Outcomes

Dr. Norman Hoffmann

When all is said and done about documenting addiction treatment outcomes, more is said than done. In principle, basic documentation of outcomes is not all that complicated or daunting. Since the research clearly indicates that the duration of some level of contact between treatment professionals and patients should be at least 90 days from intake, all programs could theoretically document what proportion of individuals achieved at least early remission as defined by the DSM-5 during the standard course of treatment.

The initially more intensive part of treatment, whether residential or intensive outpatient is usually in the range of about four to six weeks followed by some level of scheduled contact called maintenance care, or “aftercare” for a total time of contact duration of around three months. The DSM-5 defines early remission as no positive DSM-5 criteria other than craving for three months.

Unfortunately, the first thing I hear when beginning the discussion of outcomes is what “tool” to use. In reality, a tool is not required. The basic objective of treatment is to achieve remission – not to make the person employable or a model citizen. So, for a period of three months, has the person been successful at not suffering consequences of use, such as missing work or failing to meet other obligations, not had social or interpersonal problems due to use, not used in situations where use was hazardous, etc. If the person was abstinent, most would agree that early remission has been achieved. Even with some slips, remission could still be possible, if there were no further consequences of use.

The basic outcome measure is not a tool or scale, but simply sufficient questions regarding whether mood altering substances were used or not, and if there was some use, did it result in some problem or consequence. Asking about six to ten questions should cover whether the person had achieved remission. If you want another blog for some ideas on the mechanics for this, send an e-mail to norman@evincediagnostics.com.

NAATP did a pilot study on outcomes that produced some very interesting findings for the residential programs involved. The forms used for that are public domain for those interested. A growing number of organizations and companies are offering outcome services with varying degrees of relevance and utility. Most commercial outcomes services use scales of one sort or another to document either results or changes from intake. Those may be suitable or useful, but the core outcome measure should be some determination of the extent to which at least early remission has been achieved.

Bottom line: The basic mission of addiction treatment is to resolve the addiction to achieve remission. Remission is what programs get paid to accomplish. All the other benefits derived from treatment are bonuses for which most programs to not receive reimbursements.