Why Concurrent Recovery Management in Treatment for a Substance Use Disorder?

We all want to improve the care that we and our organizations provide.  To do so, we need a change in the way we think about, collect and report outcomes for substance abuse treatment. 

What do these two assertions have to do with each other?  Concurrent Recovery Monitoring (CRM) offers outpatient treatment a new paradigm for conducting outcomes evaluations that also provide clinical value at the individual client level.  Traditionally, substance abuse treatment outcomes have been measured following treatment, more appropriate for acute conditions. 

We now recognize that addiction is best treated as a chronic condition that warrants ongoing monitoring during treatment (i.e., the CRM model).  An advantage of such monitoring is that data (i.e., information) can be used by the clinician to adapt the client’s type and intensity of treatment.

To step back a bit, providers have been repeatedly called upon to institute outcomes monitoring systems as a way to justify their effectiveness and improve their performance.  These initiatives have been costly, difficult to implement because they often involve substantial work (e.g., additional “paper-work” following up clients post-discharge), and have typically been perceived by clinicians as serving management but with little clinical value (e.g., improved care or client outcomes).  As outcomes have been measured following treatment, the results cannot be used to impact individual patient care during treatment.

For other medical and psychiatric conditions, brief monitoring instruments and procedures are already standard as important components of treatment.  For example, hypertension, asthma, diabetes, and depression have tests that are a routine part of each clinical visit and are used to provide a readily accessible summary of symptom/disease status and treatment course for disease management.  It’s time for substance abuse treatment to get on board.

What might such a monitoring system look like?  How about something clinicians can easily incorporate into their usual practice with little training?  A bigger stretch: let’s think of outcome monitoring as a clinical intervention, the essence of which is the regular completion of a client monitoring instrument and clinician review of the information with the client (i.e., feedback) which may lead to specific counseling or treatment modifications.  The assessment areas might include: substance use, risk and protective factors for continued use/dropout, health and well-being (quality of life), and treatment services. 

Research and clinical practice indicate such information provides clinical guidance and credible treatment outcomes for management.  What you want is to systematically and regularly collect (e.g., weekly, monthly) during treatment information that has maximum clinical value using a minimum set of items.  A computer based application would increase functionality since each time you collect data, you discuss it with the client.  For example, the ability to generate real-time individual reports that detail client’s status and progress would clearly enhance utility for both clinicians (and supervisors) and clients.  Similarly, the ability to generate aggregate reports by counselor caseload could further support supervisory efforts, and agency level reports could support management initiatives (e.g., evaluation of quality improvement practices, reports to funders).

John Cacciola, PhD, is developer of TRI Recovery Track: My group has developed such a system, and other systems and instruments exist.  The point is, consider all models andyour specific needs. 

The Institute of Medicine has recommended implementation of systematic patient monitoring in substance abuse treatment.  More importantly, monitoring clients and taking appropriate clinical actions such as reinforcing attendance and matching service type and intensity to problems, improves outcomes.