You may have noticed some treatment centers describing their programs as ‘evidence-based treatment’. Your next thought may have been ‘what does evidence-based treatment mean exactly?
Evidence-based treatment is not limited only to the drug and alcohol rehabilitation sphere, but we will focus there. To understand how drug and alcohol treatment became what it is today, it’s helpful to know where it has been. Prior to the 1970s and 80s, drug and alcohol treatment occurred primarily in hospitals, psychiatric facilities and some dedicated rehab centers. The best most hospitals could do was to medically detox a patient safely and perhaps bring in a few Alcoholics Anonymous meetings. Many people managed to get sober this way, however, the treatment providers themselves weren’t necessarily vetting every therapy for effectiveness.
By the 1960s and 70s, it was widely understood that the 12-step fellowships did help a great number of people when it seemed nothing else could. Hospitals, psychiatric facilities and rehabs relied on the fellowships to help patients remain on the road to recovery following treatment. In fact, 12-step programs are recommended to this day and they do help. However, what was largely missing in the treatment of addiction was a standardized approach to choosing treatment methods. Ideally this would mean using methods proven by peer-reviewed research. Furthermore, internal research, as to which therapies were working best for which patients and which were failing them was rarely done. The grim recidivism (relapse) rate was well known, but there were few concentrated efforts to determine what worked best and for whom. Without that critical information and a standards-based approach for therapies, the new substance abuse treatment facilities that began to appear in the 1980s were left to their own devices. Many had “alumni departments” that did some limited follow up, but almost no one was tracking the results of specific treatment methodologies. As a result, treatment for drug and alcohol abuse did not change dramatically during the latter half of the 20th century. New medications appeared and new forms of therapy, but there wasn’t a great deal of science or technology being brought to bear on the problem.
Several changes in the addiction medicine paradigm and the world around it came together to inspire adoption of the evidence-based approach. So, what does an evidence-based model look like?
A rehab that follows an evidence-based treatment model utilizes methods that have the following qualities:
- The method has undergone study and research by reputable organizations.
- The method has been proven effective and this is documented in peer-reviewed research.
- The method can be repeated faithfully. There are guidelines that clearly define it.
- The rehab rejects treatment methods that are not proven or may even harm the patient.
In essence, evidence-based treatment means using techniques that have been scientifically studied, are proven effective, and are standardized. (1) Examples of evidence-based methods include Cognitive Behavioral Therapy (CBT), Dialectical Behavioral Therapy (DBT), Eye Movement Desensitization, and Reprocessing (EMDR). It may surprise you to know that attending Alcoholics Anonymous is also considered a part of evidence-based treatment. While AA itself conducts no research into its members, numerous studies have shown the 12-step method and meeting attendance is effective. (2)(3).
The adoption of evidence-based treatment is improving the outcomes for addiction care patients. This approach is also contributing to the evolution of care as more facilities conduct their own internal studies. The National Institutes of Health received substantial increases in funding to facilitate substance abuse research. Studies from the National Institute of Drug Abuse and others have helped bolster certain methods and discredit others. Most importantly though, the quality of treatment is better than ever before thanks to the embrace of scientific validation.