Reconsidering the evaluation of addiction treatment: from retrospective follow-up to concurrent recovery monitoring.
Historically, addiction treatments have been delivered and evaluated under an acute-care format. Fixed amounts or durations of treatment have been provided and their effects evaluated 6-12 months after completion of care. The explicit expectation of treatment has been enduring reductions in substance use, improved personal health and social function, generally referred to as 'recovery'. In contrast, treatments for chronic illnesses such as diabetes, hypertension and asthma have been provided for indeterminate periods and their effects evaluated during the course of those treatments. Here the expectations are for most of the same results, but only during the course of continuing care and monitoring. The many similarities between addiction and mainstream chronic illnesses stand in contrast to the differences in the ways addiction is conceptualized, treated and evaluated. This paper builds upon established methods of during-treatment evaluation developed for the treatment of other chronic illnesses and suggests a parallel evaluation system for out-patient, continuing-care forms of addiction treatment. The suggested system retains traditional patient-level, behavioral outcome measures of recovery, but suggests that these outcomes should be collected and reported immediately and regularly by clinicians at the beginning of addiction treatment sessions, as a way of evaluating recovery progress and making decisions about continuing care. We refer to this paradigm as 'concurrent recovery monitoring' and discuss its potential for producing more timely, efficient, clinically relevant and accountable evaluations.
McLellan
A Thomas
AT
Treatment Research Institute, University of Pennsylvania, USA. tmclellan@tresearch.org
McKay
James R
JR
Forman
Robert
R
Cacciola
John
J
Kemp
Jack
J
D003695:Delivery of Health Care / Q000458:organization & administration*; D005069:Evaluation Studies as Topic; D005500:Follow-Up Studies; D006801:Humans; D017063:Outcome Assessment, Health Care; D019966:Substance-Related Disorders / Q000534:rehabilitation / Q000628:therapy*; D016896:Treatment Outcome