What are Evidence-Based Practices?
Determining the best way to treat drug addiction is a contentious issue in the field. There are a wide range of competing theories, and different drug rehabilitation centers often have preferred approaches. There is some notable criticism, however, because there is thought to be a rift between the day to day practice of treating addiction and the research that’s been conducted into what actually works. The assumption is that if addiction was tackled using evidence-based practices, then the success rate would be better and more people would be able to stay clean after treatment.
Defining Evidence-Based Practices
The basic definition of an evidence-based practice is pretty simple. It’s easier to understand if you consider the treatment of a medical problem rather than a psychological one. Consider the treatment of a bacterial infection. For antibiotics to be confirmed as the best treatment they have to be tested scientifically. To do this, scientists take a group of people with an infection and then randomly divide them into two different groups. Half receive an antibiotic and half receive a placebo, or sugar pill. If more people who receive the antibiotic are cured of the infection than those who take the sugar pill, the treatment is likely to be effective.
This placebo is used to discount the influence of its namesake effect. If somebody is told that a pill will cure a condition by a doctor, for some reason not fully understood, they are likely to actually get a bit better. To differentiate this effect from the effect of the treatment, the "control" group (who receive the placebo) will have to show considerably less improvement than the "experimental" group (who receive the treatment). If the treatment still appears to be effective after these measures have been taken (and ideally after the results are replicated by other studies) then the practice can be called evidence-based.
How it Relates to Addiction Treatment
Interventions to help people overcome addiction should be shown to be effective in the same way. If treatments are backed up by scientific research, it proves that they hold some genuine value rather than just having a psychosomatic impact. As in the bacterial infection example, "placebo" treatments are needed in studies into addiction treatments. These are usually either generic clinical management and counseling or just no treatment at all. Only if a particular therapy consistently has a higher success rate than those can it be considered evidence-based.
Despite the obvious benefits of using evidence-based practices, psychotherapists commonly shun them in favor of less-studied or outright ineffective treatments. This was illustrated when a group of researchers famously claimed that the negative correlation between evidence-based treatment methods and standard psychological practice "could hardly be larger if one intentionally constructed treatment programs from those approaches with the least evidence of efficacy."
You can determine which treatments are evidence-based by using scientifically valid studies and reviews of multiple studies. For example, auricular acupuncture is commonly used to help with cocaine addiction, and its effectiveness has been tested numerous times. A Cochrane review (which look at several empirically sound studies in order to draw more weighty conclusions) into the effects of auricular acupuncture found that there is no evidence that it’s actually effective for cocaine addiction. It’s still commonly offered by rehabilitation centers as treatment, regardless.
What We Can Learn From Evidence-Based Practices
The most basic lesson that can be taken from evidence-based practices is that it’s useful to determine how useful things actually are. It’s easy to believe that something is effective because it helped you turn your life around, but there are often unnoticed variables which have an impact on the result. You might think that acupuncture helped you beat a cocaine addiction when in reality it was your level of motivation or the fact that you’d previously hit rock bottom. Separating our day to day tunnel-vision view of cause and effect from the independently verifiable consequences of a particular intervention isn’t easy, and that’s where scientific research comes in.
Several approaches to treating addiction have been identified as having a positive therapeutic effect in comparison to a generic treatment or no treatment. These include cognitive behavioral therapies, motivational enhancement therapy, contingency management and twelve step facilitation therapy. Consensus on the most effective treatments will change as more research is conducted, but the evidence-based practices we’ve identified so far are our best options for helping people overcome addiction.
To improve the rate of success in the treatment of addiction, the therapeutic community has to embrace science with open arms instead of shunning it like an uninvited party guest. Research isn’t something to be feared; it brings us incrementally closer to finding the best method of helping people addicted to drugs. Rehabilitation centers should adopt these methods of treatment readily instead of clinging obstinately to ineffective interventions. As we gain more and more knowledge, our approach needs to be refined to ensure the best outcome for the patients.