Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.
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Transcript of Suppose We Try Something New in Addiction? Different Perspectives and Research Implications.
Suppose We Try Something New in
Addiction?
Different Perspectives andResearch Implications
1. Build National System of “Prevention Prepared Communities”
2. Train primary care to intervene early with emerging abuse
3. Integrate addiction treatment into mainstream healthcare
4. Smarter, safer management of drug-related offenders
A Nice Simple Rehab Model
NTOMS Sample of 250 Programs
Treatment
Substance Abusing Patient
Non- Substance Abusing Patient
ASSUMPTIONS• Some fixed amount or duration of
treatment will resolve the problem
• Clinical efforts put toward correctly placing patients and getting them to complete treatment
• Evaluation of effectiveness should occur following completion
– Poor outcome means treatment/patient failure
But this hasn’t worked well…
• About 60% of outpatients drop out prematurely (< 1 month).
• Relapse rates are high – 50% @ 6-mos.
Studies show few differences between…
• Brief and Intensive Treatments
• Inpatient and Outpatient Treatments
• Conceptually Different Treatments
• “Matched” and “Mismatched” Trt.
• Gender or Culturally Oriented Trt.
How Do Other
Treatments Work? Chronic Illness & Continuing Care
A Continuing Care Model
PrimaryContinuing Care
Primary Care
Specialty Care
In Chronic Illnesses….
1 – The effects of treatment do not last very long after care stops
2 – Patients who are out of treatment/contact are at elevated risk for relapse
So, For Treatment….1 – One goal is to retain patients at an appropriate level of care and monitoring
2 – Another goal is to prepare patients to do well in the next level of care
3 - The effects of treatment are evaluated during treatment – not post-discharge
• Maybe Results Depend on Perspective
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Pre During During During Post
Treatment Research Institute
Outcome In Hypertension
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Pre During During During Post
Treatment Research Institute
Outcome In Addiction
Maybe this is why…
Studies show few differences between…
• Brief and Intensive Treatments
• Inpatient and Outpatient Treatments
• Conceptually Different Treatments
• “Matched” and “Mismatched” Trt.
• Gender or Culturally Oriented Trt.
OK, But Could This Work in Addiction?
Several Reasons To Think ofAddiction as a Chronic Illness
Continuing Care In Addiction
RecoverySupport Services
Primary Care
Specialty Care
ScreenInterveneMonitorRefer
Re-InterveneMonitor/Support
StabilizeMotivate/MedicateTrain Self-MgmntRefer
Implications?
1. For Current Addiction TreatmentSystem
2. For Expanding Treatment3. For Evaluation
~ 12,000 specialty programs in US
• 31% treat less than 200 patients per year
• Very Few Doctors • Most of those eligible do not want
care
7. Integrate Addiction Treatment into Federal Healthcare Systems
8. Performance Contracting in State Treatment Systems
9. Consumer Choice Through Vouchers for Recovery Services
How to Evaluate?
1. Model is There2. What are Performance Measures3. When/How to Measure Outcome4. How will public understand