Coparticipative Adherence: The Reconstruction of Discharge Categories in the Treatment of Substance Use Disorders

ABSTRACT

Management information systems and regulatory oversight in addiction treatment require classification of client discharge status and reports of relative percentages for commonly agreed categories, such as successfully completed or discharged for noncompliance. This article examines underlying assumptions and values for current addiction treatment discharge categories. It suggests that a “moral-choice compliance” model of addiction underpins current discharge categories despite the prevailing view of addiction as a disease, and recovery-oriented systems of care that values client empowerment. To contrast a compliance, program-driven philosophy implied in current discharge classification terminology, a “coparticipative adherence” model is suggested to drive discharge terminology. Such a model values client autonomy in the administrative and clinical program systems to participate and collaborate on goals and treatment plans, and self-fueled adherence and committed effort in treatment, which shapes discharge classification terminology. Contrasting and alternative discharge categories are offered and explained.

KEYWORDS:

• Discharge categories
• accreditation standards
• coparticipative adherence
• substance use disorders
• treatment regulations
• management information systems

Notes

1. The MCC model, as we conceptualize it, captures a “culture” of ideology about addiction and the American “culture” of addiction treatment in that while many providers advocate a “disease model of addiction,” in actual practice they convey more of a “moral-choice model of addiction.” This model is evidenced by such practices and policies as suspending clients who use even a drink or two of alcohol, not allowing them to be in group that day even if not highly intoxicated, zero tolerance and discharge from residential treatment for any substance use, attitudes like “there has to be consequences” for what is viewed as bad moral fiber and willful misconduct rooted in weak character in having used rather than a flare up or acute exacerbation of addiction needing assessment and treatment to avert deterioration and crisis; and not allowing readmission until a 30-day period away from the program; “How many times can we let a person have a positive drug screen before we discharge them”? In this context we have dubbed the real world practice in many programs as the moral-choice-compliance model.