Treatment dose

dose-responseFrom Bill White’s Recovery Management monograph:

The best single predictor of post-treatment outcome across all modalities is length of time in treatment. There is a dose effect of both treatment and recovery mutual aid participation, with recovery outcomes improving as dose increases.

. . .

Treatment duration in methadone and non-methadone treatment units has declined nationally in the past decade.Clients with shorter lengths of stay have poorer rates of post-treatment abstinence and higher treatment readmission rates.In a recent interview, Dr. Douglas Anglin, a pioneer in the study of “addiction careers,” lamented the lost understanding of the importance of treatment dose.

It has been very disappointing in recent decades to see both in-patient and out-patient services stripped down to what I consider clearly sub-threshold levels for many chronic drug problems; currently, such programs are typically capable of producing only a short-term blip in behavior and personal recovery trajectories.

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2 responses to “Treatment dose

  1. Philip Gilly

    I agree that the dose-response curve in the field of substance abuse is S-shaped rather than linear.
    That means that even with effective treatment, the patient may not demonstrate much of a response in the early going. The “dose” of each patient’s treatment will need to accumulate until they reach a “threshold” after which there will be a measurable “response.”
    Continuing to increase treatment will then result in increased results, but only up to a point, after which continued treatment is necessary to maintain the current level of results. It could be inferred that reduction of treatment at this point will lead to a decrease in response back towards the null state.
    The “dose” of treatment could be measured in length of time or intensity of service or both.
    The “response” could be measured in terms of abstinence or harm reduction or both.
    The “threshold” will obviously be different for each person, and even will be different for the same person in different situations or phases of their life.
    Therefore, arbitrary and fixed courses of treatment based on diagnosis or specific criteria will not seem to be effective if they do not reach that patient’s “threshold.” The patient will return to their zero baseline in between episodes of care, so there will not be an additive effect. This would argue against terminating a patient from treatment simply because they do not seem to be making much progress, as they may not yet have reached their threshold for response.
    Consequently, one single continuous episode of care that is sustained until the patient reaches their threshold and begins to show response will be more successful than multiple non-continuous episodes of care that reach halfway to the threshold, because the patient will regress in between treatments.
    The question has been asked why professionals receiving substance abuse treatment seem to have a better success rate than non-professionals. It may be because a profession person tends to stay in treatment continuously until they achieve the desired response and are able to maintain it. Many non-professional patients attend treatment for just as long if not longer total periods of time and intensity, but if these are separate discrete episodes spread out over time they will not have the same cumulative effect as the person attending treatment continuously.
    In conclusion, it may well be that a more important determinant of success in recovery is the continuity of care the person receives, rather than the type, location or intensity of that care.