Are you wondering what intensive outpatient treatment is like? In this blog post, we interview Dr. Laura Krum, Lionrock Recovery’s clinical director.

Q. How do you put together a treatment plan?

A. The first thing that happens is the client gets an assessment with the person who’s going to be their primary counselor. So right at that point, while we’re assessing and we’re hearing their story and we’re listening to what’s going on, we’re starting to formulate in our minds, “Okay, here’s some of the issues this person needs to deal with,” whatever they are. And a lot of times substance use is a piece of it, but it’s not all of it. There’s all this other stuff that gets involved. So we’re taking a mental note as we’re doing that. And then the first session when we meet with the client, once they’re in the program and have been assessed, then we always ask them, “What do you want to work on while you’re here?” And then we listen to what they have to say and give them some ideas like, “Well, from your assessment it seems to me like you need to work on this and that.”

Q. And that assessment happens how?

A. Everything is done via Zoom. So we’re always seeing people.

Q. Do you think the platform lends itself to a little more freedom?

A. Absolutely. Yes. Clients get very connected to each other. They could be in Tennessee, in California, in Vermont, and they’re texting each other and talking to each other. Sometimes they fly to see each other. It’s amazing.

Q. So there’s the assessment. What happens next?

A. Then we write the treatment plan between that session and the next one. When we meet with the client for the second session, we review the plan. “Okay, here’s what I came up with based on what you said. What do you think? Does this sound good? Do you want to add anything? Are there things you don’t want on here?” And we just review the whole plan with them.

Q. What might a plan consist of?

A. It’s always going to consist of something around a substance abuse goal, staying clean and sober, doing the five phases.  (The Lionrock Recovery Program consists of 5 phases of care with tools and insights that assist clients in their recovery process.) It’s going to hit on something with addiction. It’s going to hit something probably biological, physical. “Are you going to your doctor? Have you had a physical? You need to get one.” We find a lot of these people have not been to the doctor in a gazillion years. It’s going to hit on social. “What’s your social scene?” If you’re somebody who drinks in bars all the time, then we’re going to have to find something for you to do. And even if people don’t drink in bars, a lot of times people just isolate and they stay in their house and use. So they have no hobbies. They don’t know what to do with themselves. So there’ll be a social aspect to it.

And then there’ll be a psychiatric aspect to it. You see a lot of co-occurring depression and anxiety. Some bipolar off and on. But mostly it’s depression and anxiety. So we’re continuing to assess that as it goes along. And sometimes it’ll just clear when they stop using. Like, “Wow, I’m not anxious. I was drinking because I was anxious. But now that I’m not drinking, I’m not anxious. You know?” And some people, we tell them, “You need to see somebody for a medication evaluation.” And we’ll help them do that.

Q. And in addition to these aspects, the addiction, the social, the psychological, etc., is every treatment plan tailored to how often they meet with you? Or is there a formula?

A. They sign up for a program and the program dictates how often they’re going to meet with us. So if they’re in intensive outpatient treatment (IOP), they’re going to have three, three-hour groups a week plus one individual session with their primary counselor. And if they’re an outpatient, they’re going to do two, 90-minute groups a week plus one individual. Occasionally we’ll see people individually. Sometimes people come into the program and they are inappropriate to have in a group because they can’t focus or whatever. So we’ll work with them individually to get them group-ready. We have a lot of ability to think outside the box and try to figure out how we’re going to navigate the situation with some people that have really complicated presentations.

Q. What’s the length of time for treatment typically? Or is there no typical?

A. The fastest I’ve ever seen anybody do it, and do it correctly, was 12 weeks. The client kind of sets their pace because they have to do these assignments in the phases. Clients are required to meet certain measurable expectations in order to move from one phase to the next.And the sooner they do the assignments, the sooner they will be done. But to do them and do them well, minimally it’s going to be 12 weeks. And you can’t just write anything down. It has to be quality work. For example. we’ll say, “You have to write five pages,” but we’ll tell people it’s not quantity, it’s quality. If you write two solid pages, perfect.

Q. What’s different about Lionrock compared to seeing a counselor individually?

A. The research clearly shows that group is where it’s at for people that have substance problems. So just the support they get from other people that understand where they’re coming from – they come in, they’re scared, freaked out, they tell their story and people are like, “Oh yeah, I know exactly what you mean.” So they get a connection with people. And a lot of times people with addiction, they’re going to the substance for comfort and what they need. And what we’re working with them is to try to teach them you have to go to people for support and help. And so with group, it gives you the experience of being able to practice that and actually do that and have to say what’s going on with you.

Q. What are some of the concerns, or objections that tend to come up through the process, or especially early in the process assessment, and treatment plan?

A. We let them know that this is totally confidential, and you would have to sign a release of information (for an employer or anyone else to access your records), and then we would talk about what information would be released. So, usually if somebody gets referred by their employer –  if you have to go to treatment – the employer wants to know they’re showing up, and all we tell the employer is if they’re showing up, and they’re being compliant, and we just say compliant. So that could mean you come into the program, you’re in here for three weeks, and you have just an epic relapse over a weekend. You come back into the group on Monday and you say, “I had this relapse, and this is what happened”, and we tease it out, and we break it down, and we do all this work, to me, that’s a compliant client. So, we don’t share, “Oh, they used four times.” We don’t get into any of that. If you’re coming, and you’re putting your best foot forward, to me, you’re being compliant.

Q. Are there other concerns or objections that you face in the process?

A. From the clients, it’s the time. ?I don’t have time for this. I don’t think I can do all this”.

Q. And how does that play out? Do they just realize that this is something they want to make time for or does the convenience of the platform help? 

A. We just tell them, “Yeah, we get it. It’s 10 hours. It’s a lot, but how many hours were you drinking in a week? What are all the things you weren’t doing, because you were drinking, and using?” So this is a period of time that you’re going to do this, and focus on your recovery so that you can have a life that you feel is worth living most of the time. And you can be a better mother, dad, worker, all of that. And  they usually balk at first, but once they get in here, and they start doing it – some people drop out because they’re not ready – but a lot of people, they get the value of it. And then we get people that are like, “Yeah, I’m going to stay in IOP for six months because I want to be here, because I love my group.”

Q. Is there anything you wish people knew earlier? 

A. The first thing that comes to mind is I always tell them, “If you do everything I tell you, you’re going to be fine, but you won’t do everything I tell you to do, because you won’t want to, but you should do it anyway.” And then I’ll always bring it back, “Remember I told you, you should do everything I told you? And look what happened?” I think when people come to us a lot of times they just have no hope. They’re completely demoralized, and we hold the hope for them. So, they come in, and we’re like, “Yeah, you’re here! It’s going to be awesome. You’re going to love it. It’s going to be fine. We’re going to help you.” This platform gives us flexibility with the clients. So, I will say to people, “Look, when do we want to meet next week? If that doesn’t work in the middle of the week, text me, we’ll move it.” So, we have flexibility with that.