Populations-specific Group Models
Re-entry Group Model
People with carceral involvement have a higher likelihood of substance use disorders, including opioid use disorder. In addition, because their tolerance often goes down during incarceration they are at severely heightened risk of fatal overdose after release. This makes those administering carceral programs in our communities crucial allies in expanding and improving care for substance use disorders.
The Southern New Jersey MAT Centers of Excellence (SNJMATCOE) team has helped improve and establish addiction medicine programs in county jail facilities across South Jersey. Collaboration is of utmost importance and these facilities should be in contact with community addiction medicine providers to maintain support for patients during the reentry period.
The SNJMATCOE team hosts monthly case conferences which are open to all correctional facilities in the state. All correctional staff are welcome to attend these sessions. During these case conferences, we discuss challenging patient cases that correctional facilities have encountered and provide the most current medical knowledge around addiction medicine and evidence-based care. These case conferences are an opportunity for facilities to collaborate with each other and share crucial knowledge while being facilitated by a board-certified addiction medicine expert. In addition to the monthly case conference, Cooper’s Center for Healing hosts a weekly peer-led reentry support group for individuals with SUDs who were previously incarcerated. This group provides a sense of community and support while also connecting participants with resources such as its Medical Legal Partnership to address other health-related social needs.
If you’re interested in establishing an addiction medicine program in a correctional facility the National Council on Behavioral Health has put together a useful toolkit to plan and implement MAT programs in jails and prisons.
To refer patients to the Cooper Center for Healing weekly re-entry group please call (856) 342-3040 and press 1 for the Bridgeview office.
Benzodiazepine Group Model
For benzodiazepine use disorder, the Cooper Center for Healing has developed a group therapy model that combines long-term benzodiazepine tapers with a broad array of other services designed to meet each patient’s unique needs. These services include peer support, therapy and counseling, psychiatric care, care coordination & social services assistance, and subspeciality addiction care.
Benzodiazepines are used to treat anxiety, insomnia, and depression and are among the most prescribed medicines in America, but they are often prescribed and used for much longer than the medications are intended for. Even at therapeutic doses, extended lengths of use can cause significant dependence in patients. Because of the neurological impact of chronic use, for many patients who have developed either physiologic dependence upon benzodiazepines or a benzodiazepine use disorder, stopping benzodiazepine use can be one of the most challenging experiences in their recovery. Some of the challenges created by benzodiazepine use include:
Suddenly stopping benzodiazepines for someone with dependence can cause dangerous withdrawal symptoms including seizures or death.
While safe, short tapers over the course of several weeks often lead to a multitude of uncomfortable symptoms that can last for weeks or months. This constellation of symptoms is referred to as post-acute withdrawal syndrome (PAWS). This prolonged discomfort often leads to a return to use of benzodiazepines.
There are no FDA-approved medications for the management of benzodiazepine use disorder and many providers, including addiction specialists, are hesitant to try to manage a possible benzodiazepine taper due to the inherent risks, particularly when benzodiazepines are used in conjunction with opioids.
Patients with benzodiazepine use disorder often have one or more comorbid psychiatric conditions that can complicate the process of sedative tapering.
Understanding our patients’ needs are unique, the Center for Healing has created a comprehensive model of care referred to as “Beyond Benzodiazepines.” Patients who participate in Beyond Benzodiazepines have access to the following services:
Board-certified addiction medicine physicians and advanced practice providers who work with each patient to create a long-term (often greater than six months) taper that is individualized to that person’s unique needs.
Credentialed addiction counselors and therapists who are available for group as well as individual therapy services.
Care coordination and social services assistance provided by a specialized navigation team expert in addressing social determinants of health such as housing and transportation.
Psychiatric services to manage comorbid conditions such as mood disorders, anxiety disorders and PTSD.
In the Beyond Benzodiazepine group, patients meet once a week for group therapy and are seen one-on-one by addiction medicine specialists to design and administer individual tapering schedules.
It’s important for a patient who is ready to stop taking benzodiazepines to talk to a doctor and establish a tapering plan. These plans usually switch prescriptions from the short-acting benzodiazepines (such as alprazolam [Xanax]) to ones that take longer to clear the body (such as diazepam [Valium]). A months-long tapering period designed by a physician or other specialist provider is important to allow patients to comfortably discontinue these medications.
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If you would like more information on benzodiazepine use disorder, help determining tapering schedules, or finding relevant resources available in South Jersey, please reach out to the SNJ MAT COE.
Geriatric Group Model
Substance use disorder patients in advanced age face unique challenges. Their health may be complicated from many years of problematic use and they may face challenges in nding care due to provider hesitation.
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But this is a patient group that needs attention. America has an aging population. The Population Reference Bureau, a nonprofit which specializes in population statistics, estimates that the number of Americans 65 years of age or older will increase from 58 million in 2022 to 82 million by 2050.
Patients in this age range often began their substance use in their youth, during an experimental time in both their lives and the culture overall. Now, as the drug landscape has changed and adulterants in the drug supply are an increasing concern, many are seeking treatment with few providers prepared to manage their complex conditions.
In 2022, Cooper’s Center for Healing implemented a group therapy to better care for its older patients seeking treatment for substance use disorder. Patients attend group therapy and are one-by-one pulled aside to be seen by a geriatrician with a specialization in addiction medicine. Because polypharmacy—when a person is prescribed several medications to answer various medical needs—is common in this patient cohort, a pharmacist is always on hand as well.
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The group setting has proven beneficial for patients in this age range in a more than one way:
Routine
This group is held at the same time each week, with patients pulled from group therapy to be seen one-by-one by a board-certified addiction medicine specialist. The routine is important for older patients as it removes the need to continuously schedule appointments, which can raise barriers to care.
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Socialization
The group therapy setting provides older patients an opportunity to socialize with and connect with peers. Loneliness is a common factor among patients in this age range and the social aspect of this group model is a benefit to patients.
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Medical Care
Combining group therapy with addiction medicine allows for certified physicians and other specialized providers to treat patients’ use disorders. Polypharmacy, when a person is prescribed several medications at the same time for various ailments, is common in this patient cohort.
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