Want Quality Treatment? Evidence-Based Therapies Increase Your Chances of Lasting Addiction Recovery

If you broke your arm you’d probably go to a hospital, and no matter which one you went to, you’d likely get similar treatment (x-ray, pain medications, cast or sling, etc).

Addiction treatment isn’t like this, and this lack of uniformity is mostly a bad thing:

• Go to one residential program and you’ll get pharmacological management of withdrawal symptoms, cognitive behavioral therapy to learn cravings management, an introduction to community self help groups like AA and other useful evidence based interventions.

• Go to another residential program with the same problems and you’ll spend days in a hot sauna ingesting supplements and learning very little.

One provides you a solid base for recovery and the other provides little of benefit (and maybe much of harm), but before you go, when looking at 2 equally attractive websites and when talking on the phone with people who all sound very convincing, how are you supposed to know which one is best for you?

Here's how:

• You can evaluate the potential quality of an addiction treatment program by asking detailed questions about which evidence based therapies make up the curriculum -  which ones get used, how are they used and what kinds of staff members run them?

You probably don’t know much about evidence based therapies for substance abuse treatment, but that’s OK - read on, and by the end of this article you’ll know:

• Why you want a treatment program that uses evidence based therapies
• Some examples of evidence based therapies
• About red flag warning signs of non-evidence based programs
• What to ask when you call up treatment programs on the phone

Characteristics of Evidence Based Therapies

So, what is an evidence based therapy?

Definitions can vary slightly, but basically, a treatment is considered evidence based if:

1. Researchers evaluated the treatment using randomized controlled trials or other experimental means and published their results in a peer-reviewed journal
2. Other teams of researchers replicated the experiments and observed similar outcomes
3. The treatment has proven benefits and works as intended
4. The treatment can be standardized and is usable across multiple sites to produce similar results¹

So when you go searching for addiction treatment, especially if considering a residential treatment program, you’ll have to decide between two types of programs

1. Those that use evidence based therapies
2. Those that choose not to

Do you want to go to a program that uses rigorously studied therapies proven to work as promised, or do you want to go to a program that uses unstudied therapies, or even worse, therapies studied and found ineffective?

Evidence Based Therapies for Substance Abuse

The following are some (not all) evidence based therapies for substance use disorder treatment as of June 2013.

Evidence Based Pharmacotherapies

There is strong evidence that, for appropriate candidates, medications used in conjunction with psychosocial therapies increase the odds of success. According to the American Psychological Association (APA), any alcohol or opiate addicted person deemed an appropriate candidate for medication should receive pharmacotherapy.²

Medications proven beneficial in substance use disorder treatment include:

• Methadone (opiates)
• Buprenorphine (opiates)
• Naltrexone or Vivitrol (alcohol)
• Disulfiriam/Antabuse (alcohol)
• Topiramate (alcohol)
• Varenicline (tobacco)
• Buprion (tobacco)
• Nicotine replacement therapy, such as gum or the patch (tobacco)³

Evidence Based Behavioral Therapies

• Motivational interviewing
• Motivational enhancement therapy
• ‘A Woman’s Path to Recovery’ (an evidence based program of recovery for women only)
• Structured couples or family therapy, or ‘Alcohol Behavioral Couples Therapy’
• Behavioral couples therapy
• Cognitive behavioral therapy
• Contingency management (incentive programs)
• Community reinforcement therapy
• 12 step facilitation therapy (an introduction to the 12 steps)
• The ‘Matrix Model’ (an integrated system of treatment for stimulant abusers)
• 'Brief Marijuana Dependence Counseling'
• 'Strengths Based Case Management' for substance abuse
• ‘Trauma Informed Substance Abuse Treatment’ (a model for women with co-occurring addiction, mental health problems and trauma histories)
• ‘Broad Spectrum Treatment’ (an outpatient program for alcoholics that combines naltrexone and behavioral therapies)
• ‘Contacts, Prompts and Reinforcements’ (an aftercare program that you start during your last week of residential treatment)
• ‘Network Support Treatment’ (a one-on-one program of individual counseling for alcoholics)
• ‘Oxford House Model’ (a model for sober living housing)
• ‘Relapse Prevention Therapy’ (a very common program that teaches behavioral self control)⁴

Red-Flags: Programs that Conflict

While it’s not vital that a treatment program employ only evidence based therapies, programs that boast interventions or policies that contravene what's proven to work may not be the best choice for your treatment experience.

Some examples of policies and interventions that conflict with an evidence based philosophy are:

• Using acupuncture or relaxation therapy as a stand-alone treatment (these types of therapies may serve some purpose as peripheral or secondary programs, but should not serve as first-line treatments)
• Individual psychodynamic therapy
• Unstructured group therapy (not the same as structured - therapist directed - group therapy)
• Confrontational techniques
• Programs that advertise detox without continuing treatment as sufficient (some ultra rapid opiate detox-type clinics may make these types of claims)
• Programs that discharge people from treatment based on relapse

Questions to Ask When Calling Treatment Programs

• Since retention and engagement are so vital to eventual success, how will you keep me encouraged and motivated to continue (to not drop out)?
• Noting that major medical and governmental organizations such as SAMHSA, NIDA, ASAM the APA and others all endorse the use of treatment medications, what is your philosophy on the use of these treatment medications, where appropriate?
• Which evidence based therapies do you use?
• Who runs group therapy sessions? What type of credentials/license does this person have (group therapy is enormously helpful, provided it’s run by a trained counselor or therapist)?

After You Call, Double-Check What You’ve Been Told

Here’s the thing about addiction treatment:

1. Sometimes people tell you things about recovery that aren’t true. Reasons for this include: they incorrectly believe what they’re telling you, they believe that deception serves your best interest - or in more nefarious situations, they may intentionally mislead you as a way to convince you of some fact or to sell you on some program
2. And sometimes, even things that seem to make a lot of sense, aren’t necessarily true.

Here’s an example:

• You can’t solve a drug problem by taking more drugs.

On the surface it sounds pretty sensible, but in reality, research tells us that in appropriate situations, anti-craving or withdrawal management medications can help a great deal and can greatly increase your chances of maintaining recovery.

So what’s the consumer to do?

Check and recheck!

Fortunately, you don’t need a Ph.D to find accurate information. Try this:

1. When you call treatment programs, ask specific questions about which evidence based interventions they use. Tell them you plan on researching these later so you need the precise names of each therapy.
2. Write these names down
3. Check out the Substance Abuse and Mental Health Agency’s Evidence Based Treatment Registry. If the treatment is truly evidence based, you'll find everything you need to know about it on their website. The University of Washington‘s Alcohol and Drug Abuse Institute runs another good resource on evidence based programs for substance abuse treatment, which can be found here.