To Whom It May Concern,

I am writing in my capacity as a licensed psychologist in Wisconsin, specializing in clinical mental health since 2007.

My purpose is to offer a professional opinion on the intensive outpatient program (IOP) referral for Mr. Philip Frahm. My extensive experience in the field equips me with a comprehensive understanding of the guidelines essential for intensive outpatient treatment programs, particularly those addressing psychological problems such as substance abuse disorders.

Background

I first became acquainted with Mr. Philip Frahm in October 2022, and we initiated a telehealth-based working relationship.

Our work together primarily revolved around addressing Mr. Frahm’s marital issues. He was seeking assistance to navigate the complexities and emotional turmoil associated with his deteriorating marital relationship. We focused on equipping him with coping strategies and communication skills, with the ultimate goal of rebuilding trust and restoring harmony in his marital life.

Mr. Frahm’s marital relationship problems escalated to the point where he found it necessary to move out of his home and consequently filed for divorce. Mr. Frahm and I began meeting again in March of 2023, where we explored his alcohol consumption habits, undertaking a thorough assessment of the issue. His alcohol intake was found to be within reasonable limits, and it did not appear to contribute adversely to his psychological state or daily functioning.

To his credit, Mr. Frahm has remained committed to working on his emotional well-being and continues to make steady progress in therapy.

Present Circumstances Related to Alcohol

Mr. Frahm has become increasingly entangled in a contested dispute with his estranged wife, especially concerning matters related to their children leading to the appointment of a guardian ad litem to safeguard their children’s best interests.

A few mnths ago, Mr. Frahm’s alcohol consumption has been brought into question through accusations of his estranged wife’s family. Allegations of excessive alcohol use have also been made by Mr. Frahm’s former girlfriend, Ms. Leilani Nino, in the wake of their break-up.

Under the circumstances, the guardian ad litem, observing the escalating disputes and the allegations made against Mr. Frahm, deemed it appropriate to refer him to an IOP. This action was taken to ensure Mr. Frahm’s individual well-being and to maintain the best interests of the children involved.

The referral was made despite Mr. Frahm’s consistent assertion that his alcohol consumption remains within reasonable limits. Indeed, it is essential to clarify that these allegations, despite being serious, were not substantiated with concrete evidence.

In the course of my review of the current circumstances, I have had the opportunity to examine the witness statements. Furthermore, I have also thoroughly reviewed the transcript of Ms. Nino’s deposition. These vital sources of information have provided me with additional perspectives and insights into the allegations against Mr. Frahm.

Thus, it is my professional perspective that the IOP referral appears to be driven more by the accusatory context than by verified concerns about Mr. Frahm’s alcohol consumption.

Unsubstantiated allegations, fueled potentially by personal biases, can pose a significant risk to the integrity of the evaluation process and the delivery of appropriate therapeutic services.

Therefore, a balanced perspective is essential in assessing the validity of these allegations and their relevance to Mr. Frahm’s mental health needs and his suitability for an IOP. It is crucial to avoid any rush to judgment without a comprehensive and unbiased assessment.

Intensive Outpatient Treatment Program (IOP)

An intensive outpatient treatment program (IOP) is a structured model offering a higher level of care than standard outpatient services. It involves immersive therapy, including individual and group counseling, skill-building workshops, and, if needed, medication management. Although less intensive than inpatient programs, IOPs cater to individuals requiring more support than standard outpatient care but not round-the-clock supervision.

Clinical guidelines play a pivotal role in determining the appropriate level of care. In Wisconsin, specific guidelines, based on the American Society of Addiction Medicine (ASAM) criteria, outline the necessity for IOPs in cases involving sustained and high-intensity patterns of alcohol abuse, previous unsuccessful attempts at less intensive treatment, and stability sufficient for participation in the program.

Assessment Findings for Philip Frahm

Treatment protocols for Mr. Philip Frahm were implemented using multiple evaluation methods, and contrary to the allegations swirling around him, the findings do not point towards a pattern of hazardous or excessive alcohol use that would necessitate a referral to an IOP.

The specific tests executed and the result were as follows:

The breathalyzer test, a prevalent tool for quantifying blood alcohol content, returned negative results for Philip from February 26th-April 7th, confirming the absence of alcohol consumption (NIDA, 2018).

The Ethyl Glucuronide (EtG) hair follicle test is another comprehensive screening method for detecting the presence of alcohol consumption. This test focuses on identifying the presence of EtG, a metabolite produced when the body processes alcohol. Notably, EtG can be found in several bodily substances, including hair, making it a reliable indicator of alcohol consumption over an extended period. The hair follicle test specifically targets hair close to the scalp, which provides a historical record of alcohol consumption spanning several months. It is particularly beneficial when long-term alcohol use needs to be examined, as it can provide evidence of consumption that far exceeds what blood or urine tests can offer.

The results of Mr. Frahm’s Ethyl Glucuronide (EtG) hair follicle test were found to be negative. This outcome effectively demonstrates that Mr. Frahm has not consumed or very rarely conumed alcohol for several months leading up to the test. The negative results from this long-term detection test lend substantial support to the assertion of Mr. Frahm’s sobriety over an extended period. Furthermore, these findings contradict the allegations made against him, further highlighting the necessity for an unbiased and thorough assessment before making any conclusions about an individual’s alcohol consumption.

The Soberlink Level 2, an all-encompassing alcohol monitoring system, consistently returned negative results across 531 separate tests from June 5-September 18 (Substance Abuse and Mental Health Services Administration [SAMHSA], 2015).

Furthermore, Mr. Frahm has been under constant monitoring by the Secure Continuous Remote Alcohol Monitor (SCRAM), a leading technology in continuous, transdermal alcohol monitoring. This monitoring started on November 7th, providing an ongoing assessment of his alcohol consumption. The SCRAM bracelet, worn around the ankle, tests for alcohol in sweat by measuring vapor that passes through the skin (referred to as insensible perspiration). It continues to provide an unbroken chain of evidence, strengthening the accuracy of our findings.

The SCRAM’s technology, sophistication, and continuous monitoring capabilities give it an edge over traditional tests, which only provide a snapshot of an individual’s alcohol consumption at a specific point in time. Moreover, it is tamper-resistant, ensuring that the integrity of the readings remains unchallenged. The reliability of SCRAM is widely recognized in the clinical world and the legal system for its accuracy and precision.

Finally, the SCRAM monitoring device is designed to capture minute levels of alcohol consumption. It is capable of detecting low-level drinking and can even record a positive result from as little as one standard drink. This means that even moderate, social drinking could trigger a positive result, illustrating the stringent standards these monitoring systems uphold. Despite this high sensitivity, Mr. Frahm’s test results have consistently returned negative, further discrediting the allegations of excessive alcohol use.

Thus, the SCRAM system, coupled with Mr. Frahm’s negative results from other tests, further reinforces the argument that his alcohol consumption does not necessitate referral to an intensive outpatient program.

Summary of Findings

This amalgamation of negative findings substantiates the evaluation that Philip does not meet the clinical prerequisites for an intensive outpatient treatment program (Moos & Moos, 2003). It is worth noting that these tests are capable of detecting a wide range of substances, including but not limited to amphetamines, cocaine metabolite, THC-COOH (a metabolite of marijuana), methadone, opioids, and PCP (Wiseman, McMillan, & Davies, 2018).

Recommended Treatment for Philip Frahm

Given the assessment findings and my ongoing counseling with Mr. Frahm, he has been making significant progress in therapy and I deem this to be sufficient.   If the court finds it necessary for Mr. Frahm to seek additional treatment, however, it seems more appropriate for Mr. Frahm to engage in an outpatient treatment program for alcohol-related disorders, facilitated by someone certified in Addiction Counseling (AC) and that is advised by said professional.  If necessary, an outpatient program would offer the appropriate support and structured care but with less intensity than an IOP, better aligning with Mr. Frahm’s needs.

This approach typically involves individual therapy, group counseling, and educational programs about substance abuse, enabling the patient to maintain their daily routine and responsibilities while addressing their mental health concerns. It is crucial that such a program is led by a certified Addiction Counselor, who can provide expert guidance, foster a supportive environment, and tailor the treatment plan to address Mr. Frahm’s specific circumstances and needs.

This recommendation aims to ensure the treatment level aligns optimally with Mr. Frahm’s mental health status, fostering a more targeted and effective therapeutic approach.

References:

  • National Institute on Drug Abuse. (2018). Principles of Effective Treatment. Retrieved from [link]
  • Substance Abuse and Mental Health Services Administration (SAMHSA). (2015). TIP 42: Substance Use Disorder Treatment for People With Co-Occurring Disorders. Retrieved from [link]
  • Moos, R.H. & Moos, B.S. (2003). Long-term influence of duration and frequency of participation in Alcoholics Anonymous on individuals with alcohol use disorders. Journal of consulting and clinical psychology, 71(1), 81-90.
  • Wiseman, E., McMillan, B., & Davies, M. (2018). The effectiveness of alcohol brief interventions delivered in a general hospital setting: a systematic review. Addiction Research & Theory, 27(2), 93-103.
  • McLellan, A.T., Lewis, D.C., O’Brien, C.P., & Kleber, H.D. (2000). Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes.

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