The Truth about Evidence-Based Practices in Addiction Treatment

Over the last few years, the term “evidence-based” has entered the lexicon regarding addiction treatment like a bull in a china shop. Not a conversation goes by without the mention of “evidence-based” practices in the field of addiction treatment, either the need for it, how it equates to quality of care or how such practices in turn represent ethical practices of behavioral healthcare. All of which is true.

However, like other overused phrases that in turn become buzzwords in the addiction treatment space (take for example “dual diagnosis” or “trauma-informed”) the term “evidence-based” has often become misconstrued, confusion or a platform where individuals or organizations use the term to further themselves on a platform to push a specific agenda. Take for example the term “evidence-based” regarding America’s growing opioid crisis. Read news stories or watch media stories discussing the opioid epidemic and not even one occurs without an expert mentioning the need for “more evidence-based practices of medication assisted treatment (MAT)” to combat overdose deaths and the overall opioid crisis. They scream from the rooftops that the addiction treatment industry is inept or complicit in the growing crisis because many refuse to utilize the “evidence-based” treatment practice of medication assisted treatment (MAT.) They claim that the “majority” of treatment centers (sometimes quoting numbers as high as 90-95% of treatment facilities) do not utilize evidence-based practices because they do not incorporate MAT into their treatment model. First, those numbers are clearly incorrect. If the nationwide number of total facilities treating addiction were compiled, the numbers would demonstrate that many, and even possibly the majority, of facilities utilize medication assisted treatment in their programming. Second, it is absolutely a false narrative that the majority of treatment centers do not utilize “evidence-based” practices in their clinical milieu. However, by utilizing this language and creating a false narrative to push a specific agenda, the optics to an unknowing public is that addiction treatment does not use scientifically-based practices in the treatment of patients with addiction and dual diagnosis issues.

For this example, it is important to point out that Medication Assisted Treatment (MAT) is in fact an evidence-based practice. It has shown to keep patients engaged in a treatment process and to cut the mortality rates of the addicted population. However, the point being made in this example is that for some reason, based on some specific agenda, many experts that claim addiction treatment centers do not utilize MAT are then in fact not practicing “evidence-based” addiction treatment. This narrative is entirely untrue, creates a stigma surrounding addiction treatment as a whole and in fact can become a barrier for individuals and families seeking help for addiction. Medication Assisted Treatment (MAT) is ONE example of an “evidence-based” practice (and should absolutely be utilized when clinical appropriate), but unlike what many experts would lead the public to believe, it is not THE ONLY “evidence-based” practice that can or should be used to treat opioid use disorder or any other issues on the substance use disorder spectrum.

The Substance Abuse and Mental Health Services Administration (SAMHSA) lists on it’s web site the National Registry of Evidence-Based Programs and Practices (NREPP.) The list includes 577 programs and practices that are considered “evidence-based.” The National Institute on Drug Abuse (NIDA) list evidence-based practices are in two categories: Pharmacotherapies and Behavioral Therapies.

Therefore, while many people seem to want to shine a negative light on the addiction treatment field through a false narrative that most treatment providers do not utilize “evidence-based” practices, the truth is that most addiction treatment providers are using evidence-based practices and the programs they offer are clinically-driven in nature. Not all providers use every approach, but most treatment providers throughout the country use a multi-pronged approach that incorporates many different types of evidence-based practices (as not every approach will work for every patient and treatment centers must be able to utilize the best clinical approach that will work for each individual patient.)

So don’t believe the hype. Don’t believe everything you hear. Understand that there are certainly facilities treating addiction that are not utilizing best practices or evidence-based approaches, but that the majority of treatment centers do.

Here is a list of examples of different evidence-based approaches to treating addiction. There are many more examples, but here are some evidence-based treatment currently being incorporated by many addiction treatment providers nationwide:

• Cognitive-Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Contingency Management Interventions/Motivational Incentives
• Motivational Enhancement Therapy (MET)
• The Matrix Model
• Medication-Assisted Treatment (MAT)
• This can include Buprenorphine (Suboxone), Naltrexone (or Vivitrol), Methadone
• 12-Step Facilitation Therapy
• Family Behavior Therapy (FBT)
• Seeking Safety (for Trauma/PTSD and Addiction)
• Relapse Prevention Therapy

If you or someone you know needs help for addiction or dual diagnosis issues, please give us a call. Maryland Addiction Recovery Center offers the most comprehensive dual diagnosis addiction treatment in the Mid-Atlantic area. If we aren’t the best fit for you or your loved one, we will take the necessary time to work with you to find a treatment center or provider that better fits your needs.