Pubdate: Sun, 6 Dec 2009 Source: Ledger, The (Lakeland, FL) Copyright: 2009 The Ledger Contact: http://www.theledger.com/ Details: http://www.mapinc.org/media/795 Author: Robin Williams Adams, The Ledger Bookmark: http://www.mapinc.org/rehab.htm (Treatment) LRMC ENDS ADDICTION PROGRAM Dwindling Number of Patients, Ailing Economy Prompt Hospital to End Intensive Outpatient Program LAKELAND | People seeking intensive outpatient group counseling for substance abuse will no longer find it through Lakeland Regional Medical Center. A dwindling number of participants, because of the uncertain economy and patients' losing insurance, led hospital officials to end the Intensive Outpatient Program, or IOP, for substance abuse-dependence this fall. The program's staff treated thousands of patients and families during the past 20 years, a time when that type of treatment was expanding nationwide. The hospital still has short-term inpatient treatment, typically lasting about 3 1/2 days; an aftercare program for those inpatients once they are discharged; and individual outpatient counseling with a mental health counselor and a psychiatrist certified in treating addictions. In addition, two other organizations in Polk County offer intensive outpatient services - Tri-County Human Services and Peace River Center. Losing LRMC's program doesn't mean, as some may fear, having to drive to Tampa or Orlando for the intensive outpatient model. "Our volume started dwindling in the past two years," said Silvia Falcon, who until recently was LRMC's director of mental health services. "It's difficult to maintain a program where you could have maybe two or three new patients a month," she said. "We used to have that many in a week." Peace River Center in Bartow, which has provided adult substance-abuse treatment for a couple of years, is using the IOP model, as well as other types of less intensive group substance-abuse therapy. Calls to Peace River from adults who seek treatment have increased since LRMC stopped its program, said Bob Williamson, substance abuse program manager for Peace River. "We have been taking all (LRMC) referrals and we have been taking referrals they would have gotten from the community," he said. Tri-County Human Services, a longtime Lakeland provider of outpatient group counseling for substance abuse, recently got a preliminary license to start using the IOP model for some of its female clients who are waiting for residential treatment. Although Tri-County is just starting with the IOP, it has other group therapy programs for substance abuse that meet for 90 minutes per session once or twice per week. Peace River has a basic outpatient substance abuse program meeting 90 minutes per week and an advanced program meeting three hours per week, in addition to the IOP. "Group is the main modality used in substance-abuse treatment," said Bob Irving, administrative director of Tri-County's outpatient services. "Being able to share with your peers is really what works best." Nationwide, nearly 1 in 10 adults needed treatment for substance abuse in the past year, according to the Substance Abuse and Mental Health Services Administration. Approach Grew In '80s The intensive outpatient approach expanded in the 1980s when white, middle-class people with cocaine addiction sought treatment that wouldn't require them to leave work or to check into residential treatment facilities. Managed-care programs liked that approach because of the potential cost savings in comparison with lengthy residential stays, according to SAMHSA. In the 1990s, intensive outpatient treatment became the dominant model for most people battling substance abuse. Its clients expanded to include people who were homeless, teenagers or those who had co-occurring mental disorders. The need for combined mental-health and substance-abuse treatment spurred Peace River and Tri-County to broaden their programs. Insurance companies liked the IOP because patients who met its requirements were less likely to go back to using, LRMC's Falcon said, but the companies also wanted to save money. That led to companies' authorizing only nine weeks instead of the 12 recommended. If insurance companies balk at 36 sessions, Peace River can work out payment for the uncovered sessions on a sliding scale based on income, Williamson said. Hight Level Of Commitment Intensive outpatient, as its name indicates, involves a lot more commitment from participants and staff. Nine hours per week is the minimum expected, Williamson said. Clients also are linked with self-help groups like Alcoholics Anonymous and Narcotics Anonymous for ongoing support. Screening and past history determine whether a patient needs therapy that intensive or could go with the other substance-abuse programs and the self-help groups. At LRMC, the IOP clients met three nights per week for three hours per night. That included group therapy for patients only and also family therapy. One of the three nights per week included family or others close to the patients who could help them stay sober, Falcon said. Clients in LRMC's program primarily had a problem with alcohol, but some had issues with other substances, including prescription drugs. With insurance issues and the economy, more and more people who needed substance-abuse services were indigent, she said. Peace River had 22 adults actively enrolled in its IOP program in early November. It has three-hour sessions three times per week. Participants go for 36 sessions. Its IOP also includes a family component, Williamson said, calling substance abuse "a family disease." People can join at any time and there isn't a waiting list, Williamson said. For the weekly session in which families are brought in, clients and their families are together for an educational program. Then they split up, one therapist working with the clients and another with the adult family members. "When children are there, which we encourage, another therapist works with them," Williamson said. Although Peace River is better known for mental-health services than substance-abuse treatment, the two often go hand in hand. "The majority of addicts and alcoholics have an underlying co-occurring (mental) disorder," Williamson said. That could be depression or an anxiety disorder; it doesn't necessarily mean something such as bipolar disorder or schizophrenia. Tri-County got permission to open its fledgling IOP because it needed an intensive alternative for women waiting to get into its residential program, Irving said. "We need to provide interim service for our folks so they don't get lost," Irving said. That program for women is meeting two days per week for about seven hours combined. Its hours will expand, he said. And a modified IOP for men is scheduled to start next year. Lakeland Regional plans to continue its individual counseling with an increasing medical focus. Dr. William Sadowsky, the psychiatrist certified in addictions treatment, is able to treat with Suboxone, medication approved for treating opiod dependence in an office setting. The mental-health counselor works with Sadowsky on treatment plans and continues linking patients to AA and NA for further support. Hydrocodone, codeine, Vicodin, Dilaudid, Demorol and Fentanyl are some of the drugs to which those patients have become addicted, Falcon said. LRMC is studying different options, such as adding a certified addictions counselor and opening a Suboxone clinic that would include group counseling sessions. "We are committed to meeting the needs of our community as best we can," Falcon said. - --- MAP posted-by: Richard Lake