Andrew: It is my great pleasure to have Gary Fisher, the Executive Director at Cirque Lodge in Sundance and Orem, Utah here on the phone with us today. Thank you so much Gary for joining us at Serene Scene Magazine.
Gary: Well, Andrew, the pleasure is mine.
Andrew: You have been around in the addiction treatment community for a very long time. Many people know of you but they may not know your backstory. So let’s start with your backstory, what led you here?
Gary: Well actually, I got involved in working in addiction basically through my own addiction. And had the opportunity to go to a treatment program back in 1986 for a pretty vicious alcohol and drug problem. And actually, kind of an interesting piece, is it was almost from the first minute I was in treatment, I loved it. And I remember sitting in the very first group that I ever got to sit in and while I couldn’t see my own problems and how to solve those, it was very easy for me to look at others and kind of understand what they were going through.
And as a result that it kind of came full circle and as I could see it in others I started to be able to see it in myself and so from that moment on I got very passionate about treatment and got the opportunity to start volunteering. I volunteered in a little Catholic facility, Saint Benedict’s in Ogden, Utah, and got the opportunity to work on the unit. When you’re the volunteer you get thrown in to a lot of different roles. And from there, fortunately, they recruited me to go to work and so started as a front line staff. I oftentimes say that I’ve done everything in the facility except cook and be a primary therapist.
And I’m not qualified to be a primary therapist and I’m probably not qualified to be a cook either so there you go.
Andrew: You mentioned you loved being in treatment. What was it about the treatment environment that attracted you so much?
Gary: I remember sitting down and telling my story and I would talk to my family about my addiction. And, of course, it was almost like I had the alien popping out of my chest. It was, they were just stunned, and had a hard time understanding why I would drink and use so destructively when I had so many really great things going for me in my life.
But I remember sitting in the very first group and I was telling my story and the rest of the members of the group, they nodded their heads. And I remember saying, so you understand this. And everybody was like, yeah, sure. And it was, they got it. And in that same vein, I got it about them and all of a sudden it was like I was with my people so to speak.
I understood them and they understood me. So I think that was the part that kind of, was really that first spark about treatment and about the power of a twelve step program and the power of cognitive therapy. I remember saying at one point, so we’re going to sit and talk about this and I’m never going to drink or use again. And the therapist said to me, you know that really doesn’t describe the dynamic. And it doesn’t describe the dynamic, but it was incredibly powerful for me.
Andrew: And from there you went on to Saint Benedict’s and what happened after Saint Benedict’s? Is that where you got involved with Cirque Lodge or, how did that work?
Gary: No, I worked for St. Benedicts on admissions, and then I got recruited by Charter Hospitals, and this is back in the early 90s and actually Charter was a good experience for me serving just behavioral health, our facility grew throughout world I believe. And I learned a lot of great things at Charter, a lot of what not to do when in treatment. And so but they have very good treatment programs, and I think a lot of the leaders in chemical dependency and behavioral health came from the Charters of the world and the CPCs and MEs.
They were large companies and what they were really good at were training people. Sometimes we weren’t the greatest treatment venues but they were very good at getting us trained and again I think I learned a lot about what not to do. And then, I believe it was in 1994, I got recruited by kind of a mid cap treatment group.
It was called Pioneer Healthcare, and it’s actually owned by Acadia today. But I got thrust into some leadership roles and really ran into a couple of great mentors and probably almost everything I know about chemical dependency treatment I learned from a gentleman. I’ll give him a shout out, his name is MIke and he’s got his PhD in social work.
But he just really kind of understood treatment and he understood the business of treatment. And he was an incredibly ethical and honorable guy. Still is; still alive. And he taught me almost everything that I came to know about treatment. And then from then took a little consulting role for a couple of years and that’s when I got recruited by Cirque.
And, kind of an interesting piece, I, when they very first recruited me for the lodge I wasn’t going to take the position. I had worked in residential care and kind of the interesting part about it residential care for those who have been involved with it, is it’s 24 hours a day 7 days a week, 365 days a year.
So there’s parts of it that aren’t all that attractive and I had come out of some really very difficult times with managed care about really them cutting treatment back and just no treatment dollars. And oftentimes the treatment facilities would kind of get the bad rap about that. The third party payers wouldn’t pay for care but the poorer outcomes then got attributed to the treatment facilities.
And of course what third party pay would say was well, we’re not telling you to discharge the patient, we’re just telling you we won’t pay for them. And so that really put the treatment provider in a bad spot. So I was able to kind of go to work for myself for a couple of years and it was at that point, again, Cirque recruited me.
And I just became very enamored with the guy who, the gentleman who owns Cirque Lodge, a gentlemen by the name of Richard Losee. I remember, he wanted to create something great and that resonated with me. I was 43 years old at the time and I had been able to make a living, a very good living, working in treatment but I wasn’t sure that I had done anything great. And he told me, I’ll never forget, he said, if you come with me this will be great. And I think he believed that even if I didn’t come with him, that it would be great. But any rate, it resonated enough that I went home and told my wife that I had taken another job in residential care. And I think she thought I needed a bed in my own facility, that’s how crazy that was. But it was really, I will tell you this, other than marrying her, it’s been the best decision of my life. This is my 17th year now at the lodge and really have front end just the greatest people and feel like we’ve just been part of just some really great work.
Andrew: Well, Cirque Lodge is a phenomenal facilities, particularly in Sundance. I mean, the setting is absolutely beautiful and you have a large facility in Orem which many people are unaware of. But tell us a little bit about the two facilities and how they work and how they differ.
Gary: So the first facility was kind of certainly the flagship of Cirque Lodge, Cirque Lodge itself which is located up in Sundance and it’s a 16 bed facility and certainly probably caters, I mean I talk about the difference in the programs really as being the price point. But they’re price pointed differently for a reason. And I think, I talk often that really recovery is a program of attraction and I’ve had a lot of folks who’ve come to the lodge who’ve been very, very resistant to coming to treatment and walked in and seen the lodge and said well okay, I can, I’ll try this.
And you know the lodge is small and it’s 16 beds which is still large enough to have a very rich therapeutic milieu, but it’s small enough that you just don’t fall through the cracks. I tell people look the lodge is nice. I don’t know what it was about chemical dependency treatment, but for whatever reason we were always the people assigned to the basement of the church or the areas of the hospital that really weren’t all that up to date.
So we work in a few of the other facilities back in the day were really the first folks to really add an element of hey look, this is we deserve nice amenities as well. We deserve good treatment as well. We deserve the best facilities as well. We deserve the best therapists, the best doctors.
That’s just not reserved for the cardiac care unit or the orthopedic unit, that chemical dependency treatment should enjoy that same level of competency. And so I think really the biggest piece about the lodge and this is where I either lose people or they’ll say well yeah, this is the place for us to come, and that’s I think at some point during a person’s stay, there is that moment of clarity.
And I just think it’s easier to get that moment of clarity in the mountains of Sundance, Utah, than any other place I’ve really seen in my life. And then what happened is after we kind of got the lodge going, and we knew we would be successful or we were going to be successful at that point we were sending people off to other programs.
We had one of the early beliefs in extended care, and extended treatment stays, and so, but we didn’t have an extended treatment stay facility. And so initially we opened the studio, which was just a building that happened to be in the Lohse family owned, the people who owned the lodge.
And actually, that’s not true. The Losee family owned it, Richard actually ended up buying it from his family, with the idea of opening, at least initially, an extended care treatment facility. And so people would typically do 30 to 45 days up at the lodge. And then would come down here and when I say come down here, come down to the studio and they would do another month or two months and so kind of one of the precursors to long term care.
And then at that point there was just quite a need for a price pointed facility that was less than the price of the lodge, but still kind of enjoy those same sort of amenities. And the community down here is bigger. We actually have 50 beds down here, so it is a different experience.
Caseloads are a little bit bigger for the therapists at the lodge, the maximum case load up there would be a person with five people on their case load. At the Studio you could actually have eight people on your case loads if both buildings were full. But programmatically they’re identical.
Food services are identical. Level of life insure for the clinicians are identical. Same medical services. Same experiential teams. So, we’re quite proud of what we’ve created in both venues.
Andrew: And with regard to the program, can you give us a bit of an outline? What is the approach to treating addiction at Cirque?
Gary: So one of the things that probably, we’re kind of unabashedly abstinence-based, 12-step facility, and again, while today experiential therapy is kind of pretty popular and I think a lot of folks do it. You know back at the start of the lodge that was fairly cutting edge and so the piece of it we had seen a lot of people get sober with cognitive therapy.
Really when you think about cognitive therapy it’s, you know, change your thoughts, change your behaviors, get a better results. So well not everybody believed they were coming to treatment because they were alcoholics or addicts they all believed that they could get a better result. So cognitive was, you know one of the evidence based practices that, again, we wanted to augment it.
We wanted to get some better outcomes. But we didn’t want to throw away the core of the program, so. And again, I tell people all the time I mean you can get twelve step treatment or twelve step programming for a dollar a day. That’s not why you come to treatment.
You come to treatment for hopefully a very robust cognitive program, so good, good therapy, good psychoeducational lectures. So a lot of lecture, a lot of group, a lot of individual therapy. And then what we did at the time that was a little bit different, and a lot of our colleagues have caught on and done some of the same things that we’re doing now.
But we added an experiential session in the afternoon. So two days a week, we have a large equine program, so two days a week we’re in the equine arena and two days a week we’re up on the mountain. Two days a week we have a large challenge course. We have a big art therapy program. We have a heli hiking piece. We actually will take our clients out to some of the remote reaches of the. We’ll go out there, we’ll do groups, we’ll do brief groups. We have really kind of tried to encompass our surroundings, the mountains, and try to make the most of them. And then the evening for us is dedicated to 12-step work. And again, while Cirque Lodge is, we believe I certainly believe it’s one of the finest, if not the finest, therapeutic treatment experiences from a residential stand point in the country but it’s about what happens after and really we talk a lot about regular meetings regularly.
We talk about the structure of what a twelve step program can do for us. We talk about the fellowship. As alcoholics and drug addicts we become, we can become very isolated and really the fellowship of the program, while I tell people the program is actually in the book, the biggest portion of the program is actually the fellowship itself.
And so morning is cognitive, afternoon is experiential, and evening is twelve step.
Andrew: Within the setting that you have around you at the lodge, that must impact people in a particular way. You spoke to it a little bit in that it seems easier for people to be self-aware in that environment. Why do you think that is?
Gary: Well, whether it’s the ocean, or whether it’s the desert, or in our case, it’s the mountains, I think whenever you’re surrounded by nature, and with the enormity of. I think a lot of times we’ll come into care and our belief is that our problems are insurmountable. And there’s nothing like the majesty and literally just the size of the mountains to kind of put a lot of things in perspective for us including our problems and our issues. And well, Iike I said I just, I had a gentleman the one time and at the very top of the lodge, there we call it the Cirque Room.
And it’s a room at the very top and it has a 360 degree view. And you actually can see the cascade cirque. So what a circque is is actually just a glacier carved amphitheater. And so 60 million years ago the cirque was basically seabed, and so if you walk up on top of the cirque, you actually can find fish fossils. It’s amazing and it looms up over the top of the lodge. And for whatever reason I, a gentleman was talking to me on the phone, and this was in the early days at the lodge, and he said where are you at? And I said this will sound funny, but I said, I’m actually I think I’m sitting in God’s bedroom. And he said what? And I said, well I said I don’t know where God’s bedroom would be, but this would be something, this is how I would envision it. And we chuckled and he said well when you get finished, he said give me a call, and I said great.
And so I, about six months later he was visiting the lodge for the very first time. And I walked up and he was standing in the Cirque Room. And I’ll tell you one thing about this gentleman, he was kind of a grizzled guy. Not a guy that emotion really penetrated all that much. And I remember walking up to the top of the stairs, the room is accessed by a big spiral staircase, and I got up there, and he heard me get to the top of the stairs. And without turning around, he was just looking out at the view. And he said, so this would be God’s bedroom.
And right then I got it, Andrew, not that everybody will keep it but at least everybody will get it. That there’s this power greater than ourselves, this God of your own understanding whether it’s the mountain or whether it’s the God of your childhood or whatever that belief is or that vision of what it is. But at least that there is this something greater than ourselves, and I, like I said, I don’t think there’s anything better than the mountains around Sundance, Utah to bring that home for us.
Andrew: Now you’re involved as well with the Utah Council for Crime Prevention. That’s an interesting task. Tell us about that a little bit. What does the Utah Council for Crime Prevention do?
Gary: Basically, it’s a wonderful organization and they are, The Council for Crime Prevention does a lot of drug prevention programs within the school system and within different community organizations. So the accounts will provide expertise to go out, whether it’s the families, whether it’s to, like I said, the students and basically give some educational pieces.
I think that’s one of the real issues for the community, the day, why addiction has become such a plague is that we really don’t have a great knowledge about addiction. We think we know about addiction. We think we know that will never happen to me or that won’t happen to my child or that’s not going to happen to my spouse or it’s not, this is gee I got this from my physician. But the council does a tremendous job about getting out and doing some prevention work and education work.
Andrew: Fantastic, now when I think about hot beds for substance abuse and addiction, Utah doesn’t really come to mind for some reason. But it exists everywhere, doesn’t it? What is the climate in Utah when it comes to substance abuse, particularly amongst the youth?
Gary: Well I think, kind of interestingly enough, I mean like with most areas, there’s been a tremendous amount of denial. And I think one of the reasons that, this will probably sound harsh and, but as the drug addiction has begun to affect literally white middle class America, that’s where all of the sudden this has really gotten on everybody’s radar screen.
And certainly that’s, that describes our socioeconomic demographic here in Utah. And we have a gigantic prescription problem here. While the LDS church really kind of frowns on alcohol use it’s like with anything, if you push one area down, usually another area will pop up. And so here, I believe that the statistic that I read, this was probably a year ago now, time flies, but it was the per capita benzodiazepine use was the third highest in the country, per capita.
And so a lot of prescription medications, and again, like I said, as, The young people’s population has been affected by the opiate epidemic. It certainly is, it’s just as rampant here as anyplace else.
Andrew: You’re also involved with the Recovery Management Alliance, and that’s something that many of our readers and listeners may not be aware of. So can you fill us in on what that is?
Gary: So the RMA, basically, was just a group of professionals that came together with the idea of, how are we going to get education out amongst professionals in the community? Because what happens with a lot of our therapists out there is that oftentimes, they might be good marriage and family therapists, whatever their particular clinical acumen might be.
A lot of times, what they were missing is that maybe there was some sort of underlying addiction or some sort of abuse problem that was feeding into the clinical problems that were kind of surfacing in these families. And then the other portion of the recovery management alliance, was to get some like-minded professionals.
A lot of times, our national associations are so big that it’s hard to get behind. We just turn slowly as a national organization. And this was a group that is a little smaller and is a little more finely tuned and finely pointed to be able to get with some of the key decision-makers, and give them some information.
A lot of times, and I believe this, I believe that our legislators want to do the right things. But oftentimes, they just don’t know what the right thing is. They get swayed by some statistic that means really very little in people getting better. And they get these lobbyists up on the hill.
And if that’s the only information our legislatures are getting, that’s the information that they’ll go with. So I think the other kind of key piece with the RMA is to make sure that some of our legislators are hearing a piece, at least, from the abstinence-based community and why, maybe, medication assisted therapy isn’t the end all be all. It certainly has it’s place with certain populations but, well, again, just not the end all be all.
Andrew: I think we would remiss if we didn’t also mention the Cirque Lodge Foundation.
Gary: Yeah, so, the foundation is something that, again, we’re very proud of. It actually kind of started with a gentleman who had had a tremendous experience at the lodge, and had gotten better.
And kind of one of the things that, had referred a couple of people to the facility, and those people were, because of the price point of the facility, were unable to access care. And so one of the things that he wanted to do at that time was make sure that somebody could get the same sort of treatment that he had received. And he had the where with all to do it and kind of approached us about doing it in a foundation piece. And so it kind of started initially as a patient aid piece to help people get here, and so we kind of came up with some formulas where it was, look, here’s the cost, and the cost of care.
And so basically, that’s initially kind of what started. What’s really happened, though, for the foundation is that we’ve gotten into a lot of prevention work, donated to other community-based resources where actually people’s dollars can affect more people than who they would be able to affect coming to the lodge.
But there are some basic donations that get made too, where people say, hey look, I want it to go strictly to patient aid. And so, sometimes we’re able to help people, whether it’s at Cirque Lodge or whether it’s a different facilities, help them access care. The appropriate kind of care too.
I think one of the best parts about the foundation, and I’ll say this. This might sound a little grandiose, but I think I know who’s doing the good work in the facility as to the other board members, when they say the good work in the community and the good work in the country.
And so we’re making sure that when people are coming, and we’re using foundation dollars, that we’re putting them in programs that we believe are, well, just have the most, the highest level of clinical and medical acumen.
Andrew: You are a vocal proponent of ethics within our fine industry of addiction treatment. What are you seeing now? You’ve got your finger on the pulse pretty well. What are you seeing now amongst agencies with regards to ethical operation?
Gary: Well, I think people think I’m a little, outspoken about it might be probably about Better word.
One of the things again, treatment was very good to me. And so not only is it a career, but again it allowed me the opportunity to get sober, and so I’m obviously very passionate about it, and I want to make sure that people get that same opportunity.
I’m very proud of this, I think, Cirque and certainly those that came before us, the Betty Ford Center, the Hazeldens, the Carons, the Cumberlands of the world. These groups that, Promises is another agency, that got into it. And a lot of people doing the right thing for the right reason.
And then of course with Cirque, I think one of the things, it’s look, people could come in, they could do very good work, and we could make a living. And it became very, there was almost a portion or a time there, where as people started to understand that what a devastating malady chemical dependency was, and then see people return.
They started seeing successes and people got very excited about that and should be very excited about that. I mean, that’s the very best part of what we do. I think that people, the only stories we ever hear, Andrew, are just about people who didn’t make it because that’s news.
But what the truth of the matter is, is the success rates are actually quite good. So at any rate, as a result, I think a lot of folks started to get into the business. A lot of private equity firms started to see how they could monetize chemical dependency treatment.
Take a lot of mom and pop organizations, and then get some economy of scale by bringing them together. And then of course, and I think big pharma saw how they could start to monetize medication assisted treatment, and that puts a different pressure on it. And then last but not least, I think some really very well meaning people You know with the advent of the Affordable Care Act they had gone through treatment and gotten better, and with parity in the Affordable Care Act, all of the sudden all of these people had insurances. And as a result, I think it started with a lot of really well-meaning getting into the treatment industry. And then what you find out is that running a treatment center is very hard and it’s very costly and there is a lot of infrastructure. And so people in an effort probably to stay afloat started to do some things that I think could only be described as nefarious.
Whether it was the outrageous fees for urine drug screen testing, or people that were kind of going after some benefits and really kind of, for lack of a better term just really hitting the benefit in a very hard way and not really giving a service. It’s one thing to charge somebody for a service, but then it’s another thing to really not deliver the service.
And I think when you look at treatment from the outside, it’s easy to say. Yeah, looks easy. We get a few beds, we get a couple of counselors, a doctor, we’re good to go. Throw a little Suboxone on board, hey, we can make this happen. And I think that really what they found out was just how much infrastructure and really what happens behind the scenes.
That’s kind of really just the planes flying off the boat, you forget what it takes to get the boat out to water. And so as a result I have been outspoken about it. I think that we have tried to expose some of the players that were less than ethical and giving services that weren’t up to par. And as a result, the issue with that is they just don’t get painted rather with that brush, that to poor service and poor ethics. It pains the entire industry. So we have been vocal about it, about getting out and trying to expose some of whether they were private equity and venture capital folks, or whether, you know, publicly traded folks, or whether it was just somebody who was kind of a pay to play kind of player.
And the reason is, is I know that people well benefit at Cirque Lodge and what I like to think is that, it really what it benefits is that it benefits the alcoholic addict who still suffers, who’s still out there. And if these services dry up and go away then they’ll be nobody to serve that next wave of alcoholics and addicts out there. Because that next wave of addicts and alcoholics they are out there.
Andrew: Well, I thank you for your efforts in that regard within our industry. People like you keep us on a straight and narrow and that’s a really important thing to do because it is, at the end of the day, all about those people that are afflicted with addiction.
Gary: Well, I appreciate the comments and will can hopefully continue to carry the torch, Andrew.
Andrew: You’ll be participating at the Evolution of Addiction Treatment Conference as well, coming up in February the second through the fifth in 2017. We’ll look forward to seeing you there and hopefully some of the listeners and readers will attend as well and maybe come up and introduce themselves in person.
Gary: I would like that very much and I’m very excited to participate in the conference, certainly a big fan of Dr. Bergers. Again, I believe that he’s one of the gentlemen in the industry who actually, as I’ve said previously, actually gets it. Knows what good work looks like and it’s out there promoting good work for your listeners and your readers I believe that if there’s a conference that absolutely is a spectacular value and one that they could if they only get to choose one that would certainly be at the top of my list.
Andrew: I appreciate that very much. Gary Fisher, Executive Director at Cirque Lodge, thank you very much for joining us here at Serene Scene Magazine today.
Gary: Well, my pleasure Andrew. Thanks for having me.