CeDAR’s Professionals Program helps lawyers, doctors and nurses with substance misuse

Nov. 30, 2021
A woman places her hand on the shoulder of a man during a group an addition treatment for professionals.
No matter your profession, misuse of any substance — alcohol, opioids, cocaine, marijuana — is a legitimate medical condition, and seeking addiction treatment for professionals, such as CeDAR’s Professional Program, is no different than seeking help for any other illness. Photo: Getty Images.

Addiction doesn’t discriminate.

It affects all people, even those who have lofty job titles: CEOs, doctors, lawyers and pilots.

For people whose identity is closely tied to their career and where they work, admitting that they have an addiction problem — and seeking help —­­ doesn’t come easy. A professional’s identity often revolves around the pursuit of perfection, achievement, performance and leadership. The disease of addiction is incongruent with that image.

No matter what your title is, misuse of any substance — alcohol, opioids, cocaine, marijuana — is a legitimate medical condition, and seeking help for it is no different than seeking help for any other illness.

Addiction treatment for professionals

Anyone can find help for addiction through community groups like Alcoholics Anonymous, Celebrate Recovery, LifeRing or inpatient programs. For professionals, there’s an evidence-based medical program at CeDAR, the Center for Dependency Addiction, and Rehabilitation, an inpatient program on the Anschutz Medical Campus in Aurora, Colorado.

CeDAR’s Professionals Program is tailored to people who work in a profession that requires a license to practice and who are accountable to a licensing board or substance monitoring agency, or whose role is tied to public safety.

“A professionals program for substance use disorders offers the highest standards of care for addictive disorders and professionals who participate in these programs have the best outcomes,’’ said Dr. Christian Hopfer, a psychiatrist at CeDAR and professor of psychiatry in the Division of Substance Dependence at the University of Colorado School of Medicine.

“Three-quarters of physicians who participate in professionals programs have favorable outcomes after five years and are able to return to practice,’’ Hopfer said, citing this study.

The evidence-based professionals program at CeDAR has helped thousands of professionals over the years.

“You could be anyone, you could be working in a career that we term success in our society and still suffer from a chronic, progressive and lethal disease. Addiction does not discriminate. It does not matter if you’re Latinx, trans or straight, no matter who you are, it does not care,’’ said Eugenia Vasquez, a licensed professional counselor and coordinator of CeDAR’s Professionals Program, which caters to people who work in safety-sensitive positions.

Source: Getty Images

“Professionals such as pilots, nurses and attorneys have unique treatment needs.   Some factors which influence the treatment approach include the amount of stress that they are under at work and what we call in psychology, ‘image management,’’’ Vasquez said. “We’ve trained ourselves as health care workers, for instance, as professionals who have our act together.  We’re not supposed to have any problems, much less one that is associated with the stigma of addiction, homelessness and mental health illness.’’

It’s no secret that the COVID-19 pandemic has burdened people with additional stress. At CeDAR, there has been an uptick in the number of health care professionals seeking help for addictions. Physicians from out-of-state come to CeDAR on the campus of UCHealth University of Colorado Hospital; nurses and first responders who are part of the Professionals Program are mostly from Colorado.

The evidence-based treatment program is grounded in best practices outlined by the American Society of Addiction Medicine (ASAM) and a whole-person approach to care that includes psychiatry, counseling, nutrition, physical fitness and spiritual care.

“The culture that has been developed is a kind, thoughtful and compassionate culture that is really validating and accepting,’’ said Bari Platter, clinical nurse specialist at CeDAR who has been helping patients there for nearly two decades.  “It’s non-judgmental, and we are there for individuals no matter what kind of story they tell us, no matter what is going on in their lives.

“I am able to hear about issues that an individual may have never told anyone in their life, that they feel so much guilt and shame about. I am able to hear it, process it and then help them move forward in either addressing the issue or moving past it and resolving it,’’ Platter said.

The CeDAR team works closely with licensing boards and substance monitoring agencies to help professionals continue to practice in their fields. Experts adhere to strict confidentiality regulations.

When should a person enroll in a treatment program?

People who are in active addiction need help. ASAM defines active addiction as a treatable, chronic disease of the brain that involves complex interactions among brain circuits, genetics, the environment and an individual’s life experience. It is characterized by the inability to consistently abstain from substances, impairment in behavioral control, craving, and diminished recognition of significant problems with behavior and interpersonal relationships, and a dysfunctional emotional response.

When do people usually seek help?

People often seek help after trying to quit multiple times on their own, failing, and recognizing the need to reach out for help. Often, the decision to seek care at a place like CeDAR is triggered after a negative event.

It can happen in a variety of ways: Their significant other threatened to leave them or did leave. Maybe one of their kids found them passed out, or maybe somebody at work asked them if they had been drinking.

“It can be different for different people. Generally, something has occurred that made them think, ‘This is getting more out of control,’’’ said Kara McArtor, director of behavioral health at CeDAR.

Often, a person seeks help after experiencing a loss.

“I would say that it has to do with some kind of loss, some kind of huge loss. Either they lost a very significant relationship, they lost their license to practice, or their license to drive, or they lost their parents’ support. It’s usually a loss and for some people, it’s cumulative,’’ Vasquez said.

What’s the danger of not seeking help?

Addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or even premature death.

What are the goals of CeDAR’s Professionals Program?

The program specializes in supporting professionals in their journey to stop misusing substances and return safely to work. “We have programming and a treatment team that specializes in supporting some of the unique characteristics of professionals, especially with regard to the safe return to work, helping them to keep themselves safe, their patients safe and the people they serve safe,’’ Vasquez said.

How long does the Professionals Program last?

It is rare for a professional not to stay at least 30 days, and some patients can stay up to 90 days.

What happens on the first day of addiction treatment for professionals?

Medical detox. Patients are observed by a registered nurse to make sure they are not having any post-acute withdrawal symptoms. Detox is located on the same campus as the residential program on the Anschutz Medical Campus in Denver. Most patients complete detox within three days, though some patients may stay in detox for five days.

What can patients expect their treatment to look like?

“We do follow the ASAM criteria, that really is our north star because we are a medically-guided center,’’ Vasquez said. “And that ASAM criteria has six dimensions, and we are constantly assessing our patients against that criteria to determine what level of care that they will need. So that happens from the moment that they make contact with us until their last day here and in their after-care plan.’’

What happens day-to-day during addiction treatment?

“We keep our patients very busy. They’re in programming from about 8 in the morning until about 9:30 or 10 at night,’’ said Platter. “Patients are in group programming for at least four hours every day. They have psychoeducational lectures, sessions with therapists once to twice weekly and they will also meet with other members of the team as indicated.’’

In many cases, patients who are addicted to drugs or alcohol may have other addictions. For example, if someone also has an exercise addiction, they would meet with the exercise physiologist and set up a separate plan that creates balance around the way they exercise. A patient who also has an eating disorder may meet with a nutritionist to get help with disordered eating. CeDAR has a certified sex addiction therapist to help people who have addictions to sex or pornography. Therapy is also tailored to individuals who have addictions to technology, gambling, etc. – anything that is done out of balance, Platter said.

How important is psychologic and psychiatric counseling in addiction treatment?

“Think of it as an iceberg, and what’s sticking out of the water is the substance use and the mass underneath that is this big dark mass, we don’t even know how big it is or how much space it takes up. We don’t really know what is in there, that’s the hardest part of the work, figuring all of that out,’’ Platter said.

In the big book of Alcoholics Anonymous, they say: “Alcohol was but a symptom of our disease.’’

Is addiction recovery difficult?

“It’s hard, it’s very hard. We basically ask them to change everything because they are living with such cognitive distortions – how they interact with people, how they think things through, how they manage emotions without shutting down, acting out or leading to a substance. It’s hard, hard work,’’ Platter said.

Is the addiction treatment for professionals covered by insurance?

Yes, it is medically necessary care under ASAM criteria and that drives insurance coverage.

What does CeDAR offer for professionals that other addiction programs do not?

One of the advantages of the program is that CeDAR is based in an academic setting. Most of the physicians with specialties in addiction medicine and addiction psychiatry are also researchers at the forefront of advances in addiction medicine and psychiatry. Patients benefit from those medical advances.

CeDAR’s program is comprehensive and addresses psychological and psychiatric needs as well as spiritual care from a non-denominational chaplain, a physical fitness center to strengthen physical health and nutrition services. Services also are available for family members.

At CeDAR, Dr. Hopfer is joined by Dr. Jason Sapp, medical director of residential services at CeDAR and assistant professor at the CU School of Medicine Department of Psychiatry; and Dr. Jonathan Ritvo, senior medical director at CeDAR and clinical professor of psychiatry at the CU School of Medicine.

What’s the mindset needed to succeed in the program?

It’s the HOW of the program, which stands for honesty, openness and willingness,’’ Vasquez said. “If they have that how, and if they are displaying that behavior when we process in group, you can hear it very clearly. They are being honest and open-minded about the negative consequences and what led them to treatment.

“They’re also very willing, they may be hesitant, they may be scared, but they are willing to try and that is a beautiful thing to see,’’ Vasquez said.

Said McArtor: “Some people use the term surrender, and I think to admit that your way of trying to quit isn’t working, and to try someone else’s ideas, is surrender.”

What is the policy regarding confidentiality?

CeDAR adheres firmly to federal guidelines for confidentiality and strict record-keeping policies.

“All of us understand HIPAA very clearly and we adhere to it,’’ Vasquez said.

What sort of behaviors do professionals who are in active addiction manifest?

“In active addiction, a person who is in a leadership role can get manipulative around the way that they hide any issues that they’re having with substances by minimizing problems, distorting facts and holding their employees’ hostage with their behavior,’’ Platter said. “We’ve all had a supervisor who we are afraid or intimidated by. Leaders who are in active addiction can do this as well. The whole concept of perfectionism and the negative core beliefs that are behind perfectionism get amplified in active addiction.’’

What are some of the unique challenges for professionals?

“People in active addiction, especially professionals, abandon themselves. They are so worried about managing other people that they forget about themselves,’’ Platter said. “Substance use becomes a faulty strategy that either numbs out uncomfortable emotions or changes the emotional state for the person. In the more active parts of the disease of addiction, that faulty coping strategy really takes over. It takes over physiologically.’’

What happens after I leave the residential program? What services are available afterward?

Currently, CeDAR has medical detox, residential treatment that is individualized for professionals and then outpatient after-care groups that meet one time weekly with a six-month minimum commitment.

In January 2022, CeDAR is launching an intensive outpatient program for professionals.

Once I leave the residential program, how do I continue to stay sober?

“We encourage the patient to not use the substance one day at a time for the rest of their life. And, on a really bad day, it’s committing and recommitting a moment at a time,’’ Platter said. “But then we also use evidence-based practices, we use cognitive behavioral therapy, we use dialectical behavioral therapy, which both are evidence-based models for addiction therapy.’’

Cognitive behavioral therapy aims to improve mental health and focuses on challenging and changing cognitive distortions and behaviors. Platter has written curriculum for clinicians that’s called Integrating Dialectical Behavioral Therapy with the Twelve Steps, published by Hazelden.

“With DBT, what we are helping patients do is balance the acceptance of change,’’ Platter said. “We are accepting things the way that they are and recognizing those things that we can change. And if you think about the Serenity Prayer, for example, it is all about balancing acceptance and change.

‘God grant me the serenity to accept the things I cannot change; the courage to change the things that I can; and the wisdom to know the difference.’

Platter teaches patients mindfulness, de-stress tolerance skills, strategies for reducing stress, interpersonal effectiveness, including how to have a really difficult conversation without blowing up the relationship.

How do I reach the CeDAR Professionals Program?

Call the Professionals Program at 720-848-3000 and speak to an expert about enrollment. All calls are confidential.

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.