Evidence Based Treatment
By Ken Gregoire, Ph.D.
Substance Abuse Treatment:
There is much talk in the
substance abuse treatment field
these days about Evidence
Based Treatment. The phrase
refers to treatment that has
shown some sort of evidence
(presumably scientific) that it
is effective. Examples, of such
treatments include cognitive
behavioral therapy, moti-
vational interviewing, a variety of new
medications, brief interventions, etc. On
the surface of the matter it would seem
that any reasonable person would
support doing research on the
phenomenon of addiction and its
treatment and utilize the results of that
research to continually improve the
treatment that is provided. We like to
believe we are reasonable people and
certainly do support outcome research
in our field and do our best to use the
results of that research to improve care.
However, caution is advised here for a
number of reasons.
First, outcome research into
emotional and behavioral conditions is
notoriously difficult to do in the real
world. It has been described as similar
to entering a hall of mirrors. Generally
speaking, the research tends to result
in the conclusion that with any given
condition there are a number of types
of therapy that demonstrate
effectiveness. The research tends to bog
down though when attempts are made
to determine whether or not one type
of substance abuse treatment is superior to another.
Studies then begin to focus on the
attempt to match treatments that have
shown some effectiveness with certain
types of patients in order to maximize
treatment outcomes—basically trying to
determine what kinds of treatments,
provided by what kinds of therapist
work best with what kinds of patients.
The theory is that with good assessment
we can match patients with the kinds
of treatments that are most effective
given their symptoms and maximize the
chances of success. We are sort of at that
place with regard to outcome research
into the treatment of addictions. The
bottom line answer though is that it is
too early to tell. Our field has yet to be
able to even agree on how to measure
the condition we are studying so that
the results of one study or
approach can be reasonably
compared to another.
Second, because it seems
difficult to argue with science
and evidence there is a strong
tendency for those with
political, economic, religious
or social agendas to use the
cloak of science to alter an
existing substance abuse treatment system to
further agendas other than what is
actually best for chemically dependent
patients. I could say much about this
topic but will not get on my soapbox.
Rather, I think it is important to state
where we are with all of this at Valley
Hope.
We believe that chemical addiction
is a disease, that there is no cure, that
recovery is possible, that there is ample
evidence, anecdotal and empirical, that
substance abuse treatment like ours
works. We believe that all alcoholics and
addicts are human beings deserving of
caring, respectful, dignified treatment;
that they are ill not bad. We believe that
the causes of chemical dependency are
complex and not easily understood, that
the disease ravages the entire person and
that as a result treatment needs to be
aimed at helping the whole person—
mind, body and soul. We believe that
the disease is chronic not acute and that
recovery requires a commitment to a life
long plan of action. Consequently, we
believe that our commitment to helping
each patient cannot be time limited. We
believe that the active ingredients in
treatment that works are not easily
defined; that they do not lend
themselves easily to exploration through
the scientific method; and that science
looks at phenomenon through a certain
lens that colors and shapes the way a
certain picture looks. History is replete
with examples of how the meaning of
data has been transformed by a change
in perspective or by somehow
recognizing the effect of context on the
interpretation of the data. For now, we
know deep in our hearts that love moves
mountains and that a spiritual
awakening is tied to recovery from
addiction even though building a body
of data to support these realities is
difficult.
Further, we will be very cautious in
implementing new substance abuse treatments that
sound too good to be true as we have
seen so many come and go
over the years. There is no easier, softer
way to recovery, no magic pill, no easy
aphorism to guide every decision. We
will scour the research on chemical
dependency treatment to glean all that
we can to aid us in helping more people
achieve recovery. We will, however,
evaluate the research critically and
insure that we do not abandon
treatment philosophies and methods
that we know in our hearts work in order
to chase faddish treatments based on
early outcome studies that show some
statistical significance but questionable
clinical significance.
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