The Need for Addiction Treatment Outcomes Measurements
Addiction Treatment Outcomes Measurements – one of the most difficult aspects about trying to find a treatment center and/or program that is “right” for you and/or your loved one is the frustration over the inability to actually “measure” how one program works vs. another. Why is this critical? Because the typical treatment model does not take into account the American Society of Addiction Medicine’s (ASAM) disease model approach to addiction treatment. Instead, they historically have relied on a 28 day stay in rehab, followed by recommendations the recovering drug addict | alcoholic submit to random drug testing and participate in a 12-step program.
To begin this discussion…
Why is Rehab Not Necessarily Enough?
Because addiction – whether it’s an addiction to illegal or prescription drugs or to alcohol — is a chronic, often relapsing brain disease. The very nature of this disease is that it causes chemical and structural changes in areas of the brain that are vital to a person’s ability to think straight, behave normally and act responsibility. It is not possible to heal all of the neural circuitry impacts caused by the brain disease of addiction in just 28 days.
Nonetheless, a drug addict | alcoholic can make great progress in rehab, which is typically a 28-day stay at a residential treatment program or an IOP (intensive outpatient program, whereby the person lives at home and visits the treatment center for treatment program offerings). And 28-day rehab programs are but one of the ways** a person goes about beginning their recovery, which is defined as abstinence AND a productive, enjoyable, forward-moving life. But it takes continuing care, aka After Care, to carry on the progress that begins in rehab.
For you see, 21st century brain and addiction-related research now shows that treating addiction must follow the same treatment protocols as treating other diseases, such as cancer, diabetes or heart disease. Instead of the old acute care model (i.e., 28-day rehab), treating addiction must follow the disease management model, which is a three-pronged approach and involves: 1) detox/stabilization, 2) rehabilitation (rehab) and 3) continuing care (also known as after care). What is missing is the understanding that addiction, like other diseases, requires continuing care. According to the ASAM’s 2009 Principles of Addiction Medicine Fourth Edition, “…effective treatment attends to multiple needs of each individual, not just his or her alcohol or drug use. To be effective, treatment must address any associated medical, psychologic, social, vocational, legal problem, and environmental problems” (ASAM, Principles…, p. 389). Additionally, the Principles cites one of the key components of “the best treatment programs” is “continuing care” (ASAM, Principles…, p. 351).
Now to return to the topic of this post…
The Need for Addiction Treatment Outcomes Measurements
As I previously stated, one of the most difficult aspects about trying to find a treatment center and/or program that is “right” for you and/or your loved one is the frustration over the inability to actually “measure” how one program works vs. another. This sort of measurement would, in a sense, demand continuing care as that is how the measurement of success would be determined. Continuing care would have to include helping the person with dealing with their underlying issues (the risk factors they had that lead to their developing the disease), as well as overcoming the fall-out that occurred as a result of their disease (finding a job, repairing relationships, taking care of their brains – nutrition, exercise, mindfulness, sleep) – the very triggers that can trigger a relapse.
This Opinion, by Bankole A. Johnson, Chairman of the Department of Psychiatry and Neurobehavioral Sciences at the University of Virginia, appearing in the August 8, 2010 The Washington Post and titled, “We’re Addicted to Rehab. It Doesn’t Even Work,” does an excellent job of presenting the issues. I’ve included an excerpt below:
Last week, Lindsay Lohan left jail and entered a drug and alcohol rehabilitation facility. If the scene inspired deja vu, it wasn’t just because it was the fourth time she had headed to rehab in four years. It was because the spectacle of a celebrity entering a drug and alcohol treatment center, relapsing, then heading to rehab again — and again and again — has become depressingly familiar.
For decades, Americans have clung to a near-religious conviction that rehab — and the 12-step model pioneered by Alcoholics Anonymous that almost all facilities rely upon — offers effective treatment for alcoholism and other addictions.
Here’s the problem: We have little indication that this treatment is effective. When an alcoholic goes to rehab but does not recover, it is he who is said to have failed. But it is rehab that is failing alcoholics. The therapies offered in most U.S. alcohol treatment centers are so divorced from state-of-the-art of medical knowledge that we might dismiss them as merely quaint — if it weren’t for the fact that alcoholism is a deadly and devastating disease.
And the way we attempt to treat alcoholism isn’t just ineffective, it’s ruinously expensive: Promises Treatment Centers’ Malibu facility, where Lohan reportedly went for her second round of rehab, in 2007, has stunning vistas, gourmet food, poolside lounging and acupuncture. It costs a reported $48,000 a month….
To finish reading the Opinion piece by Bankole A. Johnson’s piece, click here…
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**Important: It must be understood that not all drug addicts | alcoholics need go through a formal 28-day rehab treatment program in order to recover. Not all can afford nor do they need such a program and not everyone is open to it. Regardless of the methods chosen – residential, 12-step programs, medical assistance, outpatient, therapy with an addictions specialist, group therapy, cognitive behavioral therapy, yoga, exercise, nutrition, stress reduction techniques, or some combination – the objective remains the same: abstain from the substance entirely and follow a disease management approach that involves detox/stabilization, rehabilitation and continuing care. This blog post provides additional information, “Addiction Treatment: What to Look For.”
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© 2010 Lisa Frederiksen, Rev. 2013
Lisa Frederiksen
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From a response posted this week (http://addictionandrecoverynews.blogspot.com/2010/08/rehab-doesnt-work.html)
I’ve posted about Cochrane before, the most germane is a summary of a Sara Zemore presentation last year:
She very effectively rebutted the Cochrane Review from a few years ago by making the following points. (These are based on notes I took and are incomplete. Hopefully they post video so that you can see her complete rebuttal for yourself.)
* It was limited only to randomized trials and ignored the overwhelming observational evidence.
* It included one of Zemore’s studies which was NOT a randomized study of AA.
* She acknowledged that the randomized evidence is ambiguous.
* Randomized trials of AA are hard to do because some subjects in other groups end up participating in AA. This happened in Project MATCH.
* The Cochrane Review did not find Twelve-step Facilitation ineffective. It found it no more effective that CBT and MET. (The summary from the abstract says, “The available experimental studies did not demonstrate the effectiveness of AA or other 12-step approaches in reducing alcohol use and achieving abstinence compared with other treatments, but there were some limitations with these studies.”)
* Finally, she cited 4 randomized studies of Twelve-step Facilitation: The outpatient arm of Project MATCH, a study by her colleague Kaskutas, and two others that I missed.
Addiction is a disease of the mind, which lies to the addict and convinces him/her that everyone is against them, and that only the addict has everything under control.