Restoration Center 1

THE CENTER FOR HEALTH CARE SERVICES

THE RESTORATION CENTER

601 North Frio, San Antonio, TX

Substance Abuse Treatment Programs

Continuum of Care
For Adults

Residential Detoxification Program:

Residential Detoxification is the first phase of treatment providing a safe, humane withdrawal from
substance(s) of dependence. At the Restoration Center the patients are often the most difficult and
have been homeless and living on the streets for many years. These men and women have frequented
the community Emergency Rooms (ER) and jails. Almost always their chief reason for being unable
to function in life is their substance dependence. They are in need of an extended detoxification and
have additional medical/psychiatric problems and/or a non-supportive living situation which often
necessitate admission to a 24 hour Residential Detoxification Program.

The Medical Director oversees all services and he or his designee provides daily medical care. The
residential detox is staffed by a Licensed Vocational Nurse (LVN) under the supervision of the
Medical Director and a Registered Nurse (RN) Supervisor. A Certified Nurses Aid and Recovery
Support Specialist are also on the unit 24 hours to monitor patients during their detox. Licensed
Chemical Dependency Counselors (LCDC) provide daily counseling as well as case management and
discharge planning assistance.

Patients who are not in need of the full residential detoxification length of care can be transferred to the
Ambulatory Outpatient Detoxification, Long Term Suboxone Taper Acute, or the Long Term
Suboxone Taper Sub Acute. Motivational engagement is utilized to encourage patients to continue
treatment in an outpatient level of care.

Ambulatory Detoxification:

For patients who are able to be detoxified in an outpatient setting, Ambulatory Detoxification allows
daily monitoring in a less restrictive and more cost-efficient treatment environment. This level of care
is often indicated when patients have a stable home environment, few medical/psychiatric issues and/
or family support.
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Long Term Suboxone Taper Acute, or the Long Term Suboxone Taper Sub Acute:

Historically Opioid Dependence has been a difficult drug to detox from and many patients struggle
with the short five to seven day length of stay in Residential Detox. This results in patients being
unable to maintain long term abstinence and returning to treatment to try again. Suboxone is an opioid
medication for the treatment of opioid dependence. Patients come into the facility daily and participate
in decreasing dosage of medication and monitoring by nurse and counselors. The length of the
medication taper can be up to two months based on need. While patients participate in this medication
taper, they are simultaneously enrolled in Outpatient Substance Abuse Treatment Services (see below)
to help gain new coping skills while they are experiencing the discomfort of withdrawal.

Outpatient Substance Abuse Treatment Services:

Research has proven that detoxification alone will not result in long term sobriety/abstinence, but
detoxification in conjunction with outpatient can result in as much as 70% of patients being alcohol
and drug free at five year post treatment per the American Society of Addiction Medicine. The
National Institute of Drug Abuse sites “Length of stay in treatment has been found to be a significant
predictor of positive post-treatment outcomes, such as decreases in unemployment and crime.” For
those reasons patients are encouraged to engage in our outpatient services.

Four Levels of Care (Average length of stay is 45 days each)

1. Day Treatment (5-6 mornings of group counseling/didactic education and individual

counseling two times weekly)

2. Intensive Outpatient (3-4 groups and one individual session weekly)

3. Supportive Outpatient (2 groups and one individual counseling session weekly)

4. After Care Services (1 group counseling per week and 1 individual session
bi-weekly)

Outpatient Substance Abuse Treatment provides education on the disease of addiction, relapse
prevention strategies, life skills training, and other self-care issues. Individual and group counseling is
provided by a LCDC. Clients are also introduced to 12 group concepts and connected with meetings
close to where they reside.

According to several conservative estimates, every $1 invested in addiction treatment programs yields
a return of between $4 and $7 in reduced drug-related crime, criminal justice costs, and theft. When
savings related to health care are included, total savings can exceed costs by a ratio of 12 to 1 (National
Institute of Health, 2006).

Admissions into the treatment services at the Restoration Center Residential Detoxification and
Outpatient Programs stem from multiple referral sources including: local community emergency
rooms, police, courts, Crisis Care Center, and community nonprofits working with homeless).
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Total admissions in Detoxification for the previous year were 1,489 patients. Outpatient Admissions
were 319 patients.

Residential Detox Admissions

March 2009 - February 2010

1600 1489
No. of Admissions

1400
1181
1200
1000 851
Admits
800
Cumulative
600 435 416
330 308
400
200
0
1st Q 2nd Q + 3rd Q + 4th Q +

Outpatient Admissions
March 2009 - April 2010

350 319
300
251
No. of Admits

250
200 175 Admits
150 Cumulative
88 87 76
100 68
50
0
1st Q 2nd Q + 3rd Q + 4th Q +

The number of homeless individuals admitted to the Detoxification and Outpatient is reflected below.
According to the National Coalition for the Homeless, “Addiction does increase the risk of
displacement for the precariously housed; in the absence of appropriate treatment, it may doom one's
chances of getting housing once on the streets. Homeless people often face insurmountable barriers to
obtaining health care, including addictive disorder treatment services and recovery supports” (2009).

Total # %
Admits Homeless Homeless
Residential Detox 1489 843 57%
Outpatient 319 219 69%
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We are also tracking patients who are readmitted. The Restoration Center has been open since April of
2008 and the Haven for Hope homeless transition housing was originally on track to open during 2008.
This did not occur; and, as a result many of the homeless clients do not have a safe living environment
after release from the detox program. Consequently the readmit numbers are higher than we
anticipated but we are expecting to see a dramatic decrease in these numbers when our homeless
patients transition directly into Haven for Hope and continue treatment in our outpatient services.

Total Re- % Re-

Admits Admits Admit
Residential Detox 1489 667 45%
Outpatient 319 60 19%

Public Sobering Unit:

Between April 1, 2009 and March 31, 2010 The Restoration Center admitted 3,664 public intoxicants
(PI’s) into the Public Sobering Unit. The majority of these individual (3,339) were diverted to our unit
instead of entering into the legal system through the San Antonio Magistrates Office. Their average
length of stay in the sobering unit was 6.5 hours. During this time the majority of these individuals
received a minimum of 15-30 minutes of brief intervention using Motivational Interviewing
Techniques to engage them to enter a substance abuse treatment (detox). As a result, 578 PI’s (15%)
were transferred to the detoxification unit.

PSU Demographics

459
Homeless
403 Veteran
1563 Female

Injured Prisoner:
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During this same period 635 injured prisoners were treated in our Public Safety Triage-Injured
Prisoner Program. These were individuals who needed of some type of minor medical care and
clearance prior to being booked into the jail. In the past, the arresting officer would have taken them to
a community Emergency Room (ER) to obtain medical clearence. Due to the overcrowding of the
local ER’s most officers waited between 8-10 hours to obtain medical care for non-trauma injuries.
During this wait time they are unavailable for any other type of emergency call.

References:

National Coalition for the Homeless. (2009, July). Why are people homeless? Retrieved from
http://www.nationalhomeless.org/factsheets/why.html.

National Institute of Health. (2006, July). Press Release: New drug abuse treatment recommendations
to cut costs, save money and reduce crime. Retrieved from
http://www.nih.gov/news/pr/jul2006/nida-14.htm.