We face many difficulties in the field of behavioral health when it comes to substance abuse and addiction treatment. There a many disagreements regarding how treatment and recovery from addiction works most effectively.
To add to the problem, there is very little transparency in long term addiction recovery, and many individuals decline to engage in data collection. Oftentimes, this unwillingness is a result of anonymity which is a key role in individuals becoming willing to begin the process of treatment and recovery from addiction. This insistence on anonymity as part of the recovery process is understandable from the individual’s perspective given the stigma surrounding addiction and substance use disorder (SUD). However, lack of patient data makes finding common ground about effective addiction recovery, or developing a standardized set of protocols and procedures, very difficult.
Evidence has shown the effects of active addiction on the brain. The physical impact on the brain is very visible and measurable. Here is what we don’t know: how do people stay in long-term recovery and why? This question is very relevant because we don’t have enough longitudinal outcomes data about how successful recovery happens. However, it’s possible that by using outcomes data, data that covers the end result of a health care systems effect on a population of individuals, we can begin to identify the factors that contribute to long-term recovery. Through this method, we can begin to scratch the surface on successful addiction recovery, and hopefully move towards a standardized approach to treatment.
Application of Outcome Measurements in Addiction Recovery
It is important to note that addiction recovery doesn’t have outcomes that are as measurable as the treatment of let us say cancer, as an example, and it is altogether a different kind of disease. However, it’s clear in the example above, given the correlation of improved outcomes data and cancer mortality rates declining, that as a community we would greatly benefit in making a coordinated effort in discovering standardized and effective ways to treat addiction and Subtance use Disorder patients.
One way we can begin to work towards more standardized approaches to diagnose and treat those who suffer is to look at demographic differences leading to addiction and relapse: gender, age, socioeconomic background, drug of choice, presence of trauma, veteran status, and family dynamics to name a few. Such demographic variables could prove useful in determining the kind of recovery pathway a patient should take.
If the addiction recovery community and all parties involved in the treatment spectrum were to come together and collect meaningful outcomes data, that had an adherence to certain treatment protocols as well as long-term recovery support like other chronic diseases, it’s possible we could see an increase in those maintaining long term recovery and a decrease in mortality from addiction relapse.
Collecting Outcomes Data Is Difficult
The data collected on cancer mortality spanned several decades and took the coordination of multiple institutions. Needless to say, it wasn’t an easy task. Collecting data on addiction recovery may be even harder. Where the signs of cancer relapse and remission are easy to detect, the same is not true in addiction recovery.
Addiction itself carries a lot of stigma in our society. Many who suffer from substance use disorde do not want to directly participate in any kind of research for the fear of judgement, or being belittled for their condition. Addiction recovery is typically an anonymous pursuit and those who suffer from substance use are often not as forthcoming as those who suffer from other chronic illnesses.
It is very important to understand that not every individual who suffers from Substance Use Disorder has the same severity of condition. Back to the cancer analogy: an individual with stage one breast cancer is going to be treated differently than an individual with stage four breast cancer. To take it one step further: a child with leukemia isn’t going to be treated the same way as an adult with pancreatic cancer. If that same distinction is applied to addiction as a chronic brain disease, then not all people that suffer from the disease would be classified with the same disease severity as they are now.
The 12 Step Model is probably the most widely known form of addiction recovery, and the easiest way to interpret the variation in individuals in recovery who have seemingly similar addictions. Consider these two scenarios:
Individual (A) begins attending 12 step meetings, go through the twelve steps with a sponsor, he begins to sponsor other people in recovery, and he maintains an active role in the recovery community. Because of his continued effort in recovery and his new connections, he maintains a healthy lifestyle and does not relapse.
Individual (B) goes into treatment willingly. He begins attending meetings while in treatment and continues on afterwards. He works through the 12 steps with a sponsor, and he has service positions at the meetings he attends. However, within the first 2-3 years of recovery, the individual relapses, overdoses, and dies.
What is the difference between these two individuals? What information are we missing? Why did recovery work for Individual (A) but not Individual (B)? They both had a similar experience in recovery, yet the severity of Individual B’s condition was such that they died from their addiction. Presently, the conclusion of most people would be that the severity of their addiction was too progressed for typical recovery treatment methods to be effective. But, if this were almost any other disease this huge gap in important information would never be acceptable.
Unfortunately, there isn’t a standard of measurement for the severity of substance use disorder that could be applied to these two individuals in a measurable way. The closest available applicable standard is in the American Society of Addiction Medicine’s (ASAM) levels of care. However, the flaw in using the ASAM criteria is that it is simply a placement criteria for determining the degree of medical management the patient needs. The ASAM criteria doesn’t address the severity or the underlying causes of their addiction. This is a huge problem.
The Standardized Addiction Treatment Plan Problem
Here is the question: What kind of standardized treatment plans can be employed in addiction recovery when there is also an priority on providing “individualized” treatment?
As we said before, there are a lot of unknown factors in the field of addiction recovery, and the competence of different treatments models is one of them. Since there are no clear indicators of what can guarantee a full recovery from addiction, there are also no clear indicators of effective recovery methods.
The shortage of data to support the success of one treatment plan over another, most treatment providers employ therapy procedures based on clinical judgement and preference. There are numerous modalities that are specialized and have potential benefits: yoga therapy, equine therapy, meditation and mindfulness, music therapy, cognitive therapy, art therapy, EDMR, etc… However, few have the research data to support the long-term results of their particular modality. And, while they may be a preferred method for the provider, there are simply individuals who do not show positive recovery outcomes to certain types of therapies.
For instance, we know that people that adhere to the 12 step model have a statistical advantage in long-term abstinence, and that going to recovery meetings is incredibly important to a long-term recovery journey. But, the simple fact is, not everyone wants to go to 12 step meetings.
This complexity of addiction treatment is reflected in the national dialogue, and even finds itself in the National Institute on Drug Abuse (NIDA) in their principles of drug addiction treatment. Even their own principles are broad, and are a reflection of the addiction treatment landscape as a whole. From the top down, it makes sense that we are still far away from a standardized approach to addiction treatment.
Fellowship Foundation RCO Recovery Capital Program’s goal is to develop positive outcomes for individuals, so that recovery pathways can be truly individualized and adapted based on relevant outcome data in an effort to provide a more effective approach to addiction treatment for all people who suffer from this terrible chronic condition.
Unfortunately, what the addiction and treatment industry does right now, in terms of addiction treatment, is declare they provide “individualized” treatment plans; however, in their current state, “individualized” treatment plans, with only a small degree of exceptions and variations, look pretty much the same for everyone. Utilizing comprehensive outcomes data on addiction treatment allows us to stop this “fake it ‘til you make it” mentality, and begin providing more effective and measurable results across the care continuum.