Are `the Basics` More Important Than Innovation?

Behavioral Health of the Palm Beaches (BHOPB) is a residential alcoholism and drug abuse treatment facility in Lake Worth, Florida. The desire to provide the best possible treatment for our patients has led us to seek innovative treatment interventions. Examples include Eye Movement Desensitization and Reprocessing (EMDR) for patients with symptoms of trauma and acupuncture for patients with chronic pain. Tailored interventions are also available for addicts with co-occurring chronic anxiety, unresolved anger, or grief issues.

The desire to discover how well our patients have done led us to track a random sample of 90 patients for one year. Data were collected between August 2002 and December 2004. We were eager to determine an overall success rate, as well as the impact of our innovative interventions. Patients were contacted by telephone three months, six months, nine months, and one year from their date of discharge.

We learned that 53% of the sample completed one year of continuous recovery. We believe these results understate patients' overall success. Once a former patient began using, we recommended that he/she get help, but we did not continue to follow that person. We know that some people who were using at three, six, or nine months sought more treatment or resumed their recovery program. Some of these people were clean/sober one year from their discharge date. However, they were not included in the data as having completed a year in recovery.

Some other data were interesting but not really surprising. For example, patients who were married or separated were more likely to achieve one year of continuous recovery than were patients who were divorced or single. Patients who are separated may do better because the hope of saving the marriage motivates them.

The data also provided what could be considered a surprise. Although patients clearly benefited from the interventions that we considered to be “special,” defined as being provided to patients only when the need is indicated, the best predictor of one year of continuous recovery was having and using a sponsor. Furthermore, almost all of the patients who were successful did connect with 12-Step support. Conversely, 35 to 40% of them did not connect with the outpatient program to which they had been referred.

Like many professionals in the addiction treatment field, we at BHOPB have been looking for the most promising and innovative interventions available. We have absolutely no doubt that interventions such as EMDR are extremely important. Self-reports from patients confirm this. However, the data indicate that providing patients with three to five of our special interventions had an optimal effect. Patients receiving more than five were not more likely to achieve one year of consistent recovery.

There have been major changes to the process of addiction treatment in the past 20 years or so. Some of these changes have come from the demands of third-party payers. Change also has come about from new knowledge emanating from the fields of psychiatry and social work. Many new innovations have been extremely effective. But the question that our outcome study is raising is that in our efforts to look for innovation, are we neglecting the basics?

The essentials

I use the term “basics” to refer to such things as the best possible assessment, a clean and sober life, 12-Step work, the importance of 12-Step meetings, sponsorship, spirituality, and the best possible discharge plan. A close friend of ours observed that discharge planning may be the single most important task we perform for a patient in treatment, but remains the process on which we spend the least time.

We as treatment providers may need to look more closely at how we distribute resources. Which trainings have we supported for our staffs? Which conferences have we sent them to? Do we make certain that all of our therapists are well-acquainted with the 12 Steps and basic recovery, or are we sending them only to conferences on advances in psychotropic medications or the role of acupuncture in addiction treatment? Psychotropics and acupuncture have an important role to play in addiction treatment, but not if the patient can't get clean and sober.

Acknowledgment

The authors would like to acknowledge Paul Peluso, PhD, of Florida Atlantic University for his help with data analysis.