Why is the topic of success rates in addiction treatment so important? Perhaps we believe success rates will tell us whether a loved one’s addiction are going to finally come to an end. Or perhaps family members believe success rates will tell them which treatment centre is the best.
If only it were that easy.
Success rates can be misleading because (1) there is no standard definition for success and (2) treatment centre client populations vary tremendously.
Then there is the process of conducting an outcome study. For example, outcome studies provided by independent research firms are expensive and have confidentiality implications. Outcome studies done by treatment centres themselves, on the other hand, may be biased.
Only a handful of treatment centres in North America have conducted proper outcome studies. These are the larger treatment centres such as Caron Foundation, Hazelden, and Betty Ford Center who have the finances and resources to commit to such research.
Here are some questions you may want to ask:
- Do your success rates measure abstinence, quality of life* or both?
- How frequently are outcomes surveyed (monthly, quarterly, yearly)?
- How long do you track clients (first 90 days, first year, indefinitely)?
- Who conducted the survey (staff member or independent research firm)?
If a treatment centre measures abstinence, questions may include:
- How do you define abstinence? Abstinence can be defined as (1) continuous abstinence since treatment, (2) currently abstinent with one or several prior short-term relapses**, or (3) currently abstinent with one or several prior relapses**.
- Do you consider non-problematic drug or alcohol use abstinence (many harm reduction programs consider this success)?
- Do you include mood-altering drugs, even if they were prescribed and used as directed? What about drugs for depression or other mental illness?
- How did you obtain your data (self-report from client, family member or other 3rd party, urinalysis/blood test)?
If a staff person can only provide a figure with no details then, if possible, request that a copy of the outcome study be sent to you.
*Quality of life indicators are generally based on feedback from clients or their families. Quality of life tends to focus on relationships that include: (1) stability of relationships, (2) type of social network (using or abstinent/in recovery), (3) amount of social involvement and support, (4) clients’ overall rating of their own quality of life.
**A “slip” (also known as “lapse”) is defined as drug or alcohol use shorter than 24 hours in duration. A “relapse” is usually over an extended time frame with increasing frequency and negative consequences. Distinguishing between a slip and a relapse is not an exact science. Clients and families are cautioned against rushing to judgment following a “slip.” More importantly, individuals who have slipped should take immediate action: stop, walk away, and call for support.
In a 2006 survey*, approximately 50% of our clients were completely abstinent after one year following treatment with no drug or alcohol use. Another 20% have had 1-3 short-term relapses** over the course of a year but were abstinent one year following treatment.
The remaining 30% are in various stages of relapse as follows:
- Initial period of abstinence followed by return to drug or alcohol use
- Initial period of drug or alcohol use following treatment but currently abstinent
- Binge use (repeated bouts of abstinence followed by drug or alcohol use)
- No noticeable effect from treatment
Even for those clients who have relapsed, the majority of families and clients report an improvement in quality of life (with the exception of those who saw no noticeable effect from treatment).
*Outcomes were obtained in follow-up phone interviews with clients, family members, or referral agents (e.g. counsellors, employers, etc.). Phone interviews were conducted quarterly by staff. Clients were not included in figures if they or family members or referral agents could not be contacted, declined to respond when reached by phone, or failed to respond to phone or mail inquiries. Drugs that were prescribed and being used as directed were not measured in follow-up studies.
**A short-term relapse is defined as drug or alcohol use shorter than 7 days in duration. Clients and families are cautioned against rushing to judgment following a relapse. For example, comments such as “he doesn’t want it bad enough,” “he isn’t ready,” “he hasn’t hit bottom yet,” or “treatment didn’t work” are not helpful. More importantly, individuals who have relapsed should take immediate action: (1) stop, (2) walk away, and (3) call for support.