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Informing America’s Policy on Illegal Drugs: What We Don’t Know Keeps Hurting Us
treatment fidelity, measurement reliability and validity, and the use of research design and statistical analysis in an attempt to rule out possible alternative explanations. With respect to measurement, each study utilized continuous measures of success rather than a crude categorical “abstinent or not abstinent” outcome classification. To use abstinence as the only goal would be as erroneous as using complete absence of pain as the only goal of an arthritis treatment. In the real-world situation, the goal should be improvement.
G.E.Woody, A.T.McLellan, L.Luborsky, and C.P.O’Brien (1987) Twelve-month follow-up of psychotherapy for opiate dependence.American Journal of Psychiatry144:590–596.2 A total of 120 male veterans who were addicted to opiates were randomly assigned to one of three treatments while maintained on a level dose of methadone: (a) paraprofessional drug counseling only, (b) counseling plus professional supportive-expressive psychotherapy, or (c) counseling plus professional cognitive behavioral psychotherapy. They were evaluated at a 12-month follow-up using a battery of assessment instruments, including the Addiction Severity Index and several psychiatric diagnostic instruments. Though all three groups showed improvement at follow-up, the two groups receiving professional psychotherapy showed greater improvement by various criteria.
G.E.Woody, A.T.McLellan, L.Luborsky, and C.P.O’Brien (1995) Psychotherapy in community methadone programs: A validation study.American Journal of Psychiatry152:1302–1308. This study conceptually replicated the research team’s previous counseling only versus counseling plus supportive-expressive comparison in three community-based methadone programs. This study also addressed a confounding factor in the original design—specifically, that the psychotherapy groups received attention from two therapists while the counseling only group received the attention of only one therapist. In this second study, data at a 6-month follow-up showed significantly better improvement in the supportive-expressive psychotherapy condition than in the counseling-only condition.
P.Crits-Christoph, L.Siqueland, J.Blaine, A.Frank et al. (1999) Psychosocial treatments for cocaine dependence.Archives of GeneralPsychiatry56:493. A total of 487 cocaine-dependent patients were randomly assigned to one of four treatment conditions. All groups received
Charles O’Brien is both a committee member and a coauthor of two of these studies. Note that these particular studies were selected for inclusion in this discussion by consensus of the committee.