Effective treatment research
selected articles
Treatments need to have a flexible structure
When what are thought to be effective treatments are compared, it is a common finding that there is no great difference between the two interventions providing that they have been well delivered. The main reason for this is that effective treatments tend to include similar components.
Classic paper :: What are the elements of effective treatment?
Moos R (2007) Theory-based active ingredients of effective treatments for substance use disorders. Drug and Alcohol Dependence 88: 109–121 doi:10.1016/j.drugalcdep.2006.10.010
This is a must read article for anybody interested in the theoretical underpinning of effective interventions which at the same time reviews the available evidence. In an overview of what kind of interventions work the author concludes that, consistent with social control theory, effective treatment appears to be characterised by:
❶ cohesion and support between therapist and service user ❷ moderate, ie flexible, structure ❸ goals oriented toward achieving service user’s personal milestones and objectives.
The quality of the alliance or bonding between service user and therapist or overall program has been consistently associated with treatment outcome.
Effectiveness is not the only consideration
It is a prerequisite of any treatment offered to the public that it should be effective, but there are other things to think about: Is it practical - are suitably qualified staff available to deliver it and can it be done within necessary time constraints? is it more or less cost-effective than alternatives? Is it acceptable to all stakeholders? Clinical guidelines usually address these issues.
Important study :: What techniques are suggested in guidelines?
Michie S, Whittington C, Hamoudi Z, Zarnani F, Tober G & West R (2012) Identification of behaviour change techniques to reduce excessive alcohol consumption. Addiction 107: 1431–1440 doi:10.1111/j.1360-0443.2012.03845.x
Behaviour change techniques were identified by trawling through guidelines and treatment manuals and 42 different techniques were agreed upon. The effectiveness of these techniques was then tested against a meta-analysis of RCTs where the target behaviour was heavy rather than dependent drinking. How well the interventions were delivered is not recorded.
The authors conclude that in brief interventions, promoting self-monitoring is associated with improved outcomes. How effective the other promising techniques might be could not be confirmed from the dataset available.
