Total transformation: Phoenix House will dramatically move beyond TC roots

One of the country's most prominent nonprofit addiction treatment organizations soon will unveil the first physical manifestation of a radical clinical transformation. Phoenix House, perhaps the most cited example of the therapeutic community (TC) model of treatment, is overhauling its facilities and broadening its treatment approach, beginning this summer at its Brooklyn center.

In an interview this week with Addiction Professional, Phoenix House's chief clinical officer explained that both industry changes and a shifting patient demographic have contributed to the need for what he calls a “pivot” in the organization. Benjamin Nordstrom, MD, PhD, explains that Phoenix House can ill afford to focus only on its traditional residential treatment population when payers expect a full continuum of care and the opioid crisis demands broader treatment options, including medications for dependence.

“As we move away from a TC-only model, we have taken a motivation- and strengths-based approach to these disorders,” says Nordstrom, a former faculty member at the Dartmouth and University of Pennsylvania medical schools. “We're talking about patient motivation for recovery, defined holistically. … It's better to talk to people about what they can do, instead of focusing on deficits.”

The transformation is occurring not only clinically but also with the physical plant at Phoenix House treatment centers, beginning with a Brooklyn center that in recent months wound down daily operations as it underwent a complete renovation.

“It was more than down to the studs,” Nordstrom says. “We tore the studs down too.”

Changed landscape

Phoenix House traditionally has relied largely on state-funded contracts to treat core populations that include criminal offenders, but contract arrangements have become scarce as states have shifted their addiction treatment funding toward Medicaid and commercial insurance. This has required the organization to think beyond the segment of the population for which the TC model was ideal.

“The TC was more for habilitation than rehabilitation, for individuals with core deficiencies in life skills,” Nordstrom says. “With the current opioid crisis, we're reminded of the basic truth that addiction does not make socioeconomic distinctions.”

This is not to say, however, that Phoenix House is repudiating the TC model, Nordstrom explains. The organization will continue to operate legacy TC programs in communities where those contracts remain in place. But at the same time, it will be establishing more comprehensive care centers that will be branded as Phoenix Life Centers, starting at its Brooklyn and Queens locations this summer and moving across the country. Phoenix House has invested more than $10 million for the Brooklyn and Queens site renovations, with financing from a Phoenix House Foundation donation and proceeds from sales of other facilities.

Expanding from its roots as a residential treatment organization, “Where we're moving with Phoenix Life Centers is to have full-continuum campuses, or at least a network in every area,” Nordstrom says.

The organization will retain components of its traditional approach, including nurturing peer support as a critical component of recovery. But the establishment of a full continuum of care at its sites will require a broadening of treatment options, including the use of medication treatments for opioid dependence.

Nordstrom, who served on the American Society of Addiction Medicine's (ASAM's) consensus panel on medication-assisted treatment for opioid use disorders, says the Phoenix Life Centers will offer both buprenorphine and injectable naltrexone. While the organization is not pursuing opioid treatment program (OTP) licenses to offer methadone, it will work with patients who are stabilized on the medication.

Nordstrom has been with Phoenix House for around two years, and says the groundwork for this transformation was laid a few years before that under his predecessor. “By the time I stepped in, everyone pretty much had been convinced,” he says.

“Our board has responded positively,” he adds. “Our clinical teams have taken to this with a passion that is commendable and gratifying to see.” He believes industry reaction also will be positive, even as this represents a major shift for an organization that has been so tied to the residential TC model.

“Everyone realizes the future is rushing at us,” Nordstrom says. If the organization opted only to continue to serve its traditional population, “We would have to shrink to a position no one wanted to see,” he says. “I don't think 'retreat' was on anyone's mind.”

New components

According to Phoenix House, the new Phoenix Life Centers-Riverwalk in Brooklyn will be the first New York City treatment facility to offer all levels of substance use care under one roof. A communication to Addiction Professional states, “With a withdrawal management unit and 120 beds, this new state-of-the-art center will reimagine and modernize drug and alcohol addiction treatment.”

Nordstrom adds that the shift in the organization is creating several new points of emphasis. In order to meet the requirements of commercial insurers, for example, Phoenix House has prioritized bringing on more licensed professionals, he says.

In addition, recent moves such as the appointment of Stanford University School of Medicine psychiatry professor Mark McGovern to its board reflects the organization's emphasis on improving its metrics for evaluating patient outcomes. “This will be a huge part of our business going forward,” Nordstrom says.