Research Outcomes
- AToN Center strives to be the most cutting-edge, evidence-based program available for treating substance misuse. In alignment with this aim, we have been reporting our research and outcomes since 2011.
- In an effort to step up our game even further, we have joined with a third party, Vista Research Group, who has begun monitoring our outcomes. This group not only monitors our resident’s weekly progress, but they also contact our residents periodically after their discharge in order to give AToN feedback about our Alumni outcomes.
- The intention of this move is twofold. First, as our outcomes will be monitored by a program outside of AToN, our numbers can be trusted even more! We all know that many programs “fudge” numbers in an attempt to place their center in a positive light. This unbiased group verifies AToN’s honesty!
- Second, despite our amazing results, we have been unable to compare our outcomes with other programs. The Vista Research Group represents a number of treatment centers so our results are compared to national norms AND these other treatment centers using the same group.
- AToN Center just received our first “Treatment Effectiveness Report” and we are delighted to share this report with you! This report is broken into three major portions: Patient characteristics upon intake, progress during treatment, and treatment success. Our data is from 114 residents who attended treatment at AToN between September 2017 and June 2018.
Over half of our residents participating were male (61%) and the majority of our residents were in a stable living environment (95%). Our residents have typically attained a high level of education, with 62% holding a degree of some sort. Around one-third (31%) of our residents came to treatment because friends or family encouraged them to seek treatment, while 50% of our residents reported seeking treatment because they “became tired of living this way.” Alcohol was overwhelmingly the primary substance of choice (56%), while heroin (11%), opiates (11%) and benzodiazepines (8%) were also common. A strong majority of residents at AToN (85%) met the definition for having a severe substance use disorder and 34% of respondents reported having no prior treatment prior to attending AToN.
While AToN Center if a substance use primary program, our clinical staff is highly equipped to treat dual diagnoses. Upon intake, 68% of the respondents reported moderate to severe symptoms of depression. Anxiety was also highly reported with 63% endorsing moderate to severe symptoms. Of our residents, 54% reported symptoms indicative of post-traumatic stress disorder. Of note – four of our full time psychologists are either certified in Eye Movement Desensitization Reprocessing (EMDR), or in the process of being certified in EMDR with the EMDR International Association (EMDRIA).
Symptoms of depression, anxiety, and post-traumatic stress disorder were measured upon admission and discharge to ascertain the resident’s progress during treatment. There was a decrease of depression symptoms from 72% to 14% as measured by the Patient Health Questionnaire (PHQ-9). There was a decrease of anxiety symptoms from 64% to 23% as measured by the Generalized Anxiety Disorder Scale (GAD-7). Lastly, there was a decrease in trauma symptoms from 57% to 19% as measured by the Post Traumatic Stress Disorder Checklist (PCL-6).
Treatment Success
There are several factors that comprise treatment success – treatment completion rate, satisfaction with treatment, resident feedback and meeting treatment goals.
Treatment Completion Rate
In comparison to national norms, AToN Center has an exceptionally high treatment completion rate (69% versus the national norm of 56%).
Of note, this does not take into account that 9% of our residents wanted to continue treatment, but had to discharge early due to their insurance companies denying them further care. If we take those numbers into account, then 78% of our residents completed treatment.
This is not to say that AToN Center does not discharge residents who are violating AToN rules or causing disturbances in our milieu – our rate of termination is the same as national norms (6%). Another exceptional statistic is that AToN’s rate of residents who discharge “Against Medical or Clinical Advice” (AMA/ACA) is lower than the national average (14% in comparison to national average of 18%).
Despite this positive feedback, AToN Center’s Administrative and Clinical Team is researching and brainstorming ways to decrease our AMA/ACA rate by intervening with those residents who are at high risk for this type of discharge early on in their treatment.
Satisfaction with Treatment
A very important aspect of treatment is resident satisfaction.
This can be impacted on a number of levels, such as quality of staff, clinical interventions, cleanliness of facility, respect for residents and a high standard of privacy protection – just to name a few!
AToN’s residents were overwhelmingly satisfied with their treatment – 90% of residents reported being “very satisfied” with their treatment, while 8% reported feeling “somewhat satisfied”, 1% felt neutral and 1% felt “somewhat unsatisfied.”
This is in comparison to that other treatment centers that are contracted with Vista Research Group – where 73% of residents were “very satisfied” with their treatment.
AToN’s rate of high satisfaction was 17% higher than the average!!!
When residents were asked if they were included in their Master Treatment Plan development 94% stated they were asked about treatment goals, 3% were not sure and 3% stated they were not asked about their treatment goals. This demonstrates that the overwhelming majority of residents felt they had ownership of their treatment experience. When residents were asked if they felt their treatment goals were met 87% reported that their treatment goals were met, whereas 13% reported they were “not sure yet.” This highlights how the majority of our residents feel like they are making progress in treatment.
This feedback helped AToN Center identify our strengths and weaknesses as a program – and is driving our performance improvement goals. AToN will continue to present our program evaluations in an effort to remain transparent and accountable to our past, present, and future residents.
Overview:
AToN Center holds itself to the highest standard of care and is firmly rooted in the scientist-practitioner model. In an effort to provide the highest quality of service, our San Diego treatment center continuously assesses the psychological dynamics of each individual entering treatment and assesses treatment outcomes of outgoing residents. The research and leadership team at AToN Center believes in letting data drive policy, and uses only appropriate, valid, and reliable measures to assess our performance.
In an effort to quantify AToN Alumni progress after discharge, AToN Center contacts our Alumni at three-month intervals post-discharge. They are assessed utilizing the Christo Inventory for Substance Misuse Services (CISS) – which reviews the following domains:
- Social Functioning
- General Health
- Sexual/Injecting Risk Behavior
- Psychological
- Occupation
- Criminal Involvement
- Drug/Alcohol Use
- Ongoing Support
- Compliance
- Working Relationship
This inventory has a max of 20 points, each domain capped at 2 points. An increased score indicates increased relapse risk and distress. A “good outcome” is considered a total score of 2.9 or below. Per normative data, a score of 2.9 or below is correlated with abstinence.
This project began in October 2013. Here are our most recent results – research is ongoing!
Resident’s Urge to Use decreased significantly between weeks 1-3 in particular. Additionally, these decreases were considered a large effect when reviewing the partial eta-squared (.69).
Every single scale on the Brief Symptom Inventory demonstrated a significant decrease in symptoms from week one to week two. Five scales significantly decreased between weeks one, two and three. Finally, two scales significantly decreased every single week; and these scales were overall scales. The largest effect sizes found in the BSI were in Global Severity Index (.78), Positive Symptom Distress Index (.73), Depression (.67) and Anxiety (.64). See the below charts for further information:
- Statistically Significant in Weeks 1-4 with Partial Eta Squared
- Global Severity Index (.78)
- Positive Symptom Distress Index (.73)
- Statistically Significant in Weeks 1-3 with Partial Eta Squared
- Anxiety (.743)
- Depression .(672)
- Positive Symptom Total (.66)
- Psychosis (.608)
- Obsessive-Compulsive (.59)
- Statistically Significant in Weeks 1-2 with Partial Eta Squared
- Somatization (.64)
- Paranoia (.510)
- Hostility (.519)
- Interpersonal Sensitivity (.48)
- Phobia (.385)
Residents who attend treatment at AToN Center can reasonably expect to experience a decrease in overall symptoms on a significant level. Additionally, symptoms of depression and anxiety tend to decrease the most. For a more thorough and in-depth review, click here.
After conducting a literature review, AToN Center identified distress tolerance, coping style, and abstinence self-efficacy as important qualities that can affect treatment outcomes. In response, AToN Center implemented an assessment protocol that assessed each resident’s coping style, level of distress tolerance, and abstinence self–efficacy utilizing standardized measures. These assessments occurred within 72 hours of admission. A final assessment occurred on the resident’s final treatment day.
This data allows for an understanding of how our curriculum contributes towards improved coping styles, increased ability to tolerate distress without relapsing, and also boosts confidence in one’s ability to stay sober, which significantly can predict relapse rates. In addition, all residents at our San Diego treatment center who participated in this research were debriefed on their scores at the end of treatment in a final exit interview which provides both the client, as well as family members and other professionals with information on gains made, and areas needing focus in continued treatment.
This research was conducted over a one-year period, and 79 residents participated in the pre and post assessments. These residents on average experienced a statistically significant increase in distress tolerance in the 30 days of treatment received. Specifically, our residents demonstrated on average a 32% increase in distress tolerance from admission to discharge, taking them from a mean score of 2.56 upon entry, to a 4.16 out of a maximum 5.0. An assessment of effect size demonstrated a very large effect size (eta squared .58). Effect sizes over a .4 are statistical speak for “mathematically very significant!”
AToN Center residents also had a statistically significant increase in abstinence self-efficacy; with an average score upon admission of 2.57 “not very confident” which increases to a mean score of 4.31 which is “near extremely confident.” This scale also maxes at 5. This change represents a 35% increase in abstinence self-efficacy from admission to discharge. This effect size was also very large (eta squared .76).
AToN’s San Diego treatment center residents also subjectively reported an increase of approach coping skills, which reflect use of active coping skills, in lieu of avoidance techniques such as numbing, pretending a problem will go away on its own, and self-medicating. They also reported a decrease in using less than helpful avoidance techniques. Specifically, approach coping skills went from an “average” range to a “somewhat above average” range. Avoidant coping skills decreased from “well above average,” to “somewhat above average.” This shift from focusing on avoidant coping skills to increasing approach coping skills has been reported in research to be most effective in helping individuals prepare for success in recovery.
For a more in-depth view of the research reported above, you may consult Dr. Cannon’s Assessment of AToN Curriculum.
AToN Center conducts Resident Satisfaction Surveys in order to elicit feedback from our residents about how they rate different facets of our program. At the end of their stay, we ask residents to rate 19 domains on a 4-point scale. We highly value this information as it allows us to make programmatic improvements. We are happy to report that we consistently receive excellent results!
During the first Quarter of 2017, all scores ranged from 3.8 – 4.0 out of 4, representing very slight fluctuations in some categories. The lowest score (3.8) was slightly higher than our lowest score (3.5) in the fourth quarter of 2016. Across the board residents highly rated AToN Center including an average of 4’s on overall quality, appearance, and cleanliness! Generally reflected on the tool were “Excellent” and “Good” scores. Only one former resident rated one category as “Fair” and no one categorized any domain as “Poor.”
All residents (100%) this quarter would recommend AToN Center to a friend!
It is very rare to see a treatment center disclose their data on relapse rates because the numbers at first glance can seem misleading and disheartening. The truth is that the recovery pattern from substance dependence is much like that of other relapsing conditions such as diabetes, weight gain, and domestic violence victimization. These conditions often take numerous steps forward into recovery, and sometimes, they take steps backwards, known as “slips” if they are short in duration. Some cases revert to full blown relapses, which is where the individual regresses to a more severe stage of impairment.
Some social scientists, Terence Gorski being the most famous, have dramatically influenced our understanding of addiction by describing the condition of addiction or substance dependence as a “relapsing condition.” Gorski proposed that relapse can be expected as part of the condition, and is not always a “bad” thing if it leads the individual into a deeper state of understanding of their vulnerabilities, and if exploration of the underlying factors that contributed to the relapse are used to prevent harm in the future, and re-engage in supportive treatment activities.
Our goal at AToN Center is to help individuals prevent deterioration in their lives and with their health, and to assist them in restoring whatever areas of health possible; physically, relationally, spiritually, and emotionally. As consistent with recommendations from the American Psychological Association, the safest recovery approach for individuals with substance dependence is abstinence, and that is our goal.
Comparison to National Benchmark
If you have ever attempted to identify success rates for the field of recovery, you know how difficult it may be! Below are AToN Center’s success rates. These rates must be interpreted with caution. To the best of AToN Center’s knowledge, these rates are accurate as possible. These rates are determined based on Aftercare outreach phone calls. Only residents who discharge with a “completed” status are afforded the benefit of Aftercare. After a period of time, some residents request to be taken off of the Aftercare outreach list.
Others have become very busy in their lives of recovery and respond to phone calls intermittently. Others have relapsed. Residents are removed from the Aftercare lists if they have requested AToN do so, or if they do not respond after several months. Therefore, these rates are based on those residents who are still receiving Aftercare phone calls. For the purposes of data analysis, all residents who are on the list, but who have not responded, are considered “relapsed.”
As with all research, we advise “buyer beware” if you come across a treatment program who is reporting long term sobriety rates at 85% and above as these would be far in excess of the treatment community standard, and such studies likely have questionable research design methods.
AToN Center recommends a thorough discharge plan for all residents inclusive of structured support for the first 90 days post-discharge, and the data emphasizes the importance of maintaining vigilance post 90 days as well. The good news is that many individuals, who report a slip or relapse, reengage with their providers and get back on track quickly.
National Benchmark Data from National Institute of Health Website:
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AToN Center reviews the ongoing literature in our field so we can update our treatment and curriculum as our understanding of addiction progresses. While not an exhaustive list of the articles reviewed, below are some articles that have informed our current treatment curriculum. This page will be updated on a regular basis.
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