Recovery Review directs our attention to a presentation by Jim Orford called Time to Ask the Right Questions in the Right Way: A New Direction for Addiction Treatment Research?. He suggests that comparisons between MET, CBT and TSF follow from us asking the wrong questions.
Here’s one of his suggestions.
Stop studying named techniques [CBT/MET/TSF] and focus instead on studying change processes and developing good, general addiction change theories
- Need to change, can’t do it alone, ‘surrender’
- Commitment, ‘self-liberation’
- Helper who is: credible, knowledgeable, efficient, concerned, working alliance
- Communication, self-disclosure
- Pledge, change statements
- Social support for change
- Coping with craving, negative emotions, etc.
- New identity
He offers the following tentative conclusions for this area:
Effective treatments have in common some basic process elements:
- A knowledgeable, efficient, likeable and encouraging helper(s)
- Who help(s) reinforce the feeling of need for change (e.g. encourage ‘discrepancy’)
- Help(s) develop commitment to change (e.g. ‘pledges’, ‘change statements’)
- Help(s) develop self-efficacy (e.g. ‘self liberation’, ‘seeing the benefits’)
- And help(s) build social support for change
Under another suggestion he suggests that research look beyond primary treatment to include looking at the impact of:
- What happened before
- Entry procedures
- The whole organisation
- Mutual-help, faith communities and others
- Families and social networks
- The wider community
This is such a profound paradigm shift, but so self-evident when you see it described. An important question is what interests have us doing hundreds of studies on what are now, clearly, the the wrong questions?
He offers a suggestion. Our research is focused on what he describes as, “Time-limited Professionally Dominated Treatment”. What can we infer from that?