A Breath of Fresh, Evidence-Based Air

February 5, 2013

We happily point our readers to a recent Jane Brody article in the NY Times concerning evidence-based treatments for substance use problems. Brody’s article, “Effective Addiction Treatment,” captured a number of essential points about what to look for when you are considering treatment for you or a loved one, always a bewildering maze when dealing with these issues.

It’s mind boggling but true that very few people who get treatment for substance issues receive services or recommendations for anything that is consistent with what works. In fact, it is often the opposite, with people being told that there is one, “right” way to make changes, and if they do not follow this road, they are doing it “wrong” and are in denial and doomed to failure. Treatments that have been shown to work are motivational interviewing, a range of cognitive behavioral therapies, and medication therapies. Also, it is crucial that you or your loved one also get treatment for any other challenges you are having, such as depression, anxiety, ADD, relational difficulties etc.

The article also underlines how imperative it is for treatment consumers to carefully evaluate the credentials of potential treatment providers. As the article points out, most providers of addiction treatment are not trained medical professionals. In fact, many people consider their personal life experiences to be sufficient to call themselves an addiction treatment professional. Just like your cardiologist’s heart problems do not qualify him to perform your bypass (his training does), someone’s own struggles with addiction do not, in and of themselves, qualify them to treat your addiction.

Consumers need to educate themselves about what the evidence shows actually helps people make and maintain changes in their substance use, including which types of therapeutic interventions and which types of medications are helpful and for whom they are most useful. As the article points out, there is a not necessarily warranted belief in “rehab” as the final and best treatment venue to make changes. Most important to understand (again in the one-size-does-not-fit-all vein) is that rehab is a great option..for some people…at certain times; NOT the best option for all people most of the time. As many people discover with behavior changes in their lives (weight loss for instance), these are chronic struggles that need time, work, persistence and patience. As we often say to our clients who are going to rehab: “this is the easy part”. The hard part is implementing and maintaining changes back in their lives, where all the pressures and struggles that were part of their use originally are still there. There is no quick fix to maintaining any kind of behavior change; skills, practice, and supports are needed for the long haul.

The media and exploitative TV shows often make addiction treatment look dramatic, quick, and combative. Real, lasting change would actually look REALLY kind of boring to watch.
Finally, it was thrilling to see mention of Community Reinforcement and Family Training (CRAFT), which, unlike interventions, and unlike Al Anon, helps families help their loved ones make changes in substance use, and enter and stay engaged in treatment. Really. And that’s what evidence-based means. There is real, substantial proof that this works. We are hoping that word is finally beginning to spread about what actually works and why. It will be enormously helpful to millions of families trying to navigate what is often a labyrinthine treatment system. Thank you Anne Fletcher and Jane Brody!

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