I know how they feel. I was a clinician out in the public until just one year ago. During that time, I often felt that my hands were tied whenever I tried to go against the insurance companies or facilities to do what was best for my clients. Sometimes it was the general way everyone was put through treatment that didn’t seem fair for patients. Sometimes it was the length of stay that wasn’t right.

Here’s an example: if an insurance company decides that two weeks is enough time to treat my client, you can almost bet that two weeks is all the time the patient will get in treatment, even if as their clinician I know two weeks is not enough and they are going to relapse. Often times the treatment facility will not try to fight the insurance company because they’d be giving treatment that they wouldn’t be reimbursed for. It’s a combination of big insurance companies trying to make a profit and treatment facilities trying to make a profit, and often times the ones being forgotten are the patients themselves. Sometimes it’s also the clinician that is forgotten and with little pay, huge responsibilities, and feeling like they can’t go against the flow, it makes for a very difficult profession. Those that stick it out are usually the dedicated ones that really care about their clients. But I often felt unable to really help my clients because no one would listen to me, the one who best knew what the patient needed.

How did the world of substance abuse treatment get this way? It could be in the meager beginnings of treatment facilities when individuals, usually recovering addicts themselves, welcomed drug addicts into their small community and took care of them. There was no such thing as insurance coverage for drug treatment, or protocol for what types of treatment worked best. Now we have moved from humble beginnings to an entire industry, and the transition hasn’t always gone well. The industry is run by those trying to make a profit, and even if clinicians have a heart that really wants to help their patients, they face firing or an impossible amount of resistance if they speak up for their patient.

That’s why I’m glad there is Treatment Solutions Network, which has come up with a way to get beyond the different agendas of those involved. With knowledge about how much influence insurance companies really have, along with good relationships with treatment facilities that listen to what the patients need, TSN has been able to make huge strides in the effective treatment of substance addiction. Now I’m a clinical liaison and I help the clinicians get what’s best for their patients.

I think we now have a call to re-examine the way we’ve run the field of substance abuse treatment. People are different from each other and they need to be treated differently. There should be no set length of stay in a treatment center, or one program that is supposed to fit all. Police officers, firefighters, and corrections officers face their own set of troubles when dealing with addiction, and they need to be connected with treatment facilities that will give them the specialized treatment they need to get sober.

We need to get the word out there that many people are mistreated in the system, and by making sure everyone involved plays by the rules, we will be looking out for our patients that are so in need of help.

One of the main aspects to this specialized treatment is that it encompasses the entire healing process, from the individual first entering treatment, to one year post-treatment. With the POWER initiative, firefighters, police, and corrections officers can enter treatment with others in their line of work, receive specialized care and counseling that takes into account the type of work they do, and then also receive quality follow-up and assistance after treatment. In Steve Miranda’s words, POWER is there to get the “public safety officer back to being a productive employee and a good husband/wife or parent. POWER provides the treatment necessary for individuals to get to the root of the problem and to be healthy.”

Before POWER came along, no treatment facility could be found in the country that had a protocol for treating these public workers, or that tracked their progress through treatment. While public safety officers are regular people, there is a high standard of job performance they are held to everyday, and their line of work often exposes them to some of the worst things of this world. The trauma and accidents, the destruction by fire, and the worst criminals of the country make these people’s jobs very stressful much of the time, and that is something that makes it hard to carry out the job well. “Every day they are dealing with negative things; to do that you have to be healthy in mind, body, and spirit.” (Steve Miranda)

So the need for POWER was identified, and now there is a group of individuals working to see this initiative through and make it available to all public officers across the country. In a recent Chicago focus group, advocates for POWER met with Chicago public safety groups to share this initiative with them. Not only did the Chicago group learn about the program that can help their people through substance abuse treatment, but the POWER board also learned much from the focus group. They learned how different states can do things differently and how treatment programs are operated across the country. They also came away knowing more about what the officers of Chicago deal with, and how POWER can be developed to help their people as well. Suicide is a serious issue among Chicago public safety officers, and POWER can be made to help people with this issue and mental illness as well.

POWER is a work in progress every day. Those involved with POWER have been working hard to develop this program and work with treatment facilities, EAPs, and therapists that can play a role in making this available to all public officers. Soon, POWER will be a tool that all public safety officers can use to stay healthy so they can keep performing their jobs well.

It is not that there is not any help available for Public Safety Officers and substance abuse it is that the help which is available is not good enough. The tracks offered are often only a small portion of the overall treatment experience for the individual and there is no extended support during the time when the real recovery occurs, the period after treatment. Additionally the current models utilize nothing more than traditional twelve step models with no extra support for the unique challenges faced by Public Safety Officers.

Many of the existing programs have been a well intentioned start. After all evidence shows that the core principles involved in the twelve step process are the most effective tool for battling addition. However other more effective modalities are available and should be provided in conjunction with the twelve step process. These include Narrative Based Treatment, TIRT (Traumatic Incident Reduction therapy), and process oriented psychology. In short by changing the way we think, in the unconscious we can begin to live a serene drug free life.

We believe that these processes will work very well for Public Safety Officers. The evidence is overwhelming in the psychology community that these methods work for mental illness and stress management. There is no reason to believe that they won’t work just as well for addiction combined with the unique stresses and challenges faced by an addicted public safety officer. The fact that these therapeutic models are so process based is an excellent choice of treatment for public servants who are already used to regimented training and Standard Operating Procedures. It is almost as if we are creating a standard operating procedure for the life for these individuals.

Another problem which I have noted in my years as a counselor is the unwillingness to change for the average treatment center. It has more often than not felt to me that the treatment center was worried more about their bottom line, about streamlining their process to speed people into and out of their facility that the patient became bottom priority. This has created a culture of selling 12 step treatment, which not only being unethical is not necessary. Effective 12 step programs are available to everyone, for free in their own neighborhoods. All they have to do is show up at their local 12 step group.

In order to address the specific requirements of the Public safety Officer a protocol needs to be developed for them. In our focus group by meeting and conversing with public servants and their union leaders it has become abundantly clear that this type of specialized evidence based treatment is completely unavailable to them. At least not in a model which works, even so far as to say that the current available “tracks” which some centers offer are in fact detrimental to the public officers recovery.

This gives Treatment Solutions Network a unique opportunity. Since we work so closely with clients and the treatment centers, our goal is to develop a protocol which front line therapists can use in conjunction with their existing treatment to treat the Public Safety Officer during their entire treatment stay. The treatment center would be POWER certified, displaying that they have been trained and have put in place an entire program utilizing these more effective models to treat the different challenges facing Public Servants.

Then Treatment Solutions Network will continue to offer the client a program for at least one year afterward using POWER Meetings, technologies and continued therapies to guide the individual through the real recovery period, after they leave the treatment center. That is when you will find most relapse occurring, from the time treatment ends through the first year. This is when we will be providing the most specialized help to these individuals. They will be offered trauma therapy, continued narrative treatments in adjunct with their normal 12 step meetings.

This creates a cohesive, consistent therapeutic model for the individual. This is the most effective model available and is essential to the successful recovery of the client.

I am very excited to work with Treatment Solutions Network on the POWER Initiative and am encouraged at the positive feedback we are receiving from Public Servants in all arenas and during our Chicago Focus Group. I am looking forward to working with the business and union leaders as well as with the other therapists we have involved in this initiative to come up with the best possible process. It is an honor to help develop this Initiative which will allow me to give back to the men and women who have dedicated their lives to keeping us safe and happy behind the scenes.

When it comes to public safety officers, substance abuse often has deep connections with things like post traumatic stress disorder, and trauma that has been witnessed. The need is out there for public servants to receive more personalized help for these issues, and POWER is proving to be a successful way to give that help. “Sending someone to treatment is nice and good, but it needs to be more than that; POWER is a way to further guide and support them.  Getting sober is a struggle, and any advantage we can give our people will help them out” said Lt. Dan Ryan. It is important for public safety officers to know that they are not alone, that there are other officers going through just what they are going through, and that they can open up and get help for their addiction. Post treatment is also a big component to POWER, and it provides the officers with resources after treatment that help them stay sober. “We all like to talk to people that think and speak the same language” said Sgt. Herbert White, and that’s what POWER provides.

On May 27, 2009 this advisory board and other advocates of POWER met with a focus group made up of representatives from the Cook County Sheriff’s Department, Chicago Police Department, and Chicago Fire Department, as well as a representative from the Illinois State Department of Corrections. The Boston public officials were able to speak personally with their peers from Chicago and provide evidence that this program really does work. The public officers on the POWER advisory board have seen the progress it has made already. The main benefit that POWER gives is that it provides public safety officers with peer groups and resources to deal openly with their addiction. It is easier for someone to let their guard down when they are talking with people that have seen and experienced the same kinds of things. Both the POWER advisory board and the representatives from the Chicago departments were able to relate to that point well. They know that it is not every job that insists the employer jump out of bed in the middle of the night to deal with an emergency, or rush into a dangerous situation when everyone else is rushing out. These peers from different cities were given the chance at this focus group to talk in their own words about just how effective POWER is for their circles of people. “This was public safety folks talking to public safety folks, and the Chicago group was going on our word that POWER works” said Lt. William Ostiguy.

It seems that the common reaction at the focus group was an overall excitement for POWER. When we hear about something new, it is important to hear from those we trust that it is effective, and that’s just what the Chicago focus group did. These Chicago officials were able to ask questions of the advisory board and gain a new understanding about POWER. It is not necessary to spend years inventing a program when there is an effective program out there already. POWER is a program that can be taken to every fire, police, and sheriff’s department and be used to help public safety officers there. This peer-driven program is designed to help a group of people that “aren’t special, we’re just different” said Sgt. Herbert White.

Because of the networking that was done with the Chicago focus group, there is a positive future ahead for POWER. It is important for this initiative to not be forgotten and fall by the wayside, because it really works. The opportunity that exists through POWER for the Boston and now Chicago public safety departments is available to other cities as well, and with follow up and communication, advocates for POWER are looking toward a more positive future for public safety officers. They are expecting that POWER will infiltrate other cities as well because public safety officials want what’s best for their people.

It is with great pride that I am a part of this beginning, this new initiative intended to help my brothers and sisters recover better, faster and stronger than ever before.  I have seen over the years the dramatic effects that job stress and traumatic incidents can have on our Public Safety Officers. In my experience serving with Lt. William Ostiguy as a Critical Incident Stress Management Team for the IAFF in the six weeks following the terrible events of 9-11-2001, and also the tragic Station Nightclub fire in Providence Rhode Island I know that the POWER Initiative and all of the effort which is being put into it will only help us to better serve those who need it.

Additionally my experience in creating the EAP program for the Providence Fire Department gives me unique insights into how to effectively navigate the personalities and the politics of Unions and Public Service Organizations. It is their responsibility to protect their members, therefore it is mine as well.

That is why the POWER Initiative and the way in which we are going about utilizing evidence based treatment models such as Narrative Therapies, TIRT and the fundamentals of already successful recovery techniques such as 12 step work to improve the existing system available to these individuals is so important. These men and women of the front line have different experiences when they find themselves facing substance abuse and addiction. Our jobs carry high stress levels and expectations and when we become weak it is that much harder for us to ask for help. We are the ones who people depend on, and when we need a shoulder to lean on we are the last ones to admit it.

When a public service man or woman does reach out and ask for help I believe that it is part of our duty as fellow citizens to offer them the best treatment model available to them – It may be our only opportunity to save them. This specialized treatment unfortunately, does not currently exist.

But it can and will. It’s not difficult to reach these individuals once they ask for help. You see an advantage to being a trained public servant is that you are very process oriented. Everything has a Standard Operating procedure in your job, and what we are accomplishing in the early stages of the POWER Initiative is to create a Standard Operating Procedure for Life, one that retrains and empowers the individual and their family to recover. On the same hand this procedural method uses techniques which are proven to work, techniques which attack addiction, PTSD, Trauma and grief from their roots.

I am proud to be able to bring together the best and the brightest minds toward this initiative. We have people in the public service arena, the therapeutic world and top notch business people all working together to develop a working model which addresses this gap in service. This Initiative is desperately needed, the time is now.

First let me explain a little about what POWER means to us not only as a company but the larger purpose that it serves within the substance abuse treatment industry. From its conception Treatment Solutions Network has been closely linked with the organized labor associations of Public Safety Officers. Our foundation clients are EAPs in many of the northeast’s largest public safety organizations. We work side by side with representatives from the Providence Fire Department, Boston fire and Boston Police. We provide addiction and mental health treatment to their members on a referral basis.

Through these relationships we were able to bring on Michael Blackburn a 30 year veteran of the Providence Fire department and member of the International Association of Fire Fighters to oversee our interactions with public safety unions and organizations. Over the past several years we have placed dozens of police, fire, corrections and other first responders into mental health and addiction treatment facilities which they desperately needed. This in conjunction with the feedback which we receive from our program’s alumni and their EAP or MAP representatives have shown that people leave our facilities ready to lead happy and productive lives.

However we all think that we can do better in serving the different needs which are unique to individuals in the public service field. Sure we have been successful in treating the addiction and mental health of these individuals but a greater need exists. Addiction among public servants is often tied to aspects such as PTSD, Depression, Guilt and dramatic falls from grace. These unique situations need to be approached not only from the time they are actively in a treatment center but beyond.

This created the vision of the POWER initiative. A vision which saw a mental health and addiction program specifically tailored to the needs of Police, Fire, Corrections, EMTS and others in the front lines of public service, a mission to serve them as they have served us so courageously.

So the Initiative was conceived, founded by Lt. William Ostiguy of the Boston Fire Department, Lt. Daniel Ryan of the Suffolk County Sherriff’s Department, Steve Miranda of the Massachusetts Department of Corrections, Michael Blackburn Retired Lt. Providence Fire and Vice President of Treatment Solutions Network, Juan Lesende Clinical Director Treatment Solutions Network and James Bevell, CEO of Treatment Solutions Network. From this experienced group the advisory board was created. Lt. William Ostiguy, Lt. Daniel Ryan and Sgt Herbert White of the Boston Fire Department make up the board. We were extremely pleased at the acceptance of Board Chairman by one of the most experienced individuals in this group, Lt. William Ostiguy.

In order to ensure that our efforts are pointed in the right direction we recently had our first focus group, on May 27^th in Chicago, Illinois. The meeting was well attended by Chicago Police, Chicago Fire, and Illinois Corrections Officers as well as their union representatives. Additionally all of the POWER Initiative founders attended. We are extremely energized by the wide attendance. The focus group members helped confirm that there is a strong desire within the culture of Public Safety Officers to have their unique treatment needs addressed. Through these interactions with the group we determined that a long term support network will be implemented. This aftercare will include specific evidence based treatments applied when they first walk through the doors of the treatment centers all the way through at least one year post discharge. My colleagues will discuss the specifics of what types of models and treatments will be used in their posts.

Public safety officers are a rare breed, they are the type of people who will run into a burning building or a crime scene while everyone else is running out. This Initiative is created to honor them, support them and help rebuild them as men and women of courage, bravery and honor. As Sgt. White says, “It’s not that the public safety officers are special, it’s just that they are different.” And our aim with the POWER Initiative is to address those different needs effectively.

The first, and second, parts of the above definition are about abstinence. The other three parts describe attributes. The person that displays these attributes is Sober, not just abstinent from chemicals, not just clean. His, or her, Sobriety is manifested in “all their affairs:”This person practices Sobriety, with a capital S.

This Sobriety with a capital S is manifested in the way people live their lives, not in what they say. Sobriety is life lived in the pursuit of simplicity, and “serenity;” a way of life that avoids “excess.” For excess is the way of addiction. Addiction is excess in everything. Excess in using chemicals, and in exaggerated thinking, and behaving. The addict is addicted to extremes, and drama, as much as he, or she, is addicted to a chemical. To incorporate the above described attributes into a Sober character is the antidote for addiction. And, the acquisition of this character is the foundation of recovery. As well as, the goal of any program, or therapy, that seeks to treat addiction.

To counter the addicted character, an addict must be confronted with a person that has developed a Sober character. A person that is capable of modeling what this character is. That is capable of displaying it in daily living. Capable of showing the addict how life can be lived Sober. Modeling for the addict new ways of dealing with the challenges of life from a Sober perspective.

Then, by observation, and practice, an addict begins to substitute old patterns of thinking, and behavior. Through exposure to a Sober character, they can begin to live “as if” they had this character. By ‘faking it, till they make it,” they get a sense of what Sober life is. When their new behaviors begin to yield responses that reinforce them, they become incorporated into a new pattern of dealing with life. Through this process, a new character is formed.

In the process of this new character formation, the presence of a Sober sponsor, mentor, or therapist is fundamental; the presence of a person that personifies Sobriety. If the sponsor, mentor, or therapist has not internalized, and manifest the attributes of Sobriety, all that the addict is exposed to is another role to play: The role of “recovering person.” Because addicts are adept at role playing, the modeling of a person who is clean, but not truly Sober, will invite the addict to create yet another persona, or mask. Recovery becomes a new way to act, speak, and relate to others, without true change, without authenticity.

Many in the recovering world have adopted the persona of a recovering addict. A person can become “clean,” if this is the price that he, or she, pays for sustaining new friendships, lovers, work, or status. For, they now belong to a community where respect, admiration, business opportunities, and popularity are founded on “clean time.” However; such a person is clean, not Sober. This kind of recovery is dangerous. It is dangerous to those who practice it, and for those who are seeking recovery.

A person with “clean time,” regardless of character development, is in a position to be a sponsor, a therapist, or even to run a treatment center. They can be in a position to dictate the process of addiction treatment. They can place themselves in a position of authority. They can be in a position of power. They can be in a position to do harm.

For, without the grounding influence of a Sober character, power, money, and status, become tools of the ego. They become tools for exploitation. They become means that allow the clean, but non-Sober addict to indulge in their addictive character traits. Under the guise of recovery, and “helping,” a clean, but non-Sober person can indulge in drama, chaos, blaming, and self-righteousness. They can exercise control over the lives of others, for self-gratification. They continue to act from the basis of their “defects of character,” even if they are not using chemicals. They harm themselves, and others.

The goal of the 12 Step programs, therapy, and all interventions of addiction treatment, is to “remove” these “defects of character;” not to find a new way to manifest them under the disguise of being “clean.” According to the founders of the 12 Step programs, in order to remove these defects of character, a person must engage in a spiritual path, seek a “spiritual solution.” A spiritual solution that is ancient, and Universal. A spiritual solution that has been taught by every spiritual master in history. This solution is to become free from the “bondage of self.”

What is this “bondage of self?” It is the bondage of a flawed self that the addict has constructed through the process of his, or, her life. Once this self became chronic, the addict constructed a character to protect it, to defend it. But, this self, and character are false. They were constructed as protections, and maladaptive strategies for survival. They cover up the true Self: the Self that was created by a Higher Power. So, every true spiritual path seeks the return to this true Self. Every true spiritual path offers a way, a method, and a program, to return to true living; to return to living life on “life’s terms,” to live Sober.

For, in Sobriety, life is again experienced, as it is. When the false self no longer rules a person, its demands for power, money, status, reputation, excess, drama, etc. no longer rule that person’s thoughts and actions. As a result, the person becomes free. The person is free to enjoy simplicity. Free to recognize the mystical of the everyday. And, through this recognition, a free person can find joy, pleasure, contentment, and fulfillment in the ordinary. They can again embrace life with the joy of a child at play, not because everything is perfect, but because it is all part of life; and life is good enough in its own terms. This is spiritual living. This is Sobriety.

This Sobriety is hard to attain. It is not easy to live Soberly in a culture that is increasingly hysterical. In a culture that prizes image above substance. We live in a culture of hysterical “personalities.” A culture of dramatic, “reality” television shows, screeching religious leaders, flashy gurus, “spiritual guides,” and shocking, instantaneous, psychotherapies. It is not surprising that the development of a Sober character is not a modern, or popular quest. However; for a recovering addict it is the essential quest. Just as it was for the suffering addicts that found their salvation in it, and prescribed it to future generations; as all spiritual seekers before them had done. In order for many to stay clean, many have to become Sober.

J. E. Lesende

The alarm comes in. Rescue, engine, and ladder trucks go out. Several hours later four eight, or even 12 firefighters are left with possible symptoms of adrenaline overload, horrific visions of burned or mutilated bodies, the sound of a gunshot victim gasping for breath, the guilt of not being able to save an infant, and/or feelings of not having done enough.

Twenty years ago, these firefighters would have been left to their own devices to ease their pain, Often, the local bar was the place to “debrief” Unfortunately, that kind of  self-soothing often led to alcohol or drug addiction, marital problems, financial problems, and other concerns.

Today, firefighters in Local 799 in Providence, R.I., Can get help from the critical Incident Stress Team, which includes members of the fire departments EAP as well as CIS professionals. Team members stand ready to debrief firefighters within hours of the fire. If further assistance is requested, referrals are: made to qualified professionals who understand problems unique to the fire fighting profession.

EAP staff have received advanced training in CIS using the so-called” Mitchell Model,” and we are extremely proud of the CIS component of our EAP. Through the Rhode Island Chapter of Labor Assistance Professionals we extend our services to any local in need of them.

That said, it is important to note that the core services of Local 799’s EAP are (and always have been) alcohol and drug addiction treatment and recovery. Local members know that if they call for help for treating addiction a firefighter in recovery will come to their rescue. After  first making a “reservation.” for the addict, the firefighter will personally pick up the person and take him or her to the treatment facility. The firefighter will reassure the addict’s family members and check on the person periodically while he or she is “away,” The firefighter also handles the addict’s absence from work and is available to him or her (and family members) 24 hours a day, Seven days a week.

In short, the firefighter makes it possible for the addict to focus on treatment, that is the essence of Local 799’s EAP – family taking care of family. But with the onset of managed care, the Drug-Free Workplace Act, and Department of Transportation regulations, our EAP has had to evolve. As a result, most EAP staff have completed the required coursework at the University of Rhode Island’s certification program for drug and alcohol counseling, Some of us also have had SASSI and ASAM training as well as workshops and courses on ethics, crisis intervention with drug abusers, the12 tore functions of the substance abuse counselor, and HIV/AIDS.

Because 30-day treatment stays are no longer the norm, we as EAP Professionals have had to become better educated to create a level playing field with Managed Care, Our team members can now speak the same language as the “gatekeepers”-DSM-IV presenting problems, dual diagnoses, and so on-and thus can help ensure that our brothers and sisters get the treatment, to which they are entitled.

Firelighters and their families experience personal problems common to all walks of life. With its broad-brush approach, Our EAP addresses issues related not only to alcohol and drug dependency but also to family life, personal finances, gambling, workplace stress, and other concerns. Offering these types of assistance necessitated the development of a referral list of reputable professionals-psychologists, psychiatrists, social workers,etc. ,- willing and able to respond quickly to our members needs.

We at local 799 were at the forefront in Rhode Island in forming our Labor Assistance Professionals chapter. Through our chapter, we have developed excellent working relationships with several treatment facilities, we’ve established a network of providers that understand issues and problems that are unique not only to firefighting but to organized labor as well.

Following the lead of the New York and Boston LAP chapters, we have forged a bond with Brown University and the University of Rhode Island to assist our chapter with continuing education Some  of the therapists, doctors, and treatment facilities we use offer seminars to our chapter members. Providence Fire Department EAP professionals regularly attend these seminars and are active in the EAPA Massachusetts Chapter.

The Providence Fire Department and Local 799 realize that their most important resources are their members. The chief of the department, James Rattigan, and the president of local 799, George Farrell, arc both very supportive of the EAP. We have language in our collective bargaining agreement identifying stress as a line of-duty injury and contractual provisions that provide time off for EAP staff to attend professional conferences and seminars.

Our EAP was designed to provide union members, retirees, family members, and widows with dignified, confidential,  and professional assistance without  jeopardizing job security or promotional opportunities. That is still our mission today. Our team is available 24 hours a day, seven days a week for immediate, personal responses.