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Choosing An Effective Treatment Approach: Evidenced-Based Practices

A. Tom Horvath, Ph.D., ABPP, Kaushik Misra, Ph.D., Amy K. Epner, Ph.D., and Galen Morgan Cooper, Ph.D. , edited by C. E. Zupanick, Psy.D.

3D Figure leaning on question markMany people successfully recover using a natural recovery approach. Others do not. These folks may decide they could use some help. Like most health-related issues, it becomes necessary to choose a treatment approach from a wide array of options. Making these choices can be quite difficult. People seeking treatment for health-related issues may not possess the technical knowledge needed to evaluate their choices. Even if they did, it is not a simple matter of selecting the most effective treatment, and then receiving it. A comparison to cancer treatment may be helpful. Some of the effective treatment choices include many different approaches. This might include chemotherapy; various surgical procedures; different forms of radiation treatment; and a wide array of holistic approaches. The type of treatments you might select would be based on many factors. These factors are unique to you and your circumstances. 1) What is the availability of the selected treatment in your particular geographic area? 2) What type of cancer is it, and what is the stage of progression? 3) Can you tolerate the treatment based on your overall health and age? 4) Are there any religious, cultural or other important beliefs to consider? 5) What are your own values and personal preferences? In sum, there may be no single "best" treatment for you.

Guidelines for choosing treatment options

The range of treatment options for recovery from addiction is very broad. Therefore, treatment decisions for addiction recovery can become quite confusing. We hope to reduce some of this confusion by suggesting some guidelines. These guidelines can help you make wise choices for your own recovery.

1. First, determine if you need help with just addiction. Or, do you need help with other problems as well? Most people seeking addictions treatment have previously attempted natural recovery without success. If you've made a sincere effort to recover without success, perhaps you need additional help. Maybe you need help with other issues besides addiction. These other types of problems can make recovery more difficult. It may be that people who seek addictions treatment do so because they are weighted down by these additional problems. Perhaps the people who succeed with natural recovery are people who "only" have to confront addiction itself. They may not have additional obstacles to overcome. Therefore, consider what additional issues you face. The common co-occurring problems are:

If these other sorts of problems complicate your life, be sure to choose a treatment option that specifically addresses these additional concerns.

2. Second, consider your goals. How will you know if your efforts were successful? What does recovery look like to you? What do you hope to gain by receiving treatment for your addiction? How will recovery benefit you? What does recovery mean to you? Will you abstain altogether or reduce to a level of no problems? Are you willing to put up with some problems for the sake of continuing to have some of the pleasures of your addiction(s)? In so, which problems are acceptable? Which problems are not? For example, "It's okay if I miss a day of work once in a while. My boss is pretty easygoing. It's not okay to upset my wife, or to miss my son's football games."

It can be difficult find a treatment program that focuses on anything other than complete abstinence. However, this should not deter you if you select moderation as your goal. Realize that treatment is oriented toward helping you learn how to stop. You are still free to decide where your personal stop point is. Is it before the first drink, after the third, etc.? Abstinence is perhaps a simpler goal. It is clear whether you reached that goal or not. Either you did drink, or you did not. Moderation is a little trickier because people can keep changing their limit. "Oh, did I say stop after the third? I meant to say I would stop after the third on weeknights, but on weekends the sky's the limit." These changing recovery goals may simply represent legitimate adjustments. Alternatively, it may be represent an avoidance of the problem or ambivalence about the need to make significant changes.

If you are seeking help for the first time, you may want to try moderation first. For some people, abstinence seems too extreme. However, if you have tried moderation several times without sustained success, you may be ready to abstain. You can keep attempting moderation. However, if it is not working, it may be time for Plan B!

3. Investigate effective treatment options. Determine which options appeal to you. Are these options available in your locale? Let's say you've come to the place where you've realized that natural recovery isn't working for you. You've taken a hard look at the other problems in your life. You've become clear about your recovery goals. Now what? This brings us back to our original question: How does someone find the most effective treatment?

Luckily, treatment effectiveness has already been researched for you. It is readily available at www.nrepp.samhsa.gov. Your task is to choose from among these treatments. Determine which ones match your unique needs, circumstances, and preferences. Treatments with demonstrated effectiveness are called evidence-based practices (EBP). EBP simply means a large body of research supports the effectiveness of that approach.

One of the most well-known sources of EBP is maintained by the federal government of the United States. It is called The National Registry of Evidence-based Programs and Practices (NREPP). The NREPP is intended to improve access to the most recent information about effective mental health treatments, including addictions treatment. Each of the treatments listed in the NREPP have met the basic criteria to be included as an evidenced-based treatment. We discuss these criteria in the next section.

Treatment professionals who are concerned with providing contemporary, effective treatments pay close attention to evidence-based treatments. They align their training and professional practices with this information. Unfortunately, the majority of these effective treatments are not available in all locales, except for 12-step based treatment. While this approach is helpful to many people, there are many others for whom it is not (Institute of Medicine, 1990).