Monitoring Therapy is Underutilized in SUD Treatment

Sep 28, 2022 at 12:00 pm by steve

Liz S. Read

By Liz S. Read

There is no debate that recovery from a Substance Use Disorder (SUD) is not a one size fits all. If defining successful recovery by sustained abstinence from substances of concern and the ability to return to work, research points to Physician Health Programs as the most successful. These programs, designed for physicians and nurses, similar to those for pilots and lawyers, are not perfect. Every program has its challenges. Yet these programs yield more favorable outcomes than other treatment options for the average American with 78.7 percent of their participants returning to work and maintaining their license and only a 19.3 percent rate of recidivism1.

A close look at these programs reveals critical components deemed most beneficial to include: “signing a formal PHP monitoring agreement, participation in the PHP, formal SUD treatment and attending 12 step meetings,” for up to five years2. PHP monitoring includes drug testing, which ranked higher by participants than individual counseling and therapy in beneficial requirements. The people in these programs are randomly drug screened during this time. These programs are effective because the participant has to satisfy the requirements in order to keep their medical license. Whether motivated or mandated for safety measures, the majority of people who participate get well along the way. “The vast majority (89 percent) of participants reported completing the SUD contract without any relapse during monitoring, and about 10 percent reported only one relapse.3What if American families could have this type of success?

Each of the critical components listed above is effective on its own. Sometimes. When combined, the synergistic effect in undeniable. Obviously formal SUD treatment is essential to address trauma and mental health. Anyone fortunate enough to get treatment starts here after detoxification, but it is typically not enough. Would treating hypertension for 30 to 90 days be enough? Attending 12 step meetings, in surveys, ranks high and is extremely accessible. Then the question arises: would these programs work without long-term monitoring, which is less available to the SUD patient pool unless participating in a PHP or like program? The typical SUD patient may only drug screen while in treatment where risk of reuse is minimal. Though continued therapy and recovery meetings are recommended upon discharge, monitoring via drug screen is not. Re-integration is where the true work begins and the real challenges arise. Physicians have the extended safety net of long-term accountability during their re-integration which is missing for the rest of the recovery population.

Perhaps monitoring is underutilized in long term SUD treatment and aftercare due to the historically punitive and demoralizing nature and expense. Consider that monitoring is vital for a patient with hypertension or Type II Diabetes. While every effort is made to uncover and treat the cause, monitoring is a necessity in ongoing treatment to understand if the patient is on track or nearing a life-threatening event. Uncovering a high A1c indicates there is work to do, a change in lifestyle, medication.

The goal of formal SUD treatment is to go beyond detoxification to addressing the trauma, the co-occurring disorder, the root cause. Why wouldn’t monitoring as a tool to track progress and uncover re-use allowing for timely intervention be standard procedure? Perhaps in some cases, it is not re-use but the frequency or amount of use that requires monitoring? Seeing these factors diminish over time indicates the approach at hand is working, rather than playing a game of wait and see. This is not acceptable with other medical conditions. Monitoring success can also rebuild trust and relationships which is a proven key in long term sobriety.

Monitoring can be empowering to those with a Substance Use Disorder who are recovering and rebuilding and returning to life. What if it were to become more accessible, convenient, and affordable? No one likes sticking their finger, but glucose monitoring continues to evolve becoming more affordable and accessible as a critical component of diabetes management, reducing “diabetes-related morbidity and all-cause mortality in type 2 diabetes”4. It is time to explore monitoring as routine therapy in tandem with clinical counseling post-SUD treatment and in long-term recovery, just as monitoring is used in other chronic conditions.

Mental health is as vital as physical health. It is time for change and, in the wake of post-pandemic, epic substance use, we must reconsider the tools we use and how we use them.

Liz S. Read, founder and CEO of ClearMINDnow

  1. McLellan A T, Skipper G S, Campbell M, DuPont R L. Five year outcomes in a cohort study of physicians treated for substance use disorders in the United StatesBMJ 2008; 337: a2038 doi:10.1136/bmj.a2038
  2. Merlo, LJ, Campbell, MD, Shea, C, et al. Essential components of physician health program monitoring for substance use disorder: A survey of participants 5 years post successful program completion. Am J Addict. 2022; 31: 115- 122. doi:10.1111/ajad.13257
  3. Dupont, Robert L., Merlo, Lisa J. Physician Health Programs: A Model for Treating Substance Use Disorders. The Judges Journal, Vol. 57 No.1. 2018.
  4. Martin S, Schneider B, Heinemann L, et al. Self-monitoring of blood glucose in type 2 diabetes and long-term outcome: an epidemiological cohort study. Diabetologia. 2006;49:271-278. [PubMed] [Google Scholar] [Ref list]




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