Recovery Durability: Addiction Recurrence Risk Lowers to General Population Levels in Long Term Recovery

Published in The Doctor Weighs In, July 29, 2018. View the Article Here

Individuals who engage in extended SUD recovery for an average of five years are statistically equal to being diagnosed with a substance use disorder than the average American.

This could help solve the addiction crisis.

Many people misunderstand addiction or severe substance use disorder (SUD) as a condition people eventually can “get over”. This false paradigm is made even worse because unlike other chronic diseases such as cancer or diabetes, addiction does not necessarily have a physical component like a tumor or blood sugar levels we can observe for improvement.

These components in large part are why our healthcare “system” for decades has built ineffective treatment models. Simply put, treating chronic disease with an acute model is bad medicine. Fortunately, this flawed approach is gradually being changed.

However, even with important changes taking place in the treatment space, there is not enough focus industry-wide on using existing data to encourage and reimburse for active ongoing extended recovery. For most chronic diseases, such as cancer, there are long-term covered benefits post-treatment that extend well beyond the initial treatment period to account for regular check-ups and the possibility of remission. Addiction is a chronic disease that requires the same type of ongoing post-treatment support and maintenance.

Addiction treatment expert William L. White, after a thorough examination of a wide range of data, concluded that individuals who engage in extended SUD recovery for an average of five years are statistically equal to being diagnosed with a substance use disorder than the average American.

This is important for patients, treatment providers, and insurance companies to consider and leverage properly. Implementing treatment policies based on this data could make extended recovery in SUD treatment more cost-effective in the long-term. The more data-driven outcomes we have in recovery the closer we are to solving the addiction crisis.

“Point of Durability” in SUD treatment

In regards to SUDs and most any chronic disease, many researchers and physicians concern themselves with what is referred to as a “point of durability” in the treatment of the disease. This is the point at which patients have a partial or complete resolution or disappearance of symptoms. In cancer patients, this “point of durability” is actually very similar to SUD patients. The durability point for cancer remission is generally considered to be at around the 5-year mark.

In addiction treatment, the data suggests this durability benchmark is at roughly five years of active recovery. Of course, this five-year benchmark is not an assurance that an individual will never relapse or develop a different addiction. However, their risk for meeting the criteria for a SUD diagnosis in the future is equal to the general population.

It is crucial that healthcare professionals, both treatment providers and payers, recognize and utilize this five-year benchmark industry-wide because it sets a treatment standard based on data. It also creates a benchmark to measure new treatment methods and helps patients come to terms with their diagnosis.

Data-driven treatment standards

This durability point in addiction recovery is typically considered to be when the recovery work a patient is doing reaches a point when they are at equal to developing an active addiction than the general population. This work can include:

• A return to meaningful employment, occupation, or school
• Doing ongoing work with a peer recovery specialist or a recovery coach
• Seeing physicians or therapists for regular visits
• Medically assisted treatment methods
• Regular participation in one or more twelve-step fellowship organizations or other types of recovery communities (e.g., Celebrate Recovery, SMART Recovery).

Based on this data, a treatment standard would include financial and logistical support for these types of ongoing services and regular “check-ups” until the five-year benchmark is reached and supported beyond. Establishing this type of recovery timeline for those who suffer from SUD in extended recovery helps to justify reimbursement costs that are incurred by payers as a result of the services treatment providers deliver.

Why payers and providers should support extended recovery

Healthcare payers should pay special attention to these findings. Implementing this type of ongoing monitoring and support based on this data could make extended recovery in SUD treatment cost more in the short term. However, it will certainly save them money in the long run by reducing the overall amount of relapse cases and acute care costs related to addiction treatment. Acute care costs related to addiction such as emergency room visits, ambulatory costs, readmission to treatment facilities and other related expenditures currently are an enormous financial burden on the entire healthcare system.

The best treatment providers in the space are aware of the financial burden created by the large instances of acute care costs. These providers generally do what they can to prevent a “revolving door” policy in their treatment centers. This includes providing transition programs, alumni outreach, and peer recovery support once patients are discharged from treatment.

However, the practitioners in this space who don’t attempt to reduce acute care costs or returning patients will have many re-occurrences of use. Therefore, they aren’t seeing the net benefits the treatment spectrum gains by instituting more data-driven conclusions in their procedures. If these providers institute a model of recovery that includes long-term support, recovery benchmarks, and checkups, it creates a whole different type of process to provide recovery, create positive outcomes, and generate recurring revenue in a more ethical way. If they don’t, payers will eventually recognize the deficiency and these businesses will fail.

Measuring new treatment methods

Having an established “point of durability” across the treatment spectrum for SUD patients would also make measuring the efficacy of new treatment methods far less haphazard.

I have previously discussed at length the positive effects that using long-term data in new treatment methods can have on outcomes in chronic diseases such as cancer. In cancer treatment trials, researchers generally measure a “Durability Response Rate”, which is the length of time that a partial or complete response to the treatment is observed in the patient. With cancer treatment, clinicians and physicians are generally measuring changes in the size of cancerous tumors or lesions. A point of durability is when the initial signs of cancer have either become undetectable or are no longer imposing a lethal or severe health threat.

In addiction treatment, there are no current set criteria for measuring the efficacy of different addiction treatment methods. Not having this type of criteria creates a problematic environment for developing positive outcomes. It also allows for ineffective treatment methods to run rampant in the healthcare spectrum. And it allows for a wide range of treatment providers to be especially vulnerable to litigation and liability regardless of their efficacy.

To put it simply, not having effective treatment criteria in place is the equivalent of encouraging “snake oil salesmen” to thrive within the addiction treatment spectrum. Recognizing this “durability point” may seem like a small detail, but it is crucial in the addiction treatment space because of the current lack of consistent data on extended recovery addiction treatment.

Helping patients with SUD diagnosis and treatment

When an individual is diagnosed with a substance use disorder, or worse if they or their family are trying to determine a SUD diagnosis, there is an inordinate amount of guesswork on the part of the individual with the SUD issue and their family members. This can include figuring out the logistics of diagnosis, treatment, post-treatment, and being able to finance every step of the recovery process. This puts enormous pressure on the people who should be concerned with getting effective treatment for the disease.

Having an established “point of durability” in SUD treatment could immediately provide patients with some idea of what the path to recovery realistically looks like and would help them come to terms with their diagnosis. In addition, this established benchmark could create a healthcare system where treatment providers and primary care physicians can ensure that individuals and their families have an established treatment and recovery plan in place for the next four to five years instead of just 1 to 3 months.

This type of reassurance for patients that are coming to terms with the fact that they have a severe substance use disorder would drastically shift the types of attitudes we currently see toward long-term addiction treatment in individuals and their families. In post-treatment for cancer, most patients return every year to get blood work and scans done to monitor their remission status. This allows patients to consistently have a clear picture of where they are at health-wise that simply does not exist in any consistent form for SUD patients. This type of ongoing treatment might consist of some type of monitoring, which could include drug testing.

The problem with current treatment methods

This is where things get tricky with current treatment methods. Many SUD individuals first experience certain aspects of addiction treatment as a result of criminal charges, therefore some directly associate any type of ongoing substance use monitoring as a punitive measure. In addition, many times people in recovery are under threat of legal repercussions if they do relapse. This is one of the worst ways to approach treatment for any type of condition with a mental component, especially a chronic disorder like an addiction that may have negative social determinants (e.g., trauma, adverse childhood experiences, attachment, peer, cultural, and community influences) as factors in its creation.

Ongoing drug testing and extended recovery can be approached in a more supportive manner through more frequent and deliberate testing, which would reduce some of the negative aspects associated with our current system.

Instead of random drug testing, an individual in recovery would be subject to ongoing scheduled drug testing. They would know the exact schedule on which they would be tested. This would remove the individual stress of random drug testing as well as normalize the SUD diagnosis for the patient. Regular testing could also improve the trust that family members and peers have in the individual in SUD recovery as they progress through their treatment. The Institute for Addiction Study conducted trials utilizing almost this exact type of approach and have shown more positive impacts on addiction recovery outcomes as a result.

Utilizing Data Takes Away Guesswork

In any industry, utilizing data is a proven formula to create positive outcomes for all parties involved. We should utilize this commonsense approach to business in addiction treatment on a more consistent basis. There is a severe lack of longitudinal data in the addiction recovery field, so the data that is available should be leveraged to inform policies and procedures industry-wide.

This approach not only helps treatment providers and insurance payers from a financial standpoint but also helps improve recovery outcomes and saves lives. Too many lives are being lost to the addiction epidemic in America. So let’s take the guesswork out of solving the crisis and use the data available to us.

References:

@david_sheff, D. S. (2013, April 03). Viewpoint: We Need to Rethink Rehab. Retrieved from http://ideas.time.com/2013/04/03/we-need-to-rethink-rehab/

Corkery, M., & Silver-greenberg, J. (2017, December 27). The Giant, Under Attack. Retrieved from https://www.nytimes.com/interactive/2017/12/27/business/drug-addiction-rehab.html

Garcia, A. (2013, March 25). Importance of Durable Response Rate for Cancer Treatment Trials. Retrieved from https://oncosec.com/2013/03/importance-of-durable-response-rate-for-cancer-treatment-trials/

Harm Reduction Coalition. Principles of Harm Reduction. Retrieved from https://harmreduction.org/about-us/principles-of-harm-reduction/

The Institute for Addiction Study. Recovery Management. Retrieved from https://www.theinstituteforaddictionstudy.org/recovery-management-6/

White, W. L. (2013, July 31). RECOVERY DURABILITY: THE 5-YEAR SET POINT. Retrieved from http://www.williamwhitepapers.com/blog/2013/07/recovery-durability-the-5-year-set-point.html

Zaino, J. (2015, October 9). As epidemic grows, the cost of drug addiction weighs on hospital finances. Retrieved from https://www.healthcarefinancenews.com/news/epidemic-grows-cost-drug-addiction-weighs-hospital-finances

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