`Techs` often the lifeblood of addiction treatment

In addiction treatment, staff members referred to as “techs” typically are defined by who they are and who they are not. Techs are not counselors. But they are the people who generally spend the greatest amount of time with patients in residential treatment programs, ensuring the logistics of treatment go smoothly.

Because of that close contact, they become the “heart and soul” of treatment, says Bob Ferguson, founder and CEO of the Colorado-based men’s treatment facility Jaywalker Lodge. Thomas McDermitt, senior director of clinical administration at Caron Treatment Centers, calls techs the “heartbeat” of the program. And Deni Carise, PhD, chief clinical officer of Recovery Centers of America (RCA), calls them “leaders.”

All three administrators say that without techs, there would be no treatment.

Empathy and professionalism

Out of 46 employees at Jaywalker Lodge, 21 are techs, which shows the level of importance they play in the program. The actual job of techs mainly involves day-to-day logistics, says Ferguson. For example, Jaywalker’s techs make sure patients are following their daily schedules.

But they also serve important roles in the early stages of treatment. For example, they might pick up newly arriving patients at the Denver airport, which is four hours away from campus. Some patients might be shaken when they arrive, says Ferguson, so the techs must step into a role that is far beyond just a transportation driver.

“You need a certain amount of intuitive empathy, of thinking on your feet to make sure every client arrives under the safest and best possible condition,” Ferguson says. “You don’t get two chances at a first impression. When you’re met at the airport and you’re filled with the anxiety of the fear of the unknown, it’s important that you are taken care of in a way that makes you feel comfortable.”

The techs also might need to stop by the local detox in Denver with a patient to have a blood alcohol test administered, for example, instead of going to directly to Jaywalker. But almost all of the techs at Jaywalker are former patients, says Ferguson, so many are familiar with the comprehensiveness of the recovery process and can offer empathy. While no rule requires that techs be in recovery, it is a trend among treatment centers.

Because techs rotate on site 24 hours a day, they also have a responsibility for contributing to security. Techs might be called on to handle de-escalation incidents that require more than direct clinical care. They are responsible for adherence to policies about self-harm and suicide and how to respond should something go wrong on an experiential activity.

“Our three largest buildings are located in downtown Carbondale,” in an open-community model, says Ferguson. “With this model of care comes responsibility on the part of the tech staff.”

Model of recovery

Techs also act as role models for a life of recovery.

“We function in a way that honors and respects the individual, but puts the health of the community first,” says Ferguson.

Instead of the self-centered, self-destructive, isolating behavior of addiction, techs live “structured consciousness,” he says. The simple act of getting up in the morning may be new to someone who has been addicted for some time. “No good sober day starts at 11:30 in the morning,” says Ferguson. “You have to get up, make your bed and clean up your room, not because it’s a moral virtue, but because it’s about other people—not just you.”

The positive attitude is conveyed as part of “milieu management,” not enforcement of rules.

“If you create a police state with consequences and penalties, you don’t get the benefits,” says Ferguson. “The techs are the ones modeling healthy recovery.”

He adds that techs see a lot of things that the counselors don’t, which could be helpful to the facility in enhancing recovery and building rapport with patients.

“Recovery doesn’t keep bankers’ hours,” he says. “It happens at night, it happens when guys come back from a meeting, it happens when they get a call from a girlfriend and they’re heartbroken, it happens on weekends when counselors aren’t around.”

Conflict at the community level

The close, comfortable relationship comes with cautions, however. Some patients leave treatment and stay within the local area to pursue a sober lifestyle near the place where they got well and to remain involved in alumni activity, says Ferguson, adding that there are 140 locally based alumni from Jaywalker who interact with the program on a weekly basis. There are 100 meetings a week near the facility.

However, patients and techs might run into each other around town. Good treatment programs should have strict policies on outside relationships and even on the extent to which techs can be “friends” on social media with current or former patients.

At Jaywalker, the average age of the patients is just over 24. “They don’t have a wife and two kids patiently waiting for them to return home,” says Ferguson. “They’ve achieved 90 days of sobriety for the first time, and they want to stick around.”

Counselor assistants

At Wernersville, Pa.-based Caron Treatment Centers, techs are referred to as “counselor assistants” (CAs). Caron has different units—adolescent, young adult, adult and senior—with different staffing patterns. Adolescent units have a higher tech-to-patient ratio than other units. The CAs help patients arrive at scheduled activities on time, are with them if they wake up in the middle of the night, and can be available to just sit down and listen to them, explains McDermitt.

The 21-bed unit for adolescent boys has two CAs on the first shift, three on the second, and two on the third. The night shift is “usually pretty quiet,” McDermitt says, but if something happens, the CA is there to help. Each CA prepares a detailed report on his or her shift for reference.

“Let’s say an adolescent girl goes to the CA and says she just cut, or she feels like cutting,” says McDermitt. If this happens after hours, the CA will take the patient to the detox unit, where a nurse will do an assessment. “The nurse on duty might keep her in detox for the night,” says McDermitt. In the morning, clinical and psychology staff would take over.

Caron patients fill out satisfaction surveys, and CA staff consistently are mentioned the most, says McDermitt. Patients say, “If it weren’t for so-and-so, I probably wouldn’t have stayed in treatment,” he says.

Caron is in the process of building a new detox unit and will house CAs there as well. McDermitt himself started as a CA at Caron 12 years ago.

The tech role can serve as a stepping stone for employees who want to become counselors in the future. They can use their tech hours as experience, and go to school when they are not at work.

Training for the role

RCA’s chief clinical officer, Carise, started her career as a tech in 1987 at the Horsham Clinic in Ambler, Pa., and she recalls that it was one of her favorite jobs. RCA techs are called “recovery support specialists.” And for many, their role could be a first step in a career path.

“They get more experience, and we encourage them to attend school,” says Carise.

There needs to be a strong in-house training program at the treatment facility as well, so that the recovery support specialists aren’t blindsided by things they haven’t experienced. Brad Greenstein, CEO of the RCA Danvers facility scheduled to open in Massachusetts in September, says de-escalation constitutes an important focus in training.

“They learn how to competently de-escalate a client who is experiencing a high amount of emotion,” Greenstein says. “It could be someone who is threatening, who could be dangerous.”

Other aspects of recovery support specialist training include general treatment practices and philosophies, education on the American Society of Addiction Medicine (ASAM) levels of care, the goals of treatment, ethics and boundaries.

Carise says the techs don’t get into long discussions about recovery. Rather, they help patients stay engaged in treatment.

“They have incredible strength,” she says. This kind of engagement is particularly important in early treatment, when patients ask, “‘Why can’t I just go home and go to meetings?’”

RCA also is using recovery support specialists to present educational seminars to certain groups of patients, says Carise. Topics can range from leadership to dealing with anger, drug refusal skills and more.

Additionally, in the transition from patient to tech, a recovery support specialist must be open to all kinds of treatment. “A lot of people in recovery have recovery biases, and they need to expand their appreciation of other models,” says Carise. “Faith-based, medication-assisted treatment, SMART Recovery—all different approaches—need to be respected.”