At Wit's End: Note on Numbers

Part two of the introduction of At Wit's End.

A Note on Numbers

We will steer away from statistics as much as possible, because when it comes to dual disorders, statistics tend to obscure facts rather than clarify them. As professionals, we’re often asked a simple question by families: “What is this treatment center’s success rate?” Strange as it may seem, this is a devilishly difficult question to answer. Let’s take a look.

If the patient–your loved one—completes treatment and stays sober and symptom free for one year, we would call him a success in our review of the first year. But what if he has a slip after seven months? What if he only stays sober for three hundred sixty instead of three hundred sixty-five days? Is he a success? Most people would say, yes, of course. But it makes statistical analysis very difficult. At what point do we say that treatment has failed?

New tools like the Addiction Severity Index, or ASI, have been developed to help answer this question, but they are little comfort to families. After all, a spouse or parent is not just looking for a reduction in alcohol or drug use or a reduction in psychiatric symptoms. They want their loved one back. And that should be the goal of all treatment.

Our task is further complicated by the fact that quality treatment is somewhat like exercise equipment. The old saying is true: “It works if you work it.” Therapists have many ways to engage a patient in the treatment and recovery process, but there is no magic wand. At some point, the patient must engage in the process or even the best treatment will be fruitless. We wouldn’t say a home gym didn’t work because the owner never used it. In the same way, treatment isn’t necessarily defective if the patient doesn’t engage.

A little story illustrates the point. There was a great clinical supervisor at an inpatient treatment center who was also a recovering drug addict. He went through treatment many times before he finally began his recovery. He would often ask young counselors under his supervision, “Which one of my treatments do you think was successful?” They almost always answered, “The last one.” Then he would laugh and say, “No, they all worked, but it took every one of them to make a success out of me.”

Judging success in the treatment of concurrent conditions like addiction and bipolar disorder is like judging success in other chronic illnesses like diabetes. The patient has primary responsibility, in the end, for maintaining the ongoing program of recovery. That’s why patients who are involved in Twelve Step groups, outpatient group therapy, and other support systems are so much more likely to succeed, because they are not relying on themselves alone for the motivation to carry on, day in and day out. In this way, success may ultimately be judged by the patient’s ability to stay connected to such a group, so they can deal with setbacks as well as achievement.

As families and clinicians, we want to keep our eyes fixed on long-term solutions. These solutions always include a mix of different elements to address the complex problems we face. There are no magic bullets, but there is a way out of the wilderness. We will help to arm you with tools, knowledge, directions, and tips. Knowing the odds won’t help you, because for you and your family there are no statistics. There is only success or the determination to keep trying.