I graduated from Snyder High School in Snyder, Texas, in 1996. Not an enormous city by any means, but certainly a small town full of interesting characters, eccentric personalities, and more than a few real-life cowboys. The biggest thing most of my peers wanted was to get out of there and to see the rest of the world. Some people left and made it big, some left only to decide they wanted to come back home, and some moved to a place not so distant from Snyder, but still not there. I realize this may seem a strange way to start a blog post about outcomes, but hang in there with me for a second longer.
I mention this because what many members of my graduating class leveraged to get out of this small town (and maybe later to return) was a form of outcomes research. For most of us, our ticket out was to college or trade school. What we needed to achieve our goals was a measurement of some sort predicting what our future performance might be. This might be our GPA, report cards, ACT/SAT scores, a high school diploma, or even our performance in sports or other activities. What makes it easy for academic, and even for sports, is that there’s a collective set of measurements that are agreed upon almost uniformly and for which the meaning is understood. Here is one quick example. I am not a sports buff, but I know that the RBI is the standard for measuring how many runners score when you appear at the plate (with a few nuances we won’t address here). I also imagine that managers of baseball teams use the individual players RBI statistics to inform the batting lineup. Thus, we measure something (the RBI) and then we use it to inform a decision about the game (batting lineup).
Plain and simple, we have to do this in the addiction treatment world. In its simplest understanding, an outcome is a measurement of performance which tells someone how well we perform compared to others involved in the same task. It is important because outcomes research is a report card that we can share with others, so they have a level of confidence in our ability to move toward a set goal. In addiction treatment, however, there is often disagreement about what the goal might be. Because addiction is a chronic condition, the “goal” often become more nuanced as we are dealing with remission or disease states.
Does the recurrence of a disease state across a brief period in the life of someone with addictive illness mean that our outcomes are poor? I don’t believe it does, but I think this is a barrier for many of us when we try to wrap our minds around collecting data and analyzing our outcomes. We reduce it to the one phone call asking, “On this given day when you answered my phone call, are you sober or are you using?” We miss the entire possibility that our treatment efforts, or our aftercare planning, or even that follow-up phone call, may cause the person deciding to take the recovery capital they have gained to get back up and re-engage in creating the life that they find to be worthwhile.
We can no longer afford to fall into this polarized definition of success. According to John Hopkins, “outcomes research seeks to understand the end results of particular healthcare practices and interventions”. They go one step further when talking about chronic conditions to say that “where a cure is not always possible—end results include quality of life and mortality”. In this writing, addiction does not have a “cure”. It has a remission that for many people will last a lifetime. So how do we set up our “report cards” as treatment centers to represent that good we are doing? How do we show families and payors and potential clients that we have a system that shows improvement in the lives of those we care for, even if they relapse briefly? The answer is simple. We expand our measurements beyond sober versus not sober. Addiction doesn’t occur in a vacuum and neither does recovery. Many things have to get better for overall quality of life to improve. If we don’t measure those, we are missing half of the story.
At BRC Healthcare, we believe in an abstinence-based model. That is the foundation of the clinical programming that we espouse at our facility. This does not mean that we are anti-medication or have not read the science supporting opioid replacement therapies. It means that we have chosen a course of specialization that we want to be the very best at delivering. To do that, we have chosen clinical modalities that support our philosophy and that we can track using psychometrically formed measures looking at both the measurement and change in pathology and the measurement and change in resilience/coping skills during and after treatment. The two are most often inversely correlated. In my next post, we will talk more about those measurements and how we are using technology platforms to track them in real time so that our clinicians (some you have heard from earlier in the month) have real-time data to inform their strategies with our clients.