1. Intensive Residential Treatment+
Douglas N. Brush, CACII
Director, Men’s Recovery Center
MARR, Inc.
Intensive Residential Treatment

2. MARR Components of Care
Abstinence based
Minimum 90-day intensive residential structure
Gender separate, gender specific
Intensive clinical services
Comprehensive medical services
Family recovery services
12 Step focused spirituality and recovery principals
Therapeutic Community as the agent of change
Comprehensive/intensive residential treatment with a recovery experience

3. Goals for Intensive Residential Treatment
To assess medical and clinical needs of each client
To identify core issues for treatment
Denial, Acceptance, Anger, Fear, Resentments, Guilt, Shame, Trauma, Abuse
To identify and learn to express feelings
To confront denial and dishonest behaviors
To develop trust and accountability within the Therapeutic Community
To develop foundational recovery skills
To assist the client to become willing to experience a new way of living (hope)
To help our clients to understand and to accept that the disease of addiction is a physical, mental, spiritual, and family illness not to be “fixed or solved”, but to be treated.

4. Phase I: Intensive Day Treatment
Attending 30 hours of groups per week in day treatment
Attending 3 hours of groups per week in Therapeutic Community
Attending 3 hours of professional peer groups per week for physicians, nurses, dentists, pharmacists, PAs, pilots, lawyers and other business professionals
Attending 6 12 step meetings weekly

5. Groups that Drive the Phase I Process
Life Story Presentation
Preparing and reading your life story allows an intentional opportunity for you to grasp the significance of your personal history and to give it coherence. The life story assignment helps clients to become more honest, open, real and personal with their peers.
First Step Inventory
The first step inventory is a documentation of the control the disease has exerted over your life. Unlike a life story, the inventory focuses on your behavior and its consequences. The first step inventory challenges clients to look at the harm they have caused to themselves and to their relationships with family and others. It brings to life specific examples of the powerlessness and unmanageability of their disease.

6. Therapeutic Community
Introduction into the therapeutic community
3 groups/week focused on building trust and relationships
Presentation of contract within 3 weeks (recovery goals)
Accountability to self and others
Learning how to ask for and receive help
Learning how to help others while surrendering personal agendas
Receiving feedback from peers and altering behavior
Participating in weekly chores and expectations
Eating meals together
Grocery shopping
Maintaining a clean recovery home-like setting
Community meal and life-story
Participation in 12 step and spiritual recovery as a community

7. Completion of Phase I: Intensive Day Treatment
Life Story
First step inventory
2nd and 3rd step assignments
Relapse prevention plan
Phase I review
Selecting and beginning work with a sponsor is a condition of completion of Phase I
Average length of stay in Phase I days

8. Additional Services Provided During Phases I and II
Medical and psychiatric management and follow-up
Medication supervision
Random Urine Drug Screening
Family support services

9. Transition to Phase II 7-10 Groups per week
Continued focus on trust and accountability within the therapeutic community
Mirror Image group and mirror image placement for professionals
Work phase for non-professionals
Transition from mentoring group to aftercare groups
Aftercare groups offered in Phase II include
Anger Management
Thinking About Your Thinking
Building Better Relationships
Introductory Trauma Therapy
Process Group Therapy
Individual therapy added
Continued work on core issues identified in Phase I
Participation in 3-day family workshop
Family and couples therapy as recommended
Continued attendance at 6 12 step meetings per week and working
the steps with a sponsor

10. Completion of Phase II Average stay in Phase II is 60 days
60 –Day Review within community
Phase II Review with clinical team
Discussion of progress
Review of Relapse Prevention Plan
Development of Aftercare Plan
Discussion of transition to home or recommendation to extended residential care
Therapeutic leave to home to establish recovery and aftercare contacts
Family involvement
Professional Program involvement
Joining the Alumni Association
Goodbye Process

11. Why Consider Longer Term Intensive Residential Treatment
Greater intensity of care with combination of residential and intensive outpatient treatment
Greater accountability with staff and peers
Application of therapeutic discovery in safe, structured living environment
Early implementation of 12 step recovery program rather than just intellectual knowledge
Emotional distancing from enmeshed family systems – focus on self
Intervention on chronic, long term, patterns of behavior that trigger relapse and prevent change

12. Why Consider Longer Term Intensive Residential Treatment 2
Establishment of new choices and a recovery lifestyle which in time creates a lasting and psychic change
Opportunity for gradual healing of relationships with family and significant other relationships, while living in a safe, supportive environment

13. Criteria for Considering Longer Term Residential Care
Primary diagnosis of chemical dependency and/or related addictions
Chronic, multiple relapse with inability to sustain lasting sobriety
Unsuccessful attempts at recovery after inpatient or outpatient only treatment experiences
Inability to surrender control and experience accountability
Unsafe, unstable, non-supportive family/living situations also includes co-dependency/rescuing/enabling behaviors
Inability to fully embrace 12 step spiritual model of recovery

14. Criteria - 2
Need for safe, structured recovery environment while transitioning back to work
Need for extensive life skills training (stunted development due to early chemical use and/or extended use of alcohol and drugs)
Clients who have a manageable dual diagnosis but require a treatment emphasis on recovery and abstinence
Clients in need of a safe/structured setting to experience acceptance and trust, i.e., gender specific needs, trauma and abuse experiences
Healthcare professionals who require long-term treatment, accountability, advocacy and support

15. 5 External Motivators for Seeking Treatment
Loss of Spouse/Significant Other
Loss of Family
Loss of Job/Professional Career/License
Loss of Freedom (Legal)
Loss of Health

16. Trust and Accountability Opportunities for Surrender
7 Stages of Progression in a Long -Term Intensive Residential Treatment Program
Invitation
Self-permission
Willingness
Acceptance
Trust and Accountability
Opportunities for Surrender
Authentic Affirmation/Validation of Real change

17. Age of First Use Age of First Use No. Clients Percentage of Clients 71 1% 10 2 2% 11 3 3% 12 8% 13
13% 14
14% 15 16
18%
17% 17 18
11% 88
Total does not include 8 clients whose age of first use was older than 18 years

18. As a result of earlier onset of use and progression of disease, clients are entering long-term residential treatment with an inability to tolerate:
Anxiety
Tension
Loneliness
Sadness
Hurt
Shame
Fear
Conflict
Anger
Resentment
Joy
Glad

19. Our goal is to help our clients in a structured residential treatment program:
To experience and embrace these emotions
To learn how to live with them and through them instead of making them go away through the use of alcohol or drugs or other behaviors.
What better place than in a safe, structured, longer-term, intensive residential treatment program based on community, trust, accountability and lasting change.

20. 2018 Outcomes Data for Men’s Recovery Center
Average length of stay for all admissions into Men’s Intensive Residential Program
87.5 days
Average length of stay for completion of Men’s Intensive Residential Program
100.3 days
Completion rate for Men’s Intensive Residential Program:
Non-professionals – 75%
Professionals – 88%
Overall completion – 78%
Percent of graduates transitioning to Extended Residential Program
57%
MRC clients who have been through at least one previous treatment experience
60%

21. Post Discharge Outcomes
data indicate 65% of men who completed the Intensive Residential Treatment Program are still abstinent and in active recovery after one year. We continue to monitor all male clients.