Dennis Leary is helping wage war on addiction and minimize its impact on individuals suffering from it and for those who have to experience seeing their loved ones sick and suffering. Aware Recovery Care is a pioneer in the in-home mental health and substance use disorder treatment industry, representing true innovation. Supported by a specially-trained team of addiction professionals, Aware offers a best-in-class in-home addiction treatment program backed by both logic and data. Enjoy.
The Illuminate Recovery Podcast is about Mental Health, Mental Illness, and Addiction Recovery. Shining light on ways to cope, manage, and inspire. Beyond the self care we discuss, you may need the help of a licensed professional. Curt Neider and Shelley Mangum are a part of Illuminate Billing Advocates (www.illuminatebilling.com). They are committed to helping better the industry and adding value to the lives of listeners by sharing tools, insights, and success stories of those who are working on their mental health.
Transcript (no grammar): dennis leary is helping wage war on addiction and minimize its impacts on individuals suffering from it and for those who have experienced seeing their loved ones sick and suffering aware recovery care is a pioneer in the in-home mental health and substance use disorder treatment industry representing true in innovation supported by a specially trained team of addiction professionals aware offers a best-in-class in-home addiction treatment program backed by both logic and data enjoy welcome to the illuminate recovery podcast we shed light on mental health issues mental illness and addiction recovery ways to cope manage and inspire beyond self-care we will discuss you may need the help of a licensed professional my name's kurt neider i'm a husband father entrepreneur a handyman and a student of life i avoid conflict i deflect with humor and i'm fascinated by the human experience and i'm shelley mangum i am a clinical mental health counselor and my favorite role of all times is grandma i am a seeker of truth and i feel like life should be approached with tremendous curiosity i ask the dumb questions i fill in the gaps the illuminate recovery podcast is brought to you by illuminate billing advocates make billing and collections simple with leader in substance abuse and mental health billing services verification and analysis of benefits pre-authorizations utilization management accurate claim submission and management denial and appeal management and industry leading reporting improve your practice's cash flow and your ability to help your clients with eliminate billing advocates today we are so fortunate to have dennis leary with us dennis is a certified alcohol and drug counselor he is all about creating quality in-home addiction treatment which is a little bit different than what i typically see he wants to make sure that anyone who needs treatment across the health care continuum have the opportunity for that so i'm excited to um learn a little bit more dennis about what you do but thank you so much for being here it's a pleasure to be here thank you so much for having me and i know i've you know i i myself am a clinical mental health counselor and um and i've been in the industry for quite a while i find it a most interesting industry you find the best of the best and sometimes the worst of the worst and and and you know i don't like i don't know if that's that's probably not the right political way to say that because i think everybody's most everybody's got a pretty good heart and just hasn't always had this the same opportunities or um learning capacity so i say that very lightly um i'm curious dennis when you focus on the in-home addiction treatment um let me first ask i want to come back to that but let me first ask how did you end up in the substance abuse industry right um i am a person that's in long-term recovery in myself for many years i struggled with a substance abuse and when i made the decision when i had experienced enough pain and i decided to get sober i went on and i had a pretty successful career however i started thinking about what i wanted my legacy to be and how i wanted to be remembered and um i figured that i wanted to be remembered and i wanted my legacy to be um really i know this might sound kind of you know cliche or you know but it's the god's honest truth i wanted to be i wanted my legacy to be and then i want to be remembered for doing my best to leave the world better for having been in it and so i want to do what i can for my part in this world to help wage war on addiction and minimize its impact on individuals suffering from it and the loved ones who have to experience their loved ones seeing their loved ones being sick and suffering that's pretty profound and it's very clear that to you that you found a passion for this work and definitely has made a difference especially with your own recovery story yeah um i feel like i don't feel necessarily that an individual has to have been has to be in recovery to be an effective addictions professional much like you know a brain surgeon doesn't have to have had brain surgery to be an effective brain surgeon however i do feel it does add a layer to you know another layer to where you can um add a little bit more empathy to you know you can understand from a personal perspective what uh the client may may be going through at that particular moment in time yeah agreed well it's a there's a relatability piece there um you know they might be able to put one over on on some people but less less able to on somebody that's been there yeah the any any any story they try that anybody tries to give me i wrote that book [Laughter] i wrote that chapter so they're reading to me from my own book so like chances are greater than that you know whatever whatever yarn anybody might try to spin on me i've already experienced it or said it myself isn't that the truth so talk talk to me a little bit about you know you've said that you have your own recovery journey um at what point in your life did that happen right so i um i started contemplating recovery later in life i had a couple failed attempts at it but i would probably say in my mid 30s is when i started you know attempting but i didn't get it until i was about 37 and when i was about 37 um you know i had finally experienced at whatever point you know i believe the term when somebody you know when we open here in the recovery circles somebody reaches their bottom right um i believe bottom is a relative term for one person it could be that their child saw them take a sip of beer for another person it could be that they got a dent in their bmw while they were drunk for another person it could be they were eating out of a trash can right so it's just all all relative and you know every bottom has a trapdoor because you can always go lower and so when i had finally reached the point to where i felt that i reached you know my threshold for pain um i just said there has to be another way to live and i you know i have a higher power i prayed to that higher power you know helped lead me up this pain it brought me to um the rooms of alcoholics anonymous and uh i began my journey one day at a time and here i am you know 11 years later wow that's incredible and and i mean these are these are difficult journeys right they don't come it's not like you just decide one day and it's all over there's a long road there of lots of learning and challenges along the way i would probably say the biggest misconception i had when um when i was active was that if i was sober every day would be a parade you know that every day was going to be streamers and you know oh my gosh like this is so wonderful like it is you know it's actually just life [Laughter] and one might say it can be even a little bit more stressful because when an individual is sick and suffering with an addiction that's generally the only thing that they're focused on right at least that was the only thing i was focused on was you know what was i going to do to further my you know further further my substance use disorder um however in recovery for me what it was like was driving a car and getting into a series of mini accidents until i learned how to avoid them so i was driving a car hitting hitting a wall and backing up going around the wall hitting a wall backing up and then kind of learning how to navigate so that i'm now i'm only scraping the wall now i'm just kind of fender bending the wall and then kind of now learning how to avoid the walls all together i love that analogy because that sounds a little painful well you know there's you know recovery is kind of you know um painful when it starts messy in the middle and then beautiful when it occurs yeah because it's a continuum right it really is a continuum and that goes for recovery from anything right i always like to give people a framework because an individual that does not have mental illness or you know addiction issues right might have a hard time kind of comprehending what that looks like but i believe everybody has struggled with something you know how many times have has somebody looked in the mirror and say i can't believe i ate that again you know sitting there with greasy fingertips or crumbs on their shirt and said i cannot believe i went for the fried chicken or the cheesecake again i can't believe i went back to that relationship again i can't believe i put myself in this situation for x y and z to happen again i can't believe i got fired from a job again you know and at some point we take a look at ourselves we take a look at our behaviors and we make a decision that something has to change and that's when the healing begins i love that too because i and i think you've put that probably more eloquently than anybody i've ever spoken with in the sense that we all i mean we do not come into this life without you know without the challenges that are present right it's just part of being a human being and so to think that any of us don't need some sort of help some sort of recovery it may not be substance abuse but you're right it's something we've got to figure out how to make those changes um and stop doing the same thing that's insanity over and over again right so i couldn't agree more even when you consider like the loss of a loved one or even the loss of a relationship it's really painful you have to get through that you have to recover you have to recovery from surgery it's all it's all a continuum it all takes time it all takes healing right yep it does and i'm wondering i know we talked a little bit about your family and we don't have to go in depth about that but how did your addiction and your recovery how did that affect your family right so um it really impacted my mother most dramatically i would say and that i probably would say because you know she didn't know where i was she didn't know what i was doing she didn't know whether i was safe because i'm i'm an isolator in my mind i'm thinking um you know i'm keeping my family safe by keeping them away from all of my shenanigans or whatever it is that i i was up to but in reality i'm just creating worry fear and anxiety for them because nobody's heard from me right and um and addiction it's often said in the community and i subscribe to it addiction is a family disease because um mom becomes a nurse dad becomes a parole officer uh you know your brother or sister becomes an accomplice because they lie for you or you know or they become a scapegoat because you're lying about them i didn't take it they took it you know they must have done it you know so um the whole family becomes disregulated when it comes to addiction because after years of that um you know nobody is functioning in the realm in which they're supposed to be because all the energy goes to the sick kid you know or the sick loved one you know so mom doesn't have time to also be a wife you know dad doesn't also have time to like coach the baseball team or whatever you know be the cub scout dad or whatever else it is that he's doing because all the energy is being poured into the the sick loved one that's suffering from from the disease or you know if it's a um a parent that's suffering you know the other parent you know is covering for that parent so they're they're doing dual roles and then and then nobody's taking care of themselves nobody's practicing self-care so um and that's one of the great things about aware recovery care uh is that we don't just treat the client um we have a family wellness department that actually works with the family um and so that they can start their own journey and path of healing and so they have their own team that helps them coach guide and assist them along the continuum of recovery so they can learn how to practice self-care how to get to self-help meetings we have family systems therapy once the client has been stable then is ready to engage in that to help regulate everybody back into the correct assimilated roles well that's profound and then i like the way you've said that it's systemic right it's the family you can't take uh someone that's dealing with addiction out of the family provide them with recovery and put them back in the same system you just can't and we've talked about that on this program quite quite a bit but but i like that that you offer that i'm curious how many families are resistant to going to getting that kind of support and help so um i would probably not many not many we have about we have about a 90 participation rate in the in the family and the family um in the family services and just so you know family is determined by blood um significant other or identified ally right anybody that's a support to you it could be your best friend it could be someone anybody that's in in your life that that your life impacts them in a meaningful way and their life impacts you in a meaningful way that's family um and often times friends can are the family that we choose so if it's a support person and it's an identified ally that's the person that we work with and um and we've seen great success with it because you're right it's all about systems and traditional treatment takes an individual out of their socio-cultural environment and puts them away into a designated place for a predetermined amount of time uh usually 28 days crams them full of psychoeducational material and tries to instill coping mechanisms in them and then sends them back to the same sick environment with a slip of paper that says go to an iop and hope that enough information stuck within that 28 days that they've gotten it and it's why it doesn't necessarily have the greatest outcomes however that's all we've had you know for the past 60 years it's all we've known um aware recovery care uh is a different type of model where we work in the home with the client and the family along a 52-week continuum that is a lot of time for change right and so we are we are continuously working with the client continuously working with the family and the other key differentiator is we pull in all the clients community providers so we're also working with the dentist if there is one you know the lawyer if there is one the parole officer the pcp the mental health counselor or therapist the psychiatric provider and we're asking for input from all these lenses and that's how we're generating our clients along with the clients strength based treatment plan because we're addressing every issue that the client has from a whole body person lens because we want to address not only them from a bio a biopsy a biological psychological and socio-cultural point of view we want to address their social determinants of health at the same time because by doing addiction is a very complex and multi-pronged disease it needs a multi-faceted treatment approach and we believe by doing an operating treatment in this way by facilitating treatment in this way that we're not just treating addiction we're removing barriers to recovery absolutely dennis i mean i i love the way you you describe this dynamic because you're right it is very complex and if you don't bring in support networks right people who know that you're in recovery so one you you take away the darkness and the hiding and all of those pieces the shame and you shed the light on it and you bring everybody into that place of healing and recovery and support so that's right how healthy i mean that's super healthy and i would imagine what i heard you say is that people um parole officers and corrections and i would imagine even insurance companies do you take insurance payments we do i would imagine that those organizations are watching what you're doing and really getting on board with that dynamic with that you know that multifaceted approach oh yeah well so i can tell you like you know our one of our one of our payers which is one of the largest uh insurance companies in the nation released a um you know report that showed during our program and for a year after clients that completed our program that not only uh you know when we do our problems not only are clients staying sober but their emergency room visits are down their psychiatric uh admission their psychiatric visits and in inpatient stays are are down vastly uh their their residential stays their readmissions into traditional treatment all of them are down by significant numbers and this is over 19 consecutive quarters that's impressive and so insurance companies do they pay attention to those kinds of things absolutely and and it makes a difference so how um willing are they to pay for 52 weeks of treatment right so we partner very heavily with anthem blue cross blue shield and um they're wonderful they because they see the benefit right and they see the benefit and they they know what the program does they see their client lives getting better and other insurance companies that we've worked with we work with anthem blue cross blue shield tufts florida blue blue cross blue shield of massachusetts vccn which is a veterans care administration the veterans administration network and we also work with beacon and unicare and so and other insurance companies um we've had great success with out-of-pocket i mean out of network benefits and single-case agreements that's incredible and at least matter of time um it's only a matter of time before all the other insurance companies come on board yeah i mean it is it's you have to start somewhere and you've obviously started with with your closest ally right in the insurance industry world anyway um and and then it branches out from there because i happen to know that in this industry which i am very closely connected with right of the insurance payments that insurance companies talk like they're paying attention and they talk to each other and and so what happens at one it's just going to trickle down into the others so yeah they're going to want to know well so hey if aware's doing this for you what can they what can they do for us that's exactly right and so it starts to really exponentially grow um after after you've done it a while right yeah because at the end of the day right um not only do we as providers but insurance companies want to see their patients living healthier lives they want that there they have a ton of program any insurance company you go to these days they have a ton of wellness programs they have all these programs where you can call up and you can speak to a nurse and a wellness consultant and a coach and they give you rewards and points for you know um going and getting your physical screenings and all these other things and they reward you with things like you know money off your premium and you know points that you can redeem at their store and all these other things so um they're really promoting health and wellness and um addiction costs this country when you think about it on a greater scale um in terms of you know when you think of crime when you think of public assistance when you think of just you know the the whole host of other socio-cultural factors billions of dollars a year you know and so um any way to reduce that and reduce health uh you know costs across that per capita healthcare costs across the continuum um that's really what it's about and that and that's a win for everybody because then and premiums go down equity and health care goes up people have access to more access to care uh health care is more affordable and so it's a win-win across the board for everybody yeah i could not agree more and the fact that you're also you know dealing with the systemic or the family dynamic you're breaking you know these cycles of addiction and abuse and you're going into the heart of the dysfunction and you're working with them to you know take away the shame of that and help them learn a different way of being together and having more happiness and greater you know satisfaction in life in their relationships so i can't think of too much that has more of an impact than what you're doing with these families yeah and uh in the high 90s um i can't i don't have that exact number in front of me but uh a client satisfaction survey it's the high 90 percentile said that that um as a direct result of being involved in our program that the relationship with their families improved uh uh i'm blown away let me ask you this so is all of your treatment with a wear recovery care is that all done in the home is it all based in the home it is we actually have um in-home withdrawal management which is um what the industry would call detox but we are very client centered so we will help a client withdraw from their symptoms in home um and that's done by medical staff by nurses and by um by addiction treatment staff and we have our standard 52-week in-home addiction treatment program we have in-home medication assistant treatment so we do in-home suboxone and home vivitrol and we provide that as a bridge while we source community providers for our clients because we're very community integrated by the end of our program we want to have worked our way out of a job we don't want the client to be reliant on us we don't want the client to be reliant on our providers so we patch the client into the resources in their community so they can function and assimilate into a recovery oriented based lifestyle in their community where they live from the safety of their own home and they're doing that without having to leave the things they love so their comforter that they've had since they were however old is still there they're not leaving their pets they're not leaving you know their significant others because let's face it not everybody can go away for 28 days that's not a realistic option we have single mothers we have you know business executives we have people whose jobs depend on them being there and they can't leave for 28 days but because we have such an innovative model we can meet the client before work on their lunch break after work on the weekend so our motto is meet the client where they're at and we do that both you know physically emotionally mentally you know where they are in whatever stage of change they are that is our motto wherever you are is where you're supposed to be and that's where we're going to meet you wow that is so cool dennis that's it's very powerful to think of the lives that you're changing and the communities that you're changing um i'm just i'm just in i'm just trying to wrap my head around this idea of of i don't see very many programs that go into homes there are some but i don't see a lot that really focus all of their energy there or that have been able to do it successfully um so we we have um had great success on it and i would think that that is due to one our our model and our concept the culture of our agency the culture of our agency the training that we put our staff through um because it's from for being an i-hat clinician or i-hat certified recovery advisor or an i-hat care coordinator um all those things are different in the home you can be a behavioral health clinician and be working at a traditional agency it's very different from being in the home when you're when you're doing that in the home you know what we teach you know in the the standard things in faction control we're joined commission accredited dually a joint commission accredited in both behavioral health and home health so you we have the standard policies and procedures surrounding that safety infection control so on and so forth but among that you know we're taught to be observant so you're looking you're looking for signs of dishevelment you're constantly assessing the client for changes um you're looking at the different dynamics that are within the home because that's where it all happens right and so if a person doesn't have recovery at home they do not have recovery if you don't have peace and serenity and and and and you're not feeling safe where you live then you are not safe and you do not have recovery so we will do our best to make that home the safe uh to make that home a safe treatment environment and if we feel like we can't regulate it we will then have the client placed in silver living or another another uh place where where it will be safe for us to to give treatment to the client well how much of your treatment modalities how many of the providers provide treatment through telehealth um so we have a split schedule right now right um during we never really went fully remote um so we were already a mobile-based company anyway so we had telehealth before people really were you know you know what's telehealth you know we were already using that and so when covet hit and um and and the lockdowns occurred uh you know we were well primed for that you know we already had that we already had the technology and protocols in place so it wasn't really that much of a short stretch as um as time goes on you know we were able to um lift our own restrictions and modify it based according to the you know cdc guidelines and we have a um a vice president of our integrated health who um who you know works with our compliance officer to make sure that staff and client safety is paramount and above fallout right and so we have them on a a staggered a staggered schedule and our our our program starts out fairly heavily in both visits and clinical intervention and then gradually drops down over the course of the year so that by the end of the year they're seeing us one time a week and so if a client is seeing us one time a week that's going to be a face-to-face visit um however during the more you know the first two weeks it's five it's it's five times a week that we're seeing the client that's going to be that's going to be a blend so it's going to be a blend of telehealth and in person nice um and i think it's a good balance because you still need to see them you need to be able to assess things you can't do over telehealth but telehealth can feel some of that space and right now if this was a telehealth session i see exactly what's in front of me right if i'm in the home i get the whole picture i can see everything that's going on around you do you have wait a minute this isn't really like you you have dishes in the sink what's going on wait a minute like you know the house is looking a little unkempt it's really easy to tidy up one area and make it you know appear okay right but physically in the home you get to see everything but you know what's going on with it is your husband there is yelling you know what's what you know that's that's where uh a lot of the visual aspect and the assessment comes from is what's going on in the home yeah absolutely and i love that combination go ahead the other thing i was going to say is because the other thing that's really key about working in the home with the client is um we know traditionally speaking and i'm sure you can relate to this because of your time in the field it's not often that change with the client occurs in your office during the session it doesn't right change happens outside of the office when the client is back in the you know wherever it is that they're doing and uh trying to implement those skills when faced with negative life experiences negative uh peer group associations or triggers that's where we come in and we're kind of like that second shift of whatever the medium or intervention is again dynamic is happening in therapy in with the doctor and with the prescriber because remember we're collaborating and taking those interventions we're carrying them on okay the client is struggling with medication adherence we're going to talk about medication adherence this week we're going to keep going we're going to build you out of schedule and we're going to do that in the home right until that sticks right and so like now now we've got a routine set up because that's where the change happens medication adherence happens at home when the client's got to take his medication not when the doctor's talking about it to him for the 15 minutes in the office right which is reality right you're taking it right back to the reality of in the space where things happen and and like you said there's a place for residential treatment where someone leaves their environment and goes there but not everybody can um but you're you're leaving them in this environment that's triggering instead of taking them out of it they're having to learn how to deal with it in the moment more than than if you remove them from the environment yeah exactly because again um we're about changing that home environment right we're about changing and making that home environment safe so it is not triggering so that it is peace so that it is serenity so that home is a safe space it's a refuge for you it's your sanctuary it's where you go to reflect it's not where you go to be stressed stress is for everywhere else you have that at work you have that in the community you have that over here you don't have that home is for peace nice i love that a safe place to come a safe place to retreat to and and find safety and support as opposed to chaos yeah that's your cocoon that's your that's your that's your safe happy place home is your safe happy face and i imagine it's i mean i would imagine that would take a good year or more just to change that system and dynamic that's been going in and on in that home for years and years well you know it's recovery from anything is a lifelong process it's never a one and done it's never like okay i'm cured right it's uh you know it reaches a maintenance stage where you know you've got to tune yourself up you got to keep yourself going you know however um you know it's it's never done right because the moment you stop growing and you start stagnating and start stagnating you start regressing and and and those old behaviors start creeping up because there's a there's a saying in the recovery community and i subscribe to it is that while you're sitting there in recovery your addiction is doing push-ups and it's getting stronger and stronger and stronger and shrunk and addiction doesn't come to you flat out in the open and say you know hey dennis this is your addiction talking i think the drink would be really good today your addiction comes to you in a real smart voice that says you know what it's been really stressful today oh gosh a beer would be really nice to me that's the how addiction talks to you right it doesn't doesn't come right out it kind of sneaks up on you in in small doses and unless you're maintaining those coping skills and those those um maintaining the things that help get get you silver you know it's it you can become stagnant and regress because remember relapse is a process not an event you know the the the actual picking up of the substance is just the period at the end of a very long sentence if you trace it back and do a chain analysis on it you can figure out where the relapse happened was actually three months before you ever picked up the drink and when you stopped going when you start picking up your phone call for you know from your support network or from your sponsor or whomever you you choose to call this person yeah super super that and that in and of itself is a skill to be able to trace back right to see it it didn't start here when i picked up the drink it started way back when yeah and and you know um helping the client see that too right helping the client understand oftentimes our clients are you know individuals in recovery or you know that that have had other experiences too they're so used to being penalized for um for for having you know a recurrence or for having their symptom of their disorder returned and like we're a non-punitive agency so we believe that a recurrence is a reason to re-evaluate your recovery and take a look at it because generally it means you're doing too much of this and not enough of this or all of this and none of that and it means your recovery needs to tune up when i have a client that's struggling with you know some behaviors or whatever i don't even i don't even ask about the relapse we know about the relapse we know what you do tell me about your recovery tell me about what that looked like because that's what i want to know about let's talk about where where was it unbalanced because i can guarantee you somewhere in there it was unbalanced because nobody goes from stable recovery to using overnight because it does not happen it happens to observers because that's all they see but to the person who's actually you know ended up relapsing they can trace it back right every time have you ever seen where they can't trace it back no i've never seen it once you might have to help them understand a little bit what you're looking for but then he'll be like okay wait a minute i started smoking cigarettes then i stopped going to meetings i stopped taking phone calls i started isolating i quit my job i got involved with this relationship the relationship was very toxic i started arguing and then they you know then you can start seeing i always yeah i like to draw a hill going up to how you got to recovery and then the pinnacle being when you reach you know whatever point of sobriety and then a hill going down my outline okay so you did this you did this you did this you did this now we come up with ideas and barriers but because if we put a barrier here you would have never reached here so the idea is to put as many barriers between you and the actual picking all of the substance so that like you have interventions that you can rely on super powerful i'm curious you said that you also do the detoxing in the homes how do you safely and i know you're gonna have a great answer for this how do you safely detox somebody on alcohol and benzos right so we are we what we we use the american society of addiction medicines criteria right with all of our assessments and all of our our scale ratings and so we're able to safely with help somebody withdraw from their symptoms um if they score at a moderate or a mild level uh severe we would have to refer out because it wouldn't be safe and so we issue evidence-based assessments cows sea was and uh based on their scores um nurses go out on a rotating schedule take vitals um comfort medications are prescribed on a daily basis so that there's no risk of um you know you know taking more than what you're prescribed because you want to describe what you need for the day and so uh you know and then our our certified recovery services department goes out and um everything's tailor fitted to the individual so if the individual is in the in-home withdrawal management level of care the interventions that we're working on that client with are basically like what are you going to expect and how you're going to deal with it so okay so like you know the truth of the matter is early recovery does not feel good especially if you're withdrawing for something if you're withdrawing from something so like let's talk about how we're going to deal with that and we teach them holistic and alternative methods very cool um and and powerful too because again you've you know if you need a hospital stay if you need an er stay or a detox stay then of course that's going to be what you prescribe but if not if they can meet at a lower level then you provide the services they need to do it safely we have an obligation as treatment professionals to give the client the proper level of treatment in the least restrictive level of care that's that's what we should be striving to do as addiction treatment professionals at all times giving the proper level of treatment in the least restrictive care so you know if if a client does not need to go away why would we want to send them away there's there's no need for that right the client does not need to go away through 28 days and can safely receive treatment in their home or community based support why wouldn't we do that and so it sounds like you're providing all levels of care other than a residential and the residential is really just taking place in their homes which well there's again according to the acm criteria we treat we treat people that would traditionally um be in a iop or down intensive outpatient level of care or down so if somebody requires if somebody would require residential stay or they scored that high we would not it would be inappropriate for us to have them in our program we would ask for them to go to a 28-day program and then step down to us and we would continue the care from there oh fantastic so you've probably got a lot of feeders from some of these residential programs as well i would imagine we have relationships that we've established with um um preferred preferred people that we do that we work with on a regular basis um where where you know we we have a working relationship with them um to where like you know we're safe and we're comfortable and we know the institution we know the people that work there and we will refer clients that are in need of treatment there and then you know take over their care at discharge because we we start planning for their integration back into with aware from the moment they go to that program we also have an internal higher level of care which means that if at any point during our continuum a client suffers any setbacks or has any struggles and requires additional services they can be bumped back to a certain phase at no additional cost to the client which is supporting them right it's supporting that recovery for what recovery is it's an up and a down yeah and so every time i see um an individual walking down the street with a garbage bag i'm wondering what treatment center they got kicked out of because generally speaking um addiction services is one of the very few parts of the medical community where we punishment is the treatment of choice for the disease returning yeah and it's a catch-22 because if you're living at a facility and you're using it's not safe for everybody who's there but at the same time what about this you know this person that's still struggling with the with this illness of addiction right yeah exactly it sounds like um aware recovery care has been around for a really long time from just from what i'm hearing and that they're very well established what's the size and um longevity of of this organization so we were established in 2011 and then we had a proof of concept done with two addition psychiatrists out of yale and then we started in connecticut and then we started expanding and we're now in six states we are in maine we're in massachusetts we're in connecticut we're in florida we're in indiana and we are in florida and then we have plans to expand to uh pennsylvania new york rhode island and virginia uh all within the next um you know upcoming year year year and a half wow that's pretty aggressive um growth as well well again our insurance our insurance partner has seen the impact that we've had on not just the opiate epidemic but we have had a tremendous impact on the opiate epidemic with the clients that we serve but also with um the the general uh substance use disorder population that comes to our program and you know uh if if we could be everywhere we would be but uh we need to scale and build that out and make sure we have properly trained staff in our model make sure that you know so that takes a little bit of time but to think about um you know in the five years that i've been with the company to go from one state to six that's you know it's pretty significant yeah it is it really is um and so it brings up another question in my mind it seems like that kova particularly escalated this is that there seems to be a shortage of health care providers therapists substance abuse counselors you know everybody in that industry seems to be taxed and it's a little bit hard to find the quality of person that you may want how are you guys addressing that piece so for us um we have an average turnaround time from referral to start of care of 48 hours so we're very quick turnaround time with starting our start of care and um we generally don't have a problem so all of our clients are you know part of our program um is that you know you must be you must be involved in therapy you must be involved and you know every client has the right to choose or not choose what they want to do with their life but if you want to be in this program we we have to be in this program and therapy is part of that program and so as well as you know getting routine health care and all these other things right and so um we have partnerships with therapists all over each state that we've been in and psychiatrists and pcp practices and um medication assist you know addiction medicine doctors and you know and so we have we really don't have we we're not seeing that effect right because we have these relationships built uh you know we also have uh you know in in a very worst-case scenario we have in-house therapists that can provide that if needed well our preference is external because we believe in community-based providers right because that's who they're going to stay with it's exactly what you said right we don't want them dependent on the organization we want to integrate it into the community and a safe place to be so exactly i like that it's it's impressive and i can tell that it's very a fairly mature process and system yes absolutely a lot of a lot of time effort thought and energy has went into uh developing it dennis do you have um i mean i'm i'm absolutely intrigued with this conversation and where we're going um you know and we're getting running out of time and and uh um but i'm curious as to um if people if people want to connect with you especially with the growth and and the program that you offer people are going to want to be able to connect with you and um where can they get you right so uh my email is d leary at aware recovery care dot com my phone number is 2 0 3 6 3 1 2 5 5 6 and you can always visit awarerecoverycare.com i always um i'm quite impressed with people who are willing to give their phone number which means you're not afraid to pick up that phone and talk to anybody who needs some help i am not that's why i'm in this business i had a person call me yesterday and tell me that um i am calling you and i'm sitting in front of a liquor store and i don't want to drink and those are the calls of why i got this job right that's why i do what i do and uh we talked we talked for about 20 minutes i asked him to pull away from the liquor store he did and then we talked about how to get him into treatment this is what i do and i love doing it i can tell you love doing and you're super passionate and you're super educated and knowledgeable about it so thanks for sharing your wisdom with us today it's been absolutely incredible for me i've enjoyed your stories i'm sure that you have a lot more to tell but for this particular episode we're going to call it call it and and just thank you so much my pleasure thank you for having me