Last year, Benjamin Silverman and Olivera Bogunovic, both psychiatrists with McLean Hospital and professors at Harvard Medical School, sat down at a Starbucks in Belmont.
Their plan: Build the gold standard for outpatient substance abuse treatment.
Typically, after a patient leaves a residential treatment program, where they participate in individual and group therapy more than 100 hours per week, the person sees someone once a week for a few weeks.
"Suddenly you're put back into life," Dr. Bogunovic said. "We realized that it has to be a continuum of care."
And so the doctors launched Hingham Wellness, a more comprehensive and intensive approach to outpatient care that works with patients simultaneously dealing with addiction and psychiatric disorders, which are often the crux of a substance abuse problem.
Dr. Bogunovic and Dr. Silverman chose the South Shore, and Hingham in particular, because they saw a lack of specialized addiction care in the area.
"People have been really struggling on the South Shore," Dr. Bogunovic said.
The decision to focus on co-occurring issues – mental health and addiction – was one of several the doctors made that they said will help patients maintain long-term success.
Another was to offer flexibility. Patients sign up for the program, which can run between $2,500 and $7,500 per month (insurance not accepted), for a minimum of one month but a goal of three months.
Toward the end, patients are encouraged to step down by going to fewer nights per week, but they can also step back up and add nights depending on how things are going in their life.
All of the sessions are run by doctoral-level psychologists, and Hingham Wellness also has psychiatric nurse practitioners on staff. They work with a wide variety of addictions and disorders, from alcohol and benzodiazepines to PTSD and psychosis.
"There is nothing we can't or won't treat," Dr. Silverman said.
The program launched at the end of September at 175 Derby St., sharing space with Ascendant Psychiatric, where Dr. Bogunovic is the medical director. It started with four patients and is now up to half a dozen.
Group therapy is ideal with at least three patients but not more than eight, Dr. Silverman said. Just two people becomes couples therapy, even with strangers, and with too many patients there is not enough individualized focus.
Nights begin with dinner, roughly an hour of social time that the doctors built-in to allow patients time with traffic and time to get to know one another. The "rose and thorn of the day" question is asked, and staff members participate as well.
For now, sessions are held Monday, Tuesday and Thursday, but Wednesdays will likely be added soon. Each night offers a different three-hour clinical schedule, with one-on-one therapy joining group topics such as mindfulness meditation, relapse prevention and emotional regulation.
Individualized treatment plans are developed during intake sessions with Dr. Silverman and Dr. Bogunovic. Current health care providers and family members can also be kept in the loop.
During therapy, the clinicians focus on experience and providing coping skills, rather than a lecturing approach.
"At times, we may ask clients to feel stress, anxiety, or discomfort in the group setting, in order to sit with and work through these feelings with the support of group leaders and members," as described on the program's website.
"Such experiential exercises are ideally suited to helping clients be able to utilize coping skills in similarly stressful or triggering situations outside the group room and in day-to-day life."
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