It Isn't All About Evidence-Based Practice

This article from Counselor does a good job pointing out some of the limitations of the push for evidence based practices.

The whole issue is a double-edged sword. Measuring your own outcomes is a good thing, but it’s no small burden for a treatment provider. (Imagine if every doctor had to measure their outcomes.) The adoption of and evidence-based practice (with some measures to assure fidelity) could relieve providers of this burden, but it comes at the cost of autonomy–which no one likes. Providers also hate that the process for identifying evidence-based practices is so political. (Consider the case of MRT.)

Note the straw man hit job by the journalist in the comments:

Yeah, I’m skeptical of this resistance as well: the reason there’s such a push for evidence-based practice is because the non-evidence-based practices in addiction– like harsh confrontation, humiliation, one-true-wayism (particularly insistence that the alternative to AA is jailsinstitutionsdeath: way to give hope, guys!)– are not only ineffective but harmful.

These practices are antithetical to therapeutic alliance and to most of the other things you say are important for treatment.

All evidence-based practices incorporate “best practices” like emphasizing therapeutic alliance and empathy and opposing one-true-way stuff– so it’s really rather absurd to argue against EBT’s by saying that those things matter.

If the non-evidence-based stuff did that, this wouldn’t be a huge issue, but it doesn’t and harmful and ineffective practices continue to be widely utilized.

How did this turn into a sarcastic 12 step bashing moment? (By the way, 12 Step Facilitation is an evidence-based practice.) Why does she insist on painting treatment providers with such a broad brush?

Besides, a quick google search of the author of the article finds that that the guy wrote a book on controlled drinking–hardly a 12 step nazi. Another important point is that one of the biggest critics of the push for the adoption of evidence-based practices is Scott Miller–not a 12 stepper in ANY way. In fact, he’s the biggest advocate of the notion that the therapeutic alliance is for more important than the treatment model and he uses lots of evidence to support his arguments–not just anecdotes and slurs against people who think differently.

So much for the false notion that questioning the push for adoption of evidence based practices means your a mindless, abusive treatment provider who can’t bring yourself to give up “harsh confrontation, humiliation, one-true-wayism”!

6 thoughts on “It Isn't All About Evidence-Based Practice

  1. "Note the straw man hit job by the journalist in the comments"When more than 90% of health care & treatment in the US rely solely on the "12-Step Facilitation" model — which, for all intents & purposes, IS AA — it's hardly a "straw-man" argument.If you'd taken time to do your own research, you'd know that Maia (who I'm almost certain is Maia Szalavitz) has actually been through the 12X12 treadmill & come out on the other side. In her published work (in the Huffington Post, NY Times, Washington Post, New York Magazine & several top-selling books including "Recovery Options" written with Dr. Joseph Volpicelli) hardly shows herself to be a '12 step basher'.Offering up alternatives to AA/12-step & illustrating their various pro's & cons is definitively not '12 step bashing'. Frankly, your knee-jerk use of the 'bashing' code word speaks volumes to your own prejudices on the subject.Having spent 8 years "going to any lengths" in the AA trenches myself, I'm quite happy to be free of its rigidity, empty, antiquated rhetoric, & useless, anecdotal dogma. I'm doing better than ever on my own — for three years running (never could amass that amount of time within AA's cartoonish, quasi-religious, decidedly anti-intellectual structure). Maia's story is much the same, as is Ray's (another commenter on the article cited). How's that for a non-evidenced based results?That the author of the article cited is not a 12-Step adherent & that neither is Scott Miller (mentioned no one in the article, rather simply dragged into your post to substantiate your own tirade) does not diminish Maia's very valid criticism.After 70-plus years of AA/12-Step being taken without question as an unalloyed boon to society, it's high-time for some evidence-based revision of treatment.It's also high time steppers find a new lexicon when they all too eagerly attack legitimate criticisms. If 'the program' won't do so itself, then interested parties & the general public have the right to look with a critical eye & ear toward the discourse of AA/12X12. That's not 'bashing'. That's calling it like you see it.

  2. If you'd taken the time to poke around the blog you'd know that I don't believe there is one way to recover and I don't object to fair criticism of any treatment approach, 12-step or otherwise. Criticism of 12-step facilitation (TSF) is fine, but characterizing all TSF as "harsh confrontation, humiliation, one-true-wayism" is just wrong.One can point out limitations and alternatives without slandering an entire field. There are practitioners and programs that behave has she describes–most do not and, fortunately, there are fewer today than there were a decade ago. Just as there are doctors who rip off medicare, it would be unfair to broadly paint doctors as thieves. Scott Miller is germane because he's an expert on the question she's raising (utilization of EBPs) and is the most visible advocate of the argument that the "therapeutic alliance" (the term she used) is of supreme importance in determining outcomes. Sorry you had a lousy treatment experience. I respect that there are many paths to recovery and don't feel the need to disparage your path or anyone else's. I'm happy you've found a path that works for you.

  3. It IS about evidence based practice. It is long overdue that we begin to use something logical. I am 63. I doubt that I will live to see it. I hope that my grandaughter may. We await a lister or pasteur.

  4. Hey Jason, talk about straw man arguments, show me where I said that 12-step facilitation as done through the manuals *isn't* an evidence-based practice? And show me where I said that actual 12-step facilitation is harsh and confrontational? Nope, you can't, can you?What I argued against and continue to argue against is "one true wayism" and the forced imposition of 12 step beliefs as the only way to recover. I believe that treatment providers should offer people the option of attending 12 step programs and offer 12-step facilitation as one approach, explaining what the research shows about *voluntary* affiliation. But if your primary treatment goal is "getting people into 12 step programs" that's not offering an option, that's indoctrination and it's not treatment and it's not evidence-based.

  5. You intimated that resistance to EBPs as rooted in attachment to "like harsh confrontation, humiliation, one-true-wayism (particularly insistence that the alternative to AA is jailsinstitutionsdeath…)" You painted the options as a choice between embracing EBDs and tolerating professional abuse. I see that as a straw man.As for TSF, you're correct. You never specifically criticized TSF and you're correct that TSF is antithetical to the old school treatment-as-12-step-evangelism.If you're a supporter of TSF as part of a menu of options among providers, we're on the same page and I apologize for misrepresenting you. However, I think it's fair to say that a reader of your writing over the last several years would walk away with the impression that a program utilizes 12 step programs is likely to be confrontive, abusive and resistant to science or EBPs, rather than potentially using an EBP (TSF).

  6. The limitations of evidence-based practices are evident when someone can use the results from the much criticized Project MATCH to declare 12step facilitation an evidence based practice.

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