A retrospective approach will mean that we will try to monitor a group that has undergone the entire therapeutic program by checking what percentage of this group maintained abstinence at certain time intervals (e.g. after two, three or five years). Most evaluation studies of addiction therapy programs are always carried out ex post, and this imposes certain restrictions on them. If we formulate a posteriori hypotheses, i.e. evaluate the effectiveness of the program in relation to patients who have undergone therapy, we must be aware that in this case traditional methods of statistical analysis are of limited value. There is a risk of deriving false conclusions based on significant statistical differences found, and at the same time the risk of overlooking important conclusions due to the lack of statistical significance. For example, finding positive correlations between treatment and abstinence measurements does not always mean that the treatment method you use is the most effective of all. Let’s try to explain it.
First of all, drug addicted patients most often undertook treatment several times. The long-term effects of treatment as a reduction in drug-related behavior are difficult to assess. The issue of assigning the effectiveness of this – one of many subsequent attempts just because it is the last one, remains debatable, because it can be assumed that successful treatment is affected to some extent by all subsequent experiences that make up the entire therapeutic interaction that the individual has undergone. Even if previous attempts can be assessed as ineffective due to the criterion of maintaining abstinence, they may constitute a certain motivational “leaven”, which may contribute to creating a real motivation for the patient to fight addiction during the last treatment, described as effective. In this sense, it is likely that previous therapeutic interactions have some impact on current “success.”
Secondly, it may be that at the stage at which the patient is currently, various therapies could be successful, even with different theoretical assumptions. Because it is not really known what are the healing factors in relation to youth drug addiction, perhaps the effectiveness of treatment is determined not so much by the specificity of the impacts of a specific program as the general psychological and social situation of the patient who “grew up” – as therapists define – for treatment.
Thirdly, the abstinence criterion does not work as a basic evaluation unit, because often patients after completing the therapeutic program, although they do not take drugs, “substitute” alcohol or sedatives instead. It also often happens that former patients who stop abstinence do not admit it to their relatives, colleagues or therapeutic staff.
Difficulties in assessing the results of therapy
An important problem in evaluation research is:
Determining the time that should pass between the end of the treatment process and the moment of assessing its effectiveness
Ad hoc goals often determine this. It is difficult to obtain funds for careful evaluation research, which is why they often cover too short a period or are biased – with the primary aim of confirming the effectiveness of a particular therapeutic system. They are usually carried out six months after its completion, treating abstinence by the patient as the basic indicator of effectiveness.
Abstinence is assessed based on the patient’s history and urine drug test result. G. Vaillant believes that drug addiction is a disease in which relapses occur so often that the six-month period does not allow for reliable results. In his opinion, such studies should be conducted at least a few years after the end of treatment, and five years is the minimum period of strengthening abstinence, so that you can speak with a high degree of probability of healing. During this time, not only tests whose results indicate the temporary presence of the drug (or its absence) in the body can be used as measures of abstinence, but one should rely on more objective indicators showing the adaptation of a cured drug addict to the environment and improvement of its social functioning. These include: taking up a job, permanent residence, at least correct contact with the family, no conflicts with the law, and of course narcotic abstinence, but determined not only on the basis of the test result, but also on the basis of interviews with relatives or an environmental interview.
Difficulties with verifying the results obtained
The main reason for the difficulties encountered during these tests is “dropping out” of a sample of individuals who, after treatment, have returned to addiction and started taking drugs, and not wanting to admit it, avoid contact with interviewers or are simply hard to reach. Often, if they don’t take drugs, they start drinking alcohol, they don’t work, and their relationships with their loved ones don’t improve. In evaluation studies, we must also consider the occurrence of cases due to death, because in the drug addict population the mortality is higher than in the corresponding age population of non-drug users. Another reason may be a change of residence. This is an important factor, because during therapy patients are made aware of the dangers of returning to their old place of residence after therapy because of the danger of the influence of former drug addicts.
Assessment of the degree of reliability of the methods used for statistical material analysis
Due to the lack of homogeneity of the group of drug addicts undergoing therapy, in terms of variables such as: age, gender, family situation, socioeconomic status, duration of drug use, type of drug, level of addiction (there are various levels of addiction from occasional use, through intermediate in addiction, up to heavy addiction) – using statistical calculation methods we can deal with overestimating the differences between compared units, while underestimating the differences between the compared groups. This means that statistical results must be evaluated carefully.
Basic principles of addiction therapy
Addiction therapy should be conducted by an interdisciplinary team of specialists consisting of therapists, social workers and doctors. At the intersection of these specialties, various types of conflicts may arise resulting from different approaches to both therapy problems and patient attitudes.
An important element in therapeutic work is the danger of burnout. This is particularly important in the work of drug therapists. This type of therapy is not very gratifying for the therapists themselves due to frequent failure cases, e.g. despite initial positive results, sudden resignation from treatment, or a break in abstinence or other rules in force at the center. Such failures contribute to the lack of professional satisfaction of therapists, who often not only devote a lot of time to patients, but also engage emotionally in the treatment process. The role of therapists is difficult, because they need to find a balance between allowing and accepting attitudes, and completely rejecting behaviors associated with taking drugs.
The therapist-client relationship must be based on the therapist’s understanding and empathy. This is a typical attitude for Rogers’ client-centered therapy concept. Therapeutic interactions against drug addicts should, however, be much more directive, mainly focused on providing feedback aimed at correcting behaviors consistent with the behavioral pattern of addicts.
Author: addiction recovery online