habituation to a mood- or mind-altering drug, such as alcohol or cocaine.
chemical dependency Program at Reid Hospital and Health Care Services in Richmond.
While she was addicted ad·dict·ed
1. Physiologically or psychologically dependent on a habit-forming substance.
2. Compulsively or habitually involved in a practice or behavior, such as gambling. , Phyllis kept working. Her children were grown and away from the house, and her husband didn't know about her addiction. Her employer did, and was concerned about a change in Phyllis' personality. "I was having some aggressive, angry behavior at work, and that's not me at all," Phyllis says. When her employer confronted Phyllis, she agreed to go for treatment.
She kept her job, and began an intensive outpatient treatment program at Aurora that allowed her to return home every day. Now in continuing care, Phyllis is able to go to a meeting daily if she wants, and can request one-on-one counseling.
Five or 10 years ago, Phyllis probably would have been checked into the hospital for a 28-day inpatient treatment program that was automatically prescribed for those with drug and alcohol addictions. "The 28-day program evolved in Minnesota, which was very liberal in the treatment of alcoholism alcoholism, disease characterized by impaired control over the consumption of alcoholic beverages. Alcoholism is a serious problem worldwide; in the United States the wide availability of alcoholic beverages makes alcohol the most accessible drug, and alcoholism is as a disease rather than a social problem," says Vernon Westrich, the Midwest division vice president of Charter Medical Corp. Charter operates inpatient psychiatric hospitals psychiatric hospital
A hospital for the care and treatment of patients affected with acute or chronic mental illness. Also called mental hospital. in Terre Haute Terre Haute (tĕr`ə hōt, tĕr`ē hŭt), city (1990 pop. 51,483), seat of Vigo co., W Ind., on the Wabash River; inc. 1816. , where Westrich is based, as well as South Bend South Bend, city (1990 pop. 105,511), seat of St. Joseph co., N Ind., on the great south bend of the St. Joseph River, in a farming and mint-growing region; inc. as a city 1865. , Fort Wayne Fort Wayne, city (1990 pop. 173,072), seat of Allen co., NE Ind., where the St. Joseph and St. Marys rivers join to form the Maumee River; inc. 1840. It is the second largest city in the state, a major railroad and shipping point, a wholesale and distribution hub, , Indianapolis, Lafayette and Hobart. It also has about 20 outpatient centers in Indiana.
The program became known as the Minnesota Model. Under this model, most patients were given the same treatment because that's what That's What is one of the more idiosyncratic releases by solo steel-string guitar artist Leo Kottke. It is distinctive in it's jazzy nature and "talking" songs ("Buzzby" and "Husbandry"). most insurance companies would agree to pay for.
"The old philosophy says you got the same treatment--the same thing over and over--until it worked. The belief was that eventually it would take," says Ann Kelley, director of mental health services health services Managed care The benefits covered under a health contract and an addictions counselor at Hamilton Center in Terre Haute.
Now, the emphasis is on outpatient, and tailoring the treatment to the patient's needs, she says. "It's not a blanket prescription anymore."
"I think 28-day programs are gone for good," says Brian Donley, director at Aurora. The new focus on outpatient care--instigated mostly by insurance companies that want to pay less and companies that want to keep employees at work--forces treatment clinics and hospitals to be more creative in their approach to care.
Phyllis had begun weaning weaning,
n the period of transition from breast feeding to eating solid foods.
the act of separating the young from the dam that it has been sucking, or receiving a milk diet provided by the dam or from artificial sources. herself off pain medication, and did not require detoxification Detoxification Definition
Detoxification is one of the more widely used treatments and concepts in alternative medicine. It is based on the principle that illnesses can be caused by the accumulation of toxic substances (toxins) in the body. , which is done on an inpatient basis. "I did OK with the outpatient," she says. "If I had needed more control, I wouldn't have hesitated to tell them, and they would have checked me in."
Outpatient therapy had its advantages for Phyllis. "You come home at night and you're thrown back in the same environment, instead of in a protected environment. You have to come out after a while, and everyone's scared to death to do that."
Experts think outpatient treatment has many advantages for people like Phyllis, as long as family or friends provide support. Continuing care is constant--for as long as a year for some patients.
"Treatment is generally considered to be a yearlong year·long
Lasting one year.
Adj. 1. yearlong - lasting through a year; "attending yearlong courses"
long - primarily temporal sense; being or indicating a relatively great or greater than average duration or phase," says Westrich. He adds that some medical studies now show that, in the case of alcoholism, the brain undergoes certain changes in that first alcohol-free year.
Robert Krumwied, executive director of Tri-City Mental Health Center in East Chicago East Chicago, city (1990 pop. 33,892), Lake co., extreme NW Ind., on Lake Michigan, in the industrialized Calumet region, adjoining Gary, Hammond, and Whiting; inc. 1889. , says the only drawback to intensive outpatient care is that some patients do not have a support system. They are often then treated on an inpatient basis.
He concurs that the change in philosophy was spurred in part by insurers. "The insurance companies got wise and discovered that there really wasn't any better outcome" with inpatient versus outpatient treatment. Also, he says, patients in inpatient treatment would get "artificially well," and wouldn't cope as well once they were in their old environments, with all the problems and temptations.
The cost of an outpatient program versus an inpatient one is the biggest advantage for those footing the bill, frequently insurance companies or employers. Costs vary at clinics and hospitals, but all outpatient programs cost significantly less than inpatient.
David Judy, manager of intensive outpatient programs at Chemical Dependency Center at St. Mary's Medical Center St. Mary's Medical Center may refer to:
"You can understand why employers would be happy about that," he says. For a company, the cost of treating an employee is much less than the cost of lost work time--or replacing the employee.
With follow-up care extending for a year after the patient's intensive outpatient program, an outpatient program clearly takes more time to complete than the traditional inpatient treatment. But, Judy says, that gives counselors more time with an individual, and more of a chance to see the patient in his or her own environment.
Christine Pochert, marketing director at Charter Hospital of South Bend, says that while inpatient care inpatient care Managed care Services delivered to a Pt who needs physician care for > 24 hrs in a hospital is still valuable until a patient is free of drugs or alcohol, outpatient is a successful way to treat addictions. "You get the person out of the situation where they're using and abusing and look at it from a distance," she says. "We're just all being more flexible."
"The big trend now is to go for the least restrictive and most cost effective" way to treat addictions, says Scott Lewellen, program coordinator of Counterpoint counterpoint, in music, the art of combining melodies each of which is independent though forming part of a homogeneous texture. The term derives from the Latin for "point against point," meaning note against note in referring to the notation of plainsong. Center at CPC (1) (Central Processing Complex) An IBM mainframe that has two or more central processors (CPs) that share memory. It is the collection of processors, memory and I/O subsystems manufactured with a single serial number, typically all contained in one cabinet. Valle Vista Hospital in Greenwood.
Although he was at first skeptical of the outpatient approach to treatment, Lewellen now believes that if done properly, and with the family involved, it can be successful. "It's really crucial to involve the family. Overall, I'd say it's a success."
Outpatient treatment traditionally had been "kind of a stepchild step·child
1. A child of one's spouse by a previous union.
2. Something that does not receive appropriate care, respect, or attention: "Demography has a reputation for being the stepchild of . . . " to addictions treatment, says Mike Kowalenko, manager of Lindenview at Parkview Memorial Hospital in Fort Wayne. Before the outpatient trend caught on, most insurance policies covered standard inpatient recovery, and didn't recognize outpatient therapy. Treatment for drug and alcohol addiction is becoming "a lot more service-oriented," he adds.
There is more focus on family support during recovery, and counselors immediately address the factors in patients' lives that make them abuse drugs or alcohol. "When they leave, there's not that abrupt transition" to reality, he says.
The move on the part of clinics and hospitals from inpatient to outpatient treatment truly is a "dramatic change," Hamilton Center's Kelly says. Although the Minnesota Model has not been abandoned, the emphasis now is on "relapse prevention," she says, and that's where outpatient care can help best, because counselors can identify the so-called triggers in a patient's life that cause the person to begin abusing drugs or alcohol. "We're trying to look at what kind of factors play in a role in their using."
Still, there are many experts who are doubtful that outpatient is the only way to go. Some patients still need the intense, protected environment of inpatient care, they believe. People who abuse drugs or alcohol may not be as easy to categorize cat·e·go·rize
tr.v. cat·e·go·rized, cat·e·go·riz·ing, cat·e·go·riz·es
To put into a category or categories; classify.
cat and treat when counselors see them three or four times a week.
Westrich of Charter Medical Corp. says inpatient treatment remains the choice for patients who need detoxification. Detox is imperative in treating addiction to certain drugs, while other substances require no detox treatment, he says.
"Variables begin to compound the issue," adds Robert Permut, medical director at Behavioral Care Center at Methodist Hospital Methodist Hospital is the name of numerous medical institutions.
Likewise, Aurora's Donley says patients have different levels of need, and some need inpatient care. The question is when these patients should make the transition to outpatient. In the mind of the payer, the need for inpatient care may be only medical. "The person may be medically stable," but patients are not always emotionally ready for the pressures of everyday life when they've only been clean for a week. "We're seeing a real tough time for some of our patients who go home."
Those newly drug- or alcohol-free patients are "put in an environment they can't cope with," Donley says, "like going on a diet and going into a chocolate shop. It's just not a good idea."
The payers dictate what kind of treatment a patient will receive, he says, because the bills are costly enough that most patients can't afford it on their own, and hospitals can't afford to absorb unreimbursed costs of treatment.
"I think there will always be conflict between the payer and doctor as to when a person is ready to go out, and unfortunately, payers hold the bigger stick," Donley says.
As a result, most hospitals and clinics have become much more flexible. Methodist in Indianapolis has developed a continuum of care, so that patients are treated during all stages of addiction, from inpatient detoxification to after-care and support meeting and counseling.
Fairbanks Hospital in Indianapolis also offers such a continuum of care. It offers inpatient treatment as well as outpatient programs, but also has a program known as intensive day treatment. According to according to
1. As stated or indicated by; on the authority of: according to historians.
2. In keeping with: according to instructions.
3. Fairbanks, the highly structured program is for patients who are not yet ready for outpatient programs, but who have stable and supportive living situations that make inpatient treatment unnecessary. Fairbanks also offers after-care services, as well as adult education groups for people who have experienced limited consequences of alcohol and drug use but may not need more intensive treatment.
Since the 28-day inpatient stay as a one-size-fits-all treatment seems destined des·tine
tr.v. des·tined, des·tin·ing, des·tines
1. To determine beforehand; preordain: a foolish scheme destined to fail; a film destined to become a classic.
2. for history books, outpatient treatment will have to prove successful for all patients in the future. Says Donley, "We've had to get more creative. I think the basic concept is sound, that not everybody needs 28 days, and we need to fine-tune and adjust it."