Why We Must Redefine Addiction Treatment: A More Comprehensive, Chronic Care Approach Incorporates Many Elements That Are Available Now

By Tamasi, Raymond V. | Behavioral Healthcare Executive, Summer 2015 | Go to article overview

Why We Must Redefine Addiction Treatment: A More Comprehensive, Chronic Care Approach Incorporates Many Elements That Are Available Now


Tamasi, Raymond V., Behavioral Healthcare Executive


Despite wider acceptance of addiction as a chronic brain disorder, systems of care continue to be primarily developed and defined by acute, time-limited treatments. This fragmented approach fails to provide the life-long management necessary to achieve sustained remission.

Data from the Massachusetts Information System, for example, reveals that 87 percent of patients admitted to detox units have previous admissions; over half have been there more than five times. Similar data exists for long term residential programs where 75 percent of patients have been there multiple times.

Yet, the existing system encourages and reimburses bed care while underinvesting in community-based care management. Anecdotal reports from providers indicate that patient transitions from inpatient to outpatient care are poor, ranging from to 25 percent to 50 percent. While the system surely is suffering from a temporary dearth of inpatient capacity, the greatly underemphasized problems are the absence of comprehensive community based continuing care management and the paucity of prevention, early identification and intervention.

For more than 40 years, addiction treatment has been defined and judged by the misplaced perception that a fixed amount or duration of treatment, such as a week in detox or a month in rehab, will "fix the problem." If the patient regresses after leaving rehab, it is often attributed to the patient's lack of readiness or to ineffective treatment.

Acute detox and rehab care are not the template for treatment of a lifetime chronic condition. Patients must be treated in a seamless array of services matched to the severity of their condition or need and that treatment must be sustained beyond a time limited episode.

Consider that opiate dependence is not limited to any single demographic group, and those most affected are young adults. In the last six years, Gosnold admissions for this age group have risen from 27 percent to 45 percent. Many young people are getting to treatment, and this is a good thing. However, closer examination of the data is not as encouraging.

We tracked a sample of 65 young patients during and after their detox treatment. Among them,

* 96 percent reported a supportive family, girl/boyfriend, or 12-Step colleague.

* 93 percent successfully completed their inpatient treatment.

* 91 percent accepted a referral to continue their treatment at another level of care.

Yet despite these positive indicators of motivation, follow-up contacts revealed that:

* Only 53 percent kept their initial continuing care appointment.

* Only 23 percent kept their second appointment.

* 13 percent had already regressed (resumed use) within 72 hours of discharge.

* 17 percent had regressed by the second call, seven to 10 days later.

The patients were motivated to seek treatment and remain drug free and were engaged in their care. They also had supportive family and others who cared about them. Yet, nearly one in five regressed within one week following discharge. We must find better approaches to improve remission rates and successfully bridge the gap from a detox or rehab treatment to community based care.

A better way

A more comprehensive, chronic disease management approach incorporates a range of community based elements of care that can improve remission rates and reduce rehospitalizations. And those elements are available now. We simply need to provide them to our patients.

In addition to traditional psycho-social interventions and 12-Step groups, the elements include recovery coaching and care management to help patients focus on recovery activities, navigate high risk situations, strengthen the recovery life, and extinguish the drinking and using lifestyle; medication assisted treatment; technology assisted recovery supports; family support and coaching; recovery socialization; and urine drug monitoring. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Note: primary sources have slightly different requirements for citation. Please see these guidelines for more information.

Cited article

Why We Must Redefine Addiction Treatment: A More Comprehensive, Chronic Care Approach Incorporates Many Elements That Are Available Now
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen
Items saved from this article
  • Highlights & Notes
  • Citations
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA 8, MLA 7, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Search by... Author
    Show... All Results Primary Sources Peer-reviewed

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.