Why Addiction Treatment Fails–Part 1 of 4 by David Gerber

The evolution of formal addiction treatment has resulted in a high degree of recidivism and failure. This failure of the treatment community to be successful falls into several categories which I will share in a four-part series.

REGULATIONS & DOCUMENTATION

While often well-intentioned, the simple truth is that due to over regulation and the risk of financial penalties, clinicians are not spending enough face-to-face time with those seeking help for addiction. The phrase “if it isn’t documented, it didn’t happen” has made slaves of clinicians who are forced to be more concerned about making sure that every encounter makes its way to a chart than about spending time with clients.

Electronic charting is complex and challenging, and there are many who struggle with learning and using a new format, which means it takes more time to document. The evolution of substance use disorder treatment has seen actual direct client contact time fall well below 50%, while the rest of the clinician’s time is spent completing documentation and reports. Clients in need of face-to-face time with clinicians often find that he/she doesn’t have time to see them because they are stuck behind a computer screen. Not only is this extremely frustrating for the clients, but also for the clinicians who enter the field to be of service to those who are suffering, but instead end up being of service to oversight agencies and insurance companies.

Many agencies are looking at becoming more efficient in documentation by doing “collaborative documentation”. This phenomenon has the clinician working on the computer while conducting one-on-one or even group sessions simultaneously. This cold method of “face-to-face” contact can hinder the essential benefits of being present for the client in vital attempts to build rapport. Treatment requires clients being vulnerable and taking risks. Imagine trying to share about your trauma, while a clinician is staring at a computer screen. In efforts to be more efficient, we lose a precious element of effecting change-client engagement

Since even minor documentation deficiencies, such as late documentation, can result in major fines or relinquishing of payments, treatment programs must employ quality assurance or utilization review staff to ensure that documentation meets all required regulations. This can result in excellent clinicians who are effecting positive changes with great client rapport walking away from the field of addiction treatment simply because of the exacting documentation standards. Once again, the client suffers.