Treating Addiction As A Chronic Disease - At Home

Addiction experts have long argued that alcohol and drug abuse needs to be treated like other chronic medical conditions, such as type-II diabetes or hypertension.

Putting that into practice has been difficult, however, and the chance of relapse one year after treatment for substance abuse still ranges from 40 to 60 percent. Moreover, there is little research-based evidence of how changing the existing model of short-term rehabilitation would improve outcomes.

But NHPR’s Jack Rodolico reported this week on a model that seems to be working for a group of people with severe substance-abuse disorders.

Aware Recovery Care, which opened in New Hampshire earlier this year, brings together a team of providers - physicians, nurses, psychiatrists, therapists, case managers - to treat clients in their homes. The year-long program helps people manage their addiction like they would a chronic disease, providing the kind of monitored care and long-term support that is designed to prevent relapse.

The research behind Aware’s home-based model is a study conducted at the Yale School of Medicine. Known as a “proof-of-concept pilot,” it took in five people who met the diagnostic criteria for severe substance-abuse disorder. In other words, they would fit the inelegant description of hard-core addicts, including:

  • a man who, over the course of 30 years, had progressed to nearly a quart of vodka a day;

  • a man who was consuming high daily doses of oxycodone each day, along with a fifth of bourbon;

  • a man with a 15-year heroin addiction who had failed to quit after more than a dozen stints in inpatient rehab;

  • a woman who, despite severe liver damage, continued to drink heavily.

Each client was evaluated by an addiction psychiatrist. One was sent to inpatient detox; two were prescribed buprenorphine, a drug used to treat opioid addiction. The woman was referred to a gastroenterologist to monitor her liver condition. All five clients began meeting weekly with a licensed addiction specialist or a clinical psychologist.

They were connected with 12-step programs, with attendance at the meetings tracked by a GPS on their phone or in their car. They met regularly with certified recovery advisors - peers in recovery who guided the clients through a 52-week curriculum that teaches skills and habits aimed at preventing relapse. Three clients were subsequently diagnosed with co-occurring psychiatric illnesses and began treatment.

After one year, four of the five clients had remained clean and sober for the entire program. The fifth had several brief relapses in the first three months, but in the end had been drug and alcohol free for seven months and was holding down his first full-time job in years.

The Aware program isn’t cheap - it costs $38,000, about the same as a month or two of inpatient treatment at a private facility. But those programs don’t typically include follow-up care or assistance with the kind of co-occurring physical or mental health problems that plague most people with substance-abuse disorders.

The good news is that at least one insurance company in New Hampshire, Anthem Blue Cross and Blue Shield, was so impressed with the results of the Yale study that it’s now covering the Aware program as a behavioral health benefit.

Will others follow? That’s hard to know.

But the apparent success of the Aware model offers some evidence that a coordinated system of care to combat the addiction epidemic is worth pursuing - and paying for.