Research on Addiction Treatment

There is no shortage of research about addiction. Hundreds of studies over the past few decades have examined different methods to address addiction and problematic substance use. From this research, we know what works, including things like motivational interviewing, methods that center clients as the experts of their own lives, community reinforcement from friends and families, harm reduction, and others.

Sadly, the field of addiction treatment has continued to use many of the same traditional methods since the 1930s. In fact, according to Inside Rehab by Anne Fletcher, at least 80% of all rehabs rely on AA and Twelve-Step treatments as the foundation for their centers. This includes many programs that proclaim to be “Non-Twelve-Step.” Though Twelve-Step approaches work for some people, they do not work for all.

The idea of addiction as a disease also persists, despite research that shows worse and more frequent relapse rates for those who internalize this notion. In many programs, staff authoritatively determine problems and solutions for clients rather than working collaboratively with them to help them reach their goals. Other programs deliver manualized approaches to treatment, going step-by-step through a booklet, rather than adapting to clients’ specific needs.

The result is extremely poor outcomes. The field is broken, and it’s clear that there is a need for alternatives.

Evo’s model emerges from the latest thinking on root causes and solutions to addiction. Treatment can look very different in different programs, depending on the program’s theories about how problems come to be, how identity forms, and how people get better. Evo has carefully selected treatment approaches that we see as most effective and supportive for people standing up to addiction. Delivering treatment this way is a rigorous process, requiring us as a team to undergo continuous training, to reflect, and to grow. Read more about the structure of Evo's treatment program.

Evo’s evidence-based programmatic influences include:

 
 

Motivational Interviewing

Core to Evo’s program are the principles of working with clients in a collaborative, respectful, and empathetic manner. Research has found these ideas to be widely effective, particularly in the body of research on Motivational Interviewing (MI).

Developed by Bill Miller and Stephen Rollnick, MI is a technique that evolved from their work to support clients with alcohol problems. Clinicians and practitioners more broadly now use MI to address a wide range of issues, from substance use to gambling, parenting, and classroom management. Motivational interviewing is a client-centered counseling style for eliciting behavior change by helping clients to explore and resolve ambivalence. It is a non-judgmental, non-confrontational and non-adversarial approach that attempts to increase the client’s awareness of their behavior, envision a better future, and become increasingly motivated to change it. Read more about Evo's approach to addiction treatment.

Read more about Motivational Interviewing.

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Humanistic Psychology

Humanistic therapy (Humanism) is a positive approach to therapy that centers around the idea that people are innately good. Known as the “third force” in psychology, humanistic psychology arose as a response to negative theories of behavioral therapy, which emphasized pathology and focused on past experiences.

Rather than categorizing groups of people dealing with similar issues as having the same problems, Humanism presents a holistic approach that looks at individuals as whole, complex people. Humanistic psychology emphasizes a person’s ability to use their personal instincts to find growth and healing and to achieve self-actualization. Learn more about Evo's addiction treatment program.

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Trauma-Informed Therapy

At least two thirds of addicted people have suffered at least one extremely traumatic experience during childhood. The higher the exposure to trauma, the greater the risk. Even one extreme adversity—like losing a parent or witnessing domestic violence—before age 15 doubles the odds of substance use disorders, according to a study of the entire Swedish population. Other “adverse childhood experiences” (ACEs)  include divorce, verbal, physical, and sexual abuse, neglect, active addiction, or symptomatic mental illness in the immediate household and having incarcerated family members.

Trauma-informed care understands, recognizes, and responds to all types of trauma. This approach recognizes trauma symptoms and understands potential paths for recovery. The clinical emphasis is on physical and emotional safety for survivors, allowing them to rebuild a sense of control and empowerment. Learn more about Evo's programmatic approach.

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Collaborative and Postmodern Therapies

Collaborative or Postmodern therapies take a respectful, collaborative approach to counseling, centering people as experts in their own lives. Clinicians understand that people are battling problems and they don’t need to label themselves as the problem to solve it. People do not have to define as addicts to overcome addiction. Collaborative therapies also assume people have many skills, strengths, and values that they can leverage to overcome problems in their lives.

These therapies also acknowledge power dynamics in the world and strongly advocate for social justice. Postmodern approaches in therapy address personal or "lived" experiences around race, class, gender, sexual orientation and ability, and how these experiences can impact treatment. The relationship between client and therapist is highly collaborative and the client plays a prominent role in mapping the direction of their journey.

Three main types of Postmodern Therapy are: Narrative Therapy, Solution-Focused Therapy, and Collaborative Language Systems. Also related are Feminist-Informed and Affirmative Therapies. Learn more about how Evo uses a narrative approach to addiction treatment.

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Harm Reduction and Moderation

Contrary to popular opinion, the idea that drugs are addictive in and of themselves, because of their chemical composition or effects, is a myth. Surprisingly, only 10-20% of those who try even the most stigmatized drugs like heroin, crack, and methamphetamine become addicted. Instead, addiction most often occurs as a coping strategy in response to dynamic personal and societal factors. Though most people first think of sobriety as the only solution to substance use issues, the movement toward moderation has been around for a long time, particularly in the concept of harm reduction. Read more about why Evo thinks sobriety shouldn’t be the only option.

Harm reduction refers to practices that focus on reducing the harm of drugs, providing care to people who use drugs rather than solely trying to stop drug use. During the onset of the HIV/AIDS epidemic, many countries began to provide free needle exchange, safe injection sites, and health services to drug users. Research on these measures shows decreased infection rates. Harm reduction tactics, including media campaigns against drunk driving, cut drunk driving deaths in half from the early 1980s to 2013. Harm reduction techniques are also common in non-substance settings, like safe sex education for teens.

Renegotiating relationships to substances takes time, deep internal struggle, and often involves making mistakes. Yet, many rehab programs view relapse as a sign of failure or even as grounds to kick someone out of treatment, rather than part of the natural course of recovery. By contrast, research on non-judgmental harm reduction approaches, like needle exchanges and health interventions, shows great success in reducing infection and overdose. These approaches do not prolong addiction. In fact, numerous doctors, clinicians, and community practitioners who practice harm reduction say their clients would not have started their recovery journey if not for their exposure to these alternative methods. These approaches lead with the sentiment that a person’s life is valuable, no matter what. When people see that others value them, they start to value themselves.

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