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At a Stowe Detox, Serene Surroundings Come at a Price

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William Cats-Baril in the Sana at Stowe garden - JEB WALLACE-BRODEUR
  • Jeb Wallace-Brodeur
  • William Cats-Baril in the Sana at Stowe garden

William Cats-Baril likes tours of the addiction treatment center he founded, Sana at Stowe, to start outside the front vestibule, which is lined with a few tons of small, polished stones from Lake Champlain.

The front doors are heavy, by design.

"I call it the Mercedes-Benz effect," said Cats-Baril, an entrepreneur who teaches business at the University of Vermont. "The doors of the Mercedes-Benz are much heavier than they need to be, right? But they want you to feel that safety, that quality that is built in.

"We do a lot of that here," he added.

In creating Sana at Stowe, Cats-Baril is hoping splendid surroundings and attention to detail will bring some dignity and mindfulness to patients doing the difficult work of starting the alcohol and drug recovery process. A two-week stay at Sana, which means "healthy" in Latin, costs $35,000. But it's worth it, said Cats-Baril, because Sana's serenity and quality craftsmanship are healing forces.

"I thought it was important to create in the tradition of the European sanatorium in the mountains," he said. "The sense of well-being that surrounds you had to be very much part of the treatment."

Cats-Baril and his business partners rented a former hockey academy on the Mountain Road in Stowe and renovated it last year to create 17 single bedrooms, each with a bathroom. The verdant four-acre campus includes tennis courts, a pool, an organic vegetable garden and a separate yoga studio. The first patient arrived July 13.

The former school sits well apart from its neighbors, with forest behind it; the west branch of the Little River runs through fields across the street.

A stay at Sana reflects the care that has gone into the finishes, including murals of living moss and a revolving art display created through a partnership with Burlington City Arts. Each patient can choose one of 45 pieces of art to hang in their room during their stay. The golden birch bark from North Carolina that papers the lobby walls was chosen to reflect Sana's emphasis on nature's health-giving effects, Cats-Baril said.

Awaiting guests in each room are fresh flowers and a weighted blanket, Sana-branded pajamas, a journal, slippers, a small book containing an illustrated parable, a water bottle and a small, polished stone that Cats-Baril said patients can rub to produce calm. The chosen work of art is already hanging on the wall.

This attention to detail dignifies the experience of checking in and counteracts some of the shame associated with seeking treatment for an addiction disorder, Cats-Baril said.

"Domestic abuse, DUI, an ugly scene at a corporate party: You had a public event or private event that was extremely traumatic and creates shame," he said. Cats-Baril toured several other rehabs before creating Sana and said he found many of them lifeless and depressing. "The facility we have does not make you feel like you're basically being incarcerated."

A polished salesperson, Cats-Baril also has a long history of working on projects that use data to measure how well treatments work. His health-related entrepreneurship includes an app he commercialized with Dartmouth College professor William Hudenko that can assess suicide risk in patients. He's also been involved in Vermont's medical marijuana industry and is currently listed as a principal partner in the Cannabis Science and Education (CASE) Institute of Middlesex.

Sana at Stowe - JEB WALLACE-BRODEUR
  • Jeb Wallace-Brodeur
  • Sana at Stowe

At Sana, his scientific counterpart is psychiatrist Sanchit Maruti, the medical director of UVM's inpatient psychiatry service and the UVM Medical Center's addiction treatment program. As medical director at Sana to Cats-Baril's CEO, Maruti is less focused on the physical surroundings and more on the process of getting new arrivals safely through a medically supervised withdrawal and into therapy that will continue long after the patient has gone home.

Sana's founders expect most guests to travel from out of state. Asked about the cost, which is covered by some private insurance but remains out of reach for many, Maruti noted that guests will have access to on-site yoga, massage, acupuncture and counselors. The facility has 28 employees.

"It's expensive to hire people who are really top-notch and to have programming that's really intensive," he said. Most medical treatment, he added, is driven by cost-based choices.

"Going to see your primary care provider is cheaper than coming to the emergency department, which is cheaper than coming to the medicine floor, which is cheaper than an ICU setting," Maruti said. "What you want to do is see, 'Where can I have the maximum amount of treatment at the best price point?'"

Sana will track patients' success in recovery to help answer these questions, he said. Maruti himself has hosted outcomes assessment workshops at national meetings of the American Academy of Addiction Psychiatry.

If measuring outcomes shows that Sana's approach works, "then maybe this can be made available to others," he said of those who can't afford the facility. Right now, a stay is not covered by Medicare or Medicaid.

In 2018, nearly 12 percent of people over age 12 reported illicit drug use in the previous month, a report from the Centers for Disease Control and Prevention found. And the drug and alcohol problem in the U.S. has worsened since the COVID-19 pandemic began in early 2020. In Vermont, alcohol sales rose sharply last year, and opioid overdose deaths rose 38 percent compared to 2019.

All this suffering has turned addiction treatment into a huge business. But with thousands of dollars on the line, it's difficult for patients and their families to figure out which treatment center is right for them — or legitimate at all. The Hazelden Betty Ford Foundation, one of the oldest treatment centers in the country, warns patients and families to do extensive research.

"At present, the addiction treatment industry is fragmented with no consistent operating principles or regulatory requirements," the center says on its website. It has published a white paper on choosing a treatment center.

"Some states require no regulation, which leaves treatment centers unaccountable for the services they provide. In addition, the industry is seeing an upswing in for-profit centers that offer exclusive, spa-like environments that 'guarantee' success, but offer little in the way of evidence-based treatment or demonstrated outcomes."

Vermont does regulate some treatment centers, and the Green Mountain Care Board approved Sana's certificate of need application. The document outlines the center's treatment approaches and its plan for assessing outcomes.

Sana — under the name of its holding company, Silver Pines — describes a unique system of highly customized care that includes something it calls "proprietary neural network-based algorithms." It's an approach that Cats-Baril used with his suicide risk assessment software, and it's designed to assess how well Sana's high-end facility and practices influence patient recovery.

"If four out of 10 of our patients actually stay in recovery, we're doubling the rate of recovery in this country, and that will be the metric for us to say we're making people better, at least within the first year," Cats-Baril said.

The state Division of Alcohol & Drug Abuse Programs, in a letter to the Green Mountain Care Board, said it was concerned about the program outlined by Sana's founders "because research has shown that less than 90 days of continuous treatment (at any level of care) is not effective, and without strong ties to the treatment system, it is more likely that individuals will not follow-up with continued care."

William Cats-Baril - JEB WALLACE-BRODEUR
  • Jeb Wallace-Brodeur
  • William Cats-Baril

Cats-Baril said giving patients choices about their treatment — including the length of stay — increases their feelings of self-worth. He noted that some people might not go to treatment at all if it means leaving their work or family for a month or more.

It's not clear how many addiction treatment centers there are in Vermont; not all of them require a certificate of need. The state Department of Health regulates some but not all of them. Even people who work full time in the field of addiction recovery don't know.

But Cats-Baril would like to add more. The goal for Silver Pines is to learn from what works best at Sana, then replicate it with similar businesses in other Vermont towns that have high out-of-state name recognition, such as Woodstock and Manchester, Cats-Baril said.

Peter Espenshade, the president of Recovery Vermont, a group that works with families and also lobbies for addiction recovery funding, said that care at treatment centers can vary widely in Vermont, as in other states.

"We're working within America's health care system, which is messy and confusing and expensive and noncentralized," he said. "It can be just as difficult for one to find a good surgeon as it can be to find a good substance-use disorder treatment."

Espenshade said Vermonters are lucky to have access to the VT Helplink alcohol and drug support center, which has a website; a 24-hour phone line, 802-565-LINK; and knowledgeable staff.

"In Vermont, objectively, we are way ahead of other states" in helping people struggling with addiction, he said.

Communities don't always give treatment centers a warm welcome. In Ludlow, some residents are protesting a 40-bed facility that Phish front man Trey Anastasio hopes to open later this year. But Stowe Town Manager Charles Safford said on Monday that he hadn't heard from any residents with concerns about Sana.

While patients can stay at Sana for as little as a week, Maruti said the center will keep in touch with them for at least a year. Sana helps patients find the right therapist in their hometown and continues to work with them remotely, he said.

The end goal? "That they have a better life than they came in with," Maruti said. "That they're alive."

The original print version of this article was headlined "Lifesaving Luxury"