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.