Research to Practice - Addiction Treatment That Works

To hear someone say that addiction treatment works, is for the most part, a loaded statement in the United States. Studies show that for large groups of people who need addiction treatment, about 40 percent of them will go into recovery for at least a year. This timeline has seemed to evolve into a standard for gauging success, no matter what kind of alcohol/drug treatment is received. There is also the reality that addiction treatment centers have been mostly remiss in many areas, including research specifing if the treatment they use “works”, self-examination into why they need inpatient or outpatient treatment, why they do what they do in treatment or how they know if it works.

For example, a population study done by the state of Washington ascertained that for the people reported in the statistics (mostly indigent or nearly so), 40 percent finished addiction treatment. Of those 40 percent, 40 percent stayed clean and sober for at least one year and worked for at least one year (i.e., 16 percent did well). Is that a good percentage for this population? Who knows? Most treatment facilities do not have the research on what works and doesn’t work in their own agency.

Thanks to insurance companies’ dependence on statistics, accountability and measures, the alcohol/drug treatment field is finally catching up. Doctors and staff at Schick Shadel however, have been conducting research for 60 years. Our slogan - “We have the #1 success rate for alcoholism” — is based on valid, scientific method research done by an independent and reputable research firm. Schick has known for decades that it’s treatment does indeed “work” for about 70 percent of its patients (66%-80%), and is allowing them to stay clean and sober for life - not just a year.

Patients and their families want to be assured they are receiving “best practices” treatment. Research on aversion therapy constitutes one of the largest literatures in the field. Schick Shadel lives by the mantra “research to practice”; our aversion therapy treatment is the result of medical research and scientifically proven to work.

The following is taken from Hester & Miller’s second edition of the Handbook of Alcoholism Treatment Approaches - Effective Alternatives, “What Works? A Methodological Analysis”, 1999, in which 30 types of therapy for alcohol/drug treatment were compared based on a cumulative evidence score from the number of both positive and negative studies, a mean quality score for modality, and a mean severity score for modality.

Chemical (Schick Shadel’s emetine) aversion (nausea) ranks sixth in quality and cumulative scores and third in cost (Psychotherapy, 27th and Milieu Therapy, 20th, are higher).
Faradic therapy ranks 18th in cumulative score, about 14th in quality, but ranks relatively high in number of studies done.
The lowest ranked therapies are psychotherapy, general alcoholism counseling and educational lectures and films. (We have known for decades that this type of therapy or teaching is the least conducive to learning, yet most alcohol/drug treatment programs still use it almost exclusively.)
Many treatment modalities have very little or no research to back them up. Schick Shadel Hospital has good research backing its therapy model.
There are only five treatment modalities ranked higher than chemical aversion. Schick Shadel Hospital uses parts of those modalities as follows:
1. Community reinforcement in its aftercare planning and counseling sessions, and during its reinforcement sessions.
2. Motivational enhancement during the admission process but not in the formal MET (Motivational Enhancement Therapy) format. MET is not generally required by the time a patient is being admitted. It is used during outreach sessions or during interventions.
3. Social skills training is not generally required by our patient population, however, social needs are identified during assessment and can be addressed with an aftercare plan.
4. Behavioral contracting is generally only used at Schick Shadel Hospital in cases of suicidal ideation, or for other behavioral changes when patients are acting out. We have observed however, during light sedation therapy, the benefits of reinforcing the positive affirmations our patients suggest would benefit them. This is a proven positive experience for patients, and may be more effective in behavioral change than behavioral contracting.
5. Brief interventions are the most researched modality. Aversion therapy used by Schick Shadel Hospital can be classified as a brief therapy. Cooper, in “Brief Therapy in Clinical Psychology” (Cullari, Foundations of Clinical Psychology, 1998), quotes three definitions of Brief Therapy:
  1. Therapy that takes as few sessions as possible, not even one more than is necessary, for you to develop a satisfactory solution (de Shazer, 1991)
  2. The deliberate use of a limited number of technical and conceptual principles, applied in a focused and purposeful manner (Wells, 1993)
  3. Is defined more by an attitude than by the specific number of treatment sessions (Hoyt, 1990).

Schick Shadel researchers, led by Dr. James Smith, the hospital’s former Chief of Staff and Medical Director, have contributed dozens of articles on addiction and aversion therapy to leading medical journals.