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For physicians: Levels of Care in Substance Use Disorder Treatment

By R. Stephen Pannel, DO, ABPN, ABAM

Understanding Levels of Care in Substance Use Disorder Treatment

A version of this article originally appeared in the February 2019 edition of the Journal of the Mississippi State Medical Association.

Primary-care physicians have a front-line role in recognizing when a patient may have a problem with drugs or alcohol.

With some patients, a substance use disorder is easily identified. For example, those who regularly seek out pain-medication prescriptions will trigger an obvious red flag. In other patients, however, the problem may be well-concealed. People with addictions work hard to hide them. Sometimes, it is only when treatment for other medical conditions fails to have the results it should that a physician starts to dig deeper to discern what is going on with the patient.

Physicians should be aware that, statistically speaking, one out of every 10 to 12 patients they see is in need of treatment for problems related to drugs or alcohol. Physicians may also observe a correlation between potential substance abuse and medical problems.

Substance abuse and chemical use can have a negative impact on a wide range primary-health conditions. For example, people living with substance use disorders have:

  • Nine times greater risk of congestive heart failure
  • 12 times greater risk of liver cirrhosis
  • 12 times greater risk of developing pneumonia

Meanwhile, abuse of alcohol and illicit drugs can be damaging to cardiovascular health, leading to high blood pressure and heart failure.

Even when a substance use problem becomes apparent in the scope of treating primary-care issues, many physicians are hesitant to refer a patient for treatment because of their expectations about what it will mean for the patient. Physicians may anticipate that if they refer a patient for treatment, it will mean the patient must go away for one, two or even three months, separated from their home, work and family. Those high stakes often cause physicians to hold off on intervening until it seems a patient has hit “rock bottom” and knows that he or she needs help.

While this approach may have made sense in the past, our understanding of the disease model of addiction today has shifted the treatment model away from an all-or-nothing concept.

As with other diseases, addiction can be prevented and treated early. Different levels of treatment are appropriate for different levels of dysfunction.

Modern treatment approaches are guided by a Continuum of Care described by the American Society of Addiction Medicine (ASAM). When patients receive an assessment for substance use disorder, the purpose is to identify not only whether or not they have a problem, but also where on the spectrum their problem falls.

For some patients, the severity of their addiction and/or co-occurring mental health disorders will call for an intervention at the most intensive level of care. For others, however, a less-intensive level of care will be the appropriate entry point based on their assessment.

The Continuum of Care is not designed as a start-to-finish path to recovery. Rather, patients enter the continuum at the level that best fits their needs. Based on their progress in treatment, they can step up to a more intense level of care or down to a less intense level. This model takes into account the realities that each patient’s pattern of progress is unique, that relapse is common, and that successful recovery is a long-term prospect.

Here is an overview of how today’s standard levels of care in addiction treatment relate to the ASAM Continuum of Care.


Level 4: Medically Managed Intensive Inpatient Services

For patients with a daily substance abuse problem who experience difficult or dangerous withdrawals, this is where treatment begins.

At this most intensive level of care, patients receive 24-hour nursing care and daily physician care. Inpatient medical detox programs fall into this category. Fortunately for patients, however, this level of care is no longer limited to only those withdrawals which may be life-threatening. In the past, medical detox was only available to patients for alcohol, opioids and benzodiazepines. Today, due to increased awareness and parity in substance-abuse treatment coverage, the medical community recognizes that withdrawals from other substances can also be so severe and painful that they warrant medical care and support. While not life-threatening, withdrawals from substances including cocaine, crack, methamphetamines and even marijuana can be so painful that patients have virtually no chance of being able to stop using for more than 24 or 48 hours on their own. This recognition has led to broader access to withdrawal management care for patients, regardless of their substance of abuse.

In this level of care, patients are removed from their home environment, removing access to substances. They receive medical support for withdrawal symptoms which can include nausea, vomiting, anxiety and insomnia.

While medical detox still manages the dangers of withdrawals for those abusing alcohol, benzos and opioids, providing access to withdrawal management care for those abusing stimulants has led to a significant increase in people with those addictions doing well in treatment. Previously, it was more common to see people abusing those substances continue to use and spiral out of control until some kind of medical or legal consequence forced them to get help. Now we have a chance to bring them in sooner and provide support in an appropriate environment.


Level 3: Residential/Inpatient Services

For most physicians, this is the level of care in addiction treatment that is most familiar and expected. Patients are removed from their home environment, where they would have access to substances and be very vulnerable to relapse. They stay in a supportive environment 24 hours a day for several weeks, receiving six to nine hours a day of treatment services. Those services include individual and group therapy, as well as education about the nature of addiction as a brain disorder.

While the basic structure of residential treatment remains unchanged, recent years have seen an evolution toward a more patient-centered approach to treatment. In the past, residential programs were standardized and manualized, relying primarily on 12-step models. Patients were educated in a program of recovery, and told that if they followed it, they would be successful.

In the past five to seven years, however, the patient-centered approach has emphasized a focus on the patients’ buy-in. Patients are engaged to discover their own needs, while treatment revolves around the patients’ needs as well as education.

Most residential programs also include a strong family component as well, where patient families come to the treatment center for tailored programming geared toward educating them about the nature of addiction.


Level 2: Intensive Outpatient/Partial Hospitalization Services

In this level of care, patients can continue living at home or in a sober-living environment while receiving outpatient treatment. Intensive Outpatient and Partial Hospitalization are distinct programs, each with its own programming and interventions.

Patients in Partial Hospitalization programs receive 20 or more hours a week of services, while those in Intensive Outpatient programs receive nine or more hours a week. These programs extend the patient-centered approach in education and therapy, including a focus on relapse prevention.

Patients can access this level of care in multiple ways. For some, IOP/PHP programs are their entry-point to the Continuum of Care, if their assessment shows their needs are appropriate for a moderate level of intensity in treatment. For those with greater needs, they may enter an IOP/PHP program after completing withdrawal management and residential treatment. Still others may begin at a lower level of care and move up on the continuum into IOP/PHP if they need greater support to avoid relapse.

One important aspect of IOP/PHP programs is standard drug screenings. Administered as part of the treatment program, screenings are a low-cost way to provide a high level of accountability and to boost the confidence of those who are progressing well in treatment. Those in outpatient treatment may be required to undergo drug screenings as often as three times a week.

In primary-care practices, drug screenings tend to have a bad connotation, due to the turmoil that can ensue for both the physician and the patient when a drug screen comes back positive. In substance-abuse treatment practices, however, drug screenings are as ordinary as blood-pressure tests. They are a standard measure of how well a patient is responding to treatment. When a patient passes them consistently over many weeks, the screenings actually become an encouragement to the patient as a positive, objective proof of success.

At the IOP/PHP level of care, an additional advantage for patients can be living in a supportive housing environment while they are receiving treatment.

Generally speaking, the concept of a community-enforced sober living environment has a poor reputation. But when managed correctly, sober homes have been shown to be effective for people as they work to regain independence and establish new skills for successful long-term sobriety. While there are relatively few sober-living operations to choose from in Mississippi, aspects to look for include a requirement for frequent drug screenings, a commitment to providing a very safe environment, and continued outpatient care for residents.


Level I: Outpatient Services

In this level of care, patients receive less than nine hours a week of treatment services. Typically, they live on their own or at home. This level of treatment allow people to continue working or going to school alongside their treatment schedule.


Level 0.5: Early Intervention

The ASAM Criteria includes a level of care for those who are at risk of developing substance-related problems. As with any other medical problem, substance-abuse disorders can be prevented from becoming full-blown crises through prevention and early intervention. Physicians need not wait until a patient reaches “rock bottom” to express concern over his or her substance abuse — any more than you would wait for a heart attack to recommend a patient change poor eating habits for the sake of cardiovascular health.

When a patient shows signs of substance-abuse problems, physicians can recommend he or she get an assessment to determine whether there is a problem and, if so, how severe.

Physicians and their staffs have more options than they may realize when it comes to referring for an assessment. Any center where people can go for treatment will also perform assessments, as will community mental health centers.

One of the simplest things a physician’s office can do is simply to call the patient’s insurance provider and ask for a recommendation on where to send the patient for an assessment. A physician who has identified a potential substance abuse disorder can then bring up his or her concern with the patient, being prepared to make the referral immediately if the patient is willing to consider treatment. While the assessment could point to a need for residential care, it could also indicate that only outpatient care is needed and the interruption to the patient’s life could be minimal.

Both physicians and patients need to know that their expectations about what treatment means may be out-of-date. They may expect that treatment always translates into a residential level of care, when actually it may mean only a few hours of treatment per week.

Yet if physicians and patients overestimate the intensity of treatment required, they probably also underestimate the typical duration of a treatment course — especially for those patients who do need to begin treatment at a higher level of care. Successfully working through the treatment levels can take as long as 12 to 24 months, even if more than half of that time is spent only in outpatient treatment.

Both within and without the medical community, the attention on substance abuse has never been higher. The nature of diagnosis and treatment continues to mature and advance, and to become better integrated into the broader healthcare system. These are welcome changes for the estimated more than 20 million Americans who suffer from substance-abuse disorders, and for all of us involved in their care.



Dr. Pannel is Medical Director of Oxford Treatment Center. He specializes in treating dual diagnosis issues. He is certified by the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine.

Connect with our regional Treatment Consultants for questions and referrals

Oxford Treatment Center Direct Admissions: (662) 281-9992 ext. 1








Substance Abuse: Clinical Issues in Intensive Outpatient Treatment. (2006) Treatment Improvement Protocol (TIP) Series, No. 47. Center for Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US)


SAMHSA-HRSA Center for Integrated Health Solutions. Integrating Addiction and Primary Services. Becky Vaughn, MSEd, CEO, State Associations of Addiction Services (SAAS), and Aaron Williams, MA, Director of Training and Technical Assistance for Substance Abuse, CIHS. Retrieved from


Kozor, R., Grieve, S. M., Buchholz, S., Kaye, S., Darke, S., Bhindi, R., & Figtree, G. A. (2014). Regular cocaine use is associated with increased systolic blood pressure, aortic stiffness and left ventricular mass in young otherwise healthy individuals. PloS one9(4), e89710. doi:10.1371/journal.pone.0089710


Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health (HHS Publication No. SMA 15-4927, NSDUH Series H-50). Retrieved from data/



Reprinted with permission of the Journal of the Mississippi State Medical Association© 2019;60 (3):85-86

For physicians: Addiction screening in primary care

By R. Stephen Pannel, DO
Medical Director, Oxford Treatment Center

How primary-care physicians can integrate addiction screening, referrals into their practices

When you refuse to refill a patient’s OxyContin prescription, they respond with screaming, threats, or even physical damage to your office. Have you just witnessed a manic swing due to bipolar disorder? Or is there something else going on?

A version of this article originally appeared in the January 2018 Special Opioid Edition of the Journal of the Mississippi State Medical Association. About MSMA  Download article

Embarassing scenes like that are a red flag for addiction, but many physicians would not recognize it as such or know what to do to help the patient. For most doctors and surgeons, mental healthcare and addiction were not part of their education and training. Those fields have been largely segregated from the broader healthcare system and from hospital-based physician networks, making the gap even wider.

Due to the current opioid epidemic, however, physicians are finding themselves on the front lines of the crisis. All primary-care practices now need to consider whether they are equipped to help their patients avoid or recover from addiction.

Fortunately, this does not require becoming an expert in treating addiction and co-occurring mental health disorders. Your practice can make a significant difference by adding small steps to the systems you already have in place to screen patients for potential problems and to refer them out for specialized care.

Here are three steps we recommend:

1. Understand the prevalence

According to the National Institute on Drug Abuse, nearly one in 10 Americans are in need of treatment for problems related to drugs or alcohol.

Particularly in the case of the current opioid epidemic, we have seen that addiction spans all social classes without discrimination. No matter the makeup of your particular practice, consider that one out of every 10 patients you see has a problem with drugs or alcohol. Ask your office manager how many patients you currently have in your practice, and do the math. The figure may be hard for you to believe, but those struggling with drugs or alcohol often hide it well, at least for a while.

Your practice also includes people who have not yet developed a substance use disorder, but who are vulnerable to addiction due to a genetic, physiological or psychological predisposition.

Consider this: A treatment path that may be medically appropriate and effective for 90 percent of patients can accelerate chemical dependency issues for the remaining 10 percent, due to existing substance use disorders or addiction vulnerability. For that reason, to routinely prescribe Xanax for anxiety or Lortab for pain, without considering certain patients’ vulnerability to addiction, will cause problems for them and for your practice.


2. Screen and engage patients

Despite the stakes, it can seem extraneous and time-consuming to engage patients on the subject of their drug or alcohol use when they’ve come to your office for medical care.

To streamline the process, introduce a screening tool into the paperwork that patients already complete during check-in. Choose one for your practice by reviewing the forms provided in the Clinical Practice section of the SAMHSA-HRSA Center for Integrated Health Solutions website.

The DAST-10 screening tool, for example, is only 10 questions long and can be completed in minutes. It asks patients whether they have ever used more than one drug at a time, whether they’ve experienced blackouts or withdrawals, and whether their family members have ever complained about their drug use.

By utilizing a simple check-in screening tool, physicians have a better chance of determining whether drugs or alcohol might be causing problems in a patient’s life — before a new prescription potentially sends them deeper into dependency.

3. Develop referral resources

Of course, the catch in trying to determine whether patients have a problem with drugs or alcohol is: What are you going to do with that information?

Primary-care practices need to build out their referral resources in the areas of mental and behavioral health, especially in communities where those fields are still isolated from broader healthcare systems. When a patient admits to having a drug problem, or when a patient throws a fit in full-blown denial, you don’t want to have to make 10 different calls to find someone who can help.

To identify quality treatment centers, look for appropriate licensing and credentials. A center should be certified by the Department of Mental Health and be accredited by the Joint Commission or CARF.

Referrals for treatment should be made within the context of each patient’s access to care. If they have a current insurance plan, reach out to the insurance company’s provider service network and ask for a referral for substance use disorders and/or mental health issues. Many practices routinely use insurers’ services to refer patients to in-network providers for a range of medical problems; physicians may not realize the same service can also help them refer out for mental and behavioral healthcare.

Addiction and co-occurring disorders are closely linked to physical wellbeing. Patients struggling in theses area many times present with medical complaints that are not clearly defined and also do not respond to treatment interventions. This may lead to frequent return visits.

This is a good time to consider addiction and co-occurring disorders and integration of treatment for these with your patients. This will help your patients return to good health and stay healthy.


Dr. Stephen Pannel oversees medical detox, medication management, and treatment planning as Medical Director at Oxford Treatment Center. He specializes in treating dual diagnosis issues. He is certified by the American Board of Psychiatry and Neurology and the American Board of Addiction Medicine.

Connect with our regional Treatment Consultants for questions and referrals

Oxford Treatment Center Direct Admissions: (662) 281-9992 ext. 1

Addiction & the Faith Community

Oxford Treatment Center
2017 Community Workshop Series
Fourth Quarter: Addiction & the Faith Community

Oxford Outpatient Center
Thursday, Nov. 2, 6-7:30 p.m.
Contact: Mark Russell, 662.679.0639

Tupelo Outpatient Office
Tuesday, Nov. 7, 6-7:30 p.m.
Contact: Mark Russell, 662.679.0639

Getwell Church-Southaven
Thursday, Nov. 16, 6-7:30 p.m.
Contact: Angela Quadrani, 901.484.1929

All workshops are free and open to the public

How can churches best show love to people addicted to drugs or alcohol? How can they support those in recovery?

The role of the faith community in providing care to people in addiction and their families will be explored in November, as Oxford Treatment Center presents the final installment of its 2017 Community Workshop Series.

Panel conversations are set for Nov. 2 in Oxford, Nov. 7 in Tupelo, and Nov. 16 in Southaven. All events are free and open to the public, with refreshments provided.

Previous workshops have focused on Addiction & Families, Addiction & Young Adults and The Cycle of Addiction. For the fourth quarter, the topic grew out of conversations between Oxford Treatment Center’s outreach team and area pastors.

“Particularly here in the South, churches are on the front lines of the struggle against addiction,” said Brian Whisenant, community relations representative for Oxford Treatment Center.

“When families are worried about a loved one’s drug or alcohol problem, their pastor is often the first person they confide in,” he said.

“We want to hear about the challenges that churches face in helping people overcome addiction. We also want to offer our resources and support in any way we can.”


Clinical Outpatient Therapist Larry Wills, LPC, M.Div.

Leading the panel conversation in all three locations is Larry Wills, LPC, M.Div.

A clinical therapist at Oxford Treatment Center, Wills works with clients in early recovery through the center’s Resolutions Intensive Outpatient Program (IOP) in Oxford.

Wills is also an ordained Southern Baptist minister and a former hospital chaplain. He said believers shouldn’t assume that faith can “fix” addiction, a disease that affects the body and the brain. Still, he said, the spiritual component of 12-step recovery programs can complement a person’s journey of returning to or growing in faith.

“Nobody is immune to poor choices,” he said. “You may have grown up being a very religious child and gone with your parents to Sunday School every week — and still wind up getting addicted to a substance because you made some poor choices somewhere along the line.”

Wills said that across the country, churches often support recovery and provide meeting space for 12-step groups.

“Most clergy understand that addiction is not about a moral failing or a lack of faith,” he said.

“It is a disease that hijacks the brain and causes people to act in direct conflict to their own values. Part of recovery is reclaiming those values, and building skills that give you the ability to live by them.”


Each panel also includes a local pastor and a clinical therapist at Oxford Treatment Center’s local outpatient location.

The panelists are, in Oxford, Pat Ward, pastor of The Orchard, and Deja Washington, MSW; in Tupelo, Colby Cuevas, pastor of Thrive, and Anna Warren, NCC; and in DeSoto County, Bob Ginn, ministry leader of Celebrate Recovery at Getwell Church, and Michael McCallum, MS. Daniel Farmer, an academic advisor at Stonewater Adolescent Recovery Center, will represent the 12-step recovery community on each panel.

The Oxford and Tupelo panels will each be held at Oxford Treatment Center’s local outpatient office. In DeSoto County, where the center has an outpatient office in Olive Branch, the panel will be hosted by Getwell Church in Southaven.

For more information, contact Whisenant at (662) 701-9653 or

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From our staff: 12 Myths of Addiction

When it comes to addiction, there are plenty of misconceptions

This fall, the small-town newspaper in Oxford, Mississippi, invited Oxford Treatment Center to help build local awareness about addiction and recovery through a 12-part column series.

Readers of The Oxford Eagle gained insights from our therapists, leaders, medical staff and regional treatment consultants. Each was asked to respond to one of the common misconceptions we encounter in our work with individuals and families, and in our outreach to the broader community.

The result is an overview of the research-based model that informs our approach addiction and treatment today. It’s also a picture of the many ways our society must evolve its ideas about addiction in order to best help those who struggle with it.





Myth #1: Addiction doesn’t happen to good people

“The people I worked with as a therapist and the people I help get to treatment today are not bad people. They are ordinary, good people who used substances for their coping skill. Life had overwhelmed them at one point or another, and this was what they used to survive. It wasn’t a problem until it became a problem.”

— Mark Russell, MSW, AAC Treatment Consultant


Myth #2: Faith can fix addiction

“Anytime we talk about recovery and the place of faith, we have to be very careful that we don’t try to substitute one for another. AA won’t get you to heaven, and Christianity won’t make you sober any more than it will cure cancer. But it’s a very beautiful thing when the two come together, because they truly do make a whole person.

— Larry Wills, LPC, M.Div., Clinical Therapist


Myth #3: Better parenting would have prevented addiction

“Right off the bat, we help families realize they’ve been doing the normal thing. When you love someone, it’s normal to want to help them out — bail them out, fix things, give them third, fourth, fifth chances. Yet when you’re dealing with active addiction, those are some of the worst things you can do.”

— Dee Meux, ICADC, Family Program Coordinator



Myth #4: If my child were addicted, I would know

“Parents will say, ‘She’s too smart for that. She’s a good young lady.’ The problem is, it’s not about good and bad. And if a kid seems to be doing fine, it’s easy for parents not to pay close attention.

— Reggie Watkins, MLAP, ADC, ICADC, Young Adult Program Coordinator



Myth #5: A little weed is nothing to worry about

Billy Young CEO“Anytime you have mixed cultural perceptions, the situation is set up for abuse or addiction. People say, ‘It’s a recreational drug’, but the real issue is those individuals who already have a predisposition for addiction.

— Billy Young, Oxford Treatment Center CEO



Myth #6: You have to quit work to get treatment

Deja Washington“I have not yet heard anyone say, ‘My employer doesn’t get it.’ Many people are in an Employee Assistance Program because of an addiction, and their employers are trying to give them a second chance. If an employee is willing to get help, their company is willing to work with them.

— Clinical Therapist Deja Washington, MSW



Myth #7: You can’t have fun sober

Laura Merrill McCaleb, LCSW“Whether or not you were the most popular person at a party is not going to matter to you in 10 years. What is going to matter? Your physical health. Having healthy relationships. Learning how to love yourself and take care of yourself. Simply being alive.”

— Laura Merrill McCaleb, LCSW



Myth #8: They could stop if they really wanted to

Stephen Pannel“There’s this perception that people who are in treatment have not tried to quit on their own, and that’s usually not true. Most of the time, when people get to this point, they have already tried to stop. But the withdrawal or physical pain from quitting is so severe, they can’t bear it.”

— Psychiatrist Stephen Pannel, DO, ABPN, ABAM



Myth #9: To recover, you have to want it badly

Amy Woodward“Surprisingly, there isn’t much difference in results between those who say, ‘I’ll do it, but I’ll hate every minute of it,’ and those who say, ‘I’ll do it, and I’ll love it.’ Doing it is the most important thing.

— Clinical Therapist Amy Woodward, CADC



Myth #10: The 12 steps are old-school and don’t work today

Barry Doughty“The core of addiction is total self-centeredness. But in recovery, we learn how to give back to our families, our communities and society as a whole. We learn what it means to contribute — instead of being people who just take.

— Clinical Therapist Barry Doughty, ICADC



Myth #11: I’m too old to go to treatment

Barbara Cox“When people have been abusing drugs or alcohol for many years, it’s difficult for them to imagine life any other way. When you’re in the middle of the situation, it doesn’t seem so bad. People wonder: Can I be successful in life without drugs and alcohol? Yes, you can. It’s being done every day, and the individuals we work with are living proof.”

— Outpatient Director Barbara Cox, LSW, MRC, MAC



Myth #12: Addiction is something you don’t talk about

Brian Whisenant“Both for addicts and their families, it takes a lot just to come out of your own denial and admit that there’s a problem. You don’t have to start by telling the world. Talk within your family. Talk to your pastor. Go to a support group. What you don’t want to do is let the pressure inside you keep building until it explodes.”

— Community Relations Representative Brian Whisenant


Myth #12: Addiction is Something You Don’t Talk About

Addiction is a more public issue than ever before. The epidemic of opioid overdose deaths is in the news every day. So why are so many families still suffering in silence?

It’s true that, while society’s understanding of addiction is evolving, the stigma surrounding it still exists. But here’s the catch: It’s hard to break through the stigma until people are willing to talk openly about it.

Locally, credit is due to David Magee, publisher of The Oxford Eagle, for opening a new community dialogue about addiction.

Last fall, he began publicly sharing the story of his son William’s death from drug overdose. He has since brought together support for a new wellness center at the University of Mississippi designed for prevention and early intervention among young adults.

“Drugs are the number-one killer of our young people,” Magee has said.

Larry Wills Ordained Minister

Community Relations Representative Brian Whisenant


He draws a parallel to the way breast cancer was also once a taboo topic. Over the past 25 years, though, greater awareness has led to more screenings and research. The death rate has dropped by more than one-third.

“The reason I wrote about my son, and the reason why people tell their stories, is that we have to take the stigma of addiction away,” Magee said. “Imagine where we might be years from now if we keep getting the word out.”

Brian Whisenant, who joined Oxford Treatment Center in July as community relations representative, said that openness about addiction is not a black-and-white issue.

“It’s a process,” he said. “Both for addicts and their families, it takes a lot just to come out of your own denial and admit that there’s a problem.

“You don’t have to start by telling the world. Talk within your family. Talk to your pastor. Go to a support group.”


“What you don’t want to do is let the pressure inside you keep building until it explodes.”

Cultural pressures can also be a powerful force to overcome when talking about addiction — especially in the South.

“Talking about anything you’re struggling with can be a faux pas,” Whisenant said. “You don’t talk about money struggles. You don’t talk about family issues. When you go out in public, everything is picket fences and rainbows — even when it’s not.”

Whisenant is in personal recovery from addiction, approaching three years clean.

He started speaking publicly about his recovery only a month ago, when he was asked to speak at the Third Annual North Mississippi Recovery Walk in Tupelo. He hesitated before agreeing that his name and photo could appear in the local newspaper the next day. When the story came out, he decided to go ahead and share it on social media.

“There was freedom in going public about my recovery, just as there was freedom in admitting to myself that I had an addiction,” he said. “It was like another set of chains fell off; I don’t have to hide anymore.”

Whisenant said he was careful to keep his recovery private early on, because of potential repercussions and the risk that employers might not be willing to hire him.

Addiction treatment providers and 12-step recovery communities work hard to protect people from such risks. Like all health matters, treatment services are protected by federal privacy laws. Meanwhile, 12-step fellowships like AA and NA maintain anonymity as a long-standing tradition.

When Oxford Treatment Center alumni have been clean for at least a year, they can have a chance to share their stories in blog posts, media interviews and podcasts — but always on their own terms. Some people want to share their story, but ask that their real name not be used.

“It takes brave people to come out and talk about being in recovery.”


— Whisenant said. “It’s a process for families to talk openly about it, too, and it can be hard on them.”

People who talk openly about addiction and recovery also run the additional risk of being branded a hypocrite if they struggle with drugs or alcohol again in the future. As a chronic disease with relapse rate similar to that of diabetes or high blood pressure, the risk is real.

“We can’t shun people because they’ve admitted they’re in recovery, and then they falter,” Whisenant said. “After a relapse is when guilt and shame are at their worst. It helps when people in the broader community can understand about addiction and be supportive through a relapse. A person’s recovery doesn’t end just because they’ve used again.”

Whisenant said the process of opening up about addiction can begin within the safety of settings like group therapy and 12-step meetings.

For families, Al-Anon and Nar-Anon support groups gather locally each week. Oxford Treatment Center provides a free therapist-led support group for families every Tuesday at 6 p.m.

To learn more about local resources for those suffering from addiction, contact Whisenant at 662-701-9653 or


This article originally appeared in the Oct. 1, 2017, edition of The Oxford Eagle newspaper.

Myth #11: I’m Too Old to Go to Treatment

When drug or alcohol problems have been going on for decades, is it too late to change?The truth is that recovery can begin at any age.

For people who have tried and failed to stay clean and sober, time and again, it’s easy to lose hope. Yet in some cases, their maturity and experience can actually become an asset in treatment.

At Oxford Treatment Center, people as old as their late 70s have sought help for drug or alcohol addiction. Outpatient Director Barbara Cox, LSW, MRC, MAC, said age can initially be an obstacle for people as they begin treatment.

“When people have been abusing drugs or alcohol for many years, it’s difficult for them to imagine life any other way,” Cox said. “Often, they come to us depleted, physically and emotionally. They’re convinced their situation is hopeless.”

Barbara Cox Manager

Outpatient Director Barbara Cox, LSW, MRC, MAC


Cox is a Licensed Social Worker and Master Addiction Counselor with previous experience in vocational rehabilitation. She has worked directly with clients in Oxford Treatment Center’s residential and outpatient programs. Today, she is director of outpatient services in Oxford, Tupelo and Olive Branch.

Cox said one advantage that older adults can have in treatment is a better grasp on the consequences of continuing in addiction. That can often be an abstract concept for young people.

Older clients also tend to be more settled in life. With jobs and families to go home to, they can anticipate and prepare for situations where they would be likely to drink or use drugs again.

“In treatment, we talk through different high-stress situations that they might encounter when they return to their normal life,” Cox said. “We focus on developing new coping skills they can use to respond to those situations. It’s a huge advantage when they can anticipate these situations and have a plan for how to handle them without turning to drugs or alcohol.

For Linda*, alcohol dependency became a problem after she retired from her career as a schoolteacher. Health issues related to excessive drinking ultimately prompted her to seek help. She had elevated blood pressure, liver function issues, and bruises from stumbling and falling.

“It was hard for me to accept that alcohol was causing all these problems,” Linda said.

“When you’re in the middle of the situation, it doesn’t seem so bad. You can ignore the problems, because you can just numb out again. Until you get sober, you don’t really realize you had a problem.”


Linda started her recovery through the 10-week Intensive Outpatient Program at Oxford Treatment Center’s Tupelo office. There, working with a therapist in individual and group sessions made her feel “heard” in a meaningful way. The therapist also introduced clinical concepts about addiction being a disease, not a moral failing, and about its affects on the brain.

“What I learned helped me understand what was going on in my mind,” Linda said. “I’d always thought it was my own mind and feelings telling me to drink again, so I’d listen. And it always got worse, never better. Once I understood it was my disease talking, I was able to say, ‘Don’t listen. It changed my whole life and gave me hope.”

Linda had been struggling with alcohol on and off for 20 years before the problem became serious enough for her to seek treatment.

For other older adults, addiction can set in more quickly as a result of being prescribed pain pills like OxyContin, Percocet or Vicodin. Those opioids look innocent in prescription bottles. But they are actually heroin’s synthetic cousins and are highly addictive.

Cox said she has worked with many clients who never had a drug or alcohol problem until being prescribed pain medication after a surgery.

“In many cases, they were also struggling with depression — and suddenly they discover the feeling of a high,” Cox said. “They say, ‘I never thought I could feel so good again.’ These are people who never dreamed they would find themselves needing treatment for addiction.

Whether people develop dependency late in life, or have been in and out of treatment for years, Cox said people are never too old to find recovery.

“It involves coming to a place where you’re honest, open-minded and willing,” she said. “And whether you’re a young adult or an older adult, it involves putting your laundry on the table. But it’s worth it.

“People wonder: Can I be successful in life without drugs and alcohol? Yes, you can. It’s being done every day, and the individuals we work with are living proof.”


It is never too late to reclaim your life. Take the first step: Schedule a no-cost clinical assessment at the outpatient office nearest you.


This article originally appeared in the Sept. 24, 2017, edition of The Oxford Eagle newspaper.

Myth #10: The 12 Steps are Old-School and Don’t Work Today

“Hi, I’m Jim, and I’m an addict.”

Even for those who’ve never set foot in a 12-step meeting, that introduction is a familiar refrain. But with so many modern approaches to addiction treatment, aren’t mutual-support groups passé?

In fact, the opposite is true. Around the globe, more than 120,000 meetings of Alcoholics Anonymous and Narcotics Anonymous are held each week. Meanwhile, addiction treatment centers that rely on research-based approaches continue to apply 12-step philosophies, alongside tools like cognitive behavioral therapy and appropriate medication.

That’s because the 12 steps have just as much power today as they did 80 years ago, when AA first began.

Barry Doughty ICADC

Clinical Therapist Barry Doughty, ICADC


Barry Doughty, ICADC, a clinical therapist at Oxford Treatment Center, said that working the 12 steps is not just about quitting drugs or alcohol. It’s also about defining what comes next.

“Addiction involves much more than the use of drugs,” Doughty said. “In the same way, living in recovery involves more than just abstinence from drugs. The first thing is to stop using. After that, recovery can begin.

Working the 12 steps involves a process of surrender, introspection, and making amends to those you’ve hurt. It’s described as a “spiritual” path, but not a religion. Service is also an integral part of 12-step programs.

“The core of addiction is total self-centeredness,” said Doughty, who in addition to being a therapist has nearly 12 years in personal recovery.

“When you’re using drugs, your life is about that, and everything else becomes a casualty,” he said.

“But in recovery, we learn how to give back to our families, our communities and society as a whole. We learn what it means to contribute — instead of being people who just take.”


In Oxford, the growth of 12-step meetings in the past five years is earning the town a reputation as a “recovery community.” Doughty, who helped establish NA locally, said the number of weekly NA meetings has grown from one to 17 over that time.

“In the beginning, it would often be me and one other person,” he said. “Now, there’s not enough seats for 50 people in the room. People are getting better, they’re working the steps, and they’re talking about how it’s changing their lives.”

At Oxford Treatment Center, those who seek help come from across the country. They are required to begin attending AA or NA meetings while they’re in treatment. After treatment, many choose to stay. The local recovery community becomes a critical support as they build a new, clean life.

“You can’t work the steps by yourself.”


— Doughty said. “You need a network of recovering addicts and people you can run things by. As part of a ‘home group,’ you become each other’s eyes and ears. People get to know you, and they can tell when something’s not right.”

People in a 12-step fellowship also have a “sponsor” who has been clean longer and helps guide them through challenges.

The accountability that comes with being part of a 12-step group offers layers of support that can help people steer clear of situations and stressors that could prompt them to use drugs again. The fellowship can also help them get back on track after a relapse.

The process of working through the 12 steps is designed to be ongoing. Step 12 describes a spiritual awakening that comes as a result of the journey. It also offers a call to share the same hope with others.

“Each step is a self-examination, plain and simple,” Doughty said. “They put us in touch with who we are, who we’ve been and who we want to become.”


This article originally appeared in the Sept. 20, 2017, edition of The Oxford Eagle newspaper.

Myth #9: To Recover, You Have to Want it Badly

For someone who’s been addicted to drugs or alcohol, staying clean and sober for life is not easy. Can a strong desire make the difference?

From the perspective of Amy Woodward, CADC, a clinical therapist at Oxford Treatment Center, there’s an even more important factor: Their willingness to follow professional advice — even when it makes them uncomfortable.

“How you feel about making changes isn’t really that important in the beginning of the recovery process,” Woodward said.

“Surprisingly, there isn’t much difference in results between those who say, ‘I’ll do it, but I’ll hate every minute of it,’ and those who say, ‘I’ll do it, and I’ll love it.’ Doing it is the most important thing.”

Amy Woodward CADC

Clinical Therapist Amy Woodward, CADC


Woodward is one of 10 clinical therapists at Oxford Treatment Center’s residential campus at Etta, in the northeastern corner of Lafayette County. There, her clients range in age from their mid-20s all the way into their 70s. A central part of their treatment program involves meeting with her for group and individual sessions.

Woodward communicates often with family members. She also recommends next steps for each client after residential treatment. Some clients and families follow those recommendations, and some don’t — even when they sincerely want to overcome addiction.

“Wanting to stay clean and sober doesn’t give you the ability to do it,” Woodward said. “It’s a really good place to start.”

“What gives you the ability is consistent, hard work over a long period of time.”


“I’ve also known a lot of people who have stayed clean and sober even though they didn’t want to in the beginning. They followed instructions and did what people told them would work.”

At Oxford Treatment Center, clinicians follow the guidelines of the American Society of Addiction Medicine in determining treatment length and intensity. People transitioning from residential treatment usually need to continue in outpatient treatment while spending a couple of months in a sober-living environment. That supportive transition keeps them from diving straight back into the pressures of the real world. They tend to have better success in recovery.

Ultimately, what we look for is willingness,” Woodward said. “Willingness to stay the course with their aftercare plan, willingness to get involved in a recovery program, willingness to replace unhealthy relationships with healthy ones.”

Part of being in treatment is getting plugged into the local recovery community through Alcoholics Anonymous or Narcotics Anonymous. During treatment, people begin going to AA or NA 12-step meetings. They also get a local sponsor — someone who has more experience in recovery, with whom they can check in daily.

Joanna*, who has now been clean for two years, said she went to two or three 12-step meetings a day while in the early stages of outpatient treatment.

“It was uncomfortable, and sometimes it was inconvenient,” she said. “But I did it anyway.”

Slowly, Joanna said, she became more comfortable at meetings. She even got used to the hugs.

“Around here, there’s lots of hugs,” she said. “It was hard for me to allow myself to feel love from people that I didn’t know. It was hard to believe that they had my best interest at heart. They didn’t want anything in return. They just wanted to help me not go back to the way I used to be.”

Woodward said that kind of willingness to follow advice in early recovery can mean the difference between moving forward or relapsing. She also advises people in early recovery to stay focused on the next decision in front of them, rather than trying to make long-term plans.

“We encourage people to be open to the fact their plans may not unfold the way they thought they would,” Woodward said.

“As you’re taking your first steps in recovery, it’s important to remain open-minded and willing. It leaves you flexible to accept what’s next and become more capable of coping.”


This article originally appeared in the Sept. 17, 2017, edition of The Oxford Eagle newspaper.

Myth #8: They Could Stop If They Really Wanted To

If someone chooses to drink or use drugs for the first time,

can’t they also make a choice when it’s time to stop?

For most people, the answer is yes. When drugs or alcohol start causing problems in life, they decide it’s not worth it and quit using, or just use less.

For others, though, it’s not that simple. Experts estimate about 8 percent of the population is prone to addiction. For them, a combination of genetic risk factors and physical dependence, along with the “rewiring” effect that addictive substances have on the brain, all combine to make quitting on their own virtually impossible.

Psychiatrist Stephen Pannel, DO, ABPN, ABAM, medical director at Oxford Treatment Center, said most people wouldn’t be in treatment unless they had to be.

“There’s this perception that people who are in treatment have not tried to quit on their own, and that’s usually not true,” he said. “Most of the time, when people get to this point, they have already tried to stop. But the withdrawal or physical pain from quitting is so severe, they can’t bear it.”

Stephen Pannel Psychiatrist

Psychiatrist Stephen Pannel, DO, ABPN, ABAM


Pannel is board certified in addiction medicine and adult psychiatry. He specializes in treating what’s known as co-occurring disorders — the mental health issues like depression and anxiety that frequently go hand-in-hand with addiction.

In treatment, clinicians deal with those co-occurring disorders through therapy, appropriate medication and other interventions. Taking substances away while giving people new ways to cope allows them to take their first steps in recovery.

“In detox and treatment, your access to drugs and alcohol is zero — but access to medical and psychosocial care is 24/7,” Pannel said.


“When people are first separated from these substances, they soon look healthy again. But psychologically, they get a lot worse before they get better.

“Their use before was dysfunctional — yet the chemicals they were putting into their body were, at some level, dulling the depression or anxiety. Without those substances, they need access to therapists and medications to be able to treat the underlying illness.

As a disease that affects both the body and the brain, addiction is often compared to diabetes and high blood pressure. Like those conditions, it is related to people’s daily management of their illness, has a high relapse rate, and has to be managed for a lifetime.

“The problem for people who really suffer from addiction is that their physical dependence keeps them in a trap, with an inability to have any say-so over their brain and body,” Pannel said. “Their tolerance keeps going up, and they’ve got to have more and more. That’s when you see behaviors like stealing, lying and manipulation, in people who didn’t do those things before.

“Why can’t that person just get by with a 12-pack of beer? A week later, they’re drinking 15 or 20, because the disease is progressive. It consumes more and more of them, and more and more of their resources. They usually won’t acknowledge it until something traumatic happens, like an overdose or a car wreck.

“Families are shocked by some of the extreme things that bring addiction to light. It’s often covert until something really bad happens. Then it becomes very public very quickly.”

The problems that people have with drugs and alcohol span a broad spectrum. The American Society of Addiction Medicine defines five different levels of dysfunction, with more sub-levels in between. When people get help for addiction, clinicians place them in an inpatient or outpatient treatment program designed to meet them where they are.

Families feel a deep sense of relief when their loved one finally gets help. But just like their loved one wasn’t able to quit on their own, they will also need the right therapeutic and medical support to stay clean and sober long-term.

“We’re learning from research that it takes weeks to months for a person’s brain to recover and heal,”


Pannel said. “To me, that’s the biggest barrier for people trying to understand the process of recovery.

“So much of what we do in modern medicine is fast and safe. You can have open-heart surgery, and in a week you’re doing cardiac rehab from home. For someone recovering from addiction to need weeks and months of treatment just to get back to a normal level of functioning is very difficult for people to accept.”


This article originally appeared in the Sept. 13, 2017, edition of The Oxford Eagle newspaper.

Myth #7: You Can’t Have Fun Sober

People who need help for drug or alcohol addiction can find a million reasons not to seek treatment.

Among them is this unspoken assumption: Living sober would be a real drag.

“I’ve had many people tell me, ‘I thought I could only have fun when I was drinking or using,’” says Laura Merrill McCaleb, LCSW, a clinical therapist at Oxford Treatment Center.

McCaleb is among therapists dedicated to the center’s young adult clients, ages 18-25. Among that age group, she says, those who achieve recovery are sincerely surprised by the joy they find.

“They thought recovery was going to be really boring,” McCaleb says. “But you see what you look for.

Laura Merrill McCaleb

Laura Merrill McCaleb, LCSW


When you put yourself out there and get engaged in a recovery community and create a new life for yourself — it can be really beautiful.

“It surprises people how happy they can be and how much joy they can have.”

McCaleb has been a part of the clinical team at Oxford Treatment Center’s residential campus since 2016. Her previous experience includes working with teens as a high-school-based therapist. Those years gave her insight into the social patterns that lead young people to abuse drugs and alcohol.

“So many of the teens I worked with were right on the cusp of making choices that could define their lives,” she says. “Their friends were drinking and smoking pot around them. They may not have wanted to join in initially — but the pressure was causing a lot of anxiety.”

Today, the clients McCaleb works with are those who are feeling the first consequences of abusing drugs and alcohol. Many of her clients are former college students who had to drop out because of heavy partying.

“Students often tell themselves they’ll be able to stop using drugs when they get ready to,” McCaleb says. “They say, ‘I’ll just go through the summer,’ or ‘I’ll finish college, then I’ll quit.’ But a lot of times, that doesn’t happen. They’ve become dependent on substances and now they need help to overcome addiction.”

While the costs for those young clients and their families are real, McCaleb has the perspective of seeing the advantages they have in treatment.

“If you get sober when you’re 22, and you’re working a program and engaged in your recovery, you are building rich life skills that will benefit you in your work and relationships,” she said. “To get to do this young is such a gift — instead of being 30 years older and having lost your job and your family.”

For someone in their late teens or early 20s to envision a sober lifestyle, it usually means redefining how to have fun and whom to hang out with.

McCaleb says she affirms her clients as they grieve cutting out parts of their life that would pose a danger to their recovery.

“Sometimes it’s clear that going back to a fraternity or sorority is not a good idea,” she said. “Likewise, you may have really enjoyed going to happy hour on Thursdays, and now that’s something you’re having to put down because it doesn’t line up with who you want to be. There’s grief that goes along with that.”

Support Collegiate Recovery at Ole Miss

The University of Mississippi Collegiate Recovery Community will hold its fall fundraiser, Telling Oxford, on Thursday, Oct. 26, at 6 p.m. at the Powerhouse Community Arts Center. Learn more


McCaleb and other therapists at Oxford Treatment Center typically recommend taking a year to focus on building one’s recovery before making any major life decisions — including going back to college.

At the University of Mississippi and on a growing number of campuses around the country, the Collegiate Recovery Community (CRC) movement is providing support and scholarships for students in recovery. A sober college experience is no longer an oxymoron. Still, the normalization of drug and alcohol use among teens and college students makes it a challenging environment.

You don’t want to jump right back in.

— McCaleb says. “If you’re an Ole Miss student, to think you’ll get out of treatment and go to the LSU game the next weekend is not a good idea.

“In early recovery, if you’re in a situation where everyone else is drinking or using, you’re not going to be able to say no. You have to be mindful of that and be intentional about who you surround yourself with. Your early recovery is sacred; you have to protect it.”

At Oxford Treatment Center, young adults who thought they could only have fun while drunk or high take part in therapies that involve painting, camping, kayaking and horseback riding.

The center’s experiential therapy programs help people open up and engage with therapists more quickly than they would in a classroom setting. At the same time, they open the door to new possibilities for enjoying life clean and sober.

Particularly for young people, McCaleb says, those experiences help define the difference between the fleeting fun of partying hard and a deeper joy that lasts.

“Whether or not you were the most popular person at a party is not going to matter to you in 10 years,” she says. “What is going to matter? Your physical health. Having healthy relationships. Learning how to love yourself and take care of yourself. Simply being alive.

“It’s very rewarding to watch a young person enter recovery and be surprised at the happiness they find.”