Guide: 11 Indicators of Quality Addiction Treatment

Quality check list 2

How to identify high-quality addiction treatment programs.

The Council on Recovery recommends the following guide published by the Recovery Research Institute, an affiliate of Harvard Medical School. We suggest using it to evaluate addiction treatment options for you or your loved ones. [The Council meets/exceeds all 11 quality indicators.]

Intro

With thousands of programs and rehabs to choose from, it can be challenging to assess which addiction treatment programs offer the highest quality of care.

Finding the right treatment facility is all too important, given the time, money, and energy that substance use disorder treatment and recovery requires of not only the individual, but the entire family.

The 11 Indicators of Quality Addiction Treatment:

Research has identified elements that quality substance use disorder treatment facilities should possess. These range from personalized treatments, to national accreditation, to assertive linkages to continuing care.

The experts at the Recovery Research Institute have compiled a comprehensive list of 11 indicators of effective treatment, as a blueprint to help guide you or your loved one to high-quality addiction treatment, maximizing your recovery success.

1. Assessment and Treatment Matching (Identify)

Finding effective help for an alcohol or other drug use disorder begins with reliable and valid screening for a range of substance use disorders and related conditions, as well as any physical or mental health conditions. This is followed by more comprehensive assessment of substance use history and related disorders, medical history, psychiatric history, individual’s family and social networks, and assessment of available recovery resources (“recovery capital”). These endeavors help uncover the many interrelated factors affecting the patient’s functioning and life and assess a patient’s readiness to change. This careful and comprehensive assessment can help prevent missing aspects or minimizing important aspects of a person’s life, such as trauma or chronic pain, inattention to which could compromise recovery success.

2. Comprehensive, Integrated Treatment Approach (Treat)

As discussed above, patients in treatment may have co-occurring psychiatric disorders, like depression and anxiety, as well as other medical problems like hepatitis C, alcoholic liver disease, or sexually transmitted diseases. Programs should incorporate comprehensive approaches that directly address these additional concerns, or otherwise assertively link patients to needed services. Treating the whole patient, will improve the likelihood of substance use disorder recovery and remission.

3. Emphasis and Assertive Linkage to Subsequent Phases of Treatment and Recovery Support          

Continuing care is defined as the ‘ongoing care of patients suffering from chronic incapacitating illness or disease.’ Ongoing care provides essential recovery-specific social support and necessary recovery support services after the patient leaves or transitions away from the initial phase of treatment. Programs that strongly emphasize this continuing care aspect will provide more than just phone numbers or a list of people to call, but instead, will provide assertive linkages to community resources, on-going health care providers, peer-support groups, and recovery residences. This ‘warm hand-off’ or personalized introduction to potential peers and resources in the recovery community, produces substantially better outcomes.

4. A Dignified and Respectful Environment

The treatment program should possess at least the same type of quality environment as one might see in other medical environments (e.g., oncology or diabetes care). You don’t need palm trees and luxury mattresses, but you should expect a clean, bright, cheerful, and comfortable facility. It is important that the program treats substance use disorders with the same professionalism and allocates similar resources for patient care as other chronic conditions. Creating a respectful and dignified environment may be particularly important for addiction patients, because those suffering from substance use disorders often feel as if they’ve lost their self-respect and dignity. A respectful environment helps them regain it.

5. Significant Other and/or Family Involvement in Treatment

Engaging significant others and loved ones in treatment increases the likelihood that the patient will stay in treatment and that treatment gains will be sustained after treatment has ended. Techniques to clarify family roles, reframe behavior, teach management skills, encourage monitoring and boundary setting, re-intervention plans, and help them access community services all help strengthen the entire family system and help family members cope with, and adapt to, the family system changes that occur in recovery.

6. Employ Strategies to Help Engage and Retain Patients in Treatment

Dropout from addiction within the first month of care is around 50% nationally. Dropout leads to worse outcomes, so it is vital to employ strategies to enhance engagement and retention. These include creating an atmosphere of mutual trust through clear communication and transparency of program rules, regulations, and expectations. Treatment programs can also work to retain patients by providing client-centered, empathic, counseling that works to build strong patient-provider relationships. They also can use motivational incentives to reward patients for continued attendance and abstinence.

7. Use of Evidence-based and Evidence-informed Practices

Programs that deliver services founded on scientific research and principles and that are delivering the available “best practices” tend to have better outcomes. In addition to psychological interventions, these should include accessibility to FDA approved medications for addiction (e.g., buprenorphine/naloxone, methadone, naltrexone/depot naltrexone, acomprosate) as well as psychotropic medication for other types of psychiatric conditions (e.g., SSRIs etc.). This is typically combined with qualified staff (see below).

8. Qualified Staff, Ongoing Training, and Adequate Staff Supervision

Having multi-disciplinary staff (e.g., addiction, medicine, psychiatry, spirituality) can help patients uncover and address a broad array of needs that can aid addiction recovery and improve functioning and psychological wellbeing. Staff with graduate degrees, and adequate licensing or board certification in these specialty areas are indicators of higher quality programs. In addition, clinical supervision and team meetings should take place at least once or twice a week for outpatient programs and three to five times a week for residential and inpatient programs.

9. Personalized Approaches that Include Specialized Populations, Gender, and Cultural Competence

Stemming from individualized comprehensive screening and assessment, programs should treat all patients as individuals attending to their needs accordingly. One size does not fit all, and neither does one treatment approach work for every individual. High-quality treatment programs identify the potentially different needs of men and women, adolescents versus adults, and those from different minority communities (e.g. LGBT) or cultural backgrounds, creating in turn, treatment and recovery plans that address their specific needs and acknowledge their available strengths and recovery resources.

10. Measurement of Program Performance Including During-treatment “Outcomes”

A further indicator of quality treatment is having reliable, valid measurement systems in place to track patients’ response to treatment. Similar to regular assessment of blood pressure at each check-up in treating hypertension, addiction treatment programs should collect “addiction and mental health vital signs” in order to monitor the effectiveness or ineffectiveness of the individualized treatment plan and adjust it accordingly when needed. Without any kind of standardized metrics, it is difficult to document and demonstrate patients’ progress.

11. External Accreditation from Nationally Recognized Quality Monitoring Agencies                            

Accreditation from external regulatory organizations such as the Joint Commission on Accreditation of Healthcare organizations (JCAHO; aka “the Joint Commission”), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Accreditation (COA); and other programs licensed by the state are required to offer minimum levels of evidence-based care. These licensing and accreditation requirements serve as quality assurance that the treatment program is incorporating a certain level of evidence-based care in its model and is open to random audit of its clinical care.

Baby Boomers and the Alarming Increase in Alcohol Use Disorders

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Baby Boomers are the fastest growing segment of the population. They’re also the group with the most dramatic increase in harmful alcohol use. According to a research published in the journal JAMA Psychiatry, increases in alcohol use, high risk drinking, and alcohol use disorders (AUD) among adults 65 years and older were substantially higher relative to earlier surveys.

The most alarming findings indicated that the number of adults 65 years and older who drank has risen higher than the national average by about 23 percent. And the average number of adults 65 and older suffering from alcohol abuse had risen by nearly 107 percent.

The study also reconfirmed the well-known correlation between alcohol use and the higher risk for disability, morbidity, and death from many alcohol-related chronic diseases. According to the National Institute on Aging, drinking too much alcohol over a long time can:

In addition to the medical risks are the many safety risks that alcohol creates for older adults. Drinking can impair a person’s judgment, coordination, and reaction time. This increases the risk of falls, household accidents, and car crashes.

In the midst of the medical and safety risks, the increase in both binge drinking and AUD among older adults has created a new urgency for doctors to screen for and identify unhealthy alcohol use by their older patients. Physicians are ideally positioned to discuss the risks of continued use and the options available to stop drinking for those with the problem. To support this effort, the National Institute on Alcohol Abuse and Alcoholism (NIAAA), offers multiple online resources for providers, such as brochures, fact sheets, alert bulletins, classroom resources, and videocasts. NIAAA’s website also provides the general public with information related to alcohol abuse among older adults.

In Houston, The Council on Recovery’s Wellderly program provides information and resources to help older adults, their family members, caregivers, and service providers identify and address alcohol and substance use and/or misuse. The Wellderly program’s unique suite of services include:

  • Community education and outreach to older adults and service providers
  • Screening, Brief Intervention, Referral to Treatment (SBIRT)
  • Case management
  • Specific help and guidance in talking with an older adult who has questions about their own substance use or a friend’s use of substances
  • Education and support for family members
  • Educational materials that aid older adults in taking better care of themselves

The Wellderly Program is supported by funding from The United Way of Greater Houston. For more information about the Wellderly Program please call 281.200.9109, email wellderly@councilonrecovery.org, or contact us online.

The Lifelong Quest for Sobriety…The Ultimate Hero’s Journey—Part 49

Guest Blogger and long-time Council friend, Bob W. presents Part 49 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In all these Notes, the fundamental core element is the idea of the Hero, the individual who journeys into the Underworld of her/his life to initiate a process of ongoing recovery from the ravages and horrors of addiction.  This is the same Hero that attends the core of thousands upon thousands of stories told in all the societies of the human experience all over the world. We have merely focused on it here in these Notes, seeing its parallel in the lives of all of us.

The recent DC Comics movie, Aquaman, is a tale of an undersea society of women and men living in many tribes, the center of which is the mythic world of Atlantis.  Atlantis was also a world of hubris that was created by Plato and other scholars and which, as a result of massive mythical conflicts, was eventually buried on the floor of the Atlantic Ocean. 

Aquaman
Aquaman

The hero of the modern movie, Aquaman, was a crossbreed of the queen of the undersea world and a surface human, a lighthouse keeper who rescued her from near death on the rocks at the foot of his lighthouse.  This hero, Aquaman, is blessed with significant powers and, upon reaching adulthood, he is drawn into a conflict between the tribes of the undersea world.  He is charged with the mandate to restore order to this world. To carry out this mandate, he must journey to a strange and dangerous realm and retrieve a golden trident, a weapon which grants him a set of powers that approach invincibility. This trident will enable him to prevail over all others and to restore peace and prosperity to the undersea realm.

The parallel to other mythic systems, particularly to that of King Arthur of early Celtic lore, is clear and very powerfully done in Aquaman. As in King Arthur, the golden trident is akin to the sword Excalibur which Arthur, a seemingly common man of royal blood, retrieves from a stone and is elevated to the mantle of King. As King, Arthur leads the Knights of the Round Table, each of whom set out episodically on quests of chivalry, conquest and spiritual enlightenment.

Does all of this strike you as profoundly as it strikes me…that all of us in recovery, those of us who have truly committed ourselves to lives of responsibility, accountability and service, are heroes of precisely equal stature and power…all of us?  Our journeys to achieve levels of sobriety have the same elements of these majestic stories, from the explorations into the frightening darkness of our pasts to the glory of the milestones that we celebrate with our Fellows and through the service that we are challenged to provide to others.

As we look at all the great heroic stories of the human experience, all those stories that mirror the lives of so many of us, there is this heroic mantle that seems to have been laid upon all of us.  It is the grace of a Higher Power, a mantle which we all are mandated to wear, to work, to be of service, in small and large ways, to make the world in which we live a better, safer place.

How Pornography Affects the Teenage Brain – An Infographic

Pornography addiction is an adolescent high-risk behavior that is escalating across all segments of the teenage population. By viewing sexually pornographic material, adolescents may face potential emotional, psychological, social, and physiological disorders and issues. The Infographic below, designed by helpyourteennow.com, illustrates the effects that pornography can have on developing adolescent brains. It can help you understand the problem and start important dialogue with your teen about viewing sexually explicit material.

Mindful Choices is the Center for Recovering Families’ adolescent high-risk behavior course that covers pornography addiction and 14 other risky behaviors. For teenagers and their parents, the course addresses these problems in the early, treatable stages. For more information, call 713-914-0556, email CRF@councilonrecovery.org, or contact us online.

Teen Pornography Addiction
how pornography affects the teenage brain infograph

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 48

Guest Blogger and long-time Council friend, Bob W. presents Part 48 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the Hindu traditions, there is a long Sanskrit epic called the Mahabharata, about a multi-generational feud between two ruling families, the Kauravas and the Pandavas, ruling in the ancient land that is today Northern India. The story culminates in a giant battle involving all the young men of the time, all aligned with one of the two families.

As the battle is about to begin, the head of the Pandavas, Arjuna, asks his charioteer, who is also the god Krishna, to drive him into the ‘no man’s land’ between the two armies. Seeing the size of the armies aligned against each other and imagining what is about to begin, Arjuna is overcome with grief. He asks Krishna for some relief, some way to avoid the coming armageddon. Krishna answers with a long poetic text that has become highly celebrated in spiritual circles; it is the Bhagavad Gita, aka the “Gita,” a spectacular, deeply articulated, relatively long prescription for an enlightened way of being.

Krishna begins the Gita with a direct response to Arjuna’s question.  He says that, as a warrior, Arjuna’s dharma, his cosmic reason for being, is to fight; he cannot avoid the call to arms.  Krishna says, “For a warrior, nothing is higher than a war against evil […] for it comes as an open gate to heaven.”

This is a wonderfully inspirational message for me, and, I believe, for all of us on the lifelong journey in sobriety. Active alcoholic behavior, living in the active disease, is an intrinsic evil, a place where we are active agents of devastation and abuse, abuse of people and the cosmos.  Our efforts to cross the threshold to abstinence, to a life of deeply imbedded behavior modification, and to a committed life of service are truly those of the warrior, that of the nobility of a warrior in a glorious quest for conquest over evil. Reading the Gita, from its beginning in the exchange with Arjuna, is a wonderful spiritual experience…and seeing it from the perspective of our own personal journeys is a great gift of grace from our own Higher Power.

New Research: First or Second Use of Cannabis Can Change Grey Matter Volume in Teenage Brain

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Research just published in the Journal of Neuroscience presents evidence suggesting structural brain and cognitive effects of just one or two instances of cannabis use in adolescence.

The study utilized brain scans to compare grey matter volume (GMV) in 46 fourteen year old male and female adolescents with just one or two instances of cannabis use and a carefully matched control group of non-cannabis users. The outcome showed differences in GMV among the cannabis users that were not indicated in the non-user group. It also showed that GMV differences were unlikely to precede cannabis use.

This new research confirms what The Council on Recovery has understood for years: Teenage and young adult brains are physiologically affected by substance use (such as cannibinoids) until those brains are fully-developed in the mid-20s. Substance users are also more likely to become addicted during this brain maturation period than if they wait until after full brain development.

These findings are timely as the legal status of cannabis is changing in many places and the perceived risks of cannabis use by young people has declined. In recent survey by the National Institute of Drug Abuse, nearly 35% of American 10th graders reported recreational cannabis. And that number may be increasing as the legal status of marijuana changes around the country. But, even as societal attitudes regarding marijuana shift, cannabis use and its effect on the adolescent and young adult brain continue. Certainly, while much is known, more research is needed.

In the meantime, The Council stands ready to help teenagers, young adults, and their families recover from cannabis addiction and other substance use disorders. If you or a loved one needs help, call 713-942-4100 or contact us online.