Why Customized Treatment Plans Lead to Lower Relapse Rates in Addiction Recovery

Standardized addiction treatment often does not retain patients. If a given regimen is imposed uniformly, regardless of a patient’s neurobiology, trauma history, or psychiatric status, many individuals will drop out early, and almost all will experience relapse. The data continue to settle in only one way: Personalization is not a luxury component of care; it is the very bedrock upon which successful treatment stands or falls.

The failure of standardized programs

The 28-day residential model came out of an era when addiction was typically regarded as a failure of character that could be putatively righted by willpower and routine alone. The disease model of addiction simply hadn’t been developed, so biological and environmental determinants of addictive behavior were given too little weight in the development of treatment programs.

Most modern treatment providers appreciate the need for a more personalized, patient-centered approach to treating substance use disorders, but they’re hamstrung by ancient infrastructure, funding models, and operating procedures. This is particularly true for our public treatment programs, which remain criminally underfunded and overburdened, as any public health expert will attest to.

But happily in the private space as well, change is creeping in. Recently published treatment guidelines call on providers to offer a menu of treatment options that are tailored to the biopsychosocial complexity of individual patients – the first such guidelines to do so. It’s an indication that we’re at last drawing somewhat closer to offering programs that are actually meeting patients where they are.

Biopsychosocial profiling as the starting point

Providing effective individualized care is a process that starts before treatment even begins. A thorough biopsychosocial assessment at intake provides the critical data that clinicians use to determine the most appropriate and effective course of treatment for the patient. This process allows us to create a complete patient profile based on their biological predispositions and previous experiences, current mental health, and support network, work and home life balance as well as the living or work environment they must return to post-treatment.

This isn’t just about collecting information. The data that emerges from a thorough assessment is intended to identify strengths and solutions as much as to pinpoint weaknesses and problems. Facilities like legacyhealingla.com show how, if it’s determined that a patient is at greater risk for relapse because they’re returning home to an unsupportive environment, a specific clinical professional at the treatment center should be able to coordinate a series of family therapy sessions or arrange for more appropriate housing.

Dual diagnosis treatment and why skipping it causes relapse

Approximately 50% of people with a mental illness are also experiencing a substance use disorder at some point in their lifetime (SAMHSA). It’s no coincidence. For many patients, the substance is an adaptive response to an untreated mental health condition – depression, generalized anxiety, PTSD, bipolar disorder. The drug manages a symptom the patient could not manage using other methods.

Programs that treat the addiction in isolation from the co-occurring condition don’t eliminate the need for using. They eliminate the substance, temporarily. As soon as the patient leaves treatment and faces daily life, and as soon as the untreated mental health condition emerges in full force, it’s back to square one. Relapse wasn’t in the patient’s control; it was in the treatment plan.

Dual diagnosis treatment is hard. The mental health clinician and the addiction specialist actually have to respond to each other’s assessments in real time and decide where to go and what to try based on what the other is seeing. It’s not a fixed operation. It’s dynamic and complicated. But this is the only way that dual diagnosis patients can make real progress.

Matching therapy modalities to the patient’s profile

Not all evidence-based therapies suit all patients. For instance, CBT is incredibly beneficial for those patients whose addiction is largely fueled by their distorted thinking – they wouldn’t necessarily be taught the same CBT coping strategies that someone turning to drugs as a way to escape a truly unsafe reality would. Wouldn’t it make sense that these very different sets of patients receive quite different therapies?

Engagement with pure psychology-based interventions (Cognitive Behavioral Therapy, for example) will necessarily be less strong in someone whose primary issue is not distorted cognition and poor coping but the unprocessed effects of trauma, for whom a therapy based in the processing of what happened (EMDR, perhaps) would be more useful. Or, put more bluntly: Someone whose addiction was rooted in their attempt to escape having to feel anything at all will probably struggle to see the point of a therapy that asks them in part to think a little differently.

The same goes in reverse. Would you try to treat a distress-avoidant person with a highly feeling-based approach? Probably, you’re wasting everyone’s time. They’ll take the tools they’re taught – the self-monitoring forms, the logic puzzles, the cost-benefit analyses – and run, in a frantic search to find (or develop) a reason to stop having to face those dangerous emotions.

How personalized MAT protocols affect outcomes

Even ancient cultures like the Greeks and Egyptians recognized the risks and began looking for ways to detoxify or diminish the effects of substance abuse. Today, medication-assisted treatments are used to help patients safely detox in a more straightforward fashion. Common drugs used include methadone and buprenorphine to treat opioid addiction and acamprosate, naltrexone, and disulfiram for alcoholism.

In recent years, the importance of personalizing treatment approaches to an individual’s needs and circumstances has taken center stage as a major factor in its success. Care provided under these guidelines can reduce the chances for relapse and improve outcomes throughout treatment, as they are designed to help the patient cope based on their unique circumstances.

The adaptive continuum of care

A treatment plan that is unique to the individual is not a fixed record. It is a flexible structure that changes as the patient’s situation changes. The treatment pyramid, which progresses from medical detoxification and residential treatment through intensive day treatment, and finally to extended outpatient care, ought to be defined by clinical progress markers and not by dates on a calendar.

Releasing a patient from residential treatment at the end of his or her 30 days, whether or not they are clinically ready to advance, is a design flaw that drives relapse. Some patients, after two weeks, have shown enough stabilization to warrant transitioning to the next level of care. Others will need the entirety of those six weeks to stabilize sufficiently. If they are pushed out of residential care before optimal progress is made, the likelihood of their stepping right back into use is great.

The best programs build in regular progress reviews, during which the multi-disciplinary team measures the patient’s progress according to their agreed-upon treatment plan and then makes recommendations regarding their next level of care. This scheme prioritizes the patient’s responsiveness over the administrative convenience of maintaining the current level of care.

Building a relapse prevention plan that actually fits

Preventing a relapse is not something that everyone can do in any situation. It is like a personal map that shows the dangers likely to be faced by the patient. Relapse Prevention Therapy helps to find and mark down what are the patient’s high-risk encounters. These include emotional conditions, social circumstances, environmental hints, and relationship factors that are most liable to stimulate the desire to use drugs. Then, strategies and alternatives are mapped out and practiced to face each of these dangers.

This map is different for each patient. For one, the principal cause of risk could be the reunion of the Friday night social group he or she has been part of for 10 years at a designated bar. For another, it may be the 2 weeks when there is any serious difference with or tension from a parent. Generic coping skills training might touch on stress or peer pressure, but it can’t prepare these patients to be ready to face those specific circumstances.

If the patient helps to co-create this map, he or she likely feels more responsible for using the map in actual circumstances of high risk.

Recovery can’t occur in complete separation, and treatment planning that doesn’t take into account a patient’s social surroundings is not enough. The social determinants of health such as housing stability, employment, financial strain, and family relations actually affect the risk of relapse. A patient who has to return to an unstable living situation with people using drugs in the household will face a much higher relapse risk than someone returning to a stable home with a supportive family.

Engaging the family unit of a patient directly in treatment, where suitable, makes accountability systems and minimizes the isolation that often comes before relapse. Tackling employment gaps or housing instability during the planning process will lessen the patient’s environmental stress, which they would otherwise have to deal with after being discharged when they’re most susceptible.

What this means for how we think about recovery

The average patient doesn’t exist. It’s a construct we use as a comparison point for real patients. The average patient doesn’t walk through the door at intake. The average patient doesn’t arrive in the ER. The average patient doesn’t sit in an exam room. The average patient is a mathematical estimate to whom care has historically been designed to approximate. The real patient is standing right in front of the doctor, and the traditionally wise doctor knows they have to deduct a standard deviation or two from norms to effectively treat most conditions.

Patients are atypical by definition. That is why medicine is an art. It is why medicine requires judgment. Treatment must always be tailored. The notion of a patient most similar to every other patient in order to standardize the treatment such that everyone receives exactly the same care ought to be seen as the anachronistic, nonsensical wrong turn in understanding we’ve mistaken for a mature approach to medicine for far too long.