Addiction & Treatment
1992 Redefining Rehab: Building the Correct Retreat Environment
The Industry should not dicatate what people need.
The drug and alcohol rehabilitation industry was and still is characterized by the arrogant stance that if drug and alcohol users want to get well, they should be forced to accept whatever the market had to offer and whatever clients (patients) could afford. The market spans a wide variety of choices ranging from dilapidated downtown buildings with barrack type sleeping quarters to opulent mansions offering private suites on beach front property. According to BRI research throughout its history, the "flop-house" type facilities attracted mostly Medicaid and Medicare types, while the opulent mansions on the coasts attracted the rich, by charging $80,000 or more. The middle market facilities, which make up perhaps 60% of the market, set their rates according to what insurance companies pay for in-residence treatment, regardless of the condition and makeup of the facilities and programs. It was this environment that BRI set out to change.
During our studies, from 1992 through and including 2004, significant changes occurred with respect to the social environment offered to the program guests. For example, in 1992 the first retreat house, what would become Twin Rivers Retreat) in Hagaman, New York was set up with multiple-occupancy sleeping quarters. It was thought that imposing a physical structure that forced constant social interactions protected guests from isolating themselves from the social experience of the social/educational program. As time went on the researchers attributed some of the success to this forced social arrangement, but there was really no hard evidence that "forced" social interaction was a contributing factor to the high success rate.
In May of 2004 Baldwin Research Institute opened a second retreat house in a rundown 19th Century Adirondack Mountain Hotel. This new facility would challenge the multiple room occupancy theory. The hotel rooms were small, allowing for only semi-private rooms. But even the two occupancy rooms were often single occupancy, in that, during times of low census many of the two occupancy rooms had only one guest occupying the room.
Over time there was no evidence that multiple occupancy rooms versus semi-private rooms versus single occupancy rooms had any effect on abstinence rate. There was, however, a financial consideration. In October 2008 a third retreat facility, the Saint Jude Executive Retreat, was opened in the Town of Florida, New York. This retreat addressed the high end market and fulfilled the need for a highly secured facility. It only accommodates 6 guests at a time, in private and semi-private rooms, some with private baths.
The point of this discussion is not to report on the efficacy for these different facilities but to understand the limitations of value versus cost of delivery. It is imperative to note that all three facilities provide the exact same program. Currently, the staff at all three facilities are presenting our program as defined in The Saint Jude Program, The Definitive Guide to Self-Directed Neuroplastic Change, 13th EDITION, copyright 2014. And, like the release of the 13th Edition to the retreat facilities, all previous editions were released to the three retreat facilities, simultaneously. Thus, studying the abstinence rates of the individual retreats did not detract from the study being conducted to understand the efficacy of the "program." That being said, a cursory look at abstinence rates of the various facilities revealed no meaningful variations in the data. The minor variations observed from facility to facility were definitively not the effects of the facilities, but rather effects most probably resulting from the demographics of the attendees or the staff's experience at the time or operational effectiveness such as food service selections, scheduling, outbound planning, and the like, e.g. the Executive Retreat guests have a significantly higher income level compared to the Twin Rivers Retreat. But again, the purpose of our studies has not been to identify sub-cultures among the total population, rather it is to understand the efficacy of the program across the entire population.
Thus, the question of value versus cost of delivery is significant not to the program itself, but to the guests attending the program. In this case the value referred to is not the quality of services being offered because the same services are provided at all facilities. Rather, the value is a function of accommodations. That being said, there is no indication that the additional accommodations have any effect on the abstinence rate. This puts to rest the notion that the more accommodations available to rehabilitation clients, the greater the probability is that the program they are attending will work. It also puts to rest the idea that the more one pays for treatment, the greater the probability for abstinence. According to BRI's observational studies, external conditions have virtually nothing to do with whether a person stops using substances or continues to use substances.
BRI's observational studies and subsequent longevity studies produced no evidence that swimming pools, hot tubs, massages and the like stop people from using substances. So, what was BRI's motivation for offering an Executive Retreat? All of BRI's research was not confined to the St. Jude Program. Much consideration was given to the environment in which the St. Jude Program was presented. For example, the Twin Rivers Retreat facility has gone through four major renovations and additions since 1992 and at this writing is undergoing its fifth and, hopefully, final renovation. The Mountain Retreat has undergone three major renovations. The reasons are primarily two. First, to create facilities that are comfortable and home-like. Second, the more attractive BRI made its facilities, the higher the likelihood that people would want to come for the program. This certainly was not rocket science, but the multiple redesigns and renovations were driven by the need to create an environment that offered a home-like comfort while preserving the historical ambiance of an 1800s Victorian Mansion and an 1800s Adirondack Mountain Hotel. The need to create an upscale setting within each of the retreat houses was not an effort to increase the abstinence rate of the guests, but was researched and developed to enhance the comfort of guests and to support the marketing efforts of the company. That is, the more appealing the facilities became, the more potential guests were attracted by the physical features of the facilities.
The researchers became aware that there was a population that was not being served by the first two facilities, so in 2008 Baldwin Research opened the Executive Retreat to address the special requirements of this population. Both of the existing facilities at the time were in small village settings. Guests are free to walk, jog or bicycle around the villages and avail themselves to the local culture, including trips to the friendly corner stores. For most people these freedoms are pleasurable. However, there is a group of potential guests that would find such freedoms unappealing. Consider well known athletes, police officers, corporate executives, entertainment personalities, judges, well known attorneys and physicians, politicians and many more who may well lose their life's work should they be recognized while attending a program for drug and alcohol use. The Executive Retreat offers private rooms with private baths, whereas the other facilities have shared bathrooms. It also features a large in-ground swimming pool, a hot tub complex, a sauna, changing room with shower and a massage facility staffed with a NYS Licensed Massage Therapist. These accommodations are not available at the other facilities. Further, the Executive Retreat is secluded on 80 acres for the protection (privacy) of high-profile guests. The cost of delivery of these accommodations is significantly higher than the accommodations provided at the other facilities. The additional costs are passed on to the guests based on guests' personal choice to pay more for the additional accommodations.
The Executive Retreat is located in a remote rural setting on 80 acres with no immediate neighbors. There are no signs on the property. It is just another rural home on a "farm to market" road offering total privacy.