Navigating through wilderness therapy

Written by crchealthgroup   // September 4, 2013   // Comments Off


As seen in Addiction Professional magazine, August 26, 2013, by Shannon Brys:

In the wake of a July statement from Aspen Education Group, an organization that was acquired by CRC Health Group in 2006, that announced that it would be ceasing operations at five adolescent programs, two of which were therapeutic wilderness programs, the validity, safety, and effectiveness of wilderness programs continue to be debated among the treatment community.

Rick Meeves, PhD, LMFT, who was recently promoted to Regional Vice President of Western Youth Services at Aspen, thinks highly of these programs and says the key is spreading the message about them and making programs more competitive by having dual-diagnosis programs (addressing substance abuse issues as well as mental illness).

Meeves has spent almost 17 years working with troubled teens and their families and is a veteran when it comes to the wilderness programs. He founded Outback Therapeutic Expeditions in 2001 and worked for two other wilderness programs prior to that. In his new position, Meeves will oversee six of CRC’s youth treatment programs, including one wilderness program (Outback Therapeutic Expeditions). He refers to the wilderness programs at Aspen as “therapeutic wilderness programs” to differentiate from other types such behavioral, adventure-driven and boot camp programs.

The importance of research

Meeves places a large emphasis on the importance of research and outcomes studies. Most recently, he worked on the clinical quality management team at CRC and was responsible for the outcome and efficacy studies for both the wilderness and residential programs. “I’m happy to report that not only are those studies continuing forward, but they’ve also rendered the type of results that help support our message. These programs are showing tremendous gains using measures such as the trademarked Youth Outcome Questionnaire (YO-Q).”

He continues, “You can have a quality program but if you’re not measuring and verifying treatment effectiveness, especially in your message, then it really does a disservice to the programs.”

Sarah (Salli) Lewis, PhD, director of the research division of the Center for Research, Assessment and Treatment Efficacy (CReATE), feels that studies on this topic are critical because they allow the field to better speak to the scientific merit, the legitimacy of a wilderness therapy program.

Lewis spoke with Addiction Professional about recent research on the effectiveness of wilderness-based therapy programs for adolescents and young adults. One study, which began in 2006, looked at wilderness program effectiveness for a large sample of adolescents and found that the participants demonstrated significant symptomatic reductions and maintained these improvements for a full year after treatment. The study was published in Child and Adolescent Mental Health. A second study, completed in 2012, assessed the effectiveness of substance-specific wilderness programs, of which there are only a small handful. Aspen’s Four Circles Recovery Center was instrumental in the launch and execution of the large-scale, longitudinal study, and was a primary collection site as well. Data are in the process of being submitted for peer review in a professional journal publication. Both studies were conducted by CReATE in collaboration with the Intervention Sciences Laboratory at the University of Arkansas.

The latter multi-site, substance-specific clinical study sampled hundreds of young adults from three treatment sites: two substance-specific, wilderness-based treatment programs and one treatment-as-usual inpatient program. The study served as an evaluation of the effectiveness of substance-specific wilderness treatment, which is a relatively new treatment modality, compared to the industry standard of care. The study assessed participants at five time-points over the duration of the study, including admission to treatment, mid-point of treatment, treatment graduation, three months after graduation, and 12 months after graduation. At the three- and 12-month post-treatment assessment periods, participants engaged in a phone interview to assess issues such as substance use, measures of distress tolerance, trauma, nicotine use, and other topics that are theoretically related to relapse. Findings were that substance-specific wilderness programming effectively targeted and reduced symptoms of substance use disorders, as well as associated disorders.

Leaving the wilderness programs

In the adolescent study, researchers were able to examine the persistence of therapeutic improvements as participants went on to a variety of milieus upon completion of wilderness treatment. Some of the sample went home and didn’t participate in follow-up care, some had outpatient services, and some continued with residential support such as a therapeutic boarding school. The important piece of the puzzle, says Lewis, was to then compare the durability of those improvements. Regarding disruptive behavior and substance use disorders adolescents’ therapeutic improvements were maintained, whether they continued with residential or outpatient series. More specifically, the data suggested that symptom reduction such as cravings, frequency of use, and behavioral dyscontrol overall, persisted for a full year following completion of wilderness treatment.


Results of the wilderness programs – both general and substance-specific – show significant symptom reduction across multiple life domains, including:

  • Improved symptoms associated with substance abuse and dependency, including but not limited to:
  • impairment in relationships,
  • overall functioning,
  • negative consequences,
  • cravings,
  • maladaptive coping, and,
  • distress tolerance.
  • Symptoms of co-occurring disorders also improved markedly, including:
  • depression,
  • anxiety,
  • panic disorder,
  • suicidality, and,
  • sleep disruption.
  • Positive indices increased as well, including quality of life, academic performance, and healthy interpersonal functioning.

In the substance-specific wilderness programs, 71% of study participants reported persistent and positive treatment effects three months after graduation; one year following program completion, 62% of participants maintained treatment gains, successfully managing their recovery. The outcomes of the wilderness programs were as significant as the treatment-as-usual facility that was studied. About 30% of individuals overall in the substance-specific wilderness programs reported a relapse over the course of 12 months.

Removing people from ‘reality’?

Much of the criticism surrounding wilderness programs revolves around the fact that because the treatment environment is extremely different from reality, participants may have a hard time translating the lessons into their lives after treatment. Lewis says the results of these studies suggest the opposite. “What our data suggests is that this environment appears to be beneficial because while it is somewhat contrived and different from the real world, it is providing a protected, distraction-free environment where people are able to really engage in treatment and benefit from this a multi-disciplinary approach, including many targeted components,” she says. “These components include skill acquisition and rehearsal, cognitive behavioral intervention, motivational enhancement, and 12-Step facilitation as well as other aspects we know are evidence-based. An additional and critical ingredient is relapse prevention, which directly addresses the question of ‘how do we integrate folks back into the real world, with all the requisite support to maintain their recovery, while also avoiding a deer in the headlights experience?’”

Better fit for young people

There is data that suggests that people who participate in wilderness therapy have high treatment satisfaction rates and report being able to engage more readily in treatment, appreciating the outcomes of treatment better, and overall feel like it’s a better fit.

“Therapeutic wilderness programs are very powerful in their ability to separate the child or young adult from their past at home, including friends, drugs, escapes, challenges and problems,” Meeves explains. “When you put a person out in the wilderness for 6 to 8 weeks, that really helps them start to see themselves for who they are becoming and to look at the roads they have been going down and realize that they haven’t been very helpful. Or if there are legitimate diagnosable issues, they can learn how to better deal with those than in the problematic or destructive ways that they have used to medicate their pain in the past.”


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