Matt Harrington 0:00

Hello, everyone. My name is Matt. You're listening to the A Train of Thought podcast. And today our guest is Dr. Ryan Paul Carruthers, Chief Clinical Officer and Executive Vice President at Center Point, where he leads clinical operations focused on mental health, addiction recovery, and evidence-based care. He's also the founder of Beyond the Twelve and author of Beyond the Twelve: Overcoming Addiction Without the Script, Challenging Traditional Recovery Models, and Advocating for a Greater Choice in Addiction Treatment. Ryan, thank you so much for being here.

SPEAKER_01 0:31

Yeah, thanks, Matt. I appreciate the opportunity to come on and talk to your audience.

Matt Harrington 0:36

Absolutely. I was doing a little bit of research on your book, Beyond the Twelve. And the first thing that I noticed was that in the way you describe the book, you describe it as taking control and driving on a journey instead of surrendering to a journey. Can you go into that a little bit more?

SPEAKER_01 0:54

Yeah, yeah, definitely. So the kind of traditional model of addiction recovery is this idea of admitting powerlessness. And at its core, people experience that enough in their daily lives that they're powerless over so many different things. And so a lot of people don't find it especially useful to be pushed to admit that they're powerless over their addictive behaviors. And so what it does is it's really an empowerment-based approach. The idea that you can do this, that addiction recovery is real, and that you don't have to stay stuck where you're at, basically.

Matt Harrington 1:40

What made you take that perspective from the alternative, more traditional method?

SPEAKER_01 1:45

Sure. So in addition to being an addiction counselor and a mental health therapist, I'm also a certified peer sports specialist in the state of Nebraska. And so uh I have my own story and journey of addiction recovery that goes back over two decades. And when I first came into the field as a professional, I was very much a traditionalist and was pushing people towards uh admitting that they're powerless. And it didn't quite sit right to me. Empowerment is kind of a key precept of uh counseling and therapy uh in general. And so there was this discrepancy there. And then in my personal recovery journey, I walked away from the 12-step programs myself after about five years, and I was okay, I was fine, and and I didn't need that any longer, but that really went against the script of recovery, which is you're supposed to go to the meetings and do all the things for the rest of your life. And so when I went on and did my uh PhD, my dissertation was really looking at what differentiated addiction professionals that were in this 12-step mindset and they only referred people to 12-step programs versus addiction professionals who were all, you know, maybe referring people to 12-step that were appropriate, but then also utilizing other modalities like smart recovery. And if you know anything about research, you know, normally you end up just uh with your null hypothesis and no, we didn't really find anything. And and that was the case with with mine as well. There was no real differentiator. But what I did identify in my research was for the first time in any literature, was that addiction professionals are this really diverse group, and there's certainly a group of addiction professionals that are 12-step based, and then there's some that aren't in recovery at all, and a lot has been written about those two groups, but there was this group that was in the middle, and it actually made up 25% of the sample, which is pretty huge, that they used to attend 12-step groups themselves, and they no longer do. And that was the group that was the most likely to refer people to alternatives. Uh, and so uh not only was that super interesting because it was a new group, it's never been identified or written about, but also it's my own story there. And so that kind of led me on this journey of really promoting choice-based addiction recovery, and ended up with uh with a book coming out of it.

Matt Harrington 4:40

So that's fascinating. As you reflect on how your your personal life kind of changed your clinical work, I'm curious if it had a same effect as you moved into leadership and instead of doing the addiction interventions, now coaching and leading an organization that does it.

SPEAKER_01 4:57

Yeah, yeah, certainly. One of the one of the realities of working in the addiction space is that the 12-step narrative is so strong that there aren't many organizations that embrace this choice-based approach. According to the National Survey on Substance Use and Mental Health Treatment Centers, amongst residential addiction programs in the United States in 2024, the most recent data, 98% of those programs endorse a 12-step philosophy. Uh, and so what it meant was there wasn't a lot of places that I could go work and be in leadership and be accepted because my philosophy is at odds with the the traditional approach. Uh, and so what it meant was I had to be very mindful about how I approached where I'm going to work even. Uh, and and when I had a private practice the first decade of my career, so I started off in in private practice, uh, and then I ended up buying the practice from the person who had previously owned it. I grew the practice, was there for about a decade, and I had all the freedom in the world. Uh, so I could have this approach and I could embrace uh alternatives to 12-step programs, but then eventually what happened was business, right? Uh I was more interested in in other things other than the business side, and and it became overwhelming. And so that along with my PhD student loans and working for a nonprofit, I was like, okay, I'm gonna go, you know, work for a nonprofit for a decade. And so I've been in in the nonprofit realm now for a while, and uh the first two years I jumped around and I went job to job to job because philosophically I wasn't well aligned, and and then uh I ended up with the organization I'm with, uh Center Point, like you said, uh here in Nebraska, and it's been uh you know a match made in in heaven, really. And and so but what I've tried to do is embrace my approach and try to teach it to other people. That's kind of what brought the book out because in transforming initially one program and then a series of programs uh to to embrace this choice-based approach, uh, one of the things I did was I started Nebraska's first smart recovery meeting uh 15 years ago because I believed in the the the approach and wanted people to have these realistic in-person options. And and I've just kind of brought this with me now everywhere I go. Um, and I happen to find a good fit and and the organization has embraced this approach, which has led to me being able to move up in the organization to the to the chief clinical officer role now. But the book, the idea with that is now I want to take it beyond this organization and I and I want the field to start moving more. Um, it's not that the 12-step programs don't work for people, it's not that they're not right for for some, it's that it's not a panacea, it's not the right thing for everyone. And and so starting to try to get some movement within our field.

Matt Harrington 8:29

As you have shared your different perspective, what have been some of the objections or concerns that other clinicians or other leaders have shared with your approach?

SPEAKER_01 8:41

Yeah, it's a it's a great question. Um, and I wish I knew the full nuance of it. I've uh, you know, obviously I I did my dissertation on this. I've worked in this space now for two decades, and um at the end of the day, the argument is as simple as it's not the 12-step programs. Um uh unfortunately, it's fairly dogmatic in that way. And so, in in some ways, it's fighting against something, trying to use a rational approach and you know, uh talk about science and ethics and uh, you know, informed choice against an argument of, well, yeah, but it's not the 12-step programs. And uh for many people it's as simple as the 12-step programs worked for me, and so that's what I'm going to push onto other people. Uh, and of course, the rub comes in that it's being pushed onto them rather than them freely selecting it. Uh, every now and then, uh especially when we're short-staffed, I'll have to take on a caseload. And actually, the last person uh that I had on my caseload several months ago now, in one of our residential programs, I started talking to this gentleman about informed choice and about smart recovery and all these different options. Uh, and he said, Yeah, man, that's all good and great, but I'm a 12-step guy. 12-steps worked for me in the past, I'm gonna do the 12-step programs. And I said, Okay, great. Like you're choosing it of your own volition, that's what you want for your recovery, then I'm going to embrace that as well. So it's not either or. The idea is that we just need to provide people all the information and allow them to choose amongst all the different options there are basically.

Matt Harrington 10:31

Do you ever get the objection of people saying that, well, they're if if they're able to choose, then they're going to make the wrong decision for them?

SPEAKER_01 10:40

Oh, certainly, all the time. And and one of the one of the clinical modalities under underlying this choice-based approach is motivational interviewing. Uh, and I am a motivational interviewing trainer. I'm a member of the motivational interviewing network of trainers, uh, and have been for uh 15 years or something. And and so I've really embraced this idea of choice. And and one of the things when we're training clinicians in motivational interviewing that we teach them is people have the absolute right to make unhealthy decisions for themselves. And we do it ourselves all the time, right? I could make a nice healthy tuna fish sandwich for for lunch every day, and yet often I'll get Burger King, right? It's uh we we have the right to make these informed choices, and yet somehow with addiction recovery, people think, oh no, we can't allow them to choose. And then what that ends up doing is creating this discord in the relationship, and then I'm not able to have enough rapport with the person in order to actually help them overcome their addictive behaviors. And so even if someone is going to make an irrational decision, they're gonna they're gonna uh continue to use substances, right? They're going to uh try a program, uh whether it's 12-step or otherwise, that might not be a good fit for them. That's their absolute right, and we just have to respect that. Uh, and and the idea is the more we do that, if we treat them with respect and dignity and allow them free choice, then when they struggle, when they continue to engage in their addictive behaviors, they're more likely to come back to care and specifically come back to see me because I treated them with dignity and respect and allowed them to make free choices, even when those choices were irrational.

Matt Harrington 12:45

Yeah. There's a uh semi-famous article in the ABA space for individuals, and it's written about individuals with intellectual disabilities, and the title is The Right to Eat Donuts and Take a Nap. And I I think there's a lot of similarities in those conversations here. Yep. Switching a little bit into the business side of things, since you're in leadership at Center Point, how has it been growing and scaling Center Point from a you know getting new patients in to converting into a business model that can really sustain and serve as many people as possible?

SPEAKER_01 13:21

Well, yeah. Uh so I, you know, I have to say uh Center Point was a well-established organization when I came along. And I certainly could not take any uh credit by of and by myself for its continued growth. But really over the last six years or so, uh, what we found is that uh uh initially, so if you go back to COVID, at least here in Nebraska, we had a 15% rate hike that was unprecedented, right? All of a sudden there was money coming into behavioral health as a society. We were having these conversations about uh mental health that in in general we weren't having pre-COVID uh because people realized through that through that tremendous sense of isolation that they experienced during COVID that wow, I have mental health, right? And and mental health is this thing that's on this spectrum. And so suddenly there was all kinds of money coming in, and and we were able to do some really cool innovative things with with with that money, like uh becoming a certified community behavioral health clinic, doing open access, because one of the biggest barriers for people is getting into care, like getting that initial assessment. Uh, and the idea is if if I come in today and you set appointment for me uh for two or three weeks from now just to get an assessment done, to get started into care, then I may never end up in care. Uh, and so that the idea of same-day assessments uh has been really critical for us. Uh but then what happened after COVID is suddenly the rates uh plateaued. The costs continued to increase. And over the last five, six years, we haven't seen any rate increases, and yet the cost of doing business has become more and more. And so, at least in the nonprofit space, what we've had to uh do is get really good at being efficient, making sure that the staff that uh we have on site, whether that's uh licensed staff, apparent professionals, peer sports specialists, whatever it might be, that they are seeing people whenever they are available. If if we have someone to be seen and we have a staff member available, we're going to find a way to get that person seen. Uh, and then the the other thing is, uh, at least in the nonprofit space, getting really good at grants, finding uh whether it be foundations or uh uh federal state grants, uh, and that's kind of a thing that's been up in the air as well. But getting really good at being creative uh and making sure that we stretch our money as far as as far as it can go.

Matt Harrington 16:06

If you had to pass some advice on to another business owner or leader who's currently feeling the squeeze right now, what would be your kind of best nugget of advice?

SPEAKER_01 16:17

Yeah, I think the the the biggest thing, you so often we have conversations as leaders that uh we want to focus on things like productivity and the kind of the financial fiscal bottom line, right? But when we do that, sometimes that translates to uh direct care staff as they just care about the money. Uh and and that can be very discouraging for direct care staff that are largely underpaid. And uh if the company they're working for is not communicating well why productivity standards are important, then it creates this discontent in employees. And so one of the things we focus on is like so many things in life, it's how you communicate it, it's not the message itself, it's how the message is is provided. And so we focus on the people, right? All of those dollars and cents and all that, what it means is uh if our productivity is low, it means that we are helping fewer people. Uh, and our mission at Center Point is to help people get better sooner for longer. Uh, and and we have a tremendous focus. We don't even call the people we serve clients, consumers, or patients. We use we just call them people. The people we serve or the individuals in service. And uh the reason why that's I guess important is if you're not focused on the bottom line of helping people, then it's gonna be difficult to keep staff uh when as soon as your employee engagement goes down, you are then having problems with staff turnover and discontent, then it kind of becomes a spiral, right? And it they they kind of go on top of each other. And so it's this dialectical balance between people and then the money. The money is all about how do we make sure that the people are getting high quality, person centered, evidence based care.

Matt Harrington 18:32

Yeah. Well, I can't think of a better note to end it on than that. So, Ryan, thank you so much for your time. And if you're out there listening, I hope you enjoyed this conversation. And we will catch you in the next episode. Thanks so much, everyone.