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Why We Fail to Use Treatments That Work

by Fred Rotgers, Psy.D.; SUBABUSE listServ; 12/24/1999. Originally posted: 8/21/2004; []. Also available at: [].

Note: Fred worked with me when I was Chief of the Smithers Addiction Treatment and Research Center, 1998 - 2000. He was fired shortly after I was, another victim of the "Abstinence vs. Harm Reduction Follies of Summer 2000!"   ...alex...

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In the 1989 first edition of "Handbook of Alcoholism Treatment: Effective Alternatives" Hester and Miller present extensive reviews of treatments that, at that time, more than 10 years ago, had demonstrably better efficacy than most of what was currently (and still is) used in the US. We *know* what treatments work -- but it's not what we do!!! And, it has nothing to do with Congress or the funding agencies -- they were the ones that funded the research to which Hester and Miller refer--it has to do with a hidebound, quasi-religious ideology that has dominated the addictions field for decades.

That ideology has been adopted by supposedly broad minded advocacy  groups such as the National Council on Alcoholism and Drug Dependency (NCADD), and pushed to the detriment of the very people they claim they want to help. Claiming to want science to guide what is done in  treatment, Paul Wood, the President of NCADD, has nonetheless spoken out in public against one set of procedures (moderation training) that has a massive body of research supporting its efficacy both in effectively eliminating problem drinking and as a stepping stone to abstinence for people who are not yet ready to stop completely! Why would he do that? Because the hidebound ideologues oppose moderation approaches -- despite the fact that their adopted Messiah, Bill Wilson, harbored no such prejudices!

Thus, it has to do with the fact that people cannot or will not look beyond their own experiences for ways to help people change addictions. And the people who do that paradoxically prevent new technologies from being used -- even the ones that have shown strong research evidence for their efficacy. Thus, in the 2nd Edition of the "Handbook of Alcoholism Treatment Approaches", published in 1995, Hester and Miller lamented that since the first edition, virtually nothing had changed--treatment providers still used in droves the techniques that had little or no research evidence for their efficacy, and did not use the ones that did!

So, rather than blaming Congress, NIH, or researchers for a failure to integrate new, effective technologies into treatment, the field of practitioners should be looking inward at their own prejudices and closely held false beliefs!

Fred = Frederick Rotgers, Psy.D.; Assistant Chief Psychologist; Smithers Addiction Treatment and Research Center; 12/24/1999.

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Alexander DeLuca, M.D., FASAM.

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Originally posted:  8/21/2004

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