Response: Toward Better Lives

Lucy Zammarelli: I like the way the article pulls substance abuse treatment into a standardized medical perspective. Quality of life is typically a goal in treating many diseases other than substance abuse. In the drug abuse field, it provides a broader, more encompassing gauge of success than just whether the client used a drug or how much. Dave Ross: The issue is extremely important. Quality of life doesn't mean just that somebody is now sober. It's much more than that, and it takes a multidimensional program with some longevity to truly address it. Zammarelli: The quality-of-life concept gives us a way to talk to patients about their situation that doesn't play into the shame that surrounds this disease. Instead of pathologizing their behavior, we can say, " Our goal is to help you succeed in your life. " Danny Hall: I practice patient-centered care. My perspective is that if you're truly doing patient-centered care, your outcome is quality of life. And if you're doing a good job, quality of life will improve. Instruments and relationships Zammarelli: I would like to become more familiar with the WHOQOL form that's mentioned in the article. We don't use anything like that in our program. Hall: In our program at the VA, we don't objectively measure quality of life. We use an assessment called the Brief Addiction Measure, which covers quality-of-life issues very broadly with questions about mental and physical health; cravings; work, school and volunteer activities; and religion and spirituality. I think that ultimately it will be a very useful instrument, but so far we don't have norms on it. Ross: At Catholic Charities, we give patients a form that has check-off boxes for mental and addiction issues, general and sexual health, chronic medical problems, food, clothing, shelter, and so on. Patients fill it out at intake and again when they exit the program to measure their progress. Most importantly, we use it as a clinical tool. Interestingly, we initially designed the form using seven-point Likert scales, but that turned out to be too complex for some folks at intake. We shortened the form to three-point scales, and that has been much more successful. Zammarelli: Our field has much to gain from adopting standardized instruments like the WHOQOL. We have such eclectic working methods; it'll be good for everyone when we can develop a standardized vocabulary. Quantifiable empirical data on quality of life …