New tools for addiction treatment land a Nightingale

Bari Platter combined two approaches to help addiction-recovery patients
May 25th, 2016

The first thing a person meeting Bari Platter may note is her sense of humor. If, for example, you happen to be moving a statuette in University of Colorado Hospital’s Center for Dependency Addiction and Rehabilitation (CeDAR) lobby to a spot with better light, and you say something like, “I’ll be careful not to drop this,” she responds with, “No, you wouldn’t want to dent the floor.”

She said this 11 days after she had received the statuette at the Colorado Nurses Foundation 2016 Nightingale Luminary Awards Gala on May 7. She won it for Innovation in Administrator, Educator, Researcher, or Non-Traditional Roles: an outstanding nurse who demonstrated creativity that addresses today’s challenges or opportunities. Rather than take the statuette home or keep it in her office – places with far lower potential for floor-denting mishaps – she decided to leave it in the CeDAR lobby because, she said, “I’m part of a team.”

Bari Platter on the CeDAR grounds.

Despite the sense of humor and team spirit, Platter, RN, MSN, PMHCNS-BC (that last bit stands for board-certified psychiatric mental health clinical nurse specialist), didn’t win Colorado nursing’s highest honor solely on the strength of a winning personality. Platter has an encyclopedic knowledge of a field of expertise she herself played a big role in developing.

Platter reconciled and then melded two proven behavioral health intervention techniques – the Alcoholics Anonymous 12-step program and dialectical behavior therapy, or DBT – into a substance use disorder treatment program now being used in addiction recovery and other programs across the country.

The toolbox

Platter has worked in psychiatric mental health at University of Colorado Hospital since graduating with her bachelor’s degree from the University of Colorado College of Nursing in 1985. She was certified in DBT in 2007 to train the hospital’s inpatient psychiatric unit staff. She also did DBT with patients at CeDAR until moving to the addiction recovery center full-time in 2012.

As Platter delved deeper into addiction recovery, she realized that many of the concepts in AA’s Big Book and the Narcotics Anonymous basic text jibed with those in DBT, which addresses emotional dysregulation – when emotions, positive or negative, are out of whack with objective truth – using behavioral therapy and mindfulness practice. The differences were often a matter of language, she realized. So she set out to reconcile that language, and she ultimately created a unique program that unified all three.

“The result was that 12-step strengthened DBT and coping skills, and DBT strengthened 12-step recovery for the patients that are here,” Platter said.

The Nightingale statuette having been replaced to its original spot in the CeDAR lobby, Platter fielded questions at a table out in the courtyard. She offered an example of the overlap.

“One of the skills taught in DBT is called ‘radical acceptance,’” she said. “On page 417 of the Big Book, there’s a quote that says, ‘and acceptance is the answer to all my problems today. When I am disturbed, it is because I find some person, place, thing, or situation — some fact of my life — unacceptable to me, and I can find no serenity until I accept that person, place, thing, or situation as being exactly the way it is supposed to be at this moment.’”

The Big Book was not open to page 417 on the table in front of her. She had cited this from memory as if it were the Pledge of Allegiance or her home address. It’s not the only passage, lesson, or technique she can recall with such speed and precision. In the nomination letters for the Nightingale award, her exceptional command over her subject matter was as common a theme as her uncanny ability to connect with patients. She has assembled what amounts to an enormous intellectual toolbox, from which, like some master mechanic of addicted minds, she can quickly produce the precisely correct implement.

The curriculum

She applies her many tools in CeDAR group sessions as well as one-on-one. Michael Lyons, a CeDAR behavioral health counselor, said he went through Platter’s training and now uses it every day during sessions with his own patients. He described Platter as a combination of guru and mentor.

NightingaleStatue
Platter’s Nightingale Award statue has taken up residence in the CeDAR lobby. She’s part of a team, Platter explained.

“She’s an expert in all things DBT – coping skills, de-escalation strategies, distress tolerance and mindfulness,” Lyons said. “She’s the go-to when we’ve got a behavioral crisis.”

In the award submission itself, a former patient described Platter’s “profound understanding of the program,” but then added that her ability to develop “compassionate and understanding relationships with her patients, thus helping to reduce the stigma addiction often carries with it” was more vital yet.

“I will never forget our last session together, when she told me, ‘You are a beautiful person with a terrible disease,’” the former patient wrote. “These uplifting words gave me a sense of peace for the first time in 25 years of contending with addiction.”

Platter developed the program curriculum with co-author Osvaldo Cabral, formerly of CeDAR and now with the Awakenings Recovery Program at The Raleigh House of Hope in Denver. The work came together in about six months, and was published by Hazelden in 2012.

“Integrating Dialectical Behavior Therapy with The Twelve Steps: A program for treating substance use disorders” comes in a three-ring binder and includes a facilitator’s guide with four modules, one for each pillar of DBT: mindfulness, distress tolerance, interpersonal effectiveness and emotional regulation. Those modules are then broken into 21 sessions that focus on skills that, Platter says, “are really essential for healthy recovery.” There are also 79 worksheets, and a CD with files that can be reproduced without freckles from the glare of relentless photocopying.

The curriculum is being used across the country in addiction treatment centers, community mental health centers, hospitals, child and adolescent programs and drug courts, Platter says. She has traveled to many of them to help implement the program she designed.

Lessons beyond addiction

You don’t have to plow through 21 sessions to gain from the intersection of DBT and the 12 steps, though, Platter notes. She’s hoping the Nightingale award helps shed light on the disease of addiction and how nurses can more effectively work with patients in their clinical practices, “because nurses encounter people with addiction in all clinical areas, and we get so little training in how to clinically work with them.”

Mindfulness and distress tolerance skills are two examples. Bedside nurses in any setting can use mindfulness techniques to help patients quiet the mind and focus, become grounded and centered, and participate effectively in their treatment. Distress tolerance helps patients learn to deal with distress and discomfort without making things worse through techniques that include self-soothing, relaxation, and what Platter called “opposite emotions.” The latter involves identifying the emotion you’re experiencing and its opposite, then doing or thinking about something that creates that opposite emotion.

“So if I’m a patient on a med-surg unit and I’m feeling scared, the opposite of that is feeling safe, and one way I feel safe is by talking to other people,” Platter said. “So maybe I learn to ask for a volunteer to come and talk to me and keep me company – rather than sitting in fear or pushing the call button over and over again for a nurse.”
Platter’s curriculum, which melds dialectical behavior therapy and the Alcoholics Anonymous 12-step program, is now used across the country.
Steve Millette, CeDAR’s executive director, described Platter’s contributions to CeDAR as “invaluable.” That patients seek her out is proof of the personal connections she forges, he said, and her work is important to CeDAR’s educational mission to train nurses, residents, psychologists, counselors and other disciplines in addiction medicine and nursing.

“Her innovative approach stems from her willingness to think outside of the box about how best to reach patients at the most vulnerable and frightening time of their lives,” Millette said. “Her curriculum helps bridge a path from addictive disease to recovery in a way they may never have known without her approach.”

Or, as Tim Rumsey, a CeDAR behavioral health counselor, said as he happened to walk by, “She’s the best.”

About the author

Since 2008, Todd Neff has written hundreds of stories for University of Colorado Hospital and UCHealth. He covered science and the environment for the Daily Camera in Boulder, Colorado, and has taught narrative nonfiction at the University of Colorado. He was a 2007-2008 Ted Scripps Fellowship recipient in Environmental Journalism at CU.

His latest book, "The Laser That’s Changing the World," tells the story of the inventors and innovators who saw, and ultimately realized, the potential of lidar to help solve problems ranging from smokestack-pollution detection, ice-sheet mapping, disaster recovery, and, ultimately, autonomous-vehicle guidance, among many other uses. His first book, "From Jars to the Stars," recounts how Ball Aerospace evolved from an Indiana jar company - and a group of students in a University of Colorado basement - to an organization that managed to blast a sizable crater in the comet 9P/Tempel 1. "Jars" won the Colorado Book Award for History in 2012.

Todd graduated with a business degree from the University of Michigan, where he played soccer, and with a master’s degree from the Fletcher School of Law and Diplomacy at Tufts University. Before becoming a journalist at the turn of the millennium, he was an IT and strategy consultant. He once spoke fluent Japanese and still speaks fluent German.

When not writing, he spends time with teenage daughters and wife Carol, plays soccer, and allows himself to be bullied by a puggle he outweighs by a factor of seven.