"One of the things that I we provide at the detox level of care at New Waters Recovery and other institutions like us, is we're able to provide the sense of safety for the client and the client's stakeholders, their family, and loved ones."

Ryan Jarrell

Justin and Ryan Audio

Justin Mclendon: [00:00:00] All right guys. Thank you. Thank you for joining us today at new Waters Recovery. My name's Justin McLendon. I'm the Executive director here at New Waters Recovery. I'm also a dually licensed therapist. I specialize in substance, substance use counseling, and then also in mental health counseling as well.

And I am joined by Ryan Jarrell, who is our continuing care coo. And Ryan, we thank you for being on the show today, man. Absolutely.

Ryan Jarrell: Thank you so much for having me, Justin. I really enjoy the fact that we're able to have these kind of conversations and provide education because it's such a befuddling kind of world to anyone who's an outsider, you know?

Absolutely, completely

Justin Mclendon: agree. So today we're gonna be focusing on The levels of care and addiction treatment. And we're also gonna be talking about the, that continuum of care and how that, that those level of levels of care can kind of flow and how they're intended to work. So Ryan, so maybe we could start off with just identifying what those levels of care

Ryan Jarrell: are.

Absolutely. Yeah. And again, like I really can't stress how difficult this can be to the [00:01:00] outsider family who maybe hasn't had substance use or maybe never had treated substance use in their family before. And we're battling against like Hollywood's depiction of what the levels of care are, right?

Absolutely. Which is usually like a cut scene. Sunny room where someone's doing yoga and then someone's sitting in an Alcoholics Anonymous meeting that doesn't resemble any Alcoholics Anonymous meeting that anyone's ever been in. Right. So how we kind of like battle that image is by trying to provide these kind of this kind of education.

There are different levels of care. And a lot of times they're defined partially by insurance companies, partially by best practice, by clinical visions of institutions you know, a addiction treatment. HA has had a really interesting development and I think like the evolution is very inherent in, in how it presents today.

I'd like to go kind of sequentially through these levels of care from highest level of care, with the highest level of medical, medical acuity all the way down. Sure. And the first is detox or medical detoxification. And this will be a period of time that will be focused really deeply on the medical aspects of [00:02:00] of someone who is withdrawing from a substance their, their body has gained a physical dependence towards mm-hmm.

These can be integrated into residential treatment facilities, or that can be standalone facilities like New Waters is mm-hmm. . We really can't underscore like how important detoxification is. And Justin, you know, from your own personal experience that someone who is going through detox from something like alcohol or benzodiazepines, they're not just uncomfortable, they have a real risk of dying.

Yeah,

Justin Mclendon: absolutely. Absolutely. And I think that's a, that's a thing, right? I mean, you do in A lot of times I think people think that they can just simply stop using a substance. And sometimes a lot of people seek this type of care and support on an outpatient basis. And I think the reality around it is when the level of severity of that use, especially with certain substances get to a certain point it becomes a, a potential medical emergency.

Sometimes if says, if someone doesn't have the correct supervision and medical care on board to make sure that we can, that we can [00:03:00] Avoid those potential risks that surround that.

Ryan Jarrell: Absolutely. You know, one of the things that I think we provide at the detox level of care at New Waters Recovery and other institutions like us, is we're able to provide this sense of safety for the client and the client's, stakeholders, their family, and loved ones.

Absolutely. You know, and allow them to know that they are in a safe place, being closely medically observed. detox. I think a lot of times people have the conception and I will really put myself out there. Like I had the conception that sure, I would go to detox, I would have a, a physical malady dealt with mm-hmm.

I would have a, a physical illness and a physical dependence removed and then I would be able to go on about my life. This is something that we've seen. Empirically again and again is, is not best practice for treatment. While a detox will deal with the physical dependence to a substance and hopefully make you comfortable and give you an introduction in solid clinical backing the real work is gonna come afterwards.

The real work is gonna be dealing with the mental. The emotional coping systems that you have built in place that have led you to use substances again and again. [00:04:00] Absolutely. And a detox is normally a week, and it's just not the right place to do that kind of therapeutic work. So residential level of treatment is the next level of care.

Mm-hmm. This would be inpatient treatment. You, there would be some medical staff, certainly available. You'd see. Depending on the institution of course, but you'd see psychiatrists, nurses would be present, et cetera. This could last anywhere from 30, 60 to 90 days. And this is where you do the real work, both yourself and your family in healing and learning coping skills from this disease.

Mm-hmm. . Justin, as someone who's worked in these kind of settings before as clinical director, I was wondering if you could, you know, share with us a little bit also about, Clinical aspects of, of that timeframe specifically.

Justin Mclendon: Yeah, absolutely. And as you mentioned, Ryan, you know, it can be, you know, kind of traditionally we think about these residential levels of care of being like these 28 day programs or 30 day programs, but to your point, right, sometimes it's important for someone to actually remain at that level for longer.

Right. And I think nowadays, maybe in the past 10 to 15 years or so, we are seeing more of these kind of 90 day models of [00:05:00] residential treatment emerge. And I think that's really based on a lot of research that's showing. For certain individuals longer periods of time in a controlled environment to where, you know, there's simply number one, no access to those substances.

And then also just being able to do some deeper work with 24 hour support can really increase suc, you know, chances of successful outcome in the, in the long term. . But a lot of that work would be, you know, group therapy, individual therapy integrating the family into that recovery process, providing education not only to the client but to the family.

And again, being able to dive in and do some really deep, intensive work in an, in an environment that is controlled, right? Where someone doesn't have to necessarily worry about having a a pretty. Pretty big emotional response to any particular clinical intervention. And then that being a trigger for them to fall back into old patterns or behavior or to isolate or to do something that's not gonna necessarily be productive in moving them along.

That, that continuum of [00:06:00] recovery doing that work in a, in an environment to where, if they do have a strong emotional response, there's clinical, there's medical staff, there's support staff to be there with them to encourage them to make sure that they're safe and that to make sure that we keep them on that track of moving forward and not necessarily regressing.

Right. Because I think a lot of this work. That that has to happen is is deep. It is difficult. And I think a lot of times, you know, for someone that's really struggling in those early stages of recovery our, our first response can be, going backwards, right. Kind of reverting, if you will.

Right. So that's why I think it is very important. It's very important that we give ourself that opportunity to get the help that we need in an environment that can support us until we are stable and ready enough to kind of step down to our lower level of care. And then we have the skills in place at that point to where we have a better chance of being able to navigate things in the, in the real world, so to speak.

Ryan Jarrell: Absolutely. I, you know, I, I know from my own personal recovery experience, like I really struggled with relapse for a [00:07:00] period of time. Mm-hmm. . And the issue is that I would get, I would get one bad thought and I couldn't get it out of there. And drugs and alcohol were easily available to me. Right. And that was it.

And I think something that I think maybe you know, People don't necessarily give enough credit to when they're looking at residential treatment is you get to spend 36 or 90 days without the temptation of alcohol and drugs. Right. And it seems so basic, but we can't underscore how important that is.

Absolutely. Because there are well-meaning people out there who spend 45 days doing fantastically, and on the 46 day they get a bad idea that they just can't shake, they're not in a healthy environment and they can end up doing some real damage. You know, Absolut. We've learned so much about the treatment of addiction and, and I think one of the things that I, I really love about working with, with professionals like yourself is just that we really believe that people deserve the best.

Level of care possible for themselves. Absolutely. Absolutely. So residential provides not just that kind of physical removal from alcohol, the, the clinical work that you described it, it also provides a venue for families not only to get [00:08:00] some rest and take a step back, right. And know that their loved one is in a safe place, but ideally engage in some of that family programming so that everyone can engage in this process of recovery both separately and together.

Absolutely. Post, post residential. You know, people will, will be discharged. There is, of course, you can't remain in an institution forever. You have to venture out into the world. So how do we best equip people to do that? Well, there are differing ways. You know, even though it may not be done directly, a lot of times in these treatment settings, people will take stock of, of recovery capital.

The things that, the resources that you have to bear that would seem to lean towards having a good outcome for long-term sobriety and recovery. Depending on someone's family situation, they might be recommended to move into a. Situation. Mm-hmm. , especially for people who live alone people who don't have those methods of accountability built into their domestic situation, or they're just not coming back to a healthy environment.

Sober living can be an excellent environment, not only to have that accountability built in, but develop a community of recovery, which is a huge, huge recovery capital supplier. [00:09:00] Absolutely. And this would usually be paired. Continued group therapy, either at a php, a partial hospitalization program, which is a super scary word when I tell people that they're not familiar with it.

But this is outpatient programming, multiple days a week or an intensive outpatient that's a lower level of care. Again, it would be outpatient group therapy that meets several times a week. Mm-hmm.

Justin Mclendon: and real quick. Just to add a little bit more color there. So that partial hospitalization or what we, you know, the acronym is php.

Typically that is more days, right? More days, more clinical hours than an intensive outpatient or also what we call an I O P. And then for partial hospitalization, I believe the regulations are, I think it's 20 to 25 hours a week of clinical services. So typically you're seeing that as a, you know, a multi-day process.

You're either there kind of Monday through Friday. Sometimes this, this can even be a seven day a week thing. But as you said, Ryan, that is on an outpatient basis, right? Whether you're living at home and you're coming in, you know, to the, you know, the facility or the building [00:10:00] for those services. Or if you're living in a sober, sober home environment and then coming in, you are, you are coming in each day to a facility to receive those services and then essentially returning to the community in, in some way.

as to where intensive outpatient or i o p is usually about nine to 10 hours a week. So similar, right? You're in the community, you're either living at home or with a loved one or whatever that looks like, or living in a sober home and then coming in during during the day to that, that intensive outpatient program where you're receiving and usually, you know, kind of a standard.

The way that most people do this is it's about three days a week. And you usually do three, three hour groups. Kind of spread throughout the week. And then typically these places are also, whether you're at the partial hospitalization level of care or the intensive outpatient level of care, you're also doing some individual therapy and typically some continued family work as

Ryan Jarrell: well.

Absolutely, absolutely. Providing those kind of measures of support and building a community around you and just getting to know [00:11:00] what this real life will be like. Hopefully with the coping skills that you've built up in your residential treatment and detox day. Mm-hmm. You know, the final kind of level of care if it would be outpatient care.

Probably continuing to see an outpatient therapist, continuing to see a psychiatric provider for medication management. Ideally, one who is specializes in addiction and definitely one who is aware. of your substance use disorder. Right. And the history of it and engaging in community support groups, whether it's 12 step groups such as Alcoholics Anonymous and Narcotics Anonymous Dharma or Refuge Recovery or Smart Recovery.

Mm-hmm. , just trying to find that independent. That independent community that can help support you? You know, I, I reali, I mean, as we've talked about this, we've talked about highest level of medical acuity detox. Mm-hmm. and residential treatment, 36 year, 90 days, i o P or php. That's an additional length of time.

And then this final outpatient level, and I'm sure plenty of people who are new to treatment. Who are maybe exploring the idea of, of wondering what they can do to separate substances from their lives. Or thinking like, how am I gonna have the time right to do this? Right. You know? [00:12:00] And I was wondering if you had any, any thoughts, Justin?

Because I, I know that that's a common thing that people bring when they become overwhelmed by the amount of time they'll have to invest in it.

Justin Mclendon: Absolutely. And I think, and we could, we could kind of speak to each level of that. So, you know, I think, you know, backing up to those, those inpatient levels of care, which are detox in that residential treatment, which is, you know, underneath the detox level it is true, right?

You can't continue to work and, and do those things and also be in a residential program. It's just those two things typically can't coexist. There are some programs out there, you know, for someone that may be a high level executive or someone that doesn't. The luxury of being able to completely sever ties with their, with their job temporarily so that they can get the help they need.

There are some programs that are available that you can continue to have your electronics, you know, if you need to log in and take care of some payroll and things like that. Those things do exist. We actually offer some of those things here at New Waters Recovery. If, if that is a true barrier for someone to be able to come in and get the help that they need [00:13:00] there are programs available that can allow them to not work necessarily full-time, but still be able to keep some touch with those responsibilities that they have in their life and get, you know, take care of those things.

So, so it would take, I think for most individuals it would take a willing. And also the support, you know, from work and from family and friends to, to provide the space for that individual to, to step away, you know, for potentially months at a time to focus on their health. Right. And I'd like to compare this to, because we do view addiction as a, as a, as a neurological disease, right?

Mm-hmm. a neurological disorder, and, and I. A lot of times people struggle with that idea of kind of pulling away from work and other family and life responsibilities to focus on their treatment. But I think it, it's, it's just very interesting to me that if someone was. Was given a potentially terminal diagnosis, a medical diagnosis and told that they were gonna need to do that same thing to pull out of work and other life [00:14:00] responsibilities to focus on that treatment.

It's just interesting to me how people are usually more likely to, to find the ways to get that, that freedom, if you will, so that they can focus on that medical disease. , but not so much for the addiction and the mental health. But I would say that it. Just as important, right? If for us to live a you know, a life that's hopefully full of freedom and peace and happiness and, and just a healthy lifestyle.

In order for us to accomplish that, sometimes it is just crucial for us to find a way to let people around us, whether that's our employers or our families, support us in a way that we can step away and we can truly focus on our, on our, on our health. Right? Absolutely. And I think also when we step down to that, that partial hospitalization, that intensive outpatient level of care it's, it's a lot of time.

I mean, when we're talking, you know, anywhere from 10 to 25 hours a week. That is a lot of time. I think there is a way for someone to maybe kind of return to work or still be able [00:15:00] to engage in some of those family and life responsibilities but being realistic about the fact that it is not going to look the same as if we were not engaged in treatment.

So it is important again to allow the people around us to support us, give us the space that we need to, where we can continue to focus on our treat. But then also I think as part of, of stepping back into to life and finding ways to cope with those, maybe also taking on some of those life responsibilities or maybe even taking on some of that work again.

but being realistic that it's gonna probably have to be more of a part-time type schedule. Right? Absolutely. I think it's really at the, at the intensive outpatient level, there's more freedom. You're doing 10 hours a week of clinical services. I think most people find at that level of care, they usually can reengage in work and other responsibilities that they need to attend to.

But it's not until you get to that true outpatient level where we're talking. You know, one to five, if you will, hours of clinical services a week. At that point, [00:16:00] I think most people are able to find, they're able to, you know, work full-time jobs, you know, attend to their families and their life responsibilities also be able to continue that treatment that's so necessary

Ryan Jarrell: for them.

Absolutely. I mean, it just strikes me that really at the end of the day what we're dealing with is, is battling an, it's an uphill battle against stigma. Yes. And the deep. Shame and guilt that accompanies this. And just like you said, if someone had bone cancer, right. You know, no one's weighing the days.

No one's saying, I'll go in for seven days and then come back out, but I'm not doing the 30 day program. Right. Like, it's just not gonna happen. And, and there's a real a real sad and sick belief at the core of this is that yeah, people with addiction do not deserve the best treatment possible.

Justin Mclendon: It's unfortunate,

Ryan Jarrell: but it's true.

PE people with addiction deserve to kind of suffer through things. and and, and just kind of soldier on regardless. Mm-hmm. . And, you know, I can't tell you, and I know you have this experience as well, right. When people are ready for help, regardless of what they've gone through before you see employers, you see family members, they stand up with open arms to help this person on the next level of care.

[00:17:00] Absolutely. Because at the end of the day, we, when you're deeply involved with someone, when you see someone suffering you, you want them to get better regardless of the nature of the valid. Absolutely. So it's, it's sad when people have this kind of sense of sh of shame and guilt that is, is blocking them from, from accessing that care.

You know, isn't your life worth engaging this process regardless of the amount of time, regardless of if it was a year, you know isn't it worth doing this so that you can be fully present for others in your life and, and enjoy the fruits of it. Yeah. Yeah, Absolut. But it's just, it's, it's just an unfortunate thing, you know?

And it's something that, you know, I know I had to personally struggle with and, and many others on our staff had to as well. Absolutely. I

Justin Mclendon: Oh, please go ahead. I was, I was gonna say, I think another thing that's important for us to touch on is you know, and Ryan, I think you've probably seen a lot of this as well, is, you know, when someone does get to a place where they're ready to take that step into treatment.

You know, similar to what you were just saying, I think there's a lot of stigma. I think number one, it takes a lot of courage to be willing to [00:18:00] take that step and just even to entertain the idea of, of seeking treatment takes a lot of courage, I think. But I think something that a lot of people struggle with is this idea of like, I can just.

put forth maybe some minimal effort or that I can find this kind of one, you know, magical thing that I can do and I can spend a minimal amount, a minimal amount of time on myself and my treatment and just kind of, you know, quote unquote cure this situation and then I can just get back to living my life and everything should be, should be fine.

Mm-hmm. And I, and I wonder, Ryan, if maybe you could speak to the importance I think that we see, especially working in this profession of, you know, having a solid assessment and then following through with this continuum of care in a way that you can truly get the treatment that we need. Any thoughts on that?

Yeah,

Ryan Jarrell: absolutely. I mean, I think at the end of the day, what we're talking about is just best practice, right? We're talking about meta studies that have been done on people all across the country suffering from this disease and. , what is the number one best track of treatment? You [00:19:00] know, I, I tell people in my office all the time, you know, if you had cancer, I'm not gonna recommend the third best chemotherapy.

I'm not recommending you the second best course of treatment. I'm gonna recommend to you the best to fight against a fatal malady. Mm-hmm. , I think it's a essential, you know, an essential part of the recovery process. Well, a befuddling part of the recovery process is there was a point in time in which I had become unwittingly my own worst.

And that was in ways that I knew very directly and ways that I did not know very directly, especially surrounding my fears and anxieties and these fears and anxieties over issues real or imagined would often the strain of those would lead me back to a bottle or a bag, you know? Right. And so I think I needed a period of threshing time.

I needed a period of time where I really needed to not make so many decisions for a little while. Yeah, because sometimes my decisions were good in those periods of time where I was struggling to maintain sobriety, and sometimes they completely befuddling wound me back up at the bottom. So just surrendering a little bit and allowing others to guide you.

To some [00:20:00] areas that might be, to guide you out of a blind spot is, is just really, really important. In all other areas of our life, we're gonna seek medical professionals constantly. And yet for some reason when it comes to behavioral health and mental health, there's just so much resistance there, you know?

That's true. Yeah, I think following that continuative care is just essential. Yeah,

Justin Mclendon: absolutely. And, and to your point, I think. . There's just a pro, a profound amount of research. And also I think just professional experience that we see these things live out in real time that, you know. We want to take this serious.

We don't want to continue to bounce in and out of treatment or to struggle with this disease for any longer than is necessary. Right? And I, I think it's important that when someone develops the, the courage and the willingness to take that step, that that's, you know, so important step of, of seeking treatment for their self.

It is important to just hit it with everything they have, right? Mm-hmm. . Mm-hmm. . And and again, I, I think we're, we're. So much research show that if we start at the most appropriate level of care, whether that be [00:21:00] detox, residential that we start at that appropriate level of care and that we follow the recommendations from the professionals involved and slowly step down through those levels of care to make sure that we are receiving not only just in, you know, a timeframe but levels of intensity to make sure that we are truly getting all of the treatment that we need.

It just literally is going to greatly impact the, the chances of being able to be successful in our recovery moving

Ryan Jarrell: forward. Absolutely. There's nothing more heartbreaking, and I've seen this multiple times where we have some wind in my office, we have a suggested level of care for whatever reason they're resistant, right?

Mm-hmm. , and they end up leaving, and then we get the. Three weeks later, a month later, five weeks later, and they're sitting right back in my office again. Right. You know, we've had experiences like that recently and mm-hmm. and it, you know, to cut through that kind, the level of sadness and shame and guilt that they talked to me and there's no, there's no judgment here.

You know what I mean? Right. We've all made plenty of, plenty of mistakes in the past, but I just wish I could erase [00:22:00] the pain and the damage that they've done in those months prior. Right. And more often than not, they do end up engaging in the appropriate level of care, but they've, they've. It's cost a lot, both resource wise and personally in the interim.

Justin Mclendon: Absolutely. So, Ryan, what would be one thing if there was a family member or you know, a potential identified client that was, that was listening or watching this, this episode, what would be like one thing that you would have them take away from all of this?

Ryan Jarrell: Yeah, I think one thing that. I would really want them to take away from it would be to know that it's all right to ask for help.

And I think there's a really deep belief, and it sounds really cliche, and like it would, you know, come on the underside of a yogurt container or something like that, . But that, that, that it's okay to ask for help. And if you can't speak openly and transparently about something to somebody, you gotta find someone to speak that stuff to.

And it's probably because there's a lot of shame and guilt surrounding that issue. So to be candid with someone, ideally a professional about where you. Yeah. There's a a great deal of relief that [00:23:00] can come from that and they can guide you on a course towards getting some real some real healing and wholeness, you know?

Absolutely.

Justin Mclendon: Well said, Ryan. Well said. I guess in, in closing, I would say especially again, you know, to anybody that's listening to this or watching that is a family member that is maybe looking into treatment options for a loved one, or maybe you're someone that is struggling with addiction. And you're just trying to find out what's the first step?

What do I do? I think, you know, my biggest recommendation is the best place to start is a conversation with a professional. Right? And here at New Waters Recovery, I mean, we have those conversations on a daily basis. All you have to do is just call us and we will free of charge. I mean, we will have a conversation with you, we'll d we'll we'll gather some history on what's been going on and we'll try to help navigate, whether that's with us or with another provider that is gonna meet your needs.

I think that is the best step. And that's not only with us, I think any other high quality program around, whether that's in the state of North Carolina or across the country or the world for that, That is always the [00:24:00] best, the first best step. And to, Ryan, to your point, I think having the, the willingness and the courage to, to ask for help can give you the opportunity to get a professional on the phone or, you know, on an internet chat or whatever that is, to be able to just start that conversation about like, hey, You know, openly and honestly, this is what's going on with me.

And, and let someone provide that guidance about what that, that first step can look like. And really, in my opinion, I mean, taking that first step and being willing can open the doors to, to so many other things, to where we just don't have to struggle with this stuff for the rest of our life. You know?

Ryan Jarrell: Absolutely. I, it, it's, it's another cliche, but it's always been very powerful to me. You know, someone told me one time, listen, you never have to drink ever, ever again. And it's, it's, it's so simple and such a basic fact, but if you are struggling with this or you have a loved one who is struggling with this, they never have to do it ever, ever again.

And they have the chance to put this thing in the ground, you know? It, it's just gonna take s some willingness and, and and some, some real open-mindedness. Absolutely. And willing to go to some [00:25:00] places, some scary places, both as a family and, and as an individual. It's the best. You know, I say this all the time, right?

It is the best time in the history of man to have addiction issues. Mm. And if you're in America, you're in the best possible country to receive really quality services. So if you're struggling with this or thinking about it, just take advantage while you can, you know, you don't have to live in that.

Confusing morass of gross emotional weight of I've engaged in this compulsive behavior that I don't like. You don't have to live in that again, again and again anymore,

Justin Mclendon: you know? Absolutely. Completely agree. Well, Ryan, I, I appreciate you hanging out with me and taking some time to discuss this topic. I know we both feel very passionately about this specifically, and hopefully anybody that's watching or listening, hopefully everybody's learned a little something from this.

And again, if there's any way that we can help that is literally what we love to do, right? So we'd love to help any way that we can. Thank you guys.

Ryan Jarrell: Thank you so much, Justin. Yeah.

Join our Executive Director, Justin McLendon, and our Continuing Care COO, Ryan Jarrell, as they discuss the levels of care in addiction treatment and the continuum of care. Ryan is a specialist in substance use counseling and mental health counseling, while Justin shares his personal experience with addiction. They stress the importance of understanding the levels of care, starting with medical detoxification, which is crucial for someone who is withdrawing from a substance and can be life-threatening. This show will help you gain a better understanding of addiction treatment and provide a comprehensive overview of the care and support needed for those struggling with addiction. Tune in to learn more.