Monday December 5th 2016

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How do you involve family in co-occurring disorders addiction treatment?

Involving family in treatment: Does it help?

How do you involve family members, co-workers, and friends into addiction treatment, especially when co-occuring disorders are present? Today, we are talking to expert Beth Bachelor, Director of Fellowship House, about how you can help an addict in treatment. And Beth knows her stuff.

Fellowship House is a United Way affiliated treatment center in Birmingham, Alabama that has been in operations since 1965. The organization offers a variety of programs adapted to the needs of the people that need help for addiction, but also addresses the needs of their families.

Read on here to find out more about the ways Fellowship House approaches individuals and their families during addiction treatment and the challenges you may face if you are in the same boat. Then, we invite your questions about how addiction affects the family or to how help an addict. Please leave us your in the comments section at the end. We try to respond to all questions personally and promptly.

ADDICTION BLOG: Fellowship House is a treatment center known for its family program. Can you tell us how do you include the family of the addict in the treatment process? What are they struggling with the most, and do you offer separate counseling services for them?

FELLOWSHIP HOUSE: Our experience has been that family tends to be most involved in getting someone to treatment and while the person is in treatment, then the family interacts less afterwards. For family members that can and want to engage in counseling, we usually refer out to local providers and family-oriented support groups.

Something unique that we do is to routinely provide family oriented gatherings, such as an Easter egg hunt, Back-to-School parties, Talent Shows and Halloween costume parties. The staff supports these events by bringing their own children and other family members, and creating a positive and fun sober experience as many families are still in the early stages of recovery. The talent show’s price of admission: Bring a family member or friend with you.

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ADDICTION BLOG: Is the family included from the beginning of the treatment episode, or are there any specific milestones that individuals need to reach first?

FELLOWSHIP HOUSE: Family is included and sought out immediately.

ADDICTION BLOG: What kind of events or special activities do you organize with the families? Can you point out an event you are especially proud with?

FELLOWSHIP HOUSE: I think the Talent Show is one of the best, because it incentivizes family inclusion. The talent acts are current residents, and the intermission acts are former residents and staff. This year, one of the ladies sang a gospel song (“I Know I’ve Been Changed”), and the entire audience sang the refrain on cue- families, clients staff.  Our talent judges are usually family, Board Members and other people from associated agencies like the courts/diversionary programs, state auditors. etc. It’s a unifying experience.

ADDICTION BLOG: What program or resources can families of addicts that need co-occurring disorders treatment seek out?

FELLOWSHIP HOUSE: Our co-occurring families have a great resource in our local NAMI chapter, the National Alliance for the Mentally Ill. There are also resources like The Recovery Conference (held annually for mentally ill Alabamians) and Family-to-Family, a mental health peer program.

ADDICTION BLOG: Fellowship House offers programs for people that struggle with dual diagnosis and co-occurring disorders. What have you found over your decades of experience can be the biggest challenge in treating dual diagnosed patients?

FELLOWSHIP HOUSE: In this population, many different factors can be tipping points in their stability – medication, stress, sobriety struggles, and finding a relevant recovering community. I would say that access to medication and healthy medication management are a big challenge because of the cost/availability of medication and psychiatric care.

ADDICTION BLOG: We noticed that you have medium intensity and low intensity program. Can you explain the differences between them and the benefits of each, for our readers?

FELLOWSHIP HOUSE: Medium Intensity is highly structured and offers up to forty (40) hours of programming each week. Length of stay is individualized, but usually ranges between 30-90 days. This level of care is subsidized by state and federal contracts.

Low Intensity Transitional is less structured and more independent. Highly individualized, length of stay there ranges anywhere from a month or two to a year or two. We have noticed that clients who transition from Medium Intensity to Low Intensity and spend several months have better outcomes than Medium Intensity only clients.

ADDICTION BLOG: What is the admission criteria for medium intensity and what for low intensity programs? What are the financial conditions?

FELLOWSHIP HOUSE: A client must meet diagnostic criteria for a DSM-V substance use disorder; after that, the ASAM Patient Placement Criteria is our guide for admission and ongoing case reviews, to ensure a client has the right amount of structure for their level of functioning.

All clients are charged a $35 intake fee – because our applicants tend to be indigent when they need help, most of them pay this fee after admission. Ongoing service fees are based on income, once a client starts receiving income. We’re fortunate to have service contracts and community donations that subsidize the expense of treatment. We think no one should be priced out of help when they most need it and can least afford it.

ADDICTION BLOG: Do you have any guidelines or after care programs for families so they can keep aiding their loved one when he/she is out of the facility, to prevent relapse?

FELLOWSHIP HOUSE: I wish I could say we did.

Our direct continuing care activities are aimed at former clients and focus on mutual support and action – volunteering is a part of many clients continuing care. Fellowship House is a work in progress!

ADDICTION BLOG: What kind of programs and activities have you developed to help patients with co-occurring disorders? How do you manage their interactions with the rest of the patients?

FELLOWSHIP HOUSE: Strong, supportive case management and ongoing medication management are key components of treatment. We also have employees with co-occurring disorders (Certified Peer Support Specialists), and weekly self-help meetings called Double Trouble. These meetings are strictly for co-occurring clients and co-occurring visitors from the community. Relationships with other community providers create a broader continuum of care than any one agency can offer, ensuring that as our clients get better (or regress/relapse), appropriate levels of care can be available.

Interactions with other clients have been largely smooth because the culture of Fellowship House is already highly individualized. Each client is different in some way – diagnoses, drug of choice, demographics- but all have addiction in common. There is not any great sense of division between co-occurring and non-co-occurring clients. Medication management is applied to both, whether it’s psychotropic meds, blood pressures meds, suboxone, etc.

ADDICTION BLOG: Is there anything more you would like to add for our readers?

FELLOWSHIP HOUSE: If you like what we’re doing at Fellowship House, like us on Facebook and visit our website, and support us in any way you can. We want people to remember that recovery is real, and that it takes all of us to make it happen!

Photo credit: geralt

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