Episode 105
Reading and Understanding Outcome Data

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Description

In this episode, Brandon Burns brings on Jason Friesema as well as Lauren Atencio to open a deep conversation into the very important topic, outcome data. Our team transparently shares outcome data relevant to Peaks and the industry and takes the time to debate how these outcomes should be influencing our decisions within treatment and beyond.

Talking Points

1. Introduction to outcome data
   
2. How the data influences treatment
   
3. Common misunderstandings of outcomes data
   
4. Understanding successful outcomes
   
5. Personal responsibility
   
6. How to measure success
   
7. Final thoughts
   

Quotes

“We are habitual creatures, right? I always tell this to the clients if I have a pattern of behavior that I have been practicing for over 20 years. I go to treatment for 30 days, and then I’m like, ‘I’m good after that; how am I expecting to change a pattern of behavior that I have been practicing for that long, over a course of 30 days? It goes to this place of thinking patterns if I have a way that I think and I stay in my shame. I ruminate, and then I go to treatment, I’m like, ‘Okay, this is starting to get better, and then I move out of treatment, I move out of care completely, and I start going back to my life— again, habitual creature— I’m going to fall back into those thinking patterns.”

– Lauren Atencio, Clinical Director.

Episode Transcripts

Episode -105- Transcripts

my name is Brandon Burns and I’m the chief executive officer at Peaks recovery centers and the host today for finding Peaks and today we are here to talk about outcomes specifically we will be highlighting Peaks recovery Center’s third party analysis of our treatment-wide outcomes both within and Beyond the walls of Peaks recovery centers for those of you not familiar with third-party outcome data collection we spoke with president and founder Joanna Conti of Vista research and Conquer Addiction on episode 28 and I invite you to watch that episode of you have not already seen it to better understand how these third-party relationships work and the importance of them within treatment cultures most important to our discussion today is not just the data being presented but the challenges ahead of us for producing and replicating replicating external strategies for wellness Marcus Aurelius once wrote to himself and among the things you turn to these two that things have no hold on the soul they stand there unmoving outside of it disturbance comes only from within from our own perceptions and two that everything you see will soon alter and cease to exist think of how many changes you’ve already seen the world is nothing but change our life is only perception the takeaway here is that the external world is constantly in flux change is happening all around us for example the loss of a loved one a pet a career your car your possessions even your safety nothing external is guaranteed to us our internal peace is fragmented only when our perception of the external seeps into our soul our divine Consciousness or however you wish to see the internal as much as peak’s recovery Center’s desires to create the Magic Bullet for wellness we too are in conflict with the external world we need more resources to hire more staff to treat not just more people but to treat them with quality and compassion insurance companies on the other hand see the world through low-cost and high volume as such our externalization of strategies in the absence of the Silver Bullet are hopeful sometimes at best but our internal desire to preserve quality and compassion has remained unchanged our challenges cannot stand in front of the commitment the external May frustrate us but it cannot deter us from the mission of saving lives contemporaneous to this we further look to explore what it means for each individual however they are suffering in the world to take this opportunity to reflect on where he or she’s power truly lies across all conversations of Wellness Faith philosophy and so forth it feels clear that where any one person’s control lies is within oneself to reach out to treatment program like Peaks is One external strategy that will support your internal Wellness through its medical and clinical culture but we cannot walk with you beyond its walls for example to achieve Wellness from depression anxiety trauma substance abuse requires a deep dive into the arena of discomfort and acceptance that treatment is just the beginning a Trailhead if you will the path forward will not be linear but the path is yours to walk it further requires both motivation and discipline to take one step at a time toward internal healing and today we discuss how to balance the responsibilities between the treatment world and the individual’s responsibility toward the path of Wellness
and I’m joined today by our chief clinical Officer Jason friezma LPC Lac all the clinical things and our Clinical Director for our men’s campus Lauren atencio Lac lpcc nearly all the clinical things as We’ve joked about in the past to discuss this in very important topic so let’s take this opportunity to get to know each other to balance these responsibilities and let’s dive right into it well here we are again both of you already introduced already did the intro yeah we were here you guys were a great supportive job for that yeah you did great really liked what you said about that yeah I’m really looking forward to your feedback on the other side okay yeah a hindsight view of the introduction absolutely so here we are today bringing outcomes daringly we’re gonna dare greatly today okay wow and bring forward Peaks recovery Center’s outcomes out into the fold and walk through it and per the introduction the thing where you know that I’m curious about balancing today right are you know we’re going to Showcase positive outcomes we’re going to Showcase outcomes that could be perceived as pour out comes at the end of the day but you know really at the end of the day there are extraordinary external pressures on the resources of Peaks recovery centers we work in a Managed Care System right we are responsible to the payers right and you know what does that mean for example right like well you have an individual session and now you got to spend 30 to 45 minutes documenting that session right and creating the paper trail to showcase that we did the thing right with the insurance company so that they pay us at the end of the day also we have to on a weekly basis if not every few days come up with utilization reviews and showcase these Services need to continue to be authorized so we can achieve the best value proposition for the patient in front of us right but one of those challenges that exists is no matter what the medical necessity looks like we seem to bump up against a reality out there that is we are no longer going to provide or allow services to be rendered at this place the patient needs to be in lease restrictive care possible even if we know the least restrictive care possible is a relapse a poor outcome just waiting on the other side of it at the end of the day and I think charitably the insurance companies as well too you know Lauren we were talking before the episode sometimes we’re looking at a person in front of us and we know they’re not invested in this right and they’re not committed to the project and those sort of things and we’ll get more into that later but I think balancing the external strategies against the resources we need not just to provide more care to more people but to provide quality and compassion and care to the individual and in addition to that in a world of our own limited resources and ability to nurture the individual down the path beyond the walls of Peaks recovery center is right we do have this thing of personal responsibility that we’ve also talked about on this show and how much motivation and discipline is required at the individual level to really get into something called recovery and into Wellness at the end of the day and I think not just as for our patient demographic but I think we as a staff live that ourselves whether you know we’re at the CrossFit gym getting told things by the trainer or you know meet out on the trails running around and that sort of thing um I think it exists within all of us to highlight that you know you know at the end of the day we all kind of suffer but we are all individually motivated as well too and so I bring that into the fold even though I briefly spoke about it in the introduction because that’s what we’re trying to balance and navigate right here the introspection and responsibility of a treatment center at the same time the introspection and responsibility of the individual participating in treatment and how do we move forward toward outcomes in a world where there is no Silver Bullet I know Lauren at the end of the day if you could take a good old Hammer crack him on the head and fix it we would have done that already right as a reality and our lack of ability to do that also shouldn’t take away from like the compassion and the approach each and every day as well too because we are committed professionals right at the end of the day we don’t necessarily have to do agency work we could be in private practice we could be doing a variety of different things but for some reason we stay and we continue the mission forward to save lives so I don’t uh I can dive right into the data but um you guys want to color in anything in there feeling something burning inside that you want to tell the viewers right off the bat yeah I mean I think I think data is interesting and I know we’re going to go over kind of our Vista surveys and I know you’ve had Joanna Conti uh on this podcast um I think a couple times and I I just um I find our data to be really helpful and um I interact with like our surveys all the time actually probably to a fault um but it does because it speaks to something um it gives tangible explanations for things that can seem intangible you know what I mean and and I think kind of as a whole we are looking to address people’s underlying trauma and underlying shame and underlying lack of purpose um and then it’s hard to squeeze that into motivational interviewing and CBT and solution focused therapy and so to have some sort of measure to say hey these these aspects are on track and then these aspects maybe are off track I think um I find it to be invigorating
like you said Jason something tangible also gives you know our staff the ability to even see like oh this is why I’m doing this this is where this is what we’re fighting for because it can be when we look at depression when we look at substance use it it can be a pretty daunting thing to look at clinically you know are they going to get better are we helping are they helping themselves and so just looking at as a whole what outcomes look like to be able to validate Us in some kind of way because therapy is not as validating we don’t know all the time that people are growing and then we also know that they’re really growing and so I really like to be able or it’s really cool to be able to see just what our clients are doing and and how the outcomes look beautiful let’s dive into it so of course on our episodes um you know somewhere between like uh being charitable and straight up trashing it when we think about monotherapeutic approaches to care just ssris alone to treat major depressive disorder right or using cognitive behavioral therapy alone to treat major depressive disorder uh it’s if I’m recalling the history with like Dr elardi episodes it’s something like 85 of all people experiencing major depression in America are treated with the ssris or snris alone and something like only five to ten percent more of the population is being treated with a you know a talk therapy approach like cognitive behavioral therapy alongside ssris so I think it’s important to note that you know just to recapitulate those points that we are not attacking um that ssris for example cannot be efficacious or even life-saving what we are highlighting is that ssris as a monotherapeutic intervention are incapable of resolving a complex heterogeneous condition the disorder major depression is complex and requiring many different approaches and thus the extraordinary reduction in depressive symptoms showcased in our outcomes here at Peaks there are sort of a poly therapeutic approach that we’ll get into um most so the University College of London released just to recapitulate these past points their meta-analysis in July of 2022 that challenged The Narrative that depression has anything to do with serotonin neurotransmitters uh if this were the case depression would be cure and I think and we know most professionals would acknowledge these findings but the issue comes about when the general public believes the issue is resolvable in the way um and the way in which seems to be showcased through ssris so to quote the University College London study they say the general public widely believes that depression has been convincingly demonstrated to be the result of Serotonin or other chemical abnormalities and this belief shapes how people understand their moods leading to a pessimistic outlook on the outcome of depression and negative expectancies about the possibility of self-regulation of mood and before diving into it I just want to talk about the cognitive behavioral therapy approach where generally speaking you need about 12 weeks to administer it some now there’s this like intense cognitive behavioral therapy we won’t go into it but per the studies you generally need 12 weeks of talk therapy at least once per week over that period to start resolving what are the mood issues right and starting in giving the individual access to self-regulation the fundamental assumption is that a thought precedes a mood therefore learning to substitute healthy thoughts for negative thoughts will improve a person’s move mood self-concept behavior and physical state so I think all of this research is out there and available to the public at any given time uh where you can roll through the monotherapeutic values 15 to 30 efficacy of ssris held alone never mind all of the consequences of taking those medications right major depression take a surprise the symptomology of that can be increased anxiety okay maybe you insert snris or whatever to help navigate that but we’re just pushing the monotherapeutic value back and forth and as we’ll showcase within our own data sets here these medications clearly do not uh at least greatly support individuals in long-term treatment outcomes at the end of the day and that’s visible within the data sets the meds alone are not going to get them through this historically speaking and so at Peaks never mind all the insurance stuff and noise we’ve really tried to come up with this monotherapeutic or excuse me poly therapeutic approach of yes medications but they take four to six weeks to achieve efficacy if they achieve efficacy at all what are we doing in the meantime we have talk therapy we’re going to do the cognitive behavioral therapy thing right we’ve inserted a movement team because we’re trying to promote not exercise in the have to go the jam bench press through all the tough things right but to just move and to walk around and to get some sunshine on your face and these types of things that Dr alardi has brought in that he even said it sounds like Grandma could have given us this advice to you know kind of get well at the end of the day and I think that you know as well too and we can get into it from like a future outcomes perspective when we think about you know our our phones and TV screens and that sort of thing right how much of that is impacting the individual and so how relevant is it really to remove those devices from the individual because it’s a part of the process of suffering right and coming at it we seem to at least within a 30 to 45 day modality and also our extended IOP program seemed to arrive at some pretty impressive results before the individual walks out the door and goes on their Journey off on their own with the toolkit in hand right and we’ll talk about the impressive data out that going out the door and then sort of this sharp follow-up that seems to take place on the other side where we’ll hopefully try to navigate this kind of personal responsibility thing but the progress during treatment so 71 of all clients who come into Peaks recovery centers in these surveys this data set is over a three-year period from I believe 2020 to the present if not the whole historical 2018 to the present period but 71 percent of clients reported experiencing depressive symptoms at their intake survey and of clients who took the survey again prior to discharge only 13 were reporting symptomology so from day one to the last day of Peaks recovery centers per the surveys there’s an 82 percent reduction in symptomology and against the backdrop of monotherapeutic values that’s a major victory same is true for clients in progress with anxiety systems and so to be clear for the viewers out there the surveys are the phq-9 for the depression the Gad 7 for or gad7 for anxiety 69 report uh symptoms of anxiety at the intake server survey prior to discharge 16 it’s a 77 percent reduction in anxiety symptoms trauma responses the pcl6 is the survey taken at the time of admission 68 percent report uh symptoms of trauma symptoms and prior to discharge that drops to 20 for a 71 percent reduction and then client progress on overall feelings uh between terrible and poor 71 percent report feeling terrible or poor at the time of admission and it goes down to three percent prior to discharge or a 96 reduction in symptomology for those individuals foreign criminal justice offenses 21 at intake 12 months post-treatment dropped to one percent a 95 reduction from engaging in the criminal uh justice system and satisfaction with treatment overall uh 75 very satisfied 20 satisfied 95 percent of Peaks clients are either very satisfied or satisfied with the treatment outcome and one percent or less than one percent very unsatisfied so against the backdrop of the monotherapeutic of values monotherapeutic approaches in and of themselves we seem to really be kicking those monotherapeutic you know uh outcomes in the ass right here at Peaks recovery centers and before we kind of dive into the post-treatment outcomes what are the what are the kids doing after treatment um we get to see something really beautiful we get to see people kind of in the best state of their life right we get to see this real healing we get to see pink clouds we get to see all the things along the way and differently than those monotherapeutic values you know from the clinical position are we just throwing things at a wall and these are the victories would this have happened in any other approach or you know Jason and both of you have been here long enough to know the difference between kind of old cheat sheet you know Peaks approach lack of a curriculum these types of things into a curriculum and into a staff that can really wrap around all the individuals at any given time um even if that’s not the common experience at all times it is our value system what are we seeing against the backdrop of monotherapeutic values within treatment culture that you guys believe is really driving these outcomes positively speaking for the time that they spend with us so what’s our magic sauce basically or how are we doing this because it’s not a silver bullet right the numbers aren’t zero at the end of the day right and we put a lot of energy into it and it also you know if a medication takes four to six weeks you know some individuals are leaving at 30 days but we’re pause you know reporting positively their depressive symptoms are down at day 30. so it seems like these other interventions you toss at it can really nurture alongside the medication efficacy if there is any uh the nurturing of symptomology so you know what is the operational thing that is working I mean if I were to summarize it I would say our goal at Peaks is to get to the root cause of what is driving um whatever is bringing somebody in uh to our treatment center and and you listed kind of the the phq-9 um and the other you know the gads uh and these other things this isn’t like people are coming here and getting like a camp high and just like you’re like hey I was out of my life for a week and uh we went canoeing and it was just a lot of fun and that felt great um like people like we’re treating suffering like people walking into Peaks are in the middle of suffering like if if your scoring is depressed on the phq nine like you’re depressed like things are not going well and um so focusing on the root causes of that uh but utilizing relationships utilizing um you know what Rogers called unconditional positive regard but really trying to connect um well with people and um meeting them where they are and and that that’s a cliche in a way but like if that’s at the Forefront of our mind if we really are like hey you’re you’re human we’re human too um and we can kind of meet you in this space I think that that to me so we use you know we use evidence-based practices for sure uh we put our own Flair on them to be certain but it is it’s it’s the culture and it’s the um it’s the really uh it’s using our relationships with our clients and using our relationships with one another to actually get to what is truly going on for somebody underneath um the symptomology or their um their coping mechanisms or brilliant strategies for overcoming uh their underlying issues yeah what do you say Lauren no I think to add to that um I’m going to piggyback off that um is this idea of like one of our core values is that one team one shift mentality right I know that when I walk in the door that I am going to sit down with our you know medical director Chris and I’m going to talk to the residential team and I admissions is always going to be in our rounds every day the meeting we have every single day like it’s consistent and constant communication about the client it I think it is um no offense if anyone takes fence of this but I think it’s an ignorant way to of thinking that one size fits all it’s every single client that walks into our door is different every single human being is different we have to be able to look at it in that lens we can’t just say hey CBT let’s go for all right because you know one of our clients over here might have distorted thinking patterns but then the other one over here might have a really good grip on their thinking patterns and just can’t really handle the trauma that they’re kind of holding in their body and so it’s it’s about kind of a multi-dimensional approach of what do you think medical what do you think clinical what do you think admissions residential um even you know all of our safety team and everything like that we work together as a team and being able to say oh wow this client who struggles with depression is so much different than this client that struggles with depression this client that uses is so much different than this client that uses so we have to separate them we have to it’s not fair to them if we put them in the same kind of box I guess it’s about learning about our clients getting to the root cause understanding their struggle in a way that I can now connect and understand you more and we’re not even you know I go into a session with our substance use primary clients we might not even mention substances the whole time because let’s talk about the person and the behaviors that go along with the person so I think it’s just a one team one shift thing yeah beautiful high level let’s dive in a little further if we’re if we’re you know we were talking about for the episode and a little bit in the introduction as well too sometimes it just feels like we’re looking at somebody who is not committed maybe probation forced them into treatment maybe the family system upheld boundaries and uh you know the pathology there is like you know treatment or no support and so individuals you know begrudgingly join you know the treatment protocols and they will go through it they’ll mark on the calendar about it here in 45 days and that sort of thing and the outcome will be sort of abysmal I think from a treatment center standpoint you know even though we know that’s going on right I think there’s always hope that something will latch on even if like recovery is not on the other side of the door maybe it’s like I know I can reach out for help now and maybe even like I’m not gonna bother my family I know what I’m about to do on the other side of this but I can separate that and maybe there’s some healing within that but you know within a treatment episode I think for the viewers out there you know maybe highlight a little bit about what it what it’s like to kind of feel like you have a success story and kind of right in front of you clinically and what it’s like to be like dang it how do I just get this person to know there’s help out there and to make the right choice when maybe they hit rock bottom to use old language yeah you know Brandon that’s a great point because um outcomes are tricky right it can be really easy to be very binary about outcomes um do do I expect that everybody coming into Peaks uh for depression will never feel depressed again like that seems really unrealistic to be honest with you and and I don’t think at any point do we set that expectation out there and you know for some even if they are um strongly encouraged by external forces to be at Peaks nobody’s at a zero percent motivated I would say like so I I think if we can get somebody from 10 wanting willing to change their life or to 20 realizing they have a problem like that feels like progress but but going back to to like I think setting the expectation like helping people build a path if they fall into depression and get her into an addiction again that they can um find their path back out or realize that there is a a path out that that is invaluable and I and um I was talking to one of our clinicians this week about you know a client that likely is going to re-enter a challenging family situations upon discharge and like how are they gonna accomplish their goals and this just isn’t a great setting but there just isn’t really any driver motivation to change that um I’m like we we are planting a ton of seeds in this person and and they are getting better and if if the progress that they make while in our care leads them to make a different decision even if it’s two years from now that still feels like a great outcome even if it doesn’t show up on a on a 12-month outcome study well and we’ve talked about that that’s telling you this a little bit before the episode is that we have to look at what successes or outcomes are if you go into um any industry in this industry and you say oh in order to be successful in this industry I need to have all clients and they’ll never relapse that is an unrealistic expectation to set and now you’re setting that on the client now you are putting forth your kind of expectations of them saying you can’t ever relapse right because then this wouldn’t be a success and the reality of this is is that every single client that comes through is going to relapse in some kind of way right maybe they don’t go back to substances but their behaviors are going to relapse and um it’s about how are they relapsing differently how are you you know you you still picked up that drink but you called us every single day asking for help about it that’s a different relapse because what you usually do is you drink and you run away and you don’t talk to anybody so you’re relapsing differently now right and so also going into this place of you know if the client is not motivated being able to say like okay I’m still going to show up for you if you don’t want to do any work today we’re going to sit here and stare at each other for an hour we’ve had a client in the past say I’m just not talking to you guys they don’t trust therapists well we’re just gonna sit here for an hour just so you know that at least I’m here at least someone’s not giving up on you and it’s those little subliminal messages that we give that I think are really a part of this outcome because it’s not hey you need to get sober or else it’s hey let’s try to get sober and what does that look like and how can we help you and if you don’t get sober then like how do we help you then and there is a little bit of part part of this and we we’ve talked about this on another episode where there has to be some motivation within the client the client has to put forth some kind of motivation or there will be some kind of relapse or a curse and there is that part where where is personal responsibility come in right where do I go to a 45-day treatment and say hey I’m going to take some of these things with me or I’m going to leave them there it’s up to you again going into a place of if you are lying to me about what’s coming up for you it doesn’t it only hurts you so let’s try to figure out a way to to make this a little bit more comfortable we don’t have to talk about your trauma all day if you don’t want to talk about your trauma all day but we let’s try to get something out of this session in some kind of way yeah and I I think there’s a there’s an important caveat to the motivation part of the conversation that it also requires discipline right like I went I went running yesterday good old eight miles ratcheted up trying to do my Boston Marathon thing qualified for all of that but my motivation yesterday was pretty low right but the discipline was like tie your shoes get in the damn car go down to the trail and just start running it doesn’t have to be a hundred miles an hour all the thing you know it doesn’t have to be fast it just just start just get out there right and over time I think that inserting that discipline is also going to be supportive of motivating behaviors also we’ll get back into that I just wanted to highlight that so we have a a check box to come back to in that regard when we come down to having conversations about individual responsibility as well too in the process but so viewers out there they’re listening they’re watching this thinking okay Lauren’s now just sitting patiently quiet in front of a you know a client now for an hour maybe something was said maybe nothing was shared maybe it’s just you know shooting the [ __ ] or whatever to help inspire a rapport that inevitably leads an individual to start talking about the things that gets to the root causes so we can move forward right but the American Health Care system is wildly expensive and you don’t need you don’t need me here at Peaks to tell you that family system is the amount of American Health Care debt all the charts all those things right and it can cost anywhere from ten to a hundred thousand dollars to go to a treatment episode for 30 to 45 days you know in that regard and for a lot of people out there a relapse that immediately happens on the other side of the of the fence for something that’s so costly never mind insurance policies and ever increasing deductible not-of-pocket costs for the viewers out there against the backdrop of ever increasing profitability of the insurance companies uh out there um it’s really expensive and I think out of that not just the desperation and hope for their loved one to get well but the lack of resources to continue to do this over and over and over again and what would we what can we say from your guys’s lens to the family systems out there so desperate and lacking resources hearing something like my loved one’s not motivated on why am I paying for this you know at the end of the day and I don’t think there’s a simple answer to that I think it’s complex but we should talk about the challenges of an industry right because at Peaks recovery centers you know we’ve got 36 beds at least for right now and we’ve got about a nearly 100 staff members to wrap around those you know one to three ratio in one way shape or form and the cost of that in an inflated market cost of living all of these types of things at the end of the day we talk about it with our staff I can’t afford a home I want I got a master’s degree I got 90 000 in debt right staff and people as employees go through their own suffering in the world and have their own requirements and at the same time a company trying to displace its profitability to support that right there’s all this tension that exists right but on the other side of that family interest systems aren’t interested in how a business is operating all those types of things so what can we do to support families better do you think from an outcomes perspective in a world World in which it’s at times very difficult to motivate the individual and at the same time resources are possibly limited for the family system desperate for an outcome on the other side I mean that Brandon that is a tricky question don’t mess it up yeah this is live nail it there’s one answer um
it’s it’s almost an impossible question answer if you ask me like other than you know sitting here um as a parent and I I’ve alluded to it a little bit like you know I I have a son who had a significant health issue when he was you know 10 years old and um you know we had to find the right hospital and the right doctors to to do a surgery and that happened to be in Nashville at Vanderbilt Hospital actually um today’s the anniversary of that and um and uh and even when we got there like we knew it was kind of a coin flip like whether or not he was it was going to be successful and if it wasn’t successful the results were going to be catastrophic and we put a lot of resources a lot of resources a lot of time a lot of like I had a practice that I just kind of walk away from for a while and um and there wasn’t a guarantee and there isn’t even even if the health care issue isn’t a mental health thing there aren’t guarantees with all this stuff but um I could just say from my parents Hearts which isn’t why you had me on here but like it was it was worth the risk for obvious reasons and and fortunately we had a good outcome um otherwise I’d probably be able to talk kind of casually about it but like um you know it was a it was a calculus a little bit um and and I didn’t you know what I didn’t have my story is different because like it’s not like my son wasn’t motivated to get better he just was too young to understand that in a lot of ways um but there aren’t guarantees uh a lot of times in in to your point Brandon like you know getting treatment for substance use or a mental health issue is um it is not cheap and there is there can be a motivational Factor at play here but I can also say uh I have worked for a pharmaceutical company as well and we had a whole education program about encouraging people to take their diabetes medication because that felt like it had a stigma too where people would start to feel better and so they’d stop taking their insulin it’s like that isn’t a sign that you’re getting better that’s a sign that it’s working and like there’s a ton of Education that went into that and people um you know if you know somebody with diabetes like that sometimes happens where people lose motivation to treat it and so this isn’t it isn’t uncommon for people to have uh strose with motivations at times and I do think as as skilled clinicians that we have at Peaks and hopefully at a lot of other places like helping to enhance motivation um is a big part of our training and a big part of of what we walk through and that but that can be a journey and it can be a risk I would say yeah I mean that’s a hard question Brandon I yeah on the spot yeah yeah resource wise it becomes tricky I think if we look at motivation wise we look at I’m paying fifty thousand dollars I’ve heard so many people say this is your last one there’s not another one after this I can’t afford it and um I think you know Clinton Nicholson as everyone knows um he has this kind of like saying he’s told us in the clinical team is that you know we are guides not Gods I think we get into a place within the field where people are like why aren’t you fixing my child why aren’t you fixing my husband why aren’t you why can’t you just fix them and it there’s this part of it that it’s like I don’t have the power to fix anybody I have the ability to walk with someone through a really hard time help them understand themselves and be able to look and say oh here are my issues and this is how I work on that whether they take that and work on it is essentially up to them first of all and I think second of all there’s there’s a part of this that we cannot force clients to do anything we they have to have some kind of autonomy because 30 to 45 days is a very short amount of time and it’s really unfortunate that insurance companies um don’t allow access to it more and that’s a whole nother thing right but we have to understand that within that time span we’re doing the best we can in order to allow clients to understand themselves and and find motivation find themselves and you know we can look at motivation in two ways too or we have the depressive clients who literally just can’t motivate themselves or is it the you know clients who are just like this is crap I don’t care about any of this um but at the end of the day again going into that personal responsibility is we are the biggest motivators at Peaks I think that our clients get incredibly annoyed with us at times because of how much we talk to them and how much we check in and all of those things and then and at the end of the day we do the best we can and we meet the client where they’re at and we understand that behaviors are a big part of this process we treat those behaviors we tend to those behaviors and we see them um in the best way we we absolutely can and it is unfortunate that more resources aren’t available because 30 to 45 days this is the long game like we are you will do this forever if you struggle with mental health issues with substance use that is what you’re going to be working with forever so how do you maintain that and how do you continue Continuing Care um I think just to highlight this too a thought I had was I think that’s why our family services so valuable because it is really that outlet to say like we hear you we hear your frustration we hear your fear because family they run off fear of course they do and a lot of the time like that fear comes out in a way of like why aren’t you helping and we are and there’s only so much we can do um so I think Family Services continuing care whatever we can do to make sure the client is seen or hurt you know I I know that our case manager supervisor Rachel Jenkins she still gets phone calls six months later of clients saying hey can you find me this treatment center to go to we are going to help you as much as we can but again our hands are tied a lot of the time with insurance and money and all of those things we don’t really have a lot of power over that yeah and and I appreciate you both feeling the question in real time certainly you know from my position like I just believe in transparency and I believe in the challenges if we’re going to continue to move forward in any sort of sense of progress within an industry that is fraught with challenges and certainly fraught with fragmentation if we aren’t going to have honest discussions about its reality and its condition um I don’t know how we’re going to get to anything like a silver bullet at you know some point and to that I think you know the reason also for asking the question is family system finds a website right all websites are going to have a pitch of like hope we can do this we can treat these depression we can treat the substance use disorder we can do that we do a lot of that we can do the math and all these types of things and so in a market in an industry that sells itself in that way I think it creates a level of hope that we know from outcome data isn’t necessarily true on the other side of the boat um I believe in what our website says I believe in what our admissions team tells individuals on the other side because they aren’t given a sheet that says hey you have to say these top five bullet points to bring somebody in because we know statistically 95 of the time it’ll work if you just tell them these things right our admissions team is empowered to State what we do and to reflect on that positively and so I think being honest and open you know for me hopefully not just creates Grace for uh you know providers and clinicians such as yourselves but an open-mindedness to really investigating a treatment program and what it means to be a part of it at the end of the day and so I’m thinking about a treatment center somewhere up north around here and they have ads out there right now that says it starts with keep your cell phone and your iPad come to treatment today right we live in a in a world where we’ve talked about on this episode multiple times now the conflict and the sickness that is derived from uh the the tools of social media and our phones that mess with our dopaminergic structures right and so we know more than ever it’s not just taking a cell phone away like the old kind of way of Peaks where we’re going to take your phone because you know you need to have some gratitude you got to pay for this and do all that sort of thing we’ve really shifted into a world of like this actually is a problem and we need to have a conversation about it therapeutically we got to talk about and approach it because it’s continuing to keep you stuck in your bed in a depressive State it’s keeping you close to your dealer at the end of the day from a substance abuse place what is the relationship between this device and the pornography that you’re watching how does that disrupting your relationship when it’s always accessible like that but we live in a market of opportunities for which the individual thinks I need my phone and there’s also this relationship also which Clinton was here because I know he has insights into this but of like the phone is very much a part of the world so why would we take that away but at the same time it’s creating so much conflict in the individual’s life and to me to Market to the individual to get them into a program feels financially driven and family systems should be aware of that because I don’t think we’re approaching that as an industry if that becomes the Peaks Recovery Center ad at the end of the day I think we’re about getting people into care versus about actually getting them into care so we can treat the condition yeah right it sounds like you know come to our weight loss program and eat all the pizza and cheeseburgers you want like that’s what I hear when you say that like yeah you’ll get a lot of people for that it sounds appealing um but it is like that’s a little bit um short-sighted I would say because you you don’t know what somebody’s walking in with whether it’s a pornography addiction or they may their drug dealer may live two blocks away you don’t know like that feels absurd um and risky and and of course it appeals to somebody to be like cool I can keep my phone I don’t have to disrupt my life at all to come to this program um and you know like this is a thing like we certainly allow people reasonable uh access to the outside world and as well we should but um unfettered access to that stuff just feels like if nothing changes nothing changes to quote a but I think the other part of that that kind of bleeds into this conversation is the instant gratification crisis that we all struggle with is well my child my spouse whatever it is they didn’t get better at your place they left a week ago so maybe we have to give them time to get better maybe we have they were in a bubble for 45 days went back into the world went back into their family system got triggered got overwhelmed drank did whatever relapse in their depression all these different things and now oh well you didn’t fix them that and we don’t give them the time to be able to heal and so if we look at it right are we as a society sabotaging the relapse process in a way as well saying oh you relapsed you failed you’re wrong you’re bad in this equation so what are they going to do they’re going to withdraw and they’re not going to keep moving forward so what if we continue what if we change that instead of oh okay you are going to struggle and we’ll just bear with you with that we work through that with you instead of nope you’re done you screwed everything up there’s that instant gratification I need you to be sober now I need you to be better now I need your anxiety go away now because then that means everything worked and everything’s gonna be okay it’s just kind that’s not that’s fundamentally flawed in our thinking if we think that way yeah I’m I mean I couldn’t agree more and just to just uh send that point home for like the family systems out there I’ve continued to acknowledge that we you’re being sold something on the front end and Peaks is trying to sell something that we do here at polytherapy Poly therapeutic approach we throw a lot of the kitchen sink at the individual with the hope that our long-term treatment outcomes can sustain and at the end of the day as well too I think we wholeheartedly show up with Mission Vision and core values in front of us you know versus the dollars but the dollar is a really important thing because we have to have a staff and we have to have the resources to you know insert that at the end of the day and at the end of the uh the end of the day to say it again I think at some point too we just have to know our hearts you know as well too in the process and what we are dedicated to and what we’re actually trying to come up with 45 days in treatment you know our owners for the viewers out there for as long as we’re able to we’re able to sit in front of patients and talk about um you know how they’re doing and how they’re succeeding and what the troubles are and all that sort of thing and uh so you know every Friday you know Chris and Bobby will bring forward a list of complaints and you guys get them throughout the entire process as well too but what I love about hearing about those complaints it’s like well I I could I need a like a binder that like from X Y and Z tells me exactly what’s going on in my day-to-day okay sure that’s something like we can work toward what we’re not hearing is like the therapy let me down I didn’t feel cared for I didn’t feel loved and so there are this incredible push of medical clinical and residential interventions toward the individual that I think has them feeling loved um and it’s what I’m stating here is it’s nice to just have it like a binder’s missing or the food could be a little bit better because we’re not a kitchen and we’re not a restaurant and those types of things and so um so I guess at the end of this as well too like there is a sense of like knowing our heart and I think the family systems especially those who entertain our family services because we also have that troubled outcome of like families like don’t want anything to do with it I’m not talking about how I traumatized them you know that type of thing that you know is um can dislodge outcomes in that way or leave a person feeling like my outside support world doesn’t care about that anyways the reality here is that I think when people get to know us and they listen to us and we invite them in family services individuals or otherwise they get to see that we actually care and regardless of how they leave treatment I think that is the underlying feature for which has helped us succeed in our outcomes and our reviews and those types of things at the end of the day as well too so any case to the family systems out there the research and the questions you ask going into a treatment episode I think matters greatly and I know you’re living in fear out there given the condition and the circumstances you’re seeing in front of you but I believe wholeheartedly in a in the United States of America where there’s almost 15 000 treatment centers to go to that we’re all not doing great things and to be curious about that and compare and contrast and really formulate a treatment episode for which you believe your loved one is going to be best nurtured within and if it starts with you keep your cell phone and your iPad it feels like the motivations are not about the individual but the individual in a bed at the end of the day and so I’ll just continue to antagonize because I think it’s essential here because I think for a lot of family systems like Johnny sees the ad and he’s like I’ll get my phone I’m going to that treatment what a success when you’re living in fear but at the same time it’s not generally a situation or setting that’s motivated by something other than that head to bed mentality and I’m not saying that’s always true but it might always be true at the end so uh with that let’s uh dive into factors favoring abstinent success so at month one post-treatment 52 of patients who successfully completed all recommended treatment reported having been abstinent since discharge in comparison only 34 of patients who did not complete treatment reported abstinence one month post-treatment and So within I think one of the challenging things to the point of like the data sets Jason that to allude to is like 48 of the respondents who did not complete treatment didn’t answer the phone and 38 who did complete treatment didn’t answer the phone so the outcome’s up or they are down you know if more people had answered the phone what would it look like we don’t know but 52 so you almost have what a 38 somewhere in their chance greater chance of succeeding post-treatment outcome by finishing the treatment protocols and going through the programming and the same data sets are true 44 to 34 at month six and 40 three percent to 28 those in recovery those not in recovery um for those who finished treatment that didn’t finish treatment and the longer in treatment episode thing here is kind of like what I wanted to Showcase yeah same good we’re on the same page yeah yeah that the longer you spend in this not just brute forcing it but the the continued participation and curiosity and toward internal Wellness at the end of the day is clearly driving an outcome and I think that’s so important because my I I keep I think more so over the past several episodes I keep reintroducing like personal responsibility and individual responsibility and motivation and discipline on top of it but it’s not a Brute Force thing you have to do what we say and then carry that out it’s like you really have to participate in this we can’t hold your hand outside of Peaks recovery centers um and so let’s just dive into that a little bit and hear that sort of clinical insight into what you guys are seeing for those because again it’s a 52 we don’t know what happened entirely the other 48 we know nine percent of amuse in the last uh 30 days and but the other 38 39 we couldn’t get a hold of so we don’t know exactly what’s going on there but the reality is it’s a it’s a far more likelihood of succeeding if you engage in this what’s going on yeah I mean Brandon that’s a great question and I and I think the data you’re looking at um I mean I think it’s really clearly treatment outcome success is highly correlated to length of time and treatment and not at a residential level of care like not at the highest level of care like just having ongoing clinical contact uh and it appears from our data but this is held true across a lot of studies that I’ve seen the longer you have kind of clinical contact even if at the end even if for six months after care even if you’re just going to group a week in an individual session a week or something like that um the likelihood of long-term success particularly with substance use disorder but I’m sure the data would hold true for uh depression it’s clear that that those that’s the most predictive thing we can do right like we have to maintain um what people experience in residential care they can keep experiencing that but they have to kind of maintain some contact um with the community and probably with professional care I think that part feels very true I also think um you know Lauren mentioned it a little while ago you know people can kind of force their way or pretend to be motivated or or you know kind of White Knuckle it if you will for 30 or 45 days but if if somebody is having clinical contact for six months or seven months like it’s almost there has to be some sort of internal motivation going on there right like um that has to be a component too where uh as as I think people go down in levels of care I think um we’re handing people more and more the reins of their life and more and more ability to kind of make their own decisions and um and with that I think the the implied implica or the implication then is that the longer somebody’s in care the more internally motivated they are just by definition that’s my thought yeah and maybe before we get to your you know input here too as well Lauren it’s fascinating because sometimes we’ll turn to the individual and be like yeah you’re not ready to leave and they’re like you just want me here for more money yeah you know at the end of the day but the the motivation yeah that is true the longer you stay in treatment the organization makes money that’s how business works that’s how an investment that’s how any business works the more Donuts you buy the better Dunkin Donuts is but the reality is is that if you leave treatment seven to Thirty Days uh within seven to Thirty Days at Peaks recovery centers you have a 16 chance of recovery if you stay with us for 181 plus days through IOP extended programming alumni it goes up to 56 chance right we yeah sure money in the process right but the way treatment works it’s more expensive in the beginning and you make less money over time so the longer you stay in care the less money I’m making from a chief executive officer position right but the value is recovery is better guaranteed at the end of the day right and I think it’s important to acknowledge that there is no relationship between longer and care and more money it’s more care if you want to go to detox over and over and over again that’s more money for whatever institution exists out there that’s playing that game the more you move through programming it’s going like this true you know they don’t want to pay for detox all the way through outpatient level of care right it’s more money at the beginning less money over time so when Peaks asks you to commit to the process it’s not because of more money it’s because the outcome is clear yeah I mean it goes into this place of we are habitual creatures right so if I I always tell this to the client so if I if I have a pattern and behavior that I have been practicing for over 20 years and then I go to treatment for 30 days and then I’m like I’m good after that how am I going to expect to change a pattern and behavior that I’ve been practicing for that long over a course of 30 days it goes in this place of like thinking patterns right if I have a way that I think and I stay in my shame and I ruminate and all these different things and I go to treatment and I’m like okay this is starting to get better then I move out of treatment I move out of care completely and then I start going back to my life again habitual creature I’m going to start falling back into those thinking patterns I’m going to start going into those behaviors because there’s comfort in those it’s what I’ve known my entire life it’s all I’ve known but forever and so I am always going to fall back on that and so being able to have longer-term care gives you the ability to continue to challenge those behaviors challenge those patterns interrupt them when they’re there and really it goes into a place of like you are changing the way your brain works if I’m constantly telling myself how much I suck then that’s the way my brain works and so the silly we we talk about affirmations right is okay like I want you to write down five affirmations of yourself tonight for me I’m like oh what I’m oh I’m strong I’m beautiful like no I’m not gonna do that but it really does help change the way your brain thinks like I am now oh 45 days in I’m actually starting to look at myself in the mirror and liking what I see when I never have before and so if you take care away you take everything away it’s only going to make sense to return back to that place of almost like homeostasis right is where this is where I’m comfortable my depression is where I live there I’m gonna go back and so much of treatment too there’s so many like metaphors for this process you know and I just gonna continue to talk about my running because the beginning of that process was like get on a treadmill do a 10 to 12 minute mile okay that was exhausting okay I’m motivated to achieve more of that well I need the discipline to keep returning to the treadmill and Emily I figured out you don’t have to be on treadmill you can run anywhere Brandon uh in that regard and move beyond that but sort of as I moved through it as a journey right it becomes like I want to be a little competitive so I join a race we go do Garden of the Gods or something like that okay that was fun and exciting like how do I do better I noticed that like uh my you know my hip flexors are getting sore after each run I’ll form then becomes a thing right it’s a constant experience and for me and running of learning and then okay now my form stand I feel good okay my nutrition is down I’m not taking care of myself from a nutritional value and I feel fatigued and tired as I run these distances um you know all of the things that can come alongside of it and I think that you know not to extend the metaphor too much further but it’s it’s true for like a recovery journey and I too am not just this individual who arrived in a CEO role you know once upon a time I got a master’s degree in business or anything like that I also come from a history of like traumatic experiences and I too have suffered in the world you two in front of me have suffered in this world and are shared stories in that way of things and our path forward individually has not been linear whatsoever and so I think in that way just trying to share with the viewers out there this isn’t all on the individual but there is a sense of felt personal responsibility in our own journey is that has helped us achieve at least where we’re at today and so nagging it’s like you step in front of a therapist and if you want to go in front of a therapist I’m not going to do it here with you guys but I mean you kind of are right now or yeah it would be inside you guys know if I said something like this like no my relationship with my wife is perfect oh okay okay yeah tell us about that tell us yeah we have tell us what that Perfection was yeah I know where this is going don’t end my me in front of us but it goes into the what we were talking about before right when a client is leaving and they’re like oh I’m not nervous at all I know I got this I’m going to be so nobody you should be nervous you need to have healthy fear in that like there has to be realistic expectations when we’re talking about this you’re going back to a family home that you triggered you more than anything else let’s be realistic yeah and you know to the running Point too I’m practicing for a marathon wait on July that is one day and I’m 60 some days or 70 days away from it right now all of this training opportunity guarantees nothing in that moment and I know that and that also creates an extraordinary amount of fear like and potential passivity of like why am I even trying because I can’t guarantee that future moment all I know is I can show up in that moment in the best way shape or form irregardless and whatever mistakes or things I go through just represents the future opportunity on the other side and I think that recovery Works in a very similar sort of way there is a fear that it’s not going to work right there is a fear and a resistance to doing it what’s all the work if I can’t guarantee the outcome drugs make me happy if you can’t guarantee my happiness out here in the future like why would I even bother with this process at the end of the day and so I think we get it and I think that’s also what I’m trying to Showcase and highlight for people out there that just because we’re in the position of an industry and we are able to collect a paycheck and an income resulting from it does not mean we don’t um we aren’t a part of this process as well too in front of our you know patients every day differently than them too we got to kind of like hit the door leave our personal crap behind us and like walk through and you know in a way sort of showcase like you got this because I got this you know but we don’t always got this and I think I just want to represent that because it’s not us in this position of perfection and decrees and we through that lens of knowledge alone know what’s best for you like we also struggle individually and I think all across America people struggle in that way of things and I think that’s just worth highlighting as well too here um and so when we’re talking about is also a lived experience um in that regard and through that lived experience we can showcase it’s going to be challenging but the fruits of everything on the other side of this are certainly worthwhile also every time I get to that thing of like I succeeded it’s a new opportunity and something else has been highlighted for me that I have to work on um and that’s what makes this a lifelong journey not just recovery is a process but self-actualizing awareness you know the best possible version of ourselves um is not going to be out there guaranteed to us nor in a pill nor in any monotherapeutic Approach at the end of the day so I think yes I do have something to say um which was a big surprise uh I think on that it’s where we start to challenge how we measure success I think about a client who came through our program last year um he didn’t get out of bed for 30 days and we just sat with him and we we encouraged him and we you know we talked to him and um after that 30 days he started getting out of bed and he started doing the work and and he found a way to love himself in a way that he never was able to in the past and he never really received from his family in a big way um unfortunately this client left and he um after a couple months he did pass away and to me right it’d be like that’s the ultimate failure that’s what we think about and on the other hand well no there’s success in that because he found a way to love himself to the point where when he went home his family reached back out and said we have never seen him this way before like he is he is caught more confident than we’ve seen him he is more motivated and all of these different things and so how do we measure outcome and success maybe it’s by seeing the behaviors and everything that’s changed not necessarily are they staying sober or are they not falling back into their depression and anxiety and all of that absolutely freeze solid yeah I I was hung up on your running metaphors so I’m just gonna that was too deep to go there yeah you see that from you both yeah um yeah that I think if anything to the running it’s just there’s no guaranteed markers like in this process and for as much as I want to believe I’m going to hit that Boston qualifying time like I know there’s potential of missing that Mark but it can’t be perceived as a failure what’s going to be true for me I believe now through working on myself for three three and a half years or how