What defines “clinical excellence” in addiction treatment? This article is the second in a three-part series aimed at answering that question. In the September issue of Sober World, I laid out three key building blocks of progress in addiction treatment. Now we’ll turn our attention to nine “evidence-based” practices that define clinical excellence in addiction treatment. Ideally, a quality treatment program will offer a diversity of clinical offerings, according to Dr. Jay Kuchera, M.D., an anesthesiologist with expertise in addiction medicine. In advising individuals and families regarding what to look for in quality addiction treatment, she said, “If there are five clinicians, you want to see the diversity of therapies offered and what the therapists are trained to do.” On that note, whether you’re a client needing treatment, a family member, or referring professional, these five evidence-based behavioral therapies should be on your checklist for evaluating the clinical excellence of any drug or alcohol treatment program:
1. Cognitive Behavioral Therapy (CBT) – First pioneered by psychologist Dr. Aaron T. Beck at the University of Pennsylvania in the 1960’s, CBT began as a way to treat depression. Beck observed that his depressed clients experienced negative thought patterns that contributed to negative emotions and behaviors, and he surmised that if these same thoughts could be identified and replaced, clients would begin to feel and function better.
Since then, more than 1,000 clinical trials have reportedly demonstrated CBT’s efficacy in treating a wide variety of psychiatric disorders, including addiction. As a therapy for substance abuse, CBT focuses on identifying and replacing negative thoughts that feed the addiction cycle (by triggering drug-seeking behaviors) and impede recovery (by contributing to relapse).
A number of large-scale studies have been conducted to explore how cognitive-behavioral strategies can improve recovery outcomes for clients with substance abuse issues. For example, 34 randomized controlled trials reportedly found that CBT significantly improved recovery outcomes for marijuana, cocaine, and opiate abuse. In one study, 60 percent of recovering cocaine users who had been administered CBT were clean 52 weeks following treatment.
2. Mindfulness-Based Therapies are another evidence-based practice that has shown promise in treating drug and alcohol addiction. These therapies are rooted in mindfulness meditation, a derivation of Buddhist Vipassana meditation, which in the late 1970’s became the groundwork for Dr. Jon Kabat-Zinn’s “Mindfulness-Based Stress Reduction” (MBSR) program for managing pain and stress. Mindfulness meditation encourages non-judgmental awareness and acceptance of thoughts, emotions and sensations as they arise, based on the reality that they are temporary and will pass. Where mindfulnessbased therapies have proved especially therapeutic, then, is with respect to “experiential avoidance,” or an inability to face unpleasant thoughts and experiences that are common triggers for drug and alcohol abuse. Studies have shown that mindfulness meditation reduced experiential avoidance and may also help ameliorate cravings.
3. Motivational Interviewing (MI) – A “considerable body of research” has found MI to be effective for helping people initiate drug and alcohol treatment and reduce rates of drug and alcohol abuse, according to the National Institute on Drug Abuse. MI is a counseling style built on the premise that people can move towards positive self-actualization and self-empowerment through the choices they make. The goal of MI is therefore to encourage clients to move in this direction. Within the MI model, therapists take an empathetic, supportive and directive role, by helping clients better connect with their own values and motivations in order to make core changes that better align with these values and motivations.
MI has probably been most studied with respect to its effectiveness for alcohol recovery. At least 32 studies have linked MI to improved treatment outcomes for recovering alcoholics—specifically, increased retention in treatment andreduced rates of problem drinking
4. Family Therapy – Research has shown that family therapy can prevent substance abuse, halt its progression, and increase drug and alcohol abstinence rates, by addressing dynamics within the family system that may be perpetuating the addiction cycle. Family therapy seeks to:
• repair these core family relationships • build healthier interpersonal and communication skills
• strengthen emotional connection between family members
• improve coping and problem-solving skills
The end goal, in other words, is healthier family functioning, which is linked to better treatment outcomes for people in recovery. As one illustration among many, a 2015 study looked at the effects of family functioning on opiate treatment outcome, and found a clear, direct link between level of family support and function and treatment outcomes. 5. 12-Step Group Therapy – The 12-step, self-help approach combines the spiritual principles of the 12 steps with the practical support and help of group members who share the same problem. A large body of evidence has found that 12-step group participation correlates with better long-term recovery outcomes. For instance, one major randomized trial, “Project Matching Alcoholism Treatment to Client Heterogeneity (MATCH),” found that a 12-step program for alcohol abuse yielded outcomes similar to those for CBT and MI.
Research into the efficacy of 12-step groups for treating substance abuse has turned up the following key points:
• Sustained 12-step group attendance predicts a higher likelihood of abstinence and better recovery outcomes.
• In contrast, “delayed participation and dropout” are associated with poorer recovery outcomes.
• 12-step groups may contribute to better recovery outcomes by providing “support, goal direction and structure; reward for substance-free activities; and a focus for building selfconfidence and coping skills.
The five therapeutic practices I’ve just described have been evidenced to reduce rates of drug and alcohol abuse in substance abuse treatment populations. On this ground, they are “evidencebased,” having proven effective when administered on their own and/or in combination with one another.
What may be very effective for one person with a drug or alcohol addiction may not work as well for another person, however. The highly individualized nature of addiction—a disease caused by the complex interplay of biology, environment and individual life experiences—makes it hard to predict how a client will respond to one or more of these treatments. A prospective treatment program ideally should provide all or most of these clinical offerings, then, so that clients can maximize their prospects of a positive treatment outcome, thanks to a comprehensive, integrated, therapeutic approach.
Anna Ciulla has been passionately helping clients with substance
use and co-occurring disorders to heal, using solution-focused,
strengths based care, for nearly twenty years. In her role of
directing client care services at Beach House Center for Recovery,
she uses a spiritual perspective and strongly believes in the power
of a culture of connection for both clients and staff. In addition to
addiction and mental health disorders, Anna has expertise in the
area of eating disorders and women’s issues, both as a Licensed
Mental Health Counselor and Registered and Licensed Dietitian.
https://www.beachhouserehabcenter.com/
