The treatment of co-occurring disorders — or substance abuse combined with mental illness — poses unique challenges for addiction specialists and mental health professionals. The 2010 National Survey on Drug Use and Health revealed that over 45 percent of American adults with a substance abuse problem also have a psychiatric illness such as depression, anxiety, bipolar disorder, or schizophrenia.
Michael’s House fills a critical need by offering patient-centered rehab programs that blend mental health care with recovery services. Instead of expecting patients to conform to the demands of a cookie-cutter rehab program, the staff members at Michael’s House devote their energies to motivating and educating their patients, so that they can make positive decisions about their lives.
As the clinical director of Michael’s House, Craig MacLaughlin, LMFT, gets a lot of satisfaction out of watching this process in action. Since the movement to establish integrated recovery programs began, MacLaughlin has been working to implement effective treatment models for individuals suffering from mental illness and addiction. Today, he can see those years of advocacy and research coming to fruition in his own team.
Q: Please tell us about your background in substance abuse services, especially your work in the field of integrated treatment.
A: “My work in integrated treatment goes back 20-plus years. That’s how long we’ve been advocating for substance abuse programs for the mentally ill. Before that time, there were big gaps between addiction treatment and psychiatric services. For example, someone strung out on drugs would go over to mental health services, and they’d be told that they needed to get clean before they could be treated for psychiatric illness. Or a mentally ill client would be refused treatment for substance abuse until their psychiatric symptoms had been addressed.
“Those gaps in the system were reflected in an increase in the prison population. You could see the statistics going through the roof. My work involved advocating for integrated treatment in the state of California at the county and state levels. We worked on establishing competency standards, and we set up a co-occurring disorders task force to lobby the government for integrated services.”
MacLaughlin currently acts as clinical director for Michael’s House, but his relationship with the Foundations Recovery Network goes back much further. In the early days of his advocacy, he attended a conference in Tennessee where he worked with FRN on merging resources from the mental health and addiction treatment communities.
“At that time, we were working to blend funds and services from mental health and substance abuse treatment. When I came to Palm Springs, I ended up at Betty Ford as executive director of their inpatient program. I had worked with Foundations in Tennessee, and I became their clinical director, implementing research into Michael’s House and developing an integrated treatment program.”
Q: What are some of the challenges you’ve encountered in your work in addiction treatment?
A: “The biggest challenge has been working with blending services, breaking through professional egos and bringing together a team to deliver a truly integrated program. Cross-training staff in substance abuse and mental health competencies has also been challenging. But our patient satisfaction surveys from Michael’s House have consistently shown positive outcomes for our clients and a high level of staff satisfaction.”
An individually tailored approach to treatment is most effective for patients with co-occurring disorders, MacLaughlin says. “This is where the concept of ‘continuum of care’ comes in. Each patient is evaluated for the appropriate level of care, whether it’s inpatient or outpatient treatment. We look closely at the relationship between inpatient and outpatient programs, because there’s a high relapse risk during the transition from one to the other. We work very hard to provide a consistent model of care — including therapy, medication management — to make that transition seamless.”
Q: What obstacles do mentally ill clients face in recovery? How do you help them overcome those obstacles?
A: “The continuum of care is so important. It’s sad when you look at the variety of diagnoses and medications in a patient’s chart. You know that when a patient finishes treatment, his psychiatrist at home will likely change his meds. Length of stay is another factor. We try to give our patients enough time — 90 days, six months, whatever it takes — to achieve a good outcome. Sometimes psychiatric symptoms resolve after the drugs leave a patient’s system. Sometimes new symptoms emerge. The longer we have to unravel the picture, the better the results will be. In treating co-occurring disorders, the two most important factors that we have to work with are the continuum of care and time.
“In the past, professionals were telling patients what was wrong with them, instead of listening to them and learning about what they wanted. At Michael’s House, we get a lot of patients who have given up; they’re just used to failing. We place a lot of emphasis on listening to patients and their families, so that we can instill a sense of trust and hope.”
According to MacLaughlin, many of the individuals who seek help from Michael’s House lack fundamental information about substance abuse. They also need to acquire basic life skills, like finding a job, renting an apartment, and managing their psychiatric medications.
Q: What therapies have you found to be the most effective in treating co-occurring disorders?
A: “We take a very cognitive approach. It’s like a university; we teach our patients how to make better choices. We get a lot of guys in their 30s who don’t understand the process of addiction. We give them the skill sets that they need to lead a sober life — everything from paying bills to medication management — and the information that they need to make good choices for themselves. We also introduce them to the idea that they can have a positive relationship with the medical community – a relationship that will support them in recovery.”
Q: What are the most important factors in maintaining a life of sobriety after rehab?
A: “We’ve found that there are several factors, such as how much can they learn of the new skill sets, how well can they integrate into community support groups like the 12-Step system, and how they respond to a relapse.
“Instead of insisting on abstinence in recovery, we focus on harm reduction, or minimizing the negative effects of a relapse. As part of our patient-centered approach, we teach our patients how to make good choices. It’s up to them whether they want to use drugs or not, but we give them the information and the skills they need to achieve the best outcome. Our system emphasizes the length of engagement — or the length of time that the patient is involved with recovery programs — rather than the length of time he or she abstains from drugs or alcohol.
The older, confrontational style of addiction counseling is being replaced by collaborative, client-centered approaches like Motivational Interviewing (MI), MacLaughlin says. MI is a therapeutic strategy that focuses on strengthening and empowering the patient. If a relapse occurs, patients are not judged for making this choice, but rather encouraged to come back to the program so that they can learn from their experiences.
“We’ve found that a lot of our patients have been set up to overdose and die. It’s a message they’ve clearly learned, that if they aren’t successful, the outcome won’t be good. We use Motivational Interviewing and a strength-based approach, so that if our patients do relapse, they feel comfortable about calling us for help. We want our patients to feel that they’re welcome to come back, that they have our support for as long as they need it. Some of our patients are in aftercare for years. We want to establish lasting, long-term relationships.
“Some organizations still take a coercive or punitive approach to relapse. My intention isn’t to condemn that style, but to suggest that harm reduction could be a more effective intervention, especially for patients with co-occurring disorders.”
Q: How important are 12-Step programs in recovery for patients with co-occurring disorders?
A: “A lot of patients in recovery function well with the 12-Step model. Research backs up the importance of ongoing, likeminded support groups like AA. But 12-Step groups don’t work for everyone. We specialize in treating that odd percentage who don’t respond to traditional models. In these cases, we have to find other activities that can provide an individual support network. In patient-centered care, you have to be flexible enough to look for alternatives.”
Individuals in recovery can draw strength from many community-based groups, MacLaughlin says. Examples include church groups, sports teams, volunteer organizations, therapy groups and aftercare programs. Michael’s House offers an alumni program that gives rehab graduates the opportunity to stay connected with their treatment team and with fellow grads. Alumni members support each other in recovery through reunions, fun activities and online social networks.
Q: Where would you like to see improvement in the field of integrated treatment?
A: “I’d like to see improvements on the medical component of treatment, to see that community truly come together with the mental health and substance abuse communities. There’s a lot of work involved with creating a medical model for the treatment of co-occurring disorders, so that medical professionals can interface with psychiatrists and addiction specialists in a unified way.”
Q: What do you find most rewarding about your work?
A: “The work is really very hard. From the early days of advocacy, I’ve found that it’s extremely hard to watch the individual suffer without being able to help. Then there’s all the effort involved in gathering resources and training the staff. The cornerstone of successful integrated treatment is cross training. It isn’t that easy for counselors, therapists, doctors, and nurses to develop competencies in both mental health services and substance abuse treatment. At Michael’s House, I get a lot of joy out of seeing the dedication of the staff, especially when I watch people working through their biases and fears about mental illness and addiction.
“People who come to visit Michael’s House will say, without even being asked, that they can feel the energy and support of the staff. They can feel that people care. All of that comes from the staff being willing to integrate the research on co-occurring disorders into their work. Foundations Recovery Network was pivotal in changing the country, in changing the lives of so many people by providing truly integrated programs. I hope they keep sharing that mission with the new staff.”
For more information on the innovative, patient-centered rehab programs at Michael’s House, please call our toll-free number at any time. Our admissions coordinators are standing by to provide answers and support.