Making the Case for Recovery Checkups

Among the most fun and growth-producing aspects of blogging is exchanging ideas with people who comment in writing or in person. Let’s keep it going.

My blog is devoted to treating a chronic disease over the course of a lifespan. So my recommendation has been that the minimal level of care for patients with addiction be a regular, semi-annual recovery checkup over a lifetime. Isn’t that the way chronic diseases are treated? Do people with addiction deserve anything less?

My blog has led to discussions about whether checkups would be recommended over the course of a lifetime or for a period of five years after residential care. Significant research has shown that patients who have committed to a five-year course of treatment have had very high rates of continued abstinence over the course of their commitment. This research has been conducted with physicians and pilots, and similar results have been shown more recently with people who have had DUI convictions and people on probation. A total of 77 to 88% of the people who were monitored achieved five years of abstinence. A few years ago at a conference of the American Society of Addiction Medicine (ASAM), it was remarked that “if these were results for cancer, we would be talking about a cure.”

The five-year time frame was chosen primarily because of “process of change” research that indicates new behaviors take five years to be fully integrated. However, the five-year time frame is for behaviors, not diseases. So the discussion becomes one of whether addiction is a disease or a behavior, and when does it matter?

There are times when it matters. I don’t think this is one of them. Most everyone can agree that some people who have displayed behaviors that we call addiction have returned to destructive behaviors after well more than five years of abstinence. So the debate may be moot.

I think that another variable may be involved: The people studied for five years have also perceived that they have been “in treatment” for that entire length of time. Is it important that people with addiction continue to perceive themselves to be in treatment for a lifetime? It's a good question.

Would it be helpful if the phrase “when I was in treatment” went away, maybe? I think so.

We have all been trying as hard as we can to provide lifetime care. We have created alumni associations and we encourage people to return to residential centers for tune-ups. We encourage people to attend mutual support meetings. Every source of support that we can provide is extremely helpful. But would anyone ever expect a diabetic to rely on mutual support?

I am in no way arguing that we stop providing alumni associations, tune-ups or mutual support. I am arguing that people with addiction are entitled to the high-quality, professional checkups that are provided to patients being treated for every other chronic condition (e.g., diabetes, hypertension).

It was not long ago that I was talking with patients about lifetime recovery. One woman asked, “Who does this?” I replied, “No one.”

But that doesn’t mean we shouldn’t start! To whomever I’ve presented the principles of Lifespan Recovery Management, the most frequent comment has been “it makes so much sense” and/or “it’s so easy to do.”

It could begin with people receiving residential care close to where they live. In all likelihood these patients will be participating in all levels of outpatient care at the same facility, or one close by. All that would be needed is to change the concept of what treatment is. Treatment is not 28, 30 or 60 days in residential care. It’s forever.

We need to encourage patients to perceive themselves as patients throughout all levels of care. Anything else encourages patients to perceive ongoing treatment as an “afterthought,” as in “aftercare.” ASAM recognizes four levels of care. When are we going to refer to outpatient care as “treatment,” then? If anyone out there thinks that we do, think harder.

The semi-annual check-up would be performed by addiction and medical/psychiatric professionals. It could cover all recommended ASAM dimensions:

• Withdrawal Management

• Biomedical Conditions and Complications

• Behavioral/Emotional Conditions and Complications

• Motivation for Maintaining Abstinence

• Risk of Continued or Returning to Alcohol/Drug Use

• Recovery Environment

Can a checkup prevent symptoms of addiction from becoming active? It can. Consider someone with three years of abstinence looking at having surgery in the very near future. Could the patient be guided through the process? Or, let’s say a patient six years into abstinence has experienced a major loss. Perhaps the person doing the checkup would recommend grief counseling.

(For a full discussion of what a checkup could look like, click here.)

Maybe we could get really ahead of ourselves: When a diabetic’s blood sugar becomes unstable, the endocrinologist is called. When recovery from addiction is being threatened, or the symptoms have become active, an addiction specialist needs to be called.

Why not?