Drug Abuse Treatment Outcome Study: Evidence Based 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, motivational 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.

Adolescent Drug Abuse MDFT Case Study (Part 1 of 2) – This is a presentation of a typical MDFT case. It is Part 1 of 2. To see additional videos, including part two of this case presentation, please go to our YouTube channel (www.youtube.com ), or go directly to the videos using the following links: (1) Multidimensional Family Therapy, An Introduction (Part 1 of 2) www.youtube.com (2) Multidimensional Family Therapy, An Introduction (Part 2 of 2) www.youtube.com (3) Risk and Protective Factors www.youtube.com (4) MDFT – Juvenile Justice www.youtube.com (5) Adolescent Treatment www.youtube.com (6) Adolescent Drug Abuse MDFT Case Study (Part 1 of 2) www.youtube.com (7) Adolescent Drug Abuse MDFT Case Study (Part 2 of 2) www.youtube.com (8) Future of Adolescent Treatment and Research www.youtube.com (9) Dr. Howard Liddle, Multidimensional Family Therapy DVD (APA Video Series) www.youtube.com (10) MDFT (Multidimensional Family Therapy, in Dutch with English subtitles) www.youtube.com (11) MDFT (Multidimensional Family Therapy, Dutch version) www.youtube.com (12) MDFT (Multidimensional Family Therapy, German version) www.youtube.com About Dr. Howard Liddle: Howard A. Liddle, EdD, ABPP (Family Psychology), is Professor, in the Departments of Epidemiology and Public Health and Psychology, and Director, of the Center for Treatment Research on Adolescent Drug Abuse at the University of Miami Miller School of Medicine (www.miami.edu\ctrada).Trained as a psychologist and family therapist, Dr. Liddle directs a long term program of …

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