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Paths to recovery

David H. Gustafson

David H. Gustafson (large image)

At 11 a.m., the telephone rings in a substance-abuse clinic. One ring, then two, three, four. Finally, a machine answers and the caller awkwardly leaves this important message: "I am an addict and I need help."

An answering machine? It's true — even in some of the best substance-abuse clinics, says David Gustafson, Industrial and Systems Engineering professor and member of the Center for Health Systems Research and Analysis (CHSRA). He views the answering machine as a lost opportunity for these clinics to engage patients the moment they make that first call. And it could be part of a larger set of organizational systems that negatively affect patients' access to and success in substance-abuse treatment programs.

Gustafson and CHSRA researchers are leading a $9.5 million Robert Wood Johnson (RWJ) Foundation initiative, called Paths to Recovery, that will identify and improve these systems, and share the results with substance-abuse clinics around the country, hoping to increase patient success and staff satisfaction.

Each year, as many as 16 million Americans need substance-abuse treatment, according to the U.S. Substance Abuse and Mental Health Services Administration. Of them, about 3 million people participate in treatment programs, but for a variety of reasons, half that number drop out early.

Sometimes, says Gustafson, patients start using again and are asked to leave; other times, they feel uncomfortable with the clinic's treatment methods or their counselor in general. Or they may experience financial barriers. But CHSRA — the RWJ national program office for the project — will focus on issues like transportation, communication, scheduling and information flow. "Is the best way for the clinic to stay in contact with me via an answering machine, or are there other effective ways?" says Gustafson. "Do I really need to come to a central place to do it? Would I be any more or less honest if I were just interviewed by a computer?"

To put just one aspect — the clinic check-in process — into perspective, Gustafson sought "treatment" at a cooperating facility. "In the process of going through this admission, one of the things I experienced was how difficult it is on a person who wants to get treatment," he says. "They'll interview you and then they'll say, 'Well, we can't get you in today, but why don't you call us once a week to let us know you're still interested.'"

In many cases, both large substance-abuse networks and small clinics operate with limited staff on a shoestring budget. Yet they manage some success with the resources they have. "We're going to help them find ways to work within those resources better," says LeeAnn Kahlor, the project's communications officer.

First, CHSRA researchers will identify which processes need improvement. To gather data, they will review published research on those areas and conduct interviews with contacts in agencies and industries that report successful practices. The researchers also will work with two groups of 10 treatment facilities, which will convene periodically to discuss and learn best practices from each other and from other fields. Throughout the project, staff from Oregon Health and Sciences University will conduct case studies.

"What I hope will happen is at the end of this whole project, we will conclude that there are enough successes in this whole process that we can hold a national conference that will allow us to tell the story of these experiences and allow other agencies to learn from it," says Gustafson.

The group has established a website,, where researchers will update their progress and results.