NCAD East | Long-Term Treatment More Closely Parallels Lifelong Recovery, but Short-Term Programs Have Practical Benefits, Too

While longer-term addiction treatment programs may offer a closer parallel to lifelong recovery for patients with substance use disorders, for many, short-term treatment programs may be a more practical solution.

At the National Conference on Addiction Disorders East on Sunday, MARR Inc. Chief Clinical Officer Kimberly Alexander, MBA, LPC, CPCS, and CEO William Anderson Jr, LCSW, delivered an interactive presentation demonstrating the practical application of integrative practices for treatment facilities’ clinicians, administrators, and staff to deliver care for clients of various socio-economic statuses.

Addiction Professional caught up with Alexander and Anderson to discuss practices for determining an appropriate level of addiction treatment, how co-occurring disorders impact treatment plans, and the respective benefits and drawbacks of short-term and long-term treatment programs.

What best practices can you share for determining an appropriate level of addiction treatment for patients?

Kimberly Alexander and William Anderson: An accurate and thorough battery of assessments is critical in determining the appropriate level of care for patients in addiction treatment. Oftentimes, patients can meet criteria for more than 1 level of care, and the decision patients frequently want to make, unfortunately, is based on their insurance and not necessarily on what would be best for their treatment success. Assessments from admissions, medical/nursing, a psychiatric evaluation, and a bio-psychosocial assessment help to confirm the appropriateness of the level of care and confirm whether the diagnosis is primarily substance abuse, even if a co-occurring disorder exists. Once clinical services begin, continued evaluation is particularly important because often in addiction treatment, the actual mental health diagnosis may not be seen until the patient is substance free for a period of time.

How common are co-occurring disorders in patients who are seeking treatment for a substance use disorder? What impact do co-occurring disorders have on determining an appropriate addiction treatment plan?

KA and WA: Co-occurring disorders are quite common in patients seeking treatment for substance use disorders. Prevalence rates indicate that nearly 40% of patients have a co-occurring disorder. The most common co-occurring disorders are depression, anxiety, post-traumatic stress disorder (PTSD), and attention-deficient disorder and attention-deficient hyperactivity disorder (ADD/ADHD). This requires treatment planning that addresses both (all) disease states and includes better understanding which is primary—the mental health or the substance abuse. While both can be successfully treatment concomitantly, this is critical because primary mental health issues, such as bipolar disorder, treatment-resistant depression or psychosis, for example, require specific strategies that needed to be addressed so there is a greater chance of success with the substance abuse.

What are the respective benefits and drawbacks of short-term and long-term treatment programs?

KA and WA: Frankly, any and all treatment interventions for substance abuse are an important entry point to help patients. Short-term treatment programs are sometimes the only way to get patients to agree to get treatment at all. In those shorter windows of time, medication management, psychoeducation, and treatment strategies can be taught and demonstrated, which plants a seed regarding what the patient needs to do to move towards recovery. Those patients who are only willing to go to programs that accept their insurance or are covered by the employer-sponsored employee assistance plan (EAP) find shorter programs appealing. Also, for patients who are not willing to leave their job or disrupt their day-to-day life for treatment, the short-term treatment programs may be ideal.

The benefits of long-term treatment programs not only include the psychoeducation, treatment planning and strategies, and medication management found in shorter programs, they also create an environment that more closely parallels what it means and what it looks like to be in lifelong recovery. There is space and time to actually apply the recovery principles that can prepare the client for their transition back to their environment outside of treatment in a healthy way. Longer-term treatment programs tend to offer more robust family programs that are conducive to helping patients have healthier interactions with their loved ones after discharge. These programs also help patients navigate the day-to-day challenges of life, including transitions, pitfalls, and other stressful scenarios that may otherwise cause someone to want to use.

Substance use disorder is a lifelong, chronic disease that ultimately ends in death if not treated. Helping patients string together more days of sobriety while in treatment promotes a sense of recovery and a restored life, which is so much more than just being substance-free. 

Reference

Alexander K, Anderson W. 30 days is not enough: longer length residential treatment for lifelong recovery. Presented at: National Conference on Addiction Disorders East; November 19-21, 2021; Baltimore, MD.