Measuring beyond sobriety

Let’s track sobriety but we must measure more to show true progress

A person you love seems to care about nothing of importance in their life. They disappear for days, weeks, maybe even months or years.  

At first, this person’s relationship to alcohol or drugs was no different than anyone else’s. But slowly then all at once, chaos.  

Addiction takes hold.  

It’s a vortex. Everyone gets sucked in.  

You try to extricate yourself, but you can’t.  

Love.  

You keep fighting to help this person you love. 

Finally, treatment becomes possible.  

You know very little about “rehab.” You know what you’ve seen in movies or heard celebrities talk about.  

Their life became hell. They went to some rehab center for 30, 60, or 90 days. They went home and tried to rebuild their life. 

Under these circumstances, what are the outcomes you care about? 

Outcome #1: Treatment completion. 

Outcome #2: Abstinence.  

Sure, you care about your loved one’s quality of life, but this can only improve if they complete treatment and remain sober. Right? 

Those two “outcomes” are what the entire addiction treatment system is built upon. 

Clinical modalities, programs with families, and insurance reimbursement have all been designed from these two outcomes.  

In-patient treatment is 28 or 30 days not because of strong or irrefutable scientific evidence, but because insurance companies agreed to that length 30 years ago. 

READ MORE: Why Are Most Addiction Rehabilitation Programs 28 Days? : Shots – Health News : NPR  

Sure, there’s plenty of evidence that supports abstinence for improved quality of life and decision-making, but these are notions of wellbeing and not clinical factors for substance us treatment. 

Since addiction treatment has placed abstinence at the heart of its clinical model, alternative and comprehensive success metrics have been difficult to find. 

It’s not surprising that many treatment programs – both inpatient and outpatient – struggle with both outcomes. Complete sobriety is hard. Treatment is often too short. And if the treatment protocols demand sobriety, then when someone leaves treatment early, we should expect a large portion of the population to experience a recurrence. 

Abstinence is a binary measure and that’s why it can be problematic.  

READ MORE: Abstinence drives the rest of treatment design because of social pressures 

Quitting cold turkey is medically dangerous. Committing to lifetime sobriety is mentally daunting. And the social judgement of failure is psychologically fraught.  

Measuring usage and frequency can be important.  

If done without judgement and framed around progress over time, we might reverse traditional trends of individuals cycling in and out of treatment programs. 

What does progress look like under this framework of care? 

It likely starts with whether the person has chosen complete abstinence as a goal. Either way, we can still track level of use and days of use. Tracking continuous days of non-use or reduction of use can be psychologically rewarding. Each day or change in use is a small win. The building of small wins can go a long way in achieving clinical success.  

Underlying this process is the creation of new habits. It’s about changing someone’s relationship with something what may be dragging them down.  

Most behavioral scientists highlight small, repeated actions when starting something new. For example, if you want to improve your physical fitness, doing something small every day is better than trying to do something big a few days a week. Once you build the habit, extending length and effort isn’t so hard.  

Of course, as we start to make these small changes, we want to see what the effect is on the rest of our life. 

This is where clinicians and individuals need to explore broader quality of life or recovery capital measures. 

When clinical care is necessary, it’s very likely that many facets of a person’s life are depleted.  

Employment may be jeopardized or lost. Nutritional intake is non-existent. Finances are ruined. Relationships are frayed. Personal values are challenged. And purpose in life is missing. 

We need an assessment of these factors too. A regular tracking of recovery capital builds awareness and a habit of contemplation, evaluation, planning, and action – where action can be taken.  

The use or non-use of alcohol and drugs is the tip of the spear. It’s what families, society, and the treatment system sees. It’s the most immediate and easiest target. 

We can and should measure use or abstinence. It can be both a meaningful and problematic measure. But it can’t be the only measure. 

Abstinence is not the only factor that can drive change and demonstrate success. 

VIEW OUR DATA: See what it looks like to measure beyond sobriety.