1 / 23

Understanding and Managing The Recovery Cycle

Understanding and Managing The Recovery Cycle. Michael L. Dennis, Ph.D. and Christy K Scott, Ph.D. Chestnut Health Systems 720 W. Chestnut, Bloomington, IL 61701, USA E-mail: mdennis@chestnut.org

oren
Download Presentation

Understanding and Managing The Recovery Cycle

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Understanding and Managing The Recovery Cycle Michael L. Dennis, Ph.D. and Christy K Scott, Ph.D. Chestnut Health Systems 720 W. Chestnut, Bloomington, IL 61701, USA E-mail: mdennis@chestnut.org Presentation at the Second Betty Ford Institute (BFI) Conference Extending the Benefits of Addiction Treatment: Practical Strategies for Continuing Care and Recovery. This presentation was supported by funds from NIDA grant no. R37-DA11323, and R01 DA15523. The opinions are those of the authors do not reflect official positions of the government or BFI. Please address comments or questions to the author at mdennis@chestnut.org or 309-820-3805. A copy of these slides will be posted at www.chestnut.org/li/posters and the conference website .

  2. Problem and Purpose Over the past several decades there has been a growing recognition that a subset of substance users suffers from a chronic condition that requires multiple episodes of care over several years. This presentation will present • The results of a 9 year longitudinal study to quantifying the chronic nature of substance disorders and how it relates to a broader understanding of recovery • The results of two experiments designed to improve the ways in which recovery is managed across time and multiple episodes of care.

  3. Pathways to Recovery Study (Scott & Dennis) Recruitment: 1995 to 1997 Sample: 1,326 participants from sequential admissions to a stratified sample of 22 treatment units in 12 facilities, administered by 10 agencies on Chicago's west side. Substance: Cocaine (33%), heroin (31%), alcohol (27%), marijuana (7%). Levels of Care: Adult OP, IOP, MTP, HH, STR, LTR Instrument: Augmented version of the Addiction Severity Index (A-ASI) Follow-up: Of those alive and due, follow-up interviews were completed with 94 to 98% in annual interviews out to 8 years (going to 10 years); over 80% completed within +/- 1 week of target date. Funding: CSAT grant # T100664, contract # 270-97-7011 NIDA grant 1R01 DA15523 (Scott & Dennis)

  4. Pathways to Recovery Sample Characteristics 100% 20% 40% 60% 80% 0% African American Age 30-49 Female Current CJ Involved Past Year Dependence Prior Treatment Residential Treatment Other Mental Disorders Homeless Physical Health Problems

  5. Substance Use Careers Last for Decades 100% 90% 80% Percent in Recovery 70% Median duration of 27 years (IQR: 18 to 30+) Years from first use to 1+ years abstinence 60% 50% 40% 30% 20% 10% 0% 0 5 10 15 20 25 30 Source: Dennis et al 2005 (n=1,271)

  6. It Takes Decades and Multiple Episodes of Treatment 100% 90% 80% Percent in Recovery 70% Median duration of 9 years (IQR: 3 to 23) and 3 to 4 episodes of care Years from first Tx to 1+ years abstinence 60% 50% 40% 30% 20% 10% 0% 0 5 10 15 20 25 Source: Dennis et al 2005 (n=1,271)

  7. The Cyclical Course of Relapse, Incarceration, Treatment and Recovery P not the same in both directions 6% 7% 25% 30% 8% 13% 29% 4% 7% 44% 31% 28% Treatment is the most likely path to recovery Over half change status annually Incarcerated (37% stable) In the In Recovery Community (58% stable) Using (53% stable) In Treatment (21% stable) Source: Scott et al 2005

  8. Predictors of Change Also Vary by Direction • Probability of Transitioning from Using to Abstinence • mental distress (0.88) + older at first use (1.12) • ASI legal composite (0.84) + homelessness (1.27) • + # of sober friend (1.23) • + per 8 weeks in treatment (1.14) In the 13% In Recovery Community (58% stable) Using 29% (53% stable) Probability of Relapsing from Abstinence + times in treatment (1.21) - Female (0.58) + homelessness (1.64) - ASI legal composite(0.84) + number of arrests (1.12) - # of sober friend (0.82) - per 77 self help sessions (0.55) Source: Scott et al 2005

  9. Percent Sustaining Abstinence Through Year 8 by Duration of Abstinence at Year 7 Even after 3 to 7 years of abstinence about 14% relapse 100% . 86% 86% 90% It takes a year of abstinence before less than half relapse 80% 66% 70% 60% % Sustaining Abstinent through Year 8 50% 36% 40% 30% 20% 10% 0% 1 to 12 months 1 to 3 years 3 to 5 years 5+ years (n=157; OR=1.0) (n=138; OR=3.4) (n=59; OR=11.2) (n=96; OR=11.2) Duration of Abstinence at Year 7 Source: Dennis, Foss & Scott (in press)

  10. 1-3 Years: Decrease in Illegal Activity; Increase in Psych Problems 5-8 Years: Improved Psychological Status 3-5 Years: Improved Vocational and Financial Status 1-12 Months: Immediate increase in clean and sober friend % of Clean and Sober Friens % Days of Illegal Activity (of 30 days) % Days Worked For Pay (of 22) % Days of Psych Prob (of 30 days) % Above Poverty Line Other Aspects of Recovery by Duration of Abstinence of 8 Years 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Using 1 to 12 ms 1 to 3 yrs 3 to 5 yrs 5 to 8 yrs (N=661) (N=232) (N=127) (N=65) (N=77) Source: Dennis, Foss & Scott (in press)

  11. Post Script on the Pathways Study • There is clearly a subset of people for whom substance use disorders are a chronic condition that last for many years • Rather than a single transition, most people cycle through abstinence, relapse, incarceration and treatment 3 to 4 times before reaching a sustained recovery. • It is possible to predict the likelihood risk of when people will transition • Treatment predicts who transitions from use to recovery and self help group participation predicts who stays in recovery. • “Recovery” is broader than abstinence and often takes several years after initial abstinence

  12. The Early Re-Intervention (ERI) Experiments (Dennis & Scott) Funding Source NIDA grant R37-DA11323

  13. Sample Characteristics of ERI-1 & -2 Experiments 100% 20% 40% 60% 80% 0% African American Age 30-49 Female Current CJ Involved Past Year Dependence Prior Treatment Residential Treatment Other Mental Disorders Homeless ERI 1 (n=448) ERI 2 (n=446) Physical Health Problems

  14. Recovery Management Checkups (RMC) in both ERI 1 & 2 included: • Quarterly Screening to determining “Eligibility” and “Need” • Linkage meeting/motivational interviewing to: • provide personalized feedback to participants about their substance use and related problems, • help the participant recognize the problem and consider returning to treatment, • address existing barriers to treatment, and • schedule an assessment. • Linkage assistance • reminder calls and rescheduling • Transportation and being escorted as needed

  15. Quality assurance and transportation assistance reduced the variance ERI 2 Generally averaged as well or better than ERI 1 ImprovedScreening Improved Tx Engagement RMC Protocol Adherence Rate by Experiment 100% 90% 80% 70% 60% 50% 40% 30% 20% 10% 0% Treatment Need (30 vs. 44%) d=0.31* Follow-up Interview (93 vs. 96%) d=0.18 Showed to Assessment (30 vs. 42%) d=0.26* Showed to Treatment (25 vs. 30%) d=0.18* Agreed to Assessment (44 vs. 45%) d=0.02 Linkage Attendance (75 vs. 99%) d=1.45* Treatment Engagement (39 vs. 58%) d=0.43* ERI-1 ERI-2 <-Average-> Range of rates by quarter * P(H: RMC1=RMC2)<.05

  16. 630-403 = -200 days ERI-1 Time to Treatment Re-Entry 100% 90% 80% 70% (n=221) 60% ERI-1 RMC* Percent Readmitted 1+ Times 60% 51% ERI-1 OM (n=224) 50% 40% 30% Revisions to the protocol 20% *Cohen's d=+0.22 10% Wilcoxon-Gehen 0% Statistic (df=1) 630 270 360 450 540 180 90 0 =5.15, p <.05 Days to Re-Admission (from 3 month interview)

  17. 100% The size of the effect is growing every quarter 90% 80% 70% 630-246 = -384 days 60% 50% 40% 30% 20% 10% 0% 630 270 360 450 540 180 90 0 ERI-2 Time to Treatment Re-Entry Percent Readmitted 1+ Times (n=221) 55% ERI-2 RMC* 37% ERI-2 OM (n=224) *Cohen's d=+0.41 Wilcoxon-Gehen Statistic (df=1) =16.56, p <.0001 Days to Re-Admission (from 3 month interview)

  18. No effect on Abstinence/Symptoms ERI-1: Impact on Outcomes Months 4-24 Final Interview 100% RMC 90% OM 80% 79% 79% 79% RMC Broke the Run 80% Less Likely to be in Need of Treatment 70% 60% Percentage 44% 50% 40% 34% 33% 27% 30% 21% 21% 20% 10% 0% of 630 Days of 7 Subsequent of 90 Days of 11 Sx of Still in need of Tx Abstinent Quarters in Need Abstinent Abuse/Dependence (d=0.04) (d= -0.19) * (d= -0.05) (d=-0.02) (d= -0.21) * * p<.05

  19. Significant Increase in Abstinence ERI-2: Impact on Outcomes Months 4-24 Final Interview 100% RMC 90% OM RMC Broke the Run 76% 76% 80% Less Likely to be in Need of Treatment 68% 68% 70% 57% 60% Less Symptoms 49% Percentage 46% 50% 37% 40% 27% 30% 19% 20% 10% 0% of 630 Days of 7 Subsequent of 90 Days of 11 Sx of Still in need of Tx Abstinent Quarters in Need Abstinent Abuse/Dependence (d=0.29)* (d= -0.32) * (d= 0.23)* (d= -0.23)* (d= -0.24) * * p<.05

  20. Again the Probability of Entering Recovery is Higher from Treatment Impact on Primary Pathways to Recovery (incarceration not shown) 32% Changed Status in an Average Quarter • Transition to Recov. • Freq. of Use (0.7) • Dep/Abs Prob (0.7) • Recovery Env. (0.8) • Access Barriers (0.8) • + Prob. Orient. (1.3) • + Self Efficacy (1.2) • + Self Help Hist (1.2) • + per 10 wks Tx (1.2) 17% 18% In the Community y In Recovery Using (76% stable) (71% stable) 27% 8% 33% 5% • Transition to Tx • Freq. of Use (0.7) • + Prob. Orient. (1.4) • + Desire for Help (1.6) • + RMC (3.22) In Treatment (35% stable) Source: ERI experiments (Scott, Dennis, & Foss, 2005)

  21. Post Script on ERI experiments • Again, severity was inversely related to returning to treatment on your own and treatment was the key predictor of transitioning to recovery • The ERI experiments demonstrate that the cycle of relapse, treatment re-entry and recovery can be shortened through more proactive intervention • Working to ensure identification, showing to treatment, and engagement for at least 14 days upon readmission helped to improve outcomes • ERI 2 also demonstrated the value of on-site proactive urine testing versus the traditional practice of sending off urine for post interview testing

  22. We still need to.. • Educate policy makers, staff and clients to have more realistic expectations • Redefine the continuum of care to include monitoring and other proactive interventions between primary episodes of care. • Shift our focus from intake matching to on-going monitoring, matching over time, and strategies that take the cycle into account • Identify other venues (e.g., jails, emergency rooms) where recovery management can be initiated • Evaluate the costs and determine generalizability to other populations through replication • Explore changes in funding, licensure and accreditation to accommodate and encourage above

  23. Sources and Related Work • Dennis, M.L., Foss, M.A., & Scott, C.K (in press). An eight-year perspective on the relationship between the duration of abstinence and other aspects of recovery. Evaluation Review. • Dennis, M. L., Scott, C. K. (in press). Managing addiction as a chronic but treatable condition. NIDA Addiction Science & Clinical Practice. • Dennis, M. L., Scott, C. K., Funk, R., & Foss, M. A. (2005). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment, 28, S51-S62. • Dennis, M. L., Scott, C. K., & Funk, R. (2003). An experimental evaluation of recovery management checkups (RMC) for people with chronic substance use disorders. Evaluation and Program Planning, 26(3), 339-352. • Scott, C. K., & Dennis, M. L. (under review). Results from Two Randomized Clinical Trials evaluating the impact of Quarterly Recovery Management Checkups with Adult Chronic Substance Users. Addiction. • Scott, C. K., Dennis, M. L., & Foss, M. A. (2005). Utilizing recovery management checkups to shorten the cycle of relapse, treatment re-entry, and recovery. Drug and Alcohol Dependence, 78, 325-338. • Scott, C. K., Foss, M. A., & Dennis, M. L. (2005). Pathways in the relapse, treatment, and recovery cycle over three years. Journal of Substance Abuse Treatment, 28, S61-S70.

More Related