What is Evidence Based Treatment for Drug & Alcohol Addiction?
The National Institute on Drug Abuse (NIDA) separates evidence based therapies (EBT) into two areas: pharmacotherapies and behavioral therapy. Pharmacotherapies are drug therapies. Depending on the addiction – opioid, alcohol or tobacco – the treatment will be different. Behavioral therapy, however, is more universal. According to NIDA, “Behavioral approaches help engage people in drug abuse treatment, provide incentives for them to remain abstinent, modify their attitudes and behaviors related to drug abuse, and increase their life skills to handle stressful circumstances and environmental cues that may trigger intense craving for drugs and prompt another cycle of compulsive abuse.” EBT studies have been conducted and extensively researched (and documented) on a specific treatment. It has to be proven successful. The goal of EBT in the medical community is to encourage the use of safe and effective treatments that achieve results. This is done to lessen the use of possibly unsafe treatments among addicts.
What Makes a Treatment Evidence Based?
According to the University of the Washington Alcohol & Drug Abuse Institute and the Northwest Frontier Addiction Technology Transfer Center, evidence based research and treatment requires the following:
- “Research: The practice has been subjected to scientific study that included randomized controlled trials, quasi-experimental studies, or in some cases a less rigorously controlled research design. For the most part the research has been published in a peer-reviewed journal.
- Meaningful Outcomes: The practice has resulted in benefits to the individuals receiving the service. It has helped consumers achieve desired outcomes related to treatment goals and objectives.
- Standardization: The practice or intervention has been standardized so that it can be replicated. Standardization typically involves a published description that clearly defines the nature of the practice, the audience for whom it is intended and the desired impact of the practice on the individuals receiving it. Thorough instructions are available, as well as copies of printed materials and other tools needed to implement the practice.
- Replication: The interventions and practices have been studied in more than one setting and findings have yielded consistent results.
- Fidelity Measure: A fidelity measure either exists or could be developed from available information. Such measures allow practitioners to verify that an intervention is being implemented in a manner consistent with the protocol evaluated in the research.”
This is so important because it means that the treatment being offered has scientific and clinical support. In the past, those with mental health issues and addictions were often treated as weak or less-than. Today, these individuals are seen as those who need extra support in the areas with which they struggle.
Evidence Based Treatment is Crucial for Successful Treatment
Psychology Today says, “The logic of evidence-based reforms is relatively straightforward. In virtually every professional field (including medicine, where contemporary evidence-based reforms originated), a research-to-practice gap exists in which some practices shown to be effective by scientific research are seldom used in applied settings, but some commonly implemented practices are not empirically validated and may be ineffective or even harmful. Because scientific research—especially when synthesized across multiple, high-quality, experimental studies—is generally recognized as the most valid source of evidence for determining what works, prioritizing such evidence-based practices over relatively ineffective approaches should result in increased learner outcomes. However, despite the promise of evidence-based reforms, the devil of realizing that potential lies in the details.”
Examples of Evidence Based Treatment Options
“Addiction is a brain disease, and is defined as a chronically relapsing disorder of compulsive drug use. Advances in our understanding of the neurobiology of addiction have given substantial support to the disease basis for addiction. Changes in specific neuronal and neurochemical circuits have been identified that correspond to different components of the addiction cycle. Perhaps more importantly, these changes are long lasting and in some cases can be permanent. One goal of medications development for addiction is to reverse or compensate for such pathological effects.” (Nat Rev Drug Discov. 2009 Jun; 8(6): 500–515.) Again, NIDA separates pharmacotherapies and behavioral therapy. Like the quote states, drug therapies (pharmacotherapies) work to help balance neurons and chemical connections in the brain that have been damaged by drug abuse. Here are how drug therapies help different kind of addictions:
Methadone: According to NIDA, “Methadone is a long-acting synthetic opioid agonist medication that can prevent withdrawal symptoms and reduce craving in opioid-addicted individuals. It can also block the effects of illicit opioids. It has a long history of use in treatment of opioid dependence in adults and is taken orally. Methadone maintenance treatment is available in all but three States through specially licensed opioid treatment programs or methadone maintenance programs.”
Buprenorphine: This drug treatment is a partial opioid agonist. It’s often preferred by medical professionals for a few reasons:
- It suppresses symptoms of opioid withdrawal
- Decreases cravings for opioids
- Reduces chances of relapse
- Blocks the effects of other opioids
- Helps patients stay in treatment
Naltrexone: NIDA says “Naltrexone is a synthetic opioid antagonist—it blocks opioids from binding to their receptors and thereby prevents their euphoric and other effects. It has been used for many years to reverse opioid overdose and is also approved for treating opioid addiction. The theory behind this treatment is that the repeated absence of the desired effects and the perceived futility of abusing opioids will gradually diminish craving and addiction.”
Acamprosate: This alcohol treatment reduces symptoms of withdrawal, such as insomnia, anxiety, restlessness, and dysphoria. It has been shown to help alcoholics maintain abstinence for weeks to months, and it may be more effective in patients with severe alcoholism.
Disulfiram: The utility and effectiveness of disulfiram are considered limited because patient compliance is inconsistent. However, among patients who are highly motivated, disulfiram can be effective, and some patients use it episodically for high-risk situations, such as social occasions where alcohol is present. It can also be administered in a monitored fashion, such as in a clinic or by a spouse, improving its efficacy.
Topiramate: Although this treatment has not yet received FDA approval for treating alcohol addiction, it is sometimes used for this purpose. Topiramate has been shown to improve many drinking outcomes when compared with a placebo.
Cognitive Behavioral Therapy for All Addictions
Drug therapies, however, are not effective on their own. Although they may make withdrawal symptoms less difficult, it works best when combined with cognitive behavioral therapy (CBT). CBT focuses on leaving behind dysfunctional thought patterns and risky actions. It is an effective therapeutic approach for those with co-occurring disorder such as mood disorders (depression, PTSD, anxiety and bipolar disorder). The goal is to remove self-defeating thoughts and transform them into positive thoughts and actions. Therapists work with patients to find positive and effective stress coping skills that don’t rely on substance abuse. CBT is often a short-term therapy that addresses immediate problems. There are some new, innovative therapies that work in conjunction with CBT.
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