“Severe substance use disorder or addiction is a complex chronic disease of the brain.”
Taking the first step: Successful treatment planning
When individuals and their families reach out to treatment providers, devising a plan of healing for everyone involved in the process is as complicated as the disease itself. Each patient or client deserves a plan of treatment individualized to their specific situation, which addresses their challenges and enhances their specific strengths.
Factors influencing the type of treatment plan, which is best suited for one person over another, includes appropriate screening and assessment of a variety of factors including:
- Disease severity
- Sexual orientation
- The presence of co-occurring mental health diagnosis(-es)
- Drug(s) of choice
- Chronic pain
- Family dynamics
Matching a treatment plan to the individual nuances of a given person may be the difference between long-term success or utter failure. Just as important is a person’s willingness to follow the treatment plan set before them by the professionals charged with their care. The stakes are extremely high as many people who are discharged from treatment relapse. Tragically, oftentimes, repeated relapse leads to death. With effective treatment planning and successful implementation of the plan, many people can find wellness and return to being productive family members, employees, and citizens.
Treatment plans need to be continually adjusted
Treatment plans for those who suffer from the disease of addiction need to be continually adjusted to meet the present needs of the client. Given that recovery from addiction is a growth process over time, some difficulties are better addressed earlier in the process and some later. Treatment team members need to be nimble, flexible, and patient in continually modifying the plan.
One of the things which complicate treatment planning is the variety of services that need to be brought to bear in promoting healing and growth. Such services may include detox, medication, other medical care, dental care, individual counseling, group counseling, family counseling, peer support, recovery fellowships, sponsorship, occupational/financial counseling, nutrition, legal, education, etc. Such services are necessary because the consequences of the disease impact all areas of a person’s life.
Due to the chronic nature of the disease, these services should begin in treatment but should extend at least several months post-treatment, if not longer. Extending the treatment plan to include continuous recovery planning and support is showing tremendous promise in a variety of populations. These populations include collegiate recovery, drug courts, professional assistance programs, as well as peer and therapeutic recovery support.
It is important that individuals be highly involved in the treatment plan. Garnering feedback from the client and obtaining their permission and acceptance of the process is crucial. Arming clients with choices and alternatives as appropriate can increase client adherence and follow through. Treatment plans should be visually laid out in mutually agreed upon documents outlining a success path for the individual.
Family involvement in treatment can improve outcomes
An often overlooked group necessary in developing and implementing an effective treatment plan is family members. In the beginning process of reaching out for help, those who suffer from the disease of addiction are not always equipped to provide the most accurate information about their condition. This is especially true in the assessment of disease severity and severity of use. Close family members are also ultra-aware of past safety concerns (e.g., past suicide attempts) and can give needed feedback to create a plan to protect clients during the vulnerable times of treatment and extended recovery support.
In addition, incorporating families and family intervention into the treatment plan provides family members the opportunity to provide meaningful support to their loved one post-treatment. Having safe family members on board with the client’s consent can be a game changer for long-term recovery success, particularly if they seek their own support when appropriate.
Longitudinal outcomes data for SUD treatment is imperative
One of the crucial things missing within the substance abuse treatment space is outcomes data documenting the success or failure of a given treatment plan for a given person. Such longitudinal outcomes data would help everyone involved in the care continuum. It certainly would be of immediate benefit to those individuals who need to re-engage treatment after a relapse because providers would be better informed as to what methods were effective or ineffective for an individual. The ideal result of better outcomes data would be a healthcare system where individual treatment plans—measured over time from hundreds and then thousands of individuals and families—are utilized to inform the treatment plans of others from similar background, characteristics, families, drug(s) of choice, etc.
To do this, we need to hold treatment providers accountable for effective outcomes-based treatment. Consumers and third party payers need to demand that outcomes data be gathered longitudinally to be used to change the way we provide treatment and create treatment and recovery plans in the future. If this is done, we can change the effectiveness of treatment and save lives.
An example in history when this occurred was with the treatment of childhood cancer. Thirty years ago, 8 out of 10 children died from leukemia, a form of childhood cancer. Getting a diagnosis of leukemia was basically a death sentence. Not only did most of the kids die, but the treatment left many of them disabled with long-term consequences.
How did we stem the tide of leukemia deaths? Multiple treatment and research sites with good financial backing funded outcomes research in an effort to find the most effective treatment. The most effective treatment regime available was made the “standard treatment”, and two promising experimental treatments were created. Families were allowed the choice to select into the research experience. Each child whose family agreed across the nation was put into one of three different treatment regimes. As more data was gathered over time, and when one of the experimental treatments was found to be most effective, it was made the “standard” and another promising experimental treatment plan was put in its place.
Today, because of this effort, 8 out of 10 children diagnosed with leukemia live, including my own son Nathaniel. From this effort, we also know that boys need 3 years of treatment and girls only need 2. Treatment plans for leukemia patients can also be tailored based on severity and risk based on medical testing and vulnerabilities; low, medium, and high.
We can and must gather information and data longitudinally from those who suffer from addiction and are seeking treatment. We can and must incorporate outcomes data to inform not only treatment plans but also extended recovery support. We can come together in collaboration, utilizing multiple sites and outcomes data. We can find the most effective long-term treatment plans tailored and individualized based on data from real people who have come before. Through this effort, we can stem the tide of the addiction epidemic saving billions of dollars in resources and, most importantly, saving the lives of those who suffer and those who love them.
American Society of Addiction Medicine. The ASAM Standards of Care For the Addiction Specialist Physician. Available from http://www.asam.org/docs/default-source/publications/standards-of-care-final-design-document.pdf
Borkman, T. (1998). Is recovery planning any different from treatment planning? Journal of Substance Abuse Treatment, 15(1), 37-42. http://www.naadac.org/assets/1959/borkmant1998_is_recovery_planning_any_different.pdf
NIDA (2012). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/principles-effective-treatment
Center for Substance Abuse Treatment. Substance Abuse Treatment for Adults in the Criminal Justice System. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2005. (Treatment Improvement Protocol (TIP) Series, No. 44.) 4 Substance Abuse Treatment Planning. Available from: https://www.ncbi.nlm.nih.gov/books/NBK64138/