24 Nov Extended Engagement in Peer Related Services & Therapeutic Communities Correlate to Better Long-Term Outcomes
Addiction professionals are sometimes asked, “How successful is your program?” or more globally, “Does addiction treatment really work?”
At South Pacific Private we take a tailored approach to treatment and are guided by research and evidence. The evidence would suggest that the longer an individual is engaged in continuing care and peer-related services, the less treatment episodes will be required in the longer term. This continuing care could be constituted by a therapeutic community, long-term recovery stay, day / outpatient programs, ongoing 1-2-1 therapy, 12 step program attendance, community services or other recovery / mental health support options. The range of programs offered at South Pacific Private support a long-term approach to recovery and mental health.
Studies consistently find a relationship between duration of treatment in a therapeutic community and aftercare participation and subsequent recovery (De Leon, 2010; Vanderplasschen et al., 2013).
Research outcomes indicate that approaching mental health and addictions from all angles is essential. We believe that a combination of approaches can constitute better outcomes in the long-term and recommend to all clients that they invest in whichever services are most appropriate for them and can best support them in the longer term. In a review of four studies involving therapeutic communities (902 people in total) with co-occurring, mostly severe mental illnesses it was found that these individuals had better outcomes compared with those who received standard care, including improvements in substance use, mental health, crime, employment, and housing outcomes (Sacks et al., 2008a).
What is a therapeutic community?
This can be described as a participatory, group-based approach to long-term mental illness, personality disorders and drug addiction that is usually residential but is also increasingly available in a day program setting.
Long-term Recovery options recognise that people need options for ongoing support once they complete residential treatment to promote a healthy lifestyle and help them avoid relapsing (Hendershot et al., 2011). Relapse prevention is a part of many addiction treatment programs, including South Pacific Private, where we aim to increase awareness and build coping skills both to reduce the likelihood or frequency of relapse. Research suggests that it takes an average of 8 years from the point of initially seeking treatment for addiction, to the being able to maintain a year of continuous abstinence. This 8-year time-frame is beset with periods of relapse, and ongoing support is required. If we accept the idea that addiction is a chronic relapsing disease, then we must manage it as such and accept that the treatment pathways are also necessarily long term.
Rudolf H. Moos and Bernice S. Moos conducted one such study, specific to alcohol, over a 16yr period. In a meta-analysis of alcoholism treatment outcome studies, average short-term abstinence rates were 21% for untreated individuals in waiting list, no-treatment or placebo conditions, compared to 43% for treated individuals. Similarly, Weisner, Matzger & Kaskutas found that treated alcohol-dependent individuals had higher 1-year non-problem use outcomes (40% versus 23%) than did untreated individuals. Overall, these studies suggest that, especially among individuals who recognize their alcohol problems, treated individuals achieve higher remission rates than untreated individuals.
You might conclude then, that post a treatment episode, one of the most important steps an individual can take to affect their own remission is planning. Whether recovering from drug and alcohol addiction or from a mental health concern, the process is life-long and is not confined to the length of a treatment program, regardless of the type of service accessed. An initial treatment episode is the beginning of an individual lifelong commitment to managing well being, mental health and relapse.
It is advised, as they move toward completion of a program, that individuals be aided in connecting with continuing care and self-help groups in the community. This is for a specific reason, and is also the reason that South Pacific Private advocate extended engagement in Recovery services. Overall, studies find that therapeutic community participants show improvements in substance abuse, criminal behaviour, and mental health symptoms; this is especially true of participants who enter treatment with the most severe problems (De Leon, 2010; Vanderplasschen et al., 2013). One of the largest long-term outcome study of addiction treatment interventions was the NIDA-sponsored Drug Abuse Treatment Outcome Studies (DATOS), which examined the effectiveness of several types of drug abuse treatment programs in the United States, including therapeutic communities, methadone maintenance, outpatient drug-free treatment, and short-term inpatient programs. DATOS found therapeutic communities to be effective. Participants who showed improved behaviour after 1 year continued do so after 5 years, which was also true of the other modalities studied (Hubbard et al., 2003). Research clearly demonstrates that longer time in treatment is associated with better outcomes (De Leon, 2012).
As soon as clients leave South Pacific Private, they’re going to face challenges and triggers, whether that be through work, study, social environments, family dynamics or a plethora of other sources that can potentially trigger old, unhealthy patterns of behaviour. We invite them to start thinking about their own individual triggers and help them to recognize how immediately they might be challenged after their stay at South Pacific Private.
One of the goals of any treatment service is to help individuals recognize the early warning signs of relapse and develop coping skills to prevent relapse early, when the chances of success are greatest. This has been shown to significantly reduce the risk of relapse. Gorski has broken relapse into 11 phases. However, most relapses can be explained in terms of a few basic rules. Understanding these rules can help clients focus on what is important. In addition, engaging in continuing and ongoing care can support the recognition of these early warning signs for an individual.
Each client leaves South Pacific Private with resources relative to their own unique continuing care plan. This might include: recommendations to day or evening programs at South Pacific Private, contact details for therapists in the client’s geographical area and information about relevant peer-related meetings. In addition, we also discuss how clients can self-care in recovery: mindfully eating, exercising, taking up hobbies that have been on hold, sourcing new friendships and networks (for example through the 12 step fellowship) who are going to support recovery rather than promote return to addictive and unhealthy behaviours, sourcing a 12 step sponsor, and having a structured daily plan.
From our perspective, Continuing Care is the ongoing component of the treatment experience after an inpatient stay (where an inpatient stay was required). How individuals continue to care for themselves when they discharge from any inpatient stay may determine their capacity for remaining abstinent and to live their lives with fewer mental health concerns.
At South Pacific Private we believe the research outcomes evidence the importance of this transition and will continue to support extended engagement in peer-related services and therapeutic communities.
We can support clients to engage in longer-term options for their Recovery which we know will lead to better outcomes for them and their families.
Please call South Pacific Private on 1800 063 332 for more information.