Volunteer work for patients: It`s fashionable again

There was a time—the very brief time that marked the heyday of the rehab center in the 1970s—when service work, or volunteering, was considered an essential, therapeutic part of treatment for substance use disorders. Several studies on the value of volunteering were conducted and published. But, as addiction researcher and historian William White tells Addiction Professional, “The use of volunteers was phased out as part of the professionalization of addiction treatment in the 1980s and 1990s.”

Now, volunteering is coming back. The reason, say many treatment providers: It works.

“Our programs use service both with residential clients and alums to promote recovery,” says David Sack, MD, chief medical officer at Elements Behavioral Health. Sack recommended that we talk to Patricia Meyers, executive director of alumni and client services at Promises Treatment Centers in Malibu, Calif., who he says “has kicked this up to an entirely higher level.”

Says Meyers, who has been in recovery for 21 years, “It’s about the effect of altruism and empathy on decreasing impulsivity.”

At Promises, as soon as a patient in residential treatment is medically cleared, “We start talking to them about their participation in service,” says Meyers. Promises partnered with Heal the Bay, an organization based in Santa Monica, to have patients help “adopt a beach” by keeping it clean. “It’s part of our core philosophy in terms of giving back to the community,” Meyers says.

But for such service work to have an effect, staff “from the top down” need to embrace the idea, she says. “If I didn’t have the team talking to the clients about this, about this is who we are and what we do, the clients wouldn’t do it,” she says.

Many Promises patients are well-to-do people who have not done volunteer work before. As one said to Meyers recently, “'What am I, in jail? I’m not going to go out and clean the beach.’”

Meyers, who has been at Promises for years, recalls that “back in the day, all the clients had chores. It wasn’t even a consideration that you would say no.” She adds, “It took me a while to get everyone on the same page.”

When Addiction Professional spoke to Meyers in the spring, she was getting ready for the yearly “hunger walk,” in which patients and alumnae walk to raise money for a food bank.

Helping low-income patients

Promises also started a foundation—not owned by Promises anymore but still connected to the organization—that runs the Miriam’s House program for low-income women to stay together with their children while in treatment. Current Promises patients, and alumnae, help provide child care at the house when the mothers are in 12-Step meetings, Meyers says. Current Promises patients have to have been in treatment at least 30 days before they can volunteer for this work, which is first feared and then coveted by patients.

“The nature of the disease of addiction is self-centered,” says Meyers. “My whole thing is to get people to stop thinking about themselves the whole time.”

Bringing these patients from the high-end Promises campus to Miriam’s House does that. “These women have nothing,” Meyers says of the Miriam’s House residents. “It is profound what happens—Promises clients would never have met women like this in their lives.”

Some patients and alumnae don’t do any volunteer work. “They write a check,” says Meyers. “The problem is, people are more and more removed from having high-touch relationships.” While donations are always helpful to treatment programs, giving of oneself is more meaningful in terms of recovery, Meyers suggests.

Keeping it optional

At Jaywalker Lodge, a men’s-only residential program in Carbondale, Colo., volunteering is indeed voluntary—but everyone wants to do it as a result. “We’ve always had a very robust volunteer program,” says founder Bob Ferguson.

All of the service programs are optional, so no one is forced to participate, says Ferguson. But that hasn’t always been the case. “I’m old school—everybody on the bus,” he says. “But we learned over time that if we just put up a sign-up sheet, and gave the guys a choice, then everybody would sign up.”

If volunteering is required, it “feels punitive,” says Ferguson. “It’s ironic,” he says. “Our guys volunteer to put on an orange vest and clean up the highway, because they want to. There are people in the corrections system who have that as a punishment.”

Jaywalker is located in a town, a small mountain community. “We’re not a secluded sanctuary in the hills,” says Ferguson. “This makes integration with the local community natural and necessary.”

Jaywalker also conducts a weeklong trip to the Pine Ridge Lakota Native American reservation in South Dakota, offering it three times a year. An 18-hour drive, the trip is an “educational and cultural immersion” opportunity, Ferguson says. No one is forced to go. There are eight patients, two staff members and two alumni. This is done with patients who are out of their first 90 days of active treatment and are in the transitional phase, working or going to college part-time but still residing in the area.

At Pine Ridge, the patients work with a volunteer organization called Remember, living in a bunk house with gender-separate sleeping rooms and a large dining room. “Our men are integrated with church groups and graduate students from around the country,” says Ferguson. “They work very hard during the day, getting handicapped ramps on trailers, doing winter insulation, building bunk beds. At night, a speaker from the reservation comes and talks to them.”

There are also volunteer opportunities back home in the Carbondale area. For example, 10 men sign up to feed the homeless in Glenwood Springs, about 20 minutes away. “The chef helps them cook up a gigantic meal,” says Ferguson.

He thinks the reason why the sign-up sheets for volunteer activities are always full is threefold. “It’s an honor, it’s a recreational activity, and it’s led by our alumni,” he says.

Millennials give back

Another reason the sign-up sheets are full is that the patients are millennials. Stereotypes conveying that millennials are selfish and wouldn’t begin to know how to give back are wrong, says Ferguson.

“Millennials are tired of screwing up,” he says. “They’re passionate about things like taking care of the planet. They get a bad rap for being self-centered, when what they really want to do is make a commitment.”

At the annual American Renewable Energy Institute conference held in Aspen in June, Jaywalker patients host ticket booths, manage commingled recyclables, and more. “We’re not experts but we get to hang around it, we get to be a part of it,” says Ferguson.

“Many of us started using drugs and alcohol because we felt uncomfortable in social settings, and the chemicals made us comfortable in our own skin and made us fit in,” says Ferguson, who is in long-term recovery. “The problem with addiction is it ends up making your world very small, and you become extremely isolated. The stereotype about millennials is they crave independence, but at this point of their addiction, what they want more than anything is belonging, other men to be friends with. These are ways to join and fit into the group.”

Opportunities in the facility

Even the idea that patients need to do chores while in treatment started to fall by the wayside, but is now coming back. Since its inception 12 years ago, Jaywalker has always had “therapeutic duty assignments,” says Ferguson. There are two elements: keeping the bedroom tidy and doing dishes.

“There’s a checklist for what your room needs to look like in the morning before you leave it,” he says. “Pull the duvet cover over your bed and get your stuff off the floor. It’s not a high standard, but it’s one that emphasizes that you’re now in a community It’s a way of getting out of yourself and paying respect to the idea of tidiness and hygiene.”

The task of washing the dishes falls to the six newest patients, and the patient with the most seniority in that group serves as the kitchen captain. “It’s a rite of passage, a positive way to join a new community,” says Ferguson.

At Caron Treatment Centers, where there are many tracks that include high-end programs, there is a “positive peer culture,” says Marty Ferrero, senior clinical director of adult treatment services. “Peer leaders,” patients who have been in treatment for as little as two or three weeks, take on certain responsibilities, such as welcoming new patients in the detox unit, he says.

There are also “trusted servant” lunches at Caron; this language is taken from the 12 Steps, which is Caron's core philosophy. In these lunches, a group of patients in phase two of treatment will have lunch with newer patients. “This is a way to share their experiences, and to give back,” says Ferrero.

Caron also relies on peers in its chronic pain program. “New patients are really hurting in the first week on all levels, phsycially and otherwise,” says Ferrero. Patients who have been in the pain program for a month or two and have overcome the initial discomfort are assigned to these new patients as buddies. “This helps to instill hope,” he says.

Each unit at Caron has its own “traditions and ambience,” says Ferrero. “There is a list of chores and responsibilities, and everyone chips in to clean their rooms,” he says. “You feel much better about yourself if you clean up your personal space.” Patients also have assignments to clean up community areas and to take out the trash. “It’s not all on housekeeping,” Ferrero says.

Alumni efforts

Especially for patients in shorter-stay programs or who travel from out of the area for treatment, volunteering tends to take place in the form of speaking or advocacy, or donating money.

For Promises alumni, volunteering consists of working on panel meetings, being a mentor, and being an “ambassador” by speaking with prospective clients and their families, says Meyers.

Many Promises alumni traveled to the treatment program from the East Coast. “I do a monthly meeting in New York City for those clients who have been here in Los Angeles,” says Meyers. “They want to get something going in New York, so I am proactively looking for opportunities for them.”

With many Caron patients coming from New York or Philadelphia to its eastern Pennsylvania facility, alumni often are invited to speak to patients in the Wernersville center, says Ferrero, noting that this is volunteer work. “There is a rotation of individuals who come back to speak here in the evenings,” he says.

Last year at Hazelden Betty Ford Foundation, patients and alumni donated a total of more than 16,000 hours, says Cecelia Jayme, director of clinical services. This includes the “awareness hour,” a speaker series at the Betty Ford Center in Rancho Mirage, Calif., that is open to people from the community. Patient volunteers register the attendees. Also, Hazelden Betty Ford has a nightly lecture, often delivered by an alum who tells current patients what is keeping him or her sober today.

And there is also advocacy work. Jayme recalled one woman who had been sober for six years but had been having a hard time. She was working on a project to “tell Washington that addiction is a real disease, and that we need naloxone to save lives,” says Jayme. “We were working so hard, and she was so real and so honest,” Jayme recalls. “She told me that day was the first day in two weeks she didn’t want a drink.”

Alison Knopf is a freelance writer based in New York.

Ethics issues and volunteering

“Many facilities are nervous about including service work, because of ethics,” says Cecelia Jayme, director of clinical services at Hazelden Betty Ford Foundation. “We’re not supposed to take advantage of clients. You can have people do therapeutic activities that build their self-esteem and self-worth, but you can’t exploit them.”

For example, if a treatment center was doing a benefit, it would be unethical to have patients set up the stage and sell tickets, she says. “That would be a real crossing of the boundary.”

However, Hazelden Betty Ford does use the buddy system, with new patients being assigned a patient who has been in treatment longer. The buddy will help the new patient get to appointments and “hang around with them so they don’t feel alone,” says Jayme. This system benefits both the new patient and the buddy.

“Just a week ago, the buddy was that new patient who was terrified and didn’t know what to do or how to do it,” Jayme says. “They received the support to help them out, and now they’re the one providing the support.”

A return on investment

Any addiction treatment program can work with local organizations that need volunteers, says Bob Ferguson, founder of Jaywalker Lodge. “From a programming standpoint, you get a tremendous return on investment” from volunteering, says Ferguson.

There are many local activities that are not just work, but are recreational, he says. For example, local distance running events always need volunteers. “If your clients aren’t healthy physically enough to run a race, they can sign up to walk it, or be one of the volunteers,” says Ferguson. “These are turnkey, a real easy plug-in” for a treatment program, he says.

Do organizations ever express fear of working with patients in treatment for addiction? “It tends to be divided,” says Ferguson. “Those who support your work want to integrate you into what they do,” he says.

“My experience is that these people are thrilled to see young adults getting involved in communities,” says Ferguson. “Whether it’s a church group or Relay for Life, all these groups will embrace you if you just give them a call. We have a national opioid epidemic, and these folks are connected to other families or have themselves experienced loss and consequences.”