Evidence-based medicine is set process of clinical decision-making whereby a qualified clinician will make their decisions based on clinical research or evidence that is proven to successfully treat an identified condition.
In addiction recovery this means following a path of treatment that has a proven success in treating addiction based issues and is not founded on a faith or unaccountable belief system (as is the case with most 12 step rehab centres).
The evidence-based approach to addiction treatment is distinctly different from the way most addiction has been treated in South Africa to date. The therapies used in the evidence led treatment centres are based on proven studies on successful addiction treatment worldwide.
Recovery Direct has adopted an evidence-based treatment programme that deals with a range of substance and behaviour based issues but extends to many conditions such as depression, anxiety, chronic stress, gambling, sex and eating disorders personal and relationship based trauma.
Does Evidence-Based Mean That Treatment Is Purely Clinical?
Yes and no. Yes in the sense that there are clinical studies to prove the merits of the clinicians practice. And NO. In the sense that many of these proven practices are simply conversations between human beings. Recovery Direct’s philosophy is one of individual care. What will work for you? Our mandate is to ensure that what we advise is the best course of action for you as an individual to reach your objectives.
How Does Evidence Based Treatment Work?
Evidence-based treatment can be broken down into a professional understanding of two key categories or treatment namely 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 question. 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 needs and 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 for them as they are not being confronted or resistent to the help.
This dynamic personalised mode of therapy is highly effective however mindful that therapists are 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 congruence and trust 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.
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 are based on punitive practices, belief systems or pre-conceived or standardised routines, processes or methodologies that accept no accountability in the treatment process. Often 12 step rehab centres photocopy standardised plans that do not directly relate or address to the individual’s past trauma, personal needs or personal recovery requirements.
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 as they are reliant on the establishment of a core belief system that may or may NOT coincide with the patients existing core belief system.
Where Do “12 Step Rehabs” Fail?
A large part of the process of recovery in 12 Step based “treatment centres” is handled by under qualified individuals or volunteers. In this environment the professional treatment for the root causes of the mental health disorder is side stepped or inadequately addressed. Which means that the key mental health issues presented by the patient are not suitably addressed.
While there are many “success stories” from the “12 step treatment” centres these stories tend to be conveyed 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.
The all too frequent and sad reality is that for the remaining +70% is that they continue to lead highly destructive lives until they either die, or reach some cataclysmic event where they there is no choice, life, death, permanent incarceration or relationship failure e.t.c (desperate people do desperate things). In the 12 step community this is deemed as “rock bottom” and is a nessecary process for “recovery”. Clinically it is inappropriate to knowingly allow a patient to reach such a critical state when alternative tactics to reach the better outcomes are readily available.
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 in no way obstruct it, however, it is not seen as a replacement to “personalised therapy” that they are paying for.
12 Step meetings do not cater for people that have deeper emotional and or diagnosable mental health issues. Meetings can contain un-vetted predatory individuals that seek venerable newcomers. See this documnetary here on the 13th step by Monica Richardson also featuring Dr Lance Dodes author of several books on the topic.
This is in no way intended to devalue the revered and selfless work of many individuals that operate in the 12 Step community.
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 mindfully applied in concert with evidence led treatment the 12 step recovery process is one of many tools that can be used for motivating critical behaviour change, socialisation, spiritual development, resilience and support.
Why is Recovery Direct Not A 12 Step Rehab?
“12 Step Treatment simply has no place inside an evidence based treatment centre”. Not according to our philosophy, but more importantly according to the free Anonymous 12 Step communities themselves, who vehemently DO NOT endorse, advocate, promote or condone any forms of privatised 12 Step “treatment” outside of their own free organisational meetings. This includes any and all private 12 step “treatment centres” that effectively operate their programme completely independantly of the organisation itself.