Healing in the Wilderness

All photographs taken at Four Circles Recovery Center in Horse Shoe, NC on 01.04.13 for CRC Health.  All photographs by Peter Taylor

A recovery center in North Carolina makes nature part of the process.

When you think of treatment and recovery centers, you probably don’t picture whitewater and camping gear. But “outdoor behavioral healthcare,” more commonly known as wilderness therapy, has been getting positive results in long-term recovery, particularly with young adults. At Four Circles Recovery Center, a residential facility in Horse Shoe, NC, young men and women are finding their way out of addiction through traditional counseling and 12-Step therapy, coupled with wilderness adventures that include canoeing, whitewater rafting, guided rock climbing, hiking, camping, fly-fishing, and fly-tying.

“Wilderness as therapy has always made such clear sense to us,” said Four Circles Admissions Director Shane Applegate, CAI, CSAC-I. “The families who come here are at the threshold of change. They understand that getting past the pain and sickness they’ve experienced will mean leaving their current state of being and entering unknown territory. Just as the wilderness is a mirror for our own powerlessness and unmanageability, primitive wilderness skills are a mirror for our emotional state. When we take clients on wilderness expeditions, we’re teaching them how to safely explore the woods—literally and figuratively.”

All photographs taken at Four Circles Recovery Center in Horse Shoe, NC on 01.04.13 for CRC Health.  All photographs by Peter TaylorThe center works with young adults ages 18 to 28 who are struggling with addiction, substance use disorders (SUDs), and co-occurring mental health issues such as depression, anxiety, and sleep disruption. The average length of a primary stay is about 60 days, with transition program stays averaging six months.

Four Circles takes its name from a holistic philosophy, embracing the “four circles” of health: mental, physical, emotional, and spiritual. Within these four, clients find 12-Step meetings, individual and group therapy, mindfulness/meditation training, yoga, martial arts instruction, and rites of passage.

In addition to a men’s transition program, the center offers personalized programs through three tracks: women’s primary, men’s primary, and relapse prevention. “Men and women often experience drug and alcohol addiction differently,” said Four Circles Executive Director Jack Kline, MS, LPC, LCAS, LPCS, CCS. “They can have different biological responses, triggers, and co-occurring issues. At Four Circles, the primary tracks provide the same services and supports for men and women, but the women-only track emphasizes self-esteem, body image, healthy relationships, and the development of positive social behaviors. Our men-only track also emphasizes self-esteem and body image, but from a male perspective. We also address the transition into manhood and the unique societal pressures facing young men.”

Four Circles’s wilderness component involves group expeditions into the Blue Ridge Mountains, during which participants learn Leave No TraceTM ethics as they camp, hike, climb, and paddle through a beautiful landscape. Tents, backpacks, seasonally rated sleeping bags, and other field gear keep campers comfortable until they return to base camp, which is outfitted with showers and other amenities.

For the women-only track, groups go out for two to seven days at a time and then return to base camp to discuss their experiences and relate them to their 12-Step work. They will spend about 40 percent of their time in the wilderness. Those in the men-only track will spend at least half of their time on expeditions, which last up to two weeks each.

“Wilderness as therapy has always made such clear sense to us.” —Shane Applegate

“Our wilderness experience is broken into smaller, more manageable components than what you’ll find at most therapeutic wilderness programs,” said Applegate. “We think each journey into the mountains should build on the ideas and lessons discussed in base camp, and each return to base should build on what these young people learn in the wilderness.”

Recognizing that recovery is a family process, Four Circles offers many channels for family engagement, including a two-day multi-family experiential workshop; weekly support conference calls with other families who have loved ones in treatment; family therapy sessions by phone; and more.

Four Circles also places a heavy emphasis on research-based practice, with dually-licensed clinicians who have master’s degrees or doctorates. The center recently collaborated with the Center for Research, Assessment, and Treatment Efficacy (CReATE) and the Intervention Services Laboratory at the University of Arkansas on a comprehensive treatment outcome study led by Sarah “Salli” Lewis, PhD, director of the research division at CReATE.

“With the dramatic rise in substance abuse and dependency over the past few decades, there is a dire need for more research in this field, especially among young adults who have a heightened risk associated with substance experimentation and who can be especially resistant to taking those first steps toward treatment and recovery,” said Kline. “We are pleased to be able to offer a deeper look into this population to better understand their needs for an effective and sustained recovery.”

Over a five-year period, the study looked at 468 treatment-seeking young adults drawn from three sites, two of which offer wilderness-based programs. The research team assessed participants five times: at admission, midway through treatment, at graduation from treatment, three months after graduation, and 12 months after graduation. According to the study results, about 62 percent of participants from Four Circles were maintaining their treatment gains one year after program completion, compared with the overall treatment-seeking population, where abstinence rates are 25-40 percent for alcohol and 20-30 percent for illicit drugs. The study also showed significant remission of SUD symptoms, as well as improvement in symptoms of co-occurring disorders.

“This is a very positive step for the scientific and treatment communities,” Lewis said. “The empirical evidence for a wilderness-based model of therapeutic services has lagged historically behind the popularity of these programs. As we gain greater and more rigorous scientific data, we make critical advances in closing the gap between science and practice.”

Contact Four Circles Recovery Center at 877-893-2221 or visit

Photography by Peter Taylor and David Palmer, courtesy of Four Circles

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