Episode 394: The 90-Day Benchmark: What 100,000 Patients Teach Us About Lasting Sobriety Joanna Conti

0:00All right, everybody, I want to tell you about today's sponsor, Wired for Addiction, and honestly, I am so excited about this partnership. You might remember Dr. Evelyn Higgins from when she came on the show to talk about the biomarkers of addiction. That episode landed in such a powerful way for so many of you, and I really believe in the work she's doing. Here's the thing, if you or someone you love has been caught in chronic relapse, addiction switching, or treatment that only works for a while, the issue may not be behavioral. It may be biological, and that changes everything. Dr. Higgins and her team actually measure the underlying biomarkers driving these patterns, dopamine, cortisol, inflammation, mitochondrial function, and then build a personalized plan to bring your biology back into balance.

0:52She put together a free guide for you, the Biology of Addiction 10 Core Biomarkers, downloaded at theaddictedmind.com forward slash wired. That's theaddictedmind.com forward slash wired. There'll also be a link in the show notes. And I want you to know, you are not broken. Sometimes your biology just needs to be understood, and I think that brings a lot of hope. All right, on to this episode. Hey, everyone. Welcome back to the Addicted Mind podcast. I'm Dwayne Osterland, and I'm so glad you're here.

1:30I remember one guy who was the owner of a treatment center out in California had the audacity to tell me that 98 % of his patients were in recovery one year after treatment. And I thought, you know, do you think I was born yesterday? I mean, that's nonsense. If he had any data at all to support that, maybe he was saying that, you know, that 98 % were sober the day they walked out the door or the instant they walked out the door. But I mean, it was just so frustrating. I was thinking, you're lying to me just to get our money. And my daughter's life is at stake.

2:17My guest today is Joanna Conte, the founder of Vista Research Group and the co-founder of the nonprofit Conquer Addiction. Joanna didn't come to this work as a researcher. She came to it as a mom. In 2008, she found her 19-year-old daughter was drinking at levels that could have killed her. And over the next six years, she went looking for treatment again and again with almost nothing to go on. No real data, no way to know if a place actually helped people. Just how kind someone sounded on the phone while her daughter's life was on the line. Her daughter is in recovery today, 13 years now, but Joanna couldn't let go of what that search felt like, so she set out to build the thing she wished she had.

3:05VISTA has now monitored more than 100 ,000 people during treatment and follow-up, with tens of thousands after. We talk about what that data actually shows, how long treatment really needs to last, what families can do once their loved ones say yes, and why previous relapses don't mean someone won't make it. We also get into the hard truth that outcomes haven't moved much in 30 years, and that has to change. So before we jump in, if this podcast has been meaningful to you, take a moment to rate and review The Addicted Mind on Apple Podcasts or Spotify. Even better, write a review. Those reviews help people who are struggling find this show and follow us on social media so you can stay connected.

3:53All right, let's jump into this episode.

4:01All right, everybody, welcome to The Addicted Mind. I have Joanna Conte with me. She is the founder of Conquer Addiction and the Vista Research Group. And I'm really excited about this conversation because I like this kind of stuff when we look at numbers and data and all of that. So, Joanna, why don't you jump in, introduce yourself and tell us a little bit about your story, and then we're going to get into that. Super. Well, Duane, thank you so much for inviting me on the Addicted Mind podcast. I got interested in the addiction treatment space in 2008 when I realized that my teenage daughter had developed a really strong addiction to alcohol.

4:56And we had known for a while that she was drinking a lot and there was a possible problem. But it became really apparent one day when she and I were actually preparing for a dinner party when all of a sudden she said, hey, why don't I make a chocolate cake? And she went off to the grocery store, which was three miles away. And then 20 minutes later, I got a call from the emergency support people that she had been in a car accident and they were airlifting her to shock trauma. And in that 20 minutes that she'd been gone, she had guzzled enough alcohol to get her blood alcohol level up to almost lethal levels.

5:41And that was when I realized that this wasn't just a temporary problem. We had a really serious problem. on our hands. Right. This wasn't a phase that she was going through. She was really struggling with something deeper inside of her that was really just taking over her life, it sounds like. Yeah, it was really severe. And over the next six years, we had her in and out of different treatment centers. Some of that time, she seemed to be doing okay. But a lot of that time, I was really terrified every time the phone rang that somebody would tell me that she had died because she was drinking night after night past the levels that kill a lot of people.

6:27And so it was absolutely terrifying. Fortunately, we were usually able to find effective treatment when things got really bad. But what was so frustrating to me was that each time I had to make the decision on where to send her for treatment, not on the basis of any hard data of, you know, this treatment center is helping a lot of people recover, but on how nice somebody was on the phone. And this is my daughter's life at stake. I had treatment center salespeople tell me all sorts of things. And I imagine as a mother, as a parent, that you're, you know, in such a distressed state, like you don't know who to believe, who to trust.

7:18Are these people just trying to get me in because they're making a lot of money? And are they just telling me this because they just want to sell to me? That's a scary position to be in. Who do you trust? Right. It was really upsetting. I remember one guy who was the owner of a treatment center out in California had the audacity to tell me that 98 % of his patients were in recovery one year after treatment. And I thought, you know, do you think I was born yesterday? I mean, that's nonsense. If he had any data at all to support that, maybe he was saying that, you know, 98 % were sober the day they walked out the door or the instant they walked out the door.

8:07But I mean, it was just so frustrating. I was thinking, you're lying to me just to get our money. And my daughter's life is at stake. And it was just so upsetting. So fortunately, we were usually able to find effective treatment. And over the next six years, She was in several different residential centers. She went to IOP. She went to sober living for extended periods. And our story has a really positive ending because she has now been in recovery for 13 years and has been able to completely turn her life around. She has a wonderful career. She just had her fourth little girl and a happy marriage.

8:55And I mean, just if you had told me 13 years ago, this was in the future, I wouldn't have been able to believe it. Oh, my goodness. That's such a wonderful part of the story that there is hope and that there is that possibility. Right. And I also recognize that some people don't get that possibility. Right. And, you know, doing this work, you know, making it as the most likely outcome we can, putting everything we can there to help us to get to that outcome. Yeah. So I was just haunted by the recognition that we were very lucky and that there were all these other families that we had met along the way whose children and whose loved ones were still struggling with addiction.

9:48And I couldn't put it out of my mind how frustrating it was to not have any data on which to choose what treatment centers to go to. Yeah, and validated data, not just someone making it up on a feeling that they have about their program or what they wish it would be, right? We understand if you work in the addiction field that addiction is a difficult thing to treat. It is very, very challenging. So when you present numbers like 98%, that's just, yeah, that's just as frustrating and heartbreaking. It was so maddening. So a couple of years after my daughter was back on her feet, I was still being haunted by this.

10:39And I thought, just kind of as a labor of love, I want to see if there's any way that I can help the families coming behind us. And so I decided to create a website called Conquer Addiction, where families searching for treatment could put in what they were looking for. It needs to be in California or New Jersey. It needs to take this insurance. It needs to treat these type of patients, this age group, this whatever. And they would get a list of treatment centers that met their criteria with those with the best verified outcomes at the top of the list. So I built this website and then spent an entire summer calling treatment centers.

11:22And this was back in 2015. I was able to get a grand total of five treatment centers in the entire U.S. who were following up with their patients in any kind of scientific fashion after treatment and were willing to publicly share the results. And I thought, you know, there's thousands of treatment centers. There are only five who were bothering to make sure that their treatment actually works. And so I realized I couldn't start to promote those five centers. That's flabbergasting to me, that people don't want to track the results to see if their work is actually validated and to see if what they're doing.

12:09I mean, you can't improve what you don't track. You can't make it better. you can't do that. And to only be able to find five that were willing to do that, really saying, hey, we really want to make this better. Well, I mean, I want to say kudos to those five that were willing to do that. That says something about them right there off the top. It did. It did. But I also thought, you know, I can't promote just these five treatment centers, four of which were at the same, you know, had the same company. So I almost gave up, but my family will tell you I'm pretty stubborn. And so instead I went to one of the treatment center conferences and I started talking to treatment center owners and I said, I don't get it.

12:59Why aren't you tracking your outcomes to make sure that your treatment actually works? And enough of them said, you know, I want to, I just don't know how to do it. And so I thought, well, maybe I'll take this side project a little bit further. And I have a very unusual background. I am a chemical engineer by training. I had started an international nonprofit that had helped tens of thousands of orphans in Africa and Asia. I'd run for Congress of all things. But another thing that I had done along the way was I had taught myself to program and I'd spent five years running a software company. So I could think about how would you cost effectively follow up with patients after treatment?

13:46And I said, this isn't rocket science. We can figure out how to do this in a cost effective way. So I launched Vista Research Group again as a side project. I was a different company at the time in the fall of 2015. And then later I was digging into all of the academic research about how people recover. And I came across this research that showed that if you monitor how patients are doing throughout the time they're in treatment, you know, you measure their depression and their happiness with their treatment and their therapeutic alliance and things like that. And you report it to the clinicians in some easy to understand fashion that patients get better faster.

14:34And I thought, well, that's an obvious thing to add to what we offer to our clients. So we have been both monitoring patients during treatment and following up with patients after treatment since March of 2016. Wow, that is a ton of data. That is great. What's also really encouraging is that a lot of these treatment centers wanted to do this. They just didn't know how. They didn't have the expertise. And how do you incorporate that in a way that's feasible in a treatment center? And I've run some treatment centers, and it's challenging to do all these things and have all these systems flowing to make sure you're really taking care of your clients.

15:22So that is really encouraging to hear. So what did you start to see as you started to onboard these treatment centers into this research program? So we've now monitored over 100 ,000 patients during addiction treatment, and we followed up afterwards with over 50 ,000 of them. And what we found is that on average, about 37 % of patients who go to rehab, whether that's residential or an outpatient setting, about 37 % will be reachable and will report being in recovery, not using alcohol or non-prescribed drugs one year after they leave treatment. So 37%, it's certainly not 98%, but it's not zero either.

16:16And the other thing we found was that there's a dramatic variation in the effectiveness of different treatment centers. At a number of our treatment center clients, over 50 % of patients are in recovery one year later. At others, it was less than 20%. Wow. So you really started to see, okay, this program is working over here. We're seeing higher numbers. This program isn't. You start to dissect what those programs are and really start to get some data that you can, that's tangible, you can do something with. Yeah. And there's a lot of variation in the recovery rates, you know, for a lot of the things, a lot of the reasons that you can imagine.

17:03but there's a lot of variation, for example, by what is a patient's primary drug of choice. We see the highest recovery rates with patients in treatment for alcohol use disorder, followed shortly a little bit below that for marijuana. We see the worst recovery rates for cocaine and fentanyl and methamphetamines. You know, only about 28 % of those patients are in recovery a year later. For alcohol, it's about 42%. So that's one thing that makes a difference. The patient's motivation obviously makes a difference. The age, the number of times they've been in treatment before, you know, all sorts of different factors make a difference.

17:50And what is so wonderful in our research is that we can even show that patients who have been in treatment, 10, 15 times before for the worst drug addictions possible are able to recover. There is hope for everyone. And it makes a huge difference to go to a really effective treatment center. And there are a lot of them out there. I mean, the addiction treatment industry has a bad reputation and there are some bad actors, but there's a tremendous number of treatment centers that are in this because they care deeply about helping their patients recover. And we want to help connect families with those treatment centers.

18:37That's awesome to hear. That's so, so hopeful to hear these treatment centers. There are bad actors in it, but the majority of people, and the majority of people that I've met in the helping profession, they just want to help. Exactly. They just want to help their clients get better. But at the same time, we've got to look at the data. What is actually working? You can have a really good intention, but it doesn't necessarily mean it's effective. So, you know, starting to look at that data. And I love that you said that there's hope for everyone and that you see that in the data. You see it there.

19:17If you get that right kind of support, you can move through this. So let's start to talk about what you started to find in treatment centers that were really effective. What was the thing that started to stand out to you when you looked at this data? Well, I think there's treatment centers that because of the milieu they've created, because of the therapists that they have, that they are just providing more effective treatment. So I would strongly suggest that somebody try and make sure that they're choosing an effective treatment center to send their loved one to. But once you've done that, there's a lot of other things that are under your control that make a huge difference.

20:06One of the most important factors is how long does the patient stay in treatment? We see that patients who are in treatment at one level or another for at least 90 days are twice as likely to be in recovery one year later than patients who leave treatment in 20 days or less. Finish the whole recommended treatment program. Yes, I know that your loved one is going to tell you after 30 days, I got this. They're going to look like themselves. They're going to sound like themselves. They're going to say, I know I can stay sober. help build the support around them, keep them in lower levels of care.

20:49If they've been in residential, go to an intensive outpatient program where they'll go three or four nights a week and continue to get therapy help and continue to be in that community of people needing to recover. Go on to, you know, after that, maybe they go to outpatient where they just go a couple of hours a week, but keep them in that therapeutic environment. The other things that are really important are to help them find a strong recovery support community. Our data shows that patients that get involved in AA or SMART Recovery or something like that and go regularly are twice as likely to be in recovery as those that don't.

21:34Same thing with going to sober living. And if either of those is not possible, set up some sort of randomized drug and alcohol monitoring program so that if they get tempted to slip one time, they recognize that, you know, I'm likely to get caught and maybe that'll be enough to keep them on the straight and narrow. So you just have to build a strong level of support around your loved ones. You know, there's a lot of, I guess, that 90-day mark is thrown around a lot in recovery, that this is time that the brain needs to fix itself, to repair, and it just doesn't happen in 30 days. You just don't get better and walk out, and it's just the reality of how addiction works, and it's almost like really 90 days should be the standard.

22:34It should be. It should be. But, you know, I recognize for a lot of people, they can't leave their job or their children or whatever for that long. But they can surround themselves with continued support, even if they're not, you know, locked away in a secure residential environment. Right. And they can get that support around them that helps them navigate the difficulty of life. And when we have difficult emotions that come up, if you have a support network, you can navigate them in different ways that help you not go to the drug to shift that feeling, distress, whatever it is, and get support elsewhere.

23:24Absolutely. So tell me a little bit. You said something else I want to know about. you said there were the milieu of the treatment center was important. Can you talk about what you mean by that and what that is? Because I think that's a really important thing that I've seen in my work. There are therapists and counselors out there that just know how to resonate with their clients. And just that alone sometimes can be a really powerful component for change. Just having the right person, the right voice, someone who hears you and understands you, sometimes that's the most important piece. Yeah, we ask on each of our update surveys how helpful the clinician has been to the patient.

24:18And we also ask the patient, you know, how close close how strong is their relationship. And that makes a huge difference in whether someone is going to recover if they feel like somebody gets them and cares about them. And of course, the patient is partly responsible too. It's a two-way street. You have to share and you have to be open and so forth. But yes, hiring, having really strong therapists is critically important. But there's more than that also. You know, what we've seen at some centers is that things can go in waves. If there's suddenly a couple of patients who don't really want to be there and they start talking to their peers about, you know, oh, I don't know, I don't, you know, they can talk other people into leaving.

25:13And, you know, it's just important to find a place that has created the belief that and the understanding that everyone there is there to recover. And we're not going to put up with people who are just going through the motions. In fact, one of our long-term clients, I interviewed him for my Delivering Recovery podcast two weeks ago. And he talked about when he was recovering that he had gone to like five treatment centers earlier. And he was just going through the motions and he went to a sixth one. And this time it wasn't the therapists who were on his case because he wasn't serious. It was the other patients.

26:02Patients were like, hey, hey, bud, You know, if you don't want to get sober, that's fine, but we don't want you here. You know, this is a group that is serious about recovery and we're all in this together. And if you're not part of that group, you're not part of, you're not playing the same game, then, you know, get out. And I think that sort of thing is really important to the peer support. And being able to create that environment for that to manifest with everyone there. I think that is a unique talent of therapists and clinical leads and clinical directors to be able to create that environment that says, this is what we're creating.

26:45And you're invited to be here if you play the game of recovery, so to speak, if you're willing to. If you're serious. If you're serious. And if you're not, we don't want you here. Exactly. And, you know, there are some people that will just end up leaving, but maybe that's good for everybody else that's there. Unless you can convince them to come along and get on that mindset and that positive peer pressure, if that makes sense. Like, hey, we're doing this and we're going to cheer each other on and we're going to make our lives better and we're going to work together. And it's so, in my work, it's so amazing to see that happen.

27:28I love doing group work when people get together in a group and they have that mindset. It's so awesome to see as a clinician, because you sit back and the group does it. And you see people becoming their best selves in that environment. It's just amazing to see. I'd love to see that. It's like my favorite part of the whole thing. But I also think in being a clinical director and working in that field, some clinicians are really good at doing that. And some clinicians really struggle in doing that. Can you talk a little bit to how your research data helps clinicians be better clinicians when they get this kind of feedback?

28:20So what we do is we start by screening patients for a variety of different co-occurring disorders like depression, anxiety, trauma, eating disorders, self-harming behaviors, suicidal thoughts, mania, psychosis, and anything they screen positively for, we take them to a full validated assessment. That's, you know, in a short number of questions that gives us an idea of how serious is their depression or anxiety. And then we monitor that on a once a week or more or whatever frequency the treatment center wants. We monitor that for their patients and then we display it in a way that they can really see how their patients are progressing over time.

29:07And we get a lot of other information that we share with them, like, you know, how close is the patient feeling in terms of alliance with their therapist and how satisfied are they with treatment and how happy are they on the medication that they're on if they're on a medication? What are their cravings looking like? And so we can often pinpoint that somebody is not making the progress that you think that they should be making or that, you know, somebody is, you know, is showing signs their cravings are going up, their happiness with their medication is falling off, their satisfaction with treatment just went down the drain, we can show that this person is heading for trouble and they're probably going to walk out very soon if you don't make some changes.

29:53And so just the process of monitoring and getting what the patient is feeling in front of the clinician can really dramatically make a difference in recovery rates. I would imagine with that data, the clinician can then rescue that therapeutic relationship before it deteriorates too far that the client leaves. The clinician can go, hey, it sounds like you're feeling not good here. It sounds like something's not working. Can you tell me about that? And then maybe make those changes that then keep that relationship going and helps further that progress. Exactly. And clinicians will think, well, I don't need this.

30:38I know how my patients are feeling. But if you don't have a systematic way that the patients are self-reporting, you're going to miss things. Like I've heard the same story a number of different times from clients, but one person was telling me about how they had a therapy appointment with one of their patients and the appointment was fine. You know, nothing unusual. They felt the appointment was fine. And then after the patient left, they looked at the result of the VISTA survey. And this person was thinking of killing themselves. And they went running out and they said, wait a minute, we just talked for an hour.

31:18And you didn't tell me anything was going on. Why didn't you tell me you were feeling this way? And the patient said, it didn't come up. Right? So we systematically ask the questions that bring these things to the forefront so that the clinician can do something about them. And we've had one of our smaller treatment centers tell us that they're absolutely convinced that in a 21-month period, using Vista helped them save the lives of three different patients who were just ready to say, I can't do this. I can't put up with the way I'm feeling any longer. And they found out in time to take action and help.

32:01That's also been my experience back in the day when we were running our program. We used feedback-informed treatment model from Scott Miller. I don't know if you're familiar with his research. You are? Okay. And I found it fascinating as we would track that. And really, it's, you know, a clinician that says I can read my patients really well really makes me nervous because I'm like, no, we don't always get it. And clients don't always share. They don't, for a lot of reasons, may not feel comfortable sharing. They may not want to disappoint a clinician. But sometimes these surveys, when they're not facing the clinician face-to-face, they'll give feedback that if the clinician is open to that, can really use it and rescue that relationship before it deteriorates.

32:55And because we just can't read everything. I mean, as clinicians, we just can't see everything. And that kind of data is so important. What was interesting is I did notice a lot of clinicians very uncomfortable with that feedback. That was interesting too, that it's like, oh, you're going to monitor if I'm a good clinician or not. I'm like, it has nothing to do if you're a good clinician or not, right? It's that you're getting feedback that your client doesn't know how to say to you. I mean, these are such great tools to be able to use and then really increase the likelihood that you're going to move this client forward, that they're actually progressing.

33:37I'm just telling you that. At a couple of different points in the VISTA survey, we'll ask some open-ended questions and then whatever the patient tells us, we'll immediately report back to the therapist. And a lot of patients will pour their heart out And what we hear all the time is that clinicians will say they often get much more deep information from these comments than they do face-to-face because a lot of people are just a lot more comfortable today talking to the anonymous internet, talking to their phone than they are looking somebody in the eyes and saying, you know, I don't know if I can go on.

34:17Right. Yeah. Yeah. And that's but that's something that we can use as a tool to help any of us in the in those situations to to get that effective treatment. Yeah. So with all this data, so now you have all this data with, you know, all of this information. How are you now applying this data to conquer addiction? And how are you putting this forward and helping these treatment agencies really be their best selves? So with our clients, with the VISTA clients, we regularly share all sorts of information with them about, you know, what are their trends? How are their patients doing? What different programs, how they compare to one another?

35:09We share all their post-treatment outcomes with them, of course, and we give them information to negotiate with payers and we give them reports they can put on their website to show prospective patients that they're using a third -party monitoring service to improve the effectiveness of their treatment. So we provide a lot of data back to our clients and we do, you know, management reviews and so forth. But I also dig into this very rich database that we've now created. And I regularly publish my results and share them with the whole industry. Like two weeks ago, I did an article about the increase we're seeing in psychosis as patients come into treatment, that there's been a big increase in drug-induced psychosis.

35:58You know, another thing I recently shared is, you know, the impact of ADHD. There's a tremendous high percentage of patients in addiction treatment with ADHD. It's like three times the national average. And so how does that affect knowing that your patient is struggling with that? How does that affect how you do treatment? So we do a lot to try and help the treatment centers improve. But I also have brought this whole quest full circle to working with my daughter. We've created the Conquer Addiction nonprofit to try and help families find effective treatment. And also we share the results we've learned about how to increase the likelihood someone is going to recover with the families too, so that they can encourage that person.

36:50Nope, you're going to stay in treatment for 90 days. I know that you think you're ready, but just stick with us. You're doing so well. Just give it a little bit longer and we'll support you however we need to. So what I'm excited about now is with Conquer Addiction, families can go to the website. They can put in what they're looking for. And they can find treatment centers that have proven that they are providing treatment that is substantially above the average. And so I'm pleased to be able to provide that resource that I was looking for 15 years ago. Yeah, I went on to the website and I was looking up some treatment centers on there and I saw one in our neighborhood.

37:42and I love that the data was listed there, it felt like, okay, here's something I can look at concretely instead of just guessing from a treatment center's website. Where they, you know, that's, the website, unfortunately, is also a marketing tool, right? To get clients in, in our healthcare system, the way it works, that's a necessary part of it at this point until maybe we change that stuff. But so it says, okay, well, I can look at this. This is a third party. I can look at that data and hopefully make the best decision I can in that moment. And then seeing what works. I think that's great for the client, too.

38:24He says, look, this is what we see works. Just do this. Do this, right? Here's the expectation, right? Probably 28 days is not enough, but we can get you to 90. You're going to have a better life, right? like in a positive way, like, you know, invitational and saying, this is good. This is good stuff. You're going to get better. Just do what they say. Yeah. Yeah. So the challenge we face is it's still a tiny percentage of treatment centers who are investing in following up with their patients after treatment. So what, you know, I was hoping when I started this years ago that by this time, you know, the majority of treatment centers would be measuring their outcomes through Vista or through another outcomes research company.

39:13We still see it's a tiny, tiny percentage. And so what we're working on with as Conquer Addiction is another way to estimate the effectiveness of different treatment centers through what happens that you can tell in the medical claims data after treatment. And so I'm hoping that a year from now, instead of having the data on several dozen treatment centers, we have the data on hundreds of treatment centers. But we've been working on it for years. It's finally beginning to become real. But we still have a ways to go to bring that to the public that needs it. I'm so happy that you have the passion to do this and create this.

40:00I think that is, I mean, it's just such a gift to the treatment community. I have one question that's kind of eating at me before we go. But when you look at the data, what is the general outcome for clients in recovery one year out, two years out, three years out? Do you have that data so that people can look at that and know what to expect? So what we find is about 37 % of patients are doing really well one year post-treatment, that they're not using alcohol or any non-prescribed drugs. Typically, they're living in stable housing. They're doing much better. They're back at work or back at school.

40:49They're getting much stronger relationships with their family. Their lives are back on track. Awesome. That's not, you know, there's a lot of other people who are still struggling. And it's not at all uncommon that somebody is going to need two, three, four, six treatment episodes. And I know no one wants to believe that this treatment that they're sending their loved one to right now isn't going to be the end, you know? Right. I mean, that's hard. That's hard to understand. Yeah, but that's also the reality of it. And if we have the reality, we can work with that. Yeah, my daughter needed three different long-term residential treatment centers, even though she did sober livings and all sorts of other things.

41:37And she's probably more typical than, you know, there are people who go once and they're able to get their life back on track and addiction goes in the rearview mirror, but they're probably the exception. So I just realized this is a marathon. It's not a sprint. But most people, I do believe, can recover and will recover eventually. And I think with that data, I think that can be improved over time with the data that you're collecting. Because we can actually look at what is effective and keep engineering treatment to be more effective. Because if we just stick with the 28 days and we know that isn't right, how do we create programs that help people stay in longer, that create those communities that you see, like you were saying earlier, that help people thrive?

42:36I mean, with that data, we can do something with that. And we can continue to improve it over time and get that number higher. Oh, I'm sorry. Excuse me. What Peter Drucker said, what gets measured gets managed is absolutely true. We see that the treatment centers that have been with VISTA for multiple years, their outcomes are continuing to increase because they can use their results to say, you know, let's try this. Let's do this differently. And they can see what works. But one of my biggest frustrations is that our data today, VISTA's data on 34 ,000 patients one year after treatment, is almost identical in outcomes to the last federally funded addiction treatment outcomes study, which was done in 1993.

43:311993. So in 1993, they found 36 % of patients were reachable and abstinent at one year. Today, over the last 10 years, we've increased it from 36 % to 37%. But we haven't seen a huge increase. And I believe it's because we're not measuring what works. If you think at this same 30-year time period in cancer treatment, we saw a doubling from a lot of cancers or better in five-year survival rates because we were measuring it and allowing researchers to see this is what works for this type of patient. And that's what we need to do for addiction treatment. Do you think that's happening? Do you think we're moving in that direction?

44:20Well, we're sure trying. We're sure trying. Okay. Yeah, I mean, that's shocking in some ways that it hasn't changed. But I'm hopeful that there's a new push in mental health. The things that you're doing, large data sets that we can actually use and really look at this so we can improve it. Because it is a hard thing to capture, I think. But I think we have more tools now than ever to be able to get that data. so that's that's hopeful yeah all right we are definitely at our time here joanna so before we end i always ask every guest one question maybe someone out there is struggling maybe a family member has someone out there who's struggling and you could tell them one thing in this moment what would you want them to know love them and help them find effective treatment Awesome.

45:18Don't give up. All right. Where can people find you? And if they want to know more about this, where do they go? I would suggest going to Conquer Addiction's website, which is conquer-addiction.org. And they can find the information about the treatment centers that we know are currently providing excellent treatment. They can also find research results about some of the things that we've learned will make a big difference in helping their child or spouse or sibling to recover. Awesome. And I will put all the links in the show notes at addictedmind.com. So check it out there. Thank you, Joanna, for coming on, doing all that you're doing.

46:02Just really appreciate it. Thank you, Duane. I really enjoyed talking with you today.

46:12The thing that keeps sitting with me is that Joanna's whole life's work came out of not being able to get a straight answer when she needed one most. She was terrified. She was making the decision in the dark. And instead of walking away once her daughter was okay, she turned around and built something for the families coming behind her. And I want you to hold on to something that she said about the numbers. 10 treatments, 15 treatments, the hardest substances there are, people still recover. If you're on your third try or your sixth, that's not evidence you can't get there. It's a marathon, not a sprint.

46:48Stay in it longer than feels necessary. Build the support around you. Don't do this alone. You can find Joanna's work at conquer-addiction.org or vista-research-group.com. I'll have the links in the show notes at theaddictedmind.com, so check them out. And if this episode gave you a little bit of hope, do me a favor, rate and review The Addicted Mind wherever you're listening. Write a review if you can. Share this episode with someone who needs to hear it. And follow us on social media. Every review, every share helps a family who's searching in the dark find a conversation that might just change everything.

47:26So thanks for being here. And I'll talk to you on the next episode. Thank you.