Recovery program emphasizes unique approach

Every Monday morning, Randall Aamot, M.S., a Ph.D. candidate in counseling psychology at Northeastern University, walks into a group therapy room without any agenda, worksheets or any formal plan.

“I say to the kids, ‘this is what we’re doing for group today. We’re just going to have a discussion,’ and in essence in a real overt way I’m empowering them to lead that discussion,” said Aamot, 40, who regularly wears a bow tie.

“From my experience, when you give the kids that freedom and that space, they’ll take you to the important places,” Aamot said.

The dozen or so 13-to 17-year-olds meet in an old brick building on Meadowbrook Road in Brockton, Mass., that is distinguished by a turret that makes it look like a castle. All of them abuse or are dependent on drugs like marijuana, heroin, and party drugs like ecstasy or alcohol. Many kids don’t want to be there, feel forced to be there or feel betrayed by a parent or social worker. Aamot acknowledges these things at the start of each session to give these young patients the space to let the conversation happen.

They have come to The CASTLE (Clean and Sober Teens Living Empowered), a short-term residential treatment program operated by High Point Treatment Center where clinicians practice a unique approach to help patients learn how to maintain sobriety. It’s called I-M, a model developed by Medical Director Joseph Shrand, M.D., a psychiatrist who was inspired by the symbols for electricity and summation he once encountered in physics and calculus courses.

“I” stands for potential current but Shrand reversed the words to suggest all people have the potential to change in the next second. Theorizing that if people at current potential were at their maximum current potential, then they are doing the best they could at any given moment with the potential to change. Shrand turned the summation symbol clockwise for an “M.” He initially called his model I-Max – until the legal team from a well-known Canadian theater and entertainment company contacted him.

The I-M approach is founded on the belief that respect is the foundation of trust and that trust is the foundation of potential. The framework works in contrast to the traditional  “Scared Straight” approach, which Shrand said attempted to “beat addiction out of kids.”

“People thought if we just terrified kids, we could probably get them to stop using because we’d show them how horrible things are and they could wind up in jail,” Shrand said. “Substance use hasn’t gone away with this particular approach.”

“Just like anyone who’s being criticized, I think kids get defensive. They put up a wall and then it’s very hard to really connect with them,” Shrand added.

I-M integrates four domains: the home, social environment, how an individual sees herself or himself and one’s own biology and genetic predispositions. A change in one domain can affect the other domains. So rather than judging a patient’s behavior negatively, I-M aims to look at what they’re doing and together try to understand why they’re doing it.

“When we look again, it’s really from a position of respect,” Shrand said. “When was the last time you got angry at someone who you really believed was treating you with respect?”

The CASTLE admitted 356 young patients in 2014; three out of four were male. There are six patients for every staff person, compared to the state average of eight patients per staff member. The average stay is 10 to 14 days.

Almost 2,000 patients have come through the program over the past seven years, an average of about 18 patients per day or 30,000 patient days.

“Out of those 30,000 patient days, we’ve had fewer than 50 physical fights,” Shrand said. “Think about that, we’ve got these kids in a small setting with a lot of pressure on them. They may get angry but they’re not getting violent. That says something about the approach and respect and value and trust.”

On Saturdays, The CASTLE’s staff  members give PowerPoint presentations on I-M to parents to involve them in the recovery process and keep families connected.

Aamot said the I-M approach has helped him cope with the challenges of treating kids who may be getting mixed messages at home and school.

“You get a lot more kids coming in saying, ‘I smoked weed with my mom. I smoked weed with my uncle.’ It’s hard to work with that,” Aamot said.

But acknowledging that I-M says everyone is doing the best that they can helps him stay nonjudgmental.

“When I first started as a therapist, I kind of wanted to fix those problems that the parents caused. Then it was kind of like, ‘Wait a second, I’m having a hard time because I’m mad at Mom or Dad, because Mom or Dad are doing these things that are really terrible, really inappropriate’,” Aamot said.

“That’s not helping the relationship that I have with Mom or Dad because I’m mad at them. Using the I-M approach, it’s kind of like, ‘hey Mom and Dad are doing the best they can too.’ I could be judgmental of them, but that’s not going to get us anywhere.”

“It almost sounds like something a hippie would say in the ‘70s,” Aamot continued. “For me, it’s made working with families and parents a lot easier because it helps me not become judgmental. ‘How could you do that?’ ‘Why would you do that?’ I don’t need to ask those questions. I don’t need to understand that.”