Episode #63

Analyzing Treatment Data Trends

Featured Guest: Dr. Jordan Weisman

Today’s guest is Dr. Jordan Weisman, who serves as clinical manager with the Michael’s House treatment program in Palm Springs, California. He sat down with me at the Innovations in Recovery conference in San Diego to talk about how they take a deep dive into their outcomes data to look for trends that are hiding in the details and adjust accordingly. Also, he shares how Michael’s House integrates nicotine cessation resources right alongside addiction treatment and explains what the statistics say about how smoking and quitting can affect recovery from other substances.

Podcast Transcript

David: Hey, guys, welcome to another episode of Recovery Unscripted. A podcast powered by Foundations Recovery Network. I’m David Condos and today’s guest is Jordan Weisman who serves as clinical manager with Michael’s House Treatment Program in Palm Springs, California. He sat down with me at the Innovations in Recovery conference in San Diego to talk about how they take a deep dive into their outcomes data, to look for trends that are hiding in the details and adjust accordingly.

Also, he share’s how Michael’s house integrates nicotine’s cessation resources right alongside other addiction treatment elements and explains what the statics say about how smoking and quitting can affect recovery from other substances. Now, here’s Jordan.

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David: I’m here with Jordan Weisman. Thanks so much for being with us.

Jordan: Thanks for having me.

David: Let’s start by having you tell us a little bit about your personal story and the journey you took to doing what you’re doing today.

Jordan: I knew from an early age that I wanted to be a therapist, but my vision of what that was at a young age versus what that looks like today is very different.

David: What were you thinking about it at an early age?

Jordan: At an early age I thought, “Okay, I’ll be one of these shrinks with a nice office private practice-

David: Couch.

Jordan: – couch.” As I was going through my undergrad and graduate programs I was thinking, “Yes, that’s probably where I’ll end up”. There was an academic adviser somewhere along the way that said, “I think you ought to do an internship at a hospital, you should get some inpatient experience”. I arrogantly looked at her and I said, “Lady, I’m never going to work inpatient.” Oddly enough, it’s now my life’s work since taking that internship, it really changed the trajectory of my career.

David: What was it about that opened your eyes to this is what you wanted to do?

Jordan: Well, it’s one of those things where I didn’t really realize that that kind of work existed. I think it was just in the first couple of weeks, I started looking around the hospital going, “I’m home now.” I think what it is for me is seeing the progression of how chaotic somebody’s life can be and in such a short time move to a place of relative stability while still obviously they need more work after they leave, but-

David: See the difference.

Jordan: – you see huge difference in such a short time. I think had a really powerful impact on me.

David: Now you are serving as the clinical manager?

Jordan: Yes, that’s correct. I’m the clinical manager for the men’s center at Michael’s house which is a 60-bed residential men’s facility.

David: Okay, cool. Could you unpack what that role entails, the clinical manager, what is that look like for you?

Jordan: I think one of the fun things about it is that there’s no two days that are the same. I provide individual supervision for the treatment team oversee the program from a 30,000 foot field.

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David: Anyway that foundations pride themselves a lot on doing research, looking at real world outcomes of the patients. What are some ways that Michael’s house gets into that before during and after the treatment?

Jordan: We are constantly taking surveys and we’re constantly looking at data and that, for me, is a lot of fun. Again, it’s one of those things that I didn’t really realize that that could be part of the job of a psychologist to take a look at all of this data and make adjustments to the program to have an impact. One of those things that we looked at early on after I got there, me and some of my colleagues would be in these meetings where we’re reviewing matrix.

Sometimes it’s looking at patients satisfaction and all of those things all of which we look at and [unintelligible 00:04:20] One of the things that we looked at was ACA rate, when patients leaving treatment early and we found ourselves asking these odd questions, like in a 538 way of going how old are these people and where did they come from, what’s there education background?

David: For people who don’t know 538 is a political, sports like data.

Jordan: It’s like data-driven journalism. Me and a couple of our colleagues we’ve kept asking these things in these meetings and I think people got tired of answering our questions and start saying, “Why don’t you just do this?” We’ve turned that into this effort to just constantly be looking at our ACA’s, bringing the number to life, like telling the story behind this person left on this day so we would look at things like what day of the week were they leaving on and what was their secondary drug of choice, what was their psychiatric diagnosis, were they here on an intervention and looking at ways in which we can adjust the program, adjust what kinds of interventions were happening on what day to make an impact on the patients leaving treatment early.

Adjust that constant attention to it, we’ve dropped our ACA rate significantly over the last five years work well under 10% which is under the national average for patients leaving any kind of inpatient treatment early.

David: Do you have an example of something that you saw and then you made a change and then you saw some of that improvement?

Jordan: Yes, we were noticing that the young opiate-dependent patients, young, meaning, somewhere between 18 and 30-ish. They were the ones that were leaving early. We went back to the doctor and said, “Is this at all related to our detox protocols? Could these patients still be detoxing? Or are they in such acute withdrawal when this is happening? Do we need to adjust how it is that we are detoxing the opiate patients?”

David: They must be leaving pretty early in the process if you’re looking at detox?

Jordan: They were. All of our facilities are licensed for detox that we like to detox people separately so that they can feel more comfortable in the residential program.

David: That’s the stabilization–

Jordan: Yes, that’s our the stabilization center. We were taking a look at those things and the medical team went back to the drawing board said, “Let’s make some adjustments to these detox protocols. Let’s make adjustments to when it is that we’re transferring patients”.

David: Transferring them into the residential?

Jordan: Transferring them into the residential program. Letting the families know that this patient falls into a high risk for leaving treatment early. Let’s tell the patient that they’re a high risk for leaving early. Let’s give everybody the information based on what we’ve been seeing and for the first time, I think it was last year our opiate dependent patient wasn’t our main person that was leaving treatment early. It had shifted very dramatically as our ACA rate overall was dropping. Now, the primary person that was leaving early was early 40’s alcoholic and we were seeing too that when they left ACA, they were leaving much later in the process than the opiate person.

David: Totally different thing.

Jordan: Those are completely different things. That stuff is fun to constantly look at and we review it every month and it was just one of those things that was like, “Hey, that’s interesting. Let’s look at it”.

David: I love that stuff because you are working there every day so you can make your own assumptions about trends and what you are generally seeing, but the data really doesn’t lie. That can tell you what’s really going on.

Jordan: Yes, you can have those things where you go. Well, I think it’s this, I think it’s this and then you can take a look at the data and go, “Well, no, that’s not actually what’s happening”.

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David: Here at the conference, you also gave a presentation about nicotine cessation in a residential setting such as you have at Michael’s house. Smoking, in general, is pretty common among people who are in recovery, especially. I imagine there is some skepticism out there or people who think that maybe that’s not as big of a deal. I guess, how do you respond to that? Do you see some of that?

Jordan: Yes, when we started this effort, it was a group of people who either were non-smokers themselves or people in recovery from nicotine as well that were just like, “Why aren’t we making more of an effort?” Over and over, we were finding there’s resistance from any number of levels you talk to any treatments center go, “Well, it’s too hard to quit smoking while you’re in treatment.”

Let’s focus on the really important stuff. Some of the stats are just really sad. One of the stats that I read was 50% of people who have received treatment for alcohol, for example. 50% of them are going to die from a smoking-related illness, it’s so sad because they’ve already gone through, they’ve made this significant change in their life, they probably feel damn good about themselves and yet because they haven’t addressed smoking, they still end up dying from addiction-related disease.

A small group of us got together and we started looking at more and more research, finding that it’s more of a belief that we have that you can’t quit smoking while in treatment, it’s too hard. Or that it might take away from the treatment of the opiate or the alcohol or the benzo’s because well, now we’re also focusing on this little smoking thing or people get really stressed from being away from smoking.

It’s a destruction from the real primary focus here and the research just didn’t bear that out that was more on the industry going. This is too much to do, let’s tell them to do that later. The data is showing that it’s considered endemic. It’s as high as 75% of people in treatment are smoking. That’s an unbelievable number.

David: Just from a healthcare perspective, that’s a missed opportunity if you’re not addressing that with them while you have them there.

Jordan: It’s a huge missed opportunity. I talk about this idea of cognitive dissonance. It’s a really old concept in psychology but that idea that my actions really aren’t matching my beliefs. I think that people who are entering recovery should do healthy things. My program is also going to go buy them cigarettes so that they feel better about the treatment that they’re having. That was the collective feeling that this workgroup had. We didn’t want to reinvent the wheel when it came to smoking, research bears out there’s no gold standard for quitting smoking.

David: Meaning there’s no one path to take?

Jordan: Right. If you have an infection you take an antibiotic, there isn’t that for smoking, at least yet. Most people choose to do some amount of nicotine replacement and then some community or other kinds of support. We said we wanted to reduce any barrier to entry. Even if they’re not taking any medication or anything, they go into our nursing stations to have their vitals checked every day. We made these really simple folders and a really simple goal-setting form. A patient just fills it out. We modified a form that our nursing department was already using for blood sugar monitoring. We took that form and we changed it to, how many cigarettes, what were your cravings the previous day.

The patient signs it so they’re interacting with it every day. On the very top of the page, it shows their baseline, I was smoking a pack a day. Every day, they get to just look at it without judgment in the same way they look at their blood sugar, this is what your blood sugar is right now, this is how many cigarettes I smoked today. Just really simple but a way that they could interact with a nursing professional on a daily basis about their smoking. These packets that we give them have just publicly available aids to help quit smoking.

Again, we didn’t want to be so arrogant to say, “We’re going to cure smoking for the whole world.” There’s already really great stuff out there, there’s 1-800-NO-BUTTS and the American Cancer Society and insurance companies. Private insurance companies, on their own websites, had these support tools for quitting smoking. We said, “Let’s gather as much of that free and publicly available stuff and give those resources out. Don’t make the patient go search for it, here it is in a little folder.” That’s how you enroll in the program, they can go to any staff member because we trained up everybody. The only thing you have to do to enroll is say, “I want to quit smoking.” That puts it into the patient’s treatment plan. We gave it some weight and said, “Quitting smoking is really important.”

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David: We’ve talked about a lot of research regarding the nicotine cessation. Is there some research saying abstaining from nicotine or these type of programs can affect someone’s sobriety in general, for the long term?

Jordan: It’s a good question. Talk on Monday, I drew some parallels to the opioid crisis because that’s on everybody’s mind. The opioid crisis, by conservative estimates, is killing somewhere around 50,000 people a year, which is a lot. By other estimates, it’s as high as 70,000 people a year. Part of the motivation in creating this program in the first place was smoking-related illness kill almost half a million people a year. It’s like 12,000 people a day. The thing is is that no one’s talking about it. That was, again, the motivation for it.

Then the research bears out that not only does it not have any effect on a patient’s ability to quit their primary drug, they have a higher chance of remaining sober long-term from their drug of choice if they quit smoking while they’re in treatment.

David: Really?

Jordan: Yes, a lot more. Estimates are somewhere between 20% to 50% more likely to be sober at long-term follow-up and that’s a year out, if they attempt to quit smoking while they do their primary drug treatment.

David: I guess why do you think that is?

Jordan: There’s research behind this too. Smoking in itself is its own relapse trigger for using. Really it’s simple behavioral training. If you look at what most people are doing while they’re also doing their drug of choice, it’s usually smoking.

David: It has that connection in their brain already?

Jordan: Right. It’s not, “I’m drinking, I have a little less impulse control so I’m just going to start smoking.” It’s, “I’m smoking and I’ve paired it so much my brain can’t help to think of it.” That path is so deeply carved that smoking is the trigger for the relapse.

David: You need to tell your brain that smoking is a separate thing because it’s so linked.

Jordan: Yes, some of the things we do to create that dissonance with our patients is when they transfer over to our men’s program. During the tour, there’s at least one or two staff as we’re walking around, “Hey, this is where the bed is, this is where the cubbies are, this is the main group room. Hey, by the way, are you a smoker? Do you have any desire to quit?” Most people actually do. The numbers bear that out, that most people want to quit.

David: I guess because maybe they’ve just decided to make this major change in their life and so it flows in with that trajectory?

Jordan: Yes, because we’re asking them. We weren’t asking before but the research kept telling us, “No, most people want to quit.” Even though most people in treatment are smoking, 70% of the population of smokers at any given time wants to quit. We should just ask them because we weren’t asking them before. I think that a lot of treatment centers are probably like that. We’ve got, “All right, great. You’re quitting heroin, that’s awesome. Here’s your bed and do you need any more cigarettes?”

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David: Looking at it from a more overall treatment level, I guess what are some obstacles to implementing this type of nicotine cessation program as part of the substance use program.

Jordan: We’re not a smoke-free facility and a lot of places aren’t but sometimes that idea can carry through because we offer this that we must be a smoke-free facility and we’re not. I went to the patients that were currently at our houses as we were doing this. While it wasn’t a formal poll by any means, I gathered the entire community and I was asking them, “How many of you are smoking?” Just like the research showed, most of the hands went up in the room. “How many of you may be interested in quitting at some point?” Most of those smoker’s hands went up. “How many of you are trying to quit?” Hardly anybody.

Then I asked a question that I was expecting a very different answer, I said, “If we were a smoke-free facility and don’t worry, we’re not and we don’t have any plans to, but if we were a smoke-free facility, would that prevent you from choosing us? Maybe one or two hands. Most of them said that if we were a smoke-free facility that we would still go. That tells me if our program is good enough on its own merits, then smoking doesn’t really have anything to do with patient attendance.

David: It’s not as big of a factor as you might have though it was?

Jordan: No, in fact, it didn’t seem to impact the ACA rates. It seems to be making a difference and that’s making us happy.

David: Yes, man, definitely. For someone out there who’s listening who is maybe interested in pursuing this or they work in a treatment program and they want to maybe try to bring this up at some point in the future, what are some tips you would give them for overcoming those obstacles and then building a program and maintaining a program?

Jordan: I would say don’t reinvent the wheel. There’s a lot of really great resources out there already. Train your staff, staff training is so important with any new initiative. Provide that education so that the staff can free themselves of biases.

David: Right. To get that buy-in on this is an important program that we’re offering.

Jordan: Some interesting stuff for us has come out with that. I mentioned him in my talk, his position at Michael’s House, it’s called a clinical coordinator, it’s this Jack-of-all-trades guy. He was diagnosed with lung cancer as a direct result of smoking for so long. I was working on this project and he was helping me do the research, but prior to his diagnosis, he was still smoking and all that. I could see that uncomfortable feeling around it. Then he receives his diagnosis, turns out to be really bad and he came back and he has been our strongest and most powerful advocate for this program as of other staff that we currently have who are in their own change process around smoking.

We found that by giving the education to the staff, they don’t have to feel like a fraud by saying that you should quit smoking because it’s bad for you. They know themselves its bad and they’re also trying to change. We don’t say that if you’re smoking you can’t enroll anybody. The important thing is that everybody can enroll the patient in the program.

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David: With the nicotine cessation program, specifically, do you have some results, some hard data about how that’s working?

Jordan: As a back-end consequence of putting that form together where the patients are interacting with their program every day, it tallies up the number of cigarettes that they smoked in the previous day. We ask them about how strong their cravings were and basically, what we were finding is that the longer that somebody was actively enrolled in our program, that on average people were smoking about 16 cigarettes a day. That’s a little less than a pack and we were finding at by 20 days or more enrolled in a program, they were smoking less than five cigarettes a day and their cravings on a five scale were under two.

David: That’s just from starting the program for 20 days you said?

Jordan: Yes, if they were in the program 20 days or more and it was showing that across multiple days so we averaged, all right, what were they doing just on day one of the program and one day enrolled in it, already drop it like four cigarettes.

David: Really? Just taking that step, making that decision, making that a part of the program mentally.

Jordan: Right. Like I’m quitting smoking so I’m going to smoke fewer. The longer that someone was there, they were more likely to be properly using nicotine replacement, where when they started, maybe only about 20% were using nicotine replacement close to 70% towards the end. They were also smoking way, way fewer cigarettes, their average cravings really early in the program were three out of five, four out of five. By the end there, down like one and half, 1.6 something like that. At the beginning, 30% of people were comply it with using their medication.

They became more medication compliance somewhere in the mid 60’s and in terms of their medication compliance if it’s prescribed to them. Just by this really, I call it like a soft touch program, which is by offering it, the patients took and ran and they really were smoking way fewer cigarettes. That made us feel pretty good.

David: Cool, all right. Well, I just have one last question, everyone who serves in this field devotes their time to getting up every morning at further the course of recovery, has their own reasons for doing that. Could we end by having you sum up, why helping people find lasting sobriety in all ways even when nicotine is so important to you?

Jordan: There were powerful influences on me from a very young age and I’ve seen peoples’ struggles, have seen peoples’ trials. I’ve seen the power of inpatient and residential treatment to make profound changes in a really short period of time and that selfishly makes me feel good about the work that I do, to help people get better, to help people feel better. Substance use and mental illness touches everybody’s life whether we’re talking about it or not. Certainly, that’s been the case for me across multiple generations.

David: All right. Well, Jordan, thank you so much for your time and for sharing all that with us.

Jordan: Thanks for having me.

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David: Thanks, again, to Jordan for joining us. Now I get to introduce another installment of our ongoing segment called Minute of Mindfulness. Together, will take the next 60 seconds to slow down, take a deep breath, and focus on this present moment. As always, I’ll open things up with an inspirational quote and then I’ll rejoin you to close out the episode. Today’s quote comes from writer conservationist in 26th President of the United States Theodore Roosevelt, who said, “Believe you can, and you’re halfway there”.

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David: This has been Recovery Unscripted podcast. Today, we’ve heard from Jordan Weisman of Michael’s House. If you’d like to talk with an admissions coordinator about the treatment options at Michael’s House and other foundations programs, please call anytime at 855-823-2141. See you next time.