Outcomes are important because they ultimately provide accountability for those who deliver treatment, and for your own actions. There is a wide continuum of addiction treatment services available depending on severity of symptoms, ranging from outpatient options to residential or hospital stays. As you might imagine, there is a huge range in cost for these services as well.
Clearly, seeing a private practice clinician once a week for an hour (typically $150/hour) compared to a residential program that charges roughly $2,000/day, will yield very different financial investments at the end of one month: $600 vs. $60,000 investment. And here is where outcomes are important.
If you use a reliable and validated outcome tool to assess your overall symptoms and life function on day 1 of treatment, and then you use that same tool 30 days later to reassess the same things, which intervention option is better? And by how much is it better when we factor in the cost?
But addiction is very different than an acute medical problem like a broken leg, where a 30 day outcome has some meaning. For addiction, we want the benefits of treatment to hold far beyond 30 days! So let’s carry our example a bit further, and check in with you one year later. Two years later. Now how well are you doing?
What outcomes should be measured?
The outcomes will depend on you, and they will depend on what you measure. Earlier in this post I mentioned assessing overall symptoms and life functioning, not just abstinence which for many is the gold standard.
While abstinence can be an important measure, in my opinion it’s not as important as other outcomes, such as:
- Progress overcoming your developmental deficits and constrictions
- The number of healthy intimate relationships in your life
- Whether you have a deeper felt sense of meaning and purpose in your life
- How you spend your time
- The quality of your emotional life (progress addressing other co-occurring disorders)
- Degree to which you have resolved underlying traumas
- Your time dedicated to helping others and contributing to bettering the world
- Degree to which you have reduced shame
While I can come up with many more outcomes that I feel are more important than abstinence, let me be clear, I am not saying abstinence should not be included on the list! It should be there, but in my book it should be further down the list and used as one data point among many others.
Treatment providers and their outcomes
There are numerous tools to help you measure outcomes, but listing and reviewing them is beyond this post (I will get to it soon!). Right now if you are in treatment, or planning on heading there, ask your providers:
- What measures they use to assess outcomes
- Explain how they use these measures
- What the measures mean
- How what you are doing now, will influence where you are at two years later
While most residential programs rarely track long term outcomes, and those in private practice tend not to use formal outcome assessment tools, this brings me back to my final point. If the providers you are investing your time and money in don’t measure what they are doing, then you need to be proactive in finding ways to measure outcomes yourself.
Defining outcomes
Perhaps the easiest way to begin is by making a list of the things you care about, and what outcomes you hope for at some point in the future. The list above may give you some ideas. Then look at your list often and assess whether what you are doing day-to-day still makes sense.
Life is messy, things are constantly changing. Yet if we know what outcomes we seek, if we know our own true north, then despite the storms and chaos of life, we always know which direction to head. We also know when a change in what we are doing is needed. And we are empowered to better assess how we want to invest our time and money in treatment.
Presentation on outcomes
One final thing. Scott Miller is among my favorite clinicians (and researchers) who has studied, written and lectured extensively on outcomes for decades in a way we can all understand. Recently, he provided the keynote address at the 2013 Evolution of Psychotherapy Conference where he nicely sums up outcomes, not specifically for addiction, but for therapy in general, in a great 45 minute presentation which I encourage you to watch.
I’m a student in PSU taking the Drug Education class. During the lecture about alcohol addiction, Debbie Kaufman, our instructor, mentioned that out of 19.3 million people who, based on DSM-IV diagnosis, needed treatment for their alcohol problem in the past year, 87.4% did not perceived a need for alcohol treatment. I was pondering on this number, and it seems to be too high to be explained only by the people’s blindness toward their problems. My daughter sent me a link to the article “Most People with Addiction Simply Grow out of It: Why Is This Widely Denied?” printed at the AlterNet website (1), which, as the name implies, suggests another possible explanation of this phenomenon. I read the article carefully and followed all their links, but I am definitely lacking an expertise to judge them with any authority.
I would greatly appreciate if you can take a look at this article and let me know your opinion on it. I would definitely recommend to any person with a chronic addiction to seek a help of a specialist as well as get the support from friends and family, but to know that a person crippled by the addiction could, with time, just grow out of it gives me a great hope for a brighter future of humanity. If it was only about me, I would happily hold on to this naive hope, but for my daughter I want to have the answer which is based on knowledge and expertise not just wishful thinking.
Thank you very much,
Nadia Gugnyak
1. http://www.alternet.org/drugs/most-people-addiction-simply-grow-out-it-why-widely-denied?page=0%2C0
Nadia, it is true that like other mental and emotional problems, many do move beyond addiction without any sort of help. Where things get a bit cloudy is that research has not really addressed the degree to which people give up “all” addictions. Sure, many do stop drinking or drugging without treatment, but often these addictions get replaced by something else that researchers never ask about. So in truth we don’t really know how many people really grow out of addiction. Another issue is that if you follow my blog, I believe addiction is about a lot more than just addiction. Just because someone stops doing an addictive behavior does not mean they have resolved underlying trauma, developmentally caught up, engaged in healthy relationships, or really engaged in life in a deeper and more meaningful way. And one final point – so many studies have short follow-up times, so saying people grow out of addictions without following them for years, and making sure to ask about all addictive behaviors, means we really don’t know the answer to this question. Hope that helps, and thanks for the comment!
J