While I applaud new research by anyone into any area of our
profession, I am also aware that not all research is created equal. Does
a survey of professionals’ opinions reflect research or the content of
counselor education for our professionals? Both? Neither? An approach
that allows an individual to continue to drink is a risk about which
many of us remain most skeptical.
For decades the belief in the United States has been that abstinence
is the only real solution for such individuals. This was largely due to
the influence of Alcoholics Anonymous and similar philosophies. Over the
years, our profession has grown and the attention to evidence-based
practice has come into clear focus. That said, we have tried to consider
what seems to work in other parts of the world as well.
I have clear memories of the debate over the inclusion in our exams
of harm-reduction strategies and Therapeutic Community model treatment
programs. In the end, subject matter experts agreed that IC&RC exams
should reflect all treatment modalities, not just our personal
preferences, so the exams were infused with a broader range of treatment
strategies and were weighted according to our research into what was
being used the most and under what circumstances.
One place we looked for guidance was the United Kingdom, whose
approach was heavily weighted toward harm reduction, seeing abstinence
as a last resort. So what is harm reduction? It includes everything from
“controlled” drinking to methadone maintenance programs and needle
exchanges. I can make a case both for and against each of these under
the right circumstances and so can most readers here, I suspect.
Interestingly, in the UK, there is currently a backlash building
against methadone – with some professionals referring to it as “harm
maintenance” programs. It seems that abstinence is starting to catch on
as they debate the real definition of recovery and consider the vast
numbers of clients who live for decades on methadone and claim
“recovery.” Proponents of abstinence-based treatment in the UK commonly
refer to “real” or “whole” or “true” recovery.
Another gray area concerns medication-assisted treatment. Again,
there is a case to be made in either direction. If medication is
involved in detox, the need is clear. If medication is involved in a
transition period, it can be helpful, as well. But substituting
medication for a holistic approach to the individual –that includes
counseling and education– is a one-size-fits-all approach that opens the
door to the exact same criticism some have directed at total abstinence
for all.
In the case of medication-assisted treatment, we, as professionals,
must consider the source of our education about this strategy. Many of
the research and educational efforts around “MAT” are funded by the
pharmaceutical companies that make the drugs. It makes sense that they
want us to know about what they have developed. On the other hand,
“research evaluation 101” tells us to always look at who funds a study
and “follow the money” before we give too much weight to the research
conclusions.
So my goal is to sound a note of caution against pushing too hard,
too quickly for any new approach to treating a very fragile client
population. We study. We learn. We jump the gun. Let’s be mindful of
that last one.
Phyllis Abel Gardner, PhD
President of IC&RC
