Addiction Treatment Outcomes Offer Results Beyond Abstinence Alone

The substance use treatment centers participating in Vista Research Group's in- and post-treatment monitoring of patients generally adhere to an abstinence-based philosophy. But published outcomes for their patients also indicate promising results for some clients who haven't been able to eliminate substance use altogether.

Among the data released in Vista's comprehensive report Learning From Three Years of Addiction Treatment Outcomes Research, 27.7% of patients who were tracked at six months post-treatment had remained abstinent, and another 7.9% had used post-treatment but had maintained abstinence over the past 30 days. Moreover, among primary alcohol or opiate users who had acknowledged use in the past month, only one-third were using at the same or higher frequency at six months post-treatment as they had been before treatment.

“There are a number of facilities that think if you're using at all you're on a slippery slope, but there are also some of our clients who do believe in harm reduction,” Vista founder and CEO Joanna Conti tells Behavioral Healthcare Executive.

The Vista data are based solely on patient self-report, an approach that Conti acknowledges has shortcomings but also ensures greater participation in post-treatment monitoring among facilities.

Conti, who at last fall's Moments of Change conference offered a preview of the now published full results of Vista's outcomes research to date, emphasizes two key takeaways from what has been learned overall:

• “Just having the data is a game-changer,” she says, “when for years people were told, 'You can't measure this.'” Conti believes consumers and payers are getting much closer to being able to base treatment decisions on individual facilities' outcome statistics.

• As the number of centers and patients involved in this type of research continues to increase, the field will have sufficient data to determine in advance an optimal treatment strategy based on a patient's demographic, drug use and mental health profile, she says. “We will start to be able to predict what type of treatment is most likely to have them alive and thriving a year from now,” Conti says.

The latter development will be important going forward, the report suggests, because current data show wide variation among centers in the percentage of former patients who at six months post-treatment had maintained abstinence for at least the last 30 days (the range among 17 of the participating centers was between 22% and 47%).

“Since most, if not all, of the treatment programs who've invested in outcomes research have probably done so with the belief that their post-treatment outcomes will prove to be above average, it is surprising to see such a large variation in treatment effectiveness,” the report states.

The benefits of asking

Conti emphasizes that the process of monitoring patients while they're in treatment has been demonstrated in research to assist recovery. The monitoring by addiction-focused facilities needs to encompass co-occurring mental health issues and suicidality as well, she says. “This does help the clinicians better meet patients where they're at,” she says.

All of the centers working with Vista are monitoring patients during treatment under its INSIGHT initiative, while some also are tracking patient outcomes 1, 6 and 12 months post-treatment under Vista's RECOVERY 20/20 program.

“We're definitely seeing a big push to measure their outcomes,” Conti says. “This is going to become required soon.” Still, she says, there are some centers that look at the task at hand and conclude, “I can do that next year.”

Conti became involved in this effort as a result of her frustration as a parent over trying to identify reliable information about treatment options for her daughter, who is now a recovery success story.

The Vista report generally shows that treatment completion has a positive effect on substance use patterns, mental health symptomology and quality-of-life variables. The percentage of patients surveyed at six months post-treatment who were working or attending school rose from 68% pre-treatment to 78% six months post-treatment. The percentage reporting at least a good relationship with their closest family members increased even more dramatically, from 30% at intake to 83% six months post-treatment.

The primary substance associated with the highest abstinence rate six months post-treatment was alcohol, with an abstinence rate of 42% among primary alcohol users. Heroin and cocaine were associated with the lowest post-treatment abstinence rates, at around one-quarter for each.