PHQ-9 Depression Outcomes by Steve Carleton

Gallus Medical Detox specializes in not only inpatient medical detox but also prolonged recovery and lowered relapse rates, which stem from our behavioral health team. At Gallus, our behavioral health team consists of Clinical Directors and our Executive Clinical Director, Steve Carleton, who is an expert in the field of PTSD and substance use disorder.

We recently sat down with Steve to talk about Gallus’s behavioral health screening and treatment process. Take a look at what he had to say.

What therapies and tools do you use for your patients?

At Gallus, Motivational Interview (MI) is the primary approach to engage patients and help them lay the foundation for their recovery. This patient-centered and compassionate approach allows the patient the ability to arrive at their own decisions about change and is proven to increase motivation for change. Upon admission and at the time of discharge, we administer the Patient Health Questionnaire (PHQ-9) to accurately evaluate the patient’s level of depression. We also complete Importance and Confidence rulers at admission and discharge which gauge motivation for change around substance use. Lastly, our Next Step Aftercare Process is based on Systems Theory. This theory guides our outreach to family and referent partners to ensure that people are connected and leveraged for better outcomes in our patient care.

How does this help patients?

Motivational Interviewing is client-centered and non-judgmental, which really allows our patients to identify their reasons, abilities, needs, and desire for change. By processing ambivalence about substance use, patients are more likely to arrive at healthier decisions for their follow-up care. As a result, we have been successful in achieving an 85% rate of connecting people to treatment upon discharge. The Gallus Method of compassionate detox allows us the ability to engage therapeutically. The comfort provided by our expert medical staff is not found elsewhere at the detox level of care and makes a significant difference in outcomes.

Family members and referent partners play a huge role in substance use treatment, so our Systems Approach recognizes the importance of communicating and working together towards the common goal of helping patients be successful in detox and an appropriate aftercare plan.

We administer a PHQ-9 for patients at admission and discharge. This tool measures depression reliably in 9 questions with the highest score being 27. The data suggests that upwards of 80% of patients in detox are depressed. The Gallus Method and Next Step Aftercare process has proven to reduce these scores by 5.88 points on average.

How does trauma and depression play a role in patients with SUD?

We address all our patients with a trauma-informed lens. During our clinical interview, we educate patients that there is often an underlying connection between substance use and traumatic experiences. We create a space in the assessment process for patients to disclose underlying experiences that might be driving their substance use. By combating avoidance in detox we help patients to set the foundation and set them up for success in aftercare. We reinforce in this process that the patient is in control of the process and how much or how little they choose to share.

85% of people with substance use disorder have experienced trauma. While this does not completely explain substance use disorders, it does increase the likelihood of avoidance and self-medication. By confronting avoidance and drivers for self-medication early on, it can bring a sense of self-efficacy and confidence that they can be successful in aftercare.

Research also offers that over 80% of detox patients meet the criteria for depression or some other mental health issue. The question we address in the Next Step Aftercare plan is what came first the mental health struggle or the substance use. The majority of the time patients have a sense of the answer to that question and it greatly informs what aftercare option might be the best fit for them.

Why do you think your patients have had such great success with this method?

Gallus has been collecting PHQ-9s since December of 2020. On average people score an 11.5 at admission and a 5.9 at discharge. An 11 indicates moderate depression and a 6 indicates mild depression. This is clinically significant and demonstrates that Gallus reduces depression from moderate to mild in a short period of time. This change is a direct result of the medical and therapeutic care people receive during their stay at Gallus. Often, our patients have had experiences in detox and treatment where they did not feel supported and cared for by clinical staff. The Gallus Method and Next Step process generates a newfound sense of trust in providers and the process of recovery whether it is a person’s 1^st or 15^th time in treatment. Gallus is in a different stratosphere when it comes to patient care in detox.

Our patient satisfaction scores also speak for themselves. We consistently score in the mid to high 90^th percentile of satisfaction. We do absolutely everything we can to support and care for our patients while they are at Gallus and time and time again, they give us the feedback that we are doing it better.

Technically speaking, Gallus takes a more proactive approach to both the medicine and aftercare planning process. We do not wait for clients to feel desperate in their symptoms before intervening medically and similarly, we do not wait until the 25^th hour before setting up a plan. Our medical detox protocols are unparalleled and more efficiently treat withdrawals. The truth is that withdrawing from substances leads people to feel more hopeless and unmotivated for change. This perpetuates clients continued use and hopelessness that things can and will improve with the right support. Put simply, Gallus genuinely provides a caring and compassionate experience and this increases hope that they can make a change and have a better life.

Steve Carleton

Steve worked in the Department of Veterans Affairs for 10 years. He is a PTSD and substance use disorder expert with over 14 years of experience in and around addiction. Steve is also an Adjunct Professor at the University of Denver’s Graduate School of Social work. He teaches cognitive behavioral therapies, Motivational Interviewing, assessment skills using DSM-5, amongst others.