04/12/2023 Colorado Model of Care

Shootout at the I’m Okay Corral

The “Open Community Model of Care” in the Treatment of Chronic Relapsing Addicts and Alcoholics

Bob Ferguson

CEO / Founder, Jaywalker Lodge

Cape Cod Symposium on Addictive Disorders

September 8, 2012

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04/12/2023 Colorado Model of Care

Disclosure

Jaywalker Lodge, LLC is a residential treatment program for men in Carbondale, Colorado.

It is a private, for-profit company.

I am the owner and founder of this company.

I represent this organization professionally.

I am paid by this organization.

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Personal Bio

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• Hazelden Foundation (1995 – 2001)

• Crossroads Antigua (2001 – 2003)

• Promises Treatment Centers (2003 – 2004)

• Jaywalker Lodge (est. 2005)

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William White, MAWith great sadness, the counselor reflects, “The patients who come here do SO WELL while they are in treatment, but so many of them relapse in the days and weeks following their discharge. We bring them back into treatment and they seem to do well again but often repeat the relapse pattern when they go back home. How can they do so well in treatment and so poorly in their natural environments?”

Addiction treatment was birthed in part to eliminate the revolving door through which alcoholics and addicts cycled through the criminal justice system and the hospitals. Addiction treatment programs have now BECOME that revolving door. Today, 64% of clients entering publically funded treatment in the US have already had one or more prior treatments. And 50% will be readmitted to treatment within 2 – 5 years.

“Linking Addiction Treatment and Communities of Recovery” Article 2006

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How It Works Into Action

Working with

Others

A Vision

for You

The Open Community Model of Care provides relapsing addicts and alcoholics - some of whom are in very early recovery – with the prospect of a safe and sober transition from acute residential care into real life in recovery…

And yet, these gains are not achieved without significant exposure to real-world stressors and opportunities for relapse.

Overview

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How It Works Into Action

Working with Others

A Vision

for You

• Articulate the critical differences between primary care and extended care addiction treatment.

• Examine the milieu and transition strategies for transitioning patients from an acute care setting into real life recovery.

• Explore the vital and evolving role of alumni relations and community service in residential treatment today.

Objectives

How it worksYes or No?

There is a direct and indisputable correlation between length of stay in residential treatment and the sober outcomes.  

How it worksYes AND No

Some clients DO require more time in an acute care setting… However, simply extending the length of treatment without moving the client into a real-life community setting assures only continuous abstinence, not recovery.

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PRIMARY CARE

Arresting Addiction Education Counselor directed Secluded setting Intro to 12 Steps Safe, secluded time out

from life’s distractions

Letting go of substances

EXTENDED CARE

Initiating Life in Recovery Application Peer directed Community setting 12 Step Immersion Structured, hectic re-entry

into real life recovery

Letting go of self

How it works

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How it works

It is important to define and distinguish between two very different models of care: an acute care (AC) model that focuses on bio psychosocial stabilization and a recovery management model (RM) that emphasizes sustained recovery support. As a professional field, we have oversold what a single episode of acute care can achieve…

- William White

“

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True or not true? Into

Action

Chronic relapsing addicts and alcoholics in early recovery require a treatment setting that is safe, secluded, and free from outside distractions and relapse triggers.  It is therefore essential to maintain separation between a residential treatment program and the community around it.

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True or not true? Into

Action

In order to achieve lasting and sustainable sobriety, clients must learn to manage an environment which offers a daily choice between relapse or recovery.

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A – Extended Treatment811 Main Court (90 days)

B – Transitional Treatment725 Main Street (90 days)

C – Collegiate Recovery Program 734 Main St. (1 yr)

D – Outpatient Offices1152 Hwy 133 (90 days)

E – Sober Living / Landing872 Main St. (3 – 6 mos.)

A B

C

D

E

Carbondale, CO Population 6,412

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Myth or reality? Into

Action

The therapeutic alliance between counselor and patient is the most important relationship in any treatment episode.

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Myth or reality? Into

Action

In extended care programs, the counselor’s role is to facilitate strong relationships among the clients – not with the clients. These programs value the peer-to-peer relationship above all else.

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How it works

Body Mind

Spirit

DetoxStabilizationRest / Recover EducationDisease ModelDenial

Concept of HPSpiritual principals

RecreationExpeditionsTeam Building Step One FocusPeer EvaluationBuddy System

Group as HPAccountability to peers

Service WorkTeams / LeaguesHealth Club 12 Steps GroupsService PositionSponsorship

12 Steps in ActionService to others

Self Peers Community

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Open Community Milieu*Into

Action

• Admissions Red Flags

• Culture of Community

• 12 Step Immersion

• Atypical discharges * Lessons we’ve learned along the way…

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Into Action

Pre-Admissions Interview• Clinical assessment – Is this patient

appropriate?• Essential rite of passage for patient: i.e.

Asking for help!

Full disclosure: “no surprises”• Program milieu, philosophy, length of stay• Resident expectations – medications, relapse,

etc.

Admission Red Flags• No previous Primary Care episode• Acute MH Diagnoses – Trauma, Anti-social,

Axis 2• Suboxone

Open Community Milieu

Admissions Requirements for Open Community Model

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Broken Windows Theory (1982)

New York City saw a 50% reduction in violent

crimes (such as murder, rape and robbery) as the result of a “community policing” campaign which focused repairing broken windows, cleaning up graffiti, and a crack down on minor offenses such as subway fare-scoffers and squeegee-wielding panhandlers.

* But the Jets STILL didn’t make the playoffs!

Into Action

Sun Mon Tue Wed Thu Fri Sat Compliance %

AA Meetings 2 5 15 9 10 18 9 94%

TDA's 18 18 15 16 18 17 18 96%

Dinner attendance 18 18 18 17 18 18 17 98%

Beds Made 18 18 16 18 18 18 17 97%

DFS Sheets 16 16 13 18 18 10 14 83%

Morning Meditation 18 18 18 18 18 18 18 100%

Based on 18 clients

The spiritual dashboard...Dashboard

Into ActionOpen Community Milieu

Into ActionOpen Community Milieu

2009 2010 2011 Avg

153 145

178159

64 64 62 6371 65 71 69

14 7 10 10.3

Completion Rates – 90 day program

Census WSA % Avg LOS Relapse

Immersion in Local 12 Step Community

• Monitored engagement w. 12 Step community• FCSP – Weekly speaker meeting• NFL – No rides permitted & sponsor list• Safe Harbor House – Wednesday night alumni meeting

• Not all recovery communities are created equal• Prescott, Delray Beach, So. Cal., Twin Cities.

Into ActionOpen Community Milieu

Spiritual graffiti…Dashboard

Into ActionOpen Community Milieu

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Working with OthersAlumni Engagement

Role of Alumni in Open Community Model

Official DutiesAirport pickups

Meeting drivers

Expedition guides

Unofficial Duties12 Step sponsors

SWAT teams

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Working with OthersAlumni Engagement

Alumni-driven culture

• Peer directed aftercare groups• Wednesday night dinners• Expeditions (2x per year)• Reunions (annual)• Talent show• Open door policies for:

• Counselor check ins• Lunch or breakfast• Recreation activities

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Working with OthersCommunity Service

• Fundamental to recovery process 

• Community Relations• Practical Programming• Mission and Adventure

Component

Therapeutic Benefits of Service Work

The Aspen Homeless ShelterCARE (Animal Rescue)Habitat for HumanityAspen Thrift Store (Clothes for the needy)Volunteer Outdoor ColoradoGrand Canyon TrustMission WolfPine Ridge ReservationAdopt a HighwayRoaring Fork Outdoor VolunteersExtended Table (Soup Kitchen for the Homeless)Assisting in the Rebuild of Joplin, MO

 

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Effective (+)

• Experience = educational• Adopt-A-Highway • Extended Table Soup Kitchen

• Organized, structured

• Staff and community participate with and among clients

• Prior preparation, supervision during, process experience afterwards

Ineffective (-)

• Experience = punitive• Sustainable Settings• Set up for sweat lodge

• Random, unprepared, disorganized, not structured

• Clients are separated, isolated, working alone.

• Lack of information

ServiceWorking

with others

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What’s next?• Friendship – our new

“goal-ed” standard?• Sober College Programs…

Everywhere!• Future focused care

A Vision

for You

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