Usable Insight – The Monkey is Off My Back – Relapse Prevention is Here

Stabilization of mental, drug and alcohol disorders
takes place at in patient, out patient programs and mental health professionals’ offices;
treatment can only take place where patients live.
- Pete Linnett, Founder and CEO, Life Adjustment Team

For nearly 35 years I have been in collusion with an appalling flaw and weakness bordering on a travesty in the mental health, drug and alcohol treatment systems.  It hasn’t been the fault of the professionals in each of those areas — most of whom deeply care about their patients — but of a tragically flawed system of treatment that denied and then ignored the elephant in the room.

The elephant in the room is the rate of recidivism and relapse that all treatments have done a poor job of preventing.  The reason is that all of those treatments stabilize people and then proceed to hand their lives back to them before they are able to handle it.  Over and over again for decade after decade I have met with patients, couples, families who politely agreed to do things after they left a hospital, clinic or my office, and in some cases even signed contracts, but as soon as or shortly after they were left to their own recognizance, wham… one person provoked the other, someone took a tone that was like “nails on a chalkboard,” or people just went back to the environment that so greatly contributed to their mental, drug and alcohol problems that they relapsed.

Like most other professionals, I just shrugged my shoulders, hoped that each time I saw them, provided psychotherapy, medicated them or hospitalized them (years ago early in my practice) that this time, would be different.

In retrospect the issue has often been that the treatment environments, be it a psychiatric hospital, in patient drug or alcohol program, or even my office were set up suited to my convenience and not where it would have the most impact, namely in the patient’s life.  Treatment for purely medical conditions works out okay when it takes place in a hospital, urgent care center or medical doctor’s office, because those conditions although affected by psychological, emotional and family issues (for example staying on diets or exercise routines) are not as directly affected by those issues.

When it comes to emotional, psychological, psychiatric, drug or alcohol conditions, treatment does not occur in hospitals, in patient programs, doctors or therapist offices, or even with the administration of psychiatric medications.  All of that amounts to stabilization of  the condition.  Treatment can only occur once the patient is in their life and to be effective the treatment needs to take place in their life.

I bring this up because it has been my good fortune to discover an organization called the Life Adjustment Team (LAT), located in Culver City, CA but primed to expand to other parts of California and beyond. For 35 years LAT has had Masters or higher degreed case managers who go out to the homes and apartments of recently discharged patients from in patient psychiatric, drug and alcohol programs.  From there they form deep and trusting connections with patients and their families and literally take these patients to doctors’ or therapists’ appointments, or 12 step meetings, do recreational activities with them, teach them communication and even budgeting skills.  In most of these cases, although the family may have intended to do all of those when a patient is discharged, the family is often too rife with conflict to be able to carry that out.

LAT has worked with thousands of patients from across the country and has worked with Regional Centers in California (that are responsible for distributing money to take care of the 250,000 developmentally disabled population in California).

I have become a strong advocate and even an evangelist for LAT, because the high financial, emotional, psychological and family toll that relapse and recidivism causes is unacceptable.  What pushed me over the brink is realizing that the majority of the tragic shootings we are witnessing all too frequently could possibly have been prevented if the shooters did not fall through the cracks after a prior contact with the mental health profession.

But don’t take my word for it.  Instead listen to Gilda:

And now listen to Pete Linnett, founder of LAT:

For more information, visit Life Adjustment Team.  Relapse is preventable and you owe it to yourself or someone you care about to do your best to stop it. Wouldn’t you agree?

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7 Responses to “Usable Insight – The Monkey is Off My Back – Relapse Prevention is Here”

  1. Aaron Says:

    Mark: This really is a great idea, and I agree, the LAT can help some, but not all, families. My only concern, however, will be with those individuals who see no benefit or purpose in helping mentally ill individuals and their families. I can already see people taking about costs and involvement of state agencies that are “unaffordable” given budget deficits as far as the eye can see. How does an individual like myself make sure politicans see the “story” behind the numbers with LAT and how the program can save money and, more importantly, lives that hand in te balance? Thanks for sharing the link, and looking forward to hearng more about the program in the months ahead.

    P.S. The Good Day LA link with Peter Linett doesn’t play in my Chrome browser (?). Is there a way to have the link emailed to me please? Thanks, and have a great weekend.

  2. Mark Says:

    Aaron,
    Very good points. I think this will need to be a grass roots from the ground up approach as more and more people get fed up with the high rates of recidivism and want to do something about it.

    Try this link regarding Pete Linnett: http://www.myfoxla.com/story/20542987/pete-linnett-people-need-mental-health-treatment-at-home

  3. Dona Lansing Foley Says:

    Hi Mark, It seems you always express so well, what I’ve been thinking for a while. As a clinical social worker for almost 40 years, my sense is that the helping professions are just beginning to “get over themselves” and leave the insular office bubble. Paranoia around boundaries and obsessions with diagnostic categories prevents the kind of REAL SUPPORT and connection that reach the
    souls of those desiring lsting change.. LAT has managed to cross the great divide. I’m so impresed. I work with soldiers on a big base. Many of them have been to hell and back. They are direct and demand a relationship without pscyobabble. In fact our program keeps NO written records for most issues.. To help them, there has to be real caring and a genuine compassionate presence that goes beyond the office. I’ve spent time on gun ranges, done brief stress management strainings in the fiield and attended deployment and homecoming ceremonies at 3:00AM, as have many of my colleagues. Our role makes a difference for what it doesn do, as much as what it does. It is the essence of outreach. Dona

  4. komagra Says:

    really nice post, i in fact enjoy this internet internet site, maintain on it

  5. Michael Toebe Says:

    There are “playmakers” or difference makers in life and LAT seems to be the progressive-thinking organization that is positively affecting people, families and communities. Very happy and encouraged to have read this writeup, Dr. Goulston.

    LAT seems to understand that it takes more than what is often offered to serve and hopefully, create lasting change.

  6. Mary A. Says:

    This is a good one. I wish you can get on Pierce Morgan-CNN and tell the world about it. Until the home or work or relationship environment changes,a treatment may only be dealing with the symptoms and not the root cause of the problem. The individual would be okay in the treatment center and once he/she goes back to the environment, relapse tends to occur.

    All treatments should not take place in artificial environments. After discharge from treatment centers, treatment should continue in the setting where the individual resides or works so that the root causes can be more effectively identified and coping mechanism designed to survive in the particular environment.

  7. Jan Says:

    In the geographic region where I live, it is so difficult to find help/treatment beyond therapy sessions. Very discouraging that mental illness is not accepted as an issue we can be open about and work together to treat.