November 9th, 2015


42 Years and Counting

Many changes have occurred in the world over the last 42 years. when Jim McMahon and I opened the Kolmac treatment program in the fall of 1973. Some notable events going on that year were:

•The ending of the Vietnam War and the start of the Watergate Committee hearings
•The opening of the World Trade Center in New York
•The removal of homosexuality as a diagnosis by the American Psychiatric Association
•The launching of the first space station
•The first mobile phone call being made
•Federal Express delivering its first packages

At the time, inpatient treatment — in hospitals and residential rehabilitation programs — was regarded as essential to any recovery attempt. People were commonly told that if they “really wanted to recover” they needed to remove themselves entirely from their daily life routine—with all of its stresses and dangers—and focus full-time on the treatment process in a protected setting. Things have changed over the last 42 years.

The problem was that very few patients had the resources to take off for a month to enter these programs. In addition, the system was highly fragmented. Detoxification would be done in a hospital, and then the patient would be sent to a rehabilitation facility that was often distant from his or her home. Many patients did not follow through with treatment after detoxification. Another problem was that continuing care after the residential rehabilitation stay was rare. Instead, the expectation was that participation in community 12-Step programs would be sufficient, but treatment outcomes were disturbingly poor.

Until that time, outpatient treatment was rarely effective because it did not provide sufficient structure and intensity to interrupt the addiction process. Most people, including ourselves, were not aware that beginning in the 1960s, Dr. Vernelle Fox had pioneered a successful outpatient treatment program in Atlanta. She had used a psychiatric day hospital model to provide six hours of treatment a day to non-working alcoholic patients at the publicly supported Georgian Clinic.

We set out to see if we could devise a treatment model that would help employed alcoholics successfully recover without leaving their jobs and families. Starting with our first three patients that November, Jim and I began to weave together a program that integrated into a single facility the three traditional phases of treatment: detoxification, rehabilitation, and follow up care. We ended up developing a model of treatment in which a new level of care that we had created – Intensive Outpatient or “IOP” – was central.

By having the treatment day condensed down to three hours, patients were able to attend the program in the evening between the time that they finished work and when they returned home. By scheduling the sessions at an intensity of five times a week, we created sufficient structure to interrupt the addiction without needing an inpatient level of intervention.

We were so surprised by the positive outcomes of our program that we wondered if we were working with a less severely impaired segment of the alcoholic population than was being treated in residential programs. We decided to explore this possibility through the use of a standard measure of alcoholism severity that had been developed in a residential treatment setting. When we applied the measure to our patients, we discovered that our patients had the same level of severity as patients in residential programs.

In the 1980’s the Kolmac program was expanded so patients using any substance could be treated. The addiction treatment field did not accept our model right away. The positive results, however, spoke for themselves and Intensive Outpatient Treatment or “outpatient rehabilitation” is now a mainstream form of a treatment widely used throughout the country. We are proud of everything we have accomplished over the last 42 years and look forward to the future.

Contact us to learn more about Kolmac.

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