Levels of Care

Priya Ramaswamy, a thirty-four-year-old graphic designer in Minneapolis, came home from a five-day inpatient stay with two pages of discharge paperwork and a recommendation that she enrol in either “the day hospital program at the medical centre” or “a PHP through her insurance network.” She spent most of an afternoon trying to figure out which … Read more

Marcus had been drinking a fifth of vodka every night for six months when his wife in Boise issued the ultimatum. He expected a thirty-day rehab bill that would empty their savings. Instead, his primary care doctor sent him to a clinic on State Street that ran an outpatient detox program three blocks from his … Read more

Marisol Pereira had been a foster parent in Eugene for eleven years before she said yes to her first therapeutic foster care placement. The boy was fourteen, named Jaden, and had cycled through nine placements since age seven. He had been hospitalized four times for self-harm and was stepping down from residential treatment in Idaho. … Read more

When Weekly Therapy Is Not Enough You have been seeing a therapist for several months. The first few sessions felt productive. You appreciated having a neutral person to talk to. But somewhere along the way, the progress stalled. The anxiety still spikes without warning. The depression still makes getting out of bed a negotiation every … Read more

When Daniel Hwang got out of his second residential rehab in Delray Beach, the discharge counselor handed him a brochure for a sober house ten minutes away. Daniel had bipolar I disorder. He had been stabilized on lithium and quetiapine for almost two years. The medications were the reason he had finally been able to … Read more

Dr. Elena Vasquez had been running a family practice in Tucson for twelve years before she did her first real SBIRT screening. The patient was Reggie, a sixty-one-year-old retired postal worker who came in for a sore knee. Out of habit, Elena handed him the AUDIT questionnaire she had recently added to her intake packet. … Read more

Tasha Reynolds walked into the storefront on Park Street in Hartford on a Tuesday afternoon because her car had broken down and the bus stop was right outside. She had been out of inpatient treatment for five weeks. Her insurance had paid for twenty-eight days, then run out. Her counselor had handed her a list … Read more

Pavel arrived at a Detroit medical detox unit on a Wednesday in February with a blood alcohol level of .31, mild seizure-precursor tremors, and the phone number of an outpatient counselor he had been dodging for eight months. Six days later he was discharged to a 60-day residential program in Brighton, Michigan, the next step … Read more

Renata had been in and out of therapy in Chicago since she was 19. By 34 she had collected four different diagnoses (major depression, generalized anxiety, complex PTSD, and “treatment-resistant mood disorder”), six therapists, three antidepressant trials that did not help, and a marriage that had ended after her husband told a couples counselor he … Read more

Marcus was sitting in his Phoenix apartment at 2 a.m. with a bottle of his mother’s old hydrocodone in one hand and his phone in the other. The 31-year-old warehouse supervisor had not slept in four days. His sister had moved out the previous weekend, his lease renewal letter had arrived Tuesday, and the panic … Read more