NEW BHG MODEL WILL REVOLUTIONIZE ADDICTION TREATMENT, JUNE ’21

For too long, patients struggling with OUD and SUD have received episodic care inside treatment centers with a “dose-and-go” clinical model, which can assist people in abstaining from opioids, but doesn’t help them find their way to real recovery. While other diseases like cancer and diabetes have clear protocols and dimensional care plans, addiction treatment in this country operates under programmatically-driven frameworks that put people in an ineffective, one-size-fits-all recovery box, leaving patients to their own devices in the outside world where triggers lie in wait. BHG has long challenged this paradigm and has made good progress over the years, but it’s time to make it great through our new Integrated Dynamic Care ModelSM (IDCM). 

For the past couple of months, I’ve been on a road show presenting to our teams how the IDCM will revolutionize addiction treatment by filling the gaps in care that our patients need to have for any chance at real recovery. If I haven’t made it to your area yet, I look forward to discussing this with you in person soon. In the meantime, here’s a summary of what it is and why it matters.

What is IDCM?

The IDCM helps patients struggling with OUD and SUD remain connected to the holistic care and support they need as their journey toward recovery ebbs and flows. Three different clinical pathways enable care teams to expand and contract based on where patients are in their battle, including support from community services that provide resources for basic needs to help them sustain recovery.

The desired outcome is real recovery — where a person is capable of re-entering society as a changed individual, not only sober, but capable of maintaining sobriety through healthy coping mechanisms.

Why IDCM matters

Nicole Ross, Program Director for the Asheville and Clyde treatment centers that are seeing success with IDCM, succinctly described why it matters.

“Healing isn’t linear.”  

Like other chronic diseases, addiction is dimensional. The Center of Addiction compares it to other diseases like diabetes or cancer since it’s caused by a combination of behavioral, environmental and biological factors.

For medical professionals, these other chronic conditions have clear flow charts for what to do and when. What our industry has followed are merely regulatory frameworks, not levels of care, for OTPs and OBOTs. These frameworks lack: data to guide which patient should go to which type of setting, clear guidelines on which medication to use, and how frequently patients should do counseling.

So many treatment programs for OUD focus simply on stopping use of the drug, especially within the space of Medication-Assisted Treatment (MAT). These facilities often measure success by retention. But medication should be a starting point, not an end result to be measured and filed under “mission accomplished” after a few months of avoiding opioid use. The patient who achieves abstinence without addressing the dysfunction that caused them to use opioids in the first place has not recovered. They’re the same person they were before the addiction began, and likely to repeat the same means they used to mitigate stressors.

Understanding that addiction is dimensional is fundamental when it comes to relapse — a relapse that could lead to overdose. Sadly, we know that even if a person is in remission, the possibility of relapse remains. Not every slip turns into a relapse, but every relapse starts with a slip.

If OUD is dimensional, treatment should be, too. To achieve real recovery, we need to change how we define the goal of treatment. To do that, we need to see OUD from the patient’s perspective. When we see that every person experiences addiction differently, we can structure the treatment to change with the needs of the patient, providing the appropriate level of medical services and support depending on where they are on the spectrum of OUD.

BHG is making dimensional treatment possible with the IDCM.

How does IDCM work?

We are establishing a standard of care and flexible pathways so that you and your patients are never without a compass and a map. Because standards are not the same across every state, we’ve created a model that can exist in different regulatory settings. The IDCM and full wrap-around services were developed to address patients’ holistic needs throughout the entire recovery journey. These programs integrate evidence-based, Medication-Assisted Treatment (MAT) with behavioral health therapy and counseling.

Most importantly, they meet each patient where they are as a unique individual, providing dynamic, flexible treatment and ongoing care as their goals, motivations and needs change on their personal path toward recovery.

Individual treatment plans that flex through levels of care

Every patient has an individual treatment plan and goals that start the moment they enroll in BHG’s program. The motivation and clinical needs of each patient inform where they start on their personalized recovery journey.

Providing the most intensive treatment, BHG’s Comprehensive Outpatient Experience, known as COPE, outlines a three-phase treatment plan over the course of 12 weeks. The structure of COPE incorporates intensive outpatient programming, along with early and late extended outpatient treatment, delivered simultaneously with medication-assisted recovery. COPE is designed to gradually decrease treatment intensity over time and allow patients to incrementally test out new skills and strategies as they stabilize.

Standard programming incorporates medication-assisted recovery with counseling to safely move patients from intake through stabilization, maintenance and long-term recovery, including co-occurring health conditions. BHG structures the treatment to change with the needs of the patient, providing the appropriate level of medical services and support as designed in their individual treatment plan.

Motivational enhancement programming provides care for patients who may be struggling on their recovery journey. The IDCM looks at the bigger picture for patients and allows connection to happen in the way that can be most helpful. When the patient is ready, they know the staff at the center will be there for them and ready to re-engage.


A Program Director’s Perspective

Nicole Ross is no stranger to the human services field, both personally and professionally. Today she is 13 years IV heroin-free and has custody of all of her children. Her lived experience has fueled her passion to get a master’s in counseling and work with people struggling with substance use.

“I’ve had so many different treatment attempts. That’s why I’m so passionate about everyone’s recovery looking different.”

Nicole began working at BHG three years ago as a counselor, then a clinical supervisor. Last June, she became PD for the Asheville and Clyde treatment centers. Both of the clinics began following the IDCM six months ago.

“We are seeing good outcomes and that the patients feel supported and recognized as individuals. Patient buy-in is everything. We make sure the program is client led and start by asking what their goals are and what recovery looks like to them. We build a treatment plan around their answers. We know that it’s working and that people thrive when they are heard.”

“Let’s say, for example, that we’re going to work with a brand new mom. We’ll call her Alice. She’s three days post-delivery, and her baby is in the NICU. She’s food and housing insecure and already has an open case with the Department of Social Services (DSS) which keeps calling her. Alice is highly motivated and has significant stressors in addition to her OUD.” 

With her history, Alice was assessed and placed in the COPE program at induction.  However, she had significant challenges from the start. Alice doesn’t want to be “non-compliant,” but there are things in her life that are keeping her from engaging. We need to find out what we can do to support her and we also need to move her into the motivational enhancement program to keep her engaged and safe.” 

“One of the things I appreciate most about the IDCM is when a patient may not be ready. At that point, how can we can keep her safe? Healing is not linear. It’s not a straight line. Everybody recovers at their own rate. How can we keep her safe and engaged until she’s ready to do a higher level of healing?”


As we roll out IDCM

As we roll out the IDCM in phases this year, consider the following:

  • Listen to patient feedback. On day one, ask your new client what their goals are and what recovery looks like to them. Find out what their living and social conditions are like. That will inform which program should be their starting point. Carefully assess their level of motivation to fully commit to a recovery journey.
  • Remember that this is a time to say ‘yes.’ Just because a client isn’t fully engaged doesn’t mean we can’t say yes to necessary medication and emotional outreach while they find their way back into our program.
  • Tell your community about IDCM. This is truly what we mean by ‘This is real recovery.’  The IDCM model provides long-term solutions for clients, families and communities. It’s a great story to tell and it’s unique to us!

We’ll continue to share stories in upcoming newsletters about how the IDCM is working. As always, I would love to hear from you to answer questions and share ideas. Reach out to me at Benjamin.Nordstrom@bhgrecovery.com or 603-306-6047. And, please continue to stay informed about COVID-19-related updates on our website.

Dr. Benjamin Nordstrom
Dr. Benjamin Nordstrom

Chief Medical Officer