Chemical Dependency: Why a Multi-Tiered Continuum of Care Is Crucial to Relapse Prevention

For severe and complex cases of addiction, appropriate intervention, ongoing support and recovery management services are necessary. Extending the continuum of care over several years can prevent relapse and have a positive influence on individuals, families and communities. This continuity of care has the potential to empower many addicts toward full remission and long-term recovery.

Despite being armed with the knowledge that addiction is chronic, it continues to be treated acutely rather than with a chronic disease model. Expanding the continuum of care beyond treatment episodes is necessary to ensure high-quality and effective care. While extending care, it is necessary to find balance between the provision of excellent treatment for patients, fair compensation for providers and a sound return on third-party payors’ investments. By gathering longitudinal data, the continuum can be enhanced. These data can be used to create evidence-based treatment models and intervention plans, and potentially prevent relapse before it occurs.

Decades of funded research show that addiction is a complex and chronic disease of the brain. The prolonged, and often relapsing nature of the disease complicates treatment. Current modalities include detox, acute hospitalization, residential treatment, partial-day treatment, intensive outpatient care and transitional and sober living environments. Acute care practices, when utilized, can be effective for the stabilization and remission of the disease. Due to the likelihood of patient relapse, particularly in the initial stages of recovery, the need for access to an enhanced continuum of care is crucial. This is particularly relevant within the initial 12-18 months post-treatment due to the potential for and risk of relapse.

According to Nora Volkow, M.D., director, National Institute on Drug Abuse (NIDA), the organization’s research has proved that addiction is a complex brain disease characterized by compulsive, at times uncontrollable, drug craving, seeking and use that persist despite potentially devastating consequences. Addiction also is a developmental disease that usually starts in adolescence or even childhood and can last a lifetime if untreated.

Barriers to a Continuum of Care Model

Good health and medical care are essential for overall wellness and increased quality of life. Currently, the structure of treatment and aftercare for addicts is not cost-effective for most families and may not fit within the new healthcare paradigm. The current model does not include the additional costs and resources required to extend the continuum of care many addicts require.

Healthcare reforms are needed that include an emphasis on pay-for-performance and long-term support and results. In decisions being considered and made in the chemical dependency arena, there is an obligation to individuals and families, payors and payees to provide the most effective care at reasonable and affordable costs. Balancing best practices and feasible practices is a distinct challenge that begins with detox and extends to treatment and aftercare. A model needs to be created, offering a balance that would include more effective, sustainable treatment for addicts delivered in a more cost-effective way by providers and insurance companies.

Insurance companies will begin to demand more accountability and assurance that their providers are delivering predictable, cost-effective care. An increased demand for accountability will result in more patients receiving high-quality care with evidence that their chronic disease is appropriately managed over time. With higher quality, chronic disease management, the need for readmissions will decrease, saving healthcare dollars and increasing quality of life for addicts and their families.

Collecting Longitudinal Data Is Key to Preventing Relapse

Effective, sustainable treatment is measured by gathering longitudinal data relevant to long-term recovery from addicts or alcoholics, their families and other stakeholders. Ongoing personalized support for addicts and their loved ones provides value and a foundation of trust that allows quality data to be gathered over time. This consistent support is crucial to addicts’ overall abilities to maintain long-term sobriety and has the potential to prevent relapse. Data gleaned from these conversations result in quantifiable information.

With enough data gathered from individuals graduating from different treatment facilities across the nation, the field would be armed with powerful information. Recovery data of this nature result in a quantitative, evidence-based feedback loop where treatment decisions made today are informed by accurate and relevant information from those currently in recovery. This type of data also allows for patients and payors to fully understand where the most effective treatment is available and which provider will render the best services for certain kinds of addiction. Evidence and predictive accountability will change the understanding of how treatment is provided and how addicts will ultimately maintain long-term remission.

Prevention of potential relapse is possible, as many who suffer from addiction engage in similar behaviors and thought patterns that can be detected prior to a use event. Intervening prior to a patient’s return to use is the ideal prototype. When addicts relapse, supportive relationships in an aftercare environment enable appropriate care; early intervention could help mitigate the effects of relapse, potentially reducing relational and societal costs of addiction. Recovery professionals can create a better vision of the risk of potential relapse, while family members have an opportunity to engage in behaviors that increase the probability of success.

The field of chemical dependency, treatment and recovery is at a crossroads. Decisions made today will impact treatment and recovery for the next generation. Treatment and aftercare support for the chronic brain disease of addiction must go beyond acute care and unstructured, inconsistent attempts to offer peer support. By extending and enhancing the continuum of care and utilizing a network of peers, a collaborative balance of quality services, sustainable outcomes and cost-effectiveness can be reached among all vested parties—patients, family members, providers and third-party payors.

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Thomas G. Kimball, Ph.D., LMFT, serves as clinical director of MAP Health Management, LLC; the George C. Miller Family Regents Professor; and director, Center for the Study of Addiction and Recovery at Texas Tech University.