Between 3 and 4 out of every 10 patients contacted after a substance use treatment stay reported abstinence from substance use one year post-treatment, according to data presented Monday at Foundations Recovery Network's Moments of Change conference. Numerous factors were cited in the Vista Research Group data as predicting a positive outcome, from a longer duration in treatment to a patient's nonsmoking status at treatment admission.
Vista founder Joanna Conti, who expects to release all the data by late October in a report titled Learning from Three Years of Addiction Treatment Outcomes Research, gave an overview of results encompassing more than 23,000 patients at around 100 facilities offering all levels of care. She said it has become clear through the research conducted so far that most patients entering treatment are highly ill but are able to make tremendous progress over the course of their care.
This is markedly true when looking at their co-occurring mental health issues, for example, as the prevalence of depressive and anxiety symptoms drops from the 60% range at intake to under 20% by discharge, Conti reported at the Palm Beach, Fla., conference.
Among those who don't do as well in treatment, “Relapse tends to happen quickly,” she said. “Fifty percent of those who relapsed within the first year [after treatment] relapsed within the first month.”
Conti, who also presented a session on outcomes at this summer's NCAD East conference in Baltimore, became involved in advocacy and outcome evaluation efforts after struggling to try to evaluate potential treatment options for her daughter, who is now a recovery success story. She believes that soon it will be commonplace for all treatment facilities to monitor formally their patients' progress during treatment, and for the more prestigious centers to be conducting post-treatment outcomes research involving their patients.
Vista Research Group's INSIGHT program monitors patients while in treatment, and its RECOVERY 20/20 measures outcomes 1, 6 and 12 months post-treatment. Most of the treatment centers that have contracted with Vista for this research run abstinence-based programs, and the main measure of post-treatment success that the organization evaluates is patient substance use within the past 30 days.
The Vista report's adjusted abstinence rates for adult patients 1, 6 and 12 months post-treatment are 42.8%, 35.6% and 36.2%, respectively. These numbers do not include data from client programs that mainly treat licensed professionals; their success rates, predictably, were considerably better than average, so those numbers were considered outliers and were left out of the aforementioned totals, Conti explained.
An important factor to note is that the success numbers do account for patients whom the program was unable to reach post-treatment; those individuals are considered in the survey data as not having maintained abstinence.
Conti added that she does not consider Vista's facility clients to be representative of the treatment industry in general. “These centers are confident that they are doing a good job, and they are willing to invest in the research,” she said.
She faced some probing questions from the Moments of Change workshop audience in her first presentation of the data. One attendee questioned the use of self-report data as the basis for the findings. Conti agreed that confirming results through drug testing would be ideal, but added that this could lower patient participation rates and increase providers' costs.
Patients in the participating centers agree at admission to complete surveys at baseline and then weekly during their treatment stay, and to be contacted after discharge. Ten to 15 attempts to reach the patient are made each time post-treatment, via phone, text or email.
Conti also was asked about drawing conclusions from a relatively small sample size for the data one year post-treatment, and said Vista will be able to draw on larger samples in future analyses now that more treatment centers have come on board for the project. Vista Research Group was established in 2015.
What has been learned
Conti cited these among the main items that have been learned so far:
Abstinence-based addiction treatment works, with around two-thirds of patients successfully completing treatment—a rate higher than what has been seen in national Treatment Episode Data Set (TEDS) numbers.
Treatment has a beneficial effect on quality-of-life variables in areas such as housing stability, education and employment.
The highest success rates at six months post-treatment were for patients whose primary substance of abuse was alcohol. Heroin and cocaine were associated with the lowest six-month abstinence rates.
Patients whose length of stay at any level of care exceeded 90 days had twice the abstinence rate at six months as patients whose length of stay was under 20 days.
Six-month post-treatment abstinence rates were 30% for patients who had been heavy smokers at treatment intake, but 42% among nonsmokers at intake.
Six-month post-treatment abstinence rates were highest for patients who had been in treatment twice before the current episode; this mirrors results that have been found in other research.
Asked about what they do to remain abstinent, patients often cited factors such as attending 12-Step meetings, living in a sober home for at least a month, being required to take random drug tests, being involved in alumni programs, and undergoing regular monitoring.