People don’t necessarily want you in their “neighborhood.” Get used to it. There is still a stigma in this country around addiction and those who suffer from it. Not everyone understands that addiction is a disease and that those who suffer from it need professional help. Sometimes when you try to help people in a new area or location, there will be people who don’t want you there. That’s okay — you have to keep moving forward and doing what you know is right.
As a part of our series about “Heroes Of The Addiction Crisis” I had the pleasure of interviewing Peter Piraino.
As Chief Executive Officer of Burning Tree Programs, Peter Piraino (LMSW, LCDC, LISAC) guides a team of addiction specialists who specialize in treating substance abuse disorder and the underlying mental health issues that addicts and alcoholics often face. Burning Tree is the nation’s leading treatment center for authentic long-term inpatient rehab, helping patients and their families heal through residential treatment and thoughtful aftercare. Prior to Burning Tree Programs, Peter served as Clinical and Executive Director for Origins Behavioral Health Care and The Last Resort Recovery Center.
Thank you so much for doing this with us! Can you tell us a bit of your backstory?
I was raised in Long Island, where drugs and alcohol became prevalent in my life by the age of 15. My addiction progressed under the radar for several years while I built a career owning and operating nightclubs up and down the East Coast with my older brother. When I was 24, my addiction to cocaine became crippling to the point where my family stepped in to intervene, encouraging me to attend Alcoholics Anonymous meetings and seek professional help. I ended up in treatment for eight or nine days — the most that my insurance would cover — before connecting with a counselor and an intensive 90-day outpatient program. The program worked for me, but also exposed to me the shortcomings in how addiction is handled in this country, which helped put me on the path where I am today.
Is there a particular story or incident that inspired you to get involved in your work with opioid and drug addiction?
Once I got sober, I had to decide what to do next. I had a strong foundation in business but wasn’t sure that I wanted to continue in the nightclub industry. I knew for sure that I wanted to help people but had no clue how to merge that with my expertise. My counselor at the time happened to have a similar background as me, and suggested I consider working with people like me who struggle with addiction. I ran with it, earning a master’s degree and license in social work and starting my career at local outpatient centers and rehabs.
Job opportunities brought my family and I to Texas in 2015, and eventually to Burning Tree Programs in 2018. I was drawn to Burning Tree because of their program for long-term chronic relapsers, aka getting people sober and keeping them sober.
This was important to me because during my time working in addiction facilities, I saw a common theme of patients coming into a treatment center and only getting short term solutions, which really only puts them back into a cycle of relapse, treatment, relapse. What many treatment centers are failing to address is long-term recovery and how to stay sober, which is the most important piece of the puzzle. This is what we do at Burning Tree and why I’m so proud of being part of this company. At Burning Tree our goal is to provide people the tools that they need to maintain their recovery long after they walk out of our doors.
Can you explain what brought us to this place? Where did this epidemic come from?
From my perspective, the cause of the addiction crisis in this country is two-pronged:
First, we live in a society that has been accustomed to instant gratification, we want more, we want it now and nothing is ever enough. Whether through traditional media or social media, we are seeking dopamine hits to the brain all day, every day. So many of us have such a strong desire to not feel pain, that we will try anything and everything to avoid it. This can lead directly to abuse of medication and addiction.
Secondly, but equally as important, we are here because the pharmaceutical industry continues to market their products as the “safe” way for us to eliminate whatever is causing our pain, whether that pain is physical or emotional. What many people don’t understand is that it was the pharmaceutical industry that created the pain scale used in hospitals and doctors’ offices across the country. Effectively exacerbating the notion that pain is completely curable and avoidable with a simple prescription. They have convinced healthcare providers and patients alike that use of their product is the cure-all to the symptoms they are experiencing, this is false.
It’s well documented that opioids in particular were heavily pushed by the pharmaceutical industry, the dangers of the product often not marketed or disclosed correctly. This fraud and abuse led to opioids being commonly over-prescribed, sending so many people down a dark path of addiction.
Can you describe how your work is making an impact battling this epidemic?
During college, I had a professor share an anecdote with me about addiction recovery and care that really stuck. He said, “Our job is to put ourselves out of business.” While it seems counterintuitive, it is spot on.
Our priority is to get people well by developing ethical treatments rooted in science that help our patients recover, for the long-term. We take the most “helpless” cases — from people on the edge of death to people who have spent years bouncing from facility to facility — and work with them to see the future that is possible for them. One of the things we do best is give hope back to families who have come to the point where they think their loved one cannot be helped. In most cases, they can be helped. It is about identifying the right treatment, which is something I believe we provide.
Wow! Without sharing real names, can you tell us a story about a particular individual who was impacted by your initiative?
One of the aspects of what we do is that we get to see the impact our treatment plan has on the lives of the patient as well as their family and friends. Their stories impact our lives as well. When I first moved to Texas and was working at another facility, I met a young man who had been to more than 30 treatment centers but was still struggling immensely. At the time I was already aware of Burning Tree Programs’ intense focus on long-term recovery with Burning Tree Ranch and encouraged him to seek help there. He resisted and proceeded to continue cycling through the treatment circuit in Texas and other states for several years, with no long-term success.
In 2019, after I had joined the team at Burning Tree, this young man reached back out to me seeking help. This time he made the commitment to come to Burning Tree Ranch, and I’m so happy to be able to say that it worked for him. He is sober and living an amazing life that most believed was no longer a reality for him.
Can you share something about your work that makes you most proud?
Finding new ways to reach people and help them is critical, and has always been a focus at Burning Tree Programs. It’s what first drew me to them and inspired me to pursue a leadership position so I could be part of the continued efforts to build effective treatment programs.
The chronic relapse program developed at Burning Tree Ranch is one of the best in the country. Our model includes eight to 14 months of residential treatment, followed by one year of aftercare. Having an addiction patient in treatment for such a long time and suddenly discharging them to be on their own can have catastrophic results. We set up our patients for success by having them go through a phased program where they are at our residential treatment center during the week, and at a transitional living facility on the weekends. This method allows a patient to slowly phase back into society which has been extremely effective.
Innovations in treatment like this, plus what we are doing with Mindfulness at our Renewal Lodge and our work getting young adults back on track with their education at Burning Tree West, is what makes me so passionate and proud to come to work every day.
Can you share three things that the community and society can do to help you address the root of this problem? Can you give some examples?
- Addiction is a health issue just like any other disease and we have to start treating it as such. We can do this by working to end the stigmatization of addiction. The same language we use to discuss and describe other medical problems should also be applied when speaking about addiction.
- When it comes to families and our personal relationships, simply talking openly and engaging in honest conversations with each other about struggling with addiction can be both healing and helpful. We tend to shy away from these conversations because they are uncomfortable and painful, but it is the first step toward getting someone the help they need. If addiction is identified, families should immediately reach out to licensed individuals for professional help, this is extremely important and should always be the first step taken to get someone help.
- Upwards of 200 people per day die from overdose. As a society, we tend to say, “That’s so sad,” and move on. We must collectively realize that these numbers are unacceptable and rally against the fact that the reason some of these people are dying is because they do not have access to the proper treatment. There are still many states in this country where affordable, quality treatment is not available, and there is no conceivable way to make real progress in ending our addiction epidemic unless that changes.
If you had the power to influence legislation, which three laws would you like to see introduced that might help you in your work?
- When it comes to insurance, we desperately need a nationalized standardized medical necessity scale for all providers to abide by. Right now, insurance companies base treatment allowances by determining a person’s medical necessity — in other words, what is a person’s specific medical need for a particular treatment. While this makes sense, the “scale” has been left up to each insurance provider thus creating a system with too many variables. In addition, the insurance companies do not have to share the scale with the facilities providing treatment to a patient, forcing the facilities to guess as to what will be approved and allowed for every patient and every insurance plan.
– For example, Insurance Company A may determine treatment based on a person’s physical condition, while Insurance Company B may focus on mental illness diagnosis or socioeconomic situation. These factors can also vary regionally or by state within each insurance company, further complicating the process. Clinicians and operators are often flying in the dark.
– A standardized medical necessity scale and criteria used by all insurance providers would do wonders for ensuring that patients get the help that they desperately need.
- It is a common practice for local politicians to intervene in the construction and operation of treatment centers in their districts. When politicians and community leaders care more about property values and perception than they do about their constituent’s lives, local treatment opportunities become inaccessible for many. This often leads to a higher percentage of deaths from overdose and drug addiction.
– To put an end to this practice, we need a standardized process allowing ethical substance abuse providers to operate without having to fight for approvals on a municipal or state level. You can dig further into my thoughts on this topic and my experience advising treatment agencies looking to operate in Long Island here.
- It is no secret that the pharmaceutical industry is backed by powerful players and lobbyists who tend to put the business before the patient. The companies who were instrumental in creating the opioid epidemic are the exact same companies who developed the treatment for the epidemic months later. There has to be more legal accountability and transparency for these companies when it comes to how they market their products to our population. While there have been major improvements in the past decade, there is still so much work that needs to be done on this front.
I know that this is not easy work. What keeps you going?
I don’t want to continue watching people die. There are so many people out there who are hurting, and there is not enough being done about it.
By providing and facilitating treatment, we can give a large number of people the opportunity to find their way to recovery and really make a difference in their lives. Being on the leadership side at a treatment facility allows me to guide and position how we effect change, and I am so excited and hopeful for where Burning Tree Programs is going. We have programs designed to fit specific needs and any insurance situation, which is now more important than ever. Burning Tree has never been a profit-driven company, which is something that I am so proud of and passionate about.
Do you have hope that one day this leading cause of death can be defeated?
I don’t think that we will ever be able to say that addiction has been eradicated; however, I truly believe that we can put a significant dent in the amount of people who die from their addiction. We have the power and ability to change and continue improving how we treat addiction, and to make that treatment more readily available and affordable for those who need it. The key is giving the people that need help, the opportunity for recovery.
How do you define “Leadership”? Can you explain what you mean or give an example?
To me, leadership means caring about my employees in the same way that they care about their clients. An employee’s caseload is their clients, while my caseload is my employees. I believe in investing in our team by providing opportunities for professional and personal growth, and giving them the support needed in order to be excited about their work and what they do.
What are your “5 things I wish someone told me when I first started” and why. Please share a story or example for each.
- Never stop learning. None of us know everything there is to know. There is always an opportunity to grow through continuous learning. In my way of life, I often see that people can get locked into one mentality or modality of treatment that they think is right because of their own life experience. This leads to blinders, causing them to not see the science that is coming down the line or even the changes to the population that will be seeking treatment in the future. It is imperative that you continue to expand your comprehension and understanding through learning.
- Don’t leave or give up. This one is pretty simple, but it’s also one of those things that you need to consciously work at when you choose addiction treatment or social work as a career. Even when you hit bumps in the road, stay with it and don’t give up on the mission at hand. Don’t give up on your team, the patient, or yourself.
- People don’t necessarily want you in their “neighborhood.” Get used to it. There is still a stigma in this country around addiction and those who suffer from it. Not everyone understands that addiction is a disease and that those who suffer from it need professional help. Sometimes when you try to help people in a new area or location, there will be people who don’t want you there. That’s okay — you have to keep moving forward and doing what you know is right.
- Stay Gold. Many are familiar with this quote from “The Outsiders.” It is from a poem by Robert Frost called “Nothing Gold Can Stay.” To me, this means staying true to yourself and to your ethics. At no point should you be in a situation where you are compromising your integrity. I actually have a tattoo of this as a reminder to myself to be genuine and to stand up for what I believe in.
- You Don’t Have to Be Poor to Help People. People think you have to be a martyr to help others, but even when you are helping others, don’t be afraid to ask to be paid for the value that you bring to the table. It is ok and it is possible to make a decent living and help others at the same time.
You are a person of enormous influence. If you could inspire a movement that would bring the most amount of good to the most amount of people, what would that be? You never know what your idea can trigger. 🙂
If I could influence one movement it would be to encourage others to demand that legislation allows for ethical treatment opportunities for anyone living in their community. Right now in the United States there is so much red tape and bureaucracy. One state may have multiple effective and affordable treatment centers available for their population, while the neighboring state could have hardly any options for their population. At times, even the centers that do manage to open after years of fighting are unable to offer good treatment at affordable prices because of the millions of dollars spent getting off the ground.
For much too long, legislation has placed more value on land over the lives of addicts. This is wrong. My hope would be that I could inspire others to stand up and force the government to allow wide-spread, affordable substance abuse treatment to be provided to those who need it.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
“Faith without works is dead.” That is a quote from the Alcoholics Anonymous book. It has become my personal mantra and I say it often. What it means is that you can have all of the faith and hope in the world, but you still have to put in the work. Get up every day and make sure that you are doing the right thing. Put one foot in front of the other with intention and purpose.
Is there a person in the world, or in the US whom you would love to have a private breakfast or lunch with, and why?
Bill Wilson, one of the founders of Alcoholics Anonymous (AA) is the first person that comes to mind. His book, (Alcoholics Anonymous) changed my life. It made such a profound impact on me and how I carry myself through life. I would have loved to have had the opportunity to spend time with him, to get his take on addiction and alcoholism as a whole. I’d ask questions to better understand his purpose and what guided him through life.
How can our readers follow you on social media?
- LinkedIn: https://www.linkedin.com/company/burning-tree-programs
- Facebook: https://www.facebook.com/burningtreeprograms
- Twitter: https://twitter.com/BurningTreeTx
- Instagram: https://www.instagram.com/burning_tree_programs
Thank you so much for joining us. This was very inspirational.