Evidence-Based Treatment

Importance

As recently as two decades ago, what happened during the course of addiction treatment was somewhat of a mystery. There were few empirical studies showing which treatments worked, and what was known took decades to trickle from research studies to clinical practice. A gap, not unlike the gap in medical practice, existed between scientific evidence and addiction treatment.

For addictions, which have historically been stigmatized disorders, the gap was especially wide because treatment tended to be isolated from other medical or mental health practice and because practitioners were often peers who were in recovery themselves and practiced from a base of what had worked for them. Sometimes, these approaches worked, and other times, they did not. In general, there was no compelling scientific rationale to support most approaches.

In contrast, the field has recently been moving into another paradigm, propelled by scientific inquiry. The process of scientific inquiry continues to advance understanding of substance abuse and effective ways to prevent, treat, and recover from it. As scientific knowledge is translated from the research arena to practice, adoption and implementation of evidence-based treatment by frontline practitioners is critical if the gains in scientific understanding are to be realized by the millions of Americans at risk for, suffering from, or recovering from substance abuse.

Organizations that fund substance abuse treatment, from federal grant agencies to state organizations to private foundations, have begun to demand that treatments be evidence-based because they hold promise of efficiency and effectiveness—two traditionally important factors in deciding where resources should be allocated. Furthermore, third-party insurance often requires documented use of evidence-based treatment for reimbursement.

Process

Evidence can be determined in a number of ways including expert opinion panels based on clinical observation, on blending of expert opinion with empirical evidence in consensus reviews, and increasingly, on multiple studies (i.e., meta-analyses) of published scientific evidence. For this latter standard, before a treatment can be called evidence-based, a series of steps takes place in the research domain using the scientific method.

To plan and prepare for a research study, researchers first scour published scientific literature, typically in peer-reviewed journals, to find out what already is known from previous research. They may set out to replicate, disprove, or elaborate on past findings. Or, they may aim to investigate a more novel approach. From there, researchers create hypotheses about how certain treatments (i.e., independent variables) may impact or relate to target outcomes (i.e., dependent variables). Researchers carefully specify the independent and dependent variables, data collection procedures, and plans for statistical analyses.

One of the most rigorous ways to determine scientific evidence is through the use of a randomized controlled trial (RCT) study design. In an RCT, a given treatment is tested against another treatment, no treatment, or treatment as usual in an attempt to determine how the given treatment compares with the others.

With data gathered from RCTs and other research designs, researchers use statistical analyses to examine the relations between independent and dependent variables and decide if hypotheses were confirmed or not. Researchers determine if participants who receive a certain treatment changed in significant and systematic ways. Treatments that are consistently associated with significant and systematic desirable changes in dependent variables are deemed evidence-based.

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