Support Person (SP)
A central aspect of our treatment involves the requirement that any person who comes to us while actively using drugs and alcohol must arrive with a Support Person (SP). This requirement immediately facilitates a number of important dynamics:
- A fundamental nature of addiction involves inability to tolerate relationships and the feelings that arise within relationships. The requirement that a new patient arrive with one person (or more) in the world that they identify as supporting them begins the process of depending on people rather than drugs to solve the problem of intolerance of feelings and relationships.
- The SP model facilitates family treatment; families (or friends) of addicted persons are usually some combination of unknowing of how to help, or codependent. We give information and interpret codependent behaviors of which the SP is not conscious.
- We don't admit patients to the hospital for detoxification. Many patients admitted for detoxification never go on to outpatient care (44% in a 2007 study), and the rate of recidivism to use of drugs and alcohol after inpatient detoxification is more than 90% over the year following admission. Hospitalization takes patients away from their support systems. We use innovations in detoxification pharmacology that allow safe outpatient detoxification with the SP given some responsibility for monitoring withdrawal symptoms and helping with medications. There is no longer a need for patients to be admitted to a hospital no matter how severe the withdrawal symptoms are; they can be managed at the Psychiatry Addiction Service with our system of care. Detoxifying patients are already in an outpatient treatment system where they are gradually stepped down to individual, group or family psychotherapy in a single location.
- We recommend to most patients that they have their SP or others in the network of caring persons around them, for the first year of sobriety, administer naltrexone for opiate dependence or disulfiram for alcohol and cocaine dependence. This model of psychotherapy has been shown to dramatically improve outcomes.
- We make it clear that we want to keep patients in treatment until they have entered a stable process of recovery. Therefore, the SP/family knows that in case of relapse to active use of drugs or alcohol, the patient should be brought back for another try with us.