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Words of wisdom on evidence-based treatment

May 1, 2009
by root
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I recently read an excellent online article from David Mee-Lee, MD, on evidence-based treatment. I have been a licensed clinical alcohol and drug counselor and nurse specialist in addictions for many years, and I must say this evidence-based practice “trend” is driving me to exhaustion reading about it.

Trendy approaches leave me frantic with concern, because newcomers in the counseling field do not get a chance to practice the tools of their trade because of time constraints and healthcare inspectors demanding impossible “tasks to be completed.” Instead of observing the quality of the treatment and the therapeutic milieu, inspectors grill counselors and nurses about proving that their approaches are “evidence-based.”

Meanwhile, the rest of us who are practicing in addiction treatment also are being forced to comply with programs and protocols that might be ineffective for our clients, because some research paper declared that their findings were evidence-based for excellence. The survey methods are often skewed for outcome content; numbers get crunched for success rates of treatment. How ludicrous is that, when we all know that no two people go through their addiction and recovery in the same way and no treatment protocol works successfully for every client?

According to Mee-Lee, the use of the term evidence-based treatment “usually means that there has been some study documenting that under certain conditions (usually rigorous randomized clinical trials) the model shows positive outcomes or outcomes superior to other models. This does not guarantee that the model will necessarily yield similar results when applied in real-world situations or populations that differ from those covered in the research.”

Mee-Lee concludes two paragraphs with these lines, which I will keep on my desk: “Clinicians make diagnoses, instruments do not” and “Clinicians make treatment decisions, instruments do not.” Thank goodness someone out there is giving credit where it is due: to the clinicians.

Phyllis Prekopa, LCADC, CARN-AP

Co-owner, Drugcheck Consulting

Hewitt, N.J.

Addiction Professional 2009 May-June;7(3):8