Evidence based practice is a buzz phrase in the healthcare world, but what does it mean and – more importantly – how does it relate to you as a consumer of addiction treatment and mental healthcare services? According to the Oregon Addiction and Mental Health Division (AMH),  evidence based practice is defined as “programs or practices that effectively integrate the best research evidence with clinical expertise, cultural competence, and the values of the persons receiving the services. These programs or practices will have consistent scientific evidence showing improved outcomes for clients, participants, or communities”. A quick Google search reveals that this definition – or some slight variation thereof – seems to be universally accepted. The Substance Abuse and Mental Health Services Administration (SAMHSA) includes Oregon’s data in its Evidence Based Practices Web Guide because their AMH Division also outlines a continuum on which evidence based practices can be measured.

Before launching into an examination of the nuts and bolts of evidence based practice, let’s redefine it in laymen’s terms: An evidence based practice is a practice which is supported by research and includes a collaboration between a competent care provider and a client. This practice must be historically proven to demonstrate improvement for the people(s) it serves. Even more simply expressed: it’s a practice that has measurable evidence to show that it works.

For you, as a healthcare consumer, it all boils down to one question: “Am I investing in treatment that works?”

The Standards for Evidence Based Practice

According to Oregon’s AMH Division, there are six attributes which qualify a practice for the evidence based continuum. The continuum of evidence based practice ranges from interventions that are “grounded in consistent scientific evidence” to those having been “modified or adapted,” but are still able to be “standardized and replicated” and supported by research published in a peer reviewed journal. The six attributes which make an evidence based practice “operational” are:

1. Transparency – Is the scientific evidence clear and readily available?
2. Research – What kind of study is the evidence based upon? Has it been published in a peer reviewed journal?
3. Standardization – Is the practice easily replicated by a straightforward set of guidelines?
4. Replication – Does more than one group of researchers find the evidence to be conclusive?
5. Fidelity Scale – Does the practice accurately resemble the treatment model in execution?
6. Meaningful outcomes – Does the practice improve outcomes?

Evidence Based Practice: Other Considerations

If a treatment intervention possesses the six attributes which qualify it for the estimable title of “evidence based practice,” why would anyone resist implementation? As with most things, there are two sides to the coin. Just as a physician takes the Hippocratic Oath, treatment providers must abide by the pledge to “do no harm”. Each individual is unique, and sometimes an evidence based practice won’t meet the entirety of someone’s needs. In these cases – in order not to do harm – a practitioner may need to supplement evidence based practice with other interventions. This doesn’t mean that he or she doesn’t recognize and honor the value of evidence based practice, but that he or she is placing the human being first.

While evidence based practice is an ideal toward which one can aspire, it’s important to note that you can’t develop progressive practice without trying new things. Otherwise, how do you improve? How does a practice get evidence based without first being subjected to the collection of evidence? Innovative practices will not emerge from stagnancy. While there are many creative minds in the field vying to share a fresh perspective, research is expensive. Cost is just one barrier to developing new and more effective practice. Politics and societal attitudes may pose additional barriers.

Evidence Based Practice at the Process Recovery Center

At the Process Recovery Center, our clinical philosophy is expressed through the blending of  evidence based practice with evolving supplemental perspectives. Above all, we believe in placing the person first. Recovery requires a holistic approach, and evidence based practice provides a great foundation from which to build a treatment structure unique to the individual. The evidenced based practices we utilize are as follows:

• Cognitive Behavioral Therapy (CBT): The premise of CBT is that if you change the way you think, you also change the way you feel and behave. According to the Mayo Clinic, “CBT helps you become aware of inaccurate or negative thinking so you can view challenging situations more clearly and respond to them in a more effective way…It can be an effective tool to help anyone learn how to better manage stressful life situations”. Stress management is critically important because stress is one of the most common precipitators of relapse.

• Motivational Interviewing (MI): Motivational Interviewing is a counseling style which emphasizes acceptance and unconditional positive regard. The aim of MI is to empower clients and elicit self-motivation. According to its developers, William Miller and Stephen Rollnick, MI “is a way of being with a client, not just a set of techniques for doing counseling”.

• Group Therapy: We’ve said it more than once – and we’ll probably say it again – but nurturing social connection is a fundamental part of recovery. Group therapy can provide benefits that other forms of therapy cannot; these advantages include social support, social acceptance, peer validation, peer modeling, peer accountability, collaborative problem solving, and an environment in which interpersonal skills can be learned and practiced.

• Gender Specific Treatment: Simply put, failing to recognize that women have different needs than men – and vice versa – can drastically reduce treatment efficacy.

• The Matrix Model: The National Institute on Drug Abuse defines the Matrix Model as a “framework for engaging [substance users] in treatment and helping them achieve abstinence. Patients learn about issues critical to addiction and relapse, receive direction and support from a trained therapist, and become familiar with self-help programs. Patients are monitored for drug use through urine testing”.   
• Seeking Safety: Seeking Safety is a manual developed to address co-occurring trauma and substance use. This model asserts that safety is the number one clinical need of the individual. The aim is to achieve safety in the arenas of substance use and relationships, as well as to manage severe symptoms of trauma such as dissociation or self-harm.

If you’re looking for person-first treatment with established roots in evidence based practice, please call (888) 649-1149 or contact us here.

Autumn Khavari is the Process Recovery Center’s in-house writer. She received an education in Substance Use Counseling from Beal College in Bangor, Maine.

References:

Center for Substance Abuse Treatment. Enhancing Motivation for Change in Substance Abuse Treatment. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 35.) Chapter 3—Motivational Interviewing as a Counseling Style. Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK64964/

Cognitive behavioral therapy – Mayo Clinic. (2017). Retrieved from https://www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610

NIDA. (2018, January 17). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition). Retrieved from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition

Operational Definition for Evidence-Based Practices Addictions and Mental Health Division. (2018). [Ebook] (pp. 1-4). Retrieved from https://www.oregon.gov/oha/HSD/AMH/docs/ebp-definition.pdf