An Interview with Donna Markus, Executive Director of Promises Malibu

By Meghan O'Dell

Q: How long have you been in this field of work, and how did you become interested in Promises?

A: I started working in the field of addiction in 1976, with a few forays out of it. After working in the field for some time, I decided to get my doctorate because I wanted to work as a child psychologist. My heart had always been with addiction, but I wanted to do some prevention work by intervening earlier and helping children before they turn to drugs and alcohol.

After getting my PhD from the California School of Professional Psychology in Los Angeles, I worked with children for a number of years. But health care reform made it very challenging to do quality work, so I decided to come back to the addiction field.

About three and a half years ago I got a call from the owner of Promises, who told me they were looking for an Executive Director for the Malibu location. I had been aware of Promises since they opened 20 years ago, but at the time I didn’t fully appreciate the scope and quality of services provided. I did some investigation into the company and thought, “I would love to work there!”

Q: What kind of work do you do at Promises?

A: I’m responsible for all clinical and program activities, ensuring that we provide comprehensive, quality services; maintain integrity to our treatment philosophy and principles; and adhere to the standards of licensing and regulatory bodies.

I’m involved from A to Z. I work closely with the admissions department and the clinical team in terms of client care, and I’m constantly looking at the program curriculum and therapeutic milieu to find ways to improve what we’re doing. I work closely with the Marketing/Outreach department as well; networking with other programs and professionals not only creates potential referrals to our program but assists us in identifying resources for our clients when they discharge. I believe it’s essential that when our clients leave Promises, they have all the resources they need to continue their recovery. I also occasionally have a client caseload.

My goal is to support the staff and create an environment that clients and staff will flourish in, to create the best space for clients to feel safe and comfortable to take the emotional risks necessary to do the self-examination and work here. In some respects, I look at the program as my client—what’s needed, how do I improve its functioning, how do I support it?

Q: Can you explain your philosophy of treatment?

A: I embrace the disease concept of addiction and believe there are a number of factors that contribute to the onset and/or maintenance of addiction. Recovery is a life-long process and isn’t accomplished in the short amount of time that the client participates in treatment with us. I believe that the goal of treatment is to launch the recovery process and impress upon the client and family members the necessity of following through with the continuing care recommendations to sustain the gains made in treatment and continue with the recovery process.

Another important thing is to get the client to recognize the negative impact that alcohol or drugs has had on his or her life, as well as the need to begin a complete recovery process that will be life-long. Once a client recognizes that they’ve lost the ability to control their using, they need to accept a course of abstinence, which entails behavioral, attitudinal, and lifestyle changes.

When a person realizes that what was their solution has become their problem, we need to offer them some hope that they can replace it with something better. In order to that, we need to look at each client’s internal and external vulnerabilities and any obstacles to their ongoing recovery. Most addicts have tremendous difficulty dealing with feelings, so we need to help them learn how to manage their feelings, to identify the stressors that contribute to them wanting to use, and to help them find healthy ways to cope with those feelings and stressors.

At Promises, many of our clients are high-functioning in the career world, and there are a lot of stressors that come along with that, so most of them use alcohol or drugs as a way to unwind or relax, have more energy, diffuse the anxiety. Their using has had an adverse impact on their family life and other interpersonal relationships, so we may need to work with them on restoring relationships and help them rebuild their social and communication skills. It may be that their life has centered around using and they don’t know what to do when they’re not using, so we help them re-evaluate their lives and their values, learn how to find purpose and meaning in their lives, and learn how to have fun without being intoxicated and find other ways to spend their free time.

A lot of what we do at Promises has to do with regulating feelings, so we need to teach clients how to recognize what is going on with their bodies on a physiological level and an emotional level. After we get a client to realize that they are suffering from the disease of addiction, we teach them how to replace maladaptive coping mechanisms with more constructive ones, and then we prepare them for continuing care, trying to create the best support for them once they leave here.

Q: What types of therapy do you use at Promises?

A: Clients receive a lot of individual therapy and group therapy, psychoeducation, and experiential work. We do supportive-expressive psychotherapy, insight-oriented therapy, Cognitive-Behavioral Therapy, motivational interviewing, somatic work, Eye Movement Desensitization and Reprocessing (EMDR), and a little bit of Dialectical Behavioral Therapy (DBT). Our therapists have a variety of different tools in their toolbox and we try to match people as best we can with the right therapist.

Chronic drug and alcohol use changes the brain at neurochemical, cellular, and structural levels, so a client will likely be cognitively impaired and impacted emotionally. Also, the way the client perceives herself in the world has been affected, and the way she processes emotions and memories has been affected. So we need to allow the client time to clear and for the brain chemistry to “recalibrate” and create new neural pathways.

Examples of experiential work include meditation, yoga, equine-assisted therapy, psychodrama, and mindfulness relapse prevention.
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Q: What things do you think are most helpful to a new client in treatment?

A: I think the most important thing for clients to come in with is an open mind. Some people come to Promises self-referred and some are influenced by someone. Either way, it’s important to have an open mind to the structure and services offered. In many ways, recovery is pretty simple: You just don’t pick up the first drink or drug, and then you change everything. Changing everything is the tougher part. So in many ways it’s much more than they imagine and yet it’s manageable—one day at a time.

It’s important to offer clients hope that their lives can change, and one of the ways that we get to do that is through the staff. Many of us are in recovery ourselves, so what we’ve gone through can be inspirational for clients and provide them with some hope. The 12-step program is another area where we can give clients a great opportunity to turn their lives around.

It’s also imperative to give clients a good orientation to the program and let them know what their treatment experience might look like. If they are new to recovery, we introduce them to recovery concepts because it’s really a new language.

I also like to let clients know that it’s perfectly normal to feel ambivalent about their recovery. I have never met a client who doesn’t have some mixed feelings about the process. I want clients to know that it’s okay to come to someone and say, “I’m not sure I want this; I’m having a hard time right now; I don’t know if I can embrace this idea of never using again.” These feelings are really normal, and clients need to feel safe and know that we’re willing to walk them through whatever they’re going through.

Q: You have several years of recovery yourself; how does your own experience inform your treatment philosophy?

A: I went to multiple treatment programs in the 1970s, and back then treatment for addiction was very different than it is today. When I was in treatment, the belief was that no one truly recovered from addiction, and that if you did recover, you probably weren’t a “hardcore” addict. But I was a hardcore addict. I’m nothing like the young woman who walked into recovery years ago. I hit a very low bottom—I was homeless and estranged from my family and I didn’t want to live like that anymore. I know many people with long-term recovery and I know treatment and 12-step programs work. I’ve witnessed so many people with both low and high bottoms transform from addicts in active addiction to recovery. I have a lot of passion for making treatment available to men and women.

I think recovery is about learning to live life on life’s terms, and gaining the skills to do that. Over the years I’ve gone through a lot of experiences, some wondrous and outstanding and some painful and challenging. It was the example of others and the support from others that ensured me I could get through anything without resorting to drugs.

I have a lot of empathy and compassion for the experience of walking into a treatment program scared and alone and terrified to give up the comfort of using. So many addicts are challenged with reaching out for help and allowing other people to really know them and support them. The process of honest self-examination and establishing a trusting relationship with someone to do that exploration and processing can be terrifying for a client. As I said earlier, a client needs to feel respected and cared for.

When I look back at how we were addressing addiction 20 or 30 years ago, I think, “I can’t believe we did that!” Our understanding of addiction and the recovery process has evolved tremendously. My hope is that when we look back 20 or 30 years from now, we’ll still be able to say, “I can’t believe we did that then!”

Q: What do you think sets Promises apart from other treatment programs?

A: We have an incredible staff full of really qualified and competent people who have been doing this for quite a while, so I think we are able to be flexible in our approach. We individualize treatment in unique ways—we’re able to tailor an individual’s program to fit their clinical needs within a population that wants what the other person is getting in terms of treatment services and “privileges.” Where it’s appropriate to apply those services and privileges to another person we will do so, but we won’t do it just to make them happy and not rock the boat. We strive to do what’s in the best interest clinically for the client and the treatment community.

We have more than 20 years of history here, and as a result we have a rich network of resources nationwide and internationally in terms of therapists and other care providers. When we get ready to discharge someone, we want to set them up with necessary resources like a therapist, family therapist, psychiatrist, a sober living home if necessary, or whatever else they might need.

We also have a longstanding alumni network, so we’ll do our best to match clients with up someone from their home community. Our alumni are also available to support clients while they’re in treatment.

In addition, at least 90% of our staff is in recovery themselves, so it helps clients to know that we’ve had the experience. The recovering staff have more than just the street smarts, but also the academic training and skills to support clients. We’re not going to be shocked at what they’ve done or where they’ve been because we might have gone through that too and done what they’ve done one thousand times over.

For example, I was a chronic relapser and didn’t get clean on my first attempt, and I’ll sometimes share that with clients. When someone comes back through Promises after having been here once or twice before, I’m always optimistic. They come back filled with shame and guilt and can’t believe it happened, and I welcome them back with open arms and try to provide them with some hope that they too can get clean and stay clean.

Q: What have you learned over the years about what works and what doesn’t work?

A: There are a number of things that work and that are essential, but it’s extremely important that the relationship between client and staff is about respect and care. Clients need to know that you genuinely care about them. It’s also important to take a look at the whole person and the variables that might have contributed to the onset or maintenance of addiction. I think that taking a whole-person approach—physical, emotional, spiritual, and cognitive—is really important, because all of those areas need healing.

I’m also a strong advocate of the 12-step program. Research demonstrates that long-term continuous abstinence and quality of life are associated with participation in 12-step programs. I think it’s important to address clients’ resistance to 12-step programs, if any, and their experience with it as a way to help them to be willing to engage in it. It’s also essential to equip clients with everything they need to prevent relapse, as that’s what treatment is all about—stabilizing, educating, and preventing relapse. We need to encourage and foster a willingness to continue the process of recovery when clients leave Promises.

Another thing that is essential for long-term recovery is getting the family and loved ones involved, both during and after treatment. We have a very strong family component at Promises; we have two full-time family therapists and they do incredible work with all of the members. We also have great resources out in the community that we set clients up with.
If a client’s family is out of state or country, our therapists will call them and try to get them to come out here as often as possible. If the family isn’t able to come out, we can set up phone sessions, conference calls, or even use Web cameras.

We also have the alumni group for families in Los Angeles, providing a weekly support group for alumni families as well as current family members. You can’t return a treated individual to an untreated environment, so it’s important to access and engage the family.

Q: What do you think gives people the best chance of sustained recovery?

A: I think people need to accept that they’ve lost the ability to control their using and that they’re powerless over their addiction. They need to understand that they can’t control it a little bit or substitute it with something else; that no matter what, they can’t use again. This is the first step, and I think that anyone who has done a thorough first step has significantly decreased the chance that they’re going to use again. If using isn’t an option, they have a willingness to do some of the work and to learn about themselves and what they need to do to continue to stay clean.

Early recovery is really difficult—our brain chemistry is off and we’re on an emotional rollercoaster, we’re awkward around family and friends, and we have to make a lot of difficult lifestyle changes, so there needs to be that appreciation and willingness to change everything. It’s also incredibly important to learn the universal triggers and to identify their own internal and external vulnerabilities.

We also want to get clients to appreciate that there’s a reason why we engage them in certain activities. It may not make sense to them at first, but we create a structure here that we hope they will internalize and take with them. Addicts are so used to instant gratification and their executive functioning has been severely impaired by their alcohol or drug use, so they need to have structure and to understand cause and effect and consequences. We do a lot of “fire drills”: Practice reaching out to people, going to meetings; practice using the phone now because when things get tough, it’s important to know where the phone is, who to call, and where to go if you smell smoke.