In the addiction and recovery field, we seldom talk about whether what we do works. When half of the people served go through treatment four or more times before it sticks, we say it’s time to rethink the approach.
The statistic is sobering. Today, the average number of times someone with a drug or alcohol addiction goes through treatment is four. In other words, it takes four or more multi-week treatments for a person to overcome their addiction.
Failure has been normalized. At least that’s one interpretation of the research. There are other interpretations which include not having enough resources, enough time, enough money, or blaming the patient or family.
The inherent assumption is that every clinician is great, or at least above average.
Having worked with and for clinicians on the frontline of healthcare transformation, only a few appreciated seeing their quality outcomes. These were the ones who reviewed their numbers and took steps to improve how they delivered patient care. They wanted to do better and sought out the intelligence needed to do so.
Within the addiction treatment and recovery field, those who are making the biggest difference are the ones who are measuring and predicting their outcomes. They look at a national number like the one above and pursue a better way. They take steps to prevent falling into four common mind traps:
Blame the system
Blame the patient
Blame the System
That’s easy to do in today’s healthcare climate. There are real pressures by accrediting agencies, federal agencies, documentation, payers, EMRs, and executives. Plus, the demands on a clinician’s time continue to be squeezed.
Our circumstances are not insurmountable, though. That’s what you tell patients, isn’t it? So, we shouldn’t have a double standard.
The US Prevention Task Force recently released guidance that physicians should screen for anxiety. The next day, the news cycle lit up with the expected push back. The basic message was, “The system doesn’t give us the resources to get this done.”
One of the health systems we worked with has been screening for anxiety and depression for every primary care patient for 10 years. It was hard to implement but the right thing to do for patients.
Blame the Patient
There was one memorable physician who said it best, “I’m no longer to use the term ‘non-compliant patient.’”
When a patient “ignores” your advice, that does not mean they are not ready to change. What works for one patient doesn’t work for every patient. It’s a matter of first principles.
In cancer treatment, a new chemotherapy must exceed an effectiveness rate of greater than 40% to not be considered a placebo. New research in genomics is proving that previous molecules can be used for some people based on their DNA.
Unfortunately, the stigma of addiction casts its shadow on the addiction treatment field. The rule of thumb is it’s the patient’s fault. It’s their problem, and they must want to change. While there is some truth to this—it’s not the whole truth.
Real change is hard and disruptive. Some clinicians resist change because it’s what the system has trained them to do. Others resist change because it’s easier than adapting.
Most change in most organizations, though, is incremental. The status quo remains mostly intact. Nothing other than a small pivot here or there is all that is asked of them.
But to decrease the average number of times a person enrolls in addiction treatment will require something more than minor tweaks and shortcuts. Radical change asks something more of us. This level of change is difficult because it means giving up something.
What we experience is loss. What we resist is loss. We get resistance when loss is greater than purpose. This is why a hyper focus on what is right for patients has driven change.
There is a common tongue in the addiction treatment and recovery field. The words we use define our thinking, position, and approach. Words like abstinence, sober, relapse, harm-reduction, and recovery all carry specific meanings—both helpful and harmful.
Most of the terms we use point to the bottom of the waterfall. In other words, we use the terms we’ve been trained to use after someone falls off the edge.
This is a major mind trap because it only reinforces the status quo. To go upstream and catch people before they fall demands a different language. It will feel and sound odd. But the power of words cannot be understated.
So What Do We Do?
We have normalized failure for the usual reasons. It’s human nature to fall into those mind traps. Recognizing this is the first step. Developing the systems, cultures, and approaches that patients deserve, however, will ask more of us.
As you know, habits are hard to break. A sober assessment of where we are and where we want to be is needed. It’s time we become comfortable with discomfort. Is the present reality of sticking to addiction treatment only after five or more times unacceptable to you? If not, maybe start there.
The costs are real, but be the change you want to see anyway.
Positive change will come with the right intelligence. Commonly Well provides impactful recovery intelligence through patient-driven analytics, behavioral insights, and outcomes for addiction treatment. Discover more recovery intelligence on our blog, or contact us to see how we can work together to make more informed decisions and positive change.
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