Shutting the Revolving Door

Eating disorder treatment isn't the only case of a revolving door- it exists for addiction treatment, too. Although I don't honestly think an eating disorder is an addiction in the strictest sense of the word (you can live without heroin, you can live without blackjack, but ya gotta eat), there are similarities too poignant to ignore. Both illnesses are relatively poorly understood. Both illnesses ruin lives when they don't outright kill or maim. And both illnesses desperately need more effective treatments.

In the New York Times today, an article from the ongoing series "The Evidence Gap" appeared called "Drug Rehabilitation or Revolving Door?" which looked at the dearth of evidence-based treatments for addictions.

Every year, state and federal governments spend more than $15 billion, and insurers at least $5 billion more, on substance-abuse treatment services for some four million people. That amount may soon increase sharply: last year, Congress passed the mental health parity law, which for the first time includes addiction treatment under a federal law requiring that insurers cover mental and physical ailments at equal levels.

Many clinics across the county have waiting lists, and researchers estimate that some 20 million Americans who could benefit from treatment do not get it.

Yet very few rehabilitation programs have the evidence to show that they are effective. The resort-and-spa private clinics generally do not allow outside researchers to verify their published success rates. The publicly supported programs spend their scarce resources on patient care, not costly studies.

And the field has no standard guidelines. Each program has its own philosophy; so, for that matter, do individual counselors. No one knows which approach is best for which patient, because these programs rarely if ever track clients closely after they graduate. Even Alcoholics Anonymous, the best known of all the substance-abuse programs, does not publish data on its participants’ success rate.

“What we have in this country is a washing-machine model of addiction treatment,” said A. Thomas McClellan, chief executive of the nonprofit Treatment Research Institute, based in Philadelphia. “You go to Shady Acres for 30 days, or to some clinic for 60 visits or 60 doses, whatever it is. And then you’re discharged and everyone’s crying and hugging and feeling proud — and you’re supposed to be cured.”

He added: “It doesn’t really matter if you’re a movie star going to some resort by the sea or a homeless person. The system doesn’t work well for what for many people is a chronic, recurring problem.”

And the same could be said for eating disorders. We need to know more about the cause so we can design better treatments. But we also need the treatments NOW, need to do the best with what we have, and not just to be "cost effective." Of course good treatment would ultimately cost-effective, but we shouldn't be looking for evidence based treatments just to save money. We need treatments that work in a RELIABLE and EASILY REPLICATED manner.

When practiced faithfully, evidence-based therapies give users their best chance to break a habit...“Our goal at CODA [a Portland, OR drug treatment program] is to create a system of care that uses evidence-based practices at just the right dose and just the right time,” Mr. Hartnett said. “As with many chronic diseases, figuring out dosage and timing are critical.”

A true statement if ever there was one. Note that this isn't the ONLY chance, just the BEST one.

This isn't to say throw the baby out with the bathwater, yet for a clinician to be told "The way you're doing things is wrong," might not be the easiest of pills to swallow.

"To complicate matters in Oregon, the state mandate has stirred a kind of culture clash 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."

Oregon's solution? One way to do that, 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...“We basically gave them a list of evidence-based practices and told them to pick the ones they wanted to use,” said Jack Kemp, former director of substance abuse services for Delaware, in an interview. “It was up to them to decide what to use.”

What a novel idea- and how wonderful it would be to see this applied to eating disorders.

I'm aware that I pasted large chunks of the original article in the post, but the whole thing is well worth a read. Please share your thoughts in the comments section.


A:) said...

I completely agree

We badly need research for adult treatment as well -- I don't know if hospital based treatment programs actually do anything but restore weight -- I have never been to residential but my last psychiatrist told me that many American residential programs are unregulated and relapse rates are high despite the "friendly" atmosphere

Is 60 days enough for someone with chronic or hard to treat AN? When do dependance issues arise to make treatment more harmful than helpful. How long do we keep people to rehabiltate them? What is effective and how do we determine this with small sample sizes in studies, poor control groups and high drop out rates. . .

Also, we have no defininitive diagnostic critera (strict vs loose depending on the study) or consensus on what relapse, recovery and remission actually is. . .

Big problems.


Carrie Arnold said...

Dang it, I posted a smashing comment and then the computer ate it.

Anyway, I totally agree with you.

And I hope you have a good holiday, my friend. Hang in there.

A:) said...

I would love to hear the smashing commment when you have time <3

Have a great holiday too Carrie. I hope one day I can stand where you are and truly enjoy the fesitivies.

For now, I endure and enjoy what I can.

Merry Christmas

Laura Collins said...

As usual, Carrie, you get to the heart of the matter. I really appreciate your pointing out the need for both urgency AND data.

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I'm a science writer, a jewelry design artist, a bookworm, a complete geek, and mom to a wonderful kitty. I am also recovering from a decade-plus battle with anorexia nervosa. I believe that complete recovery is possible, and that the first step along that path is full nutrition.

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nour·ish: (v); to sustain with food or nutriment; supply with what is necessary for life, health, and growth; to cherish, foster, keep alive; to strengthen, build up, or promote


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