Roanoke Times
Copyright (c) 1995, Landmark Communications, Inc.
DATE: MONDAY, July 30, 1990 TAG: 9007300070
SECTION: VIRGINIA PAGE: A3 EDITION: METRO
SOURCE: ELLIE SCHAFFZIN STAFF WRITER
DATELINE: LENGTH: Long
The moment he pushed that button was the only time anyone could suspect Jeff was a recovering alcoholic. Although he was going through rehabilitation for the five years he had been on the bottle, he was still leading a normal life.
The 36-year-old was participating in Lewis-Gale's intensive outpatient program, a new approach to an old problem.
Jeff was able to kick the habit while living at home and continuing to work as a car salesman. He attended counseling sessions that would meet as often as three times a week at first, then less frequently over a period of seven months.
Lewis-Gale now holds its meetings in an office in Roanoke County, where assistant director Ben Rogers still sees Jeff on occasion to hear how his life is going.
Jeff has not had a drink since he completed the program two years ago.
Jeff is among more than 150 patients who have been through Lewis-Gale's program in its 2 1/2 years. Rogers said a recent study showed that 78.3 percent of the patients have remained alcohol- and drug-free since completing the program, a statistic Rogers described as incredibly high.
The intensive outpatient program has taken time to reach the Roanoke area. But once here, Rogers said, it has proved to be equally or more successful than the traditional inpatient program. In those programs, a patient spends four weeks and thousands of dollars for detoxification and counseling in the hospital.
D.G. Albright of Total Life Counseling, a private agency that has just begun to offer the intensive outpatient option, said few alcoholics need to undergo detoxification, yet inpatient programs routinely include this for all their patients.
Albright also said the high rate of relapse after inpatient treatment points out a fundamental problem.
"You get this false sense of security. You're in a chemical-free environment . . . and then all of the sudden comes your discharge date, and you're home, back in the same environment, the same temptations. . . . It's overwhelming," he said.
Rogers agreed, saying that outpatients are able to apply what they are learning in their living environment and through trial and error, helping to make the recovery last.
Learning to cope in the home and at work and not having to miss work at all are not the only pluses of the outpatient program; the cost is significantly lower.
Paul Prosser, employee-assistance program coordinator for Trinity Industries, said two or three employees can undergo intensive outpatient treatment for the price of a single inpatient hospital stay, which can average about $8,000.
Prosser said that though a hospital stay often seems desirable to an employee wanting help for a drug or alcohol problem, that attitude soon changes to a desire to escape the hospital bed.
"We have very few employees that look forward to being locked up . . . although they may want it at first," he said.
Jeff said he might not have placed himself in rehabilitation at all if the only available option had been the inpatient program. He said he did not want the stigma of incarceration.
"I think a lot of it is labeling yourself," he said.
But Jeff was soon comfortable getting off the elevator on the sixth floor at Lewis-Gale, and he became open about the program with his friends and co-workers as well.
Another advocate of the program - a 37-year-old man with a Ph.D. who had a 20-year heroin addiction - found out about the intensive outpatient option only after a heroin-related illness put him in the hospital. Although the man did undergo some detoxification, doctors at Lewis-Gale told him he could qualify for either inpatient or outpatient treatment.
"It gives you one last opportunity. . . . I knew that if I failed at the outpatient program, I'd have to do inpatient," he said.
A year after completing the program, the man now returns to speak to other recovering addicts to let them know it is possible to stop. He compares quitting a drug to knowing you must break off an unhealthy relationship, but fearing the loss of security that comes with the change.
"Can you imagine breaking off a relationship you've been in for 20 years? It's very, very difficult. . . . When you break off with your drug of choice, you're stepping into the unknown."
Taking that step required support, and the man said he was able to find the support he needed while he was living at home.
"I wanted to build a support system for myself while I was getting clean . . . so it would be there for me [afterwards]," he said.
Rogers said his patients need to be taught that drugs are destructive, because they are often unwilling to believe that the companion they've had for so long is actually an enemy.
"Everyone is convinced that alcohol is the number one best friend they've got," Rogers said.
Rogers said turning this idea around is done through cognitive restructuring. Patients learn to think more positively, to be assertive but not aggressive, to handle stress and to communicate, among other things.
Rogers also said there is a strong emphasis on spirituality. He said this is not necessarily a religious concept, but "anything that is positive and creative in a person's life."
Total Life Counseling's Dave Peterson said his organization integrates Judeo-Christian principles into the spiritual aspects of the counseling, but he said the program is for everyone. For Albright, spiritual counseling equips the patient with "basic life principles that it's too bad everybody can't live by."
Both Total Life Counseling and Lewis-Gale include Alcoholics Anonymous counseling in their programming, and both provide family counseling when necessary. Rogers said he includes the patient's family throughout the seven months of counseling.
"Alcoholism is a family disease," he said.
The former heroin addict noted that whether they actually participate in the program or not, those close to the patient change as well.
"They, in their own way, went through some major changes when I went through the program," he said of his friends, adding these changes were smoother because he was in close contact with them during his counseling.
Jeff said his family, friends and employer backed him 100 percent as he went through the program. Albright cited this support and patient motivation as key factors in the success of the intensive outpatient program.
For this reason, Albright said, the outpatient program is not for everyone. Rogers listed certain cases that will not qualify for his program, such as patients who are under the influence of hallucinogens or are psychotic and therefore need to be closely monitored. The outpatient program also is inappropriate for patients in need of medically supervised detoxification or who live in a chaotic environment, Rogers said.
Ted Petrocci is director of alcohol and drug programs for Roanoke Memorial Hospital, which offers only inpatient substance-abuse programs. Petrocci said there are sometimes very clear indicators as to whether a person needs inpatient or outpatient care. Other times, testing and a look into a patient's medical and personal history are needed to determine if the person is so severely addicted that he can't be trusted in an outpatient system.
The intensive outpatient program, Petrocci said, is a new addition to the range of treatments, but studies are beginning to show the long-term success of intensive outpatient treatment.
But it is often the insurance company that calls the shots in choosing the right program, Petrocci said. According to Albright, insurance companies are reacting to the high relapse rates and higher costs of inpatient programs.
"The reality of it is that the insurance companies are starting to say: `Thou shall try outpatient treatment first,' " Albright said.
Lawrence Colley, vice president of corporate medical policy at Blue Cross-Blue Shield, said his company has begun to encourage outpatient care as a first choice, though he said this is not a hard-and-fast rule.
Albright said the problem with many outpatient coverage plans is that they do not offer the same benefits as the inpatient package. Colley agreed that outpatient coverage is still in the process of evolution, but said its benefits are improving.
Blue Cross-Blue Shield coverage for the intensive outpatient program is rarely less than 80 percent, Colley said.
Jeff keeps a calendar to count the days since he stopped drinking. He said he finds that dealing with his recovery happens one day at a time. Jeff said he still gets chills when he thinks of the dead-end he would have met if he had not entered the outpatient program.
"It's the best time and money I ever spent," he said. "It certainly straightened my hind end out. And it sure needed it big-time."
by CNB