Jabberwocky
Frumious Bandersnatch
There has been a lot of discussion about success rates when it comes to the common treatments out there for substance use disorder. There is also a LOT of confusion out there, largely due to people mistaking anecdote as evidence.
Please remember, there are a number of substance specific use disorders out there (you don't treat alcohol use disorder like you treat amphetamine use disorder). Particular substance use disorders are also labeled according to their acuity, mild, moderate or severe. Likewise, a treatment that might work well for someone with a severe opioid use disorder might not work well for someone with mild opioid use disorder.
Here is a recent example of something that has come up on the topic of success rates:
Here are some topics that seem to come up regularly when people refer to what they believe the success rates are from personal experience or second hand awareness of the research:
In the case of this particular post, I find a kind of tragic irony operating. When the user refers to "the way it is approached by most people," they are implicitly blaming the patients receiving treatment for the failure of their treatment. The logic that goes like "98% of treatment attempts using an abstinence-only based modality; the treatment failed these patients; the cause of these treatment failures is the patient not engaging in the treatment correctly" seems highly problematic to me. I mean, who do we care about succeeding more: the patient or the treatment ideology/provider?
I mean, we label (well more and more of society are beginning to label) addiction as a disease (although few seem to understand the particular of this or give it much thought). Treatment for substance use disorder is covered by medical insurance (this is probably the most significant). The most largest amounts of money folks spend on substance use treatment goes to pay for exploitatively expensive inpatient style abstinence only rehab and 12 step based programs. I don't think anyone could argue that abstinence based treatment isn't technically a form of medical treatment, however impoverished its application might be.
Wether or not it's particularly "good" (useful) medicine, it is being promoted as such by these kinds of treatment providers (and politicians, proponents of prohibition and drug war ideologues). I don't think anyone in their right mind would argue that 12 step methodolgy is a form of medical treatment, but rightly or wrongly it is being provided as such. Insurance is paying for it to be employed as part of medical treatment each and every day.
In what other field or form of medicine is a treatment failure (to be specifics, I mean a failure of the treatment provided to resolve the issue being treated) blamed on the patient? I have yet to find one. This issue, of blaming the patient, is fairly common to all types of substance use disorder treatment. After all, stigma is so insidious when it comes to drug use, substance use disorder and addiction. More so, I'd argue, than the conditions themselves. A fatal OD might have extinguished someone's life, but living in a mental prison or having a mind colonized by self hatred and stigma isn't all that much better.
I feel strongly that collecting and discussing the actual research we are always alluding to, on the efficacy of various forms of treatment, would be helpful in promoting an awareness that it isn't the patient's fault the treatment they were provided didn't work, that fault has little to do with the situation. Instead, it would promote the understand that treatment failures are the result of pairing an particular person with particular challenges with an inappropriate form of treatment (and that triage probably wasn't performed very well, as is super common among abstinence based treatment providers where patient mean paychecks).
Part of what I'd also like to do is disseminate some myths surrounding harm reduction programs. Methadone is actually probably the most studied of all forms of treatment for any kind of addiction. Other public health oriented harm reduction projects like needle exchange have been studied all over the world for decades. There is so much we know about harm reduction programs, yet the attitudes of many people in the recovery community about harm reduction reflects little about the actual harm reduction community.
Needle exchanges have proven highly effective over the last twenty to thirty years at drastically reducing the spread of communicable disease (and not just for drug injectors or crack smokers, but their friends, sexual partners, family, etc). There is also very strong evidence to suggest that public health organizations such as needle exchanges that operate according to the principles of harm reduction move clients towards the direction of abstinence. There is rarely not a decease in drug use over time when users are engaged with something like a needle exchange.
Furthermore, methadone has been used to treat substance use disorder since the 60's. The research surrounding treatments involving methadone is very robust, much more so than research surrounding 12 step mythology. It squarely indicated the vastly increased efficacy of methadone based ORT programs over abstinence based programs to treat severe opioid use disorder.
Something that must be highlighted is that ORT programs like methadone clinics are in fact abstinence based programs. They utilize methadone, in this particular case, to treat a condition. The success of this treatment is measured in days where no drugs or non-prescribed medications were used, where prescribed medications where used as prescribed. Where patients make appointments and follow through with their treatment plan. Where they don't relapse.
That sounds a lot like abstinence only based treatments, at least in terms of what they'd like to see from their patients. The difference between them is that one uses a particular medication to treat a particular condition (methadone; severe opioid use disorder) that abstinence only providers tend to view as an illegitimate form of medicine (despite the decades of research demonstrating otherwise).
And, of course, that you'll generally get kicked out of abstinence only treatment if the condition being treated flairs up (in this case, when someone diagnosed with substance use disorder uses whatever drugs they're struggling with). I never understood how it helped a patient who had relapsed during treatment to discharge them from treatment. I get how it might be better for others in the facility in a way, but that totally disregards what is best for the individual patient who has relapsed.
That is highly unethical. Again, where else in medicine is continued treatment is refused by the provider when the condition being treated relapses?
So, to the point of this thread, what research into success rates for various forms of substance use disorder treatment do you know of?
Abstinence only based rehab, 12 step programs, outpatient based program, inpatient based program, non-12 step programs, various approach to individual therapy like CBT/DBT/motivational interviewing, confrontational based approaches, ORT programs, non-opioid related MAT, whatever. Anything in a peer reviewed journal that deals with the issue of how effective certain treatments are.
Let get some reference for the 4-10% success rate for abstinence treatment, and the ~50% (or something, I forget off the top of my head) success rate of ORT programs!
Please remember, there are a number of substance specific use disorders out there (you don't treat alcohol use disorder like you treat amphetamine use disorder). Particular substance use disorders are also labeled according to their acuity, mild, moderate or severe. Likewise, a treatment that might work well for someone with a severe opioid use disorder might not work well for someone with mild opioid use disorder.
Here is a recent example of something that has come up on the topic of success rates:
Here are some topics that seem to come up regularly when people refer to what they believe the success rates are from personal experience or second hand awareness of the research:
In the case of this particular post, I find a kind of tragic irony operating. When the user refers to "the way it is approached by most people," they are implicitly blaming the patients receiving treatment for the failure of their treatment. The logic that goes like "98% of treatment attempts using an abstinence-only based modality; the treatment failed these patients; the cause of these treatment failures is the patient not engaging in the treatment correctly" seems highly problematic to me. I mean, who do we care about succeeding more: the patient or the treatment ideology/provider?
I mean, we label (well more and more of society are beginning to label) addiction as a disease (although few seem to understand the particular of this or give it much thought). Treatment for substance use disorder is covered by medical insurance (this is probably the most significant). The most largest amounts of money folks spend on substance use treatment goes to pay for exploitatively expensive inpatient style abstinence only rehab and 12 step based programs. I don't think anyone could argue that abstinence based treatment isn't technically a form of medical treatment, however impoverished its application might be.
Wether or not it's particularly "good" (useful) medicine, it is being promoted as such by these kinds of treatment providers (and politicians, proponents of prohibition and drug war ideologues). I don't think anyone in their right mind would argue that 12 step methodolgy is a form of medical treatment, but rightly or wrongly it is being provided as such. Insurance is paying for it to be employed as part of medical treatment each and every day.
In what other field or form of medicine is a treatment failure (to be specifics, I mean a failure of the treatment provided to resolve the issue being treated) blamed on the patient? I have yet to find one. This issue, of blaming the patient, is fairly common to all types of substance use disorder treatment. After all, stigma is so insidious when it comes to drug use, substance use disorder and addiction. More so, I'd argue, than the conditions themselves. A fatal OD might have extinguished someone's life, but living in a mental prison or having a mind colonized by self hatred and stigma isn't all that much better.
I feel strongly that collecting and discussing the actual research we are always alluding to, on the efficacy of various forms of treatment, would be helpful in promoting an awareness that it isn't the patient's fault the treatment they were provided didn't work, that fault has little to do with the situation. Instead, it would promote the understand that treatment failures are the result of pairing an particular person with particular challenges with an inappropriate form of treatment (and that triage probably wasn't performed very well, as is super common among abstinence based treatment providers where patient mean paychecks).
Part of what I'd also like to do is disseminate some myths surrounding harm reduction programs. Methadone is actually probably the most studied of all forms of treatment for any kind of addiction. Other public health oriented harm reduction projects like needle exchange have been studied all over the world for decades. There is so much we know about harm reduction programs, yet the attitudes of many people in the recovery community about harm reduction reflects little about the actual harm reduction community.
Needle exchanges have proven highly effective over the last twenty to thirty years at drastically reducing the spread of communicable disease (and not just for drug injectors or crack smokers, but their friends, sexual partners, family, etc). There is also very strong evidence to suggest that public health organizations such as needle exchanges that operate according to the principles of harm reduction move clients towards the direction of abstinence. There is rarely not a decease in drug use over time when users are engaged with something like a needle exchange.
Furthermore, methadone has been used to treat substance use disorder since the 60's. The research surrounding treatments involving methadone is very robust, much more so than research surrounding 12 step mythology. It squarely indicated the vastly increased efficacy of methadone based ORT programs over abstinence based programs to treat severe opioid use disorder.
Something that must be highlighted is that ORT programs like methadone clinics are in fact abstinence based programs. They utilize methadone, in this particular case, to treat a condition. The success of this treatment is measured in days where no drugs or non-prescribed medications were used, where prescribed medications where used as prescribed. Where patients make appointments and follow through with their treatment plan. Where they don't relapse.
That sounds a lot like abstinence only based treatments, at least in terms of what they'd like to see from their patients. The difference between them is that one uses a particular medication to treat a particular condition (methadone; severe opioid use disorder) that abstinence only providers tend to view as an illegitimate form of medicine (despite the decades of research demonstrating otherwise).
And, of course, that you'll generally get kicked out of abstinence only treatment if the condition being treated flairs up (in this case, when someone diagnosed with substance use disorder uses whatever drugs they're struggling with). I never understood how it helped a patient who had relapsed during treatment to discharge them from treatment. I get how it might be better for others in the facility in a way, but that totally disregards what is best for the individual patient who has relapsed.
That is highly unethical. Again, where else in medicine is continued treatment is refused by the provider when the condition being treated relapses?
So, to the point of this thread, what research into success rates for various forms of substance use disorder treatment do you know of?
Abstinence only based rehab, 12 step programs, outpatient based program, inpatient based program, non-12 step programs, various approach to individual therapy like CBT/DBT/motivational interviewing, confrontational based approaches, ORT programs, non-opioid related MAT, whatever. Anything in a peer reviewed journal that deals with the issue of how effective certain treatments are.
Let get some reference for the 4-10% success rate for abstinence treatment, and the ~50% (or something, I forget off the top of my head) success rate of ORT programs!
Thanks simco, I'll definitely check his book out.
