Andrew: I have the distinct pleasure of interviewing this morning Mark Baumgartner, the senior director of clinical services at Betty Ford Center. Thank you so much, Mark, for joining us at Serene Scene Magazine.
Mark: Oh, thanks for having me, Andrew. I appreciate the opportunity.
Andrew: One are the things that I want to ask you right off the bat is how did you find yourself in your current station in life? What led you to this place at Betty Ford Center today?
Mark: I guess the story goes way, way back for me. Being a kid growing up in Minnesota, I loved to go to summer camp, and experience being in communities with people in the outdoors, and had some leadership opportunities then. And as I went through high school and into college and got into recovery myself, I figured out that this is what I’m supposed to do with my psychology degree.
So I started working in the addiction field and worked at various places. But long story short, I came to work at the Betty Ford Center in 2001 as an addiction counselor. And about a year and a half after that, became the clinical director of the residential treatment program, which was on the main campus consisting of 100 beds, here in Rancho Mirage.
I did that until about a year ago last June, so in 2014 I started working on the pre-launch and development of the expansion of Betty Ford Center into West Los Angeles as an outpatient clinic. And then last May I stepped aside to fill a vacancy with the overall oversight of clinical programs for Betty Ford Center in Rancho Mirage and in West LA. So I’ve been in this position for about six months.
Andrew: Working at Betty Ford Center has to be such a privilege. I’m not sure if there’s any other program in the world that has the brand recognition that Betty Ford Center does.
Mark: I agree, and the privilege and the honor is the opportunity in some way, manner or form to just be a part of Mrs. Ford’s legacy and her candor.
With breaking the ground of being able to come out about addiction, and addressing the stigma of that. And then also, with her breast cancer recovery. I don’t think people talked too much about that before. She was out with that, so her leadership in the field and her heroics around that are amazing.
And the thing I like to remember about that is, I have and did have the opportunity to meet and connect with her and President Ford over the years, before they both passed. But many of the employees here who were even more intimate with Mrs. Ford, tell stories about how, with that brand recognition… I guess what I’m trying to say is that sometimes there’s this myth about the Betty Ford Center that it’s for the wealthy or the famous. And so once in a while, somebody recognizable may need come in for treatment, but she was really about the common person, so she went out of her way, both with staff and patients, to make a personal connection. And all the sorts of social class kind of things, she just threw to the wind. And she just really connected and cared for people. So it wasn’t just at the level of media and television and being a high profile celebrity herself that made a difference. Then when she was in the moment when nobody was looking, she really practiced that humility too.
So, just being associated with that and getting to be a part of that is amazing. And so that’s what we really try to do, with folks here is connect with them on a personal level. It’s all about connections in recovery. You know we healed together and she just personified that so well.
Andrew: Betty Ford’s center been around for a very long time. I’m sure that treatment philosophies have changed over time as we’ve learned more about this chronic disease of addiction. Can you tell me a little bit about what the Betty Ford Center treatment philosophy is today and how that’s being incorporated to treat so many that need help with their addiction?
Mark: We’ve always recognized in the field, way back 25 plus years ago when I was first learning about addiction as a disease, that it is a primary problem and that it’s chronic; meaning lifelong, doesn’t go away, no cure, that it’s fatal if unaddressed. And it’s progressive, it always gets worse.
These are pretty common things. You hear about that in 12 step meetings, in one form or another. But when we look at the treatment that’s occurred traditionally a lot of times the model was similar to when somebody has some sort of medical crisis and they would go into a hospital for a period of time, be it 28 days or whatever. And so say somebody has a broken leg, they go in. they get treatment, and that gets addressed. And there’s some relief and healing occurs. And so even though recovering from that takes some time, sooner or later you’re pretty close to back to normal, and you move on from that, whereas addiction doesn’t go away. But in our treatment model, we were trying to do everything all at once, for a few weeks. And you know even sometimes up to three months. But the problem with that model is, sometimes, people relapse and then that would be looked at and stigmatized, even in the recovery community, as a failure, when it’s really just a part of the process.
So when you look at other chronic diseases that demand a lifestyle change for the disease to be in recovery, such as with heart disease or diabetes. It’s critical that there is a lifestyle change and so what really works well is having a model of treatment where it’s collaborative and individualized so different people need different periods of time of treatment and different levels of care.
Someone might need a few days in residential and most of their time in an outpatient setting in order to get that lifestyle change in place for them to be in long term recovery. So the idea now is, and it’s always been, but we’re better I think at doing it now, of acknowledging that okay, we in the field of addiction treatment understand addiction and recovering. We’re experts on that, but the person coming that’s new as a patient is the expert on applying those recovery principles to their life, so we really have to work collaboratively and focus on self-management of the disease right from the get go during treatment. So we see just more individualized care plans for folks as they come in, be it varied lengths of stay or different services they get.
Andrew: I know that Betty Ford Center has been approached to the continuum of care that is unique amongst many of the treatment agencies in the United States. Can you talk about how you approach the continuum of care from detox all the way through from sober living and reentry back into normal life?
Mark: So it’s just that there is an extensive continuum of care. And that we have the stabilization. For example, the Betty Ford Center in Rancho Mirage is actually identified by the state as an addiction hospital which is kind of unique. And so, we have all the medical facilities. It means that we can address the people that are pretty sick when they come in. So as soon as people are demonstrating self-management and they’re medically stable, they move through the continuum.
So residential means you sleep on site, that there’s nursing and support staff around 24/7, and then day treatment occurs where it’s a minimum of 20 hours a week, and folks may sleep on site in structured recovery housing or sober living, or they may stay at home and attend during the day. But, it’s less expensive and a bit more flexible in terms of maintaining your regular lifestyle as you’re receiving treatment, and then there’s intensive outpatient which is a few nights a week at minimum for a few hours a night, followed by continuing care groups. And then, unique in the Hazelden Betty Ford Foundation, is a program called My Ongoing Recovery or MORE where folks can have an addiction professional or a certified addiction counselor or licensed counselor be a coach for them and they can continue without going to a group but online to be a part of a community and receive counseling online. As well as get some support in terms of continuing to get random urine drug screens, and having a whole plan and contract around that, to support staying sober for them, with a contingency plan if that doesn’t work out. So this level of care called My Ongoing Recovery, which is available, can go for quite a period of time, depending on what people want or need, from several months to over a year. And it’s available and that’s pretty unique in the industry, as part of that continuum.
Andrew: There’s some other unique programs as well, that I have had the privilege of participating in myself, in the past. The family program that’s offered at Betty Ford Center in Rancho Mirage is an incredible program. How did that program get developed? And who can participate in that program?
Mark: Thanks for bringing up family programs. So yeah, absolutely, addiction is a family disease and we have to address the family members and their needs to support the individual with the active addiction. But everybody’s affected profoundly. So our family program is available to the general public, as well as to family members of patients. And then there’s a children’s program associated with that too that folks who have children can participate in afterwards on the weekend at various times during the year. It’s been around since well before I started working here, so I think since the beginning, but it’s evolved and grown over the years and it consists of education as well as process oriented groups for family members. And then it includes interaction with the patient who’s actively in treatment as well as their family who’s having their own experience during the family week so it’s a powerful process for everyone. It’s interesting because when people show up Monday morning for the program, there’s a lot of anxiety and nervousness, and then when the program’s concluding at the end of the week there’s just this exuberance of celebration and release in healing that’s occurred and it’s fun to observe that process for people throughout the week.
Andrew: You’ve mentioned the children’s program just now, and the children’s program is phenomenal. Can you help us understand how the children’s program works and who is eligible for the children’s program and how someone might get enrolled?
Mark: The way to get enrolled in the children’s program, and access to the children’s program for children affected by addiction can happen independent of the family program, or if someone was ever a patient. In fact, the children’s program occurs here on campus, as well as in Dallas, and Denver as independent programs that people can go to and attend, but the children’s programs also go to schools and provide education in schools about addiction. And the main methods there is that when Mommy and Daddy are sick, that it’s not the fault of the child, because the child will take on responsibility for the addiction and assume that there’s something wrong with them. Similar to what family members do as well, as an addiction progresses and there’s secrecy around what’s really going on, as well as ignorance. So there’s a lot of healing that goes on within the children’s program. Jerry Moe is the national director of the children’s program and a renowned author and expert, and has books published.
But if folks want more information about the family program, children’s program, or treatment services, go into our website, just putting in Hazelden Betty Ford Foundation, or Betty Ford Center is going to bring up links to get information about all that.
Andrew: And finally, there is an alumni program in operation as well that’s quite expansive I understand.
Mark: Yep it’s a national program. It was before the Betty Ford Center merged with Hazelden Foundation to become Hazelden Betty Ford Foundation. But now those alumni programs are integrated and even bigger and collaborative, and so in early November we had another reunion here on site for the Betty Ford Center alumni that was open to all.
But there’s meetings all over the country in major metropolitan areas, and so the same website will provide links for information for alumni that may not be connected that want to be, and if a person goes through the children’s program or the family program, they are alumni too. They don’t necessarily just have to be a patient. So everybody’s included.
Andrew: Betty Ford Center has an, I would say, undeserved reputation as being an agency that offers outstanding treatment resources, but only for people that have a lot of money, financial resources, or are famous in some way. And that’s just straight up false. Can you tell us about the affordability of Betty Ford Center, and how easy it is to get in and to receive this treatment that’s world-class treatment?
Mark: Since we’re in-network with insurance companies, and really this has been a response to health care reform. In the triple aim of healthcare, which all health care systems are going through, where costs have to be reduced. That’s just demand due to healthcare reform. Outcomes have to be better, and better health has to be promoted for all. So we made the change from going from a self-pay model to access treatment, which could be expensive for many when it’s all out of pocket, to one where we take insurance. And so if someone is seeking treatment in Hazelden and Betty Ford Foundation, either at the Betty Ford Center or one of our other locations nationwide they call in and what we do is get the insurance information and then see what kind of benefits are available for that person so they can use their insurance. And the healthcare reform known as Obamacare demands that there’s parity for addiction treatment now; such that the law requires insurance to pay for addiction treatment. This is why it is more affordable. So, much of the cost of the treatment is paid for by insurance. And then as a backup, and as part of working with people’s insurance benefits, we have folks that can help come up with a funding plan. So, treatment is more accessible and more affordable for more people than ever before I think in the history of the industry.
And what’s nice is that, in that continuum of care, be it if somebody needs residential treatment or less intensive outpatient treatment, the costs are less with the outpatient treatment and so that’s part of the incentive to help people move through and have a more individualized experience where they only get the treatment they need when they need it versus treatment they might not need that costs more. So that model has changed to be more individualized, and that’s just consistent with keeping the costs low and the outcomes better and the satisfaction of folks who come for treatment higher. So, the process starts by giving us a call. Most people are looking this up on the Internet to get initial information, but then picking up the phone is the next step after that.
Andrew: So it sounds like when Betty Ford and Hazelden Foundation teamed up, that a great expanse of additional resources was made available to people all across the nation. What kinds of things are now available to people that beforehand were not available?
Mark: Well, I think a huge thing in terms of answering the part of what’s available to people is just accessibility. For treatment services, for mental health services, and opportunities for recovery centers within communities. For example, expanding into West Los Angeles, which is something we had always talked about doing at the Betty Ford Center for years but we were never able to do until we were a part of a larger organization. As we want to be a center of recovery in that community, not just be a treatment provider so we host a bunch of 12 step and other recovery support meetings and hold events for the public, be it education or self-support. And part of the way that clinic is designed, actually in its floor plan, is to have a space for the public in those meetings separate from the clinic’s where patients are so privacy can be honored, but yet there’s some opportunity for folks to integrate. There’s 16 sites nationally, within the larger organization, with three major residential treatment centers and then other sites with outpatient. But many which include structured recovery housing and sober living that can be accessed while receiving treatment services. So for the person in recovery as well as the potential consumer and family that needs recovery services accessibility.
But, what’s been interesting having been a long-time employee of the Betty Ford Center and then becoming a part of a larger system is just the benefits and opportunities we have with the larger scale. So as we’re becoming a national system of care, were able to innovate and identify for example, best practices that are evidence based and research driven, because we just have more people and resources to pay attention to what those are and learn from each other. For example, we’re going to have a state of the art electronic medical record system that we launch next summer.
Now, we have that now, but it doesn’t serve our needs nationally as well as it could, so we’re collaborating with a software developing company that does medical record software development to create something that’s never been done before at the scale that it’s going to be, that will actually improve care, it’s so innovative.
Patients will be able to access it directly and provide information about how they’re doing at different phases of where they are in their recovery and treatment. And it’s going to help standardize things. So, for example, in the organization we have a research department and a bunch of folks dedicated just to research at the Butler Center in Center City Minnesota. And that’s where we’re able to see what’s working. Hazelden Betty Ford Foundation really invented addiction treatment and has studied what works and so a lot of that occurs through doing real research. And so that’s active in making a difference because then we’re able to apply results in people’s treatment but also we talked about the alumni being richer and larger.
And there is just more support to do things right. Leadership that the organization is taking in addressing the opiate crisis that’s occurring nationally with new and innovative treatment. That if it were just the Betty Ford Center alone, it would be difficult to have the resources to respond to it, in the manner that we’re able to now with having research and staff to develop programs and try things out.
Andrew: You have just mentioned the opiate crisis. Can you talk to us a little bit about how the opiate crisis is being addressed within the treatment setting?
Mark: Well, I think that the history on that is that pre-Hazelden Betty Ford Foundation merger, the response of people overdosing frequently from opiates and that escalation, even post treatment sometimes, was just an unacceptable outcome. And so the organization there at that time took a real inventory in terms of what are we doing to meet the needs of opium addicts, specifically, to address this, get better outcomes, and really just save more lives. And so what they found is that, folks are leaving treatment. For people who come in on opioids, the brain’s even more hijacked. You had mentioned that it affects all social economic classes and knows no barriers, that’s true of addiction in general, we all know, but it just seems even more escalated with the opiate epidemic that we’re experiencing. So part of the problem with what they are finding with opiate folks, that are primary opiate, is they they’re just not feeling well even farther into treatment, so when you have this acute care model of treatment where the length of stay was for most folks a month or so, and then they’re on their own, they were barely even feeling better before they were back out on their own and going to meetings exclusively. So, we found that we needed to work harder at helping people settle in and feel better during the primary treatments. So, they have more time to engage in its benefits and apply recovery principals to their lifestyle and we needed to keep them engaged, therefore in treatment longer through that continuum in other words, commit to being an out-patient and staying an out-patient for a larger period of time. So, what they came up with was looking at providing extra counseling services and medical services for primary opiate folks to help them stay in treatment longer and have a better chance at developing a sober, recovering lifestyle. They just needed more time.
So, they came up with Comprehensive Opioid Response Twelve Steps. That’s the name of the program. And so, really what that consists of, as for certain people who are on opiates, if they meet criteria, they’re invited to consider participating in this program, which, consists of a commitment of six months. So, there’s a period, usually of residential care, and then a commitment to remain an outpatient with us for a period of time, and some of those folks use medication, past the detox period as part of their treatment.
There’s one drug called Vivitrol, which is an antagonist that helps with craving, but results in, if someone were to use opiates while on it, they can’t get high. And typically, that looks like a shot that people will take once a month for a period of time, so if somebody commits to receiving medicine, they can’t get high while they’re on it, they feel a bit better, so they’re more likely to stay motivated and stay in treatment. Use of very low dosage of Buprenorphine or Soboxone is another option that some people benefit from post detox. That drug’s been used for a long time, as part of the detox process. So, it’s almost more of a prolonged detox. And then finally, there’s one third of participants, that don’t have any medication assistance, but benefit from the extra counseling services that are exclusive just for opiate addicts, that we offer.
So, anyway, what it looks like is, the bottom line, is that complete abstinence is the goal. But we use some medication to assist with getting more time in recovery and treatment, so that people can establish that recovery lifestyle. And the way we control for that is that you have to be, say somebody is choosing to receive medication, they’re attending our outpatient CNR doctor and getting that medication from us, so that if they stop, for example, attending the counseling portion, then they stop receiving the medication as well.
So, we call it medication-assisted, and medication maintenance, and so that’s created some controversy in the field of addiction treatment where medication maintenance consists of somebody indefinitely on Methadone or Suboxone to stay stable and sober. And there’s a tiny percentage of people that need to do that and benefit from that, but the majority of folks can temporarily, just like, they need a detox, they can temporarily be on medication and be assisted by that, until a time can occur that they have enough of a recovery lifestyle established, meaning they’re attending 12 step meetings consistently, and adopting recovery principles into their life. And then, their able to go off that medication. And that decision of when to do that is made as part of a treatment team that the patient’s on, and typically is occurring at three months, six months, some folks longer. So, we’re just getting ready to have research come out in the near future, showing some of the benefits of this program.
But our retention of opiate dependent, or opiate use disorders patients, remaining in treatment who ought to be in the program regardless of if they’re on medication or not is significantly higher than folks who are opiate use disorder who aren’t in the program. So, we’ve seen some really positive results.
So, that’s one of the things we’re doing to address the opiate crisis. And then, advocating nationally, to pay attention to the opiate crisis and use science and evidence-based practices like we’re seeing with our Core12 program that Samhsa and national organizations recognized as having value in work. We’re in Washington at their invitation because politicians are interested, because there’s a lot of public awareness coming up about the crisis and people needing and looking for solutions. So, it’s exciting to see some progress occurring on the treatment end of the crisis.
Andrew: Being involved with addiction treatment for 25 years, you have seen the stigma of addiction change. Now with this new opiate crisis, it seems like we’re taking a step back with regard to the stigma attached to addiction. What message would you like to broadcast out there to individuals that are thinking, this addiction thing, it’s just somebody that can’t control themselves, they just want to escape life’s problems and they can’t handle their lives in a reasonable way. What would you tell these folks?
Mark: Well there’s, and I don’t recall what page of the Big Book, it’s on this quote, you know, “Contempt prior to investigation.” You know making a judgement before having the information and the facts. So if folks are interested enough in it, and they pay attention to the science and the research, and learn more about it, and what it is that we’re talking about when we talk about medication assisted therapy.
We’re not talking about, not being abstinent. We’re talking about abstinence, it’s just sort of a delayed or longer detox for some people. And so, I think when people don’t have the information, they jump quicker to conclusions that may not make sense. Being a man in recovery and in the field as you mentioned for 25 years, I saw this same dynamic occur 15 years ago with antidepressants. And so we saw, in 12 Step meetings, people get up and talk about, if you’re on an antidepressant for example, an SSRI which are the majority of them these days, sometimes folks would stand up in meetings, and say if you’re using that, you’re just not working your program hard enough or well enough, and it’s a crutch.
And you know what? It is possible that people were on antidepressant medications who might not need to be. But there are a lot of people who did need to be on antidepressant medications, and I think as 12 Step communities and fellowships saw some of the consequences of untreated mental health, untreated be it, counseling and therapy and/or medication, and the consequences of that.
There was more open-mindedness now about folks who are sober and in recovery who also may need medication for their mental health. So this is really the same kind of principle as some folks need some medication for staying alive long enough such that they can develop a sober lifestyle if they have opiate use disorder. And really recently in 12 Step meetings, there seems to be some increased tolerance and decreased stigma as people become educated and see folks that are on some sort of medication assistance who are actively pursuing and authentically seeking and working a program of recovery. They’re seeing that it’s okay.
And so I think that stigma is starting to drop as there’s more information out and more awareness of the problem. You can’t work a program of recovery if you’re not alive and it doesn’t take a whole lot if somebody’s sober for a period of time due to being in treatment or attempting early recovery and then they slip and have a relapse and they overdose, there’s no option anymore. I’d rather reduce the risk and chance of using to occur for a period of time until they can really get grounded in recovery and stay sober over the long term. So I think to summarize, it’s really understanding the difference between medication assisted versus medication management that with medication assistance, which is what we’re talking about, abstinence is the goal.
Our value at the Hazelden Betty Ford Foundation is recovery, and that we commit to 12 Step Principles, including abstinence-based recovery. That is one of our values but yet another value, not in conflict with it, is that we pay attention to science and treat addiction, as a family disease using evidence-based practices that address mind, body and spirit. So this use of medication-assisted therapy is again, grounded in science. And so if folks do research about it, they’ll be able to access it and see that for themselves. And we’ll have some information about it available, too, on our website.
Andrew: One of the things that I admire about the Hazelden Betty Ford operation is the treatment philosophy seems to permeate throughout all of the agency’s locations, it’s the same philosophy.
What’s on the table, for the future, for Betty Ford? Is there expansion plans? I mean West LA’s been opened. Is there additional plans?
Mark: I’m glad you mentioned that there seems to be a consistency. Because it was really interesting when the merger occurred with the Betty Ford Center and Hazelden Foundation to become Hazelden Betty Ford Foundation a couple of years ago, that the organization overall read its mission and vision, and they were so close: the mission statements of the two separate organizations. But what I really love is that the mission says we’re a force of healing and hope. And Healing and Hope is the title of one of Mrs. Ford’s books.
So when that’s right in the mission, it just felt right in terms of being, we’re all on the same path and so you do find that consistency from site to site. So, part of the model of being able to provide increased accessibility for folks in recovery, as well as needing treatment to get into recovery, is to have outpatient locations. So here in the southwest regionally we have our new West Los Angeles clinic located at Santa Monica Boulevard and Overland in West Los Angeles, and we’re looking at opening a site, we’re excited about doing that, in San Diego. And, that could continue to regionally expand in the Southwest.
In Oregon, we have Springbrook, just outside of Portland, and then an outpatient up there, so that’s the Western region. So we’re looking forward to seeing that grow, but that’s consistent with our strategic plan, going forward is to open more, primarily outpatient sites nationwide because that’s where the need and the demand is.
The more folks that can do, and start, their treatment and recovery in an outpatient setting where they can still attend to their family, work, and community responsibilities, the better. But there’ll always be a need for residential sites, for some folks who need that and need to start there.
Andrew: I want to thank you for taking the time to spend with us at Serene Scene Magazine today. Mark Baumgartner with Betty Ford Center, thank you so much.
Mark: Thanks. Can I just mention that our website is hazeledandbettyford.org, or folks can call 1-800-257-7800? Or if they can’t remember that, it’s just 1-800-IDOCARE, if you want to reach us for more information. And it’s been my pleasure and I thank you for your great questions and time.