Lessons in Measuring the Success of Drug Rehabilitation Programs
The trend toward accountability in the nonprofit sector and the resulting need for performance evaluation is a problem facing the substance-abuse treatment sector, according to an article in The New York Times on Dec. 22, 2008. The article explores the concept that few rehabilitation programs have the evidence to show that they are effective.
Private clinics, for example, generally do not allow outside researchers to verify their published success rates, while publicly supported programs spend their scarce resources on patient care, not costly studies. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate.
It’s Not a Small Problem
According to the article, every year $20 billion is spent on substance-abuse treatment services ($15 billion from state and federal governments and at least $5 billion more from insurers). These numbers are likely to increase dramatically given the new mental health parity law passed last year which for the first time requires that insurers cover mental and physical ailments at equal levels.
An estimated 4 million people are served each year by treatment centers, but with many clinics across the country have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.
Two Measurement Approaches
With each program employing its own philosophy and no standard guidelines existing for the field and because these programs rarely if ever track clients closely after they graduate, it is difficult to determine which approach is best for which patient. However, two general approaches to measuring the success of treatment have emerged: evidence-based and practice-based.
Evidence-Based Treatment
In an attempt to increase success rates various techniques are employed. When practiced faithfully, evidence-based therapies, including prescription drugs, give users their best chance to break a habit. Another technique, called the motivational interview, requires the addict to explain why he or she has a problem, and set their own goals, has been proven to help them stay in treatment longer. Other techniques such as psychotherapy in which people learn to expect and tolerate restless or low moods are also on the list. So is cognitive behavior therapy, in which addicts learn to question assumptions that reinforce their habits (like “I’ll never make friends who don’t do drugs”) and to engage their nondrug activities and creative interests.
Yet interest and awareness may not translate into good practice. And it is not at all clear how many rehabilitation programs claiming to use evidence-based techniques actually do so faithfully. About 400 programs receive state money, and most of them are small, rural outfits that are already stretched to provide counseling, to say nothing of paying for extensive training. These therapies take time to learn and most places don’t the personnel to conduct the proper training.
In studies looking at hundreds of programs nationwide, researchers have found a similar gap between what programs may want to do and what they’re able to do. For instance, most programs don’t have an M.D. on staff and so can’t prescribe any medications.
Practice-Based Treatment
To complicate matters, culture clashes erupt between those who want reform — academic researchers, state officials — and veteran counselors working in the trenches, many of whom have beaten addictions of their own and do not appreciate outsiders telling them how to do their jobs.
One way to do achieve success, some experts now believe, is to combine evidence-based practice with “practice-based evidence” — the results that programs and counselors themselves can document, based on their own work. For example, in Delaware bonuses were employed successfully for reaching certain benchmarks such as keeping a high percentage of addicts coming in at least weekly and ensuring that those clients met their own goals.
WAKE UP CALL
Techniques for measuring a program’s success must take heed of political concerns and ultimately be grounded in the practical realities of what can be implemented. With the increased call for accountability and results, smart organizations are planning their programs around measurable outcomes with the thought that, “if we can’t measure it, we don’t do it.”
This shift in thinking, helps to be more creative in conceptualizing programs that will have an impact and that can be leveraged for success in other ways – for example rolled out in other markets or taught to other organizations.
For more on impact, see the entry: The Impact of Leverage and Habits of High Impact Nonprofits
For more on leveraging results, see the entry: The Moment of Now Conference 2008
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