Nationally, people with substance use disorders in the United States are often treated with an expensive acute care model that highlights inpatient treatment as the hallmark component of treatment. For many, recovery is a life-long process, and the focus on acute care is a missed opportunity for addressing the long-term needs of the individual and family in recovery. Rates of re-hospitalization and emergency room visits indicate that far too many experience adverse outcomes of substance use after returning to the community. Furthermore, treatment systems of care are largely designed to meet the needs of those who actively seek abstinence from all substances, and often miss opportunities to help others who are deemed by the treatment community as “not ready” for treatment or who fall out of care due to a recurrence in substance use behavior. This is reflected in the high rates of individuals who are in need of treatment, but do not access it, according to SAMHSA’s National Survey on Drug Use and Health. The time in between treatment episodes has been referred to as “gaps” in care; a time when people are not motivated to engage in services. Some in the field view this as a time during which people need to hit their “bottom” or “rock bottom” as part of shoring up the motivation to engage in treatment again. An unintended negative consequence of this belief is that individuals often develop more severe courses of the disorders that brought them into treatment in the first place. This results in much hardship for the person and their families, as well as more complex treatment needs and poorer long-term prognoses. Ultimately, the sad reality is that for many people the next “bottom” may be death or some other catastrophic consequence.
There is no argument that the acute care, such as inpatient and intensive residential substance use treatment, are necessary components on the continuum of care. However, treatment that only occurs outside a person’s natural environment is not enough. As a treatment field, we need to confront the fallacy that people must experience hardship and crisis in order to engage in their recovery, and instead offer community-based recovery support services that meet individuals where they are, with an eye toward helping them develop enhanced motivation to make positive life changes. Thresholds seeks to confront the pervasive yet mistaken notions that people with substance use disorders need to hit “rock bottom” or be divorced from their natural environment before they can be helped.
Over the past 18 months, Thresholds in Chicago has been working to provide community-based comprehensive treatment and recovery support services to serve people with substance use disorders over the arc of their recovery, and not just during the acute treatment episode. Essential components of this model are articulated below in our Philosophy of Care and Staff Commitments (below):
Philosophy of Care
- Holistic, Integrative, Person-Centered & Strengths-Based: We approach each member as the whole and unique person that they are. We individualize our care by cultivating a deep bio-psychosocial understanding of each member, and building upon their resilience. We provide integrated services for mental health.
- Culturally-Relevant & Gender-Responsive Care: We recognize that culture(s), communities, and gender are vital aspects of our identity, and greatly influence our paths towards healing. Using the framework of Cultural Humility, we work to provide services that are affirming, inclusive, and relevant to all members, including lesbian, gay, bisexual, trans, queer, and gender non-conforming individuals.
- Evidence-Based Treatment: We provide access to factual information in a way that is nonjudgmental, and non-shaming. Our core interventions are selected on the basis of their strong research evidence. We continuously analyze our services in order to improve our quality.
- Trauma-Informed Care: We are sensitive to the effects of trauma and employ practices to avoid replicating it. We seek to understand, recognize, and respond to the effects of all types of trauma. Using the framework of Trauma-Informed Care, we support each member in rebuilding a sense of control and empowerment, and reclaiming their sense of self beyond trauma.
- Harm Reduction: We respect our members as the expert on their own lives, and seek to partner with them on their path towards recovery. We meet members where they are, and support them to develop goals in a nonjudgmental and noncoercive manner. We believe that members not only have the right and the capacity to make their own decisions, but that they are more likely to reach long-term recovery when we support their self-determination at every stage of recovery.
Staff Commitments
- To see you as the whole and unique person that you are. We want to know what matters to you, what you value, and your life goals. We recognize your personal strengths, and together, hope to build on them.
- To respect you as the expert on your life.
We believe that you have the ability to make your own choices, and we honor your personal journey towards healing.
- To provide affirming, and inclusive services. We recognize that culture(s), communities, and gender are vital aspects of our identity, and greatly influence our experiences and paths towards healing. Using the framework of Cultural Humility, we seek to provide services that are affirming, inclusive, and relevant to all who enter our services.
- To be sensitive to the effects of trauma and not replicate trauma. We seek to understand, recognize, and respond to the effects of all types of trauma. We emphasize physical, mental and emotional safety for Members and Staff. Using the framework of Trauma-Informed Care, we seek to support everyone in rebuilding a sense of control and empowerment, and reclaiming their sense of self beyond trauma.
- To provide evidence-based knowledge and services. We provide access to factual information in a way that is nonjudgmental, and nonshaming. The services we offer are selected on the basis of their strong research evidence. We continuously analyze our services and participate in ongoing training in order to improve our service quality.
- To never blame, shame, threaten, or attempt to control you. We uphold your essential worth and dignity as a person, no matter whatever setbacks you may encounter in your recovery. If you ever encounter a setback, or something didn’t turn out the way you had hoped, we are here to support you.
- To partner with you in your recovery. You are in the driver’s seat, and we hope to help you map out your path towards recovery. We want your ideas, impressions, feelings, thoughts, experiences, and responses during each step of your treatment.
Thresholds is committed to offering compassionate community-based and recovery-oriented services that complement all levels of substance use treatment and strive to keep people engaged in recovery by sticking with them if and when they exhibit the recurrence of substance use symptoms that suggest they are most in need of our help. If society is to begin treating people with substance use disorders with more compassion, we as service providers have a responsibility to lead the way.
Gabriela Zapata-Alma, LCSW, CADC, is Program Director, Substance Use Treatment Programs and Tim Devitt, PsyD, CADC, is Vice President, Clinical Operations at Thresholds in Chicago.
