Paradigm Shift: The movement from Drug and Alcohol Treatment to a Coaching Model
Drug and Alcohol Treatment in America has been based on the Medical Model of Treatment. According to Wikipedia, the medical model of addiction is rooted in the philosophy that addiction is a disease and has biological, neurological, genetic, and environmental sources of origin. Treatment includes potential detox with a 28 day or more stay at a residential treatment facility. The continuum of care can include an additional 28 days at the partial hospitalization level, followed by another 6 weeks of Intensive Outpatient.
With the introduction of Obamacare, the insurance companies have begun to pay less and less for the revolving door of treatment services. With the average length of stay in a residential treatment center around 28 days and the bills ranging from $12,000 to $70,000, insurance companies have cut the amount that they are willing to pay for addiction services. Some insurance companies will pay for the least restrictive level of care first, even if a clinical professional requests a higher level of care.
This leaves the client and their family in a sticky situation. They can pay cash out-of-pocket for the treatment, wait for a mental health diagnosis so that the insurance companies will pay, or look for an alternative form of treatment that might be more effective and affordable. Sometimes the insurance company will actually refuse to pay any more benefits for the client for the year since he or she has been in and out of treatment centers so many times that the insurance company feels it is not working.
Watching a loved one go into the revolving door of treatment on multiple occasions and continue to use drugs and alcohol is emotionally draining for a family member. Drug and alcohol treatment centers focus on the client and not the family as a unit. They also do a great job of keeping the client sober for 28 days. The issue arises when the client returns home to the same untreated environment he or she left. The family is not addressed and the dynamic of the family that had been established well before treatment reverts back when the client returns home. Shortly after the return home the client returns to his or her old ways and is using again. The family is frustrated, angry, devastated even. They do not know what to do, so they send their loved ones back into residential treatment and the cycle continues.
Enter Recovery Coaching or Sober Coaching.
The use of a coach in the field where a client needs to remain sober changes everything. The Recovery Coach or Sober Coach will address the family dynamics, the triggers, the stressors and the issues that are occurring in real-time. The coach can assist with facilitating the client to a meeting or integrating them into sober activities. The coach can address the feelings and issues that arise in real-time and provide coping skills and life skills that will address the negative thoughts, emotions and actions right on the spot.
A recovery coach or sober coach is more than a ‘paid babysitter.’ If trained properly, a coach is the first line of defense before the relapse and the cheerleader when things are going well. Focus on relationships, budgeting, employment, school, and other tangible items are part of the coach’s job. The coach will even dig a bit deeper than the surface items and assist with forward positive movement to obtain goals. A good Recovery Coach or Sober Coach will find out where the client wants to go and begin building the roadmap to success with the client. Life purpose and passion will be discussed. There might even be some fun creation of a bucket list where the client has something to look forward to!
With the downplay of the continuum of care and the inability to access quality care with the current issue of insurance, a Recovery Coach or Sober Coach is an excellent complement to existing services or even in lieu of services. The lack of family services and treating the entire family while a client is in treatment can be avoided by having coaching post-treatment.
Recovery Coaches or Sober Coaches can travel and meet the client wherever they may be. This includes at work, on a movie set, on the playing field or playing court, or even at the beach. The ability of a coach to travel is paramount, and the need for the services in real-time as stressors arise is the key to the client staying sober. Visiting a therapist in their office is usually a hard sell for a client post-treatment as it comes with having to be accountable and actually make it to their office. This gap is solved when a coach can travel directly to the client.
The cost of the Recovery Coach or Sober Coach can be out of reach for some, and the thought of having to spend even more money out-of-pocket can be frustrating, however; if the client can be in a structured living environment that is sober such as a sober house, sober living house of halfway house, the coach can visit them on-site and work with them on a limited basis—perhaps once or twice per week. The ability for the coach to be in the client’s real and accurate environment is what makes coaching so successful.
The basis of Recovery Coaching or Sober Coaching is rooted in working in the present and the future only. Coaches do not go back in time and try to figure out why their client is unhappy over an event. Coaches do not address trauma and past negative issues. They ask the client where they want to go in their lives and how they plan to get there. Then the coach gets to work helping the client build the roadmap to get to the desired place. As a Recovery Coach or Sober Coach, we are their guides and cheerleaders to keep them accountable for the things they want to do and the goals they want to achieve. We are not their therapists, although we can work alongside their therapists to achieve desired results.
Recovery Coaches can also interact with the family and offer education on addiction, accountability, and codependency training. They also act as a buffer between the client and the family if things are heated or if there are multiple addictions or mental health problems in the family. Recovery Coaches, simply put, offer an invaluable service that is often overlooked in treatment centers. A few have progressed and caught on to adding on the services to assist the client on the return home. These treatment centers might have a higher success rate, as time goes on and data is collected we will see what happens.
One such center collecting data on a one-year pilot program is Gosnold Treatment Center. “Gosnold director Ray Tamasi says this aggressive approach is paying off. Tamasi compared the medical records of 54 18 to 28-year-olds one year before, and one year into the pilot program. There was an 83 percent reduction in admissions to rehabilitation facilities for the one-year-in group. Emergency room admissions went from 16 to one. There were no new legal offenses.” (Wbur’s Common Health June 2014).
With pilot studies, some treatment centers are adopting the coaching model. More people who lack insurance benefits or have limited insurance benefits are opting in to Recovery Coaching and Sober Coaching as well, which seems like the logical choice to make. It can be affordable and accessible. Another instant benefit of coaches is that they can be available 24/7 if necessary and can be put on retainer. This feature can be invaluable if a client needs extra care or assistance during off-peak hours such as evenings, weekends, and of course in the middle of the night.
Recovery Coaching is definitely on the upswing. At The Addictions Academy, we have seen a rise in students taking our Recovery Coaching classes to get certified and even completing our Level II class. We offer both a level one basic that meets the International Coaching Federation standards and a level II that covers more intensive issues including the criminal client, mental health client, and the wealthy client, which are all coached in different manners with their unique needs.
We can be found at www.TheAddictionsAcademy.com and we are available at 1.800.706.0318.
Cali Estes, CEO, MS, CAP, ICADC