I recently had the opportunity to speak with David
Lisonbee the President and CEO of Twin Town Treatment
Centers located in Southern California. The following
is an abridged version of that conversation.
Ted: I am with David Lisonbee of Twin Town Treatment.
He has been very cordial in giving us a large slice out
of his busy schedule to talk to us about treatment,
where it’s been, where it’s going, and where Twin town
treatment fits in the business. David thank you for time,
David: Good morning.
T: Let’s start with a little bit about your background.
D: Yes, absolutely. I’ve been in the field for twenty-eight
years. I actually started in healthcare working in emergency
rooms, as an emergency orderly/tech/nurse’s
aide when I was in graduate school in Portland. From
there I got I nighttime shift working in a psychiatric facility
in Portland. That’s my first exposure to corporate
medicine. I worked for CPC, which was a large inpatient
provider of psychiatric services at the time. I moved
up from being a tech to their Marketing Director. I was
hired in 1985 to run an inpatient unit in a hospital in
Long Beach, CA. that was owned by National Medical
Enterprises. I worked National Medical Enterprises
psychiatric division for ten years, working my way up
to CEO of several of their inpatient facilities. One in San
Jose another one in the valley in Canoga Park. In 1995,
I got sober and three months later got a job working in
the outpatient arena. That was something I had wanted
to do for some time. I ran psychiatric outpatient
programs for Psychiatric Management Resources up
through 2000. In 2000, I assisted PMR to sell Twin Town,
which they had stock in to another buyer, that buyer
sold the stock and eventually my partner and I purchased
the stock in Twin Town.
T: Twin Town, they were doing outpatient treatment.
They were out of Minnesota?
D: Twin Town was established here in Southern California
in I believe 1987. They were an aftercare location
of a twenty-eight day model program out if Saint Paul.
They did an out care program for McDonnell Douglas
here in Los Alamitos. The managers of the outpatient
location saw the opportunity with managed care
moving into behavioral health to spin off into its own
freestanding corporation in California and do only
outpatient. It was very astute because managed care
at the time was trying to steer everybody away from
inpatient and residential, both on the psychiatric and
the chemical dependency side. The owners of Twin
Town, the eventual owners saw the opportunity of operating
the outpatient service and managed care and,
of course, they got all the contracts. Today, we have all
of the managed care contracts, other than Kaiser. That’s
our main source of funding.
T: Okay. What was it about outpatient that drew you?
D: Well, having been in the inpatient side of the business
for more than ten years, I could see with the
advent of the more effective psychotropic medications
and the economics of pushing people into less expensive
realms of care that that was where the business
was headed. Also, I saw that people that were able
to apply what they were learning directly into their
normal lives seem to get a lot more from the outpatient
experience. The residential experience the idea
is immersing people into recovery and they will take
it back home with them. For the outpatient what we
see is they can learn organically and they start to build
those tools in the environment that is going to matter.
They are going to be able to know how to deal with the
triggers at home because they are living at home while
they are going through treatment.
T: Their everyday stresses they are going to be dealing
with in the outside world they are already dealing with
on a daily basis.
D: Right, they’re dealing with the baggage and they’re
dealing with the wreckage of their past. They’re bringing
it back to the program and we are helping them
start to march through that, with the support of the
group and the feedback. They get the problem solving
and the emotional support we can give them.
T: At Twin Town, you deal only with substance abuse?
D: Yes. A co-occurring problem like a psychiatric or
mental health, process addiction or even a medical
problem, we like to work with the therapist or the physician
the patient has been seeing. If the person comes
in and it has been untreated, the medical or the mental
health issue we’ll help the patient find somebody that’s
on the insurance panel and specializes in whatever the
issue is. That’s again an organic way of giving people
recovery. We take a look at building a natural and
lasting support network, which will include a therapist
they will continue to see after they leave us. Or a
physician that will continue to see their medical issues
or a psychiatrist that will continue to treat whatever the
psychiatric disorder is they are working on.
T: Actually, you get a lot of your referrals from therapists,
D: Right, I think the economics of working in concert
with and in partnership with community providers is
also beneficial. We get cross referrals we are not competing
with our referral sources. We’re teaching the
doctors, we’re talking a lot about doctors eventually
being the gatekeepers. Under ACA, doctors will play
a much more important role in getting people to
treatment. The health homes the idea of the medical
groups having more control over the benefit administration.
All of that bears out that doctors need help
but also need education as to what’s out there to help
their patients. So, as we work with the doctors that the
patients are seeing they are becoming more aware of
the benefit of treatment and the different avenues that
people can access treatment.
T: As far as Twin Town, you’ve shown a great deal of
growth in the last few years, you have six locations?
D: Yes, six locations. We have a location in North Hollywood,
West Hollywood, Torrance, Los Alamitos, Orange
and the newest location we’ve opened is in Mission
Viejo. What we are hoping to do is maybe expand to
another location. We are not a corporation that is looking
to make cords of money, that’s not what we’re in it
for. For my partner and me it’s a nice lifestyle business.
It’s doing something that we believe in so it’s a lot
more than the financial return. We also tend to grow
organically. Our new locations have been funded solely
through our operations. We’re not looking for capital;
we’re not looking for investors. For me, it helps us keep
our eye on where it should be, which is patient care,
what the patients need. The return has continued as
long as we are doing the right thing.
T: You’ve been involved in psyche care and you’ve been
involved in recovery care, as far as recovery goes what
do you see as the evolution of treatment?
D: I think we have moved away from some of the
arbitrary and dogmatic rules about what programs are
supposed to do. The twenty-eight day program was
somewhat of a myth, like there is some magic at twenty-
eight. In fact, research demonstrates that the more
effective treatments last between three to six months.
I think also trying to fit the patient into the program
and seeing patients as unwilling, resistant, or failing. I
think we are now recognizing that people are individuals
and they have unique strengths and weaknesses.
They have different motivations that bring them in the
door. We have to acknowledge and appreciate that
and work with that. Rather than treat a program we are
actually treating people. That’s an important change
that has happened in the field. I know that with myself,
I’ve moved from being very dogmatic about an
abstinence model program, and we’ll continue to be
more of an abstinence model program at Twin Town,
because you need a clean environment for people to
attain that type of recovery. I have come to the place to
realize that not everybody is entitled, or willing or even
interested in this type of recovery. Perhaps, the best
that some people will get will is seeing the methadone
clinic every day; at least they’re alive. Some of them are
staying out of trouble.
T: So, harm reduction?
D: Harm reduction has its place. Suboxene has its
place. We would much prefer seeing it used as a part
of a detoxification routine, but it may be that it is more
appropriate than methadone for some patients if they
have to be on a maintenance program. I think that the
field is getting away from dogma and starting to look
at things a little more scientifically, a little more globally.
I think that we are becoming a little more broad,
more flexible. I think that we still want the patients to
get the best recovery that’s possible for them. We’re
all in it for that, but I think we recognize that we don’t
want people to die just because they are not willing to
comply with what we want for them.
T: Can you run me through an assessment at Twin
D: Being Joint Commission Accredited, our assessments
are very global. The assessment takes about an hour
and a half. We take a look at the patient’s physiology,
what medical problems, nutrition. What ways they can
take in information. How they best can learn. Whether
they have a history of sexual abuse. It’s a very extensive
assessment. From that, we can determine what it is that
we’ll focus on in treatment, which is more of the addictive
process and then what needs to served outside of
Twin Town. What needs to be brought to a psychiatrist?
What needs to be brought to a therapist? What issues
need to be addressed medically with their primary care
physician? What issues might need to addressed by
their parole officer? Or by an attorney? We look at people
comprehensively but we don’t pretend to be the
100% solution. Instead, we help people find resources
to take care of those problems we are not going to be
able to address.
T: To a certain extent, a little bit of case management.
D: A lot of case management. I think that the other
thing that outpatient affords us is the recognition that
treatment happens outside of Twin Town groups. We
do good group work, but to be honest treatment happens
when the patient, at 11:00 at night, is making that
decision about whether they’re going to go out, join
up with their buddies and use or whether they’ll call us
or their sponsor. That’s probably more powerful treatment
then a person sitting in-group every day. So, case
management and getting people involved. We do a lot
of homework; we give a lot of take home stuff that they
bring back to group the next day. We take a look at
how they rate their own progress I achieving their own
personal goals. We focus on patient presented goals.
T: You do a lot of twelve-step work what other kinds of
approaches do you use?
D: A lot of cognitive behavior, a lot of teaching, a lot of
Hazelden model treatment. We also do a major focus
on relapse prevention, more of Gorski style relapse
prevention. We also introduce people to mindfulness.
All of our groups start with a mindfulness exercise. Now
we’re introducing a little bit more Gestalt active exercises
inside of group. So people can observe treatment
in process and get some feedback on how they’re
T: So, where do you see yourself heading?
D: Like I said, this is a wonderful lifestyle business. I get
a lot more than just the financial gain from operating
Twin Town. There is a lot of personal. Just knowing
that people are getting better. All of our patients do
a rating three days into treatment, a month into treatment
and then five months after treatment. So getting
that feedback about how they are gaining makes a lot
of difference. Being able to steer the organization and
address new needs. Helping the organization evolve
with the times. Taking in more science evidence based
treatment. Also, I like being involved with the public.
I do some education around the issues of being prepared
for managed care. I work with SAPACC in L.A.
County doing a little bit of public service. Working with
the non-profits getting ready for managed care. I also
do a lot of work around the ethics of treatment. I think
that’s very important for patients but also for us in the
provider realm. When we turn our backs to unethical
practices we are going to be judged by the public regardless
of whether we’re practicing poor ethics or not.
I think one of the things we need to do, as an organization,
is participate in setting a higher standard. Help
people understand what the standards are. Some people
don’t understand that paying for a referral is wrong.
It starts from the basics and goes up from there. I think
it is very important that we set a higher standard. We
cease to sell patients as if they’re cattle. We need to see
patients as people and not commodities.
Interview by Ted Dunn