Improve Tracking of Recovery Progress

Introductory paragraph

Tracking progress in mental health recovery is essential because it allows us to gauge how far we’ve come, what we’ve become stronger in, what we’ve learned so far, what we can and should zero in on next, and how we can help others with the tools that we’ve learned. The U.S. Department of Health and Human Services outlines four components to recovery: health, home, purpose, and community.

• Health involves making informed decisions to promote one’s health and well-being.
• Home requires one to have a stable and safe place to live.
• Purpose gives us fulfillment in daily activities, work, school, volunteering, caring for our family, and being creative; it gives us the independence, income, and resources to effectively participate in society.
• Community allows us to build relationships and support with others to whom we can rely on.

Progress tracking is a tool used by mental health practitioners that, “measures, monitors, and provides feedback,” to allow for real-time treatment responses and adjustments to be made. The success of progress monitoring in mental illness, especially when a specific illness is targeted, is well documented and shown to be a beneficial tool that allows efficient, treatment-paced monitoring and evaluation of the treatment efficacy. While there isn’t a significant amount of literature on its use in substance-abuse treatment, the few studies done on its use with SUDs have shown similar rates of positive patient outcomes. It allows both the therapists and the client to monitor and adjust treatment in the interim, rather than waiting to view results at the end, ensuring that treatment is patient-focused and individualized. With documented results in mental health treatment and promising outcomes for substance use. Improving and implementing recovery tracking should be a key component of treatment in a population with relapse risk as high as 85% within the first year.

Key Information

Relevance of Progress Tracking

Much of SUD progress tracking has solely revolved around treatment attendance and urine testing. Since metrics are compared to group data, this often fails to address individual progress outcomes beyond the scope of continued drug use. Goodman, McKay, and DePhilippis (2013) report in their study that, while progress monitoring should be standard practice, only about 37% of therapists use any form of tracking. Further, they report that there is evidence of frequent inaccuracies in tracking and unrecognized deterioration of treatment. The importance of effective progress tracking for patients with SUDs lies in the ability to recognize ineffective aspects of the treatment and to adjust accordingly during active treatment. This ensures that the patient is receiving care that is matched to their situation. The use of scales in progress tracking allows the practitioner to maintain focus on both the individual and the symptoms. This aligns with the NASW ethical principles of commitment to the client, their autonomy, and treatment competency .

Promotion/Implementation of Progress Tracking

Current research and recommendations can be used by clinicians to lobby for available progress monitoring tools, conduction of further studies, and encouragement for the use of innovative tools that are cost-effective and user-friendly. Practices, whether private or public, should advocate for the use of (and ongoing training in) progress monitoring tools as an active component of treatment programs.

Considerations: Comorbidity of Mental Illness and Substance Abuse

Substance Use Disorder is a recognized mental health disorder and has a high rate of comorbidity with other mental illnesses, especially with anxiety, PTSD, depression, panic disorder, and bipolar disorder . For successful progress monitoring to occur, clinicians must recognize and address diagnosed and potential comorbidity.

Relevant Research

• The Canadian Psychological Association published a report titled “Outcomes and Progress Monitoring in Psychotherapy.” :

This report provides a framework for progress modeling that includes relevant research on its success and background, an evaluation of gaps between research and implementation, and recommendations for clinical implementation, maintenance, and training.

• Vista Research Group provides a website with links to a variety of current research findings. Gaps: They conclude that there is very little clinical research, especially randomized control trials in regard to progress monitoring for use with SUD, despite promising results and documented success with use in other mental illness treatments. Clinicians struggle to find inexpensive, user-friendly, real-time feedback tools, making progress monitoring a challenge.

• This article provide a meta-analysis on progress tracking in SUD. It compares several studies addressing traditional urine/attendance tracking against adaptive intervention including therapy treatments along with urine/attendance requirements. It is a comprehensive review showing the significance of including treatment and progress monitoring outside traditional parameters in relation to positive patient outcomes.

Impactful Federal, State, and Local Policies

Laws addressing progress tracking typically pertain to individuals who have a criminal history related to substance use. The U.S. Department of Justice notes that while drug testing can be mandated as a condition of bail, probation, and parole, its implementation and duration vary by jurisdiction . While treatment may also be a condition of probation and parole, its requirements also vary by jurisdiction. SAMHSA has a comprehensive list of acts regarding mandated treatment guidelines, backed by the federal government, that address evidence-based treatment and monitoring, disparities, and protected individuals .

Available Tools & Resources

Recovery Capital is the breadth and depth of internal and external resources that can be drawn upon to initiate and sustain recovery from alcohol or drug problems. (Granfield and Cloud 2004). Recovery Capital is conceptually linked to natural recovery, solution-focused recovery therapy, strengths-based case management, recovery management, resilience and protective factors, and the ideas of hardiness, wellness, and global health.

Sober Grid is a free iOS/Android app that connects you with other sober people. You are instantly connected to a global sober community in your neighborhood and around the globe. You can build strong sober support networks and inspire others.

Sobriety Clocks

Your own sobriety clock, which helps you easily track your days in sobriety and provides:

1. Ability to share your sobriety clock with people who are supporting your recovery, such as friends, family, partners, coaches, or counselors.

2. Ability to message an accountability partner if you are feeling triggered to use.

SMART Recovery Cost Benefit Analysis (CBA)

The SMART Recovery Cost Benefit Analysis (CBA) worksheet is a complement to the SMART Recovery groups]. Using the CBA tool you can quickly see the consequences of potential actions. The CBA strategy helps many people recover from addiction and addictive behaviors, ranging from substance abuse to sexual addiction. The app makes performing a CBA convenient and easy.

A CBA is an assessment of 4 questions:

1. What are the advantages of using/doing?

2.What are the disadvantages of using/doing?

3.What are the advantages of NOT using/doing?

4. What are the disadvantages of NOT using/doing?

Keeping a notebook and writing down daily activities, thoughts, ideas, etc. Without holding back, writing all thoughts down can serve as evidence to recurring thought/behavioral patterns that one can more clearly identify when reviewing entries dating back weeks, months, even years. If you have a partner, close friend, or therapist that can help you throughout your recovery, speaking with them about your progress may assist you in recognizing how far you’ve come. Oftentimes these people recognize changes before we do.

Using Scales and Feedback Programs

SAMHSA recognizes the Partners for Change Outcomes Monitoring System PCOMS) as a significant tool for progress monitoring. It combines the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) in a collaborative effort on the part of the therapist and patient . The therapist and patient work together to create goals that are reviewed by the SRS and encourage a positive partnership. The Canadian Psychological Association (2018) reports that the union of the ORS and SRS facilitates discussions of progress and relationship issues in the treatment, as well as the ability to alert the therapist to issues by “identifying off-track progress and alliance measures,” and has shown significant promise in tracking and treating SUD . Link: https://onlinelibrary.wiley.com/doi/10.1002/jclp.20111

“A Preliminary Study of the Effects of Individual Patient-Level Feedback in Outpatient Substance Abuse Treatment Programs” - this is a unique study done on the effectiveness of patient-level feedback on treatment outcomes for SUD. It showed that patients who were “off track” in their progress and given the adapted Outcome Questionnaire (OQ-45) fared better than those who did not participate in the OQ-45. There was a marked decrease in drug use and promising improvement in mental health outcomes. A review of the OQ-45 allowed practitioners information to tailor treatment to the individual and provide any additional, unique support .

This link provides a table comparing available SUD monitoring instruments based on a number of important factors, such as availability, cost, content, and much more: https://clinmedjournals.org/articles/iaarm/iaarm-2-020table1.html

Promising Practices

Progress Assessment (PA) - A recent clinician-created and tested tool, the PA includes 5 items that assess the risk of relapse and 5 items that assess protective factors . Study results showed that participants (cocaine use) with high risk and low protective scores at baseline and the 3-month mark were at greater risk of relapse. The PA is short and easy to administer and allows for flexible and adaptive intervention to take place, addressing the ongoing and changing needs of the client

Treatment Progress Assessment-8 (TPA-8) - This newly developed instrument aims to monitor SUD symptoms and treatment progress . Items that measure symptoms used DSM-V criteria, while items addressing treatment progress focused on self-efficacy, therapeutic alliance, emotion regulation, and hopefulness. The goal of this tool is a collaborative partnership between the clinician and patient to create a treatment plan based on goals, autonomy, and hope, allowing for assessment and adjustment monthly. It shows promising results in retention and preventing relapse .

Recovery Applications - An autonomous form of tracking one’s progress in recovery is to utilize modern technology. There are dozens of applications dedicated to assisting people in their addiction recovery journey. They range in modality, from providing resources, motivation, peer connection, use and recovery tracking, and much more. Dual Diagnosis and GoodRx provide a list of top-rated apps that clinicians can review and suggest to their clients:

• https://dualdiagnosis.org/apps-for-addiction-recovery-and-mental-health/
• https://www.goodrx.com/conditions/substance-use-disorder/mobile-apps-for-managing-substance-use