Your guide to evidence-based rehab treatment

The research behind evidence-based rehab strategies

Addiction recovery is an extremely complex process. Don’t let that put you off: read through the Australian rehab statistics, and you’ll see getting into rehab is absolutely worth it.

The complexity of rehabilitation comes down to one simple, obvious fact: no two individuals are alike, and neither are their addictions.

In order to provide the most effective care and help their clients achieve long-term sobriety, a good drug and alcohol treatment centre needs to rely on evidence-based rehab therapies. At The Hader Clinic, that’s precisely what we do.

‍In this article, we’re going to look at research studies done on key therapies. Don’t worry; we won’t let it get too dry. We’ll summarise what you need to know here and link you to the studies at the bottom so that you can read them in full at your own pace.

What is ‘evidence-based’ treatment?

Evidence-based treatment is a holistic strategy for helping people overcome drug and alcohol substance use disorders. Its holistic approach encourages experienced medical professionals to use multiple thoroughly researched addiction recovery strategies to help their clients meet their goals.

Put simply, evidence-based treatment is precisely what it sounds like. We, as your rehab caregivers, will design your recovery plan using therapies that we have studied and adapted to your individual needs.

What evidence goes into substance addiction treatment?

The data that goes into science-based treatment for drug and alcohol abuse is typically pulled from three sources.

Scientific research

These include large-scale studies devoted to studying the efficacy of specific treatments or combinations of treatments. Valuable data is also discovered through meta-analysis, which is a study of past studies, combining all of their research and results while accounting for the differences in methodology.

Clinical assessments

This refers to evidence gathered by rehab healthcare providers, like the staff at The Hader Clinic. As trained and experienced professionals, we are constantly recording and studying the effects of our therapies on our clients, adapting their treatment plans as we go, to ensure they get the best shot at recovery.

The evidence we gather helps us to assess and fortify our practices so that new clients always receive the best care possible.

Patient characteristics

This data includes factors like age, gender, culture, spirituality, comorbidities, values and goals. This is the most granular level of data and is collected at the individual client level. Every individual responds differently to therapy, and this data helps us to understand why and how we can adapt their treatments to be more effective.

Does evidence-based treatment work?

The short answer is ‘yes’. The honest answer is ‘yes, but…’.

Do evidence-based practices work? Yes, but that depends on how you define success. It’s not helpful to think of a ‘recovered addict’ who no longer struggles with cravings. Instead, think of a ‘recovering addict’ who, even after decades of sobriety, still has to remain vigilant against addiction.

Successful drug and alcohol rehab means more than total abstinence; it means training patients to understand what causes relapse, how to avoid relapsing, and to realise that relapsing is natural and recoverable. When you get back on the wagon, you’ll do so stronger.

Our evidence? Three years after completing their full program, approximately 74% of our clients had remained sober.

The evidence behind effective rehab strategies

Alright, let’s look at the research. If you want to understand what rehab can do for people with substance use disorders, these are some of the most effective drug and alcohol rehabilitation strategies used today. We offer all of them.

Cognitive behaviour therapy

Cognitive behaviour therapy (CBT) helps clients understand the mental and emotional triggers behind their addictive cravings, unlearn those triggers, and then replace them with healthy behaviours.

CBT is an umbrella therapy that covers several types of treatment, which can be used individually or in combination with each other depending on what works best for the client.

Here are two treatments that we commonly use:

Contingency management

Contingency management therapy (CMT) aims to offer a rewarding alternative choice, the contingency, to engaging in addictive behaviour. For example, if the client maintains their sobriety for a set period of time or through a challenging event in their lives, they will be offered a personally meaningful reward. What that reward is will depend on the client, and may include monetary rewards or access to certain privileges.

CMT has been thoroughly researched to study its efficacy in treating specific substance disorders. Studies have shown it to be effective at helping patients manage alcohol addiction as well as cocaine and opioid drug abuse.

Relapse prevention

Relapse prevention therapy (RPT) helps patients understand their relapse triggers and gives them strategies to both avoid and disarm those triggers.

Common triggers include particular places and people (bars, clubs, other addicts, certain friend groups and family members, etc).

A meta-analysis of 26 studies found that RPT is extremely effective at improving an addict's understanding of how their environment affects their sobriety. In our experience, this rings absolutely true, and this understanding is crucial for achieving long-term sobriety because our clients do often need to make significant lifestyle changes. RPT helps them understand why and how.

Individual counselling

Like CBT, individual counselling is an umbrella term that covers a range of approaches. In fact, there’s plenty of overlap between the both of them. Both are also highly effective when used appropriately. 

Here are two types of evidence-based individual counselling strategies we use at The Hader Clinic.

Brief interventions

Brief interventions (BIs) are an alternative to hour-long one-on-one sessions. They are an opportunity for therapists to offer meaningful counselling during critical moments at any point in the day.

During a BI, the counsellor will help their patient assess a challenge or success that they’re currently experiencing. The BI follows the FRAMES structure:

• Feedback
• Responsibility
• Advice
• Menu of options
• Empathy
• Self-efficacy

The FRAMES structure helps the patient understand what’s happening and what they can do about it and gives them a needed nudge to remind them that they can achieve sobriety.

As a relatively low-intensity approach, research and clinical evidence show that BIs work best for those with severe drinking problems but who haven’t yet developed an alcohol dependency (that is, a physical need for alcohol). BIs can help reduce their heavy drinking by 20-30%.

We typically use BIs to help younger clients or those who have relatively recently begun to abuse drugs and alcohol. We find that it works best for those battling alcohol, marijuana and amphetamines.

Motivational interviewing

Motivational interviewing (MI) is an approach designed to help patients overcome negative or unhelpful feelings like ambivalence about their addiction or confidence in their ability to function while inebriated. These feelings can arise at any point in a patient’s recovery journey, no matter how long they’ve been sober.

The goal of MI is to avoid an argumentative confrontation, as addicts in this state can often be highly defensive and dismissive. Rather, the therapist helps the patients reflect on their own values and assess their behaviour against their own standards.

As with brief interventions, MIs work best with patients who have not yet developed a physical dependency on drugs or alcohol. 

As you might expect, studies show that both BIs and MIs work best when used in conjunction with more stringent therapies like CBT.

12-step rehab programs, mentoring programs & peer support groups

Arguably the most famous multi-step programs are Alcoholics Anonymous (AA) and Narcotics Anonymous (NA).

A study exploring the efficacy of self-help groups like AA and NA, particularly after having completed inpatient rehabilitation, has shown good results. Of the study group:

• Of those who had attended AA/NA meetings for at least two years, 81% had been sober for six months or more
• Of those who did not regularly attend AA/NA meetings, only 26% had been sober for at least six months

However, the researchers also concluded that self-help programs were not effective if they were the sole source of therapy. They recommended AA/NA be used as a supplement to more effective rehab therapies.

Other studies have come to similar conclusions, arguing that 12-step programs are not as effective as therapies like cognitive behaviour therapy.

The research we’ve found aligns with our own experience. AA and NA meetings, by their own admission, are not professional therapy programs. They are run by laypeople who have personal experience with addiction and the struggles of sobriety.

Our opinion is that the community they offer can be invaluable and give recovering addicts a safe space to explore their struggles and work towards their wins. However, it is most effective as an after-program once inpatient rehabilitation has been completed.

Dual diagnosis treatment for substance use and mental health disorders

There is a crystal clear link between substance use disorders and mental health disorders. One is often the cause of or result of the other, and both can make each other worse.

For example, those with severe mental health issues may turn to drugs and alcohol to alleviate feelings of pain or depression. Or, those who have been addicted for years will likely begin to experience physical, neurological and emotional distress.

It is well established that in almost all cases, people in rehab for drug and alcohol addiction need therapy that addresses their mental health, even if those issues are relatively mild. The lessons they learn on how to maintain their mental and emotional well-being will help them to maintain sobriety.

Family therapy, couples therapy and community support

Several studies, as well as the testimony of countless rehab therapists and patients, reveal that a close support network creates the foundation for long-lasting sobriety. As a recovering addict, your family, friends and significant other can help remove you from trigger places and people, provide safety and, most importantly, help you build a meaningful, joyful and stable life.

Family and couples therapy are often available in inpatient rehab (as we offer them) and are designed to help clarify and mend relationships. Conflicts within these key relationships are often at the root of addiction, and so alcohol and narcotics are used to soothe emotional wounds or provide an escape.

The progress made in family counselling sessions can be used for a type of therapy called the Community reinforcement approach (CRA).

CRA is a little like contingency management therapy. As the client strengthens their relationships, then the continuation of those relationships becomes the contingency against relapse. The strength of their bond helps them resist their cravings. According to the research, and our experience, simply knowing that they’ll see their family on the coming weekend is enough to get a recovering addict through the week.

Meta-analytical studies have shown that CRA is quite effective in helping patients with alcohol, cocaine and opioid dependencies. The approach results in patients choosing to continue with long-term rehab and to then consistently engage with outpatient programs.

Final thoughts

There are dozens of evidence-based drug and alcohol rehabilitation strategies available to you. They’ve gone plenty of solid evidence gathered from researchers across the world. So, what works best?

The takeaway is this: no one therapy will help a recovering addict achieve their long-term sobriety goals. Some strategies work well for some, and not so much for others. More likely, different therapies will work best at different points in an addict’s recovery journey.

The best way to achieve long-term sobriety is to use a tailored combination of evidence-based rehab strategies, including inpatient and outpatient care. 

Alright, we’ve gone on long enough. And, taking a look at the reference list below, you’ve got plenty of further reading ahead of you. That’s only if you’re up for it — remember that you can always contact us to discuss our therapies over the phone or during an in-person tour.

References

We’re not going to worry about proper citing formatting here — this isn’t an essay. We’ve listed the titles of each study we’ve consulted to write this article. Click each title to visit the full study page.

1. 12-Step Treatment for Alcohol and Substance Abuse Revisited: Best Available Evidence Suggests Lack of Effectiveness or Harm
2. Behavioral couples therapy (BCT) for alcohol and drug use disorders: a meta-analysis
3. Behavioral couples therapy for alcoholism and drug abuse
4. Behavioral couples treatment of alcohol and drug use disorders: current status and innovations
5. Brief interventions for alcohol problems: a meta-analytic review of controlled investigations in treatment-seeking and non-treatment-seeking populations
6. Brief interventions for alcohol problems: a review
7. Cognitive-Behavioral Therapy for Substance Use Disorders
8. A community-reinforcement approach to alcoholism
9. Community reinforcement approach in the treatment of opiate addicts
10. Contingent reinforcement increases cocaine abstinence during outpatient treatment and 1 year of follow-up
11. The cost effectiveness of treatment for alcoholism: a first approximation
12. The cost-effectiveness of treatment for alcoholism: a second approximation
13. Cue exposure with coping skills training and communication skills training for alcohol dependence: 6- and 12-month outcomes
14. Efficacy of relapse prevention: a meta-analytic review
15. Evidence Based Psychosocial Interventions in Substance Use
16. Give them prizes and they will come: Contingency management for treatment of alcohol dependence
17. High effectiveness of self-help programs after drug addiction therapy
18. Low-cost contingency management for treating cocaine- and opioid-abusing methadone patients
19. Motivational Enhancement Therapy Manual: A Clinical Research Guide for Therapists Treating Individuals with Alcohol Abuse and Dependence
20. Motivational interviewing for substance abuse
21. Outcome, attrition, and family-couples treatment for drug abuse: a meta-analysis and review of the controlled, comparative studies
22. Outpatient behavioral treatment for cocaine dependence: One-year outcome
23. A Randomized Controlled Trial Comparing Integrated Cognitive Behavioral Therapy Versus Individual Addiction Counseling for Co-occurring Substance Use and Posttraumatic Stress Disorders