By the grace of God there comes a moment in the life of a person abusing substances where enough is enough and it’s time to get help. They may say they were sick and tired of being sick and tired. For many it’s as dramatic as choose treatment or die. On the lighter side of a dark situation our son adds, “and I didn’t have anything else going on that day.” It (intervention, legal consequences, a friend’s strong suggestion, desperation, the will to live, an illumination) or all, overlaps to form a moment of clarity. Since we fear what we don’t understand, I thought it might be helpful to have a professional demystify treatment for us.
My buddy Ben Bertsch was generous enough to write down a few good-to-knows from the perspective of a person in recovery who is also a treatment specialist. Pretty cool. Thanks, Ben, for chatting with us laypeople about what’s important to know at the doors of treatment.
What Now? by Ben Bertsch, Acadia Healthcare
I’m a big fan of Sarah Nielsen and her work. When we connect, the conversation invariably comes around to “helping people”. Sarah is great at asking questions like “how would you help somebody who needs help with so and so” or “I’ve heard about a program called such and such, what do know about it?” Often, Sarah and I find ourselves in the space where questions like these and information overlap:
People seek us out when they are making decisions. Therefore, Sarah and I find ourselves sharing space with some prominent figures such as Google, Bing and Yahoo. Certainly the internet can help answer these questions, but confidence in the process is conditional on our trust in the information source. Anything can look good on the internet. Verification is where it falls short. In this way, conversations – not queries – are essential. As the Russian proverb states, Doveryai, no proveryai – Trust, but Verify.
Shortly after finding sobriety and beginning my own personal recovery a decade and change back, “the industry found me” as many people like me say gratefully. While not providing direct services, I get to support those who do and those they help. Like Sarah, I help answer the question “now what?” when the reality of unhealthy behavior can no longer be ignored.
The group I am with brands our material with “Improving Lives Through Informed Treatment Guidance” – we spend our time preparing for, and answering some version of “now what?”. When informed decision making takes place, the confidence and understanding in the process carries over into treatment [residential, outpatient, individual, etc.] resulting in better patient involvement and effectiveness.
Having navigated this system myself and helped others do so as well, it comes as no surprise that people often times better understand why they choose a certain restaurant, than the reasons behind selecting their behavioral healthcare provider. With this blog I hope to introduce the idea that there is a process to answering “what now?”.
When I am speaking with people about treatment options, I’ll often contrast the process to seeking help with a broken bone: If I take a bad fall out snowboarding and it’s obvious my femur is broken, the process of recovery is pretty straight forward. For the most part; I know what’s wrong, where to go for help, and what the care and recovery consists of. With behavioral health, it’s much less linear. Often times simply determining what’s wrong can be challenging.
A useful question in discussing treatment with a patient is ultimately, “does that make sense?”. For me, the diagnosis of “Substance Use Disorder” made sense and allowed me to get on board with my treatment plan. Had I not been fully confident in my condition shortly after starting treatment, the outcome could have been less successful. It’s also imperative to consider updating a diagnosis when treatments seem ineffective.
The influence of trauma is increasingly considered an important piece of a patient’s treatment. I have been active with The Minnesota Trauma Project and defer to their view on trauma: “Anything from the past that prevents one from being present”. While only 10% of the population may ever be diagnosed with PTSD; seemingly “insignificant traumas” are more common and can be overlooked.
In cases of ineffective treatment, I think it’s worth considering factors other than lack of individual motivation and desire. For those honestly seeking psychological wellness, undiagnosed trauma or other disorders will not “work itself out” simply because the resulting maladapted coping skills have been addressed. Once sober, step based recovery will certainly work for many people seeking wellness, but for those who fail in these [or other programs], refocusing care should be considered. Returning to unhealthy behavior is not surprising when the condition which drove the behavior has yet to be fully realized and cared for.
Another question I like to ask is “tell me about yourself \ your loved one?”. Regularly I have to interrupt the response and say something like “we’ve already talked about this [the problem behavior], now tell me about yourself – have you enjoyed hobbies? What would your life look like without this difficulty?” Knowing a bit about the person, and not just the person’s condition, helps to identify programs with complementary environments. Feeling safe and comfortable are critical when vulnerability and transparency are key.
Unfortunately, the financial piece seems to ultimately drive options for care. Therefore, understanding of insurance coverage and other available funding is important. In dealing with insurance, requesting a “dedicated case manager” can help in that you will be assigned one individual who will help coordinate the insurance benefit. This individual will hopefully limit frustration, help navigate the process and advocate on your behalf.
“What now?” is typically not a fun question to be facing. Often, fear and frustration find themselves in close company. While answering this question may seem overwhelming; engaging a process which considers the condition, the person and expense can help make sense of the answer and generally improve the outcome of care. Lastly, there are many people such as myself and my friend Sarah, who would gladly do what we can to support you along the way.
Benjamin Bertsch is with The Recovery Division of Acadia Healthcare working with their Treatment Placement Specialist initiative. The opinions expressed are his alone, and do not reflect that of his employer. He can be reached at firstname.lastname@example.org or found on LinkedIn.