This is the second in a five-part series on “Finding Addiction Treatment That Works.” Read “Part One” here. What are two buzzwords often used to vouch for the effectiveness of a prospective drug and alcohol rehab program, and what should they mean if they are to indicate addiction treatment that works? “Comprehensive” and “individualized” are terms often used to describe the assessment and treatment of addictions and dual diagnoses, such as depression, anxiety or other mental health disorders. Indeed, a report by the National Center on Addiction and Substance Abuse at Columbia University (CASA) lists these two elements, “comprehensive” and “individualized” assessment and treatment, among a number of best practices that define effective, evidence-based treatment. The challenge for individuals and families seeking quality substance abuse treatment that works is that while many prospective programs may say they provide comprehensive, individualized assessment and treatment, to what degree their offerings really do qualify as such can be hard to discern. As the CASA report states, “Even the word ‘treatment’ lacks precision with regard to addiction, since historically it has been used to refer to a host of interventions, many of which are not based in the clinical and scientific evidence as are treatments for other diseases.” So just what is comprehensive, individualized assessment and treatment? And what questions should you be asking a prospective treatment program when it comes to these elements of evidence-based treatment?
Comprehensive and Individualized Assessment—What Should It Include?
A comprehensive and individualized assessment, which is arguably the most critical part of getting treatment that works, should include the following elements, according to the CASA report:
- Assessment by at least one trained physician, in consultation with other health and clinical professionals
- Reliable and valid interview-based instruments and biological tests (such as blood and urine samples) that “address all types of addictive substances”
- An evaluation of an individual’s medical, psychological, social, family and substance use history, as well as current health status, addictive behaviors, personality traits, and the presence of any co-occurring disorders
- Identification of factors that have contributed to or are related to the disease
- A detailed clinical diagnosis, including an evaluation of the severity of the disease
- A detailed plan of treatment involving case management by a trained professional
A comprehensive assessment will obtain all of the information needed to treat not just the substance abuse, but also the other multiple factors that feed the addiction and are unique to the individual. The Substance Abuse and Mental Health Services Administration (SAMHSA) regularly releases new installments of a series titled Treatment Improvement Protocols, in which it outlines additional criteria that define a “comprehensive assessment.” The criteria include:
- In some states, the use of state-mandated assessment tools
- A description of current strengths and supports as well as limitations, skill deficits and cultural barriers that may help and/or hinder an individual’s recovery
- Determination of the stage of change of an illness. In other words, an assessing clinician will need to help you determine where you are in the process of owning your addiction problem, so they can tailor treatment that meets you there.
- Ongoing assessment throughout the recovery process
- Empathic detachment: The clinician conducting your evaluation should be empathic and supportive but also maintain appropriate professional distance so as not to be overstepping in their role as a clinical caregiver (by, for example, advocating their program over and above what could be a more helpful option for a potential client).
- Trauma sensitivity: Because a history of trauma so often underlies substance abuse disorders, an assessing clinician must be prepared for this disclosure.
- “No wrong door”: SAMHSA italicizes that the purpose of this assessment is not just to determine whether the client fits in one particular provider’s program, but to help the client figure out where they fit in the whole system of care, and to help them get there. In other words, if you encounter excessive self-promotion by a prospective program—over and above a commitment to helping you find the most effective clinical care for your individual needs, wherever that care may be—look for another provider.
If the above elements are present in a clinical assessment of a substance use disorder and other potential dual diagnoses (co-occurring mental disorders), you can be better assured that your treatment will be more effective.
Comprehensive and Individualized Treatment—What Should It Entail?
Treatment must also adhere to similar standards of comprehensiveness and a person-centered (individualized) approach. As the CASA report elaborates, “When treatments are too highly focused on a specific addictive substance or behavior, they may not be addressing the actual underlying disease of addiction or the possibility of addiction substitution, where a patient may replace one form of addiction with another.” Comprehensive and individualized treatment should thus include:
- Interventions that match the diagnostic recommendations of an assessment that has itself been comprehensive and individualized
- Multidisciplinary interventions by a clinical team that includes a doctor and other clinically trained therapists and professionals
- Ongoing assessment and adjustments to your treatment plan by a trained case manager
- Adequate duration of treatment: Length of stay in an inpatient treatment program is another component of comprehensive, individualized treatment. Studies show that the longer your time in an inpatient program, the better your prospects of recovery. Ninety days or more in inpatient treatment for a drug or alcohol addiction has been shown to be more effective than shorter periods of treatment; but here, too, your length of stay should match treatment needs determined in a comprehensive assessment.
Getting Comprehensive and Individualized Addiction Treatment—Questions to Ask a Prospective Provider
If you are unsure whether a prospective drug and alcohol addiction treatment provider lives up to its promise of providing comprehensive and individualized assessment and treatment, asking the following questions may help:
- Does your assessment and treatment plan include all of the elements on the above lists?
- Do you offer options for length of inpatient and outpatient treatment, and if so, what are they?
- To what degree is your assessment and treatment “person-centered,” as opposed to “addiction-centered”?
- When you say you offer comprehensive and individualized care, what do you really mean? Letting providers answer this question in their own words can be eye-opening.
Next, Part Three will look at three medical “best practices” that are essential to evidence-based treatment and your best chance at recovery. By Kristina Robb-Dover @saintplussinner