Edward Hill PhD2, David M. Grey1,2, Matthew A. Torrington, MD2,3,
Jonathan James2, Rich Deschaine1, Johnny Courreges1,
1 A.B.C. Recovery Center, Inc.
2 HandHeld Monitoring LLC
3 Matthew Torrington MD Addiction Medicine
Abstract
The A.B.C. Recovery Inc. outpatient (OT, IOT, & PHP) program reached a cumulative treatment completion rate of 71.3% with median Length of Stay (LOS) of 86.2 days over the last year using HandHeld Monitoring’s evidence-based compliance and emotion state monitoring system. This is a 14.2% completion rate increase and 55% LOS increase over the 1-year period prior to HandHeld Monitoring installation (July 2017 – July 2018) with completion rate 57.1% and LOS 55.6 days. This exceeds the SAMHSA TEDS-D 2019 outpatient average rate of 42.4% with median LOS 54 days by 28.9% and 57.9% respectively.
HandHeld Monitoring augments professional treatment to improve client recovery outcomes through evidence-based compliance and emotional state monitoring. The goal is to detect a relapse before it happens and notify professionals so they can intervene. HandHeld Monitoring is Medi-Cal admissible.
Keywords: addiction, treatment, success, completion rate, relapse
A.B.C. Recovery Center Inc. Outpatient Treatment completion rate reaches 71% with median Length of Stay of 86 days
A.B.C. Recovery Center, Inc. is licensed and certified by the California Department of Drug and Alcohol Rehab Programs and funded by Medi-Cal. A.B.C. Recovery Center, Inc. help many to overcome their battle with drug and alcohol abuse using a blend of holistic and traditional approaches across ten programs. “We continuously improve our programs to maximize the probability of our clients’ achieving lifelong sobriety and re-entering the community as healthy and responsible individuals.”
Many factors affect addiction recovery including the client’s substance abuse profile, mental health profile, and quality of treatment. Treatment for drug abuse and addiction is delivered in many different settings using a variety of behavioral and pharmacological approaches. (NIDA, 2020). Two universally accepted metrics to compare treatment success is treatment completion rate and Length of Stay (LOS) reported annually in the Substance Abuse and Mental Health Services Administration (SAMHSA) Treatment Episode Data Set: Discharges (TEDS-D, 2021; table 1).
A.B.C. Recovery Center, Inc.’s Outpatient program consists of Outpatient Treatment (OT), Intensive Outpatient Treatment (IOT), and Partial Hospitalization Program (PHP). Clients are urine tested 8 times per month and supervised by experienced councilors. Over the last three years, clients have been monitored by the HandHeld Monitoring evidence-based compliance and emotion state monitoring system.
To equivalently compare A.B.C. Recover Inc.’s Outpatient discharge data to TEDS-D 2019 statistics (TEDS-D, 2021; table 1), we compare the range of the last 12 months (August 2020 to August 2021) with the HandHeld Monitoring, and 12 months (July 2017- July 2018) prior to HandHeld Monitoring installation. The A.B.C. Recovery Inc. Outpatient program has reached a cumulative treatment completion rate of 71.3% with a median Length of Stay (LOS) of 86.2 days over the last year. This is a 14.2% completion rate increase and 55% LOS increase over the 1-year period prior to HandHeld Monitoring installation (July 2017 – July 2018) with completion rate 57.1% and LOS 55.6 days. This exceeds the SAMHSA TEDS-D 2019 outpatient average rate of 42.4% with a median LOS 55 days by 28.9% and 57.9% respectively.
“Relapses have dropped dramatically since we adopted HandHeld Monitoring.”, says Johnny Courreges, A.B.C. Recovery Inc. Sober Living and Transitional Living manager, “Clients are more accountable to program compliance. We can monitor our clients more closely and evade relapses when there is a hint of trouble. The system sends us text notifications including missed emotion check-in, emotional distress, and missed collection. Daily medication compliance, test compliance statistics, and upcoming test schedules let me quickly see how all our clients are doing. I can also broadcast text messages to my clients anytime.”
Figure 3- A.B.C. Recovery Inc. Outpatient Treatment complete rate Cumulative moving average from August 2020 to August 2021, reaching 71.3%
Figure 4- A.B.C. Recovery Inc. Outpatient Length of Stay Cumulative moving average from August 2020 to August 2021, reaching 86.2 days
A.B.C. Recovery Inc.’s Outpatient program performance from August 2018 to August 2021 with HandHeld Monitoring
244 clients have been discharged over the last 3-year period from August 2018 to August 2021. 154 clients (63%) successfully completed treatment, 19 clients (8%) left against professional advice, 63 clients (26%) were terminated by the facility, and 8 clients (3%) were Transferred to another program. The Length of Stay for a successful program completion is 120 days, with and extension to 150 days in special cases.
Figure 5 - Completion rates by Month. The dotted red line is the exponential moving average which shows a definite upward trend of the last 3-year period
Figure 6 The red line is the linear regression of Completion rates by Month for the last 3-year period. The slope is 0.8% upwards per month
Figure 7- Length of Stay for 244 Discharges over last 3 years. The dotted red line is the exponential moving average which shows a definite upward trend of the last 3-year period
Figure 8- The red line is the linear regression of Length of Stay for all Discharges over the last 3-year period. The slope is 0.177 days increase per client discharge
HandHeld Monitoring compliance and emotional state monitoring
HandHeld Monitoring augments professional treatment to improve client recovery outcomes through evidence-based compliance and emotional state monitoring. The goal is to detect a relapse before it happens and notify professionals so they can intervene.
Clients check in daily via voice, smartphone or web browser and provide key indicators on their emotional and recovery health to support cognitive and behavioral professional treatment strategies. In the US, "Obama phones" are available for those without a phone (250 voice minutes - no data). In this case, clients call into HandHeld Monitoring, and an interactive voice interface guides them through the daily check-in. We analyze emotion in speech to get better emotional data than just self-report.
To ensure abstinence or medication compliance, the HandHeld Monitoring automated system randomly selects a client for drug and alcohol testing. The client is notified when they check-in. The Treatment center’s Nursing station then collects the sample, and updates HandHeld Monitoring. Professionals are notified via text if a client misses a collection, or tests positive for drugs. For treatment centers and other clients who do not have a nursing station, HandHeld Monitoring provides a fully automated service through LabCorp.
HandHeld Monitoring provides notification, statistics, and visualization tools to quickly assess a client’s status and analyze recovery trends over time. A client’s support group (e.g., court appointees, social workers, treatment center caseworkers, psychologists, medical doctors, concerned individuals like a mother) login to their dashboard to review status and historical trends, and receive text or email notifications in real-time when anomalies occur that could require crisis intervention such as a failed drug test, missed check-in (could indicate relapse or isolation), or negative emotional health or recovery health indicators
Emotions and Mood disorders
Mood disorders (inappropriate, exaggerated, or limited range of feelings) and anxiety (stress, panic, agoraphobia, obsessive-compulsive, phobias) are directly associated with substance abuse (E Hill et al, 2013; E Hill, 2014).
Scott et al. concluded that most chemically dependent individuals have difficulty to identify their feelings and expressing them effectively. However, Scott et al. points out that they can change their responses to their emotions as they are better able to understand and tolerate their emotions (Scott et al, 2001).
Wurmser coined the term “concretization” as the inability to identify and express emotions – a condition that often goes hand-in-hand with compulsive drug use. Wurmser further stated that it is as if these individuals have no language for their emotions of their inner life; they are unable to find pleasure in every-day life because they lack the inner resources to create pleasure (Wurmser et al, 1974).
Dodge concluded that higher depressive symptom scores significantly predicted and decreased the likelihood of abstinence after discharge from treatment centers, regardless of type of substance abuse, the frequency of substance use, or length of stay in treatment. Dodge further stated that treating the depressive symptoms could enhance outcomes in substance-abuse treatment (Dodge, 2005).
Lyubomrsky et al. determined that frequent positive affect as a hallmark of happiness has strong empirical support. Whereas the intensity of emotions was a weak indicator of self-reports of happiness, a reliable indicator was the amount of time that people felt positive emotions relative to negative emotions. High levels of happiness are reported by people who have predominantly positive affect, 80% or more of the time. There might be a connection between positive emotions and willpower, and the ability to gain control over unhealthy urges and addictions (Lyubomrsky et al, 2005)
Tugade et al. determined that the anecdotal wisdom, that positive emotions are beneficial for health is substantially supported by empirical evidence. Those who used greater proportion of positive rather than negative emotional words showed greater positive morale and less depressed mood (Tugade et al. 2004).
References
NIDA. 2020, July 22. Drug Addiction Treatment in the United States. Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/drug-addiction-treatment-in-united-states on 2021, August 24
TEDS-D, 2021. Substance Abuse and Mental Health Services Administration, Treatment Episode Data Set (TEDS) Discharges, 2019. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021.
Abuse, S. 2020. Key substance use and mental health indicators in the United States: Results from the 2019 National Survey on Drug Use and Health (HHS Publication No. PEP20-07-01-001, NSDUH Series H-55).
TEDS-D tables 2021. Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. Treatment Episode Data Set (TEDS): 2019. Admissions to and Discharges from Publicly Funded Substance Use Treatment. Rockville, MD: Substance Abuse and Mental Health Services Administration, 2021.
Hill, Edward, David Han, Pierre Dumouchel, Najim Dehak, Thomas Quatieri, Charles Moehs, Marlene Oscar-Berman, John Giordano, Thomas Simpatico, and Kenneth Blum. "Long term Suboxone™ emotional reactivity as measured by automatic detection in speech." PLoS One 8, no. 7 (2013): e69043.
Hill, E. A. (2014). An evidence-based toolset to capture, measure, analyze & assess emotional health (Doctoral dissertation, École de technologie supérieure).
Grant BF, Stinson FS, Dawson DA, Chou SP, Dufour MC (2004) Prevalence co-occurrence of substance use disorders and independent mood and anxiety disorders. Results from the National Epidemiologic Survey on Alcohol and Related Conditions. Archives of General Psychiatry 61(8): 807–816.
Scott RL, Coombs RH (2001) Affect-Regulation Coping-Skills Training: Managing Mood Without Drugs, In: R.H. Coombs, editor. Addiction Recovery Tools: A Practical Handbook. 191–206.
Wurmser L (1974) Psychoanalytic considerations of the etiology of compulsive drug use. Journal of the American Psychoanalytic Association 22(4): 820–843.
Dodge R (2005) The role of depression symptoms in predicting drug abstinence in outpatient substance abuse treatment. Journal of Substance Abuse Treatment 28: 189–196.
Lyubomrsky SKL, Diener E (2005) The Benefits of frequent positive affect: Does happiness lead to success? The American Psychologist: Psychological Bulletin 131(6): 803–855.
Tugade MM, Fredrickson BL, Barret LF (2004) Psychological resilience and positive emotional granularity: Examining the benefits of positive emotions on coping and health. Journal of personality 72(6): 1161–1190.
Tables and Figures
Table 1
Table 9.1 Page 326 (TEDS-D tables 2021)
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Author Notes
Edward Hill https://scholar.google.com/citations?user=BH1cDt8AAAAJ&hl=en
Correspondence concerning treatment and A.B.C. Recovery Inc. in this article should be addressed to A.B.C. Recovery Inc., 44374 Palm St, Indio, CA 92201
Email: info@abcrecoverycenter.org
To upgrade your treatment center with HandHeld Monitoring contact:
Handheld Monitoring LLC, 74-967 Sheryl Ave. Palm Desert, CA, 92260
Email: support@handheldmonitoring.com
