Guide: 11 Indicators of Quality Addiction Treatment

How to identify high-quality addiction treatment programs.

The Council on Recovery recommends the following guide published by the Recovery Research Institute, an affiliate of Harvard Medical School. We suggest using it to evaluate addiction treatment options for you or your loved ones. [The Council meets/exceeds all 11 quality indicators.]

Intro

With thousands of programs and rehabs to choose from, it can be challenging to assess which addiction treatment programs offer the highest quality of care.

Finding the right treatment facility is all too important, given the time, money, and energy that substance use disorder treatment and recovery requires of not only the individual, but the entire family.

The 11 Indicators of Quality Addiction Treatment:

Research has identified elements that quality substance use disorder treatment facilities should possess. These range from personalized treatments, to national accreditation, to assertive linkages to continuing care.

The experts at the Recovery Research Institute have compiled a comprehensive list of 11 indicators of effective treatment, as a blueprint to help guide you or your loved one to high-quality addiction treatment, maximizing your recovery success.

1. Assessment and Treatment Matching (Identify)

Finding effective help for an alcohol or other drug use disorder begins with reliable and valid screening for a range of substance use disorders and related conditions, as well as any physical or mental health conditions. This is followed by more comprehensive assessment of substance use history and related disorders, medical history, psychiatric history, individual’s family and social networks, and assessment of available recovery resources (“recovery capital”). These endeavors help uncover the many interrelated factors affecting the patient’s functioning and life and assess a patient’s readiness to change. This careful and comprehensive assessment can help prevent missing aspects or minimizing important aspects of a person’s life, such as trauma or chronic pain, inattention to which could compromise recovery success.

2. Comprehensive, Integrated Treatment Approach (Treat)

As discussed above, patients in treatment may have co-occurring psychiatric disorders, like depression and anxiety, as well as other medical problems like hepatitis C, alcoholic liver disease, or sexually transmitted diseases. Programs should incorporate comprehensive approaches that directly address these additional concerns, or otherwise assertively link patients to needed services. Treating the whole patient, will improve the likelihood of substance use disorder recovery and remission.

3. Emphasis and Assertive Linkage to Subsequent Phases of Treatment and Recovery Support          

Continuing care is defined as the ‘ongoing care of patients suffering from chronic incapacitating illness or disease.’ Ongoing care provides essential recovery-specific social support and necessary recovery support services after the patient leaves or transitions away from the initial phase of treatment. Programs that strongly emphasize this continuing care aspect will provide more than just phone numbers or a list of people to call, but instead, will provide assertive linkages to community resources, on-going health care providers, peer-support groups, and recovery residences. This ‘warm hand-off’ or personalized introduction to potential peers and resources in the recovery community, produces substantially better outcomes.

4. A Dignified and Respectful Environment

The treatment program should possess at least the same type of quality environment as one might see in other medical environments (e.g., oncology or diabetes care). You don’t need palm trees and luxury mattresses, but you should expect a clean, bright, cheerful, and comfortable facility. It is important that the program treats substance use disorders with the same professionalism and allocates similar resources for patient care as other chronic conditions. Creating a respectful and dignified environment may be particularly important for addiction patients, because those suffering from substance use disorders often feel as if they’ve lost their self-respect and dignity. A respectful environment helps them regain it.

5. Significant Other and/or Family Involvement in Treatment

Engaging significant others and loved ones in treatment increases the likelihood that the patient will stay in treatment and that treatment gains will be sustained after treatment has ended. Techniques to clarify family roles, reframe behavior, teach management skills, encourage monitoring and boundary setting, re-intervention plans, and help them access community services all help strengthen the entire family system and help family members cope with, and adapt to, the family system changes that occur in recovery.

6. Employ Strategies to Help Engage and Retain Patients in Treatment

Dropout from addiction within the first month of care is around 50% nationally. Dropout leads to worse outcomes, so it is vital to employ strategies to enhance engagement and retention. These include creating an atmosphere of mutual trust through clear communication and transparency of program rules, regulations, and expectations. Treatment programs can also work to retain patients by providing client-centered, empathic, counseling that works to build strong patient-provider relationships. They also can use motivational incentives to reward patients for continued attendance and abstinence.

7. Use of Evidence-based and Evidence-informed Practices

Programs that deliver services founded on scientific research and principles and that are delivering the available “best practices” tend to have better outcomes. In addition to psychological interventions, these should include accessibility to FDA approved medications for addiction (e.g., buprenorphine/naloxone, methadone, naltrexone/depot naltrexone, acomprosate) as well as psychotropic medication for other types of psychiatric conditions (e.g., SSRIs etc.). This is typically combined with qualified staff (see below).

8. Qualified Staff, Ongoing Training, and Adequate Staff Supervision

Having multi-disciplinary staff (e.g., addiction, medicine, psychiatry, spirituality) can help patients uncover and address a broad array of needs that can aid addiction recovery and improve functioning and psychological wellbeing. Staff with graduate degrees, and adequate licensing or board certification in these specialty areas are indicators of higher quality programs. In addition, clinical supervision and team meetings should take place at least once or twice a week for outpatient programs and three to five times a week for residential and inpatient programs.

9. Personalized Approaches that Include Specialized Populations, Gender, and Cultural Competence

Stemming from individualized comprehensive screening and assessment, programs should treat all patients as individuals attending to their needs accordingly. One size does not fit all, and neither does one treatment approach work for every individual. High-quality treatment programs identify the potentially different needs of men and women, adolescents versus adults, and those from different minority communities (e.g. LGBT) or cultural backgrounds, creating in turn, treatment and recovery plans that address their specific needs and acknowledge their available strengths and recovery resources.

10. Measurement of Program Performance Including During-treatment “Outcomes”

A further indicator of quality treatment is having reliable, valid measurement systems in place to track patients’ response to treatment. Similar to regular assessment of blood pressure at each check-up in treating hypertension, addiction treatment programs should collect “addiction and mental health vital signs” in order to monitor the effectiveness or ineffectiveness of the individualized treatment plan and adjust it accordingly when needed. Without any kind of standardized metrics, it is difficult to document and demonstrate patients’ progress.

11. External Accreditation from Nationally Recognized Quality Monitoring Agencies                            

Accreditation from external regulatory organizations such as the Joint Commission on Accreditation of Healthcare organizations (JCAHO; aka “the Joint Commission”), the Commission on Accreditation of Rehabilitation Facilities (CARF), and the Council on Accreditation (COA); and other programs licensed by the state are required to offer minimum levels of evidence-based care. These licensing and accreditation requirements serve as quality assurance that the treatment program is incorporating a certain level of evidence-based care in its model and is open to random audit of its clinical care.

New Study Finds Distressing Increase in E-cigarette Use by Middle and High School Youth

Electronic cigarettes (e-cigarettes), battery-powered devices that provide nicotine and other additives to the user in the form of an aerosol, have become the most popular form of tobacco use among middle and high school youth. The recent National Youth Tobacco Survey, 2011-2018 found a distressing increase in the use of e-cigarettes, also known as “vaping“, that far surpassed the rate of use of conventional cigarettes during survey period.

What’s more, concurrent studies by both the Center for Tobacco Products at the Food & Drug Administration and the Centers for Disease Control point to a rapidly escalating problem. High school students currently using e-cigarettes increased from 1.5% in 2011 to 20.8% 2018. During 2017–2018 alone, e-cigarette use increased by 78% (from 11.7% to 20.8%).

At the same time, among middle school students, e-cigarette use increased from 0.6% in 2011 to 4.9% in 2018. During 2017–2018, current e-cigarette use increased by 48% (from 3.3% to 4.9%).

Percentage of middle and high school students who currently use e-cigarettes and any tobacco product

The studies also showed that, while current use of any tobacco product among high school students grew from 24.2% in 2011 to 27.1% in 2018, the use of e-cigarettes continued to increase at rates not seen in previous surveys.

This sharp rise in e-cigarette use among U.S. middle and high school students during 2017–2018 is likely because of the recent popularity of e-cigarettes shaped like a USB flash drive, such as JUUL. These products can be used discreetly, have a high nicotine content, and come in flavors that appeal to youth.

Although e-cigarettes can be of potential benefit to adult smokers as a complete substitute for smoking tobacco, adolescent use of any tobacco product, including e-cigarettes, is considered unsafe. The Surgeon General has concluded that “e-cigarette use among youths and young adults is of public health concern; exposure to nicotine during adolescence can cause addiction and can harm the developing adolescent brain”.

The Council on Recovery provides a wide range prevention and education programs aimed reducing tobacco use, especially among adolescents and young adults. These programs are provided at area schools, churches, community centers, employers, and health fairs. For more information about The Council’s Prevention & Education Programs , please call 713-942-4100, email education@councilonrecovery.org  or contact us online.

How Pornography Affects the Teenage Brain – An Infographic

Pornography addiction is an adolescent high-risk behavior that is escalating across all segments of the teenage population. By viewing sexually pornographic material, adolescents may face potential emotional, psychological, social, and physiological disorders and issues. The Infographic below, designed by helpyourteennow.com, illustrates the effects that pornography can have on developing adolescent brains. It can help you understand the problem and start important dialogue with your teen about viewing sexually explicit material.

Mindful Choices is the Center for Recovering Families’ adolescent high-risk behavior course that covers pornography addiction and 14 other risky behaviors. For teenagers and their parents, the course addresses these problems in the early, treatable stages. For more information, call 713-914-0556email CRF@councilonrecovery.orgor contact us online.

The Lifelong Quest For Sobriety…The Ultimate Hero’s Journey—Part 48

Guest Blogger and long-time Council friend, Bob W. presents Part 48 of a series dealing with Alcoholism and Addiction from a Mystical, Mythological Perspective, reflecting Bob’s scholarly work as a Ph.D. in mythological studies.

In the Hindu traditions, there is a long Sanskrit epic called the Mahabharata, about a multi-generational feud between two ruling families, the Kauravas and the Pandavas, ruling in the ancient land that is today Northern India. The story culminates in a giant battle involving all the young men of the time, all aligned with one of the two families.

As the battle is about to begin, the head of the Pandavas, Arjuna, asks his charioteer, who is also the god Krishna, to drive him into the ‘no man’s land’ between the two armies. Seeing the size of the armies aligned against each other and imagining what is about to begin, Arjuna is overcome with grief. He asks Krishna for some relief, some way to avoid the coming armageddon. Krishna answers with a long poetic text that has become highly celebrated in spiritual circles; it is the Bhagavad Gita, aka the “Gita,” a spectacular, deeply articulated, relatively long prescription for an enlightened way of being.

Krishna begins the Gita with a direct response to Arjuna’s question.  He says that, as a warrior, Arjuna’s dharma, his cosmic reason for being, is to fight; he cannot avoid the call to arms.  Krishna says, “For a warrior, nothing is higher than a war against evil […] for it comes as an open gate to heaven.”

This is a wonderfully inspirational message for me, and, I believe, for all of us on the lifelong journey in sobriety. Active alcoholic behavior, living in the active disease, is an intrinsic evil, a place where we are active agents of devastation and abuse, abuse of people and the cosmos.  Our efforts to cross the threshold to abstinence, to a life of deeply imbedded behavior modification, and to a committed life of service are truly those of the warrior, that of the nobility of a warrior in a glorious quest for conquest over evil. Reading the Gita, from its beginning in the exchange with Arjuna, is a wonderful spiritual experience…and seeing it from the perspective of our own personal journeys is a great gift of grace from our own Higher Power.

New Research: First or Second Use of Cannabis Can Change Grey Matter Volume in Teenage Brain

Research just published in the Journal of Neuroscience presents evidence suggesting structural brain and cognitive effects of just one or two instances of cannabis use in adolescence.

The study utilized brain scans to compare grey matter volume (GMV) in 46 fourteen year old male and female adolescents with just one or two instances of cannabis use and a carefully matched control group of non-cannabis users. The outcome showed differences in GMV among the cannabis users that were not indicated in the non-user group. It also showed that GMV differences were unlikely to precede cannabis use.

This new research confirms what The Council on Recovery has understood for years: Teenage and young adult brains are physiologically affected by substance use (such as cannibinoids) until those brains are fully-developed in the mid-20s. Substance users are also more likely to become addicted during this brain maturation period than if they wait until after full brain development.

These findings are timely as the legal status of cannabis is changing in many places and the perceived risks of cannabis use by young people has declined. In recent survey by the National Institute of Drug Abuse, nearly 35% of American 10th graders reported recreational cannabis. And that number may be increasing as the legal status of marijuana changes around the country. But, even as societal attitudes regarding marijuana shift, cannabis use and its effect on the adolescent and young adult brain continue. Certainly, while much is known, more research is needed.

In the meantime, The Council stands ready to help teenagers, young adults, and their families recover from cannabis addiction and other substance use disorders. If you or a loved one needs help, call 713-942-4100 or contact us online.

#192aDay Campaign Launches to Remember those Lost to Addiction

This week, Addiction Policy Forum launched the #192aDay awareness campaign to honor those lost to drug overdose and other complications of substance use. The Centers for Disease Control (CDC)’s 2017 data revealed that more than 70,000 people died from drug overdoses — 192 a day — making it the leading cause of injury-related death in the United States, more than deaths from gun violence or car accidents. The campaign features 192 letters from the family members who have lost a loved one to addiction.

Excerpts from the campaign:

Cassidy C 192aDay
Cassidy

“She was our sunshine, our beautiful and bright angel. But to shine some light on an illness that is taking the lives of far too many, if we allow shame, guilt or embarrassment to cause this illness to become a dark family secret, hiding in the shadows, everyone loses.”-Cassidy’s mom, Charla

Anthony F 192
Anthony

“The disease of addiction is a merciless, non-discriminatory devil. The loss of my big brother has created a sore on my heart that will never heal. We must fight to end this epidemic.”-Anthony’s brother, Gino

Justice 192aDay
Justice

“Heroin took my daughter. She was 21 years old. She had barely lived. Justice never owned her own car; she never traveled the world; she never married or had children; she won’t see her brothers grow to be good men, or meet her future nieces or nephews. My daughter will never dance again. She will never see an amazing sunset, or feel the warmth of the sun on her beautiful face. I will never hear my daughter’s beautiful voice again or hear her call me mom. Heroin took that all away. We all failed my daughter. All those times she reached out for help and was denied, we failed her. I have to live with this for the rest of my life. Justice was my only daughter. She was my girl, she was my dream, she was my everything.” -Justice’s mom, Jennifer

Emmett  192
Emmett

“Emmett was the average American teen; he loved video games and BMX biking. He was a caring, funny, smart young man with the potential for greatness. He was the adored older brother to Zachary and Alice . He had a smile and charm that could light up a room – but heroin stole that from him.”-Emmett’s mom, Aimee

“It’s far past time we recognize addiction for the disease that it is and move beyond the stigma that enshrouds substance use disorders,” said Jessica Hulsey Nickel, founder of the Addiction Policy Forum. “192 a Day helps shine a bright light on the beautiful lives lost to addiction and gives voice to the families that have been affected. We encourage those who have lost someone to share their stories through the campaign so we can show local, state and national leaders the very real impact addiction has on our communities.”

Please read the stories and get involved at 192aDay.org and watch @AddictionPolicy‘s PSA  #192aDay featuring those lost to #addiction at https://bit.ly/2RlhOct .

Call The Council
If you, a loved one, or friend have a problem with drugs or any substance use disorder, call The Council on Recovery at 713-941-4200 or contact us online. We are Houston’s leading non-profit provider of prevention, education, treatment, and recovery services. We can help!