Abstinence Shouldn’t be the Only Outcome Measure for Addiction Recovery
Node Smith, ND
From the University of Wollongong Australia
Successful recovery from drug and alcohol addiction through attending a residential treatment program means more to the person than just staying clean and sober, an Australian-first study has found.
More than abstinence
While a significant body of research has shown that the length of time a person stays in a program is positively linked to abstinence, reduced crime, better employment prospects and improved quality of life, much of the work has focused on achieving and maintaining abstinence as the main measure of a program’s success.
Understanding what successful recovery means from the client’s point of view
And to date no qualitative research in Australia has moved beyond those indicators to understand what successful recovery means from the client’s point of view.
Therapeutic communities are drug-free residential rehabilitation programs where clients live together in a supportive environment over a period of months, with increasing levels of social and personal responsibility supported by counselling, personal change and skills training used to rehabilitate drug and alcohol users.
Low completion rates
Low completion rates of residential drug and alcohol treatment programs are a major challenge in establishing effective and sustainable rehabilitation programs.
A study of former residents of the Buttery, a community-based residential rehabilitation program on the NSW north coast, found that successful drug and alcohol treatment takes a wider view to include their feelings of self-worth and their ability to contribute to society through employment, study or volunteering.
Shedding light on why ex-residents might withdraw early
Tarran Prangley, a medical student from Graduate Medicine at the University of Wollongong, interviewed a number of ex-residents of the Buttery to understand the reasons people entered rehabilitation programs in the first place, which could shed light on why they might withdraw early.
“Former residents spoke about the need for a ‘circuit breaker’ in their life. They were struggling with childhood trauma and experienced ongoing poor mental health, or they were in trouble with the law.
“The suffering associated with hitting rock bottom is a strong motivator to do something about addiction, to reassess their life and seek help and some see attending a program as their last chance in life.”
The study revealed the residents’ idea of success
The study, a collaboration through the University Centre for Rural Health, Lismore, between the University of Wollongong School of Medicine, Western Sydney University School of Medicine, and the Buttery, revealed the residents’ idea of success involved their sense of overall self-worth, from how the program helped improve relationships, their psychological and physical wellbeing, understanding of addiction and putting them on the track to gaining employment, studying and volunteering.
While many of the study participants withdrew from the program early, Ms Prangley said many of them were still experiencing positive outcomes, which indicated the program was successful, even if it wasn’t completed.
“Some of the reasons residents left early were not surprising. Nine months away from the world can be quite isolating from friends and family and for some people the programs themselves can be intense, but others left because they felt they’d learned enough about how to manage their addictions and could go back to their normal lives.
“And one or two people experience lapses, they said they were able to recognize the signs early and stop themselves relapsing completely.
“In that sense the program should still be considered successful and validates the approach, but the exit surveys and other data doesn’t collect that information.”
Dr Sabrina Pit from Western Sydney University said the study’s results could indicate a shift in the way people view recovery, away from being defined solely by abstinence towards a more holistic view.
“From a policy and treatment point of view this shows the value of supporting residents to not only focus on abstinence but also to identify how they can actively contribute to the community, through studying, volunteering or finding employment.”
“Some people have returned to volunteer in rehabilitation programs and this can be a powerful way to show those in the program they can be successful in their recovery too.”
Trent Rees, Residential Programs Manager at the Buttery, said the research was a validation of the approach and reinforced the need to change how successful recovery is defined.
“One of the great things the study highlighted was that even when people leave early and they say they don’t understand why we took certain approaches or why they felt the program was hard for them, many of those in the research indicated they understand now, they get it, and that takes time.
“When people come to programs like ours they may have also tried other interventions.
“Rather than see that as a series of failures, we need to recognize that recovery is a journey and all the steps taken along the way contribute to their long-term wellbeing and recovery.”
With crime, road accidents, lost productivity and healthcare costs from substance abuse disorders costing the economy and healthcare system around $55 billion annually, Mr Rees said the cost of residential rehabilitation paled in comparison.
“An independent review that evaluates the efficacy of programs is necessary to justify funding them in the first place and to demonstrate their value in helping people become active contributors to society again.”
The research was published recently in the journal BMC Psychiatry.
The study was funded by a generous donation in memory of the Late John Shaw Warnock.
Node Smith, ND, is a naturopathic physician in Portland, OR and associate editor for NDNR. He has been instrumental in maintaining a firm connection to the philosophy and heritage of naturopathic medicine among the next generation of docs. He helped found the first multi-generational experiential retreat, which brings elders, alumni, and students together for a weekend camp-out where naturopathic medicine and medical philosophy are experienced in nature. Four years ago he helped found the non-profit, Association for Naturopathic ReVitalization (ANR), for which he serves as the board chairman. ANR has a mission to inspire health practitioners to embody the naturopathic principles through experiential education. Node also has a firm belief that the next era of naturopathic medicine will see a resurgence of in-patient facilities which use fasting, earthing, hydrotherapy and homeopathy to bring people back from chronic diseases of modern living; he is involved in numerous conversations and projects to bring about this vision.