#9 The RSAT Program

I moved to Roseburg OR. in 2002 to become the lead counselor for a program funded by the Federal Gov't called RSAT (Residential Substance Abuse Treatment). It was conducted in the Douglas County Jail and those referred were facing prison terms for drug related crimes. It was a co-ed program with the clients living in dormitories. These were was connected to a classroom where we conducted the program keeping the number of clients to 15. If the clients completed the program, and committed no further crimes or major probation violations after treatment, they could avoid a prison term. Duration of treatment varied from a 6 month minimum to 9 month maximum depending on our evaluation of their progress. Intensive aftercare for at least a year followed treatment. The program was based on the data that with long term treatment there is no difference in the rates of recovery between those who volunteer or are forced by the courts.

In our best year, 61% of those completing inpatient treatment were still clean and sober after a year. One client was arrested for a DUI right after release from jail and was sent to prison but this was the only criminal violation that year. The Federal Supervisors did not trust our figures, as that rate is unheard of. Any program that has 20% - 30% of clients still clean and sober after a year is considered successful, and the criminal recidivism that low was also unheard of. They sent a small team to investigate for a week, sitting in our process, and ended up taking our treatment model back to Washington DC as a model for future grantees. 

The program was solid, using a model of individual therapy in group dealing with developmental trauma, a strong emphasis on the 12 steps of A.A., accountability personally and to the group, an educational emphasis with treatment plans on addiction, and a strong emphasis on family involvement. Some new clients chose going to prison and rolled themselves out of the program as it was not a softer, easier way. But, that wasn't what made the program so successful. 

In retrospect, the success was because of a "perfect storm" of cultural / social support discussed previously in my posts on "Proximity" (#5 and #6). Roseburg is a small town with about 21,000 which meant there was little funding competition for social services that unfortunately often occurs in larger cities.  My female co-therapist and I had an incredible professional relationship balancing each other's strengths. The Lieutenant of the Jail was pro-treatment and he appointed a deputy as a liaison between the other deputies, the clients and our staff which smoothed the issues with many deputies who didn't understand treatment and felt we were giving privileges to criminals. She also directly dealt with our clients breaking rules. In extreme cases she put them in isolation which was dead time towards graduation. The  liaison deputy arranged for the local community college to grant 9 hours college credit for the morning addiction education. Also graduates were offered a free semester upon graduation from the program. GED was already offered in the jail and many were able to complete this while in treatment.

There was one probation officer for the whole program and he had a background in counseling and would sit in group from time to time. The Mental Health associate who came in once a week was an old friend I had known twenty years before in Dallas TX. Medical was totally cooperative with occasionally needed psychotropics as we began to notice a high correlation between ADD-ADHD and meth addiction as well as health concerns. The Oxford House movement expanded to Roseburg which provided safe and sober living. A local civic group built 8 apartments for men and a house for 5 women for safe living. A former colleague was there during the daytime providing supervision. A local restaurant was willing to provide employment, and the graduates working there were highly thought of. Other local businesses followed suit and employment became possible for graduates.

Roseburg has strong recovery self help groups, and so graduates were able to find strong sponsorship and had many options for the regular attendance required. Two after care groups were led by my therapy colleague and myself for a minimum of six months, and then once a week minimum for the second six months. An outpatient family group was also available once a week to help the recovery for families damaged by addiction. 

One interesting aspect of the program was that on Friday afternoons I would hold a session where clients could ask questions about the Bible. It was a voluntary process to respect their civil rights, but all members of the groups chose to attend. In one graduating class we had four clients, two men and two women, return to the churches of their childhood and be baptized signifying their re-commitment. 

Tragically, for circumstances beyond our control, the "perfect storm" of cultural / social / support was not to last. Initially, because of competition for funds with economic cutbacks, we lost the cooperation of Mental Health. Then the leadership of the jail changed and the new lieutenant did not have the openness and cooperation we had enjoyed.  Medical no longer cooperated as it was now run by a individual contractor seeking to cut expenses. The liaison deputy facing relocation to save funds, resigned and went into social work at the local hospital. My personality was too confrontive of the changes, and I was removed from the program to work back in outpatient corrections. 

Sadly, the program regressed back to the recovery rates expected from such a program and then funding ran out shortly after. When I do workshops with churches, I use this as an example of how a church could provide a refuge of recovery for addiction. I attempt to organize committees to assist pastors in coordinating the necessary ingredients for a cultural / social/ spiritual involvement by the church. 

In my next blog we will begin to explore neuroscience and how drugs affect the brain.