Addiction and the Stages of Healing, Part 5: “CARE FOR THE LIFETIME OF THE VEHICLE”

We take automobiles in for the lifetime of the vehicle. We have structural systems set up for vehicle care with no appointment necessary, and expert technicians with the knowledge of what to look for at that point in time, at that number of miles, at that appointment.  We know the appointment will not take long, and will be:

  • based on and include expert guidance on what is critical now,
  • what to always evaluate at each visit, and
  • what to do based on the findings.

For vehicles, we have an aggregate data set informing us of what to expect and when, and the preventative maintenance schedule to go with it.

I wish we had that in our addiction treatment field.  We could spend less time, doing better work, and add a focus of ensuring management of ongoing healing – rather than leaving long term outcomes of relatively short-term care to chance.  We could stay with our patient over decades, meaningfully, rather than having time-limited services with a narrow scope of evaluation.

To make changes this radical we would have to innovate to get there. Consequently, I would like to frame-up a suggested path for that innovation.

  • Let us follow the whole person, with our full measures, over decades. Toward this end we should include existing clinical measures from various clinical disciplines.
  • We need to add wellness-focused measures. Clinicians tend to be pathology-oriented.  That is a self-limiting endeavor and precludes our goal of supporting and ensuring long range wellness.
  • We would aggregate the outputs of these measures to form a norm reference group. If we have a large enough number of patients and follow them for decades, we would have the expectancy (data shape) of what healing would look like over time, on average.

We could also divide the data set into smaller reference groups better matched to the specific data array of the individual patient.

  • I suggest we restructure clinical follow up to last decades and retain use of clinical and wellness measures at least until thresholds are met. We would be able to see what improvements were lagging in progress against the norm reference group and modify care or support accordingly. Right now, in addiction treatment, we are comparatively flying blind and we just do not know – especially not out that many years.
  • We would eventually refine recovery management and wellness check-ins.  The basic notion of these kinds of check-ins is not new5.  But our population-sized, thorough and continuous data set could lead us to refine our methods with individuals.  These checks would include the use of relevant clinical and wellness measures, allow us to notice what is decreasing or lagging against the norm reference group, and modify care or support accordingly – if and as needed.

We would therefore begin to function from the starting point of a standard outcome of sustained full-person wellness, and we would pursue that goal from the outset – rather than merely putting out fires, merely achieving symptom control, or merely obtaining other short-term gains.  Full-person wellness would be the outcome we would work toward, rather than the way our field works currently.  And as we proceed down this path as a field, we would ultimately develop new clinical targets, clinical practices, and related measures.  Overall, as we innovate, our long-term outcomes would be improved, collectively.

5Scott, C. K. & Dennis, M. L.  (2011).  Recovery Management Checkups with Adult Chronic Substance Users.  In Kelly, J. F. & White, W. L. (eds.) Addiction Recovery Management: Theory, Research and Practice. Springer: New York.

In case you missed it, Part 4: WHAT SHOULD IMPROVE, AND WHEN? is here.


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