Cognitive therapy concept- with contents on a coversheet workshop

Treatment that is backed by scientific evidence and studies with proven results is called evidence-based treatment (EBT). Psychology and the study of the mind, and therefore treatments for mental illness and addiction, may seem subjective, and EBT can encourage safety and increase the odds for positive results.

There are several EBT methods used in psychology. The American Psychological Association (APA) publishes that evidence-based practice in psychology (EBPP) integrates peer-reviewed and scientific research with the clinical expertise of a trained professional. It also takes into account each individual’s cultural, moral, and personal views and life values.

The Association for Behavioral and Cognitive Therapies (ABCT) explains that evidence-based practice (EBP) is a three-tiered approach. One tier is the scientific evidence and review of a particular type of treatment; the second is the practitioner’s personal experience and clinical expertise; and the third tier involves the individual being treated and their personal values and preferences. Addiction and mental illness will not look the same in every person who struggles with them; therefore, it is important that treatment programs and therapies reflect individuality and are tailored to each person’s particular set of circumstances.

Evidence-based treatment options are essential in behavioral healthcare to form a comprehensive program suited directly for each individual.

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Types of Evidence-Based Treatment

EBT, which can also be referred to as research-based treatment, serves to enhance the quality of care for behavioral health programs and lends to a higher standard of care. EBTs can be offered through a wide range of treatment programs, types, levels, and settings. Both outpatient and inpatient treatment programs employ evidence-based treatments as part of a complete and comprehensive treatment program.

Some of the main forms of evidence-based treatment used for addiction and/or mental illness treatment include:

  • Cognitive Behavioral Therapy (CBT)
  • Dialectical Behavior Therapy (BDT)
  • Motivational Interviewing (MI)
  • Contingency Management (CM)
  • Pharmacological methods

Cognitive Behavioral Therapy

One of the most common forms of evidence-based treatment used for the treatment of addiction is CBT, which the National Institute on Drug Abuse (NIDA) reports was initially implemented to minimize relapses related to problematic alcohol consumption. CBT is now used to treat a wide range of mental illnesses and substance use disorders.

Research indicates that CBT can positively change nervous system dysfunctions and improve how negative emotions are regulated in the brain, the Journal of Neuropsychiatry and Clinical Neurosciences publishes. CBT is a form of behavioral therapy that helps to retrain how a person thinks and therefore impacts future actions. The way people think and feel is directly related to how they act, and by modifying moods and emotional responses, behaviors can then be affected.

During CBT, a trained professional will attempt to determine how and why a person thinks the way they do; for example, they may look at what triggers may exist for drug abuse and how these thoughts then influence negative behaviors. The root cause for substance abuse can be explored, and new coping mechanisms and tools for managing stress are taught.

CBT sessions during addiction treatment typically include both group and individual sessions, and they often include homework in between sessions to implement some of the new life skills that are learned in sessions. By learning how to better manage negative emotions and how to recognize potential stressors and handle them, individuals can learn to minimize relapse and therefore sustain recovery.

Dialectical Behavior Therapy

Dialectical Behavior Therapy is a form of CBT that was introduced by Dr. Marsha Linehan as a form of treatment for bipolar disorder. Drug and alcohol abuse and addiction co-occur with mental illnesses, including bipolar disorder, at high rates. The National Survey on Drug Use and Health (NSDUH) reports that close to 3.5 percent of all American adults struggled with both a mental illness and a substance use disorder in 2016. As such, DBT is often an evidence-based treatment used as part of an integrated care model for disorders that are dually diagnosed.

DBT focuses on four main skills training modules, as published by Behavioral Tech, which are:

  1. Mindfulness: learning how to be more aware of the self and the surrounding environment
  2. Distress tolerance: being able to tolerate difficult situations and emotions and accepting them as they are
  3. Interpersonal effectiveness: learning how to become assertive and self-reliant, including asking for what is needed and being able to say “no” while improving relationships
  4. Emotional regulation: the process of modifying emotions that need to be changed

DBT is highly structured and intense, and it is considered a short-term intervention. Group and individual therapy is included in DBT, and therapists are available for phone consultations in between sessions to diffuse potential crisis situations and offer support and guidance.

DBT focuses on life-threatening behaviors first. Then, it focuses on behaviors that can interfere with treatment and recovery before moving on to quality-of-life behaviors. Finally, it focuses on teaching new healthy life skills for recovery.

Motivational Interviewing

With addiction, individuals are often resistant to change or unable to recognize that a problem exists and that change is necessary. As such, Motivational Interviewing can address a person’s lack of motivation and help to restructure it.

The American Journal of Nursing reports that MI is a form of evidence-based treatment that is patient-centered, helping to resolve a person’s ambivalence to promote positive life and behavioral changes. With this approach, individuals come to realize and recognize thoughts and actions that are detrimental to their lives and then make the decision on their own to make changes.

MI is nonjudgmental and non-confrontational. It allows a person to come to terms with things in their own way and then helps them to develop the motivation to enhance their quality of life through positive change. MI can be a beneficial tool for helping a person to decide to participate in addiction treatment by fully engaging.

Contingency Management

This form of evidence-based treatment is another one that focuses on improving motivation. With CM, individuals are offered tangible rewards or incentives for negative drug tests. These rewards may be prize vouchers that can be traded in for services or goods or actual monetary prizes.

NIDA publishes that CM can help individuals to be more motivated to remain in a treatment program and stay abstinent from drugs and alcohol. With CM, regular and random drug/alcohol screenings are given, so the person can receive an instant reward. CM is often combined with other counseling and therapy types during a complete addiction treatment program.

Pharmacological Methods

Medications are another form of EBT for addiction treatment. There are several pharmacological tools that are approved by the FDA to treat certain forms of addiction. For example, methadone, buprenorphine, and naloxone are all used to treat opioid addiction. Buprenorphine and methadone are both long-acting opioid agonist medications that can be used to wean a person off more potent and short-acting opioids, such as heroin or oxycodone. Naloxone is an opioid antagonist that blocks the euphoric effect of opioids, thus helping to deter abuse. Naloxone is also combined with buprenorphine for long-term maintenance as well.

There are also several medications used as evidence-based treatments for alcohol addiction, including disulfiram (Antabuse), naltrexone (Vivitrol), and acamprosate (Campral). These drugs typically work by blocking the pleasant effects of alcohol and discouraging drinking.

In general, pharmacological EBTs are combined with behavioral therapies during addiction treatment programs.

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Finding Evidence-Based Treatment Options in Orange County

People at group therapy session

In order to find a program offering evidence-based treatment in the United States, residents can check the National Registry of Evidence-based Programs and Practices (NREPP) hosted by the Substance Abuse and Mental Health Services Administration (SAMHSA). On this site, people can search by type of intervention or by geographical location, and learn more about EBTs in general. The Behavioral Health Treatment Services Locator can also provide information on mental health and addiction treatment services in Orange County specifically when users input a zip code and type of service requested.

Primary care, mental health, and addiction treatment providers can all offer insight and referrals to programs that are using EBT practices in a specific local area as well. Through their Behavioral Health Services (BHS) division, the Orange County Health Care Agency (HCA) oversees and manages public behavioral health treatment programs in the county. The Behavioral Health Services Navigation can provide residents with information on how to best navigate this public system of care. For current information and referrals, residents can also access the OC Links Information and Referral Line for treatment services and help finding local care.

Evidence-based treatments and practices are considered to be the highest standards of care in addiction and mental health treatment. Providers offering this level of attention to quality of care can be highly effective in structuring an individual program that is designed to enhance the wellbeing of each person in recovery.