Empirically supported treatments

Investigators:

Katie Witkiewitz

To date more than a thousand clinical trials of addiction treatment have been published. As a result of the progress in the development and validation of treatments for alcohol and other drug problems, we have more science-based answers than ever to the question of "what works" for those struggling with an addiction. At our present state of knowledge, there is no single "best" treatment for substance use disorders, rather there are a number of treatments that have support for effectiveness. Psychosocial therapies, including contingency management, behavioral couple therapy, motivational interviewing, brief interventions based on motivational interviewing principles, cognitive behavioral therapy, the community reinforcement approach, and twelve-step facilitation are some of the treatments that have demonstrated efficacy across diverse populations and substances. CASAA investigators have been leaders in the development and testing of most of these treatment approaches. Combining pharmacotherapies with psychosocial therapies can strengthen treatment effects, and medications are helpful adjuncts to behavioral therapies for addiction. Currently four US FDA approved medications are available for the treatment of alcohol dependence - disulfiram, oral naltrexone, once-monthly injectable extended release naltrexone, and acamprosate. There are also effective pharmacotherapies for the treatment of addiction to substances other than alcohol. For example, for the treatment of opioid dependence, buprenorphine and methadone are ranked as the most effective methods of opioid detoxification and long-term maintenance of abstinence. CASAA investigators also have contributed to evaluating the effectiveness of several pharmacotherapies for alcohol and other substance dependence.

It is often difficult for new techniques, such as many of the treatments described above, to find their way into an established system of treatment. Despite science-based knowledge of what works, there is a significant gap between the knowledge of what works and the treatments that are currently in use in addiction treatment programs. Specifically, the Institute of Medicine reported that a 17-year gap exists between the publication of research results and its impact on treatment delivery. Unfortunately, some of the most commonly used treatment methods in the U.S., such as group therapy, mandated 12-step, confrontational counseling, and educational lectures and films, have evidence of little efficacy or even negative effects. Weakest evidence for efficacy appears to be found in methods designed to educate, confront, shock or offer insight regarding the nature and causes of a substance use disorder. These commonly used approaches may in fact be increasing the likelihood of a return to problematic use.

For more information about treatments with evidence of effectiveness we recommend visiting the Substance Abuse and Mental Health Services Administration Registry of Evidence-Based Programs and Practices at http://www.nrepp.samhsa.gov/

Specific areas of expertise at CASAA for studying the efficacy of treatment include:

Research designs for clinical trials

Research designs to study mechanisms of behavior change within treatments

Advanced quantitative techniques to test mechanisms of change and efficacy of treatment

Therapy process coding

Monitoring treatment integrity

Assessment of treatment outcomes

Adapting treatments for diverse populations