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.
