Donald Mullaney, Ph.D., LCSW, CAP, Michael Weiner, Ph.D., CAP, & John McIlveen, M. Ed.
(Abridged version of article submitted to the Journal of Substance Abuse Treatment)
Since its inception Behavioral Health of the Palm Beaches (BHOPB) has striven to be a provider of the highest-quality addiction treatment as well as a center for professional education and research. There has always been a value on continuing education for our staff. Opening it up to the professional community has been an easy extension.
We have always believed that research was important. To accomplish this we created a research coalition with the School of Social Work and the Counseling Department at Florida Atlantic University (FAU).
Two professors joined our team, both of whom had a history of working in the field of addictions treatment. We began to see the benefit of enlisting professionals with fresh ideas.
Since its inception Behavioral Health of the Palm Beaches (BHOPB) has striven to be a provider of the highest-quality addiction treatment as well as a center for professional education and research.
Maybe some of the best reasons to do research in a treatment center are:
Sometimes you find out something that you didn’t know.
Two new colleagues came to us with an interest in the relationship between mood disorders and addiction, particularly the mood disorder dysthymia.
Initially, this did not rock our boat. After all, most people don’t even know what dysthymia is. To be brief, it’s a mood disorder as are major depression and bipolar disorder. We have certainly paid a lot of attention to the latter two. When we identify a patient with major depression or bipolar disorder, we know that their treatment needs to include psychiatric intervention and possibly medication. Dysthymia, on the other hand, has been dismissed as chronic sadness and no specific interventions have been recommended. It’s like something that recovery will take care of.
To appease our new colleagues, and since every patient admitted to Behavioral Health of the Palm Beaches completes a personality inventory (Million Clinical Multiaxial Inventory III) anyway, it didn’t take much effort for us to at least look at the frequency with which our patients scored high on the Dysthymia scale. This is what we found.
Common Mood Disorders in BHOPB Patients as Measured by MCMI Testing
Dysthymia is far more prevalent among our patient population than the two disorders we almost always identify and treat. This is a clear case of learning something we didn’t know. Maybe this is why we need to consider bringing outside investigators into our treatment centers? They may cause us to look outside the box.
Treating an addict with dysthymia is not the focus of this article. The point is that we now know that we have something important to address. If we had not opened ourselves up to research, we would have gone on our merry way and done what we have always done. In the case of dysthymia, that would have been absolutely nothing. We would have continued to ignore something that we now know is very important.
We may find out where to get the most bang for our buck.
Almost ten years ago we first published the results of our outcome study in Addiction Professional magazine. We found that the most important determinant of a person remaining drug free for one year was having and using a sponsor.
At BHOPB, we have a number of interventions available to help our patients enhance the quality of their recovery. Eye Movement Desensitization and Reprocessing (EMDR) has helped many patients begin their recovery with minimum impact from traumas they have experienced. Acupuncture, EMDR, and cognitive-behavioral therapies have helped addicts cope with chronic pain and remain drug free. We have specialists to help people address chronic anxiety and grief issues and psychiatry to address mental health disorders. We feel that all of these interventions are very valuable and we know they are very costly.
But how many resources do we really use to assist patients in making good choices regarding finding a sponsor and working with a sponsor? We do a lot more since the outcome study.
To be fair, patients who remained abstinent and patients that didn’t both receive EMDR and/or other special interventions vary frequently. Therefore, the patients that remained abstinent and those that didn’t could not be distinguished based on interventions. The outcome study we did definitely does not mean that these special interventions are not important. Further research has helped BHOPB to determine which interventions work best for each of our diverse patient population.
Further research has helped BHOPB to determine which interventions work best for each of our diverse patient population.
The addictions field has produced research that is applicable to divergent populations.
Dr. Paul Peluso, a professor in the Counseling Department at FAU, pointed out that an addict in treatment needs to make some of the most difficult lifestyle, attitude, and even personality changes that clinicians ever ask their patients to make. In fact, we are asking patients to change their entire identity from an addict to a person in recovery. It’s an enormous change that requires totally new ways of thinking and behaving. If we have a good idea of what works with this population, we can transfer that knowledge to other populations and settings.
Prochaska, DiClemente and Norcross’s (1992) stages of change model and motivational interviewing (Miller & Rollnick, 2002) both came from insights developed in treating addiction. Also, the concept of family roles (Wegscheider, 1981) including the hero, scapegoat, lost child, and mascot came from treating families that included an addict.
What it comes down to is that there are regularly thousands of possible subjects participating in addictions treatment at any point in time. Not studying this population must be considered wasteful.
The Treatment Research Institute has championed the concept of “blending” (2005). The idea is that data collected at treatment agencies is provided to researchers. The results of research are then implemented at the treatment centers providing the data. This certainly takes away the idea that research is done in ivory towers.
It’s the right thing to do.
We believe that BHOPB is one the best addiction treatment centers in the country; however further academic and onsite research can shed light on ways to constantly grow and improve.
We were surprised when our colleagues in academia told us that most community agencies are not open to sharing their data. It might be that there are agencies that are apprehensive about looking at outcomes.
We believe that we have a moral obligation to find out what works and what doesn’t, as well as an obligation to share the information with all professionals in the field. The only way to really do this is by conducting good research.
This sounds like continuous quality improvement. It’s close, but quality research goes deeper. We do not believe that what most of us do as continuous quality improvement would meet the rigorous standards of research published in professional, refereed journals.
It’s easy to say things like “we don’t have the resources to do this,” or “we don’t have the time.” These are excuses.
There are ways to get it done.
A lot of treatment centers are within a stone’s throw of a university filled with young, bright, competent, and eager professors who have to do research to survive. We were fortunate enough to have met Dr. Naelys Diaz and Dr. Gail Horton, both of whom are professors in The School of Social Work at FAU. Since BHOPB also trains Master’s- level interns, we had the opportunity to be at a meeting of faculty and field supervisors at FAU’s School of Social Work. All it took was an announcement that we would welcome faculty interested in doing research with us. Two days later we had a coalition.
Dr. Paul Peluso, a professor in FAU’s Counseling Department, had interns placed at BHOPB and his research included the importance of family dynamics. Because BHOPB has a very strong family program it was a natural fit for us to embark on collaborative research with Dr. Peluso.
We’re sure that there are many different ways to approach a university and get the word out; forming a coalition that includes both the training of interns and research benefits everyone.
Research helps everyone.
A intern once asked me how does research help us? I replied “wouldn’t people want to send their loved ones to a treatment center that really wants to find out what we’re doing well and where we need to do better?”
We, like many people, would prefer to get medical care at a Teaching Hospital. A teaching hospital is looked at as a place that offers cutting-edge medical care. They are places that offer the most up-to-date, effective treatments because that’s where the research is done. Wouldn’t it be the same for a treatment center?