A Place to Heal

The numbers are staggering. Substance abuse (alcohol and illicit drugs only) costs the nation more than $417 billion annually in related crime, lost productivity and increased health care needs, according to the National Institute on Drug Abuse (NIDA). Add tobacco addiction to the mix, and it’s more than $700 billion. But that’s just money. The personal costs to those who suffer from substance abuse disorder—and to their families, friends and co-workers—cannot be quantified.

Heart attacks, strokes, domestic violence, theft, homelessness; children born suffering from opioid withdrawal (one every 25 minutes); lost productivity on the job, repeated work absences, social isolation, increased chance of getting cancer and the big one: death. Not only for the abuser but also for those who come in contact with him or her. According to NIDA, one in three fatal automobile accidents involves a driver under the influence of drugs or alcohol.

In the North Bay, substance abuse reached “epidemic proportions,” says Robin Stuart, founder of Conscious Healing Innovations (CHI) Recovery, an evidence-based substance abuse treatment program based in Sebastopol. Her observation is echoed by Jill Moss, manager of community outreach at Queen of the Valley Medical Center (QVMC) in Napa.

“As a nonprofit, we conduct a needs assessment in the community every three years. For the last three assessments, drug and alcohol abuse has surfaced as a major issue in Napa County,” Moss says. Drug and alcohol-related arrests are higher than the state average (1,494 arrests per 100,000 in Napa County versus 1,203 statewide) and 38 percent of adults in Napa responding to the needs assessment survey admitted to binge drinking at least once over the course of a year. Binge drinking has many definitions, but the Napa survey defined it as two-to-three days or two-to-three weeks of round-the-clock drinking.

And while derelicts and street folk are less common sightings in well-heeled Marin County, admission rates to treatment facilities in the county continue to climb, as do the number of drug-and alcohol-related arrests, according to the most recent Marin County health survey. Binge drinking is also high – at 37 percent of adults.

Big business

When it comes to health care services, substance abuse disorder is, quite simply, big business— just not the kind anyone wants.

Case Management at the Medical Center has estimated there are times when up to50 percent of the patients at QVMC, both emergency room and admissions, have drug or alcohol issues in addition to the acute symptoms from which they suffer (such as heart palpitations, diabetes or seizures). A good number of injuries (broken limbs, head gashes and the like) are also caused by drug and alcohol-related falls and accidents.

For other businesses employing substance abusers, the disorder translates to a major loss. According to the National Council on Alcoholism and Drug Dependence (NCADD), the direct financial cost to American employers is $81 billion per year. That’s because 70 percent of those with substance abuse disorder are working, and their employers are paying the price via lost productivity, absenteeism, on-the-job injuries, fatalities, theft and low employee morale, plus increases in health care costs, legal liabilities and workers’ compensation costs.

“The cost to employers can be very high,” says Stuart. “You have absenteeism and poor performance—employers can pay for eight hours work and perhaps get half of that from their employees. Substance abuse also impacts creativity and memory, plus ethical and professional decorum. Then there’s criminality: One guy I know burglarized his last three employers; another got so drunk he broke into the restaurant where he worked, set up a barbeque and a cot, and camped out for the weekend, with absolutely no memory of having done it afterwards.”

One of her favorite stories is about a group of employees at a well-known Southern California tourist attraction (not Disneyland) who got smashed and put on an entire naked dinner party onsite after the gates had closed.

“[Substance abusers can] think nothing of taking anything from employers that isn’t screwed down in place. Theft can be so high with addict employees because it’s one way they can subsidize their drug abuse. Anything they can sell on the street that doesn’t have a serial number on it is fair game,” Stuart explains.

With substance abuse so common, it’s critical for employers to understand addiction and know how to address it. Experts suggest employers implement drug-free workplace and other written substance abuse policies—(and enforce them—plus offer health benefits that provide comprehensive coverage for employees who suffer from substance abuse disorder, including aftercare and counseling.

It’s also important to educate employees about the health and productivity hazards of abuse by offering company wellness programs, Employee Assistance Programs (EAPs) and Work/Life Programs.

Employers can then utilize the EAP services to help employees with substance abuse problems, while at the same time respecting their privacy.

Getting treatment

While most North Bay hospitals offer support and lifestyle management programs for people with substance abuse disorder, none actually offer treatment. Instead, they make referrals to specialists better equipped to handle the unique needs of the substance abuser.

QVMC embarked on an innovative approach to help its clientele, working with the Napa County Health and Human Services Agency and its mental health counselor, Suzanne Sculley. The program grew from a personal experience of Moss, coupled with the Napa County needs assessment study that highlighted substance abuse as a growing problem.

“I watched someone near and dear to me struggle with alcohol addiction,” Moss explains. “When my loved one went to the doctor seeking services and admitted to the doctor that he was an alcoholic, his doctor replied: ‘Yes, and what do you want me to do about it?’ He was offered some antidepressants and sent on his way. In the months following, I sat by and watched his addiction tear apart his family, watched him lose his job… lose everything. I’m not sure this situation would’ve turned out differently, but I do feel strongly is that when someone has the courage to admit they have an addiction, we need to do everything possible to get them to the services that are available in and out of our county—and connect them with specialists that have the skills to help them be as successful as possible.”

When QVMC suspects patients might have substance abuse problems they contact Sculley, who meets them and makes an assessment. “Some will come to the emergency room and need to go to detox, either through the county or through private pay treatment centers. Some may need to go to residential,” she explains. Sculley, who is co-located with QVMC in the Community Outreach program offices, is the conduit to see they get what they need—as long as they want the help. Sculley says about 50 percent of the patients, despite their need for help, don’t want to meet with her at all; of the remaining 50 percent, only about 30 percent take referrals for additional services.

The key is “everyone admitted to this hospital with drug or alcohol problems is connected with me to know there are services. We want everyone to know where the services are and how to access them. If they in turn ask for services, I go further and connect them.”

Duffy’s Napa Valley

Perched at the top of the Napa Valley, Calistoga is a quiet town, home to hot springs, mud baths, fine wine and its own version of “Old Faithful” geyser. At its north, you’ll find Duffy’s Napa Valley, a collection of picturesque red buildings and well-landscaped fields that comprise a refuge for individuals seeking to recover from drug and alcohol addiction.

Robb Schuler, Duffy’s Napa Valley marketing manager, heard many times folks are surprised to find a rehab center in Wine Country. But it has been there 48 years now and was one of the very first such centers in Northern California.

“You have to admit it’s a serene location,” Schuler says. “We’re at the base of Mount St. Helena, with the Palisades Mountain Range on one side and Mayacamas on the other. It’s a great place to reflect and take on the challenge of changing one’s life.”

Gene Duffy, a successful New York and Chicago contractor, founded the facility in 1967. Duffy struggled with drinking “which eventually got the best of him,” Schuler says. “He found himself on Skid Row without his family—he was pretty much homeless. But someone in Alcoholics Anonymous approached him, helped him turn his life around and the rest is history.”

At first, Duffy leased the property until his business of helping others succeeded to the point he could purchase the property outright. The Duffy Family has operated the center ever since. Gene Duffy’s grandson, Mick, is in charge today.

Duffy’s Napa Valley follows the 12-step recovery model developed by Alcoholics Anonymous (see sidebar). “It has a proven history and effectiveness,” Schuler explains. “I know there’s some controversy about it, but there always has been and there probably always will. But the [success rate] speaks for itself.”

“Guests” at Duffy’s stay a minimum of 30 days if it is their first rehabilitation effort. “Most programs won’t sell less than 30 days, for business or insurance reasons. Plus, there’s data to support that 30 days ought to be the minimum,” Schuler says. Duffy’s also offers seven, 14 and 21-day stays for various reasons, usually for “high functioning people who may have had a program for living that was effective, but they’ve relapsed and need to try something different.”

Guest demographics show most of the guests are male, Schuler notes, saying, “There are all kinds of opinions why. I think the stigma that goes with mental illness or substance abuse disorder is difficult for all, but probably even more difficult for women.” The age range is from 18 to 80, with an average guest age of about 40.

Guests share quarters and have all their meals provided (private rooms are available for an additional fee). Base rate for services is $23,400 for 30 days. This also includes 90 days of followup or 12 sessions with a therapist after leaving the residential program, provided through Full Circle Addiction and Recovery Services of San Rafael. “It’s fabulous,” Schuler says. “Sessions are conducted via iPhone, Skype, Facetime or in person. We also provide continuing urinalysis to prove sobriety,” which is often required by employers.

Schuler says Duffy’s is seeing a real uptick in guests addicted to prescription drugs and heroin. “People get on heroin because they can’t afford the prescription drugs they started with,” he says.

Prescription drug abuse is on the increase because physicians write so many prescriptions. “Oftentimes we trust those who write prescriptions for us so much that we don’t realize what they’re prescribing can be harmful,” Schuler explains. “I like to think what they give you in the hospital is perfect—but what they send you home with is kind of like sending you out with a grenade that has no pin.”

Duffy’s is licensed to serve 61 guests at a time and has a staff of 63 people to serve them in one way or another. A typical day includes class lectures and specialty group sessions, private counseling, free time and an evening 12-step meeting, with meals sandwiched in.

Relapse is common in drug and alcohol recovery. “The longer someone is sober in the beginning, the odds of maintaining sobriety increase dramatically,” Schuler says.

The most successful Duffy’s graduates? “Licensed professionals—pilots, doctors, nurses, and others—because of the requirements they must meet to keep their licenses. Their recovery rate is in the 90th percentile.”

Alta Mira Recovery Program

With sweeping views of San Francisco, Alcatraz and the Bay Bridge, Alta Mira is one of the nation’s most beautiful addiction rehabilitation centers—and among its priciest, as well.

In Spanish, “alta mira” means “higher view,” and as the client brochure states, the name “captures where we set our sights for our clients, their families and their lives in recovery.”

Before becoming a rehabilitation center, Alta Mira was an historic hotel that beckoned the rich and famous (Joe DiMaggio and Marilyn Monroe spent part of their 1954 honeymoon there). Today, it still attracts those with financial means, albeit for a different reason.

“Most of our population here is dealing with substance abuse and co-occurring mental illness, such as bipolar disorder, anxiety disorder, depression or trauma,” says Drew Paxton, chief operating officer of Constellation Behavioral Health, which operates Alta Mira.

According to Paxton, Constellation founder Bill Morrison’s personal experience (through both family members and himself) spurred him to find a better way to treat individuals seeking recovery. “He felt there was a lot of opportunity to do better. Many high-end facilities, he observed, were not asking family members, doctors or therapists about patients. They were simply treating the patient and then handing them back. They weren’t collaborating with the larger care continuum,” Paxton says.

While patients at Alta Mira usually stay for 30 to 90 days, “that’s just a small sliver of their path,” Paxton says. Alta Mira works with families and other professionals so clients will have a better outcome and less chance of relapse. “What differentiates us is that we get to the right diagnosis, offer individualized care and provide exceptional treatment experiences,” Paxton explains.

“People who come here are usually high users of the health care system and may have multiple doctors, therapists and psychiatrists. They go to one and he prescribes one medication. They go to another, and she prescribes another. No one is talking to each other. By the time they reach treatment, they’re often on as many as six different medications—and it’s hard to tell what’s working and what’s not. Our practice is to do a comprehensive neuropsychological assessment with clinical and medical evaluations. Detox can take two to four weeks, and then you have to get them on the right medication. We start with genetic testing—we swab the inside cheek and run a test that shows what meds they will metabolize well,” Paxton explains. In many cases, this results in fewer medications, “which is a benefit because meds can have serious side effects.”

Paxton further explains that not everyone does well in a traditional recovery facility. “For example, it might take someone four to five weeks to detox. In some programs, if you’re not on step three in week three, you’re considered off-track. There’s no off-track here. Each person stabilizes at their own rate before they start the program and it may take more or less time to complete.”

Exceptional treatment experiences involve many things, Paxton continues. “We have to give people enough of what they want so they stay in treatment long enough to get what they need,” he explains. “We have a clientele that’s used to getting what they want when they want it. We have to give them good food, a comfortable environment and a quality staff.”

The shortest stay is 30 days, at a cost of $54,500 (double occupancy), paid up front. If they commit to 90 days, the cost is $129,500. If they complete their program early, Alta Mira has a refund policy.

“We’re private pay because insurance companies often dictate treatments, which can interrupt the process. We want to give people the treatment they need, not what an insurance company might authorize. We want them to unpack physically, so they can unpack emotionally to do the work they need to do.”

Alta Mira uses the 12-step program. “It doesn’t have a monopoly on recovery. However, it has been shown to be very helpful for many people,” Paxton says. The typical Alta Mira client

“gets on the right medication, receives the right therapy and goes to a 12-step meeting every night.” The facility has a network of peer support programs, it’s not unusual for clients to make a decision to relocate to Marin to keep their peer support group intact.

“They feel safe, connected and they have a community. And it helps to de-stigmatize the process, since everyone has the same issue.”

Alta Mira has five buildings, some with private rooms and suites. It’s licensed for up to 150 clients at a time. People ages 18 to 70 come from all over, including 5 percent from other countries.

Three groups are common, the most being unemancipated, younger people who come from families of wealth or privilege. “They may not be finished with school, or they aren’t married or maybe aren’t in a career,” Paxton says. Another group is individuals “who have been quite successful in every other area of their life, but the addiction problem is the one thing they can’t take care of on their own. The third common group is women.  “In more traditional programs, the normal split is two-thirds men and one-third women. At Alta Mira, it’s almost always 50-50.”

CHI Recovery

The first thing Stuart will tell you is that CHI Recovery “doesn’t consider itself to be a rehab.”

Headquartered in Sebastopol with offices near the Barlow complex, CHI Recovery is instead a program that uses a network of organizations, medical professionals and a variety of practitioners to deliver evidence-based care on an outpatient basis for six months (or longer, depending on the need of the individual suffering from substance abuse).

Evidence-based medicine believes decisions and policies should be based on evidence, not just the beliefs of practitioners, experts or administrators. It means a clinician’s opinion, which may be limited by knowledge gaps or biases, is supplemented with all available knowledge from scientific literature so that best practice can be determined and applied. “In other words, evidence based on scientific studies, not distorted by who’s funding them,” Stuart says. “Things that have been implemented in practice and show efficacy.”

CHI (Conscious healing innovations) Recovery is Stuart’s baby. Founded just a little over three years ago, the program started small but has gained ground, particularly among those who do not want to follow the traditional 12-step recovery program. It’s the only evidence-based treatment program in the country to meet all 14 of the essential components for treatment, set by CASAColumbia, the national Center on Addiction and Substance Abuse, a science-based organization that conducts research and recommends best practices for prevention and treatment of substance abuse disorder. It also was recognized by Pscyhology Today magazine (January, 2014) as “Best in Treatment in the Nation,” ranking in the top 8 of the 30 treatment centers so honored.

“Evidence-based treatment has determined that substance abuse needs more than a 30-day treatment,” Stuart explains. Most of the people who are substance abusers have life-long issues that need to be addressed, and they also need a variety of therapies simultaneously.

In studying how to provide evidence-based care at a financial level that was more affordable than other treatment programs, Stuart came to the conclusion that the program had to be outpatient driven and community reinforced.

“All studies show people are more successful if they’re treated as an outpatient as opposed to in a lock-away rehab center. People need to learn how to be sober in the world where they live. That’s part of why relapse rates are so high. Patients in recovery do fine in the bubble, but the minute they return back to their communities—with their dealers and their stressful families and jobs and lives—they relapse,” Stuart points out.

CHI Recovery treats patients as young as 14 (18 and older is the standard). Youth services are always customized and are somewhat different from the core adult recovery program. Youths detox, then are streamed into volunteer or apprentice programs. They get help with finishing their high school diplomas or GEDs. Many enroll in Santa Rosa Junior College. The “kids” get access to learning specialists, transformational coaCHIng and many other services.

“It always surprises those who come here for help how busy they are and how successful they are when they leave,” Stuart says.

Adults also become apprentices in trades they can eventually use to earn money, such as plumbing, carpentry, electrical work. One special program places adults into jobs where half their hourly wage is paid for by the program for six months.

“It’s wonderful. For six months, an employer saves half of the money they would have to put out for that employee, and the employee has six months to prove him or herself as being worthy and capable for the job. It’s win-win on both sides,” Stuart says.

CHI Recovery marries Western and Eastern medical philosophies. “Almost everyone comes with pain issues that may have contributed to why they became an addict,” Stuart explains. “Pain can be spiritual, psychological and emotional, as well as physical. So we have those who administer pharmaceuticals and oversee their use, and we also have Eastern nutritionists, acupuncture providers and we use acupressure and massage. Eastern medicine is extremely valuable in reducing the number of drugs people need to manage pain.”

CHI Recovery recently opened a residential home in Santa Rosa, but doesn’t offer residential rehab services. The home was purchased to provide safe housing for clients whose own communities might not be safe—and for out-of-area clients that need a place to stay.

CHI Recovery’s program is $10,000 per month ($60,000 for the entire six-month program).

“In some cases, that’s the same cost as a 30-day rehab program elsewhere,” Stuart points out.

Everyone’s problem

“Substance abuse disorder’s impact is anywhere from an inconvenience to devastation,” Sculley says. “It’s important to know it is a chronic illness and, because of the nature of the disorder, it’s progressive. It affects not only the person [suffering from substance abuse], it’s also connected to their workplace and community. People are unable to show up to work, they can’t be responsible and they have problems with interpersonal relationships. The coworker down the hall is affected when so-and-so isn’t able to be at work. Meanwhile, the addict’s spouse and children are living through emotional devastation. Domestic violence is another frequent consequence of continued use. Eventually, people with substance abuse disorder become isolated, unable to maintain personal relationships and engage in day-to-day living. They just drop out.”

Substance abuse disorder, in the end isn’t just one person’s problem and it isn’t just a business problem. It’s everyone’s problem.