Given the choice, you want an evidence-based treatment center for yourself or a loved one, right? It sounds like the best choice. It is a great choice but do you know why? And do you know what to look for?
What Is Evidence-Based Treatment?
Evidence-based treatment (EBT) refers to treatment that is backed by scientific evidence. This means that studies have been done and the results of extensive research have been collected on a certain treatment. If the results show it to be successful, it encourages the use of safe and effective treatments that are likely to achieve the desired results and lessen the use of unproven and possibly unsafe treatments.
How Did Evidence-Based Treatment Start?
Evidence-based treatments have an important role in evidence-based practices (EBP) in psychotherapy and general health care. EBP is the offspring of evidence-based medicine which was established in 1992 for the same reasons. EBM encourages the use of safe and effective medicine as opposed to poorly studied, possibly harmful choices.
The National Registry for Evidence-based Programs and Practices is kept by the United States’ Substance Abuse and Mental Health Services Administration (SAMHSA). The Registry lists all evidence-based programs and practices. To be listed, a practice must have undergone extensive research and have been shown to have a substantial impact on individual mental health results.
The American Psychological Association (APA) has supported the idea of more evidenced-based practices and treatments in dealing with mental health issues. A statement from the APA defined EBP as “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.”
Goals and Benefits of Evidence-Based Therapy (EBT)
The main two goals of evidence-based practice are:
- Increased quality of treatment
- Increased accountability
Meeting these two goals will ensure that patients will only pay for and undergo treatments that have proven to be effective. Research has shown that evidence-based therapy is cost-effective because of the decrease in time spent receiving treatment compared to patients who undergo treatment plans which may or may not be effective.
Researchers stress that along with the push for cost-effective therapy, it must also be clinically effective. Some argue that therapists should be held accountable for their effectiveness just like the treatment plans are.
What is Evidence-Based Rehabilitation Treatment?
When looking for treatment for a substance use disorder (SUD) most people who want or are forced into treatment do not receive health care that is lined up with evidence-based practice. According to the BMJ Medical Journal, evidence-based “means integrating individual clinical expertise with the best available clinical evidence from systematic research.”
It also includes the patient’s individual circumstances, preferences, expectations, and values. There is no “one-size-fits-all” solution. Any list of evidence-based treatments will include a variety of approaches.
Evidence-based therapies do not support the idea of “hitting bottom.” With any chronic disease, including addiction, early intervention will give the best outcomes. And even more important is prevention because SUDs are preventable and treatable.
In evidence-based practice, the treatment process uses individualized care and uses a holistic perspective. That is, it treats the whole person. It takes into consideration the mental and social factors instead of just the symptoms of the disease. In this way, the care provider can use her specialized knowledge, the patient’s values and preferences, and the best research evidence to see what combination of treatment tools should be used.
Interventions Used in Evidence-Based Therapy
Every approach to addiction treatment is meant to address certain features of addiction and its consequences on the individual, family, and society. Each approach is meant to add to or enhance existing treatment and others are complete in and of themselves.
- Pharmacotherapies—Pharmacotherapy is the treatment of disease and especially mental illness and substance use disorder (SUD) with drugs. Some medications used in pharmacotherapy include:
- Methadone—Methadone is a synthetic opioid medication that prevents withdrawal symptoms and reduces cravings in people who are addicted to opioids. It can also block the effects of illicit opioids.
- Buprenorphine—This is also a synthetic opioid that does not cause the euphoria and sedation of other opioids but can eliminate withdrawal symptoms and has a low risk of overdose. Buprenorphine treatment for detoxification or maintenance can be provided by qualified professionals who have received a waiver from the Drug Enforcement Administration.
- Naltrexone—Naltrexone for opioid addiction is usually prescribed in outpatient settings, but the treatment should begin after medical detoxification in a residential setting to prevent withdrawal symptoms. Naltrexone also blocks the receptors in the brain that are involved in the rewarding effects of drinking and the craving for alcohol.
- Acamprosate—This medication has been shown to help dependent drinkers maintain abstinence for several weeks to months. It may be more effective for patients with severe dependence.
- Disulfiram—Disulfiram interferes with the break down of alcohol, which results in a very unpleasant reaction if a person drinks alcohol.
- Behavioral Therapies—Behavioral approaches to treatment help involve people in substance use disorder treatment, providing incentives for them to stay abstinent, and change their attitudes and behaviors as they relate to drug use. In addition, behavioral therapies increase a patient’s life skills to handle stressful situations and environmental triggers that may bring about another cycle of substance use. Some evidence-based therapies that effectively address substance use include:
- Cognitive-Behavioral Therapy (CBT)—People in CBT learn to identify and correct problem behaviors by using a range of different skills that can be used to address drug use and other problems that often co-occur with it. The main part of CBT is preparing for likely problems and developing coping strategies.
- Contingency Management (CM)—CM involves giving patients physical rewards to reinforce positive behaviors, such as abstinence. Studies have shown that incentive-based programs are very effective for increasing treatment retention and promoting abstinence.
- Dialectical Behavior Therapy (DBT)—This is a type of cognitive-behavioral therapy that is focused more on emotional issues. The main goals are to teach the patient how to live in the moment, cope with stress and painful emotions, and improve relationships with other people.
- Family Behavior Therapy (FBT)—FBT has shown positive results in both adults and adolescents. It addresses not only substance use problems but other co-occurring conditions. FBT combines behavior therapy with contingency management. The therapist tries to engage families in using the behavior strategies taught in the sessions and obtaining new skills to improve the home situation. During sessions, the behavioral goals are reviewed and rewards are provided by significant others when goals are fulfilled.
Are 12-Step Programs Evidence-Based?
Alcoholics Anonymous, Narcotics Anonymous, and other 12-step programs use a social model of recovery. This model is built on the idea of peer support in a safe environment. There has been research on the effectiveness of 12-step programs. Research shows that they work for some people and there are some benefits to this model of recovery.
The principles of the steps must be personalized in the individual’s mind for the person to achieve lasting abstinence. Twelve-step programs are an incomplete approach and don’t meet the requirements for the classification of evidence-based treatment because they don’t have biomedical and psychological parts and they tend to use a one-size-fits-all approach.
Addiction researchers have found that individually, cognitive and behavioral therapies, including supports like 12-step programs are not complete treatments for a chronic disease like a SUD. Involvement in a support group would be only one piece of the puzzle for treating a disease that has physiological and genetic origins.
Evidence-Based Treatment and Insurance
The increased attention to the importance of EBT has led to increased demand from insurance companies. Medical professionals are being pushed to choose EBP and EBT to qualify for coverage.
Requirements for determining whether a treatment is evidence-based are very specific. Some physicians are doubtful whether the emphasis on EBT is necessary. Research is important, especially regarding medications. However, some argue that there are treatments that may not meet the EBT requirements but have shown to be successful in other ways.
Using EBT is just one part of evidence-based practice. EBP also highlights the importance of informed decision-making when deciding how to approach a person’s health condition. This means that the physician or mental health professional needs to be aware of current discoveries in research. This will allow him or her to explore all possible approaches to treatment.
What to Look For When Choosing Evidence-Based Treatment
It’s a major decision to go for treatment. Or to help someone close to you go for treatment. When you are deciding on where to go for mental health or substance abuse treatment, look for a facility that provides a variety of evidence-based therapies. It can’t be overstated that every person needs and deserves a treatment plan specifically for them. Some choices include:
- Cognitive Behavioral Therapy
- Exposure Therapy
- Family Therapy
- Dialectical Behavior Therapy
- Motivational Interviewing
- Group Therapy
- FDA-Approved Pharmacotherapy for:
- Alcohol Use Disorder
- Opioid Use Disorder
- Nicotine Use
- Bipolar Disorder
Where Can You Go For Evidence-Based Treatment?
Since 1970, the Discovery Institute has been offering evidence-based programs for the treatment of substance use. We have a variety of therapies. Any treatment plan can be developed to specifically meet your needs and preferences. Our staff is made up of medical and clinical therapy professionals. Their only job is to help you accomplish your goals. Also, we offer several levels of care from residential treatment to sober living after your formal treatment is completed.