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In the past, when people were struggling with drug addiction, the first thought was to send them to a 28-day inpatient program. These days, there is more emphasis on outpatient treatment.

"Outpatient treatment can be just as effective," said Brian Boomgarden, manager of Tamarack Behavioral Health Center.

John Schmidt, a licensed clinical social worker-psychotherapist at Aurora Behavioral Health, said he thinks intensive outpatient treatment is "the wave of the future."

Outpatient treatment can range from seeing an alcohol and other drug abuse counselor on a weekly basis to attending group therapy four or five times a week for three or four hours each time, according to Schmidt. The treatment would be combined with Narcotics Anonymous meetings and, if the person has a mental health issue, being under the care of a psychiatrist.

"For some people, that works just fine," he said.

Schmidt said most of his clients have been in treatment before. Many of the people he sees have a dual diagnosis. For instance, they may have depression or anxiety problems along with an addiction. He works with them on both problems at the same time.

Group sessions

At Tamarack, treatment consists of group meetings twice a week, each lasting about two and a half hours. The groups typically meet for about seven weeks, and then people are transferred to an aftercare group that meets for an hour and a half once a week for 12 weeks. They also meet individually with a counselor and a family member to develop a relapse prevention plan.

Family members fill out a form indicating the effects they see the drugs are having on their loved one. Learning how family members feel can be powerful, according to Boomgarden.

The treatment groups at Tamarack usually consist of no more than eight people. Each group consists of people who are at different places along the road to recovery. Newer members can receive support from those who have been participating longer.

Topics of the group sessions include the physical aspects of addiction, the negative consequences of using drugs, the positive aspects of staying clean, and how to deal with relapse triggers.

Relapse isn't unusual, and people shouldn't beat themselves up if it happens, according to Boomgarden.

"It's a life-long condition, a chronic disease," he said.

Group treatment is less expensive, allows more people to receive help than would be possible with individual counseling, and Boomgarden believes it is just as effective.

There are no waiting lists, and people usually can get in the same week they have an assessment. Most insurance covers the groups, although it may limit the number of sessions, he said.

Tamarack also refers people to Narcotics Anonymous as an adjunct to their group therapy.

Most people who come to Tamarack for treatment have gotten into some kind of trouble, such as being arrested for drug dealing or having several OWIs, Boomgarden said. But whether they seek treatment on their own or they're court-ordered to be there, "they have the same treatment results," he said. They become aware of the harmful effects of their behavior, and come to realize there is another way to live.

Help for those who can't afford it

Some of the people receiving treatment from the Manitowoc County Human Services Department also are there only because the court has ordered it, said Gary Daehn, an alcohol and other drug abuse counselor there. Counselors hope to help their clients develop motivation to work on their problem by helping them see the effects their substance has had.

Human Services provides treatment for people who don't have health insurance or much money, Daehn explained.

"We have a sliding fee scale," he said, with costs based on the client's income and other factors.

Treatment consists of a primary care phase, when groups of eight to 10 people meet once or twice weekly, and an after care phase, which is a transitional support period, he said.

Group meeting topics include the consequences of drug use and developing new coping skills.

"A big part of treatment is breaking through denial," Daehn said.

Residential treatment

If people need more than outpatient treatment, Human Services refers them to MARCO Services, the county's only residential treatment program.

Kelly Jodar, an alcohol and other drug abuse counselor with MARCO Services, said 95 percent of the time the facility's 12 beds are filled and there's a waiting list.

Holy Family Memorial used to have a unit for people with mental health and substance abuse problems, but it closed a few years ago. Schmidt said he thinks its closing "was pretty ... devastating to the community."

There are inpatient and residential programs in Oshkosh, Green Bay and Appleton, but Schmidt said he wonders how many people who need such treatment don't get it because of the distance.

Everyone coming to MARCO, which is funded by the county, must be referred through the County Human Services Department, Jodar said. People may refer themselves or others, but even those cases must go through Human Services.

Multi-faceted approach

Treatment at MARCO consists of group therapy, individual therapy and mandatory attendance at Alcoholics Anonymous or Narcotics Anonymous meetings. Group therapy topics include conflict with family members, anger management, goal setting and effective communication, Jodar said. A session may start with a generic discussion about the topic of the day, but the focus usually changes to discussions about personal experiences.

Counselors try to help clients look within themselves to determine what it is that's keeping them sick, she said. Counselors are facilitators; they don't fix people. Instead, the healing takes place in the dynamic of the group.

"It makes your hair on the back of your neck stand up sometimes it's so powerful," she said.

Individual therapy focuses on looking at how clients are doing in meeting their goals, dealing with abuse, and getting rid of a "prison attitude," Jodar said. Most of the clients at MARCO have been in prison or the county jail. While incarcerated, they develop a persona that includes always being in control and not letting their feelings show. She said such an attitude is necessary in prison but isn't beneficial when they're released.

Meeting with a psychologist at the Human Services Department also is part of the treatment plan for many MARCO clients. Between 85 percent and 95 percent of the people living at MARCO have a mental disorder in addition to their addiction problem, according to Jodar. Depression is the most common, but other mental illnesses she sees are bipolar disorder, anxiety issues, schizophrenia and schizoaffective disorder. People with schizophrenia and schizoaffective disorder tend to relapse more frequently than others, she said.

Jodar said the nature of the relationship between drug abuse and mental illness is unclear, but it may be that people who are struggling with mental disorders turn to drugs as a way to cope.

90 days minimum

The length of stay at MARCO varies, but executive director Craig Pauly said the average stay for those graduating from the program is 22 weeks.

The goal is to help the clients become successful in life, Jodar said, and that takes more time for some than for others. Some people already have a house and a job, for instance, while others come in with nothing but the clothes on their backs.

Jodar said the minimum stay is 90 days because the core material takes 12 weeks. People often put in their required time and decide to stay longer, she said.

The more treatment and exposure to recovery people get, the longer their sobriety will last, according to Jodar. She said the optimal amount of time in treatment, including after care, is 18 months.

Aftercare

MARCO offers an alumni group, and graduates are free to call or stop in at any time, Jodar said.

"My continuum of care goes until they don't call anymore," she said.

MARCO also owns two houses, called Crossroads and Sebora, that offer "three-quarter" living to help ease the transition from treatment to regular life, and hopefully reduce the likelihood of relapse. One house has a capacity of four, and the other can hold five people. The three-quarter homes are open to graduates of MARCO or other AODA programs. They rent their own room and share the rest of the living space with the other residents.