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Evidence-based Treatment
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Treatments and their Differences
Different treatments have different goals, different definitions of the root cause and cure for substance use disorder, different definitions of who a substance abuser is, different types of treatment settings, different ways of treating the problem and different levels of scientific evidence to support their use. Bear with me here, I would like to walk you through some of the characteristics of different treatments.
Evidence-based Treatment or not? Say what?
If you are going to hire someone to help you with a substance use problem, how do you want to spend your time and money? Does the practitioner or program you hire use evidence-based methods, which are treatment methods that have been rigorously tested to make sure they work?
Aunt Rosie’s chicken soup will not cure “strep throat”, antibiotics will. Scientific research studies showed that antibiotics work against streptococcal bacteria (and also showed that Aunt Rosie’s soup does not). The same goes for substance abuse prevention and treatment. Research studies of prevention and treatment programs show which programs work and how well. This type of research is called “treatment outcome research”.
If you are interested in a basic introduction on how treatment outcome research is conducted, you might want to take a look at the Scientific Method and Treatment Outcomes page.
To sum up the idea of an evidence-based treatment: the odds are that a program found through treatment outcome studies to be effective will work better than a program found not to work. Buyer beware. You may want to spend your money, time, and energy (and emotions) on a tested program. Aunt Rosie’s soup tastes great, but it may not handle the problem you want it to.
Philosophy and Goals of Treatment
Treatments can differ in the goals they set for clients. Two main goals are harm reduction and abstinence.
Harm Reduction focuses on reducing the harm caused by over-using a particular substance. Some of the harm reduction methods used are:
- teach people how to drink alcohol or other drugs moderately
- teach people how to set up a designated driver for each outing
- teach people how to switch from cigarettes to electronic cigarettes (vaping).
- provide clean needles for people who inject drugs, or teach them how to sterilize needles
- provide prevention education in schools and through the media
Abstinence focuses on helping the individual completely stop using the particular substance. In the spirit of “Been There, Done That, Bought the Tee Shirt” an abstinence-oriented program does not endorse moderate use and promotes the idea that the individual has had so many negative things happen to them that complete abstinence is the only rational goal.
In summary, harm reduction programs emphasize reducing the negative effects of substance use without saying the person must stop using the substance. Abstinence programs promote completely stopping use of the substance and not trying to moderate use.
Treatment Settings
Outpatient
- Individual Therapy
- Group Therapy
- Continuing Care and Step-down Therapy
Inpatient
- Detox
- Short-term residential
- Long-term residential and half-way houses
Models of Treatment
Different models of treatment make different assumptions about the nature of the substance use disorder and the people who use the substances. Here is a table of the various assumptions that different models of treatment make:
Evidence-based Treatments: A Primer
- Cognitive Behavioral
- Facilitative Conditions (aka 12-Step)
- Motivational Interviewing
tl;dr: Evidence-based treatment may be your best bet. Know and understand and feel comfortable with the goals and philosophy of a particular treatment model before you buy.