Cliffside Malibu, at $58,000 a month with a recommended length of stay of at least three months, self-admittedly caters to the wealthy; it’s the Malibu model with all the amenities. But Cliffside CEO Richard Taite and research director Constance Scharff, PhD, look beyond Malibu—and in fact, beyond the United States itself—when it comes to spreading the word about treatment.
Cliffside's leaders believe their mission doesn’t end with providing top-quality treatment only to those who can afford it. So Scharff spends many of her days and about $100,000 of Cliffside’s money traveling the world, talking about how to help people with addiction.
“We are deeply committed to make sure every addict wherever they are gets treatment,” says Scharff. Addiction Professional spoke with her in December just after she had just returned from speaking at the Global Addiction Conference in Rio de Janeiro, and as she was preparing for an early January speaking engagement in Israel at the United Nations Educational, Scientific and Cultural Organization (UNESCO).
Altruistic business model
Asked if the money Cliffside Malibu spends on Scharff’s travels is lost or recouped, Taite says, “I wouldn’t consider it lost—but it’s certainly not recouped.” Taite characterizes Scharff's work as altruistic.
The effort is not meant to promote the Cliffside model; in fact, most people in the United States, much less other countries, couldn’t afford it. But Taite, who like Scharff is in long-term recovery, says he views it as Cliffside’s responsibility “to educate the world about what works.”
Treatment systems are much more limited in other countries, and Scharff speaks with providers about how to use the resources they do have to treat addiction. For example, she recently met with groups in South Africa “where there were practically no psychiatrists,” she says. “I knew I just had to throw this protocol out the window, and just talk about what do you do creatively. It’s about thinking outside the box to make treatment possible.”
She adds, “We need to be better advocates for addicts. We are absolutely committed to ensuring that people who can’t afford our treatment center get the best care they possibly can.”
Scharff speaks only where she is invited, so by definition her audiences are interested in her message. And as a researcher, she is able to translate effective approaches into practical tools that can be used wherever she is speaking. “I take the best evidence-based, cost-effective, resource-efficient therapies and put them together in a culturally appropriate package,” she says.
She looks at what other researchers are finding in Europe, North America and Israel. “I look at what they’re doing and how it can apply to addiction treatment,” says Scharff. “I’m looking for therapies that are inexpensive, no cost to implement, and for therapies that have few or no side effects. For example, take meditation—if you do it wrong, at the worst you’ve wasted 30 minutes of your life.”
A key message, particularly important in developing countries, involves countering stigma. “Even in the United States, we have this veneer of ‘It’s a disease,’” says Scharff. “But then you get to the intervention, and the family keeps saying, 'I wish he would just stop drinking; he would if he loved me.'” In other countries there are similar perceptions. “It’s usually along the lines of, ‘Why can’t they pull themselves together?’” Scharff says.
She thinks that some of the ways addiction is regarded in the United States promote stigma, as well. She divides addiction treatment into three types: the moral model (jail or prison, or religion), the disease model, and the neuropsychological model, which is what Cliffside uses. “The problem with the disease model is that it is demoralizing to the addict,” Scharff says. “It’s popular with physicians because if you have a disease, insurance will pay—at least in theory.” Scharff also dislikes medication-assisted treatment, saying that it “creates lifelong addicts.”
Under the neuropsychological model used at Cliffside, addiction is viewed primarily as a behavioral problem, says Scharff. The behavior of the addict “co-opts the structure and function of the brain,” she says.
Cliffside's services aren't based on 12-Step principles, “because the 12 Steps focus on what you have done to wrong other people,” Scharff says. “It’s confession.” Instead of focusing on the addiction, Cliffside looks mainly at what happened that made the patient need drugs, alcohol or whatever the issue is in the first place.
It’s important to look at the underlying sources contributing to addiction, says Scharff. This concept has relevance no matter where she is speaking. She relates a story from Israel, where a patient had been in the military and was suffering from undiagnosed post-traumatic stress disorder (PTSD) even though he was being treated for addiction. “Speaking to this man, it was clear it was standard PTSD,” she says. “When they treated the PTSD instead of the addiction, all of a sudden the addiction fell away.” The man still needed to go through detoxification. But after the PTSD was successfully treated, he had “no more reason to use,” Scharff says.
One of the problems with research is that much of it wouldn’t be practical in a clinical setting, says Scharff. She takes a broader view of “evidence-based” than just what is examined in randomized controlled trials. “I go through the journals every day looking for any evidence-based holistic therapies,” she says.