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Q&A with a Therapist: Andrew Lightfoot on Using Data to Refine Treatment

Andrew Lightfoot joined Eagleville Hospital in 2015 as an intern. Today, he’s a therapist in the men’s co-occurring disorders unit. Andrew sees drug and alcohol counseling as a science and he considers himself a “data scientist” as well as a clinician. We asked Andrew to explain the ways that data shapes his approach to treatment.

What does data mean in the context of your therapy?

I like to say numbers are narratives. As a therapist, I get to hear the personal narratives of 10 people on a daily basis. But as a statistician, I can hear them for hundreds and even thousands of people.

Data tends to get a negative reaction from people who aren’t nerdy math people like myself. So we need to be able to explain how data can be used in therapy so that people understand how it can be beneficial.

Why is it important to talk about statistics in a therapy session?

One of the first things I noticed here is that the patients are treatment-savvy. Many have been to other facilities before they arrived here, so many patients know the negative statistics about addiction, and they don’t want to become just another number.

But they’ve rarely heard the more positive side of the story. They believe they have a 1 in 10 chance of staying sober. But according to nationwide studies from the Department of Justice, 56 percent of the people who complete their treatment program remain sober for the next year.

Four things will greatly improve a patient’s likelihood of being among that 56 percent: finding a purpose, developing healthy relationships with supportive people, engaging in service work in the community, and being vigilant with your after-care treatment.

At the start of their therapy, then, I make sure to not only explicitly explain what treatment is and both of our roles in it, but I’ll also emphasize that a more positive outcome is possible.

What’s the value in hearing that for the patient?

Because so many of our patients have extended experience with treatment programs, it can make them cynical. By highlighting the more positive outcome and how they can achieve it, they’re more willing to experience hope and engage in their treatment. Their attendance at therapy sessions is better, they’re completing more of their treatment work plans, and they tend to have a more positive outlook throughout their treatment.

And it’s not just patients who can start to become demoralized without looking at all the data. Clinicians can, too, when we don’t fully appreciate our patients’ progress.

How is data-driven therapy different from more conventional therapy?

It really shouldn’t be all that different. Every clinician at Eagleville, including myself, is applying evidence-based practices. I incorporate individual data collection in two ways. First, I have my guys keep mood and craving journals and second, I have them set their own SMART goals.

The journals are a single sheet of paper that they carry around with them at all times. When they notice a shift in their mood or a craving, they note the time, their mood, what’s going on around them, and how they’re reacting to it. That lets them make the connection between the work they’re doing in therapy and the everyday results.

SMART goals are specific, measureable, attainable, realistic, and time-oriented goals. I remind my guys to focus on short-term milestones and measure their success today, for the next 30 days, the next 90 days, and so on.

Does the data collection have an immediate impact?

It depends on the individual. Collecting data helps them engage in the treatment, but the effect may start to lag around the midway point. If someone’s coming right off the street and into detox, their symptoms are going to be severe, but they’re going to feel markedly better quickly. As they progress through rehab treatment, the huge gains are harder to come by.

At the end, however, it clearly illustrates for them just how much progress they’ve made. These journals let them see how all the little wins accumulate. If a patient with depression tells me he feels OK today, for instance, that’s a big win. Too often, those little wins don’t get the recognition they deserve in treatment. When we do note them, we’re able to see that they’re not so little, after all.