Cohort Based Recovery at The Clearing—What It Is and Why It Matters For People Seeking Residential Treatment

By The Fix staff 10/31/18
"We’re looking for more and better and different ways that are more effective in healing addiction."
Two women embrace on what looks like a deck with green grass and white fence in the background.
Image via The Clearing

The decision to seek residential treatment for addiction is not one that any family takes lightly. Addiction is a notoriously complex issue. When someone finally does decide to get the care they need, they’re often faced with an entirely new, complex set of questions. How much is reasonable to pay for treatment? What are the major differences between the programs? Is 12-step or non-12-step the best option?

Though there’s obviously not one right choice when it comes to recovery, the recovery industry has become something of a monster in recent years. According to an article in the Daily Beast, the rehab industry now represents a $35 billion dollar pie—and many of the practices therein seem ultimately concerned with the bottom line rather than the long-term health of their patients. By way of example, most facilities use rolling admissions as a way to keep as many clients coming in and going out as possible. After all, the more clients who come in, the more insurance money can be collected and the more the industry can grow.

Although this paints a somewhat sinister picture of an industry that does undoubtedly help many people, the question remains: is this the best way to do recovery? For Joe Koelzer, CEO and co-founder of the non-12-step rehab The Clearing in Friday Harbor, Washington, the answer is a resounding no.

For their part, The Clearing emphasizes a cohort-based recovery model where all clients enter the same day and graduate the same day, completing their therapy programs together. “As it turns out, it’s a really great healing model,” Koelzer says. “It’s a much harder business model, which is why nobody else does it.”

All jokes aside, Koelzer believes in the cohort-based approach as a response to the revolving doors of rolling admissions found at the majority of other residential programs. “When we decided to create The Clearing, we made a conscious decision to start with a blank piece of paper,” he said. “We said, ‘We’re not going to look at what everybody else is doing, we’re not going to look at what insurance wants to pay for. Let’s just focus on creating a program with the best chance of healing, what would it look like?’”

The answer is a program that breaks most of the familiar recovery molds—including a defiance of 12-step dogma. The philosophy expressed is similar to one presented in an article in the Atlantic, which took the recovery industry to task for relying almost exclusively on the 12 steps as an outdated treatment protocol. In reality, according to the article, the success rate of such programs alone is between 5 and 10%.

While this shouldn’t necessarily disqualify 12-step entirely, what’s clear is that this recovery philosophy was developed as far back as the 1930s—and there’s likely more to the story of addiction that needs addressing. “Our program does have a spiritual component to it,” Koelzer says, “but we mean true spirituality. We’re not preaching a dogma but rather we are working with each Participant to assist them through their self-discovery process.’”

From the perspective of Koelzer and The Clearing, the approach that practitioners take to recovery ought to be a lot more fluid. “I don’t think we’re the answer for everybody. I don’t think anybody is the answer for everybody,” Koelzer says. “Almost nothing is the same as it was in the 1930s. We need to let our evolution, our new understanding of science, psychology and spirituality change the way that we heal. We’re looking for more and better and different ways that are more effective in healing addiction.”

To put things in perspective, there are many things that The Clearing has in common with other programs—namely, evidence-based psychotherapy, holistic care methods, dual diagnosis support and a qualified staff. The primary difference, however, is in allowing clients to chart their own emotional journeys in a calm environment without the disruptions of people coming and going. “How do you create any kind of true consistency and safety within [a program that’s] always changing?” he says.

Above all, according to Koelzer, the shift in addiction medicine that may need to happen is to slow the pace of treatment more generally. “The whole industry is built around the urgency of, you’ve got to go to treatment today.’” he says. “Well, you don’t have to go today. You’ve been doing this for 15 or 20 years. If you take the made-up urgency out of it, you can say: ‘Let me go to the place that I need to go rather than just the place that has a bed open.’”

Reach The Clearing at (425) 678-3566. Find The Clearing on FacebookTwitterLinkedInGoogle+YouTube and Instagram

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