Evidence-based medicine is a specific form of clinical decision-making or methodology in which a practising clinician makes informed decisions when examining or treating patients when providing a prognosis of disease treatment or disease prevention that is based on evidence or clinical research that is proven to successfully treat a specific scenario.
Recovery Direct is an evidence-led treatment programme that works with a range of substance and behaviour based issues such as drug and alcohol use disorders, depression, anxiety, chronic stress and eating, personal and social issues. The evidence-based approach to addiction treatment is distinctly different from the way most addiction has been treated to date in South Africa. The therapies used in the evidence led treatment processes that are based on modern proven studies on successful addiction treatment worldwide.
What is Evidence Led Treatment?
Evidence-based treatment can be broken up into two categories Pharmacotherapies and Behavioural Therapies.
This means that substance withdraws are medically treated using medicines administered by a doctor in prescribed and managed doses depending on the substances in play.
Pharmacotherapy is intended to alleviate symptoms being presented by the patient. Many pharmacotherapies are popular in countries such as the USA and UK in treating heroin and other opiate use disorders but in South Africa are most commonly used in the format of prescription medication for depression and anxiety.
Include iterations of psychotherapeutic conversational talk therapies that help patients find order and natural resolution to many disordered emotions, thoughts and behaviours. Cognitive-Behavioural Therapy and Emotion Based Talk Therapy are today the most commonly used, proven and effective modes for evidence-based behaviour treatment.
The goal of this treatment in addiction recovery is to help the patient realise and effect a critical positive behaviour change in congruence to their physical and emotional wellbeing.
Two interchangeable and dynamic talk therapies are most frequently employed in evidence-based treatment for addiction.
- In Cognitive Behaviour Therapy, this change is realised by the patient identifying their problematic behaviours and consciously stopping their default responses to select and favour of more conscious and positive outcomes.
- In Emotion-Based Talk Therapy, patients are taught to explore their dysregulated emotions and thoughts and that start classifying and settling disruptive and intrusive patterns of thinking by identifying reprocessing internal emotional markers.
Both formats of therapy are founded around the empathetic, nonjudgemental understanding of the individual and used in concert with their life circumstance, past trauma and present life obstacles.
Dynamic Questioning and Thought Guidance
In consultation, professional therapists are able to gauge in the conversational feedback from their patient and dynamically adjust their mode of questioning, rationalisation based on the presented topics. This dynamic process is intended to adjust with the patient to have the most positive intended outcomes or “breakthroughs” or meaningful behaviour changes.
Theoretically, this dynamic personalised mode of therapy is highly effective however in reality and therapists are also contending with lifetimes of disrupted thought, irrational belief systems, complex and well-manicured defence mechanisms and many hidden past traumas or agendas.
These established layers in patients can skew their authentic responses, meaning that more time is required in therapy to establish fair congruence, trust and candour with the therapist before the most impactful dialogues can occur.
In rehabilitation centres, therapists work within what they call “multidisciplinary teams” that consist of other professional therapists that work together to identify the best directions and modalities of therapy for each patient session based on noted feedback.
The ability for therapists to dynamically adjust the direction of individual treatment based on cross skilled feedback is a powerful component to rapidly assisting patients within limited time frames for recovery. This hive skillset is particularly important in cases with substance use disorders, where patients are faced with complex combinations of past trauma, social stigma and highly dysfunctional family environments.
“Psychotherapy Does Not Work”
Many people are inherently resistant to “psychotherapy” due to the many stigmas that surround mental health and or the roles that therapy can play in their lives. While talk therapy is medically proven to aid in the treatment of many mental health disorders, it is still frequently regarded socially as pseudoscience and is placed in contention with many belief systems embedded in society and individuals viewpoints.
These viewpoints frequently stem from community and family system upbringings that counteract the perception that psychology and talk therapy can be used as a progressive tool in the process of personal recovery.
In reality, most alternative and theological belief systems can and often do co-exist with psychotherapeutic practices, yet there are still many individuals that will simply refuse and resist personal therapy from a registered counsellor and view it as an opponent to their personal treatment.
In many cases, understanding why therapy may not have worked in the past for the individual or re-framing of the principals of psychotherapy into more mainstream palatable personal growth, life coaching, mentoring, mindfulness e.t.c can all serve to reach or meet similar objectives for personal breakthroughs.
What is Non-Evidence-Based vs Evidence-Based Addiction Treatment
In contrast, many centres which still use methodologies such as “12 step treatment”, “tough love” treatment that is based on punitive practices, belief systems or pre-conceived or standardised routines, processes or methodologies. Often 12 step rehab centres photocopy standardised plans that do not directly relate or address to the individual’s personal needs or requirements to recover.
Evidence-backed therapeutic care for addiction revolves around understanding components of personal trauma or the interpersonal issues that are driving the persons’ subconscious habits and behaviours. Thus standardised methodologies and photocopy plans are clinically inappropriate with evidence-based therapy.
Where Do “12 Step Rehabs” Fail?
While there are many “success stories” from the “12 step treatment” centres these stories tend to be perpetuated by the estimated 8 to 12% of people that actually find recovery in the 12 step process in isolation. The remainder of people do not report on 12 Step or find their way into recovery, do so through combining more evidence-based approaches and philosophies.
In 12 Step Treatment Centres, one-on-one or personalised therapy is frequently diluted as the costs of providing professional psychotherapeutic support is significantly more than 12 Step meetings (which are essentially free and readily available anywhere in the world.)
“Professional treatment” in “registered rehab centres” can often be as low as a one or two individual counselling session a week and still not contain multidisciplinary practices required for rapid recovery.
The inadequacy in the initial treatment timeframe consequently results in ongoing repeat admissions and costing considerably more than effective evidence-based centres like Recovery Direct where the process of evidential treatment is the core focus. If Recovery Direct’s patients choose to attend meetings or include 12 Step principals to their recovery process, we absolutely and unequivocally support it, however, it is not seen as a replacement to “personalised therapy” that they are paying for.
This is in no way intended to devalue the revered 12 Step treatment program.
When placed in a correct context of recovery lifestyles of the 12 step process can add immense value to long term recovery from addiction. Provided the mechanics of 12 step are understood and applied correctly in concert within solid evidence led treatment continuums the 12 step recovery is a powerful tool for motivated behaviour change, socialisation, spiritual development, resilience training and support.
Where Anonymous Meetings Work
The 12 step recovery is important to many in the respect that it serves the function as a spiritual guide and support system in the absence of guides and support systems. 12 step meetings to some degree provide the function of trauma reprocessing (shares), re-socialisation (group meetings), mentorship (sponsors) cognitive behaviour change (repetition of meetings) that challenge a conscious self-awareness and provide a “safe” (anonymous) platform that is effectively free and readily available.
For the last 80 years, the same spiritual programme (with some minor alterations) has been in effect throughout the world.
As a free programme, there are many positive behaviour changes, guidance and social principals in play that do have positive effects in recovery, the majority of individuals that directly enter 12 step meetings. People with severe substance use disorders or “rock bottom” substance use issues are most likely to adopt the 12 steps model as they simply have no option but to recover.
A survey conducted by AA in 2014 showed that:
- 32% of people were introduced to the group by another member
- An additional 32% were introduced to AA by a treatment facility
- 59% of AA members received some form of treatment or counselling before going to AA
Ergo the frequent success stories in AA tend to dovetail with some form of evidence-based counselling engagement such as provided by our care centre or in personal growth, coaching and development programmes that are based on core psychology principals. Evidence suggests that for those people, AA attendance can be a source of long term recovery in that AA/NA is free to use, easy to access with a global support system but should be used in conjunction with evidence-based treatment as the primary source of treatment.
Bottom line is we do recover, all in our own ways and that is something we support at Recovery Direct. If you have tried 12 steps and you still can’t quiet the noise in your head, perhaps you ought to start looking at evidence-based treatment options.