Scott Webb (Host): After completing a 30-day treatment program, some clients may feel like they've reached the finish line, so to speak. But my guests today are here to explain that a treatment program is really just the beginning of recovery for most people. And joining me today are David Cato, he's a specialty therapist at Sierra Tucson, and Dr. Ryan Drzewiecki, he's the Chief Clinical Officer at Sierra Tucson.

Welcome to My Miracle Radio, a podcast by Sierra Tucson Alumni Relations. I'm Scott Webb. So, I want to thank you both for joining me today. We're essentially going to focus on, you know, folks who've had treatment, they've finished treatment. So, what now, what next? And so, David, first one to you, what are the next steps in the treatment and continuing care world?

David Cato: Yeah. So, being at Sierra Tucson, we actually have a team of people, case managers, who put plans together for folks while they're here. And so, if somebody's leaving treatment, they most likely have worked with a case manager to be able to have everything all ready or mostly already pre-set up before they go. But if, let's say, somebody's leaving treatment and they don't really have that team, that's been that support for them to help provide appointments and set up some of their aftercare.

The biggest thing is going to be to seek out support. And there are a lot of different methods of finding support networks. And one of the things that I tell people regularly, the biggest way and easiest way to do that is through a community, such as a 12-step community, whether it be through AA or NA or CoDA or other, they have some mental health component types of 12-step meetings for folks, or just getting into meetup groups, finding places. There are a lot of sober groups that people have online through Facebook, through the Meetup app. There's a lot of different resources that people can access.

Ryan Drzewiecki: One of the things that I say when people arrive here, and I say this to all of our new hires as well, we're primarily working with the residential level of care here. We have a small inpatient unit. We also have PHP and IOP. But when we're talking about residential treatment, I always say residential treatment ends at the finish line. We are here to get people up to a place where they're ready for a lower level of care. We're not here to, and I think most cases of treatment failure pop up when somebody thinks that we're here to just wave our magic wand and, in 20 something to 30 days, kind of fix everything that's going on for them. So, I like to make it really clear, that's not what this particular level of care is about. You know, it's about getting you stable, it's about figuring out those barriers and figuring out how to move forward.

But, I mean, to the point of your question, Scott, and piggybacking off of what David said, the work just starts here. You both have kind of formal continuing care, like David alluded to, that here we have case managers work on, so we have these formal recommendations, like this should be your next step after residential. And then, we also have like the stuff that you have to do every day, which is, you know, creating meaningful connections within your community and with your family and with the people around you and figuring out how to take care of your own mental health on the day to day. So, I think those are really important things to recognize if you are looking at treatment, even if you go to those big treatments, that's just about getting to the starting line. This is where you start, and then you continue afterwards at lower levels of care, and you continue on in changes that you make to your everyday.

Host: Right. Yeah. The magic wand would be nice. But that's something maybe for television and movies. But in the real world, folks are starting there at Tucson. And then, the journey continues, of course. Just wondering, Ryan, what are the elements of a good treatment or discharge plan?

Ryan Drzewiecki: To be specific to this level of care, but at all levels of care, one of the first things I look for is just that acknowledgement of continuing care. Just understanding that, for residential, you're going to be here for 30 days. We're not going to make all your anxiety go away. We're not going to completely change everything about you. But, you know, here is what we're going to do within this plan. And then, this is what the future looks like.

You know, when we talk about levels of care, you've got inpatient and then you've got residential and you've got partial hospitalization or PHP. You've got intensive outpatient or IOP, and then you have your kind of standard outpatient. So, I think a good treatment plan acknowledges that and says, "This is what we'll do here, and this is what you're going to pick up at that next level. And this is what you'll pick up after that." Because you know, if you really sit down and do a giant treatment plan with everybody to talk about what recovery looks like, it's a very, very long-term process of growth and discovery and rebuilding and all that. What do you think, David? What is a good treatment plan or continuing care look like to you?

David Cato: It's going to be different for every person, and it's different for people coming out of residential treatment. Because if you're in residential treatment, it means that things weren't going well before you got there. And so, you're going to need more of a support when you go. And one of the things I remember early on as a primary therapist making recommendations for folks, it was a big recommendation to give 90 meetings in 90 days, meaning that someone needed to attend ninety 12-step meetings in 90 days, which feels like a lot for folks. And I learned that over time that I evolved that into 90 recovery activities in 90 days so that they didn't feel like they had to-- because not every location was going to have a meeting every day of the week, and this was before virtual meetings too, but to let them know, you know, 90 meetings in 90 days being a lot. Let's say for example, you have an IOP one day, and then the next day you get a massage for yourself. The following day, you make sure you go to the gym. There are things that you can do, one activity each day to focus on recovery that keeps you in that momentum after leaving treatment. And so, that's just an example of what it could look like for somebody. I know, like Ryan said, we have the different recommendations of levels of care that we give for step-down. Sometimes it's PHP. Well, sometimes it's boarded PHP, meaning that you go live at the place where you're getting treatment before you go home. But sometimes people go back home to a PHP, partial hospitalization program, or step down to an IOP, intensive outpatient program, which is a lower level of care than PHP. And then, people will step down to outpatient. I never, ever will recommend that someone leave residential treatment and not do some kind of either IOP or PHP, just because of the amount of support that they were getting around the clock here. I always view it as a staircase and like each step represents a different level of care. And if somebody skips a step going down the stairs, they're more likely to stumble.

Ryan Drzewiecki: What do you think, David, is a good or maybe the better question is what's an example of like a bad treatment goal? Because when you mentioned the 90 and 90, I mean, I love that because it's measurable, you know, it's a SMART goal, as we say, specific, measurable, attainable. You know, maybe it works for some people, maybe it doesn't. But I think that's really important when you're looking at treatment goals.

My least favorite treatment goals or one of my pet peeves are around things that are unmanageable. Like, you know, "I won't have this type of thought anymore. I won't feel this way anymore." I saw one once that drove me nuts. It was like, "I won't have any more suicidal thoughts." it's like, well, that's something you don't have any control over. You can control how you react or respond when you have them. But if your goal is to control your thoughts or control your emotions, you're setting yourself up for failure. Do you have any examples? Good goals, bad goals?

David Cato: Yeah, for sure. Like, I like what you said about measurable. As someone to say I'm never going to do this again or never going to have that again. Even for people who say, "I'm never going to drink again," like that may not be measurable enough. Like, ideally, if you feel like you're an alcoholic or somebody who has substance use issues, like you may have cravings again. And that idea of "I'm never going to do it again" may just lead you back to it. And if you say like the example you said, "I'm never going to have suicidal thoughts again," what if you get that suicidal or even self-harm thought, and then you're like, "Oh, I failed. That's it."

Ryan Drzewiecki: Yeah.

David Cato: You know, I do think that goals should be appropriate and measurable, absolutely.

Ryan Drzewiecki: Yeah, there's something to be said. I mean, you're certainly opening up a big can of worms about sobriety-based goals and everything, but I think your point is spot on. Like, what happens if a person kind of fails at their goal and how do you respond to that? How do you react to that? Is that part of their treatment plan? Always good questions.

Host: Yeah, I'm sure, you know, we're talking about the start line and finish line and how do folks get there and, ultimately, you know, how do they reach that wellness point, I guess. So, I'm wondering, David, when we think about defining it, if you will, like what does wellness look like?

David Cato: Oh, goodness. I wish that there was a defining way to say that this is what wellness looks like. Wellness is going to be different and individualized for every human being. There are so many times that people get so wrapped up in what they believe the standards of wellness are. I think of today's current society. Let's take Hollywood wellness, for example. Like if you look at people in LA or who were on these TV shows and the other kinds of things that are all over the TV, including internet, YouTube, social media stars, TikTok sensations, et cetera. Like, there's just such a high level of wellness expected. And, you know, it's interesting to see, if any of these creators or, actor, celebrities, whatever you want to call them, when they have a moment of weakness, they kind of get read to filth for it. They get judged about having something that's outside of what wellness is.

But wellness is breaking down. Wellness is having moments where there's no perfection. One person's wellness might be that they do yoga once a week and that's just enough for them. And then, other people, they have a map, a guide of different things that they have to do each week and sometimes each day to just kind of stay as part of a healthy mental process. Like for example, some people need to meditate when they wake up in the morning to be able to ground themselves for the day. That's going to be different for each particular person.

Ryan Drzewiecki: I think what you're saying and how it ties in too is understanding that wellness does not mean the absence of distress. Wellness doesn't mean that you never feel anxiety, that you never have any struggles with your mood. It just means that-- well, and again, this is where maybe it's different for every person-- but I think it means that you are striving to do your best. You're striving to be your best. But that question, Scott, about what is wellness is so important, because I think that most treatment failure comes from sort of misaligned expectations, thinking you might go into treatment and everything will be magically solved, or not recognizing how difficult it is to stay in a place of wellness.

You know, David and I talk about this a lot. I think instead of talking about not struggling with your mental health is normal, and that, you know, pathologizing when somebody's struggling with anxiety or depression, I think that's somewhat backwards. I think it's more exceptional when you find somebody who deals extremely well with life. I think it's much more common to struggle, whatever that struggle looks like for you, whether that's anxiety or mood or, you know, compulsive behavior. I think it's incredible when people are able to manage that relatively successfully most of the time. So that's how I like to talk about wellness. This is not something easy that you're going to slide into when your problem is solved. It's something that you're going to have to work on really hard every day. If you want to stay well, you've got to really put in the work and check in with yourself and constantly reevaluate how well you're doing. That's what I think about when it comes to wellness is that's a big goal and it's difficult to get there.

Host: Yeah. And maybe this is oversimplifying, but just to put it in sort of lay terms, maybe it feels like maybe a part of wellness or attaining or achieving wellness is understanding and accepting you're going to have good days and you're going to have bad days, and that's okay. And it's more about expecting the good and the bad and what do you do and how do you handle, how do you process, you know, where do you go? Whom do you speak with on those bad days? Does that sound right, Ryan?

Ryan Drzewiecki: It sounds great to me. I think you said it very well.

Host: David was mentioning about using stairs and you skip one, you're undoubtedly going to stumble, right, Ryan? So, what are some of the common pitfalls when we think about post-treatment, that what now, what's next? What are some of the pitfalls? What are some of the, not mistakes, but you know, like when folks skip a step, walking up or down the stairs, what are some of them and what do they do about them?

Ryan Drzewiecki: There's two main questions that we ask about continuing care that maybe everybody should think about to figure out if they're skipping any stairs or not. You know, the first of those questions is just, what does your living situation look like? Are you at a place where it's going to be good and manageable and reasonable to have you return home. You know, do you have a mostly supportive family environment? Is that home environment positive for the most part? Or is it not? You know, are you going to look for maybe a next step where there's still some housing away from home? Do you want to live in sober living or something of that sort?

So, that's kind of question A is like do you need to continue to kind of be separated from that place from home, if you will. And the second question is just like, What's the frequency of mental health services that you need? Do you need kind of like an everyday sort of program, like a PHP? Do you need just maybe a couple hours, a couple times a week? Or might you be successful kind of at the outpatient level of care, just seeing your team maybe weekly or something like that? So, I think when we see people stumble on the steps, it's because they've kind of gone too far too fast. They've said, "No, I'll be fine. I'll go back and, you know, live at home and pick my job back up again and just try to do the bare minimum." I think that can often be skipping a step. At the same token, I suppose it's also possible to move on too slowly, to become over-reliant on a very intensive level of care and not step yourself down quickly enough. So, those are two big missteps. What do you think, David? What are some frequent stumbling blocks that you see?

David Cato: Yeah. I really liked the one that you said and I see it the most, which is, "I can do this and everything will be okay. Like, "I don't have to go to IOP or PHP, because I've gone to treatment before and I didn't find it helpful." And it's kind of like that, you know, I know this is going to work, and then we've seen it not work so many times, and then we get to say, from our professional expertise, "This is what we've seen doesn't work," and just wanted to give them that input. And then, they say, "Well, we actually know better," or "I know better, and that's not going to work for me." And then ,sometimes we end up seeing them back here again.

Ryan Drzewiecki: Yeah, it's always such a red flag when they say, "I just need my medications changed. I just need a little bit more EMDR." You know, "I just need to quit my job and everything will be fine." I think that's a huge warning sign. Anytime anybody, you know, "Life is going to be perfect if I can just see these one or two changes." It's like, "Oh, no, no, no, no, no. Life will continue to be a struggle for you, just like it is for everybody else," because life is not easy. And when you come in here and say, "Oh, I've got everything I need. Everything's going to be great," or, you know, "just need this one thing," boy, am I concerned about you.

Host: It's been great to have this conversation today. Ryan, I just want to give last word to you. Final thoughts and takeaways.

Ryan Drzewiecki: Sure. Yeah. So, I think it's really important to recognize that this is just the start of a journey and you really want to build a good network around you as well to help you both regulate from day to day, but also navigate mental health after here. It's really complicated, particularly if you're insurance-dependent, to kind of figure out what does the field look like? When do I go to a social worker versus a counselor versus a psychologist?

One great advantage we have here, and it's probably available to you all wherever you're listening, is Acadia Healthcare has a giant network of treatment placement specialists, TPSs. These are resources to you and your own communities that can point you in the right direction. A TPS can tell you what's available locally and nationally at your level of care and kind of get you pointed in that right direction. So, if you have questions about what treatment looks like or what all these levels of care are or, you know, what your loved one's treatment does or should look like, a TPS is a great place to start and to figure out what's the next best step for me, and then, what are the best steps after that as well.

Like I said, this is a long continuum of care. You can come to a great place like Sierra Tucson and get a great, you know, 30 days to get your feet back under you. But then, you got to keep that work up. You got to keep on learning new things and being open and connecting with others.

Scott Webb: And Doctor, what does Sierra Tucson do to ensure a client's success, you know, post discharge?

Ryan Drzewiecki: That's a great question. You know, a lot of our services here are geared toward that next step, as we've talked about so much of, Treatment is about figuring out what comes next. Some of the special services that we offer, you know, number one, we have dedicated case managers, of course, who focus on aftercare kind of from the moment you come in till the moment you leave.

, and they will find you the right level of care, the right place to go. They'll work with you to make sure that you've got everything that you need when you're walking out the door to be successful. Whether it's at our own PHP or IOP or somewhere else, we'll work to find the best spot for you. On top of that, we've got some really cool programs here.

Connect 365 is one of our aftercare programs. So we offer every resident a recovery coach for a full year after discharge. That recovery coach will reach out, weekly , to our, alumni. They'll provide some tools, some resources, some encouragement. Guidance, accountability, what have you. Every week they're reaching out and they're always available as well.

 So we offer that to , every one of our residents for a full year. And there's an option to extend that as well. A lot of people find that to be super helpful. Connect 365, that program has an app as well. The app lets you text with your recovery coach or get to some of the Sierra Tucson podcasts and webinars, connect you to online support groups and the alumni section of our website and, We also offer just ongoing alumni relations as well.

Support groups, I think eight times a week, even on holidays, which are often the most stressful times. The private Facebook page, , and we also have an annual retreat. So there's a ton of services for alumni. I think Sierra Tucson does it incredibly well. I haven't seen any place that really approximates that Connect 365 program.

So it's something I'm really proud of, , that we're able to do here.

Host: Yeah. Yeah. Really interesting. Good stuff today. Podcasts like this seem to focus typically on the treatment itself. And so, I was really interested to have your expertise today and talk about, "All right. Well, I did the treatment. I did my 30 days. Now, what? What now what's next?" and have a better sense of that. So, I appreciate your time. Thank you so much.

Ryan Drzewiecki: Thank you, Scott.

Host: This has been My Miracle Radio by Sierra Tucson Alumni Relations. For more information, please visit sierratucson.com. I'm Scott Webb. Thanks for listening.