Perhaps one of the most significant advancements in the field of behavioral health is its embrace of the biopsychosocial model — one that acknowledges the complexity of the disease of addiction and co-occurring mental health conditions. The fact that dual-diagnosis conditions affect every aspect of life, and are often triggered by negative life events and extra-therapeutic factors is reflected in the new definition of addiction published by The American Society of Addiction Medicine (ASAM) in September 2019 — “Addiction is a treatable, chronic medical disease involving complex interactions among brain circuits, genetics, the environment, and an individual’s life experiences.”
Experienced treatment professionals and those living in recovery know that helping people manage their conditions and sustain recovery takes significantly more than stopping the misuse of substances. It requires understanding and addressing the reasons why patients felt compelled to self-medicate. This realization is why today’s leading care providers strive to tailor “whole-person” treatment plans that meet the multifaceted needs of patients.
Holistic, individualized care can improve outcomes, but many providers find it challenging to ensure that patients receive a full complement of clinically-recommended services. Programs and patients reliant upon insurance to cover the cost of care are often limited to delivering prescribed types and amounts of medical and psychotherapeutic interventions.
Individual and group therapy covered by many plans are vital mainstays of evidence-based care. However, many clinicians believe that the added use of time-tested and innovative new support services and treatments — so-called “wellness services” — can address more patient needs and significantly improve long-term outcomes.
Addiction treatment providers define wellness services differently and use the term to refer to many different services. This malleable use has led some people to believe that these services are amenities designed to make treatment more attractive to patients. In truth, high-quality wellness services are evidence-based practices provided by skilled caregivers acting in concert with the entire treatment team to meet patient health goals. Significant research supports the efficacy of wellness therapies during the recovery process. When the mix of wellness services is aligned with the needs of patients and seamlessly integrated into treatment plans, they can profoundly improve patient outcomes, better address underlying conditions, and increase the likelihood of lasting recovery.
Wellness services play a central role in Orenda programming and are one of its four pillars of care. Orenda’s wellness services are used strategically and in concert with other therapies to address patient needs.
“Our wellness services are primary tools that make a tremendous difference in addressing core issues and increase our patient’s ability to maintain recovery and good health following treatment,” says Terry Macho, Orenda Primary Therapist. Among other benefits, Macho credits wellness services with elevating the mood of patients, making them more comfortable, and increasing their overall engagement in treatment. “I typically recommend that patients take part in wellness services in the mornings because it helps them feel great and ready to work for the rest of the day.”
“We are truly one cohesive team. Wellness services are designed into treatment plans from day one.”
Dr. Ahmed Rashwan, PT, DPT, Orenda Director of Wellness Services
Dr. Rashwan is used to teamwork. As a physical therapist for Major League Baseball and the PGA, he developed an appreciation for the power of finding the overlooked physical problems that prevented elite athletes from performing at their best. He also witnessed the interconnection between physical and mental health, spirituality, and overall wellbeing — an insight he brings to his work with Orenda patients.
The wellness program Dr. Rashwan designed for Orenda individualizes a regime of services based on thorough assessments of patient health, behaviors, and treatment needs. Orenda patient evaluations include imaging and other medical screenings to identify injury, pain, trauma, fitness level, exercise history, and other factors that are important to delivering personalized and responsive wellness programming. The results of assessments inform highly individualized wellness service plans that typically include physical therapy, fitness training, yoga, acupuncture, eastern medicine, mindfulness training, recreation, and experiential therapies. Patient needs vary greatly, from trained athletes who need to maintain peak fitness during treatment to people suffering from severe pain due to physical injury or illness. In all cases, the role of wellness services is to help patients develop a mentality oriented toward total health and wellbeing. Orenda’s wellness services are well-supported by on-campus facilities, including a fully-equipped fitness center, meditation spaces, and on-site massage and acupuncture studios. Advanced and specialized supplemental therapies are available at nearby facilities if needed.
Nutritional health is also integrated into Orenda’s wellness programming. Eating disorders, disordered eating, and malnutrition can result from long-term substance use disorders. Restoring nutritional health plays an important role in improving overall health, well-being, and quality of life. Orenda patients receive a nutritional screening to assess their needs, and Orenda’s private chef works closely with a dietician and the wellness team to develop personalized meal plans.
At Orenda, wellness services are integrated into the patient’s overall care plan to achieve multiple goals — reducing pain, improving executive function, enhancing self-image and self-confidence, relearning to experience authentic joy, and strengthening the therapeutic alliance.
Using movement and exercise to treat underlying pain is a primary focus and one that yields lasting benefits. The linkage between chronic pain, addiction, and mental health conditions is well-established, and identifying and treating pain is essential to removing triggers that can lead people to relapse. Unaddressed pain can also cause depression, anxiety, and the reduction of activities that give meaning and purpose to our lives. Terry Macho frequently witnesses the positive effects of wellness services, especially in older patients and those struggling with a long-term injury. “We may not be able to eliminate one’s pain. But if we can meaningfully reduce one’s level of pain and empower them to manage it on their own, we are on the way to restoring their overall quality of life and reenabling them to pursue their aspirations. This ability has profound positive implications for the rest of a patient’s life.”
Dr. Rashwan regularly meets patients who have struggled with debilitating pain for years or decades without realizing that the causes of their discomfort could be alleviated and managed without the use of substances. “Making small changes can have an incredibly positive, immediate effect on people’s lives. Most people don’t realize that learning a few simple exercises can help them move without pain and feel stronger and more self-assured.”
Coordinated physical therapy, exercise, acupuncture, and massage often increase mobility, relieve pain, and improve emotional affect within days of starting the treatments. The ability for patients to feel better quickly can set a positive tone for the entire treatment stay and deepen patient engagement.
Addressing pain early in treatment has significant psychological benefits. “People who experience chronic pain and long-term stress can become locked-into a constant state of fight-or-flight and develop an overactive nervous system. They become hyper-vigilant and begin avoiding things that they believe may worsen their pain — a spiral of fear and anxiety that can lead to people doing fewer things that they used to enjoy and developing poor mental health,” says Dr. Rashwan. Patients often feel elated and hopeful when they experience sudden relief from physical and mental pain.
Therapeutic manual therapy plays an important part in Orenda’s wellness experience. People living in pain and suffering from the effects of substance use and mental health conditions are often mentally and physically isolated from friends and loved ones. Touch may be a source of stress for those suffering from unaddressed trauma. “Many of the people we treat are unused to the power of therapeutic manual therapy. Given the luxury of time and our healing environment, we are literally able to help patients through the laying on of hands.”
Patient education increases the perceived relevance of wellness services and improves retention. “We spend a lot of time on neuroscience education. When people understand how body and brain health are directly related, they tend to do a better job of continuing their pursuit of fitness, practicing mindfulness, and eating nutritiously,” says Dr. Rashwan. “Showing someone how to exercise or giving them a nutritious meal is good. But taking the time to teach people the reasons why we do these things and the benefits that they offer helps them to internalize these lessons and continue them after treatment.”
Time makes a vital difference at Orenda. Patients and staff are not limited to a set number of hours. Instead, therapy is allocated based on patient needs and progress. “There is no reason to stop a patient who is highly engaged and benefiting from therapy,” says Dr. Rashwan. “We don’t have to say ‘time is up.’ We can keep on working on an issue or practice a technique until the patient feels that they have reached a new plateau. This freedom is powerful. Not everyone moves at the same pace. The ability to work with patients at their speed can make a massive difference to them and to us. Spending time helps patients feel genuinely cared for. They become more comfortable, open, and trusting in our care. And we can feel good about the contribution we’re making as part of the patient’s care team.”
Time together also leads to authentic collegial relationships between patients and patients. These friendships are emotionally fulfilling, and they afford opportunities to deepen and reinforce the themes of recovery and wellbeing.
For Dr. Rashwan, bonding often happens on the golf course where he brings patients to play eighteen holes and enjoy talking along the way. “Our patients are wonderful, fascinating human beings, and we truly get to know one another. Whether we’re in the gym or on the golf course, we can use what’s around us to reinforce the psychoeducational aspects of recovery while having fun.” For many of his patients, golf is inextricably linked to drinking. Golfing sober can be a new experience for them, and they are frequently triggered during a round. Dr. Rashwan takes these opportunities to instill one of recovery’s most important lessons — the need to find ways of experiencing authentic joy without the use of substances. Learning to be happy in sobriety is also why Orenda emphasizes outings, cultural events, and self-care services that help patients experience enjoyment while sober and learn new ways to enjoy life following treatment.