SMMGP has a great downloadable presentation on addiction treatment research. By Jim Orford, it’s a couple of years old now, but it has not lost any of its relevance. I’ve been writing on the problem of lack of addiction research generally and a definite near absence on recovery research. But we don’t want research for research’s sake; we want addiction and recovery research that is asking and answering the right questions. If we were to come at addiction and recovery research from a different direction, would it help us in a way that traditional approaches have not?
Orford is a Professor of Clinical and Community Psychology at the University of Birmingham. He sets out some of the problems with existing research – why it ‘fails’:
- It assumes a technological model of treatment
- It adopts a narrow focus on time-limited professionally dominated treatment
- It uses an out of date, restricted definition of science and knowledge production
Technological model of treatment
He make a very relevant point around the ‘Dodo Bird Effect’ – the outcome equivalence paradox which views the therapist in an addiction treatment setting as a technician delivering a ‘treatment’ and neglects what we think we know is at the heart of helping people move on – the quality of the therapeutic relationship. So we measure the treatment as the dominant intervention, rather than the personal relationship. The problem with this, argues Orford is that many treatments end up providing much the same kind of outcomes (think Project Match).
His tentative conclusion:
Well-delivered, credible, named treatments are, in most important respects, the same, which would account for supposedly different types of treatment having equivalent outcomes.
Professionally dominated treatment
The problem with professionally dominated treatment is that it tends to ignore professionally unaided change (or, in my experience, resists it); ignores the settings and systems in which treatment is embedded; neglects wider social networks like family and community resources and defines outcomes narrowly. If recovery takes place more in communities than in clinics we are going to miss the impact of community recovery capital on outcomes, something I touched on before.
Restricted definitions of science and knowledge production
Here lie dangerous pitfalls. Research can miss the importance of culture and assume that the findings will be universal. Orford lists more problems:
- Which assumes research is value-free and researchers are neutral
- Which privileges top-down expert theory over tacit, implicit knowledge
- Which ignores the patients view
These chime true for me. The value of lived experience and of recovering people, peer supporting in services has largely been unrecognised. What the patient wants can be lost in delivery of what ‘the evidence’ says works. “Successful” treatment can be one where the patient never reaches his or her goals, but agreed outcomes are still achieved. The service may end up more satisfied than the patient.
In addition there are amazing things happening in recovery communities, in mutual aid groups and in family support services, some of which are peer-led. This is community inspiration, asset building and growth and it is largely not being captured.
The prof is not just identifying the problem; he has some suggestions:
- Stop studying named techniques and focus instead on studying change processes and developing good addiction change theories
- Study these processes within broader, longer-acting systems of which treatment is a part
- Bring the science up to date by acknowledging and using the variety of available sources of knowledge (e.g. qualitative research, action research and participative research)
The part that other recovering people (peers) play in recovery from addictions is becoming clearer, at least to those who have eyes to see it. Community recovery capital is on the radar a bit more. Those of us working in treatment need not be afraid of acknowledging that there is more to getting well than professional interventions. When you ask someone in long term abstinent recovery what helped them get there, treatment figures, but it’s not necessarily top of the list and the technical aspects of treatment will hardly be mentioned.
What will be remembered is how kind professionals were, whether we listened to the story, empathised with the struggle and kept faith in them, even when the client struggled to believe in his or her self. In other words, exactly the sort of stuff that traditional addiction treatment research doesn’t measure.
It’s time for change.