During the 14 years that he has worked in addiction medicine, Dr. Carlos Tirado,
medical director at , saw a common pitfall among patients leaving treatment centers and trying to sustain their recovery outside those controlled environments.
“One of the common threads related to transition of care planning and community support was the real lack of primary care providers and competent psychiatric care,” Dr. Tirado said.
That led Dr. Tirado to found , an Austin-based practice that provides a collaborative approach to on-going healthcare for people in recovery. CARMA connects patients with a primary care physician who is knowledgeable about the physical and mental health complications that accompany addiction, and allows patients to access psychiatric services through their primary care clinic, rather than seeking out an additional office.
“The usual experience of patients who were readmitted was that the doctors they were referred to were just someone from their health plan,” Dr. Tirado said. “It's often the case that the physician has little to no experience treating addiction, has low to no comfort managing psychiatric medication and in the worst case actually prescribes addicting controlled substances. There was also a serious lack of access to in-network psychiatric care.”
Now, Recovery Unplugged’s patients in Austin can bypass those issues by arranging their aftercare through a collaboration with CARMA. After completing Recovery Unplugged’s unique , Dr. Tirado and other providers connect patients with a primary care doctor well-versed in the needs of people in recovery.
“That’s important because addicts need a relationship with a qualified, competent medical provider to help them manage their illness through their lifespan,” Dr. Tirado said. Primary care providers should be able to help patients through relapse risks, and also with chronic physical ailments that often accompany addiction, like diabetes and Hepatitis C.
The partnership between Recovery Unplugged and CARMA is so innovative that Recovery Unplugged will soon become the first Joint Commission approved behavioral health home in the private sector. The program is eligible for this designation because it integrates family medicine offered by CARMA with substance abuse treatment, and tracks patient outcomes closely.
The model is important for cutting down on stigma. Primary care providers with an understanding of addiction are more likely to understand substance abuse as a disease and less likely to judge their patients.
“Finding a primary care provider who is free from stigma is pretty hard,” Dr. Tirado said. “Our commitment is to disregard preconceptions and ignorant view points about what addicts are and are not, and treat them just like anyone else.”
Another critical part of the collaboration between Recovery Unplugged and CARMA is the presence of psychiatric services in the primary care setting. Normally patients need to establish a primary care provider and then seek out a separate mental health provider, a process that can be stressful and confusing. However, CARMA allows for one-stop care.
“A primary care practice can directly contract with a psychiatric care provider to act as a consultant to the practice to help them manage psychiatric patients,” Dr. Tirado said. “That keeps the person attached to their trusted primary doctor.”
Dr. Tirado estimates that 80 percent of clients at Recovery Unplugged have a co-occurring health issue in addition to substance abuse. Those patients benefit from a collaborative approach to aftercare.
“We do all of it: we treat the whole patient for all their medical needs,” Dr. Tirado said. “We really want these people to understand they have a medical home.”
In the long run this can help people sustain their sobriety, he said. In the event that relapse does occur, this model helps people access interventions more quickly.
“I think the biggest thing that we are contributing, in addition to the day to day work we do, is to help bring addiction and recovery in a more substantial way into the mainstream of modern medicine,” Dr. Tirado said. “The goal is to spend less time sick and using, and more time well, leading a productive, integrated life.”
Recovery Unplugged is a music-based rehabilitation and recovery center in Fort Lauderdale, Florida and Austin, Texas. Get more information at or connect on , , and .