Episode 52
Behind The Care: The Importance Behind Case Management

Watch Now

https://youtu.be/Reda4YzER2I

Listen Now

Description

What makes Case Management and Aftercare important in recovery? In this episode, we go into Peaks Recovery’s perspective on the importance of case management and aftercare within the recovery healing process.

Talking Points

1. Explaining what case management means in terms of recovery care
   
2. Going into different types of aftercare and aspects of them
   
3. The importance of aftercare
   

Quotes

“A good IOP program is going to reinforce the fact that actually, the answer is you. You are the answer to your own problems.”

– Clinton Nicholson, MA, LPC, LAC, Chief Operations Officer

Episode Transcripts

Episode 52 Transcripts

empathy is knowing your own darkness

without that connection you don’t have

anything what’s the opposite of

addiction just freedom

and here we are

welcome back everybody

episode 52 of finding peaks i believe

i nailed it i know i got that right it’s

number 52

for all the naysayers out there i can

count anyways welcome back everybody

brandon burns chief executive officer

for peaks recovery centers excited to be

hosting again today

to talk about uh a not often talked

about topic case management joined by

chief clinical officer jason friesma

might have some good things to say about

it and for all the viewers out there who

have been emailing us you know fervently

at finding peaks at

finding peaks

at peaksrecovery.com

obviously i haven’t done this in a while

bear with us team clint nicholson’s back

in the seat he’s been gone for like a

month and a half yeah welcome back yeah

chief operating officer for peaks

recovery centers

all here today to talk about all things

case management

to fire off this topic i remember

once upon a time being a marketer for

peaks recovery centers and what that

entailed at the time when we didn’t have

residential and detox programming is i

would go into other facilities and

market for peaks i would hand out

brochures and i’d say these are the

things that we do

and um

for all the viewers who you know watch

these episodes you know i’m engaged in

our vision of disrupting an industry and

uh what i found disruptive to me at that

time was instead of

case management stating hey peaks

recovery centers in this example is the

right center for you

they what they would do was is they’d

hand out four or five different

brochures and say

here are these tour these facilities and

you pick one

and for me that was discouraging because

it didn’t feel int there that there was

any intentionality behind the case

management that it wasn’t directional

and it wasn’t uh moving in the direction

of what the

of the curriculum of the residential

program and what they had already done

with the patient care at that time so

ultimately uh peaks created a curriculum

or a full continuum of care

that allowed us to kind of move away

from that and choose our own path in

regards to case management and what we

do with patient care but

it’s it’s a challenging position

it’s a challenging department within

any organization within addiction

treatment for a variety of different

reasons one of those being that you know

insurance companies aren’t out to pay

for this as a service

so it usually

you know falls down the letter the

ladder of importance from medical to

clinical programming to residential into

case management and so forth so just

hopeful

after that

winded introduction to talk a little bit

more case management how we can make it

a bit more intentional but also to talk

about the different features of what you

know treatment might look like beyond

the levels of cares of you know detox

and residential programming and i

thought a fun place to start would be

that

occasionally it doesn’t matter that we

believe somebody needs to go into a php

program or to an iop model or an

outpatient model or receive medication

management some people say i don’t want

to do any of that i’m just going to go

into the rooms you know a a n a c a and

so forth as my path

um you know for recovery so that in a

way kind of um

removes the opportunity for case

management to be effective because

there’s no there’s nothing we can really

advocate for or be intentional about um

i do want to advocate and be pro you

know aana they’re invaluable resources

they’re absolutely free to anybody out

there who you know at times can’t access

care or just needs you know um a good

group of individuals to hang out with

maybe to

um you know avoid a relapse or whatever

the case might be but

um

so an individual picks and chooses say

alcoholics anonymous to go to you know

as their after care plan

and just hopeful that we can review kind

of the um the pros and cons of that

decision maybe as the only path of a

case management out of a residential

programming so i think starting with the

pros is important

it’s been around forever i think this

industry built you know it’s collective

effort on the backs of the rooms in in

and of themselves the big book in

general um so what are the positive

aspects when somebody chooses and says

you know what i’m not going to do all of

this after care stuff that you guys have

highlighted as an organization but i am

interested in a and that’s what i’m

going to do

um

immediately we feel good about that and

why

i’ll start i think

um

i think there’s a variety of pros

actually a uh accessibility

um you don’t have to wait or be on a

waiting list or do an intake you

literally can walk into a meeting any

hour of the day in any city

really around the world for the most

part and i think

um

so that accessibility and then it’s free

as well um

and then

i do think some of the magic sauce that

aa has

is the sense of community and i think

that part

um

that has kind of stood the test of time

a little bit is that the need for

uh community and the need to kind of

connect with uh other people

um yeah so i took three pros what do you

got well i’m i’ll piggyback because you

took all the good ones yeah

uh i think that’s why i went first

exactly yeah okay i’ll go i’ll go first

yeah i think the sense of community is

probably the key actually um

you know content of meetings is exactly

the same everywhere you go and that’s

actually kind of the point

besides the the individual shares that

happen in the rooms the actual format of

the meeting is the same the contents of

the meeting are generally the same the

messages are generally the same they’re

all coming out of either the big book or

the n a book whatever whatever the case

may be

and so there’s something about that

predictability which is also really

important it provides structure um

within a community as well um and i

think that

you know the the reality of the

situation is

you get out of a residential program

and you’ve only just gotten out of

treatment like but your recovery

actually starts as soon as you walk out

the door you know that’s when recovery

actually starts and you have uh

access to

a very uh

a lot of access actually like jason was

saying to a recovery community which in

the end is what you’re going to need to

stay sober or or sort of stay on the

right path if you are struggling with

mental health issues um regardless

and it has uh the unique feature too of

course right of a sponsor right not only

do you have the group environment where

you create that community uh get that

nice a.a coffee in your hand um which is

usually heavy with caffeine absolutely

yeah in the rooms as it goes and you

have the sponsor and the sponsor’s

guiding you through the steps right a

person of accountability is created in

your life that you can engage with phone

calls text and so forth right uh as a

positive experience of that and

uh so i think there’s a lot operating as

you guys said within like a community

sense of things right and i also think

about the rooms in a big way

around you know addiction in general

right so we have the maladaptive

behavior of drinking in the face of you

know having an uh emotional

dysregulation driving down the road i’m

angry i’m frustrated or

issues with you know uh spouse in that

regard i drink you know so uh triggered

drink right triggered drink right well

when you leave a residential model after

from a hundred to a thousand you know

triggers depending on the amount of time

that you’ve been using drugs or alcohol

in general and so i think about the

meanings as well too as like triggered

through the lens of neuroplasticity that

i’m triggered now and i choose a meeting

and i’m triggered and i reach out to my

sponsor and i’m triggered and i do the

meeting and rinse wash repeat that over

the course of a year or two now and the

neuroplastic you know the plasticity of

the brain then says you know trigger and

we have this safe environment i think

there’s a lot of

value in that now i said pros and cons

i want to be delicate here because this

is a massive organization these

organizations are massive and so

important can i throw also just because

we do mental health as well throughout

nami as far as meetings for people who

are struggling with mental health as

well that there are actually these

community-based meetings and we partner

with nami and they do great work but

yeah yeah perfect and so the cons aren’t

about what they’re not doing because

they do what they do and they’re

significant in the way that they do it

but if somebody picks that path you know

say who has a history of trauma or who

has a history of mental health

and you know doesn’t utilize maybe a

therapist or something

so now we’re in the lens back in the

lens of case management okay trying to

encourage somebody yes take all those

things seriously do those things those

are those are actually very important

aspects of aftercare at the same time

what are we missing if we only go down

that lane by not choosing an iop program

or seeing a therapist on the side and so

forth

and i’m sure it’ll be let’s go first

again jason

yeah uh so i can take the low hanging

yeah and you have to reach a little

higher

um

i think there’s a variety of things

missing and

clinton started to allude to it a little

bit but uh

um at least in the anonymous communities

like it is difficult uh there’s a wide

spectrum of views on mental health um in

that

i’ve certainly known a lot of people who

have left a

treatment facility

meet a sponsor and the sponsor is like

you can’t be on any medication uh that’s

all drugs and you got to come off of all

of that and that can kind of unravel

a lot of work and a lot of

effort on behalf of a client when they

are attempting to get

stable from a mental health issue um

you know and like uh

i i think there tends to be this uh

there can be a tendency uh naa to just

view aaa as the only cure for all

uh

mental health type needs and and i i

don’t think uh that tends to be the case

i

and i see it happen truthfully um and i

think

so having good aftercare for psychiatric

needs and that sort of thing um and then

dealing with depression or dealing with

trauma

i think going through the steps working

a good fourth and fifth step

that can bring out some trauma and if

there isn’t kind of a container or way

to process it sometimes that needs some

professional help i would say so just

having that as an avenue

it certainly has worked for a lot of

people and i’m not uh disparaging that

in any way

however

i think it leaves a wide lane of things

that aren’t treated

fair yeah um okay

okay

uh

yeah i think that

yeah again to be delicate because

they’re you know these 12-step programs

have been around for so long that have

helped so many people

um i guess in my own experience the

the primary difference between like a

well-run iop program and

um something like aa or na or c a

is typically the message of the of the

rooms is that the answer is a a the

answer is n a the answer is c a and a

good iop program is going to reinforce

the fact that actually the answer is you

like you are the answer to your own

problems like in the end you’re gonna

have to come up with a lifestyle with

the skills and with the

and with the motivation to actually make

the change that you need and the program

doesn’t do that for you and i think that

there’s a pretty

it’s and sometimes it’s a subtle

distinctions and sometimes it’s pretty

glaring as far as what the reliance is

if i can piggyback on what you said i

think

um

i think it it can be stated too that

that

like the anonymous programs

not only is they the the solution but

it says i am the problem right i am an

alcoholic i am an addict and like it’s

important to work through denial that’s

a really important thing to kind of walk

through but

that statement and kind of having to

really adhere to it says i am the

problem this meeting is the solution the

program is the solution and to your

point i think going to an iop program

says

here’s the problem over here and you are

the solution for the problem right yeah

yeah and one of the things because i

want to uh i can i can feel the room

sort of boiling behind us

uh as a metaphor here but the

the one thing that i actually want to be

charitable to the rooms about too and

the frustrations and if the public the

general public doesn’t know this there

is a sort of tension between the rooms

and treatment centers in general um why

is that i think to simply put it is

because uh this industry took the rooms

and inserted it into

uh

group services and then billed for the

past 40 50 years since insurance started

covering behavioral health billions of

dollars on the backs of free programming

yeah and i just want to make that

distinction make that clear where this

sort of tension arises i think between

you know treatment centers and the rooms

in general and charitably to the rooms

like um

in my absolute opinion that was

completely inappropriate and uncalled

for and unnecessary it goes against the

profiting from

aaa meetings absolutely yes literally

against their bylaws and it could have

been something where there was actually

like a marriage where there was

something that was very um where uh

where each of those programs really

could help to support each other but

instead there was just this

um

like sort of bastardization of what the

rooms actually offered and done under

this like sort of i don’t know very thin

clinical lens which isn’t uh which is

something that i mean

you know peaks we’ve really moved away

from very intentionally and i think good

programs in general have done that as

well

yeah it’s a we should do this

collectively and together and then when

the a when the rooms are doing their

things and treatment centers are doing

their things appropriately iop programs

and so forth there’s a healthy marriage

that’s operating there

but conflating the two and charging for

something that is free i think it’s

inappropriate i just wanted to highlight

that because uh of where this general

tension when i say like you know the

rooms are boiling in the background

about a treatment center talking in this

way

i think it comes from that sort of arena

so

uh so we’ve highlighted a moment where

we where an individual says not doing

any of the therapy stuff i think we see

you know we can kind of improve upon the

setting to have you know uh to be doing

the rooms but also to be doing

alternative things as well too

um but

you know with intentionality right peaks

has its own curriculum you know we’ve

talked about it on past episodes here

that this is one of the most fragmented

sides of health care where everybody

under their own philosophy can be doing

their own curriculum that’s different

from the curriculum here curriculum here

if there’s even a curriculum over here

and for that reason we have sort of them

on their own sort of roller coaster

trajectory here right and so we want to

have some intentionality with what’s

working with them here into that next

step

and

uh

with that uh curious from your guys’s

clinical lens um you know what’s

important about that and sort of how do

we get that uh right and also what are

we trying to actually do with the

individual on selling them into these

aftercare models right because it’s not

it’s not for the sake of it right you

know the the brain still needs a ton of

time to heal in the process so we’re not

trying to do it for the sake of it what

are we trying to do here

i think

i i do think um

we are we we are professionalizing

um both the mental health treatment and

then providing an opportunity for

community i think a good iop program

and can emphasize both uh importantly

and

really kind of helping people continue

to build and form relationships and

figure out how to navigate um

relationships uh effectively is actually

a really important skill

to build a primary support group

in the long run

while dealing with without judgment

clear mental health issues as well i

think that

that part matters a ton i think

yeah um

that

thank you yeah yeah segway awkward segue

maybe yeah um i was dissociated okay

sorry welcome back

no uh i lost you

for me i think iop is this opportunity

for integration right it’s like when

you’re in residential you get these

intensive long days of just heavy

deep

um

insight work right so you’re really

gaining insight into who you are as an

individual why you do the things you do

why you’ve chosen the coping strategies

you’ve chosen how you can do those

differently you start getting introduced

to different coping strategies and

different ways in which to sort of

uh respond to the world right like

trigger a drink

now it’s now it’s trigger go work out

trigger meditate you know you get this

opportunity in a very safe and

controlled environment to start

practicing these new skills that you’ve

learned after building all of these deep

insights but iop is the first chance

when you’re actually in the real world

and now you have to you have to fully

integrate the things that you’ve learned

and to do that right to just send

somebody on their way without any

support afterwards is pretty

irresponsible in a lot of ways because

it you just

it’s like asking somebody to be a

professional football player like you

know 45 days after you taught him how to

throw a football you know that doesn’t

make any sense

there’s practice has to keep happening

and um iop is that opportunity to sort

of practice in a semi-controlled

environment but in real life

circumstances in a real-life world yeah

and i love that too because that that

that awareness we gain in residential

programming because also what we’re

combating too in residential programming

nearly on a daily basis is like i’m not

actually sure i need to be here i’m not

actually sure i have a problem i mean

one of the major things we overcome

within a 30-day model is ambivalence you

know and i share this with families all

the time who come through you know peaks

certainly but sharing it with the

families and the you know the viewers

out there today is you know an

individual comes in even if we have a

six-week curriculum over 45 days

and they cut that to 30 days we’re

missing two weeks of a curriculum now we

have four weeks of a curriculum well if

detox took seven days we missed that

part of the curriculum and now in the

next two weeks if we’re exploring just

ambivalence about being here we’re not

taking seriously the curriculum we’re

not we’re not only not downloading the

tools we’re definitely not implementing

them and we get one week of an actual

curriculum like okay i get it i think i

have a problem now and i’m engaged in

this and then we do no aftercare and so

the you know the thing that comes up out

of that for me is you know people turn

around and say well you know something

like peaks didn’t work from here this

treatment center didn’t work for me uh

you know we don’t get to open your you

know the heads of the individuals look

at what the issue is and pluck it out of

there there’s an application that has to

take place here

um

from the settings that they’re in and

out into the real world and i think

there’s at times that

i don’t know the right word here maybe

you guys can help me out here but i

think some you know patients feel like

that’s there’s sort of operating

parentalism about like you know what’s

best for me rather than what’s what is

actually best for me and what’s best for

me is to do these sort of things and so

there’s this you know

uh

you know sort of tugboat future back and

forth between you know the treatment

center and the individual to really

ensure that they get right what the

actual issue is and then from a setting

that is safe and secure that is nearly

triggerless in a residential environment

though we find ways to trigger people

all the time at peak’s recovery it could

be our pillows it could be the ipads it

could be whatever but

those aren’t enough to get ahead of

everything from an application

standpoint and i think we’re getting to

the essence of what the importance of

case management is is moving from an

environment of safety and security where

we can get comfortable with each other

to build enough rapport to state hey we

need to apply these skills somewhere

yeah absolutely

and it takes time yeah and i do think

you know it

i think it’s pretty well accepted and

and there are a lot of studies out there

that the longer somebody is in

some form of treatment it doesn’t have

to be

six months of residential care but if if

people are

getting um clinical contact and contact

with the with the community

even once a week

at the back end of this

you know if they can get to a year of

doing that like the the statistics are

actually quite

er significantly better for people to

remain sober for the long haul and it

just speaks to that like you just need

people asking you some of these

questions or

a place to say i found a new trigger or

my dog ran away or whatever it is that

you have to begin to navigate um in a

new way

those triggers so i think

i can’t emphasize it enough

we do a lot of magic i think in 45 days

in our residential program but it’s

really just the beginning of a journey

yeah um absolutely i mean you’ve again

we have a stabilization model like we’ve

stabilized you it’s why you feel good

you know like that’s why you have

confidence it’s you’re clear-headed

you’re healthy you’re exercising you’re

eating right you’re sleeping finally

you’re on the right medication regiment

you’ve you’ve landed in a place where

you’ve built community even if you’ve

only been there 30 days you’ve made

connections that you feel that have

helped you feel safe that have helped

bring back a level of cert a certain

level of confidence and as soon as you

walk off that campus all of it can

disappear you know like it is it happens

all the time right and it’s not because

the program didn’t do what it was

supposed to the program did exactly what

it was supposed to it’s that the hard

work happens as soon as you leave you

know that’s when the real work comes in

because it and that’s what it is it’s

actual work you know it’s every day

staying focused staying engaged staying

on top of of your thoughts like really

building on all of that insight that

you’ve gained over the last 45 days and

to try to do that alone or to try to do

that in the exact same environment that

you came from it’s it’s almost it’s a

near impossibility and at the very least

it’s just not fair it’s not fair to

for a client to do that to themselves

it’s not fair for a family to have to go

through that it’s um

but at the same time because people feel

good there’s this sort of like eh

aftercare maybe i don’t need it and and

that ambivalence that’s that last little

bit of ambivalence that you get at the

very end of the treatment episode that’s

actually probably the most dangerous

yeah absolutely uh you know never mind

the the the neuro you know the plastic

brain operating in the background though

it’s feeling good and healthy in that

moment from a stabilization standpoint

all of those wires are in place to when

they experience trigger right to trigger

drugs it’s the the brain is impulsive in

that moment and gonna pick what it’s

used to even though there’s some

satiated period right in a way and so

you know the last bullet point here i

think that i wanted to talk about and

bring to everybody’s attention i think

we’ve mentioned the florida model of

care uh in past treatment epis or in

past finding peaks episodes

charitably charitable reading of the

florida model of care is to

kind of

build a framework for what would be like

an ideal campus and on this campus

families or individuals in treatment can

do

can get their therapy here and they can

walk across the campus they can get a

job and then they can walk across the

campus and do their meditation they can

walk across the campus go into the rooms

those sort of things but there is no

real campus setting and out of that you

get a sober living home and the uh the

business model is to bus that individual

from the sober right or wrong from the

silver living home to

the treatment center where they receive

you know partial hospitalization or iop

services in that regard and then they

can take them after those group services

are rendered to the job environment to

apply for the job or they can take them

to the meetings to build community and

sponsorship and so forth and so in its

most

cleanest ethical sense

it is a really nice thing and i think

what it really does control is because

people get into these models and this is

more of a residential setting i don’t

want this i don’t need this right but i

think the advantage of it

and correct me if i’m wrong or if maybe

there’s better language for it is that

it’s containing that impulsivity uh that

when you get outside of treatment now if

you

are on this theoretical campus and you

do your groups and you go into the rooms

and you’re triggered well the you know

the the bus picks you up at the end of

the day brings you back to the sober

home you continue to have this you know

community and the support effort uh all

along the way versus if you’re in just

an intensive outpatient program call it

three days a week and it’s a

uh it’s a tuesday and there’s no groups

going on and you’re triggered in that

moment

the impulsivity can flare up in any

direction without that support structure

especially if we don’t have the rooms as

a backup or a belief that that’s

appropriate to go to or whatever the

case is

so that is an opportunity post you know

detox stabilization residential models

um and it does have efficacy but you

know the common complaint is that’s too

much structure when the structure is

really doing something healthy there and

it’s containing that impulsivity and

giving it more time to

adapt itself to

the world in which it will be less

triggered in

yeah i mean it’s a step down model right

it’s this idea that

things come in a sequence there’s a sort

of order of operations to this process

and in the end the underlying theme is

it just takes time like this is this

does not happen overnight you are

literally rewiring the brain and that

will not happen in 45 days it will not

happen in 30 days it will not happen in

it takes time and every

in every little bit of time that you can

give yourself any any

any extra day or week or months that you

can give yourself more structure and

more support like jason spoke to earlier

the better chance you have of being

successful and yeah it’s a lot of

structure in the beginning but you’re

coming most people

i don’t care if it’s

if it’s substance abuse or if it’s

mental health uh like severe acute

mental health disorders you’re coming

from a world of chaos you know so give

yourself the time like enjoy the

structure lean into it that is that is

going to be so profoundly important in

your long-term recovery and to to pull

away from that is is really counter to

what the recovery process looks like

yeah

frieza final words finally final piggy

back here i mean you guys have said a

lot and i i just couldn’t i could not

agree with uh

i couldn’t agree with you more and i do

think

you know i just think about how many i

was sitting here thinking about how many

medical

procedures have a similar format whether

if you break your leg you get a surgery

and maybe a cast and then a lower cast

and then a walking cat like right it’s

immune therapy yeah and then all right

it all is progressive and building on

one another

and if you’re going to get knee surgery

you might as well follow through with

the physical therapy afterwards right

like if you’re gonna otherwise it was

kind of almost pointless to get through

you’re gonna have to go back and get

another knee surgery yeah exactly and so

you know like there’s a there’s a just a

lot of template for doing this and it’s

interesting that that we have to sell it

so hard because it isn’t as visible as

like you know a scar on one’s knee right

but it is the same concept for sure yeah

and all the trade-offs along the way to

families intentions about what they

think the patient should be going

through and where the patient’s actually

and what they’re capable of is kind of a

different narrative at times so there’s

a lot of conflicts

you know throughout this as well too but

if you get knee surgery you don’t argue

with your orthopedic surgeon and say no

i don’t want to do physical therapy like

that’s so good yeah i feel great yeah

you just do your physical therapy yeah

there’s something

about our industry that makes it

difficult right because we go and say

well we want these things to help well i

don’t want to do those things you know

that’s you know that’s where you know

going back to the beginning about

intentionality and not doing it for the

sake of it we’re not

trying to just insert you into you know

peaks iop post treatment fine not our

iop program we get it not colorado

springs maybe not denver wherever you’re

going though you got to tie into

something to continue to know through

this yeah so please like listen to case

management if your loved one is in

treatment in case management like you

said is it’s probably one of the hardest

things to do within our setting because

of the fragmentation but you have no

idea what you’re going to get half the

time if you’re going which is one of the

reasons why we built an internal iop

step-down program right because we knew

that that quality is lacking or at the

very least is inconsistent but at the

same time this step-down process is

vital so

please if your loved one is at peaks or

any other facility listen to the case

management team follow an aftercare plan

and take time and be patient with this

process because healing takes time if

anything

yeah

well clint wasn’t the host today

he gave us an exit in and out there so

um

i’ll be angry with him later yeah and

everybody’s welcome for taking us out

there so with that uh now that i know

what i’m doing finding peaks at

peaksrecovery.com questions thoughts

insights case management florida model

care iop the rooms bring those questions

to us they’re invaluable as far as what

we can bring to the table and continue

to support and educate family systems on

the facebooks the twitters the tick

tocks chris burns everybody

find us on the tick tocks he’s screaming

into the mic having a good time with it

creating a you know recovery journey in

real time it’s very exciting so tune in

to that another host here of course if

you haven’t seen president founder chris

burns on the show but he’s on all the

tick tocks so pay special attention to

that otherwise

i’m going to be a part of the three of

us are going to be a part of we’re going

to have some medical team members a part

of um we got dr steven elardi coming out

on may 12th i believe is the date for

that

we’re going to be doing some finding

peaks episodes with him his book is the

depression cure we’ll have more ads out

about it as well too but looking forward

to having him on as a guest in the

coming days again dr stephen elardi with

the depression cure

and until then and until next time

thanks for joining us and we’ll see you

again soon