Addiction and the Stages of Healing, Part 10: IMAGINE THE DAY; WHAT CAN WE DO RIGHT NOW?

IMAGINE THE DAY

It would be wonderful – imagine the day – when those clinicians working in addiction treatment or recovery support could clearly identify the patient’s normative position in progress related to measures in:

• neurological/brain structure and function
• specific aspects of initial cognitive clearing and later cognitive flexibility as they move along
• emotional self-regulation and later emotional resiliency
• shedding and accommodating paradigms of thought
• parameters of craving and craving management
• increments of improving self-efficacy
• movement from the culture of addiction into a personal culture of recovery, and new lifestyle development that would be needed
• shifting from egocentrism to a community-connected or service-oriented lifestyle.

Currently we do not have these measures. We are not sure where the patient is with respect to total healing and wellness over the decades in front of them.  And our service is concluded far too soon.

Knowing the stages of healing from addiction and having access to the markers of that healing within each stage, in live time, would help us help others – with respect to patient progress, and pursuit of total and normed healing.  We would:

• better gauge the advantages and inherent limitations within our various types of treatment
• better be able to match, sequence and coordinate types of treatment over time
• be challenged to coordinate provision of effective and necessary spiritual practices during care
• look at total patient health and well being
• improve full disease management and full recovery management for all present conditions.

Overall, many improvements for the person would be had – including those that we currently relegate to out of our scope of care and outside our professional obligations. 

We would push for more healing over time than the patient is (merely) initially interested in (when they are charged with choosing their initial care, during their most symptomatic phase of illness).  And we would push for full healing as related to clinical outcomes, return to full function, and full-person wellness – rather than referring to “healing” in a disparaging and dismissive sense.

• Should the Stages of Healing from substance use disorders remain unknown?
• Should the scope of all relevant, specific markers of total healing from substance use disorders remain invisible?
• What are the normative Stages of Healing from addiction, and what are the normative markers of that healing within each stage?
• Is our patient in fact improving entirely and normatively, or only with respect to what we currently measure? We just do not know.

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WHAT CAN WE DO RIGHT NOW?

I suggest four things:

1. We can form inter-disciplinary teams and utilize their full competency (knowledge and skill). We have many resources available. We are just not together and working together with the available resources we have.
2. We can ask people in long term recovery what matters – what indicators we should be evaluating. This is a suggestion that Bob DuPont gave me. ²²
3. We can read the recovery management check-up literature. Christy Scott and Mike Dennis have done work in this area. We can become familiar with those concepts and methods.
4. We can set up long term care/support frameworks that will start to accommodate the needs of long-term recovery and healing, rather than be limited to short term treatment outcomes. We would thus walk with our patients down the corridor of time, with the lights on, and know where they are.

Hopefully by now:

• the current limitations of existing measures of clinical response to formal addiction treatment are clear; 
• you can compare and contrast clinical outcome measures from healing and its indicators;
• you can discuss a broader framework of whole-person indicators of improvement across Stages of Healing from addiction illness;
• you know a range of existing stage-specific theories pertaining to addiction;
• you can discuss the potential utility of Addiction and the Stages of Healing as a framework for advancing assessment approaches, therapeutic strategies, and research agendas. 

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By way of review, Addiction and the Stages of Healing pertains to the segments and sequence of improvements during recovery from more serious substance use disorders. For those serving people with moderate to severe substance use disorders (addiction illness), some clinical markers of improvement do exist, and we know they do. And some markers of early recovery have been identified.  But we lack a comprehensive and normed set of bio-psycho-social-spiritual markers of improvement – that is, whole person healing – and we lack their associated measures.

Would it be important or useful to have this at our disposal? Yes, it would be.  It would help us:

• sequence and time clinical care and coordination among and between modalities
• keep long term whole person healing in view  
• prolong our structure of work with people, while aiming for full recovery and related support
• and know where the individual patient sits on a norm-reference based set of expectancies against similar individuals with their problem array; we do not have that ability now.

I hope you can see that for clinical service delivery, it would be helpful to know the normative Stages of Healing from addiction, and the normative markers of that healing within each stage.  Hopefully you will begin (in your work with each person, your service systems, and your ongoing research endeavors) to pursue knowing if the person is improving entirely and normatively, rather than only with respect to what we currently measure.

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²²DuPont, R.L. (2016).  Interview with Brian Coon for the North Carolina Recovery Advocacy Alliance Summit.

In case you missed it, Part 9: STAGE THEORIES RELATED TO ADDICTION is here.

Last Up and Coming Next: “BUT THAT COULD NEVER HAPPEN”