The Mire of Mandating Success Rates

By Sam Darcy, MA, CAP

17 November 2015

This topic of ‘success’ stirs controversy and one can expect that myriad opinions will continually differ on its definitions, metrics, qualifiers, level of care differentiation (inpatient, partial hospitalization etc), primary diagnoses treated, type of treatment approach and milieu.

First, let’s put some of the struggle on insurance companies. One, because they’re an easy target and easy to blame, second, facilities should have a responsibility to keep accurate data of their outcomes assuring that most persons will complete the program and participants reap some tangible measure of benefit from the treatment experience.

What is difficult to assess in the paradigm of gauging ‘success’ is the tangible measurement of how long the participant maintains that benefit.

In a recent deposition the metric of long term success was scrutinized with skepticism when the outreach was conducted by staff phone contact with the former participant for 6 or more months post treatment and based upon the participants self-report of well being (such as medication compliance, remaining abstinent from harmful behaviors/drugs, vocational or educational improvement and more trusting and healthy social and interpersonal relationships). The distrust was based on believing information of a former participant without another verification resource; the assumption was that addicts always lie.

A couple of rejoinders interjected here: If a participant is not doing well post treatment, they typically won’t be answering the phone if indeed they can even be reached. Those in relapse may be willing to re-enter treatment and that in itself has to be considered a success given the intangible depth of shame/guilt/remorse that can prevent one’s re-entry into treatment.

To avoid relapse and/or decompensation some programs have included the costly measure of including post treatment case management services that involve frequent contact with the participant (up to 2 or 3 times a week) and coordination with the participant to provide UA or bloodwork that verifies their compliance with abstinence or medications respectively. This type of follow-up is often provided by some insurance companies as they take a more proactive role in maintaining the health of their insured.

In a few hours spent researching success rates from facilities advertising on the web and on agency websites, the language has certainly changed during the past few years and there is obvious skill in the phrasing of applauding a facility’s success rates. Mostly gone are sites that tout 90% or even 100% “success rates” where one franchise qualified that high rate ‘as long as [one] stayed in the program,’ the other measured success as those who got through the program and it was strongly suspected that many participants were successfully discharged whether they complied and completed their treatment plans (think of social promotion).

Success for establishing long term stability or abstinence is never assured as we are simply not that advanced in any treatment approach. No magic combination of medication or therapy is certain to ‘work.’ A person entering treatment has to have motivation or be receptive to personal and healthy change; most facilities are equipped to provide encouragement to their participants to stay through treatment despite the desire to leave or give up.

Of the near 15,000 treatment providers registered with SAMHSA (Substance Abuse and Mental Health Services Administration), ALL should be required to be both licensed by the state they are located in and accredited with one of the nationally recognized accrediting agencies such as CARF, Joint Commission, HFAP et al. This accreditation assures that the consumer is getting a higher level of care than many states require – and some states have NO licensing requirements specific to behavioral health – in addition to giving consumers a much stronger avenue to register complaints, concerns and compliments than a review site.

Review sites are perhaps the worst place to decide whether a treatment facility is well suited for a participant. Long conversations with one’s insurance provider is a place to start, yet many will find that they need to find a program that is out-of-network. Reasons to go out of network may include needing to attend a facility with specialty services not offered within one’s regions (PTSD/Trauma, significant co-morbid conditions, Eating Disorders or specialty hospital based programs) or perhaps the person simply has to get away and stay away from their environment to achieve and maintain any measure of “success.” In speaking with admissions staff it is not unreasonable to ask to speak with the program or clinical director toward making an informed decision.

Word of mouth- there are 2 edges to that. What may have been ‘good’ and promotional for one person, may not be so valuable for another and the converse is just as true. Reputation is usually well deserved, but not always.

High priced and expensive is NOT any guarantee of emerging blessedly cured and successful.

One facility’s website addressing success simply said that they were committed to doing their best in encouraging a person to get and stay healthy and enlisting the help of healthy and willing family members, significant others, social networks and other providers.

To 12 Step or not to 12 Step. Getting healthy is a very private and personal decision that one has to make. 12 Step does have the longest history and while detractors assert AA/NA has terrible success rates (indeed the research remains almost invisible) Millions has been rescued from their affliction due to 12 step recovery and 12 Step recovery being popular on every part of the globe certainly attests to its success and popularity (it also happens to be free). However, for those just not able to embrace 12 step recovery attending a licensed and accredited non-12 step facility will almost always avoid a fringe or potentially dangerous intervention technique. Some therapies are simply bad and wrong, yet that is not to condemn every new technique or medication that is coming out almost monthly, but be wary, and with anything new being dubious is wise.

In sum, behavioral health remains one of the most baffling illnesses- it is potentially fatal, the concrete medical science of the illness is still not fully explained and even current irrefutable science has its detractors. Yet in the past 100 years the treatment field and the formalized ability to help those with psychological and addictive behaviors has emerged with exponential and synergistic progress, and millions, if not billions, have achieved a life with success: happy, joyous and free from the bondage of uncontrollable compulsive behavior.