The document outlines a 5 year plan for addiction recovery. It begins with an intervention, followed by a minimum of 90 days in treatment and rehab. This is then followed by a stay at a sober living facility with intensive outpatient treatment. Long term recovery involves ongoing monitoring, 12 step meetings, and case management over the course of 5 years with the goal of preventing relapse. Motivators, leverage, and consequences are part of ensuring compliance with the long term recovery plan.

1. The 5 year Plan
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2. The 5 year Plan
DID YOU HEAR THAT?!
Someone dies of an accidental overdose
every 19 Minutes, in this country!
80% of THE WORLDS RX’s are taken by
Americans & we are only 5% of the global
population
We prescribe in a year, enough pain meds for
every Man, Woman & Child 1 pill every 4 hours
for 3 weeks.
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3. The 5 year Plan
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4. The 5 year Plan
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5. The 5 year Plan
The 5 year plan is applicable to any addiction
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6. The 5 year Plan
Statistically Speaking
• 40-60% of people relapse after drug and
alcohol treatment. NIDA
• Anything less than 90 days of treatment
increases the chance of relapse – NIDA
• An individual's treatment and services plan
must be assessed continually and modified as
necessary to ensure that it meets his or her
changing needs - NIDA 6

7. The 5 year Plan
What do we know about the success rate of 30
days in treatment?!
How do treatment centers come up with their
numbers?
What’s really their criteria?
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8. The 5 year Plan
Are there any hardcore, evidence based
statistics out there? There better be…
Do you think they’ll let convicted felons out with out being sure they’re clean?
..or a pilot get his license back without knowing for sure?!
..or a Dr. work with a patient?
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9. The 5 year Plan
Drug Courts are proven to retain offenders in treatment considerably longer
than most other correctional programs.
3 phases starting with a treatment plan
90 days inpatient treatment
Continued random monitoring
Intensive case management
Over 2 year span
http://www.nycourts.gov/courts/2jd/brooklyntreatment/handbook.pdf
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10. The 5 year Plan
The Airline Pilots
HIMS (Human Intervention Motivation Study) is specific to commercial
pilots and coordinates the identification, treatment and return to the
cockpit of impaired aviators. It is an industry-wide effort in which
companies, pilot unions, and FAA work together to preserve careers and
further air safety.
http://www.himsprogram.com/Content/Aftercare
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11. The 5 year Plan
HIMS is the program that United and over 48 other airlines use.
(except for American, they have own EAP program.)
4500 total since 1970's
400 are with United
80 are currently active
If they fail a test, DOT Offence protocol is to wait year to start process to re-apply
for license
FAA looking to take license if they are using BUT offer this program
92% long term recovery rate 2 years- less then 10% relapse
8% decided to retire
They need to have medical certificate that they are able to fly as long as they are
accountable
FAA requires quarterly reports from airline from AME (Areal medical evaluator) who
decides what should be required
The weakest component is the link to aftercare
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12. The 5 year Plan
Physician Health Programs (PHPs) have a record of success
• Blueprint Study* – 904 physicians from 16 state PHPs who’d been under PHP care for
5+ years
– 79% no relapse
– Most relapses not followed by another
– No patient harm
• Domino Study – 735 physicians in WA state – under monitoring from 5-11 years
– 80% no relapse – no patient harm
*Dr. Skipper
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13. The 5 year Plan
PHPs oversee evaluation and treatment
Monitoring evaluation and treatment programs
• 28 of 37 programs (76%) maintain list of authorized
providers
• 48% maintain criteria for authorizing them
• All but one program (95%) require treatment programs
to send regular progress reports during treatment of a
physician
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14. The 5 year Plan
Treatment alone often fails to attract and retain people
suffering from substance use disorders (SUDs). Even
when patients complete substance abuse treatment,
relapse is so common it is frequently cited as a hallmark
of the disorder.
Dr. Greg Skipper, MD
TREATMENT IS ONLY THE BEGINNING OF RECOVERY!
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15. The 5 year Plan
Key Components of The 5 year plan are Case
Management & Care Planning and they include…
 Intervention
 Minimum 90 day treatment, Reevaluate
 Sober Living - Reevaluate
 IOP, Reevaluate
 12 – step, continuing
 Monitoring, Reevaluate
 Motivator /Leverage, Reevaluate
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16. The 5 year Plan
The 5 year timeline
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INTERVENTION
An Intervention is a meeting of the entire family and or support system to
address collectively the problems and or concerns of the family and or
support system.”
Right there…at the very beginning of treating the addict…we are recognizing
that this is a MUCH BIGGER deal than just getting the IP off drugs or drink.
This is the meeting that takes place before the IP ever even gets into the
room!
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17. The 5 year Plan
The 5 year timeline
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I P TREATMENT
At this point the IP may or may not even think they have a
problem at all. We all see it…The people around the IP all
see it, but the IP most likely thinks that their disease is still
manageable. So then the solution becomes…”let’s get ‘em
to rehab.
Yeah…That’s a great next step. Most insurance will pay for at
least 28 days, but most professionals agree that 90 days is
the minimum amount for any meaningful and effective
recovery to begin. The best adjunct for 28 days of residential
treatment is 90 days in sober living combined with an IOP
(Intensive Outpatient program).
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18. The 5 year Plan
The 5 year timeline
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SOBER LIVING
The best plan after treatment is if IP’s are placed into sober
living facilities directly from treatment. This will help
maintain some of the structure they’ve become used to in
treatment….
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19. The 5 year Plan
The 5 year timeline
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SOBER LIVING
The problem most sober living facilities is that the IP goes
from the intense structure of treatment into a very
unstructured sober living facility so they take advantage of
the excessive freedom and that’s when they get into
trouble, therefore it’s very important to find a Sober Living
facility that has a good relationship with their treatment
facility and can work with both the IP and treatment team to
keep the momentum going…
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20. The 5 year Plan
The 5 year timeline
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INTENSIVE OUT PATIENT
IOP is extremely valuable in terms of supporting the
transition from “In Patient” recovery to the delicate task of
reintegration into full life.
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21. The 5 year Plan
The 5 year timeline
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MONITORING
The quantitative component of the plan.
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22. The 5 year Plan
The 5 year timeline
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12 STEPPING & Peer Support
NOBODY Does this alone
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23. The 5 year Plan
The 5 year timeline
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INTERVENTION
I P TREATMENT
SOBER LIVING
MONITORING
INTENSIVE OUT PATIENT
12 STEPPING 23

24. The 5 year Plan
Ongoing Case Management
Ongoing Case management can really take you from the pre-
intervention phase through all 5 years of monitoring. It includes
contingency contracts, intensive monitoring of Urine Testing,
validating meeting slips, monthly or quarterly reports, intensely
structured phone support for family system, ongoing frequent
check-ins with recovery team and, if warranted…check-ins with
therapists.
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25. The 5 year Plan
Ongoing Case Management
The benefits of Long term Case Management & Care planning are
numerous. Case Management is:
•A tool the therapist can use to help the patient with compliance
•The ability to create plan to elevate to a higher level of care if they
fall out of compliance
•The Therapist and/or Family do not having to “police” behavior
•Support to treatment plan established by therapist or facility
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26. The 5 year Plan
Also part of the recovery plan…
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27. The 5 year Plan
Motivators
Leverage
Consequences
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28. The 5 year Plan
For many, the idea of addiction is that it is still a
moral issue. For others, they understand that it
is a medical problem. What most non-addicts
fail to understand is that it’s NOT a curable
disease; but it is a treatable one.
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29. The 5 year Plan
If we were dealing with Cancer…When would be
the best time to start treatment?
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30. The 5 year Plan
Why is an outsider better than doing it yourself?
Same reason that a company shouldn’t monitor
an employee
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31. The 5 year Plan
Full Disclosure..Addicts respond better when
they know what’s coming ahead of time & they
are a part of the process.
Very important to plan & implement while still in
treatment.
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32. The 5 year Plan
Contracts, Contracts, Contracts!!!
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33. The 5 year Plan
“The “carrot” is the ability to practice medicine, and
make a living, without a public record. The “stick” is
action against the license if the physician does not
comply with the requirements in the contract. As you
know, consequences are GOOD!!! Our success is based
on behavior modification. Good behaviors are rewarded
and unwanted behaviors result in prompt negative
consequences.”
Dr. Scott Hambleton
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34. The 5 year Plan
Why a skilled interventionist
Will minimize the natural progression of negative consequences
Will know how to dissect the family system to create the bottom
line (license) to motivate the loved one
Will educate family on the importance of the 5 year plan
Will insure case manager remain objective about their recovery so
the family can be emotional in the relationship
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35. The 5 year Plan
Motivators
Leverage
Consequences
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36. The 5 year Plan
Questions?
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