The Hazelden Blog

Valerie Slaymaker is chief academic officer and provost of Hazelden’s Graduate School of Addiction Studies and also serves as Executive Director of the Butler Center for Research at Hazelden

The conversation starts out innocently enough. Small talk. In the grocery checkout, at a social gathering, or on a flight. Once it’s out that I work at an addiction treatment center, and that I’m a  researcher, the next question is inevitable. People want to know. “What’s the success rate for addiction treatment?”

Cue the crickets.

What I want to say is, “You have posed a question that has confounded the treatment field for decades.”

What I actually say is closer to this: There isn’t a standard success rate quoted by the field. You will hear figures anywhere from 50% upwards to more than 80%, but consumers need to look behind the numbers and ask more questions. Addiction is a chronic and progressive disease, and there are different ideas about what treatment “success” means and how it’s measured.

And then, depending on how interested they seem, I go on to explain more:

Within the alcohol and drug treatment field, the traditional gold standard of outcome is continuous abstinence from all mood-altering chemicals during a specified period of time. This standard has been challenged in recent years. Opponents point out that chronic disease outcomes are rarely reported in an “all-or-nothing” manner. Instead, factors such as treatment adherence and symptom reduction are reported. 

Others debate whether treatment centers are truly responsible for continuous abstinence among their former patients, particularly as more time passes since discharge. Rather than abstinence, some argue that significantly reduced alcohol and drug use constitute success. In this manner, those who relapse and get quickly back on track are counted as treatment successes rather than “treatment failures.”

And then there’s the whole notion that treatment success is not necessarily limited to alcohol and drug use outcomes. Because alcohol or other drug dependence negatively impacts overall life functioning, success can also be measured by improvements in employment, legal problems, family/social relationships, and psychological functioning. However, some argue that addiction treatment can’t be expected to result in global improvement across all life areas.

Adding to the confusion, definitions of “success” can vary from one treatment center to another. Treatment centers also differ in the way outcomes are reported, making comparisons between them difficult. Some report continuous abstinence rates; others report on the percentage who significantly reduce their use. 

Time frames may also differ. One center may report six-month outcomes while another reports one-year outcomes. And, to complicate the matter even further, one center may report on how patients functioned during the entire six months after treatment while another might report how well the patients did during the 30 days prior to the time of the six-month follow-up interview.  

Another difference has to do with the types of patients assessed. An “intent-to-treat” sample includes all patients who are admitted to the facility regardless of how long they stay. “Treatment completion” samples include only those patients who successfully finish the program. Not surprisingly, treatment completion samples demonstrate better outcomes than intent-to-treat samples. So, when trying to understand a center’s outcomes, it is important to understand the type of sample included.

I know. A way-too-long answer to a seemingly simple question. As a scientist, I just can’t help myself. We have an unresolved debate going on in the field about how “success” should be defined and how outcomes should be reported. The good news is that research studies continue to document that addiction treatment is effective and restores lives, no matter how success is measured. In short, treatment works.

There’s been a sharp drop in the percentage of America’s children being bullied or beaten up by their peers, according to a new national survey by experts who believe anti-bullying programs are having an impact.

by Anna Bjork, Clinical Nursing Supervisor at Hazelden in Center City

If there is one question that I am asked regularly by patients, it is “What medications are safe to use in recovery?”

The answer is this: All medications have the potential to be abused, some much more than others.

The first thing you should do is be upfront with your physician/nurse practitioner and pharmacist about your addiction. Although some “addictive” medications (stimulants in cold medications, short term opiates, etc.) may be appropriate for you, medical professionals may have other suggestions that would work just as well and put your recovery at much less risk.

Recently, I was able to attend a seminar at which our CMO, Dr. Marv Seppala, was speaking. He shared a story of a person who did notify his physician that he was an addict prior to a minor surgery and yet that physician still tried to prescribe a large amount of opiate medication — in fact, a great deal more than would be needed for that particular procedure. If you come upon a situation like this, get a second opinion. Better yet, try to work with an addiction specialist, if possible. Most HMO’s should be able to refer you to an in-network provider.

Have a conversation with your doctor about what to expect after the procedure so the two of you can plan accordingly. As a person in recovery, you need to advocate for yourself. Ask for help from your sponsor as well.

As a general rule, there are certain medications that should be avoided by people in recovery. Be sure to read labels carefully on medications as some of the secondary ingredients may have addictive properties such as:

• any medication containing pseudoephedrine, diphenhydramine or dextromethorphan contained in such brands as Sudafed, Dayquil, Theraflu, Benadryl, Robitussin DM or any other “DM” cough syrup
• prescription opiates of all kinds such as in Tylenol #3, Percocet, Vicodin, Darvocet
• all benzodiazepines including Ativan, Xanax, Klonopin, Valium
• stimulants such as diet pills or ADHD medications such as in Adderall, Ritalin, Concerta, phentermine
• sleep agents with addictive properties including Tylenol PM, Advil PM, Ambien, Lunesta
• all preparations that have an alcohol base such as mouthwash and cough syrup

If this list seems large, it is only to bring attention to some agents that could put you at risk. If you and your doctor do feel that the above medications are to be used, they should be used with caution under close supervision by your provider and for only a brief period of time. None should be used long term. A well-trained addiction medicine physician should be able to provide you with alternatives.

Luckily, there are also medications that can be used to manage cravings. Several pharmacologic interventions for addiction medications are available for use as well:

• Naltrexone is given as a part of an alcohol or opiate treatment program. It is a once-daily oral medication. It blocks intoxication associated with opiates. It also helps patients with alcohol dependence by reducing cravings. Vivitrol is the once monthly injectable form of Naltrexone. Although Naltrexone has been approved for both opiate and alcohol dependence, Vivitrol has only been approved for alcohol dependence at this time.
• Campral is given as a part of a treatment program for alcohol dependence. It is an oral medication given three times a day. It helps by reducing the desire to drink again. Studies are also showing that relapse rates are shorter in duration as well.
• Antabuse is used as a part of a treatment plan for problem drinking. An oral medication given once a day, it creates an unpleasant series of reactions if alcohol is consumed, which reduces the desire to drink.

Ask your doctor if any of the above pharmacologic intervention medications may be right for you. There may be some lab work that should be drawn prior to beginning these medications. These medications are not to be used alone, but as a part of of your ongoing recovery program that includes medical supervision and counseling.

Pharmacologic intervention medications seem to be the wave of the present and the future as research findings show that these medications help patients sustain lifelong recovery.