This standard has been challenged in recent years. Opponents observe that chronic disease outcomes are rarely reported in an "all-or-nothing" manner. Success rates for treating diabetes and other chronic illnesses are not measured in this way, so why should the chronic disease of addiction be measured so stringently?

Opponents to a strict abstinence standard argue that factors such as treatment adherence and symptom reduction may be more fair indicators of success.

Others debate whether treatment centers are truly responsible for continuous abstinence among its former patients, particularly as more time passes since discharge. Rather than abstinence, some argue that significantly reduced alcohol and drug use constitute success. In this manner, those who relapse and get back on track are counted as treatment successes rather than "treatment failures."

Treatment success is not necessarily limited to alcohol and drug use outcomes. Because alcohol and drug dependence negatively impacts overall life functioning, success can also be measured by improvements in a variety of areas of a person's life, including health, employment, legal problems, family/social relationships, and psychological functioning. However, some argue that alcohol and drug treatment can't be expected to result in global improvement across all life areas.

Definitions of success vary
Clearly, definitions of "success" can vary from one treatment center to another. Treatment centers also differ in the way outcomes are reported, which makes comparisons between them difficult. Some report continuous abstinence rates; others report on the percentage who significantly reduce their use.

Time frames may also differ. One center may report six-month outcomes, while another reports one-year outcomes. To confuse the matter even further, one center may report how patients functioned during the entire six months after treatment, while another might report how well the patients did during the 30 days prior to the time of the six-month follow-up interview.

Another difference has to do with the types of patients assessed. An "intent-to-treat" sample includes all patients who are admitted to the facility, regardless of how long they stay. "Treatment completion" samples include only those patients who successfully finish the program. Not surprisingly, treatment completion samples demonstrate better outcomes than intent-to-treat samples. When trying to understand a center's outcomes, it is important to understand the type of sample included.

What does Hazelden do?
Consistent with Hazelden's treatment philosophy, the Butler Center for Research is committed to honesty and transparency in scientific research. To this end, we use the gold standard of research and report outcomes based on an intent-to-treat sample. We use continuous abstinence rates as our key indicator. But we don't stop there. Because alcohol and drug dependence is a chronic and complex disease, and definitions of success vary, we also report on reductions in use to capture those who may be struggling, but struggling in the right direction. We also provide the percentage of patients who report significant improvements in the quality of their lives.

For example, our adult outcomes are typically reported in the following way: "Ongoing outcome studies show 53-55 percent of our adult primary care patients maintain continuous abstinence from alcohol and drugs during the year after treatment. An additional 35 percent reduce their use significantly. Overall, between 70-80 percent report improved quality of life in such areas as relationships with family and friends, job performance, and ability to handle problems."

Moreover, Hazelden is committed to continuous quality improvement efforts throughout the recovery continuum and to identifying the key milestones of recovery-those behaviors or attitudes that signal positive outcomes-such as attendance in AA.

In summary, we believe in telling the whole story. It's a matter of scientific integrity and Hazelden's promise of quality.

Val Slaymaker, PhD, is a licensed psychologist and director of the Butler Center for Research, the research arm of Hazelden that is dedicated to the advancement of knowledge and understanding of addiction recovery. Slaymaker can be reached at vslaymaker@hazelden.org.

Published in The Voice, Winter 2004