Evidence-Based Care for Substance Use Disorders: Year 1 Outcomes

After a year of providing evidence-based counseling and case management services to people with substance use disorders and co-occurring mental disorders in the New River Valley and Roanoke Valley of Virginia, I wanted to share my outcome data with you.

For context, to protect clients’ privacy, I have a direct-pay private practice. I currently limit my caseload to 20 clients. My results are reported from a case study level, not a research data level. There was no random selection and no control group. Data analysis is limited by the reports offered by my electronic health record, analysis by hand rather than with software, and by my limited human power to follow up with clients after termination. Enrollment is open and data is based on clinical observations and client self-reports. I count all clients who enroll, not just those who continue.

Since the defining symptom of substance use disorder is persistence in use despite negative consequences, my primary criterion for measuring treatment success is the absence of negative consequences. Conducting urine drug screens can cause harm, toxicology reports are frequently false – even up to 20% – and performing them as a counselor may constitute violation of the American Counseling Association’s Code of Ethics. For those taking medication for opioid use disorder, urine drug screens are not associated with health outcomes. I do not perform urine drug screens.

From October 1, 2018 through October 1, 2019, I enrolled 56 clients.

  • 7% no-showed for the first appointment. In addiction treatment settings, the no-show rate can range from 29% to 42%. (Molfenter, 2013)
  • 20% did not return for a second appointment. In addiction treatment settings, rates for not returning for a second appointment can range from 15% to 50%. (Molfenter, 2013)
  • 73% attended from 2 to 150 individual, group, partner, and/or family sessions.
  • Of the 73% who continued in treatment, 72% have experienced no additional negative legal, employment, educational, and/or health consequences since beginning receipt of evidence-based treatment.
  • Of the 73% who continued in treatment, 34% enrolled in Cognitive Processing Therapy (CPT) for relief from trauma symptoms. 70% of people with substance use disorders have experienced trauma. ((Khoury, 2010) I am trained in CPT, a protocol for PTSD recommended by the American Psychological Association and the Veterans Administration.
  • 67% of the clients with severe substance use disorders who opted to – rather than attend residential treatment – remain in situ and engage in the trio of recommended evidence-based treatment protocols -1) medical care, 2) counseling with cognitive behavior therapy, motivational interviewing, and contingency management, and 3) social support – have been in remission for 6 months or more. Return to active use rates after exiting rehab can be 70% or more.

I welcome speaking with groups or organizations about this work. If I can be of service to you in anyway, please do not hesitate to contact me.

The views expressed are mine alone and do not necessarily reflect the positions of my colleagues, clients, family members, or friends. This content is for informational purposes only and is not a substitute for medical or professional advice. Consult a qualified health care professional for personalized medical and professional advice.