Here more of the latest research on "what works" in therapy...

What Works in Therapy?

So, what works in the treatment of adolescent substance abusers?  The received wisdom, of course, is that clinicians need to use clinical strategies deemed "empirically supported" or "evidence-based" by various professional organizations such as the American Psychological Association (APA), Center for Substance Abuse Treatment (CSAT), and, of course, the Substance Abuse and Mental Health Services Administration (SAMHSA).  On the other hand, agencies and clinicians dedicated to the treatment of kids with substance problems are forever complaining about meager treatment resources and constant budget trimming.  According to this latter group, there simply isn't enough time, money, or treatment options to provide the kinds and depth of treatment needed.  And round and round the system goes.  Now, enter the Cannibas Youth Project.  Briefly, this large, randomized controlled clinical trial examined the impact that the dose and type of treatment had on the outcome of 600 substance abusing adolescents.  Responding to critiques of previous research, participants included in the study were actually more severe than those seen in routine clinical settings with significant comorbidity.   The types of treatment included in the study were those currently deemed best by the powers that be (motivational interviewing, and, of course, CBT).  Dose of treatments compared ranged from 5 to 12 weeks as well as various combinations of treatments.  The findings?  Consistent with findings gathered over the last 40 years (and reviewed here on this website), neither the type or the dose treatment exerted any effect on outcome.  Ignoring the potential impact on the careers, the authors and researchers conclude, "The results…[showed] that neither the best-practice nor the research-basedinterventions were clearly superior…” .   What factor was related to outcome?  You guessed it: the alliance.  Indeed, ratings of the therapeutic alliance predicted premature drop out (how effective can the therapy be if clients drop out) and substance abuse at 3 and 6 months post-treatment.  Sadly, the researchers appear to miss the main point of these and other similar findings from the treatment literature.  Instead of counseling the field to explore an alternate paradigm (i.e., using client ratings of the alliance and outcome to guide treatment), they suggest more research on specific models of treatment using tighter experimental controls. 

Alas, a paradigm is holding the field captive: the idea that psychotherapy works like medicine and should work better when the right treatment is applied to the right problem.  The data clearly indicate however, that time would be spent more productively helping clinicians figure out what will work for the particular substance abusing client sitting in their office at that moment rather than for abusers in general.  Sound difficult?  It's really not.  In fact, we describe the process and summarize the research in a brand new article.  Click here to download it.   

Dennis, M. Godley, S., Diamond, G., Tims, F. Babor, T. Donaldson, J., Liddle, H. Titus, J., Kaminer, Y., Webb, C., Hamilton, N., Funk, R. (2004). The cannibas youth treatment (CYT) study: Main findings from two randomized trials. Journal of SubstanceAbuse Treatment, 27,97– 213.

Godley, S.H., Jones, N., Funk, R., Ives, M Passetti, L. (2004). Comparing Outcomes of Best-Practice and Research-Based Outpatient Treatment Protocols for Adolescents.Journal of Psychoactive Drugs. 36(1), 35-48.

Tetzlaff, B.T. Kahn, J.H., Godley, S.H., et al. (2005).  Working alliance, treatment satisfaction, and patterns of posttreatment use among adolescent substance users.  Psychology of Addictive Behaviors, 19(2), 199-207.

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