It’s great to see the New York Times bringing to light a phenomenon CMC psychologists know all too well: there are many types of psychotherapy that have demonstrated effectiveness, however, these are typically NOT the treatments clients receive. Some of the barriers are lack of therapist training, therapist belief systems (therapy as art, therapy as solely about the relationship) and a gap between researchers and clinicians in effectively sharing information about best evidence-based treatments (“EBT’s”).
In our experience, this phenomenon is even more pronounced in the field of substance abuse treatment. As Bill Miller, one of the originators of Motivational Interviewing (a leading EBT) so eloquently and accurately put it: “the negative correlation between scientific evidence and treatment-as-usual remains striking, and could hardly be larger if one intentionally constructed treatment programs from those approaches with the least evidence of efficacy” (Miller, 2003). We’re doing the oppositie of what the evidence has shown us works!
The treatments that have evidence to support their effectiveness in helping people make and sustain changes in their substance use are mostly under the umbrellas of a) motivational and b) behavioral therapies. Included in this list are: Motivational Interviewing (MI), Motivational Enhancement Therapy (MET), Behavior Marital therapy (BMT), Community Reinforcement Approach (CRA) and contingency management approaches. There are also several effective medications for specific classes of drugs (opiate maintenance medications like suboxone for opiate dependence, antabuse for alcohol abuse) that have demonstrated effectiveness. There are other therapeutic experiences that might be quite meaningful for a given individual, such as experiential therapies including psychodrama and art therapy. However, there is no consistent evidence linking these treatments with positive outcomes in terms of changes in substance use outcomes.
The list of questions posed in the Times article are also quite helpful in looking for a therapist more versed in EBT’s. Looking for a good therapist, one that can help you most effectively address the challenges you want to work on, is a daunting task. Different experts will sometimes give wildly divergent opinions as to what can best help you. Educating yourself about the types of treatment, training, etc that have been shown to be the most impactful will help you navigate this system and pick someone who you not only feel comfortable with, but who also has the skill set best suited for your needs. In terms of additional questions to ask when seeking addiction treatment specifically, Anne Fletcher’s new book, Inside Rehab, provides a fantastic list to help you discriminate between the tons of programs that supposedly use evidence based practices, and find those that actually use the ones you need based on your individual situation.