Addiction and the Stages of Healing, Part 3: A CLEAR IMAGE

I have been asked to represent the idea of Stages of Healing in the form of a picture diagram.

This is the image I am currently using.

What I mean to represent here is a (large/representative) norm-reference group of 10,000 people or more.  This group would be evaluated prospectively across biological, psychological, social, and spiritual measures over the remainder of their lives – beginning at the time of their initial entry into formal addiction treatment.

I think the resulting data set would be something like a topographical terrain of various indicators (biological, psychological, social, and spiritual) and how these tend to look in the long term, going forward, for the large population.  Addiction treatment and research are largely blind to this aggregate data set because we do not pursue measures in this way; we do not conduct prospective evaluation for nearly this long and nearly this thoroughly.  Thus, we are blind to the data for the individual person over the long term, and we are also blind to the data for long-term population averages.  

I showed this image and described my thinking to a family practice physician who also works in addiction medicine.  That person understood immediately, smiled and said, “You know if you talk to a physician about scoping the individual…” and the physician then paused, peered into this image, crooked their finger while pointing at it and continued, “…we are always curious about what is around the corner that we cannot see – that the scope cannot reach”3.  I thought that was a good metaphor for problems ahead, progress ahead, stuck points ahead, and so on.

Without comprehensive, prospective, and continuous information about the patient, and without that kind of data aggregation for the population, we are flying blind over the long term.

  • We are left to work in a limited way (scant and narrow data, not holistic).
  • Our view of the patient is short-range.
  • All existing and available clinical measures are not typically used.
  • We do not have a norm reference group to compare against the individual patient’s personal problem array at the time they enter care.
  • We cannot see where the individual patient falls compared to the norm reference group on expectancies of improvement.

One might ask if this basic idea can be expressed in a different way, to help ensure the clarity of the notion.  I will try. 

It would be helpful to know the Stages of Healing from addiction and it would be helpful to know the normative markers of that healing within each stage. By that I mean it would be helpful to know:

  1. What expected results we can have for a specific person, presenting with specific problems
  2. If our patient is improving entirely and normatively, rather than improving only with respect to what we current measure.

It would be helpful to know:

  • If the person is really getting better or not?
  • What should be expected to improve, and when?    

3Smith, R.  (2017).  Personal communication.

In case you missed it, Part 2: GETTING WELL IS LONG; MEASURING IS SHORT is here.

Up Next: WHAT SHOULD IMPROVE, AND WHEN?

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