My Experience at Kolmac Clinic

By Karen Chen

As a fourth year medical student on Psychiatry Ambulatory Care, I went to the Kolmac Clinic in Silver Spring, Maryland on Mondays and Tuesdays for four consecutive weeks.  Though I only visited once during my third-year psychiatry rotation, it felt comfortingly familiar, rather homey with its apartment spaces converted into offices and group therapy rooms and its decidedly non-fluorescent lighting.  On my first Monday, I was introduced to Kolmac’s Associate Medical Director, Dr. Negro, and soon thereafter began seeing a steady stream of Continuing Care patients, who check in with one of Kolmac’s psychiatrists once every couple of months.  These appointments are much like other outpatient psychiatric visits, focusing on medication management but also including a small dose of counseling when appropriate.

From day one, I got to meet college students, young mothers, middle-aged mothers, businessmen, warehouse workers, repairmen, unemployed folks young and older, who all share one thing in common: they have a recent history of alcohol or drug abuse.  They vary in their substances of choice — alcohol, opioids, benzos, cannabis, cocaine, and so on.  Many have co-morbid mood disorders, and, unsurprisingly, it’s often unclear which came first, the drug addiction or the mood disorder.  I found it interesting that all these individuals are so different, with their own unique stories to tell, and yet so similar.  They sought help at Kolmac because they wanted to overcome their alcohol and drug addiction and thereby create a better life for themselves.  They keep coming back to Kolmac because, well, it works.  If an individual is truly committed to their recovery, then Kolmac provides an exceptional rehabilitation program and support system.  From the day a patient arrives for detoxification, he is treated with care and respect, while simultaneously measures are put in place to help ensure he is held accountable for his drug-using behavior.  Notably, patients are required to enter group therapy immediately following detox, so from the start they are surrounded by supportive staff and other patients in different stages of recovery.  The environment is very safe and welcoming and also very necessarily and appropriately strict — a truly balanced combination that I find impressive.

On Tuesdays, I often sit in with the third-year students as Dr. Kolodner, addiction psychiatrist and founder of Kolmac, describes his unique vision of an effective, intensive outpatient drug rehab program, which he has clearly successfully brought to life.  The students and I join the patients in group therapy, our role to deliberately remain as observers.  It is in group therapy where the most difficult work is done.  Patients are asked to dig deep into themselves, confront their unspoken fears, share their hopes and dreams, and open themselves to a level of vulnerability and self-honesty previously unheard of.  One young man voiced his fear that he would one day encounter such an obstacle in life that his well-intentioned resolve would just melt away in a split-second.  Another gentleman explored his lifelong struggle with alcohol addiction, describing that he has often been lulled into complacency, and though he regularly attends support groups, his tendency is to remain on the fringes.  No, the sessions are not perfect, and yes, conversations get off-topic, but overall, in the course of the 20-something sessions over eight weeks needed for completion of acute rehab, patients learn to recognize their triggers and modify their old thinking and behavior, developing internal and external tools to help prevent future relapses.

At the core of recovery from addiction is “the group,” the community of previous substance users who will for the rest of their lives be, to some degree, vulnerable to relapse, consisting of individuals whose combined power of support is almost boundless.  Patients are constantly asked by staff and other recovering patients, “Do you have a sponsor?  Do you go to meetings?”  At Kolmac, patients learn that recovery is ideally the first day of the rest of their lives.  Their work at Kolmac provides them with a solid foundation, gives them the best chance for successful, sustained recovery, but in the end it’s up to them to keep up the good work they started there, one day at a time.  It has been quite a privilege to participate in the process from beginning to end.  I have met the patient during detox, still miserable and shaky from withdrawal, knowing he will soon transform into the patient in intensive rehab I saw in group therapy, a bundle of frustrations and hopes, knowing he, in turn, will go on to continuing care, working hard to stay on the path of recovery, and eventually become an alumnus of the program, perhaps returning on a Tuesday to Silver Spring to enlighten wide-eyed medical students on their third-year psych rotation.  After my experiences this month at Kolmac, I can say with newfound confidence, “I understand what you’re going through, and I know how I can help.”