The Importance of an Addiction Treatment Continuum of Care

Whenever anyone thinks of addiction treatment or rehab, especially someone that has never experienced it or has little knowledge or understanding, invariably the thought is that rehab is a 30 day stay in a resort-like atmosphere. Or, perhaps, they picture it as a month in a locked down hospital. This idea is reinforced time and time again through media images on television and in movies.

The traditional 28 day residential care model of treatment is a model that took hold in the 1980’s and for no clinical reasoning became the standard of care for addiction treatment. The issue is that addiction is not an acute illness, rather it is a chronic, progressive, ultimately fatal illness if left untreated.

So why does cancer, heart disease, diabetes and a host of other diseases get necessary long-term care while addiction, with its high rate of relapse and mortality, gets 28 days with a graduation ceremony and a list of numbers of AA and NA meetings and maybe a recommendation to a sober living house?Unfortunately, insurance companies make it almost impossible to get coverage for addiction treatment. And so instead of creating a true continuum of care with positive recovery outcomes, those suffering from addiction are left to hope that their insurance covers 10 days of a proposed 28 day treatment stay. Sometimes patients are even told they need to “fail at a lower level” before their insurance will authorize an inpatient level of care. Even with parity through the Affordable Care Act, some insurance policies won’t cover inpatient rehab and only a very short time for any outpatient treatment.

So what should be taking place? What would improve recovery outcomes, recidivism, relapse and aid in stemming the tide of increasing number of overdose deaths taking place in America? Rather than 28 days, which typically turns into 20 or less, and a referral to a halfway house, what should it look like when someone begins the process of receiving treatment for addiction? What that looks like is a long-term comprehensive care plan that includes an actual continuum of care.

What that looks like is, just like a doctor sits down with a patient and their family and gives them a roadmap that may span several years of treatment planning, someone suffering from addiction and their family are given a similar treatment services roadmap. The disease of addiction is the only disease that tells the sufferer they don’t have it and the person will fight tooth and nail against treatment recommendations. A standard of care needs to be set so that the addict/alcoholic and their loved ones are extremely clear on what treatment will entail and what the roadmap of success will look like in order to overcome the addiction.

The definition of “Continuum of Care” is: A concept involving a system that guides and tracks patients over time through a comprehensive array of health services spanning all levels and intensity of care. The continuum of care covers the delivery of healthcare over a period of time. Another term for continuum of care in the addiction treatment or behavioral health space is what is called a “Recovery-Oriented System of Care” (ROSC). The definition of a ROSC is “a coordinated network of community-based services and supports that is person-centered and builds on the strengths and resilience of individuals, families and communities to achieve abstinence and improved health, wellness and quality of life for those with or at a risk of alcohol and drug problems” (SAMHSA).

So this looks like a patient in need for a substance use disorder getting to sit with a professional along with their family and getting the next year of their life mapped out. It starts with a medical detox and moves on to residential treatment or inpatient rehab for 30 or 45 days. This is the necessary acute level of care. Next, after discharge, the patient moves onto an extended care treatment program, a partial hospitalization (PHP) or full day treatment program with a structured living component. This level of care would occur for several months as the patient would transition to a lesser level of clinical care and begin transitioning back to work or school or a vocation while still in a structure living environment. Next for several months the patient would engage in an intensive outpatient (IOP) level of care, possibly also transitioning from a program structured living environment to a less intensive living situation in a recovery residence or sober house. Next the patient may discharge from treatment but continue seeing a private therapist to continue the clinical work they have been doing while in treatment. Additionally, since leaving inpatient the client should have begun engaging in an outside program of recovery, whether a 12 Step program like Alcoholics Anonymous or Narcotics Anonymous, SMART Recovery or an organization like Celebrate Recovery. By the end of the first year, the patient would be at the end of the clinical continuum, while being engage in an outside recovery program with sober supports as well as being fully self-supporting in their living situation and career. Finally, throughout this time continued family work would have established a family system that is also in recovery with healthy boundaries in place.

The above continuum certainly looks different than what we have now, doesn’t it? It looks much different than 30 days rehab and then right back to work? It looks much different than “All I need to do is get detoxed and then just resume my life.” Addiction is a disease that requires treatment. Furthermore, addiction is a disease that creates behaviors and emotions and negative coping skills that cannot be undone in 30 days. These behaviors need consistent work in order to be overcome and the patient be able to exist and live and react in normal society without automatically escaping through the established destructive pathways of drugs and alcohol or even the many other similarly addictive behaviors such as sex or gambling.

Above any evidence-based research on addiction, the one common agreed upon fact is that longer term treatment equals better results. The longer a patient is engaged in a continuum with addiction treatment professionals the better the sustained recovery outcomes will be for both patient and family. This is even strengthened when like-minded providers exist and collaborate along the continuum, so the clinical work began in the 30 day residential rehab and continue all the way through the process. If we are ever to make a dent in the horrific addiction epidemic we are now facing, we must begin treating addiction like other chronic, progressive diseases and begin engaging patients in a continuum of care that sets them up for their best chance for success and a long-term, sustainable recovery.

If you or someone you know is in need of help because of drug and/or alcohol abuse or addiction, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis substance abuse treatment in the Baltimore, Maryland, Washington, DC and Virginia area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs. Please give us a call at (410) 773-0500 or email our team at info@marylandaddictionrecovery.com. For more information on all of our drug addiction and alcohol addiction services and recovery resources, please visit our web site at www.marylandaddictionrecovery.com.