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CEO calls for more attention to cognitive deficits in assessment, treatment

July 5, 2016
by Gary A. Enos, Editor
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At recent public appearances and an interview last week with Addiction Professional, the CEO of San Clemente, Calif.-based Sovereign Health Group has decried the lack of standardized measurements in addiction treatment, which he says often leads to undetected cognitive deficits in patients and poorly conceived treatment plans.

“We have argued hard for parity. But are we at par? With surgery, with OB-GYN?” says Tonmoy Sharma. “Have we moved to measurement-based care?”

Sharma's overall message has emphasized that addiction and mental health treatment programs do not need to go to extraordinary heights to gain a clearer picture of their patients' needs from the initial assessment. “You don't have to do an eight-hour neuropsychological battery,” he says.

By using standard and accepted assessment tools, he says an organization such as Sovereign can, for example, uncover previously undetected cases of adult attention-deficit hyperactivity disorder (ADHD) and prevent inappropriate treatment planning.

“What are you doing putting a person in a process group if they can't process information?” Sharma says.

Cognitive remediation

At a May 31 presentation to behavioral health professionals in Costa Mesa, Calif., Sharma discussed cognitive dysfunction as a precursor to addictive behavior in some individuals, as well as the need for treatment to be more intensive and more focused to reversing cognitive deficits. He said Sovereign's approach employs a number of strategies meant to address directly a patient's deficits in memory, attention, problem-solving and reasoning.

Most of Sovereign's treatment facilities are licensed to treat primary mental health conditions as well as addictions. All clinical staff are master's-level, Sharma says, and the organization seeks to be the destination for early-career psychologists. “We behave like an academic institution,” he says.

Around half of Sovereign's patients are referred from hospitals, and about one-quarter from other treatment centers, Sharma says. Assessment is intensive and emphasizes gathering collateral information from family members early on, he adds.

Sharma says he hopes his organization can become a national voice for use of standardized assessment and evidence-based treatment in behavioral health. In general in the field, “We have a big educational task ahead of us,” he says.



The need for a cognitive assessment as part of the initial client engagement is a no brainer, but like many treatment innovations not widely implemented.

Another aspect of the problem is the need for treatment to reduce the cognitive level of so many of the basic concepts used in treatment practice.

In our trainings for persons working with the developmentally disabled we encourage the use of simplified language and avoidance of abstractions such as "addiction", "moral inventory" and "higher power". For more see Adapting programs to help the developmentally disabled: abstract language can stymie a population in need, in the Sept/Oct 2013 issue of Addiction Professional.