What should be the gold standard for addiction treatment: A little more.

Earlier today Jason Schwartz posted about the active ingredients and basic framework of a multi-year clinical and recovery support model.  The information he shared included elements from Robert DuPont, MD and William White, MA. 

Jason included a statement Dr. DuPont made about the short length of even our longest treatments (such as outpatient methadone or suboxone maintenance, or residential therapeutic community) compared to the length of addiction illness. 

Later in his post Jason also included the idea that the success rates associated with physician health programs, lawyer assistance programs, and programs for professional aviators, etc. simply don’t pertain to the real world or to people without as much recovery capital. 

During my interview with Dr. Dupont, we covered those topics.  I wanted to add a little more.


One point Dr. DuPont made in the interview was that our services are also short compared to the length of recovery.  In that vein, Dr. DuPont noted his approach to a five-year standard (as he pointed out is used with cancer outcomes), was to aim for full recovery five years after the last clinical touch.  Dr. DuPont stated he was interested in how a physician was doing five years after their standard five-year monitoring.

Secondly, I asked Dr. DuPont to comment on the Hawaii HOPE probation program, and the South Dakota 24/7 Sobriety Project – as examples of implementing these principles and practices with people who are involved in the criminal justice system, are not physicians, and do not generally have advanced degrees and lucrative careers.  Dr. DuPont commented on those innovative programs as starting with the same multi-year framework, the use of recovery-oriented methods, and obtaining positive results far beyond what one might normally expect.

I also covered the topic of collegiate recovery programs as aiming at a demographic that could be considered by some as hard to address.  In doing so I included the typical phrase of the “recovery-hostile” undergraduate campus environment as far from ideal to initiate and sustain recovery.  He applauded the innovation and expansion of these types of supports and programs.


Overall, we discussed these different populations all considered hard to help, and noticed shared features of these very effective programs:

  • A multi-year framework
  • The natural environment (not a clinical environment) as the main center of focus
  • Inclusion of family or other close support persons as central, not peripheral
  • Person-centered goals (both diminishment of problems and advancing personal aims) as paramount
  • Incentives to help initiate, support, and sustain change over time

The interview with Dr. DuPont was one part of the agenda for that year’s Recovery Alliance Summit – a multi-year effort focused on building awareness, collaboration, advocacy and action for the sake of the person served.  To help bring this about, the Summit effort aims for its participants to begin to take a multi-year perspective across systems

For example, do the local or regional recovery courts, collegiate recovery programs, and professional monitoring programs know each other exist? Do the staff of such programs know about the other programs in terms of eligibility requirements, practices, and specific benefits to the individual? 

  • Do we expect that the person we serve will discover all on their own that very specific support and advocacy can continue through the years of their recovery journey?
  • Do we just assume the one we are serving will get along well enough after we are done helping them in our own silo?    

Helping a young adult understand and investigate1 collegiate recovery programs is one example to study, while helping an undergraduate or graduate student2 understand and investigate the advocacy of a relevant professional monitoring program is another.


References

1 Crowe, K., Hennen, B. & Coon, B.  March 31, 2017.  A Seamless Transition: Linking College-Bound Emerging Adults with Collegiate Recovery Programs.  Recovery Campus Newsletter.  

2 Coon, B.  (2015).  Recovering Students Need Support As They Transition.  Addiction Professional.  13(1): 22-26.

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