Horizon Treatment Services
Welcome to the Horizon Treatment Services Podcast, where we delve into the forefront of alcohol, drug, and mental health services. As industry pioneers located in the Beloved Bay Area, CA - HSI is committed to empowering adults and adolescents through evidence-based programs, fostering a secure space for tackling substance use disorder and mental health challenges.
Join us as we explore cutting-edge strategies, discuss success stories, and share insights that propel individuals towards their full potential. From prevention initiatives guiding youth towards substance-free lives to community outreach initiatives promoting safer neighborhoods, HSI's interest and expertise extends beyond treatment, shaping a future where well-being takes center stage.
Tune in to stay informed, inspired, and at the forefront of transformative change with Horizon Services, Inc. www.horizonservices.org
Horizon Treatment Services
Ep 02 - Measuring Treatment Success: The Science Behind Recovery
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A mother's desperate search for effective addiction treatment ignited a revolution in how we measure recovery success. Joanna Conti founded Vista Research Group after discovering that despite the life-or-death stakes of addiction treatment, virtually no facilities were scientifically measuring their effectiveness. Today, her company has tracked over 80,000 patients, revealing crucial insights about what truly works in recovery.
The data paints a clear picture: patients completing recommended treatment achieve 41% recovery success versus just 25% for those who don't. Treatment duration matters enormously - those staying 90+ days have double the recovery rate of those leaving before 20 days. And perhaps most striking? Treatment center effectiveness varies dramatically, with the best facilities helping over half their patients maintain recovery while the worst help fewer than one in five.
Through real-time feedback systems, clinicians gain insights patients might never share face-to-face. As one therapist discovered, showing a discouraged client her dramatically improved depression scores provided the confidence boost she needed to embrace her recovery journey. For treatment teams, aggregated data identifies program strengths and opportunities for improvement while validating their challenging work.
The research has identified ten key factors affecting recovery outcomes: treatment completion, duration, facility effectiveness, substance type (alcohol shows highest success rates), post-treatment behaviors (support groups, sober living), initial motivation, smoking status (non-smokers fare better), PTSD symptom levels at discharge, and number of previous treatment attempts.
Horizon Treatment Services is pioneering this approach at their Cronin House residential program, embracing measurement-based care to enhance treatment effectiveness. By collecting standardized assessments throughout treatment and following up after discharge, they're gaining invaluable insights to provide more personalized, responsive care while demonstrating their commitment to science-based approaches.
Ready to learn more about evidence-based addiction treatment? Visit www.horizonservices.org or connect with us on social media to discover how measurement-based care is transforming recovery outcomes.
A Mother's Journey into Addiction Treatment
Speaker 1Horizon Treatment Services inspiring hope and healing. Since 1976. I had a daughter who was a serious alcoholic and I was thrown into this world that I knew nothing about. It was impossible to find a treatment center that was scientifically measuring its effectiveness. I was forced repeatedly over the next six years to choose where to send her for treatment on the basis of how nice someone was on the phone, rather than being positive that this was a treatment center that you know was doing effective treatment. I thought there has to be a better way for the families coming behind us to find the treatment centers that are really providing effective treatment.
Speaker 2We are always looking for ways to enhance the experience of, and positive long-term outcomes for, our clients and, in this spirit, we're currently partnering with Vista Research and piloting a program at our men's Bay Area residential program in Hayward, california, cronenhaus. Measurement-based care is the practice of basing clinical care on client data collected during treatment. Today, to tell us more about it, I'm thrilled to interview Joanna Conte, founder, ceo and president of Vista Research. Let's get right into it Today to tell us more about it. I'm thrilled to interview Joanna Conte, founder, ceo and president of Vista Research. Let's get right into it.
Speaker 1Take it away, joanna Well thank you so much, jen, for inviting me. My name is Joanna Conte and I'm the founder and CEO of both Vista Research Group, which is a research company that does research for addiction treatment and behavioral health care programs, and also the founder, with my daughter, of a nonprofit Conquer Addiction, where we're trying to help families and individuals struggling with addiction to find effective treatment and to increase the likelihood they can recover. I had a daughter who was a serious alcoholic At 20, she started. I realized she actually started earlier than that, but I realized that she was drinking day after day to potentially lethal levels, and after multiple car accidents, including being airlifted to shock trauma and stuff, I realized I absolutely had to find treatment for her immediately, and I was thrown into this world that I knew nothing about. It was impossible to find a treatment center that was scientifically measuring its effectiveness, and so, instead of being able to do some research to determine where were the most effective treatment centers for someone like my daughter, I was forced repeatedly over the next six years to choose where to send her for treatment on the basis of how nice someone was on the phone, rather than being positive that this was a treatment center that you know was doing effective treatment.
Speaker 1Now, we were incredibly lucky and we always found effective treatment and, as a result, my daughter has been in recovery now for over 10 years and is, you know, completely turned her life around, has a way exactly as a fascinating career.
Speaker 1As three darling little girls, the youngest of which is only 11 weeks old, I mean, we've been incredibly blessed. But if you'd asked me 10 years ago if this is what my daughter's future would look like, it would have been impossible to believe, because I was terrified every time the phone rang that someone was going to tell me she had died. So when she was on the path to recovery, I thought there has to be a better way for the families coming behind us to find the treatment centers that are really providing effective treatment. So, as a side project I was running a different company at the time I decided to create a website where families searching for treatment could put in what they were looking for. It needs to be in California, it needs to provide this type of care, it needs to take this type of insurance and so forth, and they would see a list of treatment centers, with those with the best scientifically measured outcomes at the top of the list. So I created this website in 2015.
Speaker 3Just as a little side project. Huh, Just as a little side project, you get all this Wow.
Birth of Vista Research Group
Speaker 1It was a way to give back to the industry that saved my daughter's life and other families coming behind us to find effective treatment for their children and spouses and family members. I created this website and discovered there were five treatment centers in the entire US who were tracking their outcomes in any kind of scientific fashion and willing to share the results with us, five out of thousands of addiction treatment centers.
Speaker 1And so at that point I almost gave up. And then I thought, you know, I'm just a teensy bit stubborn Thank goodness Thank goodness, as my family would tell you. And instead I decided to start talking to treatment center owners and I said I don't understand it. Why on earth aren't you tracking your outcomes? Because you're providing healthcare. And enough of them said you know, I want to, I just don't know how to do this. That I thought, all right, well, maybe I'll take the next step.
Speaker 1And I have an incredibly odd background. Among other things, I'm a chemical engineer by training, I've started international nonprofits, I've run for Congress, of all things. And somewhere along the line I had taught myself how to program and spent five years running a software company so I could figure out how could you cost effectively monitor the outcomes for treatment centers. And I said this is a rocket science. And again, as a side project, I was running a different company. I said, well, I'm science.
Speaker 1And again as a side project, I was running a different company. I said, well, I'm going to start Vista Research Group to provide this service to addiction treatment centers and the patients who rely on them and shortly after I started doing the research for this, I was digging into all of the research about addiction treatment and I discovered the data that showed that if you monitor how patients are doing during treatment and report those results to their clinicians, that patients get better faster. Dr Ingrid Carlier had done analysis of 45 different mental health clinical trials and she discovered that among those trials that where the counselors had access to data directly from the patients about how they were feeling, that those patients got better faster in 65% of the cases, including all three of the addiction treatment studies.
Speaker 1So I said you know this really is important and we need to add this to what we're providing to our addiction treatment clients. So we've now been monitoring since March of 2016, patients both during treatment and following up with afterwards. We've monitored over 80,000 patients in addiction treatment and we followed up with about a third of those during the post-treatment year and we've learned a lot.
Measurement-Based Care in Addiction Treatment
Speaker 3And thank goodness you had all those experiences, because this is really important work that you're doing. So in all of the research and in all of the folks that you've tracked, have you found that there's anything specific, any factors in particular that assist one's long-term success, their outcomes?
Speaker 1Yes, there's quite a number of them. We've identified at least 10 that have a big impact on how likely a patient is to recover and again, these aren't necessarily surprising. But what's interesting is now we've got hard data proving that One of the most important factors is did the patient successfully complete all recommended treatment? Among patients that did not complete all recommended treatment, only about 25% of them are going to be meeting their recovery goals one year later. Among those that did successfully complete treatment, it's 41%. So successfully completing treatment makes a big difference. The second thing, very closely related, is the length of time that patients stay in treatment. So patients who remain in treatment for 90 days or longer have twice the likelihood of being in recovery one year later as those who are in treatment for 20 days or less. A third factor that makes a huge difference is the effectiveness of the treatment center that they attend. What we found is that, on average, about 36% of patients are in recovery one year later. 36% are meeting their drug and alcohol treatment goals. Whether most of our data is among centers that are proposing abstinence and they want us to measure their patients against, you know, were they using drugs or alcohol during the last 30 days at one year post-treatment. But we also have other clients that follow a harm reduction model where we allow their patients to set their own goals. You know, somebody who had been perhaps using meth for several years might say I don't want to use meth anymore. But you know, if I have a few beers or I smoke some pot, I will still consider treatment a success and we will measure their success against those goals. So anyway, on average about 36% of patients are meeting their recovery goals one year later.
Speaker 1But the difference between different rehabs varies all across the way. At the best rehabs, over 50% of those patients are doing well one year later. That's better than one out of two. At the worst rehabs, over 50% of those patients are doing well one year later. That's better than one out of two. At the worst rehabs, it's less than one out of five. So the effectiveness of the treatment center that you attend makes a huge difference. Some other factors that make a big difference are what substance you're in treatment for abusing. We have the highest success rates among patients who are in treatment for alcohol use disorder. We have the worst results among patients in treatment for heroin or cocaine use disorder. So there's a big variation.
Speaker 1Another thing that makes a big difference and there's kind of a couple of things here is the actions that patients take after treatment to help themselves remain in recovery. Patients who attend recovery support meetings on a regular basis do substantially better than patients that don't. So do patients who live in sober living for a while or have randomized drug or alcohol testing or part of an alumni program. So the actions the patient takes makes a big difference. Another thing that makes a big difference is how motivated the patient is to meet their goals at the start of treatment has a dramatic impact, as does whether they're a smoker. So patients who come into treatment as non-smokers are more likely to be meeting their recovery goals one year later than those that are light to heavy smokers. It looks like a direct correlation.
Speaker 1Another thing we've discovered makes a big difference is the level of PTSD symptoms that patients are still reporting having when they leave treatment. Interestingly, we don't see the same correlation with depression or anxiety, but if patients are still reporting a lot of issues with flashbacks or trouble sleeping or whatever as a result of their traumatic experiences, they're less likely to be in recovery. Let's see. The last one I'll talk about is the number of previous substance use disorder treatments. Last one I'll talk about is the number of previous substance use disorder treatments. There seems to be a slight advantage for patients coming into treatment the very first time. If it's the second or third time, their results are almost as good. But once somebody has been in treatment many, many times, the likelihood of success really falls off. So anyway, none of that is rocket science, but now we have hard data to confirm each of those factors.
Key Factors for Long-Term Recovery Success
Speaker 3Yeah, and, joanna, I'm really interested in some of what you said. If you don't mind, I've got a few questions myself with those. So, um, uh, you know, as you said, none of it is rocket science, but now we have some data Folks who complete their program have higher success than those who don't. And then you went on to say that in some of the I think you said better treatment centers there's 50%, I think that are successful. And you didn't say for a year, like a year long, after treatment, but you said within the last 30 days when checked in upon at a year. So we they may or may not have relapsed in the course of that year. We're just checking in a year. There's success in the last 30 days. Is that right?
Speaker 1Right, that is how we measure success, because addiction is a chronic disease and if somebody relapses at six months but they're able to get back on, you know, on the path to recovery and they're not using for at least 30 days at one year, we consider that a success.
Speaker 3Okay, great. So one of the things about the folks who stay in treatment and complete it and those who don't. I can tell you that one of the most challenging parts about working with folks suffering substance use disorder, and oftentimes co-occurring disorder, is retention in the program, and so any ideas or tips or tricks about retaining?
Speaker 1or tips or tricks about retaining. Yes, what we do with our clients is that we get a lot of information at the start of treatment about what brought a patient to treatment, what's their primary drug of choice, how long have they been using problematically, and so forth, and we also screen them for a variety of different co-occurring disorders like depression, anxiety, trauma. We screen them for suicidality, self-harm, eating disorders, etc. And then we also get a lot of quality of life information about the patients. You know, where are they living, are they working, how are they getting along with their family members, how's their health? And then throughout the time they're in treatment, we will ask them again about any of the co-occurring disorders that they were struggling with at the start of treatment. So we use academically validated scales like the PHQ-9 for depression, and we will. I'm sorry, just a second, excuse me. I had a pet that has been scratching on the door saying let me in. I hear you in there.
Speaker 3Yeah, I have some of those as well.
Speaker 1So we monitor the level of symptoms of the patient's co-occurring disorders that they're struggling with, and we monitor them throughout the time they're in treatment and report them immediately to their clinicians. So this is how measurement-based care makes such a difference is that, because we're asking, using standardized assessments, about patients' feelings, we're able to identify for the clinicians things that they are struggling with that might not be immediately apparent to the clinicians and that allows the clinicians to be a lot more productive in their treatment sessions, because they can actually see before the patient walks in. You know that, gosh, this patient is. A level of anxiety has just been climbing a great deal, or they're starting to think it would be easier to go to sleep and never wake up that sort of thing and so they can spend their therapy time with that patient really diving into the issues that are really affecting that patient.
Speaker 1We also provide a couple of open-ended questions where we ask the patient you know, how satisfied are you with treatment, or how well are you feeling like you're benefiting from the therapy that your clinician is providing? And after they give us, you know, a rating from you know I'm very satisfied to I'm not at all satisfied, we'll ask why and we report. Anything that the patients tell us to the clinicians is they feel they get a very different type of information from those comments than they often get face-to-face, that some people are just a lot more comfortable talking to the anonymous internet than they are face-to-face. And I can't tell you how many different times clinicians have told me that they learned things through the VISTA surveys that they were totally unaware of that changed the way that they were treating their patients.
Speaker 3Well, I like that because it's just a whole, nother source of information, Like it or not. Time is limited with each client. Even in the best situation. If you can get information from multiple sources, I think it's only going to round out the particular service being offered to the client, to the patient. So I appreciate that.
How PTSD Impacts Recovery Outcomes
Speaker 1And one of the questions that we ask, you know, I know that a lot of your patients are in treatment using medication like Suboxone or Buprenorphine or naltrexone or something, and one of the things we ask on every survey is how satisfied are you with the medication you're on? And you can see in the charts, because we report all the results to the clinicians in real time and you can see that this patient was feeling very satisfied with the Suboxone they were taking before, but all of a sudden it's really dropped and now they're thinking, gosh, I wish I wasn't taking anything at all, and that would be a perfect thing to bring up in the therapy discussion and say let's talk about what's going on. Would you rather try a different medication? Or, you know, are you sure you want to? You know, stop taking it, and so forth. So we're providing a lot of information that I think improves retention because it provides the opportunity for the clinician to know what's really going on in their patient's head.
Speaker 3Yeah, and I think that's valuable too, because an intervention of that sort at that point in time usually I would imagine that the satisfied measurement at the beginning is because the patient they start to feel better or more stable. It gets to that thought process of maybe I don't need this Exactly, and that is something I think that happens with psychiatric medication and these medications, medication-assisted treatment, because once you start to feel better then you're kind of like I really don't want to be dependent on something. But that's a wonderful opportunity, as you said, for the clinician to intervene and explain that, yes, right, and encourage them to, you know, consider maintenance or whatever. So that's wonderful. Thank you for sharing that.
Speaker 3I have two more questions in particular, if I might. One is going to be about how we are piloting this at Cronin House. I'm very excited to hear what you think about that, what kinds of benefits we can sort of look forward to and expect. But before we get to that, I also noticed that you said, in terms of co-occurring disorders, we have not as much poor results with depression and anxiety as with PTSD. I think you said the chances of long-term success were lower with those experiencing PTSD. Is that what you said?
Speaker 1If they, left treatment still experiencing a high level of PTSD symptoms. Yes, what we find is, you know, most people coming into treatment are reporting a fairly high level of depression, anxiety, trauma, suicidal thought. I mean. The whole process of entering treatment is a very, very difficult time, but what we find is that most people, shortly after they get into treatment, once they've settled in, you know the decision is made, they're safe, you know they're on a path. Usually, we see the levels of depression and anxiety really plummet pretty quickly, and that's true, you know, at all the treatment centers we work with. What I was saying, though, was that if somebody's level of trauma remains high throughout the time they're in treatment, and it's still high when they leave treatment, in those cases the success rate the long-term success rate, is lower, Whereas, interestingly, we didn't find the same correlation for depression and anxiety. So it was just very frankly surprising to me, Because we know a lot of people start taking medication to self-medicate.
Speaker 3Sure, sure, and while trauma is sort of in the body and long, lasting and so it takes, I think, some very intentional processing to sort of move through that, do you find that a lot of the folks who arrive with high levels of PTSD Are these folks from wars? Are these veterans? Are these folks from, you know, underserved neighborhoods and zip codes? What do you find is the correlation there and what are they returning to? Because that was another thing that you said is one of the factors. Are they able to return to a place of support and some stability and some safety, or are they returning to their zip code, which is not offering those?
Speaker 1things. I wish I had more information about the last question you asked. Up until the last year or so, most of VISTA's data has been from patients who are entering treatment with commercial insurance. We've had some patients, you know some centers that are Medicaid supported, but most of our research up to about a year ago has been among the commercially insured population. So I don't have as much information as I hope to have a year or two from now about the impact of economic status and safety and so forth from where people come from. And I'm sorry, what was the question? Again, I'm sorry, I got kind of distracted.
Speaker 3No, I think that's it. Ptsd is something you know, as we know can happen for war veterans, but it also is with the adverse childhood experience studies that have been happening in terms of health care and long-term health outcomes. We also know that substance use and one's propensity toward that is higher the higher their ACE score, which is just experiences of traumatic events before the age of 18. And so I was just curious that's a passion of mine and I was curious as to whether some of those that we're seeing having poorer outcomes, or folks maybe with higher ACE scores, and whether those were. You know where the population is derived, that's all. So you've answered it. I think you've answered it.
Speaker 1Yeah, we don't ask about the ACE. It would be interesting to do so, but I will say that you know you. One thing you asked was you know, are most of these people coming from wars? And no, you know, somebody who's been dealing with a serious substance use disorder has probably had some really traumatic experiences. A lot of the young women have been raped or sexually assaulted in other ways. Maybe a lot of the young men have had other issues. They've had to, you know, get their drugs in scary places and they found themselves in really unsafe situations and so forth. So we see a lot of a very high level of PTSD symptoms in a large number of patients coming into treatment.
Implementing Measurement at Cronin House
Speaker 3Many people who are using substances are using it to self-medicate. I believe that substance use just was more a result of seeking pain relief than seeking enjoyment. You know it starts off seeking pain relief. So well, thank you. Very interesting and very excited about this project that we have started with you at Cronin House in Hayward, california, one of our residential programs. Can you give me an idea of what kinds of things programs? How do they benefit? What have been some of the challenges or what have been some of the solutions found through the process of implementing them at residential programs? Sure, tell me the good stuff. Tell me the good stuff.
Speaker 1Good stuff. And I'll start with saying you know, we know that change is always hard. There's always a transition to a new tool, like using VISTA's outcomes research. What we find is that oftentimes there's one or two champions at a center and they will say, hey, I really want to see this, how this works. And then they will have a breakthrough moment, a ha-ha moment, where they learn something about one of their patients from the VISTA research that enables them to, you know, have some breakthrough and they'll start talking about it and other people will be like, oh my gosh, you know, I really, you know, I'm really going to focus on this more. And so typically over the next couple of months, I think what you'll see is that the clinician's getting more excited, more and more excited over time about the type of data that they're collecting.
Speaker 1You know, there might be some resistance from the patients at the beginning, but oftentimes what we'll see is, you know, a clinician will sometimes show the patient's dashboard to the patient and show them the progress they're making. Like, I remember, um. You know, one of our uh clinicians was saying that he'd had a woman in um treatment for three or four months who was ready to leave. You know it's time, time for her to leave. And she wasn't feeling ready. She's like I, you know, I just don't feel like I've overcome what I needed to. You know, I don't feel like I've gotten much better. And he showed her the dashboard that showed that she had come in with really high levels of depression and now they were way down. He said Look at all this hard work you've done. You have wonderful, a long way. And she's like you know, you're right, I am ready to do this. So you know, I think among the patient population to, you know, nobody likes filling out surveys, you know. So there might be some, you know, complaining at the beginning until somebody says, hey, you know, this is what happened as a result of using this outcomes research. And you know like I'm anxious now to really share how I'm feeling because it makes such a difference in the treatment that I'm provided. So probably, you know you're in a period of transition.
Speaker 1I think over the next couple of months you'll start seeing some tremendous benefits from using the research.
Speaker 1And the other thing is it's not just the research that you know that you can look at for each clinician which, as I said from Dr Carlier, has found that patients get better faster with that sort of feedback loop to the clinicians.
Speaker 1But we also enable your management team to look at all of this data they're collecting in aggregate and you can start to see maybe that satisfaction is going down in this area and you can look and see what type of comments people are making and maybe nip a problem in the bud.
Benefits for Clinicians and Patients
Speaker 1Or you can see that maybe one therapist is particularly good at treating people's anxiety and maybe that therapist could do some training for the other therapists and things like that. So I think you'll start to see a whole lot of benefits. And then, a year from now, when you start getting the post-treatment outcomes and you can see how many people are still doing well a year later as a result of the treatment that your team has provided and the type of comments they make On the six-month and one-year surveys, we ask them to tell us what really made a difference for them in their treatment and some of them will go on and on about how helpful their therapist was or this made such a difference. Or the folks at Cronin House to really get you know wonderful feedback about the very difficult work they're doing and to know that it's really appreciated and it really is making a difference in people's lives.
Speaker 3And I think that that is really valuable because oftentimes when we do this work, whether folks stay or stay the whole time, or whether they leave early we've often invested, you know, heart and relational energy and vulnerability and all of these things into an individual and we often don't know how it plays out to an individual, and we often don't know how it plays out, and so that the workers, the folks who do this work on the ground are. I did it years ago and I recall just not knowing if I was making an impact.
Speaker 3And so I think, like you said, having some of these charts and this data to be able to show folks, this is the progress that we're making as a program, that you're making as a clinician. This is how many people do you remember that one guy? Yeah, he's still sober, and look what he said.
Speaker 3You know, these are really, really important because we have to keep our patients inspired and hopeful for their tomorrow, and that is, in large part, by how inspired and hopeful the clinicians feel in doing this work, and so it's critical, I think, in this challenging work, for everybody involved to stay in a positive frame of mind, and getting this kind of insight, feedback loop is, I think, incredibly valuable. Yeah, and I'm you know I said it before we started, but I'll say it now, while we're recording. I want to thank you for doing this work. I'm so, so happy for your daughter and your family that she was able to find, you know a new, a new day, and and grateful that this work is no doubt helping others to do the same.
Closing Thoughts and Gratitude
Speaker 1I feel very honored to be able to work with people around the country who are just doing incredible work helping people recover from their addictions. It's very, very hard work. I mean, I remember I could never be a clinician I just wanted to strangle my daughter at so many different points. Yeah, we're just. It's really exciting to be partnering with people who are making such a difference in people's lives across the country people's lives across the country.
Speaker 2Please visit our website to learn more and to connect with us on social media. Our website is wwwhorizonservicesorg. Horizon Treatment Services, inspiring hope and healing since 1976.