Magazine article Addiction Professional

Show Your Long-Term Outcomes

Magazine article Addiction Professional

Show Your Long-Term Outcomes

Article excerpt

Many significant behavioral illnesses, from substance abuse to psychotic disorders, are relapsing in nature. Patients are almost always better when they are discharged from reputable treatment programs, but typically there is little information about their course after discharge. Do they maintain their improvement? Did the treatment facility that they chose help them avoid a relapse effectively? For anyone seeking help, that information should be essential to deciding where to get treatment, but reliable post-discharge outcome data is exceedingly hard to find. It shouldn't be.

The demand for treatment outcome data is increasing, from federal and private insurers that fund treatment but also increasingly from consumers. More and more, consumers are choosing from available programs based on limited selfreported information about outcomes and efficacy. These data are not peer-reviewed, and the information is usually presented selectively. Each program may use parameters that differ from those of their competitors. It's easy to be creative with the numbers when producing what is in essence marketing material to attract patients to a treatment program. Consumers typically have no way of knowing how a program comes up with its outcome data, and thus have no way of making "apples-to-apples" comparisons among programs.

This lack of transparency and standardization is a glaring shortcoming in the fields of addiction medicine and psychiatry. A prospective surgical or medical patient can review and compare hospital outcome data for aortic valve replacement survival rates or leukemia remission. It should be just as easy to make direct comparisons among psychiatric or addiction programs.

We can easily measure and report "before and after" data, comparing patients' signs and symptoms at the time of admission with the time of discharge. The results typically look good, but they don't tell you how effective the treatment of a relapsing illness has been when it really counts-one, two or even three years after discharge.

Call for standardization

There are some fundamental reasons why long-term patient outcome data are so challenging to gather. Treatment evaluation studies are expensive to do well, and currently there is no mechanism to fund them. It also can be a frustrating undertaking because patients often aren't interested in maintaining contact after discharge, so dropout rates can be significant.

Leaders in the field, ideally in collaboration with a federal agency such as the National Institute of Mental Health (NIMH) or the National Institute on Drug Abuse (NIDA) and a professional organization such as the American Psychiatric Association (APA) or the American Society of Addiction Medicine (ASAM), must begin working together to establish industrywide standards that treatment programs agree to use and that would provide a common structure for collecting and reporting data on treatment outcomes. For this to work, institutions will have to agree to report their data in some standardized way-not just selectively on their websites-perhaps in an annual journal of treatment program outcomes data or on a dedicated website hosted by the NIMH or the Substance Abuse and Mental Health Services Administration (SAMHSA). …

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