Asking the right questions in the right way

021-640x480Recovery 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’
  • Incentives
  • 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.
  • Persistence
  • 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?

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One response to “Asking the right questions in the right way

  1. No question about it. The motors revving and the wheels are spinning but we aren’t going anywhere. We’re stuck. The NIAAA funded a study that found 24% of people quit spontaneously, maybe we could start by asking some of those people what changed in their lives, minds, souls, or whatever.

    We have went from the “blame and shame” tactics of yesterday to a “predisposed pity party” and have seen no improvements in success rates.

    On the other hand, according to Daily Finance, we are going to generate $34 billion dollars worth of revenue in 2014. Wall Street probably likes us. If we do not have success at least we have friends.

    Oh yeah, we did one other thing.
    We messed around with the definition of alcoholic and addiction so much that the general public thinks we are full of crap. They are forced to rely on their own ideas when addressing alcoholic family members, employees, etc.