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| Evidence-Based Practices for Treating Substance Use Disorders - Talking Points |
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The intent here is not to demonize EBP - any approach can be just the ticket for a particular client - but rather expose its limitations because it is often wielded as a mandate for competent and ethical practice. Such edicts are gross misrepresentations of the data and blatant misuses of the evidence.
1. What exactly is an evidenced-based practice? It usually means an approach that has established itself better than placebo or treatment as usual in two clinical trials. Such demonstrations are nothing to write home about; intervention of nearly any kind has demonstrated its superiority over placebo for 50 years! This research tells us nothing that we already do not know: Treatment works. So, when Multisystemic Therapy (MST) says that it is an evidence based practice, it only means that it is better than no treatment or treatment as usual, not any other systematically-applied form of treatment. When Ontario implemented MST province-wide, they found that MST was no better than treatment as usual (probation officer visits in this case) as did an independent meta-analysis conducted by the Cochrane/Campbell foundation. Is MST worth the cost of implementation?
2. What does the "evidence" touted by proponents really tell us? Treatment is on average four times more effective than no treatment and twice as effective as placebo. So when Functional Family Therapy (FFT), for example, reports in one study that the no treatment group had a 41% recidivism rate, while FFT achieved 9%, that's great but nothing more than would be expected. Any approach systematically applied by individuals believing in what they are doing will be similarly better than no treatment. FFT has never demonstrated that it is better than any other model of treatment. Is it worth the cost of implementation?
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About The Author:
Barry L. Duncan, Psy.D., is a therapist, trainer, and researcher with over 17,000 hours of clinical experience. He is co Director of the Institute for the Study of Therapeutic Change (ISTC) and practices in Boca Raton, Florida. Dr. Duncan has received numerous awards for his contributions to the mental health field, including the Wright State University School of Professional Psychology's first annual "Outstanding Alumnus Award," the Menninger Foundation's 15th Annual Award for Scientific Writing for the book The Heart and Soul of Change, and the Psychotherapy Networker "20th Anniversary All Time Top Ten Award" for the article "Exposing the Mythmakers," recognizing it as one of the most influential features in the magazine's history. Barry has over one hundred publications, including thirteen books.
Contact him at: http://www.talkingcure.com or http://www.whatsrightwithyou.com/ |
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