Andrew: I’m here with Jerry McDonald, consultant for
Betty Ford Center in Rancho Mirage, and Director of
Business Development for Beacon House in Pacific
Grove. Jerry McDonald is a name that many of you
would recognize, I’m sure. He’s been around in the
industry for many years, and has been involved in so
many interesting projects. I want to start with the
fundamental question. Why, Jerry, are you sitting here
today?

Jerry: I’m sitting here today because of a decision I
made over 36 years ago; that I wanted to help other
alcoholics. I found that I was not unique in people that
experienced treatment for alcoholism. Because of the
involvement that many treatment centers have, their
patients attend AA meetings while in treatment, I just
fell in love with Alcoholics Anonymous and the alcoholic.
Whenever I finished my treatment and continued
on as a participant in Alcoholics Anonymous, it became
very clear to me that if I could, I would like to help other
alcoholics, and to investigate the possibility of a second
career. At that time, I was the Director of a YMCA in
San Pedro, California, and decided to go back to school
to set the stage, if you will, of a possibility of changing
careers. I attended what, in those days, was called the
Alcoholism Treatment Studies Program at UCLA and
at Loyola Marymount University in Westchester, and
completed that certificate program. The final part of
that program was to do an internship. I completed an
internship at San Pedro Peninsula Hospital in the little
town of San Pedro, California, and not long after that
was asked if I would like to join the staff, and I did so
on a part-time basis. It wasn’t too much longer, another
six months, and I decided to completely change
careers and left my YMCA career for a career in health
care addiction studies.

Andrew: You mentioned your love of AA, and that’s
something that I know about you. Can you talk about
your love of AA for a little bit?

Jerry: Alcoholics Anonymous and treatment... Treatment
was the beginning of the interest, of course. The
reason I was so fascinated with treatment and Alcoholics
Anonymous is it told my life story of being raised
in an alcoholic family, and I had all of these questions
about the behavior of my family and all of the kinds of
things that children experience in an alcoholic family,
that I was relieved to find out that I was dealing with an
illness. I had no idea that alcoholism and chemical dependency
or addictions in general was an illness. That
fascinated me, and I thought that if I got this kind of a
benefit out of AA, I really wanted to help others find
the same experience that I had, and finally getting the
answers to what was the problem with my own family?
It was a big relief to find out that we were an alcoholic
family. That’s the reason I was so excited, and continue
to be excited today about Alcoholics Anonymous and
Al-Anon and all the information that’s out there about
families and addictions.

Andrew: And it’s free.

Jerry: And it’s free. Yes, it is.

Andrew: You have a passion around family.

Jerry: Yes.

Andrew: Let’s talk about the Family Program that’s so
well known at Betty Ford Center.

Jerry: Betty Ford Center is unquestionably a leader in
looking at families as the patient as opposed to the
person that may be in the bed, and Betty Ford Center
has a unique Family Program in that it’s open to family
members from across the country. One does not need
to have a family member in treatment at the Betty Ford
Center to come to the Family Program. What I love
about the Family Program is it’s sort of edu-therapy ...
A lot of education about addiction because most family
members, as I did, coming into treatment had a family
experience with it and didn’t know the answers to
any of the questions. The thought, whatever thinking
I did have, was probably erroneous. We see families in
a week-long treatment be able to turn that corner of all
the myths that they’ve believed over the years about
the illness and all the behaviors that they’ve seen and
all of the behaviors that they had as a result of addiction
being in the family. There are some reasons and
some answers for that within the explanation of addiction
itself.

Andrew: As a little bit of self-disclosure, Jerry, I went
through that program at Betty Ford Center over eight
years ago when my wife was in treatment there, and
completely changed my life. That program is what led
me to my recovery.

Jerry: Incredible. Oh, wow.

Andrew: I owe you a great deal of respect.

Jerry: Wow, it’s worth it. It’s worth it.

Andrew: You mentioned San Pedro Peninsula Hospital,
and that was really your first recovery job I suppose.

Jerry: Yes, it was.

Andrew: That was at a time when the treatment of
addictions was quite different than it is today.

Jerry: Yes.

Andrew: What have you seen? You started out at San
Pedro Peninsula Hospital and you went on from there,
and you have been involved with many programs.

Jerry: Yes.

Andrew: What have you seen as the major shifts in the
treatment continuum of care that have really led us to
where we are today?

Jerry: One of the major shifts has been that, along the
way in the evolution of treatment and treatment centers,
has been the licensure of the treatment programs.
Licensures from the State Department of Alcohol and
Drugs which, in the past, we did not have. If there were
certifications, one came out of social services; another
one came out of mental health. We never had alcohol
and drug certification. We have that now. We also
have a CARF accreditation, which is a nationally recognized
accreditation program. To have that as an experience
and as a standard of care has been elevating.
Then of course we’ve always had, even before CARF,
the Joint Commission and Accreditation of Hospitals,
JCAH. They put an on O on end of it later; the Joint
Commission and Accreditation of Hospitals Organization.
If you have a JCAHO, and if you have a CARF, and
if you have a State Department of Alcohol and Drugs...
All three levels of rising standards of care... That has
changed the treatment industry, sometimes for good;
sometimes there have been problems.
Here’s the problem. As that evolution has continued,
there’s been a lot of emphasis on the deepening and
the broadening of the clinical application of treatment
for the addictive person and family. Our licensure and
accreditations brought with it a much higher standard
of traditional staffing patterns for treatment centers, so
that the very highest, of course, would be all licensed
clinical staff, MFTs, PhDs, LCSWs. Not far behind that,
but certainly separated from that, all of the different
licensures are actually certificates of competence by
CADAC and there are ten or twelve additional ones in
the State of California. There’s very seldom a time that
we have professional staff come through today in our
treatment centers that don’t have one of those credits,
but are expected in the course of their professional experience
to always be looking forward to the next level
of excellence in their accreditation.
How has that changed the industry? It’s changed the
industry because we’re doing fairly deep clinical work
on the front side of treatment. We all realize that 90
days is really the minimum we would like to see, but
that continues not to be the reality today. We’re probably
still getting 30 days as the standard that most
people have. The problem becomes, we’re so sophisticated
clinically now, that we’re applying that in the
first 30 days of treatment, and the patients are getting
overwhelmed with clinical treatment as opposed to
developing social skills, getting out to the Twelve Step
groups, participating in the Steps of the Twelve Step
groups; to come along a little slower than what the
application of clinical skills are of the professional staff.
One of the examples of that might be is that we’ll hear
a lot about... We utilize DBT, we utilize EMDR, we’re
specialists in trauma. All of these are very, very sophisticated
clinical applications. My concern is that that
might be a little too early in the treatment experience.
What we’ve developed over the years is we sort of
outrun ourselves and we still have the 30 day being the
most popular for patients and families; 90 days gaining,
but not nearly there yet, and yet we’re applying our
clinical skills to early treatment because that’s the majority
of patients today. That work, at least much of it,
probably needs to be further down the line. For example,
after 30 days we always recommend extended care
or an intensive out-patient program.
We can begin that work there, and I really believe that
the best time to begin that work is beyond 90 days,
so that the patient and family have an opportunity to
establish themselves in the Twelve Step groups of AA,
NA, CA and Al-Anon family group, Nar-Anon family
groups, so that they get a basis of stability before
we do the surgery as required in the clinical process.
That’s my concern.

Andrew: Do you think that this change in the clinical
process is driven by basically where the money comes
from... Health insurance, management organizations or
maybe hospital-based programs. The buzz word today
is, of course, evidence-based- treatment protocol. We
need to see forward motion, constantly. On every
chart that’s written, we need to see something that’s
an improvement.

Jerry: That’s right. And why do we need to see that?
We need to see that because the insurance companies
are telling us we need to see that. And some accrediting
agency who comes around and does their surveys
are looking for that, too. We begin to do things for the
insurance companies and for the certifiers that maybe
is ahead of schedule of what the patient needs.

Andrew: I understand that.

Jerry: That’s the dilemma. It’s not that we don’t believe
that evidence-based treatment is the most desirable.
I also have some interest in what is evidence-based
treatment: and where is the research? I would like to
see the research put out by the insurance companies
that defines evidence-based treatment that they’re
bringing down the line to the treatment centers, saying
they have to have that whenever I see no material accompanying
that as far as the research confirming what
evidence-based treatment is. If there is the research,
I think they want to show that. As far as I know, there
are some studies, but they’re very limited studies. I
don’t even know if I would classify them as research.
Many of them are less than 100 people, 50 people. I’m
saying how about long term, how about little larger
numbers than that? Certainly we have no problem in
wanting to meet the standards, but to simply use the
term evidence-based treatment without the evidence
of what evidence is; that’s a little disturbing.

Andrew: What was your next stop after San Pedro Peninsula
Hospital?

Jerry: The model that was developed at San Pedro
Peninsula Hospital is a model that would be a standalone
in Camelot of the treatment industry, and the
treatment of addictions. There was a Camelot. The
Camelot was between 1980 and 1990. The model
developed at San Pedro Peninsula Hospital was the
Camelot. We took that Camelot at San Pedro Peninsula
Hospital and moved over and designed the same
program at South Bay Hospital in Redondo Beach, also
a hospital-based program. What was then called, and
would be today called a CDRS, a Chemical Dependency
Recovery Service in a full-service medical center. And
that was the second stop, same model. Very successful,
same as San Pedro. On an out-patient evening on
a Monday, Wednesday or Friday night at either place,
you’d have 200, 300 people; that’s how many families
and patients... The formula was what generated that,
and the program design generated that.
That’s when we really began to see that alcoholism or
addiction is a family illness, and the patient is the family.
Probably through the 90s, that was the Camelot and
then, as managed health care came in and it became
more difficult relative to financial resources, what happened
is that many programs simply dissolved, or they
had to redo the program design to be able to price
the product at the reduced number that occurred as a
result of managed care.
Then you started to have all kinds of things happen.
Abandon this, abandon that. You had to pare your
program down, so to speak, in order to survive. Many
survived, but with a different model. Many, many did
not survive at all. San Pedro Peninsula Hospital and
South Bay Hospital, with that model design, did not
survive. Nobody’s been able to duplicate it since. The
lone evolution of effectiveness in family work really
was started, certainly at the same time as San Pedro
Peninsula Hospital or South Bay or even before, are the
week-long family programs at some treatment centers.
That’s the most intensive that’s out there as far as
family is concerned today as being a centerpiece of
treatment in general. There are still those out there.
Betty Ford Center is one of them. Certainly, Hazelden
has a family program. There are a number of others
that have week longs, but even that is a big challenge
because for the staff to commit... I’m talking about all
the staff in the treatment centers... To commit to the
family being so important that we won’t do a four-day
program, we won’t do a three-day program, we won’t
do a Friday, Saturday and Sunday program; we’re going
to a five-day program. That’s a commitment of a different
nature. Although others are committed to family
but they’re not able, for a number of different reasons,
to do a week long. The standard out there today are
for family is at least one week long of family program,
which is the closest to the model of days gone by at
San Pedro Peninsula Hospital and South Bay Hospital.

Andrew: Thirty-two years ago, Betty Ford and Leonard
Firestone founded Betty Ford Center. How did they tap
you? How did you get involved with that project?

Jerry: That’s an interesting story. Many of the staff at
San Pedro Peninsula Hospital and at South Bay Hospital...
We started in 1980. We have to now look back
and know that Betty Ford Center didn’t start until 1982.
In 1978. No, before that... Maybe 1975 or 6, there was
a program at Eisenhower Medical Center, where the
Betty Ford Center was born, called the Awareness Hour.
It would have a community lecture, 90 minutes in
duration. People would come from all over the desert
because it was the latest information about addiction.
We didn’t even call it addiction in those days; we called
it alcoholism.
Here’s the evolution... Alcoholism and drug addiction
coming together to form chemical dependency, then
add eating disorders, gambling, sex and love addiction
and whatever else, sometimes called the process
addictions. And now you have addictions. So you had
alcohol and drugs, to chemical dependency to centers
for the treatment of addictive disease. That’s where we
are today.
Colleagues at San Pedro Peninsula Hospital at that
time were Dr. Allen Berger, Ed Storti, Fr. Leo Booth, Dr.
Judy Hollis. We would then all carpool to the desert
on the Saturdays for the Awareness Hour. A sample of
some of the people they brought in... They brought
in Fr. Joseph Martin, who was a legend in our field; Dr.
Stanley Getwell out of New York, who was a legend in
our field; Dr. Joe Pursch, who was at the Naval Hospital
in Long Beach; Dr. Conway Hunter in Atlanta. All over
the country, the best came. This was an incredible
opportunity to get the latest information; what’s going
on out there. We would carpool to the desert for the
Awareness Hour, and that Awareness Hour is still going
today. We’re going to go into our 38th season in January
of next year. That’s where we got our information.
It was a center for information at that time from the
same person who motivated Mrs. Ford and Leonard
Firestone to go to treatment, and his name is Dr. Joseph
Cruz. Dr. Joseph Cruz is still living today. He lives
in Las Vegas. He was sort of like the father, really, of all
of the chemical dependency work or alcoholism and
drug addiction work at Eisenhower Medical Center
before the Betty Ford Center. He did the intervention
with the Ford family on Mrs. Ford. And then after Mrs.
Ford’s intervention, an intervention on Leonard Firestone,
who sat on the board with Mrs. Ford at Eisenhower
Medical Center where the doctor was on staff that
did the intervention, who always had the dream of a
residential center, and who was currently doing, at that
time, an out-patient program at Eisenhower Medical
Center.

Andrew: When did you start your work with Betty
Ford?

Jerry: When I finished at South Bay Hospital in Redondo
Beach, that was 1983, I did go and talk with John
Schwarzlose because during the course of all of this
experience of going to the desert, going to back to LA,
going to the desert, going back to LA... When they put
together the Betty Ford Center they had to do what
was called a CON at that time, a Certificate of Need. All
of general hospitals, if they had any services, they had
to go through a certificate process which included a
community hearing. We drove down for the hearings
to listen to all that, and then when we found out there
were no rules or regulations to govern chemical dependency
and all of us were working in the field... There
were no guidelines. The Betty Ford Center was going
to put the guidelines together. We went down for all
the meetings in the development of Title 22. That’s
how I got interested.
I met John Schwarzlose, who recently retired, and was
our one and only executive over the years, and just
became fascinated with the Betty Ford Center. At the
end of my career at South Bay, I was ready to come to
the Betty Ford Center when I got a call to go to the old
Marina Mercy Hospital in Marina del Rey, which later
became the Daniel Freeman Marina Hospital. I went
over. They were moving a comp care program to a
hospital-owned program. I helped them put that in.
That’s when I got the call from Len Baltzer, who was in
Monterey, who had put together the Scripps Hospital
in La Jolla, and the only other chemical dependency
and recovery hospital in the State of California called
the McDonald Center on the campus of Scripps Hospital
in La Jolla. And that’s that.
I finished a career in Monterey of seven years. Then
there was an opening at Betty Ford Center. Ed Storti
and a few others, and John Schwarzlose and Mike
Netherton invited me to join staff at Betty Ford Center.
The only downside was I had to start all over again. So,
I started all over again as a Line Counselor as an Admission
Counselor at Betty Ford Center 22 years ago. And
the rest is history.

Andrew: Fantastic. What a journey you’ve had through
this industry. Wow, you’ve seen tremendous changes.
What do you think the change with the greatest impact
has been with regard to the benefits to the patient?

Jerry: One of the things I’m concerned about as we
continue to evolve is the incredible... And this is almost
like a survival mode explanation... That we have become
so consumer oriented that we had to relax some
of the structure that we normally have in treatment
because we want to please the consumer. In many
cases, good treatment in chemical dependency does
not include pleasing the patient. Because there’s a
number of pieces of the structure where the patient is
given direction and in trying to please the consumer.
Then they say, Well, I want to bring a laptop. Well, you
can’t bring a laptop. Well, I can’t come then. Well, wait
a second. Maybe we can have you bring a laptop and
you just do it on weekends. No, I can’t do that either.
How about Tuesday, Thursdays and weekends?
My point is, to be consumer responsive, many things
that the consumer wants in the treatment of addiction
are counter-indicated in the treatment of addiction.
We have to be careful about pleasing the customer.
Many times the customer is the family. The family, too,
may put some perimeters on what they want to see
happen, and sometimes what they want to see happen
is also counter-indicated in the treatment of the patient
and the family. It becomes sort of a mixed bag you
have to be careful of.
That’s a major change and that, of course, is to survive
the patient, a, not coming because we won’t give them
what they want and, b, when they’re there and they
insist upon moving perimeters and getting what they
want once they get into treatment and having to put
some kind of a structure around that, then our big
concern is we don’t want to lose the patient because
we’re going to lose revenue so we back up and give the
patient their way, and now we affect the whole community
of patients.
Consumer expectations have changed over time, and
the major reason is that in order to survive we have to
have the revenue. Sometimes we’re sacrificing program
content and program structure and program design,
because we want to have the patient experience
the treatment and not leave or, certainly, not come.

Andrew: You’ve been in the business for 36 years and
have witnessed and have been a part of the discovery
of what this disease is about. In your opinion, what are
the one or two things that you’ve seen that have really
turned us on our ears, so to speak?

Jerry: That’s a great question. Thank you for that. I do
have a few things over the course of my experience.
The very first head turning information that I got was
probably two years into recovery when I learned that
in my alcoholism... I’m sure it’s the same for the other
addictive diseases, but I can only speak on alcoholism
at this point... Is that my problem was not alcohol.
My problem was something called alcoholism. And
it sounds a lot alike, and we talk a lot about alcohol,
but that’s not it. That little suffix at the end of the
word alcohol changes everything. What I learned that
changed the course of my own recovery, and what I
then brought with me as I experienced the profession
over the years, is that we’re dealing with a phenomenon
that, in a way, beverage alcohol is the medicine.
And that beverage alcohol, the medicine, we become
addicted to and it becomes the agent for tolerating
the pain of alcoholism to the point where it works for
a number of years or whatever it is, for everybody’s
different, but then it also becomes the problem. So
we have two problems. The first problem is beverage
alcohol that we become addicted to, it being the
medicine for the illness of alcoholism and then when
we take the medicine away, now we’re going to experience
the illness of alcoholism without the benefit of
a mood-changing chemical, which means we’re in the
raw. We’re in the raw, facing a world that’s crazy. And
everybody in the world of alcoholics, addicts and everybody
else respond to that world in a different way.
And everybody wants some kind of relief to that craziness
of the world. Because we’re sane people living
in an insane world. So people choose alcohol, people
choose food, people choose gambling, people choose
sex, people choose all of them, people choose illegal
drugs, people choose prescribed medications, and on
and on and on. The major thing that I learned was that
this illness has to be treated while the patient is in abstinence,
and abstinence becomes sobriety when you
do certain things. In a way, it’s sort of like diabetes.

Andrew: Yes.

Jerry: We give you the directions in treatment. Here’s
what we found to be the most successful. The example
I give that’s the most successful for 80 years now is the
Twelve Step programs, beginning with the grandparent,
Alcoholics Anonymous. As far as we know, those
are the most successful interventions to the progression
of the illness of alcoholism or addiction, if you will,
that’s ever been known to man. We know what the
directions are. We do the directions ourselves, and we
know that AA and NA and CA and Al-Anon; they all
follow the directions. Whatever we give you is going
to be predicated upon your willingness and you’re
consistently following the directions. ... That was new
information for me. I thought I just want me to stop
drink. I even felt that my first years of not drinking, I
was doing really good, but then... And this is the difference
between an alcoholic and a non-alcoholic... If
your problem is alcohol, you might quit and you might
never return again. But if you’re an alcoholic, you quit
and you don’t put anything in between your quit, you
will always drink again.
And this thing you put in between quitting and not
starting again is a thing called Alcoholics Anonymous
or the Twelve Step group or the principles of the program
which are all spiritual principles, of which one of
the highest is sorry about this, but you’ve got to help
somebody else, too. You’re not getting away this free,
so you have to help somebody else. It all really boils
down to identification and willingness, incorporating
the knowledge and the experience you’ve been given
and continue that and help somebody else along the
way. That seems to be the formula.
But I didn’t realize that, even though I was told that
when I went to AA, that really didn’t sink in, and it
didn’t sink in to me what the difference between what
abstinence and sobriety was, because I asked a guy
one time. Wise guy. Used to be in radio and television.
I said, Walter, what is this thing about sobriety? What a
terrible word. No class word. Can you give me another
word? And he said, Yeah, I can give you another word.
Do you want one? And ... I said, Yes. He said, Maturity.
... I said, Oh, my God. That’s worse. But then I had to
ask the question. Walter, what is maturity? And then
he told me, something I’ve never forgotten. He said,
Maturity is the ability to live peacefully with unresolved
problems.
When you get down underneath those unresolved
problems, what always breaks out are your emotions.
And that, for the sake of the most simple explanation
that I’ve heard in the industry in all of these years, is
that underneath alcoholism is really emotional illness,
and that we’ve never really, for whatever reason, matured
emotionally. We may have matured physically,
intellectually, all those things, but not emotionally.
The interesting thing is that people who come into
recovery who’ve never matured emotionally are one
group. The other is a group of people that did mature
emotionally, but in their drinking and drugging, those
coping mechanisms atrophy and they come back to
zero, just as the people who never developed emotional
maturity are, and so they both start out at the same
place. Two different experiences, starting at the same
place.

Andrew: Where do you think we’re headed, as an industry?

Jerry: I think that this industry will explode into out-patient
programs across the country, and that that will
be the predominant giver of care for our addictive
population, including families, over the next 10 to
20 years. That many places are already moving into
areas and establishing out-patient programs. Why are
they doing that? They’re doing that because the best
information they have about national health care or
ObamaCare is that drug and alcohol money is going
to filter down to outpatient, for the most part. Don’t
know how many episodes. Don’t even know if they’ll
be any kind of transition funding into residential or an
in-patient program. But that the bulk of the money is
going to out-patient care. And, the number that seems
to be prevalent out there is somewhere between seven
and ten thousand dollars. These out-patient position
places are really popping up all over in anticipation of
ObamaCare. Now, if that doesn’t happen, everything
changes. I think that’s what’s going to happen and
that’s what’s in the cards at this point. An interesting
challenge, then, is going to be for the residential and
the inpatient programs. Is there going to be any insurance
benefit for them? And if not, how much outpatient
care is going to take away from residential care?
Because this general philosophy is still, although it’s
bizarre that we still think this way in many cases... We
think that you should do outpatient first before you do
in patient. Now, the problem with that is... That’s great
reasoning, but the reason most people fail in outpatient
is because they shouldn’t have been out patient
in the first place. They should’ve been in patient. We
may help them for a week or two weeks or five weeks,
and if they either leave or at the conclusion of their
out-patient treatment they continue on in their addiction
or return to their addiction, then what do we do?
Repeat outpatient? Where is the residential care, and
then where is the extended care after residential care?

Andrew: Jerry McDonald, I want to thank you for making
the time to spend with me today and talk about
some of these fascinating issues and learn a little bit
more about yourself.

Jerry: Thank you, Andrew.

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