Setting a New Standard for Treatment with Five-Year Recovery

The following article is based on and adapted from a commentary published in the Journal of Substance Abuse Treatment.

As the nation responds to today’s significant drug abuse problems and in particular the growing opioid epidemic, there is an increased focus on the crucial need for treatment. While funding for treatment is always a high-priority issue, overlooked in the general discussion about the role of treatment is the striking and often tragic mismatch of the short-term duration of treatment and the long-term, and often lifetime, nature of substance use disorders (SUDs).

Further complicating this picture is the fact that the vast majority of people with SUDs do not recognize that they have a problem or want treatment. Most of those who enter treatment drop out before completion. Moreover, among those who successfully complete treatment, many relapse, often soon after discharge. Even though the goal of treatment is sustained recovery including no use of alcohol and other drugs, regrettably, in many ways relapse is the expected outcome of treatment. The continuing use of buprenorphine, methadone or naltrexone is entirely compatible with this recovery standard, provided that the patient is using the medicine as prescribed and is abstinent from the any use of alcohol and other drugs of abuse. 

Three factors have the potential to reshape the management and the measurement of the effectiveness of SUD treatment: 1) the severity, complexity and chronicity of SUDs among persons in treatment; 2) recognition that SUDS are seldom the result of the use of a single drug; and 3) the rapid organizational and management changes occurring in health care today. With long-term recovery as the goal of SUD treatment, providing chronic disease management for SUDs is possible using the clear, objective biological measure of drug screening. This is comparable to the management of other serious chronic diseases which relies on measures such as blood pressure, weight, HgA1c, etc. Screening helps determine the effectiveness of care delivered to that point and provides guidance for how to adjust treatment that has not yet achieved the goal of sustained abstinence. 

A new standard of five-year recovery has the potential to dramatically improve the way in which SUDs are managed, changing clinical practice and changing treatment outcome research. An example of a system of care management that consistently produces five-year recovery is that of the state physician health programs (PHPs) which includes in addition to formal high-quality but brief treatment, prolonged drug and alcohol screening, participation in community-based recovery support groups, and immediate intervention when relapse is detected.

The use of five-year recovery as a standard measure of effectiveness for SUD treatment will encourage treatment programs to look well-beyond the brief episodes of care provided to patients. Once measuring the ability of treatment programs to deliver five-year recovery is established, even though the initial results will disappoint many, powerful incentives will be in place to find new and better ways to increase the percentage of patients who achieve this new gold standard outcome. This applies to both treatment programs that use and do not use medications. Using the five-year recovery standard will provide a common outcome measure against which all treatment programs and all treatment modalities can be judged. 

Robert L. DuPont, MD
President, Institute for Behavior and Health, Inc.                        contactus@ibhinc.org

DuPont, R. L., Compton, W. M. & McLellan, A. T. (2015). Five-year recovery: a new standard for assessing effectiveness of substance use disorder treatment. Journal of Substance Abuse Treatment, 58, 1-5. Abstract: http://www.journalofsubstanceabusetreatment.com/article/S0740-5472(15)00198-1/abstract