The leafy grounds of the Center for Dependency, Addiction and Rehabilitation (CeDAR) at University of Colorado Hospital might be mistaken for a section of a botanic garden, with ancient trees spreading protective shade over benches and flower beds awash in color.
The peaceful portrait belies the emotional turmoil of the lives of patients within CeDAR’s walls. But it also symbolizes the themes of birth and rebirth that are at the heart of CeDAR’s mission to help people recover from addiction.
“We see patients move from being miserable to having hopefulness and a sense of purpose,” said Bari Platter, MS, RN, PMHCNS-BC, a clinical nurse specialist who has been with CeDAR since it opened its doors in 2005. “Anyone can follow a path to a healthy life.”
This month, CeDAR will celebrate its first decade by acknowledging its past while pointing to the future. The July 26 “Best Day Kick-off” at the Denver Center for the Performing Arts Seawell Grand Ballroom will launch CeDAR’s endowment and capital campaign. Special musical guests The Fray will perform.
Toward the next decade
The event is also an opportunity to acknowledge and thank the Anschutz Foundation and University of Colorado Hospital, which contributed $3 million and $5 million, respectively, toward the endowment and capital necessary to fund the facilities, research and education, and infrastructure necessary to extend integrated care to thousands of people seeking recovery, said Steve Millette, CeDAR’s executive director.
A total of more than 8,000 people have been served by CeDAR’s residential and outpatient treatment and family programs since 2005, thanks to steady growth and increased capacity. Data from CeDAR’s Recovery Management team show strong percentages of patients still sober one year after treatment at CeDAR, Millette added.
“The Anschutz family, the Anschutz Foundation and UCH understand the importance of addressing addiction and behavioral health issues,” he said. “This event is a celebration of the many lives we have changed. We have lost some along the way. But we have saved many more than we have lost.”
Building on the past
The pillars supporting CeDAR’s mission have not changed since its opening, Platter said. It began with the support of Philip Anschutz for an addiction treatment center that would wed evidence-based medical practice with behavioral health, self-help, wellness, and spiritualism. The holistic approach guided the late Robert Harmon, MD, a psychiatrist with the University of Colorado School of Medicine who served as CeDAR’s first medical director.
“His vision was to create a culture of recovery that encouraged people to take care of themselves emotionally, spiritually and interpersonally,” Platter said.
Harmon brought that view to life even before a shovel turned the soil on the Quentin Street site. Frank Lisnow, CeDAR’s first executive director, recalled that on his job interview in 2004, CeDAR was nothing more than a design on paper. Lisnow was nonetheless intrigued.
“We clicked immediately,” Lisnow remembered in a 2011 interview shortly before his retirement. “We had the same passion and love for helping people get into recovery. Our philosophy was the same – that people change when they decide their behavior needs to change. We both wanted to help people in recovery through a commitment to behavioral change.”
From that philosophical foundation, CeDAR emerged and grew organically. The main building, residential cottages, and the Spiritual Center, completed in 2009, feature elements of wood, stone and glass, reflecting a “rustic charm,” as Platter put it. The quiet, manicured grounds reinforce the sense of a self-contained community dedicated to reflection and finding a sense of purpose. And many of those working at CeDAR to help others turn from addiction are themselves in recovery. A strong alumni program – now called Recovery Management Support – was a core element of CeDAR’s program early on and reflects the principle that recovery is a lifelong process that frequently requires helping hands.
Both sides now
Linnea Lindroth is among the group who has seen CeDAR from multiple perspectives. As a 19-year-old student at the University of Colorado in 2008, Lindroth drank heavily, got a DUI and overdosed on Tylenol PM. With the encouragement of her mother, Lorna Prutzman, RN, MSN – then director of the Emergency Department at UCH; now executive director of Cardiac & Vascular Services – Lindroth checked into CeDAR on Mother’s Day weekend in 2008.
“It was terrifying,” Lindroth recalled. “But I escaped by the grace of God and was given a second chance at life. I am alive today because of CeDAR.”
She completed 30 days at CeDAR and credits, among many, Platter for teaching her behavioral therapy techniques for coping with stress. After extended care in California and a period of employment there, Lindroth returned to Colorado in 2011 and began volunteering in CeDAR’s women’s cottage, which had recently opened. Three months later, she was an admissions assistant at CeDAR, then moved on to a series of jobs at UCH to gain different experiences in health care.
This past spring, though, she returned to CeDAR, where she is now intake and access coordinator with the admissions team. “I was missing the connection of being a part of something bigger than me,” Lindroth said. “I needed the connection with patients and families.”
Next month she’ll write another chapter in her life of recovery as she begins the CU College of Nursing’s Integrated Nursing Pathway program, a route to earning her bachelor of science in nursing degree. Wherever her career takes her in the future, the principles of recovery will provide a foundation, Lindroth said.
“For me, recovery is about restoring family relationships, developing spiritual connections, continuing to leave things better than I found them, contributing to society and my community, and being available to anyone at any time who is struggling with addiction,” she said.
That struggle affects more than those who are addicted, as the Family Program at CeDAR recognizes. Jody James can attest to that. She applied for a job at UCH in 2005 and was taken aback when she saw an opening in admissions at a new facility called CeDAR. James’s grandmother, ex-husband and older brother had all struggled with alcoholism and substance abuse.
James first encountered addiction in the late 70s and early 80s, a time when there weren’t many sources of support for those like her who had been affected by it. But she found Al-Anon and attended meetings regularly for 13 years. In speaking to others and educating herself, she came to the realization that addiction is a brain disease that can’t be written off as the result of a lack of individual willpower. She also learned to deal with the damage that addiction inflicts on family members and loved ones.
“There is a lot of fear because you don’t know what’s going to happen,” James said. “An alcoholic is going to die. There is a lack of security.” Her efforts to fix the problems only enabled the negative behavior, she ultimately realized. “Addiction is a manipulative disease,” she said. “I found out that I’m stronger and can walk away. I hadn’t realized that was my choice.”
With that as background, she experienced a first when she interviewed for the job at CeDAR. “I was asked, ‘What do you know about addiction?’” she said. “It’s the only interview I ever cried at.”
When the doors opened on Oct. 10, 2005, CeDAR admitted two patients. It ended the year with 33 admissions. By comparison, fiscal year 2016 ended June 30 with 527. James, who is now clinical office operations lead, has seen firsthand the fine line CeDAR walks in a field that requires emotional sensitivity and business sense in equal measure. Payment options are slowly changing to include insurance coverage, but until recently the vast majority of patients had to pay a steep price for services out of pocket.
“In many of the first calls we got, people were angry about the cost of the program,” James said. The Anschutz Foundation helped with money for scholarships, and positive word-of-mouth from alumni about the care they received, along with marketing of the unique mix of services, contributed to steady growth.
As an admissions assistant, James learned to balance CeDAR’s financial realities while she spoke to individuals and families in crisis. “I worked with them to understand the value of the treatment and take the emotion out.” And she could always relate to families. When an angry wife said, “You don’t know what I’m dealing with,” James could truthfully say she did.
Forging the future
With the close of its first decade, CeDAR can look back on growth that goes beyond increased capacity and rising admissions volume. With Millette’s arrival in 2011, the center has increased its emphasis on research and on forging a stronger relationship with the School of Medicine. Patients now have access to integrated outpatient services, broader extended-care programs, and tracks for professionals and athletes. CeDAR hosts chaplain resident and addiction medicine fellowship programs and has developed gender-responsive training for staff. It’s now in the midst of joining with primary care and mental health professionals to build a behavioral health service line for UCHealth.
But the times demand that innovations continue, Millette said. One of the most important, he said, is a digital platform CeDAR is developing to help patients and staff in recovery management stay connected through computers and mobile devices. The idea is not to replace “the primacy of face-to-face contact,” but rather to help patients access coaching and education, sustain relationships with staff, create online communities and build other connections as they progress “toward this thing we call recovery,” Millette said. Patients admitted to CeDAR began receiving the app in December.
The digital technology is part of what Millette sees as a necessary transformation of health care delivery for addiction treatment. This includes providing preventive services before people need intensive treatment of the type the CeDAR residential experience provides, and offering the most convenient and accessible support possible for those who have completed treatment. Building more treatment centers can’t possibly address the need, Millette said.
“We have to find new ways to keep people in recovery and moving toward wellness,” he said. “We’re building products and services that meet people where they are.”
Millette also noted that CeDAR will continue to strengthen its academic medical base – not at the expense of longstanding self-help approaches like the 12-Step program, but as a necessary component of recovery. He said CeDAR is engaged with the Division of Substance Dependence in the CU School of Medicine’s Department of Psychiatry to create an infrastructure for evaluating treatment outcomes. The “Best Day” endowment will help to support that.
“This will allow us to lead the field in the advancement of evidence-based practices and train the next generation of clinicians in these practices,” Millette said.
The start of CeDAR’s second decade coincides with rising public awareness of the human and financial toll of addiction, notably highlighted by soaring rates of opioid addiction. An area of health care once scorned and stigmatized is now attracting billions in private equity and attention from the political arena, including the White House, Millette said. The Comprehensive Addiction and Recovery Act of 2016, approved by the U.S. Senate this month, includes – among many other measures – a provision that aims to increase access by expanding prescribing authority for medications to treat “opioid use disorder” to licensed and trained nurse practitioners and physician assistants.
“The conditions are ripe for new ideas,” Millette said. “We have news of the epidemic of addiction along with science saying there are solutions in treatment and recovery. There is recognition that addiction is not an acute problem. It’s a chronic health care problem and a public health issue.”