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.]
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.