Magazine article Psychology Today

Treating Substance Use Disorders: A Resolution to Embrace Measurement-Based Care in 2017

Magazine article Psychology Today

Treating Substance Use Disorders: A Resolution to Embrace Measurement-Based Care in 2017

Article excerpt

Dr. Tonmoy Sharma, MBBS, MSc

CEO, Sovereign Health

We are well into the second decade of the 21st century. On almost a weekly basis, new discoveries gleaned from advanced neuroimaging techniques, rigorous clinical trial outcomes data, and the development of novel neuropsychiatrie medications are opening new pathways in addiction treatment. Individuals with substance use, and those with the comorbidities of addiction and an underlying psychiatric condition, should be reaping the benefits of evidence-based addiction treatment. But sadly, even in 2017, data show that health care professionals are not implementing evidence-based science (Scott & Lewis, 2015) in treating the 21.5 million Americans who have a substance use disorder (SAMSHA, 2016).

We know that quality health care, including substance use and addiction care, should be firmly rooted in established biomedical research. Measurement-based care (MBC) - the practice of basing clinical care on client data collected throughout treatment (Scott & Lewis, 2015) - is a core component of evidence-based practices (Klerman, Weissman, Rounsaville & Chevron, 1984; Beck & Beck, 2011). Over the past decade, MBC has emerged as an incontrovertible, evidence-based method that can be used for virtually any health issue (Lambert et al., 2003; Trivedi et al., 2007), and research has shown that applying MBC (such as monitoring symptom change using idiographic assessments) is beneficial for improving client outcomes (Weisz et al., 2011). Overall, MBC elucidates treatment progress, allows for adjusting treatment plans as necessary, reduces exacerbation of symptoms, and empowers patients to participate in their own care while improving their outcomes (Lambert et al.; 2005).

In 2015, the Kennedy Forum released an Issue Brief titled "Fixing Mental Health Care in America: A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services," which illustrated the domino effect caused by a non-MBC approach in behavioral treatment. The conclusions are mind-boggling; per the Brief, a mere 18 percent of psychiatrists and 11 percent of psychologists monitor the efficacy of specific treatment approaches by routinely administering symptom rating scales and therapist assessments to their patients. This lack of assessment cements clinical inertia, and creates barriers to improving clinical services. Providers and, indeed, entire health care systems miss opportunities for ongoing improvement. A lack of symptom rating scales precludes individual practices and health care networks from proving the efficacy of their treatment protocols to third-party payers. This lack of empirical data on treatment success leads to chronic federal and state underfunding of behavioral health treatment, and decisions about reimbursement for services rendered are not aligned with treatments that are proven to be the most beneficial (Kennedy Forum, 2015).

Despite the deleterious effects of not implementing an MBC model, clinicians have been slow to change. It is worth noting that, in general, it takes 17 years for 14 percent of research to reach consumers (Balas & Boren; 2000). …

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