Alternative to AA, 12-Step, Disease: Practical Recovery Services

We offer the full spectrum of addiction care: detox, traditional residential treatment, residential alternative, intensive outpatient, outpatient, brief treatment, and brief assessment.
Comprehensive assessment and treatment planning (including psychological testing: we choose among dozens of reliable and well validated tests)
Detailed review of personal history
Detailed cost-benefit analysis of your addictive behavior(s)
Individual sessions (the core of our program; most of the other services on this list are provided in individual sessions)
Couple and family sessions (family members may conference in by phone if needed)
Group sessions (support oriented, process, and workbook study groups)
Long distance counseling and coaching by telephone (or videophone)
Treatment team meetings (for selected clients)
Treatment for individuals ordered by a court or probation officer

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Focuses and methods of treatment

Problems of living, including parenting problems, work stress, relationship problems, legal problems, neighbor problems, money problems, perfectionism, guilt, upcoming decisions, etc.
Most co-morbid psychiatric and psychological disorders, including mood disorders (depression, bipolar), anxiety disorders (panic and agoraphobia, PTSD, GAD, OCD, phobia, social phobia), eating disorders, personality disorders, impulse disorders, sexual disorders, and ADHD
Stress related physical conditions, including psoriasis, IBS, headaches and asthma
Coping with craving training
Moderation or abstinence training
Motivational enhancement
Psycho-education (including assertiveness training, stress management, self-hypnosis, anger management, relaxation training, etc.)
Psychological pain management techniques
Social skills training (including dating and social conversation)
Relapse prevention training (especially high risk situation analysis)
Core belief identification and modification (cognitive restructuring)
Shyness, self-concept and self-esteem work
Catharsis (you talk, we listen; despite this extensive list of services, the experience of really being heard and understand remains one of the most powerful experiences most clients have here)
Shadowing and coaching out of the office (we can accompany you in tough situations)
Cue exposure and exposure training (in the office we have drug paraphernalia, alcohol, cigarettes, and other cues about substance use; we go out of the office as needed, including bars, dining out, preparing dinner, concerts, parties, parts of town, and 12-step meetings for addiction clients, and feared settings or situations for anxiety clients)
Specialized psychotherapeutic services (including hypnotherapy, neuro-feedback, EMDR, and TFT)
Smoking cessation (multi-modality)
Mind-body exercises
Breathing re-training (especially useful for anxiety)
Mindfulness and meditation training
Acceptance exercises
Pain management medications. Clients who need pain medications are encouraged to consider using them.
Psychiatric medications. Many of our clients are on anti-depressants or other psychiatric medications. Such medication use is ultimately your choice. Our experience suggests that these medications are over-prescribed.
Addiction medicine, including naltrexone, acamprosate, buprenorphine, Antabuse, bupropion (Zyban), nicotine replacement therapy, and other medications. Many of our clients use these medications. Their use is ultimately your choice. Our experience suggests they are often quite helpful.

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Support for treatment

Audio taping of selected psychotherapy sessions (if you provide the tape)
Assisted identification and experience with workbooks, treatment manuals, videotapes, self-help books, websites, literature and movies (extensive resources onsite)
Assisted journaling and behavior tracking
Activity scheduling (with electronic reminding system if needed)
Drug testing (on site, or off site referral)
Consultation with other psychotherapists or other professionals who are working with you (we regularly work in conjunction with other professionals of your choosing)

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Executive and business coaching and consultation

Business communication training

Executive and leadership development and coaching

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Referral for outside services

On site services include: addiction medicine, psychiatry, dietetics and nutritional counseling, acupuncture, massage, bodywork, meditation and yoga instruction. In some cases clients are referred to other providers off site when there is a better match between the off site provider and the client's needs.
Support groups (if desired; typically SMART Recovery, Women for Sobriety, Moderation Management, or LifeRing Secular Recovery)
Leadership Development Conferences at the Leadership Studies Program, University of San Diego, where some of us have been adjunct faculty
Ibogaine treatment, at a facility a short drive across the border in Mexico (http://www.ibogaine-therapy.net/). From their website: "Ibogaine is a natural medication used to detoxify addicts, which eliminates 80-90% of withdrawal symptoms. Published clinical trials show that it produces a reduction in post treatment drug craving. It also has psychedelic properties with powerful psychotherapeutic benefits." If ibogaine is unknown to you, then check out http://www.ibogaine.org/. We prepare clients for their ibogaine experience, then work with them afterwards to integrate the insights they have gained from it. We provide the same service for individuals who wish to have an ayahuasca experience as a support for recovery. Ayahuasca ceremonies normally occur in South America under the guidance of a local shaman. We have information to guide you in your selection of shaman and program.
Other medical, alternative medical, specialized psychological or health enhancement evaluations or services, including specialist physical evaluation, chiropractic, learning disorder interventions, neuropsychological assessment, biofeedback, art therapy, optometric vision development, exercise and fitness training, Pilates, spa experiences, and others.

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A Spa for the Spirit!

Although our list of services may seem overwhelming, in the first session or two we will collaborate to identify your principal goals and deepest values, and a course of action that suits them. Then we'll go to work. We'll keep refining our understanding of your needs, goals and values as we go. You may have attended a health spa before. We are a Spa for the Spirit!

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The Psychotherapy Team

PRS staff frequently works as a psychotherapy team. With your permission, you may see several staff members, each of whom will work with you on one or several specific aspects of your treatment plan. A major advantage of the team is that "several heads are better than one."

Our therapy team is one of our primary innovations. Although treatment teams exist in many healthcare settings, we know of no other team that consists of up to ten highly skilled doctoral level psychotherapists, each of whom is working intensively with you, yet coordinating treatment with the other therapists and the other providers. Our team meets formally three times per week, and informally as often as needed, to maximize your progress.

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Success rates

Inquirers understandably want to know, how successful will I be if I attend your program? We have several answers to this question, but not the answer many programs give (which is the percentage of "successful" graduates).

All of the primary treatments we offer have strong scientific support. This is not true of most programs. Traditional treatment (i.e., 12-step, disease model treatment) has not even been the subject of much government funded research. Government funded research currently investigates primarily cognitive-behavioral treatment (CBT), or similar treatments, because for now CBT is considered state of the art psychotherapy. CBT is at the heart of our services. We also continue to investigate and incorporate promising new approaches, so that we stay state of the art.

Almost all good research is government funded, because good research is so expensive. Treatment programs cannot afford to conduct good outcome research. They would go out of business if they passed these costs onto the consumer. The largest study of alcohol treatment ever conducted (Project MATCH) cost about $33 million dollars, and followed 1,726 clients for two years. When you divide the cost of the study by the number of sessions actually conducted, each 45 minute session cost over $1500! This study, published in late 1996, was actually the first significant evidence that 12-step based treatment might be effective. Subsequent research has yielded mixed results.

Click here to read more about Project MATCH

Unless a "success rate" study is conducted at or near this level of rigor, whatever statistics a program offers are open to significant scientific objections. It's hard to know how much faith to put in them. Furthermore, almost everyone has slips after treatment, regardless of which program they attend. Should these clients get counted as failures? There is no simple way to handle this. What you are really interested in is the amount of change over the long term. There is no way to assess this at any one moment in time, which is all a "success rate" can ever tell you, and about all a treatment center can afford to investigate.

Scientific papers themselves do not use a term like "success rate," for the reasons just mentioned. Whatever summary statistics might be found in a scientific paper are invariably lower than any "success rate" a treatment program publicizes. If a program's success rates are so good, why aren't they published in the scientific literature?

There is an even more powerful reason why a "success rate" is not informative. By the time someone is suitable for intensive addiction treatment, the chances are good the addictive behavior has become a well established pattern. A single treatment, without any substantial followup, is unlikely to be successful. As Dr. Tom McClelland at the University of Pennsylvania has argued, we need to consider addiction to be like other long-term conditions, such as asthma, hypertension or diabetes. No one expects that a single treatment will "cure" these conditions. Instead our perspective is, if this individual makes all of the needed changes, and continues to do so for a long time or indefinitely, then can this problem be reduced or completely controlled?

Of course you will likely be successful while in a treatment program (especially residential treatment, where you can't get to your substances or activities!). But what happens afterward. That is why we spend a substantial amount of time determining what changes you need to maintain in your life, in order to maintain the success that you are likely to leave treatment with.

If you are committed to change, almost any program will help (if it seems sensible to you), but if you are not committed to change, almost no program will help. Whenever it is important enough, people change. You have already (even if you don't remember it) controlled your behavior when it was important enough. Is this change important enough to you right now?

What we will do is help you to decide deeply, even more deeply than you already have, that change is important enough. Then we will help you follow through on that decision. Along the way we will help you identify and overcome related issues so that you don't decide to go back to addictive behavior because life without it is miserable. Most of our time is actually spent on these related issues, because teaching someone how to cope with craving (the central issue in addiction itself) is relatively simple. How successful our efforts will be is mostly up to you.

What is amazing is the number of individuals who can read the above paragraph, realize their own fundamental role in change, decide to change on their own, and then not actually follow through. However you decide to change, if you are not going to follow through NOW, then WHEN? Indeed, there might be good reasons not to begin immediately, but when will you begin?

So, we suggest you not get distracted by "success rates." Pick a course of action, then do it! Even a small step is better than nothing, and builds confidence for the next step. We would also like to emphasize that we maintain long term, informal contact with many of our clients. Although we do not summarize these contacts into a single success rate, we observe long term success regularly, particularly among those who are deeply committed to maintaining change.

Let's conclude this section with a scientific paper that addresses the issue of success rates. Drs. Miller, Walters, and Bennett, writing in the Journal of Studies on Alcohol (2001, March issue, Vol. 62, No. 2, pages 211-220, How effective is alcoholism treatment in the United States?), summarized their work combining the results from seven large multi-site studies. In the year after treatment 1 in 4 clients remained abstinent, and 1 in 10 used alcohol moderately. The remaining clients improved substantially on average, abstaining 3 of 4 days and reducing alcohol consumption by 87%. Alcohol related problems decreased by 60%.

Of course, some clients didn't get better at all, and the article does not address what happened to clients after the first year. However, if you are looking for an average "success rate" for being in (alcohol, and probably any substance or activity) treatment, this may be about as precise as one can get. Our perspective is, pick a program that seems right for you, then work hard to be as successful as possible!

Recovery is not an all-or-none event, but an ongoing process. It is quite possible for someone to become recovered, but it may (or may not) take some time. Moderation approaches work for some. For those who neither abstain or moderate, reducing consumption is still valuable and worth supporting. Ultimately success in treatment, like success in getting an education, is fundamentally about your own effort.

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For families and concerned others

Physician (after completing a physical exam): You know, Joe, for your age, you are in pretty good health. However, the best thing you could do for yourself is to give up smoking and lose weight.

Patient: Doc, I don't deserve the best. What's the 2nd best?

If you are reading this website for someone else (who has addiction problems), you may be alarmed to see that PRS supports abstinence, moderation or harm reduction.

You may be looking for a treatment program that will "force" your loved one to change. Despite what some programs may promise, there is no forcing someone to change. No one has to change! The only things we have to do in life are age and die. Everything else is a choice (although we may not always like the options available). We also may not like the choices others make.

Treatment works best when the treatment program accepts the client as he or she is. The reality is that most clients enter treatment with ambivalence about their behavior. Addiction has caused major problems, but it has also been a major source of pleasure. If I'm doing too much of a good thing, maybe I should just do less. This may seem highly irrational to others, who have seen repeated failed attempts at self-control, but it doesn't seem irrational to many clients.

Sometimes the shortest route is not the most direct one. We are deeply concerned about our clients, and aim to have them experiencing no negative consequences from addictive behavior. Usually this change occurs in small steps. We are not opposed to big steps, but they cannot be forced. If your loved one has already attended several treatment programs (a very common occurrence), you may already understand this idea!

In most European countries, and in Canada, the ideas of moderation (cutting back to non-harmful level of use), or harm reduction (cutting back to a less harmful level of use) are accepted as realistic options. Ironically, these countries typically have lower levels of addiction problems than the US, which pursues "zero tolerance" both in treatment and legally.

We propose that, instead of attempting to force your loved one, you begin with yourself, by seeking counseling on how to change your reactions to the addicted individual, and how not to shield the addicted individual from the consequences of his or her behavior. Ultimately someone changes addictive behavior because the costs outweigh the benefits. Family and friends are a crucial component of the costs of addiction, and they often overlook this fact. By working with you we aim to increase the chances of seeking treatment, while helping you maintain a caring and supportive relationship (assuming you wish to do this). Once the addicted individual has begun treatment, we can also coach you on how to enhance the likelihood of maintaining progress.

The new approach to dealing with your loved one will not only increase the likelihood of seeking treatment, but strengthen and improve your life as well. As one preview of the new course of action you will likely be taking, you will stop insisting on seeking treatment or a particular kind of treatment, and stay focused on the consequences of the addiction itself. Your stance will be:

"I will not tolerate these behaviors anymore. How you change them is up to you, but time is running out."

In short, you will focus on ends, allowing your loved one to choose the means to accomplish those ends. The advantage of this approach is that your loved one can let go of resisting what may be viewed as intrusive guidance, and stay focused on attacking the primary problem. If you have already tried to "force" someone into treatment, you probably have already seen the amount of unproductive conflict that can occur.

To accomplish the above goals we recommend that families of our clients participate in the CRAFT program. We are one of the few centers in the country to offer this option.

CRAFT (Community Reinforcement And Family Training)

www.robertjmeyersphd.com/craft.html

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Family asset succession planning (estate planning)

Families with one or more chronically addicted members often face anguishing decisions during estate planning. The addicted member wants his or her share. The other children may understandably object that this is a waste of resources, and may lead to a binge that ends in death. The parents want to be fair, but what is truly fair in this situation?

Unfortunately, estate planning attorneys by themselves are typically of little help for the emotional aspects of these situations. They are not trained to identify and respond to the intensity of emotion underneath a technical discussion of asset allocation, or to the family dynamics involved. However, if these emotions and dynamics are not identified and dealt with, it is unlikely that a good solution to conflicting needs and priorities will be discovered. The attorney will be able to accomplish whatever estate planning goals are presented, but will likely have little input on how to clarify and refine these goals.

We work in conjunction with an estate planning attorney and a business attorney (or we will work with the professionals you are already consulting with) to help you identify and accomplish the most reasonable estate plan available to you, given your circumstances and priorities. In simple terms, we will help you determine what you really want, and then the other professionals will advise you on how to accomplish it.

Here are some of the issues that may need to be addressed before a technical discussion of asset allocation is sensible:

Will the child (or children) recover to some degree, stay about the same, get worse, or perhaps have a major relapse after receiving an inheritance? Because the future is unknown, how can we plan for all possible outcomes?
Do parents blame themselves (or one of them) for the addictive behavior? Is there any factual basis for this blame?
Do the parents or others enable the addictive behavior? That is, do they shield the child from the consequences of his or her own behavior, which might persuade the child to change, if experienced?
How much conflict are the parents in, about possible enabling, or about how to divide the assets?
Are there conflicts within the family about enabling or asset division?
If there is a family business, should the addicted child share in ownership, to the possible detriment of the business?

The fundamental strategy in a good estate plan will be to reward the child for good behavior, with degrees of good behavior recognized, and degrees of corresponding rewards. How that strategy will get carried out in your particular circumstances, however, may take some careful analysis to determine. We refer to the result as an "addicted child trust," which is a variation of a spendthrift (or sheltering) trust.

On the bright side, when parents address these issues directly there is a good likelihood of improved family functioning, even if the children are not directly involved in the estate planning process.

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PRS groups

Addictive Behavior Change (ABC)
An ongoing educational and support group, ABC is designed to assist you in moving from uncertainty to active participation in addictive behavior change. This group uses Dr. Horvath's workbook, Sex, Drugs, Gambling & Chocolate, as its text. The group's goal is to develop, enhance and maintain motivation while setting goals and problem solving. The group also focuses on relapse prevention skills to keep you on the right track. The group includes optional homework assignments. The fee for ABC is $35 if paid monthly in advance, $50 otherwise. The fee for a group screening appointment is $50.

Please note: these groups are not drop-in groups. You must be screened by advance appointment. These groups do not always have openings available. If you are interested in joining a group please call 858-453-4777 for a screening appointment.

Tuesdays, 5:30 to 7:00 PM
Wednesdays, 11:30 to 1:00 PM
Fridays, 11:30 to 1:00PM
All groups are led by Dr. Galant.

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Free addictive behavior and mental health screenings

PRS offers free 10 minute screenings for alcohol problems, other drug problems, gambling, depression, or anxiety. Participants complete a brief questionnaire (about 5 minutes), and then discuss the results with a PRS staff member (about 5 minutes). The purpose of screening is to determine if there are enough problems to indicate the need for further evaluation. If needed, further evaluation and/or treatment options will be offered. These free screenings are available on Mondays, Wednesdays, or Fridays from 1-2pm. Please call ahead to confirm that we are available.

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Range of Services

Introduction

For families and concerned others

For Clients with Addictive Behavior

A Spa for the Spirit!

The Psychotherapy Team

Success rates

For families and concerned others

Family asset succession planning (estate planning)

PRS groups

Free addictive behavior and mental health screenings