"People don't come to Hazelden for treatment, they come here for recovery," says Tom Galligan, executive vice president of Strategic Planning and Implementation at Hazelden. "Addiction to alcohol and other drugs is a chronic, relapsing disease that demands a steady diet of recovery resources, from day one of sobriety to year 25."

The perception of the 28-day quick fix is a mindset that Hazelden clinicians have tried to deflect over the years. It's something Minnesota Model architect Dan Anderson debunked in describing the core perspectives of the model; he defined alcoholism as a chronic disease--one requiring self-care, mutual help, and "a caring rather than a curing philosophy" to manage. And it's an impression that will likely fade forever, because Hazelden is poised to launch a unique post-primary system of care that reinforces the chronic nature of the disease and aims to significantly improve patient outcomes.

This new system is a cutting-edge continuing care initiative, to launch in 2006, that will integrate new systems, technology and resources into the treatment/recovery process. The goal is to significantly improve the support patients receive during the first 18 months after leaving Hazelden and to carefully nurture their new program of recovery for a lifetime.

That support will come via many sources, including a phone-based case management system led by a recovery coach, an interactive Web curriculum, a print delivery program (for those without Internet access), and a host of continuing care resources already at Hazelden. A cornerstone of the effort is a program that will provide enhanced support to patients after they leave primary care treatment. It will provide real-time information to sustain lifestyle changes through a Web- and print-based program. It is a powerful way for patients to connect with Hazelden and stay engaged in their recovery process.

Enhancing the Hazelden model
In essence, the continuing care initiative represents a major expansion and improvement in the Hazelden system of care, says Sam Dresser, director of Continuing Care Development. "What we're really doing is changing the way patients experience primary treatment," he says. "The goal is to radically improve patient engagement in continuing care. The importance of continuing care needs to be engrained in patients so that they view recovery as an ongoing process, not just a 28-day affair. We want them to view aftercare as part of the primary treatment experience. The program is focused on getting our clients engaged in recovering activities, teaching Twelve Step recovery principles, and supplying them with a range of resources and information.

"The emphasis on continuing care shows Hazelden's commitment to the chronic nature of addiction disease," adds Dresser. "If we leverage our relationships with patients and sustain those relationships into the future, we can greatly improve outcomes."

Other chronic diseases, such as diabetes, cardiovascular disease and high blood pressure, have shown great promise with a disease-management concept that utilizes a coach or case manager to engage patients in continuing care efforts, according to Dresser. The goal of disease management is to support people who have a chronic disease and to monitor and encourage compliance with lifestyle changes that are needed to live well with their disease. Hazelden is partnering with HealthMedia, Inc. of Ann Arbor, Mich., to develop a highly tailored continuing care program. Hazelden is providing the treatment/recovery framework and content, while HealthMedia is creating the delivery framework. HealthMedia is a leader in creating and implementing individually tailored solutions to change health behavior. It has partnered with other major health care providers and pharmaceutical companies to deliver behavior change programs for people with diabetes, cardiovascular disease, back pain, nicotine addiction, and more.

"Hazelden believes that addiction, like diabetes and heart disease, deserves and will respond well to this support strategy of combining personalized information and targeted case-management support," says Dresser.

Technology, research propel CC effort
Support for enhanced continuing care comes from research in the addiction field and the experience of Hazelden. "Research shows that the longer patients remain engaged in the treatment experience, the better their outcomes," says Val Slaymaker, PhD, director of Hazelden's Butler Center for Research.

The Scientific Panel of the Butler Center for Research has been consulted throughout the planning of this project and has provided expertise to help design the initiative and develop an outcomes measurement system. In addition, surveys of Hazelden's adult patient population were conducted to identify continuing care needs and issues. Focus groups were held with patients, alumni and clinical staff. Surveys of Hazelden patients showed that more than 90 percent have access to the Internet and that a similar percentage are avid users of the net. Thus, the Web-based component of the program should prove to be an effective resource.

The development of an online continuing care component is simply an idea whose time has come. The program has its roots in past Hazelden projects, such as RecoverCare, a continuing care program that launched in 1997 to provide helpful materials to patients at key milestones in their early recovery. Technology was not available at that time to customize the RecoverCare product for individual patients. But today technology makes it possible to efficiently tailor appropriate aftercare support for each patient.

"RecoverCare was really a one-size-fits-all format," said Dresser. "But now we can tailor feedback to what patients need based on their assessments. We can get immediate feedback and deliver more materials via the Internet."

Recovery coach is key
Central to the initiative is the recovery coach, a continuing care specialist who will be assigned to every patient at Hazelden. The recovery coach is a significant addition to the primary care unit treatment team charged with engaging each patient, developing a continuing care treatment plan, and monitoring patient progress. The coach will meet on Day 14 with the patient and a couple times more during the final two weeks of treatment. During that period the goal is to get to know the patient and gain some rapport, identify primary concerns, set some goals, and determine methods to address concerns and goals. The coach will introduce the patient to the Web-based program or print version, whichever one can be accessed and used most easily.

By about Day 27, or several days before leaving Hazelden, patients will attend "Transition Day," an educational process that will include lectures and exercises to give patients an understanding of what they'll face when they leave. Part of that day includes a self-assessment to identify some struggles or barriers to recovery. They'll receive some printed materials about key issues that they may face in early recovery (eg, relapse risks, workplace issues, finding Twelve Step meetings, and more). The coach will connect with the patient within 72 hours of discharge and then weekly for the first three months thereafter.

Home page is waiting
When the patient returns home, they'll have their individually tailored "home page" waiting for them (either Web or mailed-print version). The program includes seven modules with a curriculum progression that is flexible and open to the situation of each participant. Each module begins with an assessment. The assessment measures the participant's progress and directs participants to specific areas on the module for review before moving ahead in the program. For instance, Module 1, geared to the first 30 days after primary treatment, will tailor its content based on the answers to the assessment. Our clients can do a ‘recovery checkup' at the end of each module that will then flow into future content to address areas of concern.

The ongoing measurement of the participant's progress includes a prioritized flagging system to alert recovery coaches to certain conditions in the assessment or activities that might be of concern. Thus, if a relapse risk, such as lack of hope or disengagement from recovery activities, is detected, the recovery coach can intervene.

Content for the continuing care initiative is intended to encourage people to get out and take part in the recovery community and engage in recovery-related activities and behaviors. Content comes from the wealth of information, including the vast knowledge base at Hazelden's publishing and research divisions. Information on a myriad of recovery topics, from finding a sponsor to return-to-work issues, is included.

For instance, Module 1's goal is to help patients readjust to life after treatment, said Sue Thomas, senior acquisitions editor from Publishing and Educational Services who helped compile content. It covers basic relapse prevention skills, a look at Step One again, connecting people with Twelve Step programs, and relationships at home. A key feature is an online library that provides comprehensive resources. Much of the content is research based and comes from some of the leading curriculums in the field, including Living in Balance, the Matrix Model, and Stop the Chaos.

The phone-based case management component of the continuing care plan is being tested this summer, while a test of the Web-based program will take place later this year. Rollout of the overall continuing care initiative is expected to begin with two or three patient units in early 2006.

Ambitious goals
Within five years, the goal is that 75 percent of all Hazelden primary patients will be continuously abstinent one year after their treatment stay, up from 53 percent. "Having an ambitious goal is very motivating," said Ellen Breyer, president and CEO of Hazelden. "We need to set ambitious goals and stretch and reach for them. Identifying such goals helps people to focus their energies and resources. The size of the goal is connected with the huge impact that we think an improvement in outcomes will have on our patients."

The initiative to bolster post-primary care is a key goal of the five-year Hazelden strategic plan.

"This program is really about walking alongside our patients in the recovery journey," said Mark Kulhanek, a Hazelden recovery coach. "They're not sure what to expect when they leave Hazelden, so we need to be there when they have difficulties. We need to be there if they relapse and remind them that this is a disease and not a lack of willpower. Their treatment stay is just the beginning, not the solution of their problem. It's the beginning of a whole new lifestyle, and we need to facilitate that transformation the best we can."

--by Marty Duda

Published in The Voice - Summer 2005