WHAT IS MEANT BY HIGH-ACUITY SUBSTANCE USE DISORDER OR HIGH-ACUITY ADDICTION? High acuity substance use disorder (SUD) refers to cases where an individual is experiencing severe, complex, “treatment-resistant” symptoms related to their substance use. Often, these individuals have sought treatment many times, at various facilities. At Red Door Life, we successfully treat high acuity cases where individuals have sought treatment at other centers in the neighborhood of 20-50 times. Characteristics of high-acuity substance use disorder include isolation, expulsion from multiple programs, frequent relapses, and extreme behaviors.
In this article, we will dissect the complexities and evidence-based best practices as well as help broaden mainstream understanding. As discussed in greater detail later, most mainstream treatment is not equipped to handle the complexities of high acuity cases and with the continual invention of new synthetic drugs such as Fentanyl, we are seeking to call attention to this critical conversation to help advance treatment globally for those who are suffering, their families, and society.
In understanding high-acuity substance use disorder it is important to understand this level of severity is much more complicated than just the characterization of someone who cannot stop using. This acuity level includes multiple challenging factors such as:
High Levels of Substance Dependence: Individuals may have a strong physical and psychological dependence on one or more substances, requiring significant amounts of the substance(s) to achieve the desired effects, and experiencing severe, dangerous withdrawal symptoms without it.
Medical Complications: High acuity SUD often involves serious medical issues caused or exacerbated by substance use, such as liver disease, cardiovascular problems, infections (like HIV or hepatitis), or respiratory issues.
Co-Occurring Mental Health Disorders: Many individuals with high acuity SUD also have co-occurring mental health disorders, such as severe depression, anxiety, bipolar disorder, or schizophrenia, which complicates their treatment. These disorders may have driving factors in using the substance(s) in the first place, or came into existence (or were exacerbated) as the brain and its critical regulatory circuits became damaged by the ongoing substance use.
Behavioral Instability: The individual may exhibit extreme behaviors, including aggression, impulse control, self-harm, or suicidal tendencies, which require immediate and intensive intervention.
Social and Environmental Factors: High acuity SUD is often accompanied by severe social and environmental issues, such as homelessness, inability to hold employment, legal problems, engaging in treacherous situations with unsafe people, and/or lack of social support, which makes recovery more challenging.
Frequent Hospitalizations or Emergency Care: Individuals with high acuity SUD may have frequent interactions with emergency services due to overdoses, accidents, suicidality, or acute medical crises related to their substance use.
… BUT WHY CAN’T THEY JUST STOP USING?
This is a question we hear frequently from the loved ones of those struggling with high-acuity substance use disorder.
Substance abuse injures the circuits of the brain- particularly the critical capacity for executive function. Executive function controls decision-making, the ability to regulate emotions, impulse control, and many of the basic skills needed to manage simple tasks of daily life. We use these skills all day long to manage our daily lives- to learn, work, attend to our needs, and create safety. Executive function also allows us to maintain relationships, take into account consequences, and make choices in alignment with our desired future.
Executive function is the management system of the brain- a set of mental skills that include working memory, flexible thinking, impulse control, decision-making, and the ability to self-regulate emotions.
It can take many months- or a year, or longer, for the brain to heal its executive function damaged from substance abuse so one can regain control of their impulses, mood & behavior. This is why compassion and deeper understanding is critical in our methodology at Red Door Life- to separate the essence, gifts, and uniqueness of each individual from the disease. The symptoms need to be supported and treated, but they are not the human being.
HOW DOES ONE BECOME HIGH-ACUITY?
In mainstream thinking, a common misunderstanding is that one becomes high-acuity by using repeatedly- that being the complete picture. In truth, there are other contributing factors- factors that can begin to change the way treatment is provided when we begin to understand this bigger picture. The failure of mainstream treatment to adequately help clients recover directly contributes to the individual becoming high-acuity or treatment-resistant. Clients develop the impression and belief that they're "too sick to be helped". Repeated treatment failures lead to a lack of trust in those providing the treatment. Multiple treatment attempts result in a reluctance to form connections, viewing relationships with both those providing support and care and the idea of community itself as transient.
At Red Door Life, we believe disconnection is the primary reason people don’t recover and go on to become high-acuity.
HOW DOES MAINSTREAM TREATMENT CONTRIBUTE TO THIS?
The inherent structure of most mainstream treatment is not individualized to the reality of higher acuity needs, or, in a lot of cases- the needs of the individual in general.
The status quo in mainstream treatment which directly contributes to worsening acuity:
Set 30, 60, or 90-day programs, which are not based on individual needs or enough time for the brain’s executive function to heal. This pre-determined length of stay is a construct of insurance companies and does not take into account a person’s acuity level. In all other forms of healthcare, the severity of the condition is taken into account.
Lack of truly individualized care, one-size-fits-all programs which are only customizable to a point
Failing to provide an environment engaging enough or equipped to handle longer lengths of stay individualized to one’s specific needs
Not understanding the specific, nuanced challenges that arise with new synthetics such as Fentanyl
Not attachment-based, lack of community and support that extends beyond the time in residential treatment
Disconnection after leaving residential care
Expulsion, abandonment, and disconnect for mistakes or failing to conform
Lack of adequate personal development (sober world re-discovery, deeper work such as trauma healing, family integration, support for all aspects of one’s life that need transformation, cultivation of purpose, and continual support on that pathway forward
THE RED DOOR LIFE DIFFERENCE At Red Door Life, our proprietary model of care and methodology is based on decades of observing poor treatment outcomes, the worsening global crisis, and channeling our heartbreak into designing a system that uses evidence based methodology to help people, not just achieve sobriety- but to transform their lives. Red Door Life is not just “treatment”, we are a model of recovery. We believe by sharing information about what this means we can create a paradigm shift surrounding the idea of “treatment” and “recovery” to help advance care for those who most need it.
Red Door Life is recovery re-imagined. We offer client-centered, truly individualized care with lengths of stay that are tailored to the specific case. As an attachment-focused center, we are committed to undoing the aloneness caused by mental health and addiction struggles. This means we create a bond that supports human beings throughout their life, and wherever it may take them- not just limited to the confines of time spent in residential treatment.
Clients are partnered with their Client Advocate who walks with them through all the twists and turns on the road of recovery. We use our proprietary model of care, The 12 Dimensions of Health & Wellness to evaluate and monitor 12 key aspects of life determining which areas need support.
The key life areas we assess are: substance use and medications, education, finances, career, legal (criminal and civil), family, romantic relationships, purpose, connection to community and friendships, housing and living situation, medical and physical health, spirituality and religion, mental health and emotional regulation, and nutrition and fitness.
We collaborate with our clients to build an individualized multidisciplinary team based on their specific needs. This team is continually adjusted as the client’s needs change and as new life circumstances arise. This team may include the client’s existing therapists and clinicians, as well as those integrated from our community network of leading-edge clinicians, medical doctors, and facilitators practiced in a broad spectrum of innovative, evidence-based modalities. This is critical not only during the initial stabilization period but also longer term in helping people navigate recovery through the many things that can be stressors in life- divorce, death of loved ones, new or terminated employment, life transitions, loss of relationships, family dynamics, anniversaries, etc.
Through the 12 Dimensions of Health and Wellness, we also help our clients discover greater purpose and take action in building that purpose into reality. Recovery isn’t just about treating symptoms or working through deeper trauma, it is about building a bright and fulfilling future. It is about taking our experiences and wisdom and with the right support, building something brighter than our difficult stories. Part of this is sober world re-discovery. We help our clients re-engage in the world in safe ways to discover what they love and what they are gifted at.
When a client is ready to transition out of residential care, they remain connected to their client advocate, and treatment team. We collaborate to create the individualized support they need to continue to stay grounded in their recovery. Through careful planning and connection, our clients remain an active, welcome part of our programs and community.
Additionally, we work hard to foster an incredible community that extends far beyond one’s time in residential care. Over the decades we have cultivated a robust community of diverse, extraordinary people committed to making beneficial choices in life, supporting, and lifting each other up. Red Door Life is a supportive, forever family no matter where our clients are at on their journey.
THE COMPLEXITIES THAT ARISE IN TREATING HIGH ACUITY SUBSTANCE USE DISORDER INDIVIDUALS
Even though we offer the best evidence-based methodology in the industry, treating high-acuity cases is not without its challenges. Despite being an upscale center on Mulholland Drive in Bel Air, (Beverly Hills) Los Angeles… our staff members have been attacked, threatened, spit on, called names, and had the police called on them. Mired in the throes of high-acuity addiction, clients have spread false rumors about us and even contacted journalists who were looking to create sensationalized headlines rather than using their power to address the most important issues- the worsening substance abuse crisis, the ways the mainstream model is failing, and what can be improved.
In mainstream treatment centers traditionally when a client acts out in these ways or relapses, they are expelled. Although this is a commonly accepted practice, it is dangerous and can be deadly! During these times, a person is in their most vulnerable state. This is the worst- and often most deadly, time to lose all their connection to safety. It is a little-acknowledged fact that when someone has been sober for a period of time and begins using again, they are much more vulnerable to overdose or death. And when someone is in crisis they are also much more vulnerable to making reactive, unsafe decisions. Through this commonly accepted practice of disconnection, of expelling clients who are struggling- a bump in the road becomes a much greater downward spiral which worsens the severity of their condition and can result in great destruction and death.
With decades of experience and insight into this complex issue, we do the opposite. We do whatever we can to maintain a connection to the struggling person… to not abandon them and allow the person to slip into the dangerous darkness of isolation. Isolation is where conditions become worse and can result in death. We approach these clients with love, compassion, and forgiveness despite their challenging behaviors. We focus on viewing these behaviors as symptoms of the condition, not personal attacks. Our highly experienced and trained treatment team is grounded in strong core values and embodies a culture of compassion. Compassion- through the eyes of love, we hold the view of a person’s essence rather than their present manifestation. We do this through our strong community support system among staff members to manage potential dysregulation and burnout.
Committed to creating the opposite of the disconnect that happens most often in mainstream treatment during crisis, we double down on connection during these times. Mainstream treatment practices choose the well-being of the community over the struggling individual- to the detriment of the individual and their loved ones. This is a false choice. We believe we do not have to choose one or the other. We can choose both reverence for the individual’s life and reverence for our incredible community. There is powerful growth, healing lessons, and strength built for both the individual and community when we come together and navigate these challenges. We can see the issues all around us that have been created in our society by the mentality of disconnecting from those who are struggling, leaving them to fend for themselves in crisis. Though it is certainly more work, and not without challenges, we don’t have to choose between worsening someone’s condition and allowing them to slip into dangerous isolation- or our community, we work to keep both the community and the individual safe.
We surround the client with connection and support. We adapt in real-time, adjusting the multidisciplinary team to meet the rapidly fluctuating needs of the client. We also assign 1-1 certified peer-support Recovery Partners to be with the client 24/7. The Recovery Partner serves several functions. First, to be with the client and help keep them safe from whatever conditions they tend to create in these states and help them ease back into a state of regulation. Second, to report vital information (such as self-harm, suicidal ideation, sleep patterns, eating and drinking habits, needs, and mood changes) to medical doctors, psychotherapists, and client advocates so that the treatment team can be adjusted as needed. Third, to help the client remember who they are beyond the crisis so that they can get back on their recovery path with minimal rupture.
The sad truth no one is speaking about is how easily substance use disorder becomes high acuity. When we think of high acuity cases we may think of certain types of people, but this is false stereotype. All races, genders, nationalities, high-level executives, business people, actors, musicians, creative geniuses, parents, siblings, and beloved children, etc.- all domains of society- can become high-acuity. There is no discrimination. Many beloved figures throughout history and our time would be classified as high-acuity.
The other sad truth is that most treatment centers are not equipped to handle high-acuity cases. Nor do they want to- the time, effort, and resources to treat the high acuity population is exponentially greater. The liability is greater as there is a much greater risk of overdose in this fragile population. The media and its hunger for scandal and click-bait, without conscience towards improving society, helps keep this fear-based practice in place as they are quick to scandalmonger while providing no true illumination, support, or call towards justice for the real issues.
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