What's Missing In Alcohol Treatment
The article and consensus paper begins by exploring problems in current treatment modalities and the need for different approaches for finding the best outcomes in recovery. It explores genetic and neurobiological impacts and recent legislative changes in the health care system, as pertinent issues for examining treatment needs, needs beyond various counseling therapies. Also, the article explores AUD treatment as time limited when AUD is a long-term, chronic illness needing continual management such as other long-term illnesses like diabetes with blood glucose monitoring. The authors continue to note that there is “not yet the evidence-base needed to guide a personalized, chronic care approach to the treatment of AUDS.”
What Is Proven To Work
The research panel was tasked to look at such evidence-based treatment needs by convening the panel for an all day meeting exploring questions about the value of SoberLink in an individual’s recovery. SoberLink “uses a standard breathalyzer, allows real-time monitoring of BAC at virtually any time and any location; provides real-time notifications to the treating clinician(s) and to an approved list of patient support contacts; and has been in operation since 2011, with more than 55,000 individuals.” The article then explores the collection process for gathering the information from a patient that is being monitored, the role of the sponsor (i.e., SoberLink), and the process for attempting consensus regarding the outcomes from the panel. Finally, a hypothetical patient situation was used to set the standards for care regarding the use of SoberLink for outpatient or office-based care.
Results of Clinical Monitoring
- The panel was in consensus of the recommendation of utilizing 3 tests per day as it is able to detect alcohol usage for 2 – 5 hours after imbibing and because it was felt that 3 tests were not too invasive for patients. The panel also allowed for different rates of usage during other mitigating circumstances, both due to either favorable or unfavorable issues, such as decreasing use after 4 weeks of positive results.
- Another consensus result was that patients should be monitored for at least one year during and following outpatient treatment and which could be extended if needed. This was based on other studies of monitoring results.
- Also, the panel was in consensus that the scheduled testing needed to be agreed upon at certain time points; other circumstances may require random testing.
- The panel was in unanimous agreement that while tampering , including providing false samples, was rare, that this is a serious problem that needs to be addressed and consensus was given regarding giving the data to the individual’s support group as well as to the monitoring clinician for an appointment and a follow-up test such as a urine sample. It should be noted that the panel members did not believe this was grounds for discharge from treatment.
- Recommendations for a missed test: panel members did not come to consensus on this due to believing there were a number of legitimate reasons for this to happen. However, all felt this was a cause for concern and yet not as significant as if the patient had failed a test.
- There was unanimous agreement that one positive test was clinically significant, but there were various responses regarding how to follow-up with this issue including contacting the patient’s support group, contact by phone or in person for an individual session, and increasing the frequency of the monitoring which would be dependent upon mitigating circumstances.
- Recommended clinical responses to a second positive test were unanimous including contacting the patient’s support group, contact by the clinician, increasing the frequency of monitoring, and increasing treatment programming.
- The most controversial item for the panel was regarding sharing monitoring results with the support group as this could create a time problem, perhaps sharing only positive results, the potential violation of patient confidentiality, and difficulty in having client’s contact members be trained in the treatment needs.
Panel Participants include Alan Gordon, MD, Adi Jaffe, PhD, A. Thomas McLellan, PhD, Gary Richardson, MBBCh, Gregory Skipper, MD, Michel Sucher, MD, Carlos F. Tirado, MD, MPH, and Harold C. Urschel III, MD
In summary, this article was able to explore the successes of this monitoring system, other needs regarding monitoring and treatment decisions, and recommendations for future use of the system as well as for further research. SoberLink is changing the focus of treatment and shows a positive relationship with other recovery modalities such as treatment and counseling; further research can only enhance this relationship.
Reach Out Recovery Exclusive by Carol Anderson