Because there is no “how-to” manual for early recovery.

Professional Voices usually brings readers “behind closed doors” to illuminate the clinical interventions that are integral to addiction treatment. This week’s piece goes “behind the scenes” with an experienced recovery coach, highlighting the way that a skilled navigator of the treatment system can serve as a critical liaison between clients, families, clinicians and facilities that can make the difference between a successful treatment plan and a relapse to past behaviors. -Richard Juman

I’ve seen how recovery coaching can help the homeless crack addict in a Detroit recovery support center or the alcoholic wife of a hedge fund entrepreneur on Wall Street. But unfortunately, most people, including many health care providers, are unfamiliar with recovery coaching, and so they are unaware of how a recovery coach can benefit a client’s recovery as an important part of a treatment team. A recovery coach is a hands-on partner and support person who helps a newly sober client to relearn all of the life skills that addiction robs from its victims. Here’s a behind-the-scenes look at one of my recent engagements.

“Elizabeth” is a 45-year-old woman whom I was engaged to help as she was leaving a long-term treatment center after over one year in residence. The plan was for Elizabeth to enter a halfway house after discharge, but unfortunately, as is true in many cases, a bed was not immediately available and she would have to wait three days to be admitted. I was called in to ensure that Elizabeth remained sober during that period of time. The plan was for us to stay at a nearby hotel, visit the halfway house, complete the admission paperwork and wait for the bed to be available. Leaving an inpatient treatment facility, a client is very vulnerable to relapse during the initial days and weeks following their discharge. In fact, within the first year after discharge 65% of the addicts will have experienced one or more relapses. Thus, it is important to link a client to a recovery coach as part of a continuing care program prior to discharge.

My introduction to the team was through the facility’s reunification therapist, who had described the role of a recovery coach to Elizabeth’s husband and suggested that he hire me. I would also be working with a caseworker that was court-ordered because of a restraining order preventing Elizabeth from seeing her husband or her children, and an attorney representing Elizabeth in that civil dispute, as well as an outstanding DUI case. After discussing Elizabeth and her situation with the therapist, I went to meet Elizabeth at the hotel where she was staying.

Like many people, the idea of having a coach, as opposed to another therapist, was very appealing to Elizabeth. When I was an executive, I had received coaching to help improve my job performance. I received coaching on public speaking, on writing and on conflict management. I really liked my coaches. When I entered recovery, I met other professionals dealing with their addictions, many of them high achievers in the business world, and I made the link: Executives in recovery need to learn how to balance work as well as recovery. Entrepreneurs in recovery need to fix the collateral damage that the addiction has caused their business. Then I read an article in the New York Times about a young, tattooed recovering heroin addict coaching a music industry executive to remain sober. The picture of this recovery coach was, to me, (a middle-class, suburban white girl) a bit shocking. The coach was a 20-something male, muscular, pierced, sporting a goatee, shaved head and tattoos over the majority of his body.

“He was an ex-gang member, convict, an addict, and he was a recovery coach! Was this the industry I was interested in? I said yes! “

Although Elizabeth seemed to connect well to me, unbeknownst to everyone on the team, Elizabeth had no intention of entering the particular halfway house she had been assigned! This became evident to me after we visited it, when she told me:

“No way am I going to that halfway house! The people in there are criminals, addicts, tattooed and too young. There is no way I am going to room with a criminal, a girl really, a twenty-year-old with tattoos, and tracks on her arms. What can those people teach me?”

As her coach, I wanted to begin by letting Elizabeth know that I respected her opinion. and this was made easier because my assessment of her perspective was that there was validity to it. She was an affluent, middle-aged mother who might have had great difficulty connecting with the other clients. Here I used my experience as a coach, and as a person in recovery, to help me in my decision-making. I had also suffered great loss because of my addiction. Although I now have over 25 years of recovery from drugs and alcohol, I remembered how important it was to have a recovery-oriented peer group, especially in the early stages. So, I notified the caseworker, the reunification therapist, her husband, and her attorney that I was looking for a halfway house that would be a better fit for her, one more likely to foster connection and continuing recovery.

There were other things to get in order as well. Elizabeth needed to see a psychiatrist to get updates on her medication prescriptions. Unfortunately, an appointment with a new psychiatrist was more than a week away, and she was out of her medication. Speaking to her caseworker, I let her know that something needed to be arranged quickly, noting that Elizabeth couldn’t afford to have anything less than her optimal decision-making skills in the coming days and could not afford the interruption in her psychotropics.

The first step for a recovery coach is often to remove all cash and credit cards from a client that might be used for the purchase of alcohol or drugs. At the same time, we will often make sure that the client has no access to a cell phone or other electronic media equipment, like tablets and laptops. I know this sounds a bit harsh, but you can imagine the difficulty a person with a porn addiction would have with a laptop and Wi-Fi connection after being released from treatment for a sex addiction. Somehow, in the two hours between the taxi dropping her off at the hotel and my arrival, Elizabeth had obtained a cell phone with which she was texting her children and harassing her spouse with demands and rants about her wanting to return to the family home. I attempted to stop this behavior and remove the phone, but Elizabeth would not relinquish it, saying, “It’s my right to have a cell phone, I paid for it, I can do anything I want with it.” I made a series of calls to the reunification therapist and the lawyer to discuss the cell phone use. Ultimately, we decided to let her keep the cell, but we urged her to stop texting her children, as it was upsetting them. It was my job to reinforce this policy.

However, the text contact with the spouse, and children continued and caused so much conflict, that almost on an hourly basis, I had to request a time-out on phone use. Elizabeth had been without her medications for several days at this point, and the situation was becoming harder and harder to control. Luckily, her minutes ran out on the phone and I let her know that the team was not purchasing any more minutes for her phone. This texting conduct was a sign of more troubling behavior. On my urging, the psychiatrist made an opening to see Elizabeth sooner than the original appointment. Her medications were renewed, and she began to even out emotionally.

The next step was to find a suitable halfway house in the area. I used a web site to search for a halfway house. In the New York City suburbs there were two very comfortable halfway houses for women, but none had beds available at that time. There were also four all-female houses in Manhattan, and we began visiting them (luckily, more female-only halfway houses have since opened up in the NY metropolitan region). Every time we visited a house, Elizabeth had some objections to the home:

“I belong at home with my girls. I need to go home, not forced into a halfway house.”

“These houses are filled with trustfund babies, I’ll never fit in. I better go buy a Prada handbag if I want to live there”

“Only the wealthy can live there.”

I worked patiently with Elizabeth on the inevitable issues and predictable complaints that she brought forward; finally she agreed on a particular facility. I reported back to the team on the specifics of the house, the financials and the issues we’d been grappling with. We met face-to-face as a team, with the husband and the psychiatrist on conference call, to formulate a new plan for the upcoming admission to the Manhattan halfway house. We discussed the things that needed to get done, and I was asked if I thought she would be able to handle the transition. I informed the team that she needed a new therapist and a new psychiatrist in Manhattan, and that she would need help learning to navigate around New York City. Also, I shared that she was very intimidated by the city itself, with Elizabeth noting, “I have never lived in a city, I cannot live in New York.” Read more “the fix”…