On August 28th, 2005, Hurricane Katrina (Katrina) closed the entire New Orleans substance abuse treatment system, leaving people in need of treatment, including those in the treatment already, without services. Since then, the New Orleans substance abuse treatment system has re-opened in a flurry, with staff members attempting to establish order with what resources exist.1 The period of reconstruction after Katrina presents an opportunity to examine how substance abuse treatment agencies have begun to operate in new ways. This report describes Katrina's impact on the clinical operations of the largest residential substance abuse treatment facility in New Orleans. Specifically, our intent is to briefly delineate how this facility operated clinically before Katrina, and how the concepts of therapeutic community were introduced into this facility to mitigate the stressors associated with a post-Katrina environment.
Previous disaster research
Post-disaster research suggests that Katrina may have had major effects on people in New Orleans with substance abuse problems.2–5 As a result, treatment agencies may have to modify operations and resource allocation to accommodate a post-Katrina clientele with significant potential for increased impairment that may necessitate more intensive and longer treatment. For example, research has shown that providing health care in a post-disaster environment may lead to (a) a reduction in staffs' ability to address clients' post-disaster treatment needs, as well as (b) an increase in staffs' own post-traumatic stress symptoms.6–7 Thus, substance abuse agencies may see an increase in staff taking sick leave,2 physical and/or emotional exhaustion and low morale,8 as well as regression to less effective intervention techniques.9 During recovery from Katrina, New Orleans' substance abuse agencies face the unprecedented task of rebuilding a treatment system and treating a potentially more severely impaired and chronic clientele with potentially unstable staff. [End Page 482]
Bridge House: Pre-Katrina
Bridge House, Inc. is Louisiana's largest residential substance abuse treatment program. Bridge House has treated New Orleans's indigent residents with substance abuse problems since 1957. Bridge House is a not-for-profit (501.c.3) organization that, prior to Katrina, employed 80 staff members and had the capacity to treat 130 adult men. Approximately 75% of Bridge House funding was generated through in-house businesses (e.g., used car sales, thrift stores). Six years ago, Bridge House operated from a traditional treatment philosophy where counselors routinely used a confrontational approach by pressuring clients to accept themselves as alcoholics/addicts. If clients did not commit to one year of treatment and remain abstinent from substance use, they would receive ultimatums from counselors that led to the withdrawal of services for non-compliance. This clinical approach was not idiosyncratic to Bridge House, but representative of traditional substance abuse treatment.10–11
Bridge House also operated from a loose organizational structure; it lacked the infrastructure and characteristics that organizational research has shown to be key to effective and sustained organizational change.8 Improvement efforts were unstructured and haphazard. Moreover, counselors and clients were minimally involved in the improvement process, and they typically viewed improvement efforts as a separate function within the organization. Thus, organizational improvement efforts were fragmented and their effects were unclear and difficult to sustain.
However, by August 2005, Bridge House was an example of an improving organization. The transition began in 2000 when Bridge House was awarded a grant to support the implementation of an evidence-based relapse prevention treatment curriculum. The model became the core treatment curriculum at Bridge House. Subsequently, Bridge House participated in a Center for Substance Abuse Treatment project. This project facilitated the adoption of motivational interviewing, an evidence-based counseling style.10 Motivational interviewing (MI) replaced the traditional confrontational approach as the core clinical style at Bridge House. Bridge House also implemented a client database including the Drug Evaluation Network System software.12 Finally, for the past three years, Bridge House has participated in the national Network for the Improvement of Addiction Treatment, an...