What is an Alternative Peer Group (APG)?

Alternative Peer Groups (APGs) are thriving in Texas, and because of a new documentary Generation Found, you will be hearing more about them. I recently had a chance to meet the godfather of APGs: John Cates, MA, LCDC, founder and CEO of Lifeway International, a residential treatment, IOP, PHP, APG, and a recovery school under their umbrella of services. Lifeway is unique in that it has expanded the APG model to also treat adults over twenty-five. John has over 40 years of experience with addiction treatment and counseling. John is also one of the vice-chairs of the Association of Alternative Peer Groups.

In this interview, you will learn what an APG is, the Baylor research which shows the success of Alternative Peer Groups compared to other options post-treatment (IOP, PHP, etc), and how to start one if you dare to.

As a preface, APG models are not clinically based, but instead community-based recovery services that may have clinical support. This means that there are social events tied into an APG and family services. This is a key difference between an Intensive Outpatient Program (IOP) and an APG. Alternative Peer Groups also welcome participation and communication and continued relationships with any therapist, psychiatrist or referring professional who is connected to the client prior to enrollment. Their approach starts with addiction is a disease. (For those that do not want to read, watch this video about what an APG is.)

John, you have been working with APGs and recovery schools for over 40 years. Because you are a walking history of recovery with Houston’s adolescents, the board of Three Oaks Academy recently voted to rename it Cates Academy. Congratulations for this honor. John, would you share why the research began 7 years ago and what the key findings were? (Click here to view research.)

Well, Jenney, APGs have been operating for the last 45 years. They have always been considered a quasi-professional, non-clinical support type service. Unfortunately, they began in Houston, Texas instead of the east or west coast cities or Minnesota, so did not get the attention that usually comes to organizations that are often making these big advances. In addition, the program was not designed in a place of higher learning or medical facility, but rather by a group of young people just holding on to one another and attempting to keep from dying or going to jail in the 70’s.

Finally, Dr. Scott Bassinger of Baylor College of Medicine…my hero… caught the rumor of this thing that had been going on for the last few decades, and he made the momentous decision to initiate a comprehensive research plunge into the effectiveness of this “legend”. His outcomes were, in fact, that the legend held water and that all things even, the use of an APG would approximately triple the chance of success of the next runner up….typical treatment procedures we are all used to, and even further outdistance the success rates of “let them hit a bottom” and find their way, unassisted.

What are the key components and Best Practices of an APG?

Of course, the startup answer is to follow the appropriate laws and codes of ethics, but the rest of the answer should in my opinion be couched in the reality that we are dealing with a disease, and when dealing with a disease, the goal is always to get 10 out of 10 well. If you are not getting 10 out of 10 well, then are you not doing something you should or doing something you shouldn’t? Or both? Until these life-threatening questions are answered, there is a need to never set up sacred cows that will keep one from changing approaches. Given this principle, the first best practice is to keep looking for efficacy-based answers to augment a program until there is no more suffering. BE WILLING AND EVEN EAGER TO LEARN AND ADOPT NEW TOOLS INTO THE PROGRAM.

Over the last 45 years, all of the APG programs and their people (staff and clients) have created a giant bag of practices that equals the successes they enjoy. The Association and its members are tenaciously working trying to tie this bag into a curriculum that will encompass all that we do. This is a huge undertaking because it has to take into account a variety of environments, resources, and opportunities. An Alternative Peer Group program can be a beginning group of a few family members and clients who meet with a facilitator one night a week, or a large multi-national program that has a huge number of clinical options and services. A “best practice code” has to fit all these situations.

The most functional way to approach this is to answer the first part of your question, “What are the key components of an APG”. The core is what I cited above, “family and clients meeting regularly with a facilitator”.

In addition to the core there are all the other components of the clinical elements, where offered. As I said, the Association of Alternative Peer Group Programs has been coding Best Practices, and my co-vice chair in the Association Annette Edens, Ph.D, offered the following, “Family involvement, Individualized planning with continuous review and adjustment of plan, Age-appropriate social activities, Social Skills training. I would add (for both teens and parents) recovery support community, clear rules and consequences, serious accountability, peer mentoring, and education in areas relevant to parenting and addiction.”

Of course, as the service offerings expand, these best practices expand. You can imagine what it will look like when we start talking about an APG Program like Lifeway that provides school, residential, etc. My personal favorite best practice is summed up in the concept:

Enthusiastic Recovery!

Are APGs steeped in the 12 Step model or is this an alternative type of recovery?

Typically APGs have a considerable element that is associated with the 12 Step organizations. However, many APGs will also take into consideration and use a variety of clinical approaches as well as preparing the clients to insinuate themselves into the most case-appropriate maintenance organization.

The APG is not AA or NA junior. An APG is a professional approach dressed in populist clothing whose main focus is to help a client and his family to insinuate himself into the most appropriate recovery maintenance process possible as soon as possible. For many, the 12 step organizations fit this goal. One of the tricks that an APG performs is getting a client through the period when leaving recovery processes is most likely and problematic . An APG has employees who are there and charged with intervening, or helping family members intervene when things are going badly, helping family members learn how to support when things are going well, and how not to sabotage. This support is available for 18 months to 4 years in whichever venue the client and their family has entered. For example, if the client is in a residential venue and wanting to leave, the APG facilitator will coach the loved ones and friends on how the redirect the client. Failing that, the APG facilitator will coach the loved ones on how to intervene so that the damage during the slip is minimized and return to the recovery road is as rapid as possible, reducing the neuropsychological and psychological damage and further parlaying the experience into a learning experience for the client, the family, and friend relations in the APG group.

What is the average length of engagement for an adolescent with an APG, or specifically at Lifeway?

Different APGs will have different lengths of engagement based on several factors. One of the most significant is the access to non-staffed maintenance programs upon discharge. Should a community have strong non-staffed maintenance programs available, the discharge will be based upon sound clinical and research based indicators. In Lifeway, we have used the research to identify several behavioral indicators of stabilization that can be observed. When these objective behaviors occur, then we have a big hullabaloo celebration and say goodbye to the clients as clients and hello as brothers and sisters in recovery.

Of course, there are a variety of systems that are engaged to help the clients and their families transfer from Lifeway’s support to the new non-staffed maintenance program in their plan. Because the research is powerful in determining that stabilization in recovery in this disease takes an average of 18 months to four years, most of our discharges occur during that period of time. However, we begin the transition to the non-staffed maintenance program upon entrance into Lifeway.  If a family looks like AA will be the most appropriate landing program for them, we start introducing them into those elements upon admission.

What does a week at an Alternative Peer Group week look like?

If it is a new family of an adolescent, and the school is appropriate, Monday morning will start with school. However, this school will be a different world. The student body will be made up of almost all experienced sober students who, because of their recovery, are actively studying emotional responsibility in all their living environments. They will be involved in trying to support each other in that process – and their families will be pledged to the same process. It is probably impossible for most readers to imagine this as few of us have seen a high school like this since the 40s if even then. The school is dedicated on the principles of honesty including facing the truth about our culture’s dishonesty concerning the use of mind-changing chemicals. Because a school of sober kids creates a totally different academic situation, it becomes academically super-charged because no one is having a hangover or missing school because they were in juvenile detention, or wired out of their mind on their friend’s Adderall. During the school day, there are meetings and personal help sessions with facilitators that have “been there”. At the end of each week, a report goes out to all the involved people letting them know what was accomplished and what needs to be worked on.

At the end of each day, Monday thru Thursday, the young people will, as long as one is available in their APG Program, go to the day center for social activities before they go home. Usually two nights a week, they will attend meetings. At least one of those (usually two) meetings are APG meetings with a facilitator and their parents in the other room in their own meeting. Other meetings during the week will be a non-staffed maintenance program like AA.

On Friday and Saturday nights, the young people will attend pre-planned social functions. They will be fun, but substance free! The parents may well attend one of these themselves.

Additionally, there will be special treatment and social activities spaced, usually on a monthly basis, throughout the year.

Adults follow a similar schedule, but instead of high school, they are involved in the daytime in college, or work. In the case of a college student, the Alternative Peer Group will work, if possible, in a recovering students program within the college; likewise if it is work, the APG will attempt to work with the employer or an Employee Assistance program at the workplace. The adults have similar schedules for meetings and social functions.

If the client is involved in therapeutic elements like intensive outpatient counseling, the school/work days fold around that as needed.

It is a very busy schedule, but most studies suggest that idle time and isolation in the first years of recovery are not helpful. There is an old saying, “My mind is like a bad neighborhood…not a place I should go alone very often.” APG Programs work very hard to help our clients and their families stay out of those neighborhoods and instead hang in neighborhoods of hope, growth, and healing.

Lifeway has a Recovery School, John Cates Academy, as part of its programming. Is this the norm?

Unfortunately, no, it is not the norm. Being thirty one years old and my having a history in education made it a natural for Lifeway to develop its own school. Fortunately, however, the importance of requiring the APG for students at a recovery school is now becoming better known and we are seeing great programs where recovery schools are aligning with APGs or building their own. In Houston, Archway Academy is a great example of a school that requires all its students to be in an APG Program to attend, and the results are wonderful. In Austin, University High School is following a similar path and other schools around the country in the Association of Recovery Schools are digging in deep and finding out how to pull this off. All of us in the Association of Alternative Peer Group Programs and the Association of Recovery Schools are working overtime to help facilitate these enhancements whenever requested.

Where are other APGs in the country?

The list is growing, as there are new programs being built as we write, but the states that we know of are listed in the Association of Recovery Schools report, accessed (along with a great deal of other great information) at https://recoveryschools.org/marketstudy/.

How could a professional or group find out more about creating an APG in their community?

That is the easiest question you have asked, Jenney. I am in charge of handling new membership at the Association of Alternative Peer Group Programs, so all they have to do is contact me and I will put them into the process and get it done. My email is lifeway2@aol.com and my cell number is 713-459-9427. Just give me a call.

Am I wrong that Lifeway & Teen & Family Services have replication models and share their experiences with other professionals who might be interested in these services?

No, you are right. Again, they can be accessed by contacting me at the above places.

About the Author

John is currently one of the vice-chairs of the Association of Alternative Peer Groups.