Evidence Based Treatment

Evidence based treatment.... how often do we hear the phrase and what does it actually mean? It is supposed to mean that treatment is based on "what works" and that "what works" has been scientifically validated by research. However.....

Here in the UK we consistently ignore evidence that does not suit the political agenda. There is a wealth of research on the effects of addiction on the brain - using various brain imaging techniques - that demonstrates that the effects that drugs have on the brain and which show that the human brain does not show signs of recovery until a considerable period of abstinence has passed. Without going into a small book this research has considerable imlications for the treatment of chemical dependency. Walk into 100 or so alcohol and/or drug agencies up and down the country and ask if any of the staff are even aware of this research and you will find not.

This week an American psychiatrist was quoted as saying that the brains of compulsive gamblers also show similar abnormal scans and it is also a known fact that Naltrexone has been researched in the US as a potential treatment for compulsive gambling.

We also know that there is a distinct correlation between the availability of "addictive" substances and behaviours and the number of people exhibiting problems. Do we take all this evidence into acount? Do we hell - it just doesn't suit the governments agenda! Lets roll out 24 hour drinking and loads of casinos. Then act suprised when the number of people with alcohol and gambling related problems goes up! It will, the all the evidence predicts that it will - but we will ignore the evidence when it doesn't suit us!

Consider the so called "assessment" of individuals with alcohol and other drug related problems. There is a wealth of evidence that shows that there is substance use, substance abuse and substance dependency. The evidence also shows that these are distinct conditions with distinct needs in terms of treatment. Do all alcohol and drug services then actually sit down and diagnose which of these groups an individual falls into? No most do not, and consequently most treatment is inapropriate not to mention ineffective. Why is this? Because dependency requires intensive skilled (and often residential) treatment and the system is generally speaking not geared up to provide this.

It is easier for services to train staff to deliver MET or SFBT (it requires a short 3 day course in many peoples eyes!) than it is to train staff for the year or so required to deliver abstinence based services.

Don't get me wrong - I have nothing against Motivational Enhancement Therapy or Solution Focussed Brief Therapy - with the right individuals at the right time there is no doubt of it's effeciveness. For the rest of the client group however is a sentence to failure and dissilusionment with treatment.

Lets carry on then, blame the clients when treastment fails and concentrate on what is usually economics rather than the real evidence!