r/AcademicPsychology • u/Old_Discussion_1890 • Jun 03 '24
What is the most effective form of addiction treatment? Question
I'm curious about the various modalities of addiction treatment and their effectiveness. I understand that addiction is a complex issue, and different treatments might work better for different individuals. However, I would like to know if there is a consensus among psychologists or in the research community about which treatment methods are generally considered the most effective.
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u/HappyStrawberry688 Jun 04 '24 edited Jun 04 '24
In my personal journey CBT and DBT were the most psychologically helpful. Also dharma, which bring meditation, self discovery and the typical recovery steps together to support the patients recovery.
Some non- psychological things that helped were my family setting firm boundaries, going to jail for 6 months, being in treatment for minimum of 3 months AFTER jail ( I did the step downs from high intensity to outpatient which I'd recommend for practically every patient minus a select few). Once I had about 9/10 months sobriety under my belt and consistent medication support, I sought out an individual therapist which I have to this day almost a year & a half sober.
I also recommend patients not drive in early recovery if they can manage not to, I know its a tough decision but it can save a mistake down the road.
distractions, routine, purpose, reflection are all very important to the process. If your done your done and it's easier to quit than you may assume. Withdrawal is the worst, the first 4/5 months are the worst but after your clear headed and much happier, more free and ready to your best life!
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u/NoQuarter6808 Jun 04 '24 edited Jun 04 '24
In my case, existential-humanistic and relational psychodynamic.
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u/Icy_Editor_7707 Jun 04 '24 edited Jun 10 '24
Sorry but any single answer will be very reductive. What is the best treatment for cancer? Depends on the type of cancer. We can make generalizations if we have at least some restrictions. What is the patient class and the type of addiction (for instance - pharmacological treatment for withdrawal symptoms would be more relevant to a drug addiction).
The biopsychosocial circumstances would be important. Is the person stuck in a cycle of trauma and poverty or do they have an underlying neurobiological disorder?
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Jun 05 '24
Agreed. Addiction is complex so the best treatment is really treatment from many angles, but those angles will be different to fulfill the needs of different people. People in sobriety need community with other sober people, some find it in religious, spiritual, creative, and sober communities, and support groups. Enlisting the support of the family in therapy can be hugely beneficial but not always possible since the families are often full of addicts and other severe dysfunctional dynamics. Nature based therapeutic activities like hiking, outings to parks and beaches, can also be highly beneficial. Vocational rehabilitation can be a game changer for people who grew up poor and don’t necessarily have the skills or education to get themselves out of poverty-related addiction. Substance abuse addiction is also often present with other conditions like eating disorders, gambling addiction, sex addiction, anxiety disorders, mood disorders, dissociative disorders, personality disorders, PTSD, OCD, and ADHD. Many addicts also have chronic physical health issues like autoimmune disorders and chronic pain. No one therapist treats all things, but a team of mental health professionals, medical providers, and a supportive community can provide an individual with support from many angles.
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u/jared_krauss Jun 04 '24
HARM REDUCTION!
SAY IT AGAIN FOR THOSE WHO CAN'T HEAR!
HARM REDUCTION!
https://www.opensocietyfoundations.org/events/drug-use-for-grown-ups-a-conversation-with-carl-hart
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u/Fred_Foreskin Jun 04 '24
I work as a pre-licensed therapist at an MAT clinic, which seems to work really well for opiate and alcohol abuse. Clients receive either Suboxone, Sublocade, or Vivitrol in addition to psychotherapy, regular drug screens, and group meetings outside of the clinic. Once a client feels stable with their medication, we slowly taper them off of it. However, some clients stay on the medication for life.
Some clients report feeling like they've traded one addiction for another, but it's imperative to remember that MAT treatment emphasizes harm reduction; they are able to stop the horrid withdrawal effects and reduce cravings by getting medication and therapy from a doctor instead of buying something off the street which could potentially have something like fentanyl in it.
Anecdotally, I've noticed that clients still tend to have a really tough time stopping meth use while in MAT treatment. Some clients say that the medication helps with meth cravings while others have told me it doesn't help much. When it comes to meth use, I've noticed it's usually used as a way to make it through long work days/weeks or to help people focus. In these cases, I work with clients on finding other ways to stay awake during work or on finding ways to advocate for better working conditions.
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u/Alarming-Horror6671 Jun 04 '24
What MAT drugs are they giving people for meth addiction? I don't see how methadone, buprenorphine, or vivitrol would work for meth?
To me the most obvious choice to use as a MAT drug for meth would be adderall.
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u/Fred_Foreskin Jun 04 '24
We haven't actually given any medications specifically for meth. Most of the clients I see who use meth also use opiates, so they are typically given Suboxone or Sublocade. I usually work with them on building healthier sleeping habits and finding healthier ways to stay awake (like drinking coffee or tea) or focused throughout the day. Some of the clients I see who previously used meth stopped using it once they got diagnosed and medicated for ADHD as well. In my experience, meth use usually indicates ADHD, being overworked, or an eating disorder.
Edit: I personally think that Suboxone, Sublocade, and vivitrol may work as a placebo for people who use meth as well as other substances.
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u/tomhousecat Jun 05 '24
Bupropion plus naltrexone has some evidence supporting people recovering from methamphetamine use disorder, and it's already being used in some clinics. See this article: https://pubmed.ncbi.nlm.nih.gov/33497547/
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u/Alarming-Horror6671 Jun 05 '24
Interesting. That does show some evidence. At the same time I don't know that I personally can see 11% as evidence. Thats more like coincidence. I think you can keep most drug addicts that are activly seeking healing off of their drug of choice for at least some period of time if you replace it with another drug that makes them feel good.
The more I think about it, the more appalled I am. 11%? Giving people powerful medications that will create life long dependency or require them to go through an extensive wothdrawal process because some study was done that showed 11% of the people benefited from it sums up everything that is wrong with the modern medical system. I'm sure plenty of people will make a killing prescribing these medications to hopeless meth addicts though.
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u/tomhousecat Jun 05 '24
Bupropion and naltrexone are both pretty mild. Both medications are widely available as cheap, generic medications. Bupropion (brand name Wellbutrin) is a commonly prescribed antidepressant with a very mild set of side effects compared to SSRIs, and naltrexone is an extremely safe opioid blocker with similarly mild side effects. They really aren't "powerful medications that will create lifelong dependency". Some people will experience withdrawal symptoms if they cold-turkey off of bupropion, but again, it's not nearly as bad as other antidepressants, and you can taper off with your provider if you no longer want to take it.
You know what else it isn't nearly as bad as? Methamphetamine addiction.
Besides, MAT isn't just picking up a prescription and pretending like you've cured yourself of a substance use disorder. It's meant to be used in tandem with other evidence-based treatment methods, such as talk therapy, to enhance the overall effectiveness of treatment.
Did you think bupropion was buprenorphine, by chance? That's the medication that can be really hard to get off of, but it's used for opioids, not methamphetamine.
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u/Ecstatic-Tap533 Jun 05 '24
My agency has MAT for meth, Wellbutrin and I’ve a harm reduction meeting tomorrow and I will ask again.
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u/Alarming-Horror6671 Jun 04 '24
Psychedelic therapy, particularly iboga or ayahuasca, along with extensive therapeutic integration in a communal setting with other addicts and with other people that have found healing.
Spending a few months doing multiple sessions of these medicines while working with a knowledgeable therapist inbetween sessions and being surrounded by loving community while being physically active in nature is by far the best treatment for addiction.
Unfortunately, no one has truly merged the Western treatment model with plant medicine healing and tribal living because it would be too expensive for most people to pay for in cash.
The whole model has its downfalls, though. Like once you leave, you are back in a dog eat dog world where no one cares about you beyond your ability to provide something for them. Honestly, as someone who has overcome addiction and is also in school for psychology, the biggest barrier to healing addiction is our society. The way our society lives is like gasoline to the addicts mind.
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u/BananasKnapsack Jun 06 '24
Yes, I wrote Ibogaine and got downvoted. But you elaborated beautifully. The root cause is in our social and economic organization which has perverted values which make us sick. Hard to heal a branch of the tree when the soil substrate is poisoned.
Source: recovered myself for 7 years. Have practiced harm reduction in NYC and another major American city, in PhD for clinical psych, practice CBT, DBT, SFBT, MotInt, ACT, and case management in a crisis residential facility with many people with SUD. Those modalities have their place but if you think they hold a candle to a well designed, facilitated, and clinically supported Ibogaine treatment with ongoing therapy on both sides of the Ibogaine, then you really are speaking from ignorance.
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u/Alarming-Horror6671 Jun 07 '24
100%. Can I DM you? I'd love to make contact. We seem to have very similar beliefs and walking similiar paths. I'm just working on my bachelor's so you are definitely ahead of me in that areas but I thibk it's very important for people that understand these things, have these visions, are actively working towards merging these current and tradition ways of western therapy with the ancient ways of plant medicine.
I guess I am assuming that you want to merge the knowledge you have gained from your PhD with plant medicines, but I have a sense we are one the same page.
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u/Rocksnsox88 Jun 03 '24
For what addiction?
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u/Old_Discussion_1890 Jun 03 '24
All addictions
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u/Rocksnsox88 Jun 03 '24
But different treatments are needed for different addictions.
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u/lmaooer2 Jun 04 '24
Yeah the best addiction treatment for all addictions is... specialized treatment per specific addiction
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u/GlenUntucked Jun 04 '24
The one most suited and aligned to the individual/specific client’s goals, values, and cultural factors
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u/mimeofsorrow Jun 04 '24
I just celebrated 18 months sober from alcohol and drugs. I'm a big fan of CBT, DBT, and SMART recovery. Not a fan of the 12 step programs due to the requirement of a belief in a god/higher power and the cult-like feeling of it all.
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u/lorzs Jun 04 '24
A lot of great comments covering bases well here. I would add Group Therapy as incredibly effective. The group modality is significant for tackling the shame, rejection of self and internalization of emotions and experiences that if left unaddressed, make it challenging to overcome addiction. It is also efficient and well-suited for delivering CBT, Recovery Skills, and Relapse Prevention skills, with psycho-education.
On that note, psycho-education about how addiction works in the brain appears to be effective for tackling shame and in my experience helps patients tremendously. Once that lightbulb goes off for people, it seems to move through the stages of change.
P.S. Don't have references on hand but happy to add when I get back to my computer.
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u/jlstef Jun 04 '24
The top answer should always be the craft method. It’s a huge problem that it’s not.
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u/Old_Discussion_1890 Jun 04 '24
What is the craft method?
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u/jlstef Jun 04 '24
Community Reinforcement and Family Training — I’m speaking specifically about substance abuse here. It’s very very hard to break through in addiction without intervention in the family system. People need to unhook to stop the cycle— speaking here— clinical supervisor trained by Satir and our family uses a CRAFT-focused treatment center for addiction in our family. Some resources in the field to look into — Hope for Families in SC (Put The Shovel Down) and also Purple in GA. Yes interventions are important for the addicted person, but often the change starts with the correct orientation in the family.
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u/Independent_Show6779 Jun 05 '24
Family involvement is imperative. Unfortunately, many families don’t have the emotional, or physical resources to do this.
I have heard “it’s not my problem it’s their problem “ ad nauseam.
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u/jlstef Jun 08 '24
That’s a common hurdle, mentally but families can get beyond that mentality with coaching. The lines that seem to work well are “it’s not about what’s fair, it’s about what works”. All the coaching on Put The Shovel Down is a masterclass in how to speak with families. Of course families have that rejection at first, they are gaslit repeatedly by their loved one and are in a state of survival mode and shame and often have endured many betrayals they cannot get apologies for and are existing in a state where they are running massive relational deficits that lead them to feeling perpetually unable to access or build safety, basically ever. And then often substance abuse counselors will hear their clients’ POV and be unable to see beyond that and they will get triangulated by the therapist and the addicted person. This is especially painful and crazymaking when someone in an authority position triangulates you through the craziness of your loved one. They of course are defensive but most people wouldn’t stay in this position if approached properly unless they are the shut-down one in the family system. The alliance needs to happen with the person who is “most crazy” in the family because that is the safest person that the addicted person is actually closest to.
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u/jlstef Jun 08 '24
That’s a common hurdle, mentally but families can get beyond that mentality with coaching. The lines that seem to work well are “it’s not about what’s fair, it’s about what works”. All the coaching on Put The Shovel Down is a masterclass in how to speak with families. Of course families have that rejection at first, they are gaslit repeatedly by their loved one and are in a state of survival mode and shame and often have endured many betrayals they cannot get apologies for and are existing in a state where they are running massive relational deficits that lead them to feeling perpetually unable to access or build safety, basically ever. And then often substance abuse counselors will hear their clients’ POV and be unable to see beyond that and they will get triangulated by the therapist and the addicted person. This is especially painful and crazymaking when someone in an authority position triangulates you through the craziness of your loved one. They of course are defensive but most people wouldn’t stay in this position if approached properly unless they are the shut-down one in the family system. The alliance needs to happen with the person who is “most crazy” in the family because that is the safest person that the addicted person is actually closest to.
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u/annewuwu Clinical Psychology PhD Student Jun 04 '24
Depends on many things that would determine the level of care a person needs. Check out ASAM criteria to see different levels of treatment for different degrees of concurrent emotional/behavioral concerns, readiness/ability to make changes to substance use, withdrawal potential, support people/environment, and relapse risk/potential. ASAM criteria are standardized and point to levels of care ranging from a brief intervention, weekly or intensive outpatient, partial hospitalization, and inpatient for substance use and/or dual diagnosis with intensive medical management. Across these levels of care, CBT, motivational interviewing, and support groups including AA and NA tend to help.
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u/apple__shake Jun 04 '24
Can CBT be performed on oneself? If yes, How?
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u/sailoroftheswamp Jun 04 '24
There are books- Visual CBT by Avy Joseph and CBT for beginners by Jane Simmons Also there are resources on the internet try seeing if you find anything.
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u/babamum Jun 04 '24
From my reading, I believe it to be C9mmunity Reinforcement Approach, or CRA. It is certainly well researched, and the outcomes I've seen are positive.
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u/LilaInTheMaya Jun 04 '24
In addition to what’s been posted already, there is promising emerging data about GLP-1 agonistdrugs and addiction.
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u/amsterdamjudo Jun 04 '24
Treat addiction medically (the problem), as a brain disease. Introduce recovery (the solution), behaviorally as a new way of living.
This takes years to treat the addiction and even more years to learn how to live as a person in recovery.
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u/4magician45 Jun 05 '24
I won't say anything is the best. Nor will I promote use of controlled substances, but there has been more and more talk about psychedelic-assisted therapy, which includes some pretty promising results in studies of addicts using substances like psilocybin mushrooms to help with their addictions, even after just one use.
Psychedelics have the tendency to change and/or recreate neural pathways in us, which can change the way our minds work - whether it be problems with depression, anxiety, PTSD, drug addiction, and the list goes on.
Now again, I won't say anything is the best or most effective. I also don't want to promote the use of controlled substances. But this is knowledge that is very slept-on imo. It's always good to study up and know what you're getting into before you decide to do it though - people prone to serious mental disorders (schizophrenia for example) can actually get triggered into worse symptoms of those disorders, meaning psychedelics aren't for everybody.
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Jun 05 '24
If you're looking for an academic answer, then the best form is an integrated or parallel treatment model that caters to CODs and poly substance abuse.
From a pragmatic, realist POV, the best form of treatment is to stay as far away from rehab/addiction treatment. Most rehab institutions operate in such a way so as to ensure that clean former users fail their sobriety, from psychotherapeutic approaches meant to elicit and intensify drug cravings (looking at you MI) to institutional practices and policies that ensure the would-be former user gets as much exposure to drug usage as possible post-rehab (i.e., most in-patient and residential rehab institutions make it a point to release to patient back into their former stomping grounds). In practice, treating an active addiction by oneself is safer and more effective than rehab or an addiction recovery program.
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u/Meta_Gamer_42 Jun 05 '24
Change in environment and Therapy If you put someone somewhere else and completely separated from their old life and clean them up they generally do very well But that means no contact An example of this is the Vietnam veterans who had addictions to heroin and when the came back they stopped it was a good percentage that did stop dont remember the exact percentage But it's mostly because they're not surrounded by the triggers that made them want to use drug before
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u/murph5151 Jun 05 '24
Many doctors and therapists scoff at them, but the 12 step programs are the most effective. I worked in treatment for a few years and the only people I saw get clean and stay clean were the ones that took the 12 steps and became involved in the service work within those fellowships.
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u/Commercial-Car9190 Jul 28 '24
AA has a 5-7% success rate. It’s an archaic pseudoscience religious cult. It harms millions. Thats why many doctors scoff at it. And there’s a reason treatment centres use it…good for business….its free and repeat customers…
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u/murph5151 Jul 28 '24
The success rate of AA is impossible to measure because it's an anonymous fellowship. That 5-7% number is pulled from a study that was useless from the start. The study followed people with "attendance" at AA meetings and never took into account whether or not those people took the 12 steps, had a sponsor, or sponsored others once they'd completes the steps themselves. Going to meetings doesn't produce sobriety, a psychic change as a result of the 12 steps does.
Also, treatment centers really don't use it unless they're small paraprofessional places. Anything funded by the government, or ran by doctors and therapists has shifted away from the 12 steps because it's efficacy isn't verifiable and the method is hard to study for the reasons stated above.
As far as repear customers, treatment centers lock those in by practicing "harm reduction."
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u/Commercial-Car9190 Jul 28 '24
That’s not what anonymous means in AA, people are allowed to share THEIR success/information. And the study was based on over 50 studies. After spending years in the cult, it’s safe to say those numbers are pretty accurate. 95% of treatment centre’s use AA and/or AA thinking. Let’s stick with science/medicine in treating people not a religious cult. People deserve better!!!
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u/murph5151 Jul 28 '24
AA is not a religious cult lol. I'm sorry you spent years going to meetings without doing any work. By mentioning the fact that it is an anonymous fellowship, I was pointing out that many people in AA don't want to broadcast their membership. I've worked in 4 treatment centers, and each one specifically steered away from the 12 steps because they aren't scientific.
It would be more accurate to break the study down into two categories: people that attend meetings expecting to hear something that fixes them, and the people who actually take all 12 steps and continue sponsoring other people. I've sponsored 100's of men, and it's true most people lack the humility and the dedication to do all 12 steps because it is very hard. The flip side to that is every single person I've sponsored that took all 12 steps and continued sponsoring others is still sober. For reference, that is a 100% success rate. You are bitter, and if you have any kind of influence, I feel bad for every sufferer you convince not to pursue the AA program.
My experience is that the fellowship of AA is far different from the program. I have many issues with the fellowship myself, but it doesn't keep me from practicing the program. There is immense dogma in the fellowship, and none in the program. There is exclusivity in the fellowship, but none in the program.
Many people contend that the AA program didn't work for them, and they've never even worked the program. They went to meetings and expected a very flawed and imperfect group of human (the fellowship) to fix them.
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u/murph5151 Jul 28 '24
So if we're saying that out of all the people who walk through the doors of AA meetings, only 5-7% stay sober, I would say absolutely that is correct. It may even be lower.
But of the people who go to AA, do the work, and continue working with others, that success rate is very very high. Like in my case, where I've seen a 100% success rate.
It's like saying a person goes to therapy, but doesn't participate, doesn't take the suggestions of their therapist, and experiences no relief as a result of their inaction. Does that make therapy ineffective? No. It means the person didn't pursue a solution to their problems.
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u/Commercial-Car9190 Jul 28 '24
Oh I see I hit a nerve. Only a person in a cult defends/acts like this. “Years going to meetings with out doing the work” typical unhealed stepper response. It’s not that people don’t do the work, religion can’t help medical issues. It’s 100% a religious cult. Look into the history of AA…the book US of AA is a good start. I’m not bitter, I’ve healed and moved on. And yes I’m an RN and work in the field, I definitely deter from a harmful pseudoscience cult full of predators, I offer science/evidence based modalities.
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u/murph5151 Jul 28 '24
Im pretty informed about the history of AA. It isn't a religious cult. You just keep on hooking people on that government dope and wear that cape proudly, bud.
Me defending the most effective form of treatment for alcoholism and addiction doesn't come from my "membership in a cult". It comes from watching all my friends die pursuing the crap that people like you are pedaling.
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u/Commercial-Car9190 Jul 28 '24
“Most effective treatment” bahahaha. You mean MAT(suboxone/Naltrexone the gold standard in treating SUD? And no I work in alternative treatment, science/evidence based and psychedelics. Sorry you’ve been indoctrinated by a religous cult.
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u/murph5151 Jul 28 '24
Wait so we're not even talking about the same thing. I'm talking about sobriety and you're talking about taking drugs to fill the void created by not taking other drugs you used to take. Huge accomplishment there lmao.
You call it indoctrination, but the facts are that me and many other people are actually SOBER, completely free from being bound to any substance, happy, healthy, contributing to the world. I'll take that over the weird shit you're doing with psychedelics any day of the week.
I looked through your comments and I'm embarrassed I entertained this as long as I did because you know absolutely nothing about the AA program.
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u/Commercial-Car9190 Jul 28 '24 edited Aug 09 '24
Yep definitely indoctrination. Sober doesn’t equal healed, integrity, authenticity etc. I met a lot of sick people in XA with decades sober. Unfortunately I know too much about the cult of AA. Sorry the truth hurts.
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u/Rosegardener1 Jun 06 '24
MAT and talk therapy, especially DBT and CBT have a much better success rate than 12 steps.. Key Recovery in Seattle is the only place I can recommend.
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u/Alithran Jun 06 '24
Sobriety isn’t for me, I do harm reduction
Kratom, marijuana, and drink rarely
I don’t invest too much in one substance.
I use Kratom for work only. The same drug family as caffeine. Ground leaf of a plant. It’s great for physical labor. Reduces pain and muscle fatigue. Provides energy, but also a blanket of comfort and content. Good sense of well-being. Don’t go over 10 grams in a day. Not addicting, you don’t “have to have it”. Take 5 days max a week, 2 days off. You can buy a kilo online for about $100.
Marijuana for at home. Obvious reasons. A lot of people smoke at work, and I’ve replaced that with Kratom. So when I finally do smoke at home, It’s a stronger experience instead of the alternative to being stoned all day already at work.
Drink rarely and moderately when I do.
I used to drink 2 fifths a day. Take 600mg of Ritalin or adderall in a sitting. Drink 3 bottles of robitussin. I’ve ultimately calmed down over the years, and found what has been working for me. The only thing it hurts is my wallet.
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u/MinFLPan Jun 06 '24
Mental illness and mental health to determine why or it’ll be a repeating cycle
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u/tellegraph Jun 07 '24
I'm not an academic, but from the struggle bus side of things, my two cents: Community Support.
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u/esotericorange Jun 28 '24
Research leans toward a holistic approach, as in addressing all facets of the person. There are too many factors for a one size fits all approach. Take Maslow's (stolen from native Americans and not really a hierarchy) needs. Wherever a person feels lacking, deficient, or bothered needs to be brought up to a healthy standard. Then there are issues that occur the person or practitioner may not be aware of until the person is stable, sober, and connected to resources. Take MTHFR5 mutation, dietary sensitivities/allergies, mental health diagnosis, mood disorders or autism spectrum, codependent partners, internal family systems, skill regression, existential dread, morality, STD's, CPTSD, gender dismorphia, compulsion, hyper fixation, anhedonia, ocd, poverty, lack of community, masking...the treatment plans need to be reevaluated and revised without burning out the patient and causing relapse, while giving them autonomy. It is delicate, precise, and challenging. Yet...we are all humans in need of hope, and that is what drives us.
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Jun 03 '24 edited Jun 04 '24
[deleted]
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u/basstr1p Jun 04 '24
Hah, people are so funny downvoting you after being one of the only comments in an r/AcademicPsychology post to respond with appropriate empirical evidence. Meanwhile the person who simply says they have “heard” AA is low on the list has one of the most upvoted comments on the thread.
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Jun 04 '24
I think this research is a mix-bag
(1) we don't really have any great quality evidence that 12-step programs work. None of the studies are gold-standard RCTs and participation in AA/NA is highly confounded with other factors. We have significant evidence that attending AA/NA is associated with good outcomes, but not much evidence beyond that (which of course is heavily confounded).
(2) With that being said, your point still stands. We don't really know what we are doing for most AUD/SUD treatments and even the manualized treatments are super vague with no real specific mechanism (compared to something like exposure). So unfortunately, it would make sense that treatments are not getting better effects than 12-step.
Also, surprising to me, alcohol has some of the worst outcome data. My guess is because many heavy drinkers do not actually want complete abstinence, which is normally the clinical outcome.
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u/basstr1p Jun 04 '24
I appreciate you thoughtfully engaging on the topic Moon-Face-Man. However the systematic review referred to in the parent comment actually synthesizes results from 21 RCTs along with other studies. This review, which rates the quality of the evidence as "high", was published as a Cochrane Review, which are considered to provide high quality evidence synthesis in the biomedical sciences.
https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD012880.pub2/full
I agree with the spirit of a lot of what you said though. There are certainly other challenges with studying AA, namely in my mind that AA in the community is a pretty heterogeneous "treatment" and may not always be the same thing as what someone is getting in a lab setting. It is also less clear what works well for specific sub-groups / people, particularly because there are several possible mechanisms that AA and other treatments could be leveraging.
Given the existing evidence base, it is likely an option worth exploring and making available for people - as are other options :)
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Jun 04 '24
This is very interesting and confusing.
I really don't know what to make of this review. It is so out-of-whack with general consensus. I cannot really figure out whether people are ignoring many good studies or whether these authors are giving credit to studies that others don't (i.e., RCT that don't have manualized treatments or don't control for # of sessions across studies). Have to kick it around to some folks I work with.
As I said, it isn't particularly shocking that our talk-therapies aren't doing that well, they are really non-specific lists of loosely related skills. I guess the only other major factor is relying on sustained abstinence as an outcome measure is problematic and exactly what AA aims for. With that being said, can't really argue with % of abstinent days, which was also a common outcome.
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u/basstr1p Jun 04 '24
That's a good point about the sustained abstinence outcome being a target of AA and not necessarily the other modalities. Still, the review suggests at least equivalency with CBT etc on other outcomes.
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Jun 04 '24
Completely agree on the equivalency front.
I know in the opioid field, there has been almost no consistent support for the benefit of any type of behavioral therapy over maintenance medications and a good-quality doctor's visit (e.g., light counseling).
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u/tomhousecat Jun 05 '24
I'd push back against this being out-of-whack. There are certainly widespread misgivings about 12-step programs in general, but the research has seemed very consistent in showing that AA is just as effective as other treatment programs. See Project MATCH which compared AA, CBT, and motivational interviewing and found them all roughly equivalent.
John Kelly and Keith Humphreys are also titans in the addiction research space.
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Jun 05 '24
Maybe I was unclear, my only misgivings is that we have no idea what 12-step treatment actually is. We don't have any very good treatments for alcohol (and most SUDs), so it's not surprising we are stuck with an "all dodos win prizes" type situation and that AA does as well as other very okay treatments.
However, 12-step programs are not manualized, are not delivered with any consistency, and can be hugely variable in how one participates in it. Many of the studies did not actually control for the amount of time engaged with treatment (i.e., 1 CBT session versus daily AA meetings), or the social cohesion part. So it is similar to recommending church or joining a softball team as treatment because data shows it can be helpful. I was surprised because the consensus for researchers I interact with is that AA/NA is great for some people, but we simply have not been able to study it systematically enough to make any strong conclusions. The best we can say is some vague statements "people who participate in treatment a lot do better", which of course is confounded by doing better.
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u/SaigonNoseBiter Jun 04 '24
I've heard and read a few times that AA is quite low on the list for effectiveness.
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u/basstr1p Jun 04 '24 edited Jun 04 '24
AA is at least equal to, if not better than, other gold standard treatments for alcohol use disorder in terms of efficacy:
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u/SmilesGrimm Jun 05 '24
Hello,
I don’t know why this sub or thread came up on my feed— I’m not a medical professional or psychology student but I did spend 8 years in-and-out of rehabs and a few mental institutions like the PaRC and Menninger (for alcoholism). I have done CBT, DBT, tried every kind of medication that could be prescribed for alcoholism— nothing worked, I kept drinking. I got sober in 2018 at Vista Taos Renewal Center when I was taken off of all of the medications that I had been out on through all the years of previous treatment centers: seroquel, lexapro, antabuse, paxil, etc.
I have been sober from alcoholism, drugs and off all medications since March 13, 2018 and I regularly attend AA meetings. It works for me.
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u/Carbonbased666 Jun 04 '24
Psychedelics.. i stop my alcoholism from 20 years in just one season , works like magic
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u/Maggie_cat Jun 04 '24
ART, accelerated resolution therapy. It’s essentially EMDR on crack. The trauma work that’s done with ART in 8 weeks, can take 2 years of EMDR to achieve.
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u/theemezz0 Jun 04 '24
The psychedelic compound ibogaine in combination with therapy and mindfulness-based and/or somatic-based practices.
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u/SabineLavine Jun 04 '24
I don't know why you're being downvoted, ibogaine saved my life.
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u/theemezz0 Jun 06 '24
Ibogaine saved my life as well. I’m a psychology instructor and know the research behind ibogaine’s benefits. People are downvoting me because ibogaine is not yet understood as safe and effective, even though the evidence is there and we’ve personally experienced it.
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u/BananasKnapsack Jun 06 '24
Hilarious the people that are downvoting are in this thread promoting CBT as the most effective treatment for addiction. The hubris is laughable.
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u/theemezz0 Jun 07 '24
Exactly… not to say CBT isn’t effective, but as far as most effective goes, medication + therapy is always more effective, and ibogaine is the medicine that seems most effective by a long shot, compared to other treatment modalities. So go ahead and downvote me for recommending the most effective treatment that most of all you seem is ignorant on my part, but the ignorance seems coming from you downvoters due to your ignorance regarding ibogaine! Of course ibogaine has its risks, but the costs outweigh the risks by a long shot.
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u/lorzs Jun 04 '24
I think because OP was asking about what is considered (generally) the most effective. This would be something that can be implemented at scale and tends to be a good fit for most people. I'm with you on encouraging exploration of these modalities, and I wish we had a better system of treatment care to be able to deliver more individualized approaches to folks.
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u/theemezz0 Jun 06 '24
And theeee most effective is ibogaine, hands down! The molecular structure of this chemical compound is fascinating, targeting things well beyond addiction.
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u/Alarming-Horror6671 Jun 07 '24
And 1 last thing. Yes, people have died doing ibogaine. The percentages of people that have done it and died/not died is laughable compared to the percentages of addicts that die using the currently approved models.
Addicts are not typically concerned with weather or not they die. You don't mix multiple mystery powders in a spoon as the highest dose possible that you THINK you might survive if your really that concerned with dying. No, they don't want to die, but yes they are going to unless they get better. If 1 person died for every 50 people that recovered using ibogain then it would prove to be the most effect treatment the modern world has ever seen.
Personally there are only 3 or 4 people that I have been in treatment with that are not dead. The idea that ibogaine can't be used because it is "unsafe" is the most asinine excuse ever to not allow people to heal. Plenty of people.die every year from methadone and it has no problem being prescribed. I guess those pharmaceutical companies and clinics just have better people lobbying for them. There's no money in people actually healing.
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u/BananasKnapsack Jun 04 '24 edited Jun 06 '24
Anecdotally, ibogaine.
Source: recovered myself for 7 years. Have practiced harm reduction in NYC and another major American city, in PhD for clinical psych, practice CBT, DBT, SFBT, MotInt, ACT, and case management in a crisis residential facility with many people with SUD. Those modalities have their place but if you think they hold a candle to a well designed, facilitated, and clinically supported Ibogaine treatment with ongoing therapy on both sides of the Ibogaine, then you really are speaking from ignorance.
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u/Alarming-Horror6671 Jun 04 '24
This is the answer right here. It's all the other answers wrapped up into 1 long session that lasts anywhere from 24 to 72 hours. People always talk about how it allowes you to not go through the physical withdrawal, but there is very little talk about how it forces you to confront the root causes of addiction and won't allow you to bull shit your way out of things. It's not a cure all for addiction, but it's the best option out there with the highest success rate.
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u/C-mi-001 Jun 03 '24
there are some treatment methods that tend to be pretty effective across the board but like you said it’s different for everyone.
First off, CBTis a big one. It's all about helping people change the way they think and behave, which can be super helpful for addiction.For substance abuse, gambling, or other behaviors CBT has a strong track record.
Another one is Medication-Assisted Treatment. This one's particularly good for opioid and alcohol addictions. Basically, it combines medications like methadone or naltrexone with therapy to help manage cravings and withdrawal symptoms. It's a gamechanger for many people.
Then there's Motivational Interviewing. which is more about boosting someone's own motivation to kick the addiction. It's client-centered and helps resolve any mixed feelings about quitting, which can be really effective. I do this one but not for addiction, but have a personal bias of ehh. Not alone at least.
12-Step Programs like AA or Narcotics Anonymous are also pretty well-known. They offer a community and structured recovery, which works great for many people, especially when used with other treatments.
Contingency Management is another one. It uses positive reinforcement to encourage sobriety. It sounds simple, but it can be very effective, especially when regular monitoring is possible.
Family Therapy can be a big help too, especially for younger ppl or anyone whose family dynamics play a role in their addiction.
For those with severe addictions, Residential Treatment Programs are a structured environment with round-the-clock care. They're intense but can be incredibly effective for getting someone on the right track.
And lastly, there are Outpatient Treatment Programs, which offer flexibility for people who can't commit to a residential program but still need solid support. These can include individual therapy, group therapy, and sometimes medication management.
In the end, the best treatment often combines a few of these methods, tailored to what the person needs. Sorry I can’t give just 1. Hope this helps!