By Geoff Thompson – MA, CCC
As part of the new programming at Sunshine Coast Health Center in Powell River, Melanie Alsager, the Center’s Administrator, is opening its doors to public scrutiny. Unlike most managers of treatment facilities, she believes that what Sunshine Coast does, why it does it, and how well it does it should be transparent.
Ken Hart of the University of Windsor, one of Canada’s experts in the field, has already accepted Ms. Alsager’s invitation to study its program.
Sunshine Coast will be the first private treatment centre in Canada to be transparent. If this sounds odd, it is. Imagine the public outcry if the local hospital just did what it wanted to without having to answer to regulatory bodies or patients. But one of the more peculiar things in the treatment of addictions is its secrecy.
Public scrutiny scares most facility managers because it means inviting professional researchers in to take an in-depth look at how successful they are.
A handful of private facilities have offered the invitation, with embarrassing consequences. Renascent in Ontario advertised an “independent study,” which concluded “60% have stayed clean and sober two years post-treatment.” Phoenix House in New York City declared publicly that 80 percent of its clients stayed sober for at least five years.
These public declarations are invitations to researchers, who promptly proceeded to report, equally publicly, that the studies were flawed. In fact, there were even suggestions of deliberate deception. The experts didn’t bother dissecting the Renascent figures after they realized that the methodology was substandard. They simply embarrassed the centre on television.
After researchers got their hands on the Phoenix data, the successful outcomes plummeted from 80 percent to 16 percent. Even 16 percent after five years is high, according to scholarly research, until one recognizes that the Phoenix programs are 18 and 24 months long. Thus, only the most motivated clients enter the facility.
Small wonder that managers of treatment facilities steer clear of researchers. Renascent and Phoenix were hard lessons.
Still, many continue to publish rates that are wildly more successful than any published in scholarly research. A taxpayer-subsidized program in BC’s Lower Mainland advertised a 90 percent success rate, though its annual report dropped the figure to 66 percent. I suspect that I’m one of very few who even paid attention to the numbers. Most researchers wouldn’t waste their time. It was obvious that the study’s design and methodology were weak, and it lacked sufficient data. Most damning, it conveniently omitted those who did not complete the program, which was rather significant since the attrition rate was 60 percent.
But regardless of Renascent, Phoenix, and the rest, researchers have known for years the outcomes of mainstream treatments. In the old days, we used to measure them by abstinence. Success meant never using substances; failure meant any use of a substance.
Under this now dated way of thinking, success rates were as follows:
- Up to a year (clients are usually followed only for three months): about 25 percent abstain
- At four years after treatment, the figure drops to 7 percent
- At seven years, the figure is 5 percent.
But measuring success by abstinence has not been done for a generation. The new method is to examine various life areas before treatment and after treatment. Typically, researchers want to know if there are improvements in physical health, family relationships, ability to work or attend school, emotional and mental stability, and criminal involvement. Drug use is used as one more indicator.
Successful treatment means a statistically significant improvement in these life areas. Generally, of those attending mainstream programs, one-third improve, one-third stay the same, and one-third deteriorate. In the very best researched-based programs, with clients who are motivated and have lots of support, about half will significantly improve.
Professor Hart will soon be studying Sunshine Coast, and both he and Ms. Alsager are excited. Preliminary discussions with several universities, including one in the US, have indicated that many are eager to see the results. And why wouldn’t they be excited? With only a handful of centers in North America willing to invite researchers in, Ms. Alsager’s belief in transparency is welcome news to them.
About the Author
Geoff Thompson, MA, is the Program Director at Sunshine Coast Health Center, a private addiction treatment facility for adult men. His book, A Long Night’s Journey into Day, explores Eugene O’Neill’s life to uncover the truth of addiction and recovery.