Episode 68
Is IOP the Best First Step?

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Description

In this episode we discuss how outpatient and intensive outpatient therapy plays a vital role in recovery, though not always is it the best first step. Determining what level of care an individual truly needs is an important decision that needs to be thought through and directional.

Talking Points

1. Private practice and when someone needs to be directed towards a higher level of care
   
2. Why people may chose the path of least resistance first
   
3. When is IOP the appropriate level of care?
   
4. ASAM connection
   
5. 3 vs 5 days a week for IOP
   
6. Family engagement
   

Quotes

”The foundation of IOP is psychosocial stressors, and being able to manage and navigate psychosocial stressors in real time, in real life, and being able to stay at the level of recovery that you’re looking for. But in order to do that you have to experience those psychosocial stressors so that you can deal with them, hence the exposure piece.” 

– Clinton Nicholson, MA, LPC, LAC

Episode Transcripts

Episode 68 Transcripts

hello everyone welcome back to another fantastic episode of finding peaks made fantastic by yours truly the host brandon burns chief executive officer for peaks recovery centers joined today again by rarely seen jason friesman clinton lobster lpclic all right brain things clinical absolutely chief operating officer clint nicholson all oh no excuse me lpclic all left brain things absolutely gotta drop the the gotta get the credentials and the credentials in there they are the most important aspect today on this show we are gonna talk about uh iop not the services in and of themselves and which we do at peaks but just kind of a around the edges skirt around it talk to the family systems out there you know maybe future patients of iop programs in pursuit of these things and um going back to uh the most recent episode we did behind the care viewers check it out uh i think it was an excellent episode you might notice me tearing up at the end of it because it got emotional but i held it in like a strong left brained person does here right so i think diving into this i the kind of the first question i wanted to just ask to you guys because sometimes it feels like it’s true okay we find that johnny has a substance use disorder or a major mental health you know disorder of some type you’re the family member you’re looking at them and there’s going to be an incredible amount of ambivalence right around like i don’t have a problem or maybe they see that they have a problem but uh in our collective experiences for me it seems like the first option is always going to be kind of the the path of least resistance right detox into a residential stabilization model off into iop and those sort of things um you know and and being that you i think both are in private practice at some point or at least you you’re a prep practice both private practice right uh i would imagine you get a lot of individuals just saying no i’m gonna go do counseling and then they arrive at the frieza’s office and it doesn’t look like they just need counseling i mean is this accurate is this a good starting point for you i mean you’re hitting it right on the head absolutely people every day i’m sure walk into outpatient or private practice offices and say i might be drinking a little too much and i need to stop uh oh i need to cut down that would be i need to cut down that would be the outpatient too many calories empty calories uh yeah yeah so i need to cut down i want to go from two bottles of wine to two glasses of wine yeah like that kind of thing a lot of that mentality especially if people are just going to private practice and um and really what you see is a sort of unrecognized like substance use disorder or even you know major mental health issue if somebody is like really not functioning and they barely made it to your office in the first place yeah so from that moment in a private practice setting are you referring into an iop are you looking for residential detox or generally what is the kind of the go-to there you know brandon that’s interesting when you when you kind of mention that we’d be talking about this today i thought about um when i was doing outpatient therapy um the the training i had received was that people were supposed to kind of challenge you know maybe go to detox but then back to outpatient fail that iop fail that php fail that then go to residential huh yeah i don’t i don’t know why i was trained in that fashion but that was the way i was trained that like the qualifications to send people the residential treatment was failed treatment episodes at lower levels of care maybe that comes out of my small reading of our small reading of the history of our industry kind of going back to the 70s when they came out with 30-day model i think i gave it this was part of my speeches once upon a time at a conference with something in like 19 when insurance benefits first came out in that regard the state of massachusetts basically was like the the the state that said this has to continue for at least 30 days so if you’re going to insure an individual within the state of massachusetts you have to provide 30 days of care as an insurance benefit plan so this would be blue cross cigna had would have to pay for these 30 day benefits and then out of that of course you get an extraordinary amount of abuses when you say you have to you know do 30 days in that regard and so insurance companies upon all those abuses went in the other direction to say you had to have these prior failures to get into the residential to avoid that 20 years later out comes the florida model of care and the abuses have take place on the other side of it we’re not going to bore the audience with that but i think this is where this is sort of coming from so if it’s the if it’s the path of least resistance you know why in your clinical experiences is it that case that it is the pat like by the way like the model that i just described like model but like you know client comes in and they’re trying to you know sit down with the price i’m sure some of these patients right you inevitably end up getting to work with and so why do why do you think it starts with this sort of like no i can just do it over here and just do some talk therapy one hour a week and and be fine and move forward from there i think um

often times uh you know talking about in the in the substance use world like people don’t necessarily know what’s best for them and their treatment there’s a lot of um lack of self-awareness or maybe even some lack of self-honesty that can occur and um and i think this is just kind of human nature to do the minimum like if somebody wants to lose 10 pounds maybe i can just you know not eat after 8 pm or something and that maybe should do it or whatever and and i think that that’s a con like i feel like it’s a common human thing to just like i’m just gonna try a little i don’t need i mean i’ve heard it so many times in that setting like i don’t need to go to rehab or anything it’s not like i still have a job i still have all these justifications of why i don’t need to go to rehab um but i just need some help cutting back a little bit um so i just think it’s it’s human nature is what it feels like to me what do you think yeah i mean i think it’s i don’t know if it’s human nature if it’s more cultural that i mean we are as americans just always looking for the easiest way to get the most uh and best outcome possible and i think um especially with something like rehab like treatment uh and like a residential treatment there’s so much stigma behind that there’s so much there’s a huge misunderstanding of what it actually is and what um or at least there’s a huge lack of knowledge about what treatment actually is once you get in there and what you do and what the purpose is so i think that there are just multiple factors and probably a lot of fear as well from clients because for that very reason because they don’t know what it is there is a lot of shame and associated with it a lack of insight perhaps as well but it’s so they’re i think they’re you’re kind of going up a pretty big monolith of things and issues that will always guide people towards well i’ll do the least amount possible and just hope that i get better so you know one run up the ladder here for you know coming out of private practices maybe the the next path of least resistance is an intensive outpatient model of care iop programming that we can meet uh three days per week five days per week uh the general curriculum for that from an hour standpoint is three clinical hours or more per day within a sort of a per diem rate we won’t get into all the logistics of it to and bore the viewers around the insurance side of things on that but basically three hours per day three to five days per week so anywhere from nine to fifteen hours of clinical contact uh time in that regard um we’re still kind of considering this as the the path of least resistance you know correct me if i’m wrong it feels like if you’re going to go from hey i recognize i was called out maybe by a family member or a loved one or a friend or somebody in my life that said hey maybe i think you have a problem to me it feels like to really engage in an iop model with um with any sort of promise of a sincere outcome would require the individual to already be dedicated to hey i heard this i recognize i have this problem and so now i’m invested in this and i’m doing this because you know i gotta work from nine to five you guys have iop services at six pm and i’m engaged in this and i’m gonna show up wholeheartedly each and every day feels like the right candidate for that move who has already bought in that i have a problem i don’t want this to collapse around me and i’m curious about how to find resolve moving forward yeah they’re past that like contemplation stage of change and they’re in that more preparation like recognizing like something’s got to change i just don’t know what and or how much yet but i know that i need more than just going to my therapist once a week yeah and and again you bring up a good point when you talk about work and family and all that i mean residential treatment is disruptive you know it disrupts all of that it’s it’s all day 24 hours a day and some people just can’t walk away from their lives like that but um i think that uh yeah that that would be sort of the ideal person is somebody who’s passed that sort of well maybe i have a problem maybe i don’t have a problem and they’ve kind of more committed to this like all right i’ve gotta i’ve gotta work something i’ve gotta figure something out or else this is just gonna get worse yeah because that iop level of care implies um that the person can kind of manage the other um 21 hours in the day right and and they have enough structure and enough support and enough other um things in their life that can help them remain sober because you know certainly if somebody does not have a job and doesn’t have much support doing iop is really challenging because they have a ton of other time throughout the day that needs to be filled and um and there that iop level of care is kind of it’s a risky level of care if you will because there is a lot of time and a lot of exposure to to whatever it was that was causing um the the drinking or drug use or whatever is going on um so i think uh that’s an important factor too like okay if you’re i mean nine to 15 hours a week you know for us who work full-time jobs like that would be a major commitment in our lives but there are people that um that drugs or alcohol are taking up the vast majority of their life and the removal of that um still leaves a gaping hole even at 15 hours a week yeah so i’m gonna we’re gonna we’re gonna we’re gonna do a delicate dance here we’re gonna call out some stuff in the industry at the same time we’re gonna put it back together and to make sense of it but i think you know one thing that’s clear from at least what we do is a stabilization model right we’re so equipped from a staffing standpoint certainly other treatment centers out there have you know equal opportunities from staffing standpoint to do things like this but you know we had a little little tiff in the detox area this morning right clients went after each other for whatever reason right and our company culture turned and gave attention to that while also turning and giving attention to the other clients and also turning given attention to the staff involved in support structures even if this was happening at 1am you know in the morning we would have had on-call you know provider come in on-call clinician you know on-call residential staff we can you know bring people in to nurture those uh intense situations as they take fold on the other side of this you get representation across the 14 000 addiction treatment centers in america of oh we do residential services too and we’ve talked about it on the show on several times but we just want to recapitulate with the viewers the florida model of care here and the way that that works and it gets the name from its uh induction in from the florida healthcare system and in this regard but the whole goal of it was really to create sort of a campus style feel right you can live on campus you can walk over to here do your job you can go to school over here and it’s this real tight-knit communal sort of setting in that regard but what our industry really did with that is place sober homes all around you know the city in that regard and then set up an iop program over here and then we put the person in this home and we call it residential because we staff it you know and to be clear with everybody peeks did this four or five years ago we know what this model of care looks like and what it means and out of that you end up getting putting you know pretty uh unqualified individuals into a really into an environment where you’re telling the family system we can support them in this residential model as if you’re a stabilization culture a real inpatient residential setting with all the staff around it but we’re really talking about an unlicensed professional kind of just being sort of parental within these environments to negotiate that and then in the mornings you get them up and you bus them over to the treatment center where you can actually build for services and so the thing that i want to call out on behalf of this industry that all family systems should be aware of and that our industry can as we did with our own immaturities as a company move away from it but to create an actual ambulatory setting as we’ve done with our intensive outpatient where people actually come in and aren’t driven in you know in that regard and i highlight that because what ends up taking place especially if we’re not collecting sober living fees over here is insurance companies only paying for this location for the iop services so if this isn’t being paid for we get into these ethical issues of fee splitting taking insurance premiums to pay for sober living infrastructure at the same time it’s being conveyed to the family system that this is a residential inpatient environment and it’s nothing of the sword and so with that as sort of a backdrop and an introduction and or reintroduction in this florida model of care you know we were talking about on finding peaks uh behind the care episode around how old peaks used to have sort of a narrative right that uh the patient’s just not ready they’re not willing or they’re unwilling they’re disruptive they’re you know you you end up exchanging in real time a narrative that’s not true for the patient to negotiate with family systems in that regard that it’s actually them not wanting to do the treatment when in fact you don’t have the support structure around the individual to actually negotiate with them and get them on the right track in that regard that’s kind of a long spiel there in that regard but i think it’s an important bullet point to this because iop services should be strictly ambulatory and that’s why we opened up the beginning of this with that whole concept of like the path of least resistance the florida model of care attempts to do that but it comes with all of these other sort of red flags alongside of it and misuses of treatment episodes and we’re just not being honest with family systems about what’s actually going on so family systems at home if you were able to stomach that long narrative i just gave you in that regard think about that when you’re calling treatment centers who say they’re residential in that regard and are they actually doing that because residential inpatient services should be and look much different than due to its reimbursement potential in intensive outpatient service and if you find something like that i’m not saying it’s bad treatment just be wary of what’s going on when you’re in those discussions and maybe highlight this episode with them to say are you doing you know the speed splitting stuff and whatever at the end of the day but um to the point of the behind the care episode it seems like when we’re in those model of cares we start delivering narratives to the family systems that aren’t necessarily true because the company itself as you spoke to last time lacks introspection doesn’t actually have the capacity through that introspection to actually do something different over here and so we law about these narratives um and i just wanted to just briefly talk it doesn’t have to be pointed at that model of care but just briefly talk about in the absence of larger company cultures how you get into these narrative conflicts um in that regard and maybe just recapitulate that a little bit well the thing that i thought of when you were saying all that brandon was um hey i just want to make sure we understand what ambulatory is because that that isn’t maybe a common term that is used maybe outside of these rooms but ambulatory just means like people have the capacity they transport usually themselves from their residence or wherever they’re staying to receive treatment and iop that we were talking about today is an ambulatory level of care meaning they don’t live in our program they don’t live in our houses like we don’t have that opportunity for people to do that and that is where that florida model of care taking advantage of people building you know saying that their residential level of care meanwhile these clients are staying in their houses and so i think that part is important to say and um and there’s a there’s a like the iop model of care is designed for that ambulatory level of care meaning people are at home experiencing their lives and they come to treatment to learn how to navigate those experiences um and and remain sober through that navigating their life um that’s that’s the point of it so there’s that iop is kind of this exposure level of care there’s this exposure uh to those to triggers and to to events that um could lead down that path so i i just wanted to clarify that from from your long bullet point yeah i like that you called it a bullet point at the end yes

yeah you know yeah i know yeah a lot of commas yeah i i think that you bring up a really important point jason that iop is the foundation of iop is psychosocial stressors right and being able to manage and navigate psychosocial stressors in real time in real life um and and and being able to stay either with the level of recovery or um sobriety or whatever you want to call it um that you’re looking for right and so you have but in order to do that you have to experience those psychosocial stressors so that you can deal with them hence the exposure piece and when you’re not and to some degree what you’re describing is like a ha it’s not really exposure at all it’s still contained and it’s and um there’s not a really a chance for that individual to actually experience how they’re going to relate to the world and how they’re and if they are actually adequately equipped to navigate the stressors that they face so that’s really what ilp is geared towards at the same time it also recognizes that hey maybe i don’t have all the tools i need and so in the fact that i’m going to be experiencing these indicates that i still need more support or at least a level of support that i can’t get with like an hour of therapy a week right psychosocial stressors didn’t want to do this but that we’re kind of inching into a sam criteria right you said we weren’t

to that point briefly diving into it right i think it’s an important element of this because it’s out of a sam criteria that we’re largely advocating for uh authorization length of state timelines inpatient iop services whatsoever and those psychosocial stressors are under so asam for those out there the american society of addiction medicine has these six dimensions that you look at when an individual comes into treatment those psychosocial stressors are dimensions four five and six and the other side of that are dimensions one two and three primarily dimension two is any biomedical issues that might be going on in biomedical could be intense craving states awful dreams um you know issues around medications those types of things right this is where the stabilization is so important dimension three being primarily mental health concerns criteria medication management around all those types of things and so asam in that regard has done a really good job at hey this is residential inpatient services over here and then the psychosocial stressors should be over here into the point of the path of least resistance uh if we don’t have any of these underlying significant difficulties this is suited also you’re fully engaged in it at that point the point of stabilization models to get dimensions one two and three under control and encourage the individual to see the value of pursuing these additional services if they’re ambivalent or treatment resistant right is that a good recap of asam you just described medical necessity right that’s what you’re establishing is and that’s really into your very first statement of like how do you like about identifying what is the right level of care right whether it’s stabilization or intensive outpatient or just outpatient or php level of care it’s all based on that right there are these criteria these very objective criteria that we can look at to help establish does this individual meet medical are they medical necessity for the level of care that we’re recommending and that’s a great for my left brain makes me feel so good inside because it does it just lays out an objective path that we can kind of lean into and obviously there are nuances within that but it’s what keeps uh it’s what keeps the client healthy what provides them with the right level of care and it keeps us on a clear ethical pathway right as as an agency and every other agency that follows it totally yeah one last stab at this florida model care thing right the florida model of care is taking individuals at times who have significant dimension one two and three criteria and stating after a short detox stint we can support that in really this dimensions four five and six culture and it is a major error and i’m just going to keep bringing it up because it’s the the model of care isn’t bad in and of itself it’s when somebody a family calls and says i have this desperate situation and you say that it can support this when it doesn’t actually have the utility principles the staff or any of that stuff to really do dimensions two and three positively speaking in that regard so we’re not anti-florida care model we’re just gonna call it out when it says that we’re doing the stabilization thing in that regard or when it goes even further and it’s violating all these ethical insurance principles along the way for family systems just to be aware of and the power is in the hands of the family in that regard to again ask these questions be thoughtful because admissions line promise a lot of things and these are things we’re not thinking about in these moments of desperation where we can actually take a breath and just say okay this is really important to my loved one they’re in some serious awful pain whether it’s a detox episode or otherwise do you do it this way or do you do it this way because i’m looking for this way in particular in that regard so education is important here jog through some asam medical criteria in that regard we can see now the kind of the separation to this uh coming in in turn and for me and my experience um you know at peaks we do our intensive outpatient with you know peer recovery coaches we’ve got people constantly communicating with individuals even post stabilization to nurture that sort of you know resistance that might take place in the process so we really come after it but correct me if i’m wrong even for the uh the energy we put into our intensive outpatient those who come into our intensive outpatient from another stabilization model or from our stabilization model into it have higher rates of getting through the whole program than those who just come from uh the community uh in that regard and um that feels you know kind of going back to the path of least resistance the problem with just taking this path of least resistance because we’ll choose the iop model similar to choosing the private practice and so i think our data is pretty clear and that’s why i brought it up in the beginning and just want to rehash that one more time if that’s your guys’s experience in looking at our iop model in particular yeah i think i mean i don’t have obviously the stats in front of me but i do think okay yeah this is clinton left brain stuff yeah but certainly um when people do have i mean i can’t believe we are talking about asam like this but when they have these other dimensions uh uh addressed and under control their medications are regulated their physical health is on track um that gives iop the opportunity to work on the other issues like a primary support system and getting relationships repaired or if there’s a financial burden or an occupational burden or even a housing burden those are the types of things uh that get to be addressed um in an iop program also to include mental health stuff like yeah uh that’s a that’s a time to to deal with some ptsd issues and also uh implement ongoing support for depression and that sort of thing as well so uh yeah that usually works best because the problem with the way i described earlier is that usually you know when when people are having you know very physical cravings that have not been addressed but they’re trying to address it at this lower level of care it can get really frustrating when people aren’t successful in getting sober um i’ve kind of colloquially said that like a callous begins to form like if if people have repeated failed attempts to get sober at these lower levels of care like it creates a callous over uh like this is hard and hard work and maybe i can’t do it and maybe i maybe it enhances shame and that sort of thing so in a lot of ways i i think it makes a lot more sense to kind of get way ahead of it and walk through the detox and residential levels of care to get that stabilization to then clear the deck for addressing the psychosocial stressors yeah and i think on the other side of that you can be successful coming in from the community absolutely and we have actually i think our program is pretty good about that we have um some really wonderful successes of community iop members it’s a matter of how many psychosocial stressors are you trying to manage when you walk in through the door and that’s so that’s something that we’re always going to assess for on the front end and at that point if we see like oh right every dimension that we’ve been talking about is just in shambles we’re probably going to recommend why don’t we do some stabilization you know because this i i understand that you you want to go this direction because it feels like it’s going to be because this other direction maybe feels too heavy it feel you’re it’s there’s too much fear there’s too much shame there’s you don’t have enough support whatever the case may be but chances are going this path going in the iop level at this point in time with all of these psychosocial stressors um so activated and kind of out of control chances of success are really limited you know so at the very least at that point even if the client still chooses to go the iop route at least we’ve started the dialogue like we’ve started that conversation of like look we um will go this route with you but know what our recommendation is and know that when we see that if this doesn’t get better we’re going to continue to to move you in this direction because what what everybody who goes through the eye the doors of iop wants is change right they all want to get better and at some point once we’ve established the rapport established the trust and given them uh and shown them what’s what’s possible within that level of care then they start to see all right maybe i actually i do need something greater i need something more yeah certainly we’re invested in outcomes at peaks and want to punch through this data but you know as joanna conti said on the vista research episode the conquer addiction that per her understanding of all the research outcomes and data sets out there there’s only 100 treatment centers now to be charitable to the industry of a hundred treatment centers some of them have three or four different locations maybe five you know ten locations so we’re talking potentially a thousand locations that are pursuing outcome data at any given time uh in that regard so but a hundred of 14 000 treatment centers pursuing outcome is kind of a small number uh in that regard but i share that caveat because at least right now one year since the last use you have a 50 chance of not relapsing in the process from last use to one year you reduce you go down 50 percent and your potential to relapse right at year two you get an 85 percent outcome per these historical studies in that regard and i the reason i bring that up is because you know we’re in this conversation i can imagine you know some of you are out there just hammering away at finding peaks at peaksrecovery.com of course you guys are going to promote the stabilization model in this regard and of course it’s going to lean back into that direction but i think we’re really trying to share a sincere experience that this can go on for decades if we don’t get this right and take it seriously and create a path forward and be thoughtful about it not only as an industry but as a family system and being honest with patient care about this is not the path of least resistance this whole thing is going to feel like resistance uh in that regard because uh it’s challenging to go through craving states it’s challenging to gain awareness about why we started using drugs and alcohol in the way that we did it’s a path forward so in my head i think you know this starts under the notion of like what’s the rush we really do need time to figure this out and it’s helpful to be in a nurturing sort of stabilization setting to really accommodate and get that right and then of course for the viewers out there you know test these admissions team make sure it’s the appropriate stabilization setting in that regard but moving forward here coming off a stabilization model into a three day a week iop or a five day week iop path of least resistance and we say three days to all of our patients at peaks everybody’s gonna pull the three day cord now we insert this five day week of thing and i and uh and i’m speaking to those out there like well of course you’d want to do five days over three days higher range you know you know insurance reimbursements and so forth but it’s not really about that for us um three days a week is just fine uh and but we’re trying to navigate with the five days right three days a week works for us when you have a job you have these outside things going on already and then the five days a week if you don’t have a job you don’t have community built all that sort of stuff we’re really trying to make up some of that lost time throughout a day and nurture that and get those components right through the peer recovery coaches uh am i off here or is this kind of the general direction when we’re being thoughtful about these things we’re putting people into the buckets according to their downtime in a world that needs them to get to at least one year to get them to a 50 reduction in relapse rate yeah i mean medical necessity right like if you don’t need it we’re not going to recommend it and but that’s what uh again that’s what these pro these programs are designed for iop5 is designed for those individuals who have again really uh really disrupted or chaotic psychosocial stressors you know like that is what the program is designed for into your but like you said if somebody doesn’t have that if the majority if they’re only dealing with like you know two or three things in their life that they still need to uh really focus on and really really ground in order to feel like they can move forward in their recovery then five days a week is is too much and eventually you actually get a diminishing return you know it actually it becomes frustrating it seems uh an event and they’ll just throw their hands up and not do anything at all so there you run a real risk actually if you put somebody in to your to use your words the wrong bucket coming out of a stabilization model yeah and i think i think he did a great job describing exactly what our program does it was actually pretty affirming to have you say all that because that’s exactly how we designed it like the the two extra days we offer people are literally targeting like housing and finances and and that sort of thing and to clinton’s point not everybody needs that like some people have an intact career in intact finances despite their behavior and they don’t need that stuff but a lot of people don’t too so and for all of those out there hammering away psychosocial stressors into google right now uh and listening to the cycles of stressors are you know financial uh situations that the individual is challenged by its living conditions that you know maybe they don’t have a home to go to post stabilization treatment or whatever the case might be they don’t have a job or they have shame around pursuing a job or other downward pressures they’re you know they just get out of treatment and they lost a loved one in their life and they’re you know grieving through that and that’s causing you know disruption and even maybe even pursuing you know going to look for an apartment that day those types of things uh correct yeah also like lack of community or um unstable relationships like lack of emotional psychological support yeah totally just things that compound upon each other yeah you know the life things that all of this all the adulting the adulting stuff yeah why why do we you know so strictly ambulatory speaking right why do we encourage individuals especially young adults to not go home to go into the community sober living all that sort of stuff we get a lot of family systems say no it seems stable come back home live in the basement what are we trying to avoid there i mean sometimes we do recommend that honestly so i don’t think we have a hard and fast rule about that or against that um but there are there are certainly uh sometimes there are just dynamics that are kind of so ingrained that that without interrupting those it’s hard for parents to get back into a parent lane rather than a probation officer addiction counselor or a doctor themselves like it sometimes it takes longer space than even in our stabilization model sometimes those relationships take longer to literally stabilize sometimes they don’t sometimes a lot of repair work can be done and there isn’t enough of those patterns like honestly those are case by case basis i would say absolutely yeah i mean you just in general we just don’t want somebody to go back into like a maladaptive environment right or an environment that was at um at least in part at the a motivating factor or at the heart of what what drove them to either um dealing with severe mental health issues or substance use you know we want to avoid sending people back into the lion’s den so to speak if if but again if there’s if it’s just kitty cats and not lions then we’re fine yeah yeah well and i asked the question and you know it’s going to be a sidebar maybe this episode but uh a positive tangent do not delete this chelsea behind the curtain uh positive uh some i’m talking family systems in it as a non-parent right address that on this episode multiple times but as a parent jason it feels like at some point right you kind of trade out this parentalism with like hey you’re in college and we’re buddies now and we’re going to have conversations i would like not to have as a parent but as your buddy we’ll have the conversation right and it seems like there’s this nice transition of yes mom dad son or daughter whatever the case might be where it becomes more friendly and less parental and the cautionary tale i think of when i think of sort of the frustrations experience when johnny gets back in the basement you know so to speak in that regard is that it’s really challenging to stay in friendship lane because somebody’s living with you you know maybe the expectation of a non-family member would be to pay rent to be looking for a job to be you know sort of taking care of yourself and i think it’s a challenge for family systems and my kind of view and experience of it to uh live in that friendship lane but at the same time having to reinforce sort of this parallelism under this tough situation of like boundaries now learn boundaries at peaks and these sort of things and it seems to at times kitkats or lions and alliance then for sure create a ton of tension but even in the family systems that are pretty healthy at times it feels like it can create some pains there and so i just wanted to you know highlight with family systems maybe how to be just thinking about that as their loved one returns home or as they consider an alternative path yeah i think you know for parent that parent child dynamic like um i usually i usually say you go from that parent role not necessarily to full friendship but more like friend but also like a consultant because there’s like there’s always going to be a power dynamic there’s always going to be a generational gap um and you can’t ignore kind of uh that aspect and sometimes it’s it it just it can be too difficult for families to step into a different role other than it’s by house and and my rules and and i don’t have any problem with that i just think to me the issue is just communicating that really clearly and i’ve we’ve certainly had parents and again i don’t begrudge them at all but they’re just like i can’t you know if if he if my son or daughter isn’t home by nine or ten o’clock at night i can’t i won’t be able to sleep i won’t be able to tolerate my stress and i’ll get you know acid reflux or whatever and in those cases it’s like well then maybe they just shouldn’t come home like if it’s that stressful and and you know your your child is in their 20s like it might be an unrealistic expectation it’s okay and and so uh maybe we just need to look in in this other direction again i just see it so much as a case by case and and every home is certainly different in that regard as well he does the family stuff yeah so yeah i think if any a lot of people miss the million dollar word it’s boundaries yeah it’s it’s before individual companies are always going to say boundaries yeah just like our leadership i literally was talking about boundaries didn’t just say the word but yeah okay he he’s a little too on the nose yeah he knows what he’s doing we’re just we’re joking it’s not my first rodeo boundaries are the thing before johnny comes home right yeah you’re negotiating these boundaries hey i have this tension about you being home past 9am i want to talk about it now because i don’t want it to be a problem then yes i can honor the 9am thing now we have already hashed out the conversation right because as we’ve talked about you don’t introduce boundaries in the moment you negotiate those prior to any given moment for that internal safety right that’s exactly right okay otherwise we defend our boundaries with anger rather than yeah our belgians become a means of control rather than a means of support all right all right boundaries i’ve been watching some of these uh for the audience out there throw some popcorn in your mouth as i go on a small tangent here i’ve been watching some of these episodes uh in the past and i do that abruptly like the last episode you said some brilliant stuff especially around the introspection stuff and right when you’re done i go yep

i mean you can’t be in the studio but i’m looking at like clocks and time things are counting down so in a way i feel like move faster you know in that regard and so i’m like yep even though if they’re after very powerful points i apologize i’m getting better but you’re doing great call it out in real time we’re all learning here yeah absolutely negotiating this in real time so are there is there anything that i’ve missed about intensive outpatient or things that we would like to highlight further or just educate families on in this regard because you know the real journey here has just been able to i think you know from the beginning talk about there is going to be resistance to treatment whatsoever and that the path of least resistance is generally going to be chosen an opportunity okay if this fails at this point to build boundaries up as a family system walk through it hey i understand you’re going to take iop as the journey here watch something that you know finding peaks episode and brandon said stabilization is important so if this doesn’t go well i want to have a boundary that you will commit to these you know higher levels of care okay yes i mean you know when it’s good it’s good and negotiate within those positive moments uh and then getting into the differences between real ambulatory levels of care and real residential levels of care medical necessity should dictate kind of the uh which you know bucket we land in here for my lack of good language in that those bucket moments and so and then we’ve briefly described what iop is in general how we look at five days a week three days a week different psychosocial stressors that determine that as an episode uh am i missing something yes okay the thing that that we do that i think uh is rad i think it’s so cool dang it uh as we had uh this episode i i just did that for the drones i know um but we we do offer this family component we have both educational and support family groups and then we’ve recently added a multi-family group to work on boundaries uh and and just healing relationships and frankly i don’t know of a lot of iops that are taking the family system as seriously as we are to be honest with you to to really dial in on that primary support system um uh as much as possible um and so that i think that part we can’t miss like we’re talking to families in a lot of ways in this episode but it is really important to say um we really i mean we clinton and and i talk a lot about that it’s not just the client that is our client if you will it’s the system comes into our program and that includes at the iop level of care and it’s part of our core values that you’ve laid out for us brandon and like we’ve really taken that seriously not just to apply it at a residential level of care but to carry it through to the iop level of care as well it’s a great plug yeah i love that it was brad yeah honestly that’s right i told you one of our core values is family obsession jason gave it away so we’re always thinking about how to engage the families in this and to the viewers out there listening i wholeheartedly believe that families can really get the the term boundary correct in their life you can be such a powerful force not in the parental is a mode of things but a powerful source as an advocate of an individual’s recovery journey that doesn’t in turn come at your own emotional and lack of safety expense probably could have came out a little bit better there but that was good uh yeah and i think that’s powerful and i think that’s a thing we’re trying to nurture in that regard unfortunately insurances don’t cover family systems and programming at the same time it’s this thing to be paid for on the side and um we’re not the only program out there in the world of course doing these types of things but it’s important to us to invest in the family systems in that regard uh even if there’s not you know a recruitment of fees on the other side of it because we believe that if you guys get these concepts correct you can be more powerful than even the agency work that we provide at times especially post treatment so

boundaries stick with it learn it do them and invest just as much time as your loved one is in treatment whether it’s through al-anon outside service you know third-party outside free services or just finding a counselor that you can negotiate these boundaries with as your loved one goes through treatment and stick with it for a year i think one of the challenging things for me is families who go well that’s not working for me it’s like now we sound just like the individual who’s struggling over here you know we have to have this mentality that we’re in it as well uh to be the best possible advocate for the individual because they need these supportive structures and we have to be able to communicate well so we don’t cause that dysregulation around every corner fair anything else another plug that’s it no no more plugs i think the only thing i want to say is if you’re out there and you think you need help and iop is all you’re willing to commit to commit to it you know start there like it’s it’s a place to start and it can at the very least give you a level of support that you don’t already have give you insight that you don’t already have skills that you don’t already have and give you an opportunity to sort of acclimate to what it means to be in treatment and maybe eliminate some of the fear and shame and stigma that might be creating barriers for you to get to a higher level of care that may be more appropriate some you know support and treatment some support and treatment is better than no support and treatment if you’re struggling so no matter what don’t feel like there don’t ever let that become a barrier to getting help like not knowing uh if if iop is going to be enough or thinking that you have to go to residential treatment like don’t don’t hold yourself up like that it’s um come in get the help and then move forward from there um and make sure that you’re you’re going to a place that is willing to meet you where you are in that moment because that’ll be a pretty good indicator of the kind of the level of care that you’re going to get as far as quality is concerned yeah and that’s completely fair and in adding to that right private practice doesn’t hurt to say i don’t have a problem and you show up in the private practice and at least have one good conversation about it also doesn’t hurt there are free support systems you know if it’s mental health it’s through the nami lens but certainly aa ca um all of these anonymous communities in that regard are frontline potential intervention opportunities for you to at least you know sit in a room and see others experiences and see if you can relate to those well enough to you know get well on your own journey in that path in that regard so i really do appreciate you stating that glenn because help of any sort is better than no help whatsoever so good thank you i like that yeah fine yeah yeah yeah all right with that everybody uh thank you so much for joining us here for this episode of finding peaks to talk about intensive outpatient programming some of the variations of it uh and how it is this ambulatory program opposite of residential settings uh out there hopefully this was educational and for informal for all the uh family systems out there thinking about how to explore treatment opportunities uh finding peaks at peaksrecovery.com send us your ideas thoughts concerns questions bring it all to us we’d love to talk about it on this episode of course the the twitters the facebooks the tick tocks chris burns heart days chase them on the trails find them there lots of energy lots of love for people in recovery and i’m sure i missed something like an instagram spotify that’s a lot of teen stuff but and whatever uh jason has a spotify app i guess that makes all the apps yeah yeah anyways we’re out of here folks until next time love y’all