Strict adherence to continuing-care plans is crucial if the addiction field intends to improve recovery outcomes for those treated for chemical dependency. The responsibility for ensuring this adherence, and for the lack of adherence to date, rests squarely upon those of us in the addiction profession. For too long we have done what we have perceived as “our job” while clients were within our care, and then hoped for the best as they made the very difficult transition to early recovery—often with predictably disappointing results. If we are to continue to evolve as a profession and improve our efforts' results, we have a responsibility to create new paradigms for continuing-care plan implementation and accountability.
Addiction professionals know that treatment for chemical dependency works. Yet 40 to 50% of clients experience a relapse during their first year out of residential treatment.1 For many years, solutions have been in place to ensure long-term, sustained recovery from chemical dependency. Those solutions are found in the form of “assistance programs” that are generally accessible only to licensed professionals in regulated industries such as the medical profession and the airline industry.
Last year, when our addiction consulting firm Addiction Intervention Resources (A.I.R.) began to research ways to improve our clients' posttreatment outcomes, we were amazed by the rates of success for professionals participating in these assistance programs. The question we continued to raise was: If this type of program is so successful, why isn't it available to the general public? After a year of research and trials, we are convinced that structured monitoring programs that focus on adherence to the continuing-care plan hold the key to improving recovery rates for all who suffer from chemical dependency.
Chemical dependency is a chronic illness. Other chronic illnesses, such as asthma and diabetes, see relapse rates similar to those for chemical dependency.2 But there is a difference between treatment and recovery for chronic illness in general and for chemical dependency. This lies in addiction professionals placing the responsibility for following the prescribed continuing-care plan solely in the client's hands.
For most chronic illnesses, regular follow-up visits to a physician are a standard, accepted practice. During a follow-up visit a physician can monitor a diabetic patient's health and determine if the continuing-care plan (involving medication, diet, and exercise) is being followed. With chemical dependency, follow-up is generally not part of the continuing-care plan. Why? A mother and father certainly would ensure that their diabetic child followed through with the recommended continuing-care plan from their physician. However, loved ones too often do not understand the significance of continuing care for someone with chemical dependence.
Inventory of existing programs
In an effort to identify what was available and what was working in continuing-care efforts for chemical dependency, our organization looked at some of the more commonly used modalities. One of the assistance programs that we looked at closely, designed specifically for airline pilots struggling with alcohol and drug problems, is based on the Human Intervention and Motivation System (HIMS). The purpose of HIMS is to identify the pilot's problem, intervene, refer the pilot to the appropriate treatment facility, and then ensure that the pilot maintains sobriety. The overriding goal is to allow the Federal Aviation Administration to allow the pilot to resume flying.3 The data show that airline pilots have recovery rates as high as 92 to 95%.1 This represents a 32 to 45% improvement over the recovery rate found in the general population.
HIMS has been used as the model for the majority of assistance programs that deal with licensed professionals such as doctors, nurses, and attorneys. The end result has been increased rates of recovery.
We examined two other more common and accessible forms of assistance programs that are available to the general public. “Monitoring” programs typically involve toxicology screens combined with self-reporting on posttreatment activities. After reviewing several of these programs, we concluded that they were too narrowly focused on the toxicology screening component. Also, dependent as they were on self-reporting, they failed to provide an accurate assessment of an individual's recovery. And with little to go on other than toxicology screen results, they lacked any allowance for relapse in the treatment of a chronic condition and were ultimately purely punitive. While monitoring may work for some individuals, it focuses too heavily on producing a clean urine sample and misses the big picture—a successful life in sobriety.
The other type of assistance program we looked at is referred to as “sober coaching.” A sober coach is typically an individual who works one-on-one with a client over an extended period of time in an effort to keep the client sober. Sober coaching comes in many forms; these services can range from structured, short-term programs of two to five days to long-term coaching where the sober coach actually moves into the client's home. Sober coaching can be useful for some individuals in the process of recovery, but we see it as only one element of a more comprehensive solution.