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.
In the field of addiction treatment, the term “continuing care” has been used to indicate the stage of treatment that follows an initial episode of more intensive care. This article reviews controlled studies of continuing care conducted over the prior 20 years. The results indicate that continuing care interventions were more likely to produce positive treatment effects when they had a longer planned duration, made more active efforts to deliver treatment to patients, and were studied more recently. However, there was considerable variability in patient response and room for improvements in participation rates and effectiveness. It is possible that the effectiveness of continuing care interventions could be further improved by the use of adaptive algorithms, which adjust treatment over time on the basis of changes in patients' symptoms and status. The use of alternative service delivery methods and care settings may also lead to greater engagement and retention in continuing care, particularly among the large numbers of individuals who do not want traditional, clinic-based specialty care.
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