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Bringing research-based practice to fruition

July 21, 2010
by John W. McIlveen, Med, LMHC
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Facilities can take simple steps to establish a culture guided by research findings

The issue of research’s impact on clinicians and patient care in the helping professions is not a new one. In 1949, at the Boulder Conference on graduate education for clinical psychologists, the concept of the scientist practitioner model was introduced, with the idea that clinicians should model their therapeutic interventions after research findings, or empirical data. Although the conference was directed toward psychologists, its impact spread throughout the therapeutic world. While there has been debate over the pros and cons of this model over the years, it is certain that this topic takes on a new importance in the current healthcare climate.

The addiction treatment field is at the forefront of this movement for several key reasons. An increased emphasis from insurance providers, consumers and government agencies on outcomes of treatment as a basis for funding has led to the need for a new look at the role of research in our field. In states such as Oregon, Delaware and North Carolina, more and more funding for addiction treatment is being tied to the provider’s use of research-based practices.1

The passage of behavioral health parity legislation, achieving the long sought goal of equity with other chronic and in many cases fatal medical conditions, only adds to the need to continue to adapt to the changing healthcare landscape. While this landmark legislation will certainly provide more access to addiction and mental health treatment for millions of Americans, there is no question that funding sources, including insurers, will increase their emphasis on working with providers that can produce clear results from their treatment protocols. Showing outcomes, and evaluating how well we as clinicians do with helping our patients achieve goals such as long-term recovery, is becoming an increasingly important task as our field enters a new era.

There are several reasons why our field hasn’t fully adopted this model; however, by changing the way we view the role of research in treatment, providers can continue to flourish by giving clients the necessary foundation to begin their recovery journey.

Prominent substance abuse researchers for years have presented the idea of “blending practice,” emphasizing a need for more clinical interventions to be based on empirical evidence, or at the least for clinicians to become better consumers of research findings.2 The National Institute on Drug Abuse (NIDA) has held a series of conferences over the last several years to promote this concept. However, in the substance abuse treatment community, many still view researchers and clinicians as representing different sides of the coin, with different values and goals. Researchers often are seen as lacking insight into the true impact of the disease of addiction and the severe psychological toll it exacts on the individual battling it; practitioners frequently are seen as reluctant to adapt to new concepts regarding treatment and recovery.3

Those of us who have worked directly with clients for years know the facts—treatment works, and any methods we can employ to help our patients begin to improve their quality of life are important. Research tells us that comorbidity and other factors play a large role in predicting a client’s quality of life following treatment. It also tells us that support systems, including active 12-Step fellowship involvement, play a large role in creating an atmosphere that will help a client not only survive, but thrive.

Changing the mindset
Creating a clearer picture of what outcome research really means for clinicians, administrators and clients alike is the first step to changing our way of thinking. Research should work hand in hand with clinical processes, with good outcome measurement supporting and adding to the quality of care. For the purpose of this article, let’s focus on one specific type of research: outcomes measurement.

Outcomes measurement can be defined as simply measuring treatment outcomes over a specific time period; the measures (or instruments) can track factors such as reduction in symptoms, overall quality of life, and even a patient’s satisfaction with treatment in general.4 In short, it is tracking a patient’s progress, and beginning the process of collecting data that can be used, at that time or in the future, to assist in treatment planning and service delivery. In non-technical terms, that means “let’s see how well we do what we do!”

While ethical standards must be in place to ensure proper methods are followed, beginning the process is not as daunting as it may seem. Laying the foundation for a treatment culture where research-based ideas can thrive and become a vital part of an organization’s mission can begin with a few simple steps.

Despite the challenges in adopting research-based practices into treatment facilities, we have some unique advantages in the addiction field in regard to their application in our day-to-day work. For example, our primary goal as providers is helping our patients achieve long-term recovery. What could be more outcome-based than that? While the argument can be made that many other medical treatments are more easily quantified in terms of their effectiveness through testing and other methods, several studies have highlighted that in terms of adherence to aftercare protocols, success rates in addiction treatment (as measured by sustained abstinence) are no worse than those seen in the treatment of other chronic medical conditions, such as asthma and diabetes.5 While few insurers would place restrictions on follow-up visits to providers to treat these addictions, this unfortunately is an all too common practice in addiction medicine.