Meet Mike McDaniel
Medical Director, Heartland House
Mike McDaniel grew up in Pacific Beach, went to college at UCSD, graduated medical school from UCLA, and completed his residency in psychiatry at UCSD. He has practiced psychiatry for forty years, is married, and has “three grown children who are self supporting through their own contributions, and three very cool grandchildren.”
- What brought you to Heartland House and the treatment of alcoholism and drug addictions?
Every doctor wants to be where there’s an epidemic; we all want to heal and be useful. Alcoholism and addiction is epidemic. Being the product of 27 years of California public education, I’ve always felt a responsibility towards the community that nurtured and supported me, San Diego, CA. Heartland House is in a San Diego neighborhood, it’s part of a community, it’s pragmatic, and oriented toward the solution. I immediately felt comfortable there. In my practice, I noticed that psychiatric treatment alone wasn’t generally useful to the active alcoholic/addict. I became very interested in 12 Step Recovery when I saw how beneficial it could be, both in interrupting the addiction and in offering a program for living that’s so practical and accessible. Heartland House’s no-nonsense approach to recovery and the 12 Steps made sense to me as a doctor. I consider Bill Wilson the pre-eminent psychologist of the twentieth century, even though of course he wasn’t formally a doctor.
- Briefly describe your position and duties at HH.
As the medical director at Heartland House, my role and duties have evolved, but my main job is to oversee treatment, review individual treatment plans with staff, and to confirm that treatment is consistent with established standards of care. Oversight and quality control, you could say. Nothing too creative; Robert’s the creative one. I dot the i’s and cross the t’s. I think that’s one reason we work well together.
- How has your role changed with Covid?
Covid 19 brought about many changes to my role. Men couldn’t get to their regular doctor’s appointments, so I took over a certain amount of direct patient care, including evaluations, diagnosis, treatment, and writing prescriptions to make sure the men had the medications they needed. Covid produced a lot of confusion in the early stages, like uncertainty about how safe it might be to keep your psychiatrist appointment, things like that. And then Covid itself was so confusing. As one of my friends said, “This virus doesn’t play by the rules.”
I was most afraid of the possibility of asymptomatic carriers, people who weren’t showing any sign of the illness but had been infected and could be contagious. One man like that could infect the whole house before we even knew it. Honestly I thought that was a pretty scary prospect. It was Jean McAllister who came up with a solution, “Why not quarantine the new men before they come into the main house?” A brilliant idea! And a very effective plan, which meant securing an area, putting aside beds for quarantine, thus lowering our census. The financial sacrifice of cutting our numbers in half was extremely concerning, but the health of the men and the safety of our house was most important.
There was a lot of seat-of-the-pants improvisation early on, a lot of educated guesswork which we mostly, fortunately, got right. Re-orienting the beds so the men slept head-to-toe, less likely to cough in each others’ face, things like that. The epidemic and the lockdown have been hard on the men; they’ve had limited visitors, limited outings, but mostly everybody’s made the best of it and cooperated. Then there’s the constant uncertainty and tension around unexpected visitors, and concerns about what the staff is doing in their off hours, who might be contagious, who might be bringing the virus in. In retrospect, it was pretty stressful for all of us. We’ve been very vigilant and we’ve been very lucky. Finally, we developed a routine that works, and we’re all more comfortable.
- What makes HH unique and maybe a cut above other residential programs from a mental health/medical perspective?
Heartland House is very diverse, a real strength. We’ve worked with local Native American tribes, the US military, and other recovery programs to broaden our appeal and approach to all men. We’ve learned a lot from each of those experiences. Whenever I’m in the House, I’m struck by the overall tone of serenity. Not that there isn’t all manner of discord, disagreement, failure, disappointment, and frustration at times. I think that’s all part of recovery, especially in the early going. But if you sit in our living room, with the photos of Bill Wilson and Dr Bob, I think you’ll see how calm a place it is, and how the diversity really works. I value that.
When I talk to fellow doctors, I find ample support for the point of view that alcoholism and drug addiction are spiritual maladies; I think that’s pretty apparent. Some psychiatrists, having come up in a more mechanistic tradition, aren’t always on board with that idea, and of course neither are all patients. At Heartland House nobody pushes spirituality on the unwilling; we’re open to any approach that works. But most of us who work at Heartland House try to keep a perspective on just what it might mean that an illness has spiritual, as well as psychological and neurologic roots, and what a spiritual solution might look like. If nothing else, it promotes team cohesion, and it can be a real comfort when things go sideways, as they sometimes do. Each resident is evaluated on admission, and weekly thereafter, to determine level of severity and treatment needs. The old notion of one-size-fits-all treatment–everybody needs 28 days, or 60 days, whatever–is replaced with an evidence based individual assessment. In that way we’ve broken out of the time-bound model.
The sad fact about treatment for drug and alcohol addictions is that hard numbers are difficult to come by, but if a quarter of the people seeking recovery are still abstinent at one year, that’s a lot. And this for a disease that is terribly destructive and frequently lethal. So one of the most exciting aspects of the Heartland House program is we try to keep track of our graduates to see how they’re doing after discharge. This is a work in progress, and we’re acquiring and deploying new tools to improve our follow up data. We also orient our treatment around the guidelines of the American Society of Addiction Medicine (ASAM).
When you ask what’s special about Heartland House, what makes us different, I’ll come around again to talking about our staff. Each of our counselors is comfortable using both the language of evidence-based addiction science and the language of 12 Step Recovery. They use algorithms and they use intuition. The combination is very powerful, and very moving to watch in practice. Our counselors are genuinely there for our men, whole heartedly, but also hard headedly, if that’s a word. We discourage codependency, and we’re all on board with that. Many of our men have been knocked around pretty hard, whether in prison, in combat, or on the streets. We use a trauma-informed approach, which is fancy, new language for compassion, empathy, and a general desire to follow the Golden Rule.
- What changes are coming?
What do I see ahead for Heartland House? Starting with the idea that Heartland House is not time- bound, it’s always been my dream to extend care beyond the original recovery. I’d like Heartland House to be a place where men could live and recover, men with jobs, without jobs, bosses who want to give them a chance despite their alcoholism/addiction, and that we are an integral part of that process. They know to call Heartland House. I think we’d be good at that, because our design (the heart of Heartland) is already about seeing the men through to success, not through 30 or 60 days of treatment. I imagine us reaching out to small businesses, unions, and EAP’s to develop long-term, full-circle support systems.
Right now we do as good a job as hospital programs that cost $30,000 a stay, yet we cost maybe $6,000 a month. We’re a bargain, and a high quality program. We’ve learned a lot over the years, including these most recent years. Mostly I’d like to see us embedded in our neighborhood and our community. We want to be a good neighbor. Attraction rather than promotion. And, unfortunately, addiction shows no signs of going away.