Center addresses triangle of pain, addictive and psychological disorders

A California treatment facility whose leaders are touting the establishment of the first “triple diagnosis” program is seeking clinical success in part by keeping its treatment groups small—no more than six at a time in any level of care. On the business side of the equation, A Healing Place, The Estates is exploring partnerships to serve high-need public-sector populations, ultimately aiming to build the critical mass necessary to attract private insurance contracts.

“We're presenting ourselves to these programs as a cost-offset program,” says chief medical officer Joseph A. Cabaret, MD, describing the facility's outreach to Medicare, Medi-Cal, workers' compensation and Department of Veterans Affairs representatives.

Located in Camarillo, Calif., near Santa Barbara and open since last fall, the facility came together through the brainstorming efforts of Cabaret; John Stenzel, former CEO of The Bridge to Recovery; and Stephen Grinstead, PhD, developer of the manualized Addiction-Free Pain Management System. Stenzel serves as A Healing Place, The Estates' CEO and Grinstead is chief clinical officer. Their idea involved trying to improve upon traditionally dismal outcomes and premature discharges seen in addiction treatment programs that serve patients with chronic pain.

The “triple diagnosis” refers to chronic pain, an addictive disorder and a psychological disorder, but the facility's leaders also emphasize that a common current running through the life experiences of these complex patients is trauma.

“We've got to address the underlying trauma,” says Cabaret. “We've got to get these patients off their dependence on the biomedical model.”

That's not a simple task, he says, given that the typical patient will arrive to treatment with a shopping bag full of prescribed medications, reflecting how the medical community has commonly addressed their problems.

Clinical strategies

Stenzel explains that, as was the case with The Bridge to Recovery program model, A Healing Place, The Estates is not an open enrollment program. Individuals must be medically and psychologically stable in order to be admitted. This eliminates concern about patients leaving against medical advice, he says, as the program is working with a highly motivated population.

In the early stages of treatment, Cabaret says, it becomes important to assist patients in shifting from a body-focused mentality to one that taps into their psycho-social-spiritual reserves. “Let's try something new” becomes the theme, he says.

“These individuals have become fixated on their bodies, which has distracted them from their underlying psychological pain,” says Cabaret.

The program employs a number of evidence-based healing interventions, from neurofeedback and trauma-based therapies to physical therapy and acupuncture. “We have seen good results from neurofeedback on sleep and other issues,” says Stenzel.

The organization intends to operate a continuum of services that will include primary residential, day treatment, an evening intensive outpatient program (IOP) and transitional living services. The ideal size of any one group at these levels of care will be around six patients. The six-week IOP costs around $11,000, with a six-week residential stay priced at $60,000.

Multiple populations

Stenzel says that around half of the program's patients are in self-pay arrangements. But the organization is moving swiftly to establish ties that will allow it to serve local Medicare, Medi-Cal and veterans populations, as chronic pain and related behavioral health issues plague many in these groups.

Regarding Medicare, which generally does not pay for the services the facility offers, “We are talking with a local hospital to partner with us,” says Cabaret. Likewise, a Medi-Cal health maintenance organization in Ventura County could sponsor a pilot project to test the center's approach with the local Medicaid population.

“We want to reach the Medi-Cal population, whether with them as a partner or through a foundation,” says Cabaret. All of this could ultimately allow A Healing Place, The Estates, to be able to go to major private insurers and build out the concept for their patient populations as well, he says.