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How to be a disruptive force in addiction treatment

August 2, 2015
by Julie Miller, Editor in Chief
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When building a new treatment network from the ground up, an organization has the unique opportunity to cherry-pick the  best practices for its foundation and deliver service that rewrites the status quo.

That’s the vision for the emerging Recovery Centers of America (RCA) brand, according to Deni Carise, chief clinical officer, who spoke at the Behavioral Healthcare Executive Summit today in St. Louis. With $240 million in private equity funding and eight properties set to open next year, RCA has also met its share of challenges.

Carise said one significant struggle for the roll-out organization has been educating local communities on the reality of addiction today and the role of treatment centers.

“If opioid abuse is an epidemic and a leading cause of accidental death, why do I have to beg to provide services, and why do I have to force a community zoning board to let me become part of the solution and invest $20 million?” she said. 

Even with convincing evidence of the positive effect treatment access can have on a community, some neighborhoods simply won’t have it. On one occasion, a gentleman with a “not in my backyard” attitude personally threatened Carise with harm if she dared to open a treatment center in his community. 

It seems ironic that an organization that can help neighborhoods fight an epidemic--and she does believe opioid abuse is by definition an epidemic--would be met with such resistance.

Carise advises that providers entering new areas should specifically communicate what they plan to do for the community and dispel any myths about the population accessing services. 

“If you find a great place in a neighborhood with real need, and you can do something really special, you want to go and fight the fight,” she said.

Doing better

RCA is recruiting a comprehensive advisory board of addiction specialists and clinical researchers who will meet twice a year and evaluate new best practices, including care for special populations. Carise said the idea is to bring in a dream team of top thought leaders to create a better system of care that challenges the prevailing delivery norms.

For example, she believes the “fly away” model in which a patient travels by plane to access treatment is too risky. There are too many time delays and breaking points where the patient could abandon the decision to get treatment. A neighborhood treatment center is better because a patient can enter care in hours instead of days.

Also, she said, the regimented daily agenda for those in treatment offers little choice. It’s better to provide a few choices for patients in each time block of their day, which allows for a far more individualized treatment experience.

“We owe it to ourselves and our clients to do better," she said.

Carise also recommended other improvements to build a superior care model:

  • Use evidence-based treatment modalities;
  • Obtain accreditation;
  • Measure performance;
  • Use an electronic medical record system;
  • Offer patients choices rather than regimented agendas;
  • Create solid care transitions;
  • Make time to thoroughly train staff;
  • Optimize staff-to-patient ratios; and
  • Participate in dialog to discover and meet the local community needs.





I applaud RCA for rewriting the status quo with respect to treatment. The treatment industry is one of the last remaining bastions of volume-based, fee-for-service delivery systems. It's about time that a private equity group breathed some life into a model that's been broken for decades. Now, if RCA will only design treatment to be but a part of a broad chronic care model, including unlimited access to recovery support services, that delivers outcomes that matter to patients and payors, it might just thrive in a new world order that rewards performance.

Did anyone bother to ask this guy WHY he didn't want a treatment center "in his own backyard? It is possible you know that maybe the 12 step recovery in the area is strong and your treatment center threatens this. Old timers are deliberately moving to rural areas to GET AWAY from the reach of treatment centers. You treat our program like we're not even an issue to consider. It may be that the recovery is doing well in that town and they don't want you to mess it up. In Allentown for example there is a very strong NA there. Their rates of those who come to NA are very high. If you were to bring in a treatment center you're going to be pumping more of these people who are absolutely not serious in about 98 percent of the cases into the meetings. As for flying out of town - in many cases getting the heck out of town might be the safest thing for them - especially in cases of abused women. It would help to ask and leave it up to the client. If they're going to run before they get there - they aren't ready. Something to think about.