A great irony exists in the addiction treatment field: families of clients, who are often the most compliant and empowered entity in the recovery process are the most underserved. Understanding the benefits of maintaining contact with the family system and why its ongoing participation is an essential factor in achieving positive treatment outcomes is indispensable for provider success in the new health care paradigm.
I run an organization that provides services to thousands of clients in recovery and their families. Our company possesses a large repository of addiction treatment outcome data and we frequently interact with this data in order to better serve our clients. However, my profession aside, my greatest qualifier in understanding the deficiencies in the delivery of services to the family is based on my personal experiences.
I have been involved in putting loved ones in treatment more than a dozen times. I’ve seen them do well in recovery and I’ve seen them leave ASA (against staff advice) within a day or two of admission. I relate to the horrors that go through the mind of a family member of a using addict during sleepless nights lying in bed listening to the thump…thump…thump of high-pressured heartbeats emanating from the pillow. I have been really fearful, I have been really at peace and I have been totally indifferent to the whole recovery process.
What I have never experienced is being on the receiving end of meaningful service from my loved ones’ treatment providers. Should I have been? Yes, and here’s why: Addicts and alcoholics with family members actively engaged with treatment providers post-discharge have a 12 percent reduction in substance use events compared to patients with no family engagement . When distributed across a facility’s annual census, or the number of individuals treated in any given year, the volume is significant. Any phenomenon with the potential to reduce substance use events by 12 percent within the first year warrants serious review and considerable action.
An honest assessment of the family experience reveals that families are underserved from the moment they verify policy benefits with their insurance carrier. It continues long after their loved one has left treatment. In the high-stakes world of addiction treatment, missed opportunities are measured in lives lost and dollars spent. It is essential to identify junctures in the treatment process in which family members can be engaged and their involvement leveraged to improve outcomes.
Currently, insurance companies are not effective at delivering provider information to a family who inquires about substance abuse treatment benefits. Fortunately, this process has begun to evolve as some major payers realize that pairing clients, through suggestion, with outcomes-oriented providers proven to be best suited to treat their individual needs will result in a better outcome.
Astute insurance carriers understand it is the family system and often a single power within it that determines the treatment decisions for the client. While payers cannot, and should not, restrict the freedoms of choice, their ability to suggest providers who meet certain evidence-based thresholds for quality will have an influence on the way in which subscribers choose treatment providers. In the commercial world, payers are not a significant source of patient referrals. This situation will change as they effectively utilize provider networks and other patient management systems.
The majority of addicts and alcoholics who seek treatment do not facilitate their admission; rather family members such as mom, dad, a spouse or an adult child ensure an admission for their loved one. This opportunity is all-important for families to start playing a positive role from the onset of treatment; it is also when they are most likely to begin doing so. Providing quality healthcare for chronic diseases such as addiction requires systematic communication with the patient’s care coordinator.
The continuity of contact between treatment providers and family members can be the difference between knowing when a client is struggling and knowing nothing at all. If providers and families work effectively and execute a predetermined communication plan, a significant and positive result is achievable. When communication breakdown occurs and actionable information fails to reach the appropriate party, an enormous opportunity is missed.
Nothing erodes a treatment environment quite like a rash of patients leaving against staff advice. It is almost viral in nature and works its way through a census like an unchecked flu. The result is a cacophony of people walking out of treatment before they are ready; it’s tragic. Who is generally waiting on the curb to pick them up? None other than the family! What if a parent never arrived to take their son or daughter home? Imagine what could be gained if family members systematically attended a ‘What To Do Now That Your Loved One Is In Treatment’ session led by a skilled counselor – remotely if necessary – the day the client admitted to treatment. The cascade of patients leaving would stop or be greatly reduced.
It is natural for some patients to want to leave treatment, especially at the very beginning and toward the end of the episode. There is no eradicating what is usually fleeting emotions in many. What can be affected is the role the family plays in enabling their loved one to leave treatment without consequence. This involvement will give counselors precious time to help clients through fragile moments of doubt.
Further, 80.2 percent of clients with loved ones actively engaged with treatment providers post-discharge obtain 12-step program sponsors within their first year of recovery. Sixty-three and a half percent of clients who have no family engagement obtain a sponsor .
While this promising statistic requires additional research regarding causation, the numbers serve to reinforce substantive value in treatment providers maintaining contact with the family post-discharge. Additional data suggests that client discharge plan compliance is higher when families are involved in the recovery process. For example, 25.3 percent of clients with family actively engaged with treatment providers post-discharge sponsored others in their first year of recovery. Nine and a half percent of clients who have no family engagement sponsored others .
With a pattern suggesting a constellation of engaged family members, providers and clients result in better outcomes, clinicians are conducting research to understand the specific factors that underlie this information. It is fascinating to contemplate the evolution of family programs that emerge as a result.
The causes underpinning the family’s relevance to recovery are numerous, wide-ranging and warrant extensive examination. There are many variables in motion that contribute to the relationship between provider, client and family. If outcomes are not systematically and reliably tracked, understanding the complexity of who gets well and why is totally lost on the scientific and clinical realm of the addiction treatment field. The power to inform the clinical environment and treatment plans with this information is a revolution on the verge of beginning. While accumulating data shows how communication between family, provider and client render better results, we can focus on what we know now to be relevant and take action.
One key and actionable fact known with certainty through evaluating communication compliance data: the family is significantly more compliant than the client. Communication with clients post-discharge may ebb and flow; however, the family, and specifically the health care decision maker within the family system, tend to maintain a communication compliance rate of more than 90 percent throughout the first year.
Regardless of whether the client is doing well, families reliably answer the telephone. If they are trained to call and engage when significant events occur, they typically do so. The family may not always engage in recovery activities on their own and may lapse in and out of patterns of co-dependent behaviors; however, we know they will almost always speak to someone regarding their loved one’s status and care.
Additionally, through recognizing co-dependency within the family system in the post-discharge environment and understanding the negative impact these behaviors have on their loved one’s addiction, an opportunity exists to course correct the family and guide them to appropriate resources.
We must recognize the willingness of the family to play a communicative and active role and respond with action and service. Prevention and informed care coordination are fundamental tenets of the national health care strategy. If providers do not manage the process of care coordination for their discharged clients, someone else will. Patient charts and clinical information must flow seamlessly and follow the client in the event escalated care is required. This quality health care through responsive action is likely to enhance provider reimbursement and be a laudable factor in the pending pay-for-performance agreements.
Whether for future treatment episodes or for assistance in sourcing a therapist, providers who embrace the concept of care coordination for their discharged patients will position themselves to thrive. In the near future, providers will not successfully exist as a single silo or disconnected element of the patient’s care constellation.
The commercial reimbursement landscape is being designed to reward providers who are integrated, both through information and collaboration, across their patients’ continuum of care. Providers cannot effectively maximize the opportunity without a working relationship with the family. The provider must have frequent interaction, such as at least two times per month with the family for no less than the first year following discharge. How many facilities are accomplishing this today? Not enough. But many are waking up to the value proposition of actively maintaining these relationships. In time, economic factors will likely drive this direction of collaboration and accountability.
A society in which clients, family stakeholders and providers across the treatment continuum communicate to deliver the best-suited treatment services and improve outcomes is attainable. It takes providers assuming a leadership role and requires insurance companies to recognize the value in providers doing so.
I didn’t understand all of the dynamics at the time. But I now see that my personal experience as a family member engaged in an environment of support and continuing care would have been beneficial for my loved ones, their providers and the insurance company.
I could have played a more effective role in coordinating health care in a system that recognized my powerful role as a treatment service decision-maker. If that system had been in place then, I would still receive phone calls today. That is the system we must demand: a system that provides sustainable health to their loved one, validated success to treatment providers and lower risk to insurance companies.
When we work in unison toward a shared goal, achieving better outcomes will be our reality.
 Bagheri, A. and Meinke, T. (2015). Data from: Testing for unequal rates of sponsorship and use events in patients with and without family support. MAP Digital Repository, Document ID no. 8expbhzuxrl1rhgl2xpb942kq7hfgk40