On May 23, 2023, the Royal Examiner – an online news outlet serving the community of Front Royal, Virginia – published a story in their Town Talk section called “Front Royal Treatment Center – A Conversation with Steve Quakenbush, Executive Director.”
The article is based on a sit-down between Royal Examiner publisher Mike McCool available here:
Town Talk: Front Royal Treatment Centers
The conversation revolves around how Steve and his team at Front Royal Treatment Center help people with opioid use disorder (OUD), alcohol use disorder (AUD), and other mental health and/or addiction challenges move past the harmful cycles of addiction and start the road to recovery.
Front Royal Treatment Center is a federally licensed Opioid Treatment Program (OTP), which means they’re licensed and accredited to offer medication-assisted treatment (MAT), which is considered the gold-standard treatment for opioid use disorder (OUD).
To learn more about medication-assisted treatment, please navigate to our MAT treatment page here:
Medication-Assisted Treatment at Pinnacle Treatment Centers
While medication is a primary component of treatment in an OTP and at Front Royal Treatment Center, it’s not the only component. In fact, as Steve says in the interview above:
“Medication is a small part of what we do. The big part is the counseling and the case management. We utilize every tool we have to help people in recovery from a horrible drug during a horrible crisis.”
What Steve means is that at Front Royal Treatment Centers, and at all Pinnacle Treatment Centers nationwide, we take a holistic, integrated approach to treatment. That’s important, because – as he mentions – we’re still in the midst of a decades long public health crisis in the U.S.: the opioid overdose crisis.
We’ll share the most recent facts and figures on the overdose crisis, then explain how Front Royal Treatment Center is ideally situated to meet the needs of individuals and families in the Front Royal community.
The Overdose Crisis in the U.S.: Where We Stand Today
Here’s the latest data on overdose fatalities from the Centers for Disease Control (CDC):
Drug Overdose Deaths, 2020-2022
- 2020: 92,478
- 2021: 107,573
- 2022: 105,452
Those numbers show an increase of 16 percent from 2020 to 2021, and then, for the first time since 2017, a two percent decrease in overdose deaths from 2021 to 2022. Total fatalities for 2022 were close to 4,000 fewer than predicted by CDC data analysts. That fact, along with our new nationwide commitment to reducing barriers to care through harm reduction, offers good news, and a glimmer of hope. But we should reiterate that we still have a significant amount of work to do. In 2001, 19,394 people died of drug overdose, 434 percent fewer than in 2022.
That’s why we simultaneously embrace and temper our optimism.
One thing we know, however, is that at Front Royal Treatment Centers, we’re ready, willing, and able to keep these figures going in the right direction. In human terms, that means we’re committed to reducing the harm caused by the overdose crisis.
We’ll explain how.
Personalized Treatment Model: Tailored Integrated, Holistic Treatment Programs for Individual Needs
The integrated model prioritizes a whole-person approach to treatment for both mental health and alcohol/substance use disorders. Before the advent of the integrated treatment model, clinicians treated mental health disorders and alcohol/substance use disorders separately. Over the past twenty years, however, evidence shows that the integrated treatment model is effective not only for people with co-occurring disorders, but also for people with either a mental health disorder or an alcohol/substance use disorder.
For people with co-occurring disorders, research shows that treating one and not the other can lead to worse outcomes for both. And for people without a dual diagnosis for co-occurring disorders, the integrated treatment model is effective because it addresses all the elements of a patient’s life that can affect recovery. These may include interpersonal things like relationships and lifestyle changes, or practical support with vocational challenges, housing support, and access to various social services and programs.
At Front Royal Treatment Center, we focus on patients with a primary SUD diagnosis, but also support patients with co-occurring, dual diagnoses.
Each integrated, holistic treatment program begins with a comprehensive evaluation called a biopsychosocial assessment.
During a biopsychosocial assessment, a clinician collects detailed information in the following areas:
Biological:
- Complete personal and family medical history
- Existing medical conditions or diagnoses
- Existing prescriptions
Psychological:
- Individual history, including:
- Past or current psychiatric prescriptions
- Past or current therapy or counseling
- History of early and/or childhood trauma
- Current major life events
- Recent life stress or challenges
- Family history, including:
- History of mental illness
- History of alcohol/substance use disorder
Social:
- Presence of risk factors alcohol/substance use disorder
- Protective factors for alcohol/substance use disorder
- Academic and vocational history
- Gender identity and/or identification as LGBTQIA+
- Impact of current mental health or alcohol/substance use disorder on ability to participate in basic activities of daily life
Once a patient receives a comprehensive evaluation and an accurate diagnosis, our team creates an individualized treatment plan. We’ll explain what a custom treatment plan might look like at Front Royal Treatment Center below.
Essential Elements of Integrated, Holistic Treatment
The Substance Abuse and Mental Health Services Administration (SAMHSA) indicates that an effective treatment program for people with substance use disorder (SUD), a mental health disorder, or both, must include the following components: counseling/therapy, medication (if needed), education, lifestyle/life skills support, trauma-informed care, community support, case management/aftercare, and relapse prevention.
We’ll describe these components now.
Individual, Group, and Family Therapy/Counseling
Types of counseling may include:
Cognitive Behavioral Therapy (CBT)
CBT therapists help patients identify life-interrupting behaviors and patterns of thought, then replace them with life-affirming skills and productive coping mechanisms that help decrease chances of relapses and increases chances of sustainable recovery.
Dialectical Behavior Therapy (DBT)
DBT therapists help patients whose symptoms involve intense emotions and elevated levels of psychological/emotional reactivity. DBT therapists teach patients the skills they need to manage and process volatile, unpredictable thoughts, emotions, and behaviors. Many patients and therapists find success with DBT because in almost all cases, patients can apply DBT skills immediately: they’re simple to learn and work right now – not at some undefined point in the future.
Family Therapy
To understand an individual – especially an individual seeking support for a mental health or substance use disorder – it’s essential to understand their current and past family environment and dynamics. When family members understand what their loved one is going through during treatment and learn how to support them in the best way possible, outcomes improve.
Group Therapy
Group therapy facilitated by skilled clinicians offers a safe space for individuals facing similar challenges to share their experiences and support their recovery peers. Peer group sessions create lasting connections, and often include the most pragmatic, realistic advice a patient hears during treatment: when someone who’s been in recovery for years speaks, people new to recovery listen.
Medication-Assisted Treatment
The Substance Abuse and Mental Health Services Administration (SAMHSA) defines MAT as follows:
“MAT is the use of medications, in combination with counseling and behavioral therapies, to provide a ‘whole-patient’ approach to the treatment of substance use disorders.”
The medications approved for the treatment of OUD and AUD are called medications for opioid use disorder (MOUD). Medications we use at Front Royal include:
- Methadone
- Buprenorphine (Suboxone)
Evidence on the benefits of MAT dates to the opening of the first methadone clinic in in the U.S. in the early 1970s in New York City. Research over the past fifty years consistently shows the following benefits of MAT:
- Decreased overall mortality
- Decreased use of opioids
- Reduced overdose fatalities
- Decreased criminal activity
- Decreased incidence of infectious disease transmission
- Improved personal relationships, including family, friends, and peers
- Improved participation in work and school
- Increased time-in-treatment, which improves treatment outcomes
It’s important to reiterate what Steve says above: the M in MAT is only one part of the treatment. People who engage in MAT programs also participate in counseling, therapy, relapse prevention training, life-skills training, and the various modes of support we list below. Let’s be clear: MAT not only saves lives, it changes them. The medication helps people get to a point where they can restore, repair, reclaim and rebuild their lives. No medication can do that: that happens through hard work and honest collaboration between the patient and the treatment provider.
Education/Lifestyle Changes
Patients participate in education workshops, including:
- Group sessions on the science behind substance use disorders
- Group sessions on the science behind substance use disorder treatment
Patients participate in lifestyle counseling, with topics such as:
- Diet
- Exercise
- Stress management
In addition, patients may participate in complementary supports that include:
- Mindfulness
- Yoga
- Meditation
For some patients, these lifestyle changes and complementary supports make all the difference. Addiction can often lead to a sedentary, unhealthy lifestyle. When people in treatment rediscovery what it’s like to eat well, exercise, and feel good in their bodies – outcomes improve.
Trauma-Informed Care
Evidence shows that trauma, particularly early or childhood trauma, is often a root cause of disordered substance use. Therefore, clinicians at Front Royal follow the best practices in trauma-informed care. Here are the three core principles of trauma-informed care:
- Realize the widespread impact of trauma and understand potential paths for recovery.
- Recognize the signs and symptoms of trauma.
- Seek to actively resist re-traumatization.
To learn more about trauma informed care, please read our article here:
What is Trauma-Informed Care?
Community Support, Peer Support, 12-Step Programs
During treatment at Front Royal, patients may participate in the following peer support groups:
- Alcoholics Anonymous (AA)
- Narcotics Anonymous (NA)
- SMART Recovery
Case Management/Aftercare/Relapse Prevention
Before completion of a treatment plan at Front Royal, patients have access to our robust case management services, which help patients navigate the ins and outs of the treatment process. To learn more about case management at Pinnacle, please read our page here:
Case Management and Peer Support
Upon completion of a treatment plan at Front Royal, clinicians provide patients with an aftercare plan. This plan will include details on what worked during treatment and how the patient will stay in recovery after formal treatment. Aftercare plans include the following:
- Connections to peer support meetings
- A list of effective individually developed relapse prevention strategies
- A list of referrals for/connections to:
- Physicians
- Therapists
- Social services
To learn more about aftercare plans at Pinnacle, please read our page here:
Aftercare Services
In addition, all Pinnacle patients have access to our nationwide alumni support network upon discharge from a formal treatment program. To learn more about our robust alumni program, including our Pinnacle Treatment Fellowship App, please read our page here:
Alumni, Family, and Friends
That’s an overview of what a treatment plan might look like at Front Royal Treatment Center. Keep in mind that since every person is different, every path into and out of addiction is different. The exact makeup of a treatment plan at Front Royal is determined by the outcome of the initial biopsychosocial assessment, individual patient goals and needs, clinician input, and treatment progress.
Outpatient Treatment at Front Royal: Personalized Care With A Full Range of Treatment Options
In the 12-month period ending in December 2022, the CDC reports that 2,348 people died of drug overdose in Virginia. While that’s lower than the predicted number of deaths for Virginia, we can all agree on one thing: that’s 2,348 deaths too many.
One overdose death is too many.
That’s why we advocate for treatment and support using the holistic, integrated model. That’s also why we embrace the harm reduction approach, including medication-assisted treatment with methadone or buprenorphine. When we can help people move past the severity of withdrawal and engage in counseling and therapy, they can implement lifestyle changes that help them achieve sustainable, long-term recovery.
Our team at Front Royal meets every patient exactly where they are and offers treatment in the way they’ll accept it. We’ll learn everything we can about every patient, assess their motivation to change, and design a treatment plan that meets their specific needs.