Big changes here

Many of you already know that, after more than 25 years, I left Dawn Farm last month.

One unsettled question was the future of this blog.

Well . . . we just sorted that out. Dawn Farm intends to maintain this blog and there was agreement that it doesn’t make a lot of sense for me to continue to blog on for an organization I no longer work for or speak for.

So . . . I am starting a new blog with a handful of other contributors. You can find that at recoveryreview.blog.

If you want to continue to receive my posts (and posts from the other contributors), you’ll have to sign up for email updates at recoveryreview.blog, add it to your feedreader, or follow us on Facebook or Twitter.

After more than 14 years and 2893 posts, this will be my last post on Addiction & Recovery News. (Though Dawn Farm may re-blog some of my posts here.) However, all those old posts will live at both sites and I’m pretty excited to see what happens at both sites.

Follow Recovery Review

It’s been almost a year since there’s been any action here.

We’ve moved to Recovery Review and we’re struggling to rebuild readership.

Please follow us there.

A consumer’s guide to research on substance use disorders (part 9)

Part 9/9
What’s missing?

In previous posts, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives. Today is question #6.

8) What questions does the study not answer?

No study can answer every question, nor should any study seek to every question. However, it can be helpful to stop and ask, what questions does the study not answer?  

There are two ways to group these questions.

First, there are questions that simply cannot be answered by the study. Considering what was asked, and not asked, provides context for the study.

Second, and maybe more important, is what questions does the study appear to have data for, but chose not to answer? For example, if a study looks at the impact of a treatment on drug use, as measured by urine drug screens, does it report on…

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A consumer’s guide to research on substance use disorders (part 8)

Part 8/9
Who is funding the research, and what are their motives?

In previous posts, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives. Today is question #7.

7) Were there any conflicts of interest (real or potential)?

A conflict of interest is a situation in which financial or other personal considerations have the potential to compromise or bias judgment and objectivity. It is worth noting that a conflict of interest exists whether or not decisions are affected by a personal interest.

Conflicts of interest can lead to more than unreliable information about particular treatments. For example, Stenius (2016) described alcohol and tobacco industry influence on the assumptions underlying policy decisions.

It is well documented how the tobacco industry for decades funded research aimed at producing uncertainty about the danger of smoking (e.g., Brandt, 2012). For alcohol, the transnational producers have invested resources in…

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A consumer’s guide to research on substance use disorders (part 7)

Part 7/9
Do the authors accurately represent the findings of the study?
Watch out for whether the “discussion” section of the study is actually supported by the data.

In previous posts, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives. Today is question #6.

6) What were the actual findings and does the authors’ discussion accurately represent the findings?

This sounds very straightforward, but it often requires a lot of effort to answer this question. Outcomes are sometimes reported very clearly in raw numbers and percentages, other times they are reported in the form of statistical terms that can be a challenge to decipher. 

• Do the discussion and conclusions focus on findings that support one theory/model/approach and ignore others?
• Do the discussion and conclusions overstate the real-world implications of the findings?
  • Keep in mind that statistical significance may not translate into significant improvements in quality of life.
  • Study definitions often differ from real-world definitions. For example, a recent study set…

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A consumer’s guide to research on substance use disorders (part 6)

Part 6/9

In previous posts, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives. Today is question #5.

5) What were the study methods?

There are many approaches used in SUD research and each approach offers advantages and disadvantages in different situations. Methods include experimental (including randomized control trials), qualitative, case studies, meta-analysis, and observational.

It’s often said that randomized controlled trials (RCTs) are the gold standard for research. It’s important to keep a few things in mind about them. First, they lend themselves to studying easily quantifiable outcomes, which means they tend to focus on relatively narrow outcomes in relatively narrow contexts. Second, they tend to be very expensive, which means that they often only get done with financial backing from large institutions (public or private). Third, in some cases their use may…

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A consumer’s guide to research on substance use disorders (part 5)

Part 5/9
This is really important.
The outcomes measured in studies are often reduction is symptoms (fewer overdoses, fewer deaths, fewer days incarcerated, fewer instances of disease transmission) and not the presence of positive indicators of health and wellness (stable housing, employment, positive relationships, sense of purpose, etc).

In previous posts, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives. Today is question #4.

4) What outcomes did the study measure? (How did they define success?)

Outcomes measured in research do not necessarily correspond well with the outcomes patients are seeking.

Common outcomes include:

• retention in treatment
• illicit opioid use
• mortality
• illicit drug use (non-opioid)
• criminal activity
• HIV risk behaviors

Less common outcomes include:

• abstinence from alcohol and other drugs
• quality of life measures like employment, housing, and family status.

The implications for this are profound. For example, a study may investigate the effects of a treatment on people with opioid use disorders. If the study is only examining the impact of the treatment on illicit opioid use, the treatment could be described as effective when subjects sustain alcohol, cocaine…

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A consumer’s guide to research on substance use disorders (part 4)

Part 4/9
What is the duration of the study? Short-term interventions might not be telling us much about long-term outcomes.

In previous posts, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives. Today is question #3.

3) How long was the study? 

Robert DuPont once observed, “The most striking thing about substance abuse treatment is the mismatch between the duration of treatment and the duration of the illness.” ¹

Addiction is a chronic disease and recovery is a long term process, but research is often limited to days and weeks.

The longer the study, the better. For example, Dennis, Foss and Scott ² found relapse rates of 64% for people between 1 and 12 months abstinent. Those relapse rates drop to 34% for people with between 1 and 3 years abstinent. 

Therefore, a study that reports on any outcome at less than one year may say very little about what can be…

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A consumer’s guide to research on substance use disorders (part 3)

Part 3/9
Not all people need the same types of help, so paying attention to the demographics and problem severity is important in trying to determine what works and for whom.

A couple days ago, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives.

As if to drive the point home, I just saw a tweet by an advocacy group demanding access to “science-based treatment.” That sounds great, but what does that mean? And, how directly and completely does/can science speak to my needs, or the needs of my loved one or community? Unfortunately, it’s not as clear as many make it seem.

Yesterday, we looked at question one.

Question 2: Who were the subjects?

There is a wide spectrum of alcohol and other drug problems, with addiction on the most severe end and misuse on the less severe end. Further, there can even be considerable variety within a category. Additionally, there can be significant differences in where the subjects are…

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A consumer’s guide to research on substance use disorders (part 2)

Part 2/9
Not all interventions are the same.
What are we offering to try to help, and to whom, and with what frequency and duration?

Yesterday, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives.

1) What is the treatment or intervention being studied?

It’s important to pay close attention to the intervention being studied. It is common for news reports about the study to describe it poorly. Further it’s common for the study itself to obscure the details of the intervention.

Interventions might include:

• Medication with, or without, counseling
  • Opioid agonist medication
  • Opioid antagonist medication
  • Other medications
• Education
• Medical care
• Harm reduction
• Case management
• Mutual aid groups such as 12 step meetings, faith based meetings (Without professional treatment)
• Specific types of counseling or combinations of them, such as:
  • Motivational Interviewing
  • Twelve step facilitation (Professionally directed treatment focused on linking and encouraging active participation in 12-step organizations.)
  • Relapse Prevention Therapy
  • Cognitive Behavioral Therapy

It’s also important…

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A consumer’s guide to research on substance use disorders (part 1)

Part 1/9
This is a helpful series in navigating the literature about treatment, addiction, and recovery.

Reading about addiction and recovery can be overwhelming and confusing. Media reports and experts often make strongly worded statements that are contradicted by statements from other media sources and experts. Other times, they seem to negate or minimize the lived experience of people with drug or alcohol problems and their families.

For example, it’s very common for press releases, media reports and, occasionally, researchers to make statements about a study demonstrating the effectiveness of a particular intervention. Other times, we hear people say something like, “science shows that [insert intervention] works.”

However, when we look closely at the study, we may find that the outcomes don’t fit our idea of “effectiveness” or “works.” Further, the conditions and subjects don’t resemble the real world.

This isn’t confusing just for lay people, it’s confusing for professionals and policy makers too. And, to make matters worse, most of us are pretty reluctant to…

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