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‘The Human Prerogative’: A Critical Analysis of Evidence-Based and Other Paradigms of Care in Substance Abuse Treatment

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Abstract

Present-day substance abuse treatment is characterized by a compelling demand for applying evidence-based interventions. Vehement discussions between policymakers, practitioners and researchers illustrate this clash of differing paradigms. The aim of this article is to situate evidence-based practice among the leading paradigms of care and to elucidate its implicit assumptions and potential implications. Evidence-based practice is inherent in the empirical-analytical paradigm of care and science, founded upon randomized and controlled studies. This paradigm is compared with the phenomenological-existential and the critical post-structural paradigm, which focus on elaborating the human potential and exploring individuals’ subjective interpretations, and on criticizing social inequalities and striving for compliance with human rights, respectively. Evidence-based practice and the methodological rigidity in each paradigm are analyzed critically. We conclude that through the dialectical integration of these diverse approaches, evidence, existence/humanism and social emancipation can be combined for the benefit of the human prerogative of care.

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Notes

  1. During this conference a first draft of this paper has been presented and was published in Greek in the Proceedings of the Society & Mental Health Conference, pp. 53–62.

References

  1. Autrique M, Vanderplasschen W, Broekaert E, et al.: Practitioners’ attitudes concerning evidence-based guidelines in substance abuse treatment. European Addiction Research 15:47–55, 2009

    Article  PubMed  Google Scholar 

  2. Miller WR, Sorensen JL, Selzer JA, et al.: Disseminating evidence-based practices in substance abuse treatment: A review with suggestions. Journal of Substance Abuse Treatment 31:25–39, 2006

    Article  PubMed  Google Scholar 

  3. Ravndal E, Vaglum P, Lauritzen G: Completion of long-term inpatient treatment of drug abusers: A prospective study from 13 different units. European Addiction Research 11:180–185, 2005

    Article  PubMed  Google Scholar 

  4. McGovern MP, Fox TS, Xie HY, et al.: A survey of clinical practices and readiness to adopt evidence-based practices: Dissemination research in an addiction treatment system. Journal of Substance Abuse Treatment 26:305–312, 2004

    Article  PubMed  Google Scholar 

  5. Berglund M, Thelander S, Jonsson E: Treating Alcohol and Drug Abuse: An Evidence Based Review. Weinheim, Wiley-VCH, 2003

    Book  Google Scholar 

  6. Schippers GM, Schramade M, Walburg JA: Reforming Dutch substance abuse treatment services. Addictive Behaviors 27:995–1007, 2002

    Article  PubMed  Google Scholar 

  7. Brown BS: Commentary on ‘Evidence-based treatment: Why, what, where, and how?’ Journal of Substance Abuse Treatment 30:87–89, 2006

    Article  PubMed  Google Scholar 

  8. Miller WR, Zweben J, Johnson WR: Evidence-based treatment: Why, what, where, and how? Journal of Substance Abuse Treatment 29:267–276, 2005

    Article  PubMed  Google Scholar 

  9. Petrova M, Dale J, Fulford B: Value-based practice in primary care: Easing the tensions between individual values, ethical principles and best evidence. British Journal of General Practice 56:703–709, 2006

    PubMed  Google Scholar 

  10. Autrique M, Vanderplasschen W, Pham TH, et al.: Evidence-based werken in de verslavingszorg: een stand van zaken. Reeks Wetenschap en Maatschappij, Antwerpen-Apeldoorn, Garant, 2007

  11. Autrique M, Vanderplasschen W, Broekaert E, et al.: The drug-free therapeutic community: Findings and reflections in an evidence-based era. Therapeutic Communities 29:5–15, 2008

    Google Scholar 

  12. Broekaert E, Vanderplasschen W, Colpaert K, et al.: The Human Prerogative: Questions on Integration of Evidence-Based, Existential and Social Critical Paradigms of Care in Substance Abuse Treatment. In: Proceedings of the Society & Mental Health Conference, Thessaloniki, 2008

  13. Haynes RB, Sackett DL, Gray JM, et al.:Transferring evidence from research into practice: 1. The role of clinical care research evidence in clinical decisions. Evidence-based Medicine 1:196–198, 1996

    Google Scholar 

  14. Bloch RM, Saeed SA, Rivard JC, et al.: Lessons learned in implementing evidence-based practices: Implications for psychiatric administrators. Psychiatric Quarterly 77:309–318, 2006

    Article  PubMed  Google Scholar 

  15. Gray GE, Pinson LA: Evidence-based medicine and psychiatric practice. Psychiatric Quarterly 74:387–399, 2003

    Article  PubMed  Google Scholar 

  16. Sackett DL: Evidence-Based Medicine: How to Practice and Teach EBM, 2nd ed. New York, Churchill Livingtone, 2000

    Google Scholar 

  17. Chalmers I, Haynes B: Systematic reviews: Reporting, updating and correcting systematic reviews of effects of health care. British Medical Journal 309:862–865, 1994

    CAS  PubMed  Google Scholar 

  18. The Cochrane Library: The Cochrane Library. Evidence for healthcare decision- making [in http://www.theCochraneLibrary.com, December 2008]

  19. Kwaliteitsinstituut voor de Gezondheidszorg (CBO): Evidence-based richtlijn ontwikkeling: Handleiding voor werkgroepen. Utrecht, Kwaliteitsinstituut voor de gezondheidszorg CBO, 2005

    Google Scholar 

  20. Rigter H, Van Gageldonk A, Ketelaars T, et al.: Hulp bij probleemgebruik van drugs. Utrecht, Trimbos-instituut, 2004

    Google Scholar 

  21. Lingford-Hughes AR, Welch S, Nutt DJ: Evidence-based guidelines for the pharmacological management of substance misuse, addiction and comorbidity: Recommendations from the British Association for Psychopharmacology. Journal of Psychopharmacology 18:293–335, 2004

    Article  CAS  PubMed  Google Scholar 

  22. Van Gageldonk A, De Zwart W, Van der Stel J, et al.: De Nederlandse Verslavingszorg: overzicht van de kennis over aanbod, vraag en effect. Utrecht, Trimbos-instituut, 1997

    Google Scholar 

  23. Miller WR, Wilbourne PL: Mesa Grande: A methodological analysis of clinical trials of treatment for alcohol use disorders. Addiction 97:265–277, 2002

    Article  PubMed  Google Scholar 

  24. Gowing L, Ali R, White J: Buprenorphine for the management of opioid withdrawal. Cochrane Database Systematic Reviews 2:1–49, 2006

    Google Scholar 

  25. Mattick RP, Breen C, Kimber J, et al.: Methadone maintenance therapy versus no opioid replacement therapy for opioid dependence. Cochrane Database Systematic Reviews 2:1–19, 2003

    Google Scholar 

  26. Malcolm R, Myrick H, Roberts J, et al.: The effects of carbamazepine and lorazepam on single versus multiple previous alcohol withdrawals in an outpatient randomized trial. Journal of General Internal Medicine 17:349–355, 2002

    CAS  PubMed  Google Scholar 

  27. Holbrook AM, Crowther R, Lotter A, et al.: Meta-analysis of benzodiazepine use in the treatment of acute alcohol withdrawal. Canadian Medical Association Journal 160:649–655, 1999

    CAS  PubMed  Google Scholar 

  28. Mayo-Smith M: Pharmacological management of alcohol withdrawal. The Journal of the American Medical Association 278:144–151, 1997

    Article  CAS  Google Scholar 

  29. Miller WR, Wilbourne PL, Hettema JE: What Works? A Summary of Alcohol Treatment Outcome Research. In: Hester RK, Miller WR (Eds) Handbook of Alcoholism Treatment Approaches, 3rd edn. Boston, MA, Pearson Education, 2003

    Google Scholar 

  30. Cohen AM, Stavri PZ, Hersh WR: A categorization and analysis of the criticisms of evidence-based medicine. International Journal of Medical Informatics 73:35–43, 2004

    Article  PubMed  Google Scholar 

  31. Broekaert E, De Wilde J: The Construction of the VACT for Women: A Flexible Tool for the Treatment of Female Substance Abusers. In: Pedersen MU, Segraeus V, Helleman M (Eds) Evidence-Based Practice? Challenges in Substance Abuse Treatment. Helsinki, NAD Publication 47, 2005

  32. Colins O, Broekaert E, Vandevelde S, et al.: Max Weber and Alfred Schutz: the theoretical and methodological background of the case-oriented quantification approach behind winMAX. Social Science Computer Review 26:369–378, 2008

    Article  Google Scholar 

  33. Broekaert E, D’Oosterlinck F, Van Hove G, et al.: The search for an integrated paradigm of care models for people with handicaps, disabilities and behavioural disorders at the department of Orthopedagogy of Ghent University. Education and Training in Developmental Disabilities 39:206–216, 2004

    Google Scholar 

  34. Lyotard JF: The Post-Modern Condition: A Report on Knowledge. Minneapolis, University of Minnesota, 1979

    Google Scholar 

  35. Foucault M: The Archaeology of Knowledge. London, Tavistock Publications, 1972

    Google Scholar 

  36. Derrida J: De la Gramatologie. Paris, Editions de minuit, 1967

    Google Scholar 

  37. De Waele I, Van Hove G: Modern times: An ethnographic study on the quality of life of people with a high support need in a Flemish residential facility. Disability & Society 20:625–639, 2005

    Article  Google Scholar 

  38. Bergmark A: Evidence-Based Practice—More Control or More Uncertainty. In: Pedersen MU, Segraeus V, Helleman M (Eds) Evidence-Based Practice? Challenges in Substance Abuse Treatment. Helsinki, NAD Publication 47, 2005

    Google Scholar 

  39. Bergmark A: On treatment mechanisms—What can we learn from the COMBINE study? Addiction 103:703–705, 2008

    Article  PubMed  Google Scholar 

  40. Finney JW: Limitations in using existing alcohol treatment trials to develop practice guidelines. Addiction 95:1491–1500, 2000

    Article  CAS  PubMed  Google Scholar 

  41. Welsh WN: A multisite evaluation of prison-based therapeutic community drug treatment. Criminal Justice and Behavior 34:1481–1498, 2007

    Article  Google Scholar 

  42. Soyez V, De Leon G, Rosseel Y, et al.: The impact of a social network intervention on retention in Belgian therapeutic communities: A quasi experimental study. Addiction 101:1027–1034, 2006

    Article  PubMed  Google Scholar 

  43. McLellan AT, Hagan TA, Levine M, et al.: Does clinical case management improve outpatient addiction treatment. Drug and Alcohol Dependence 55:91–103, 1999

    Article  CAS  PubMed  Google Scholar 

  44. Pedersen MU: Drug-Free Treatment of Substance Misusers: Where Are We Now, Where Are We Heading. In: Pedersen MU, Segraeus V, Helleman M (Eds) Evidence-Based Practice? Challenges in Substance Abuse Treatment. Helsinki, NAD Publication 47, 2005

    Google Scholar 

  45. Gabbay J, May A: Evidence based guidelines or collectively constructed “mindlines?” Ethnographic study of knowledge management in primary care. British Medical Journal 329:1013–1017, 2004

    Article  PubMed  Google Scholar 

  46. Parker M: False Dichotomies: EBM, clinical freedom, and the art of medicine. Medical Humanities 31:23–30, 2005

    Article  CAS  PubMed  Google Scholar 

  47. De Leon G: Commentary: Reconsidering the self-selection factor in addiction treatment research. Psychology of Addictive Behaviors 12:71–77, 1998

    Article  Google Scholar 

  48. De Leon G: Commentary on “Self-help organizations for alcohol and drug problems: Toward evidence-based practice and policy’’. Journal of Substance Abuse Treatment 26:163–165, 2004

    Article  Google Scholar 

  49. McLellan AT, Lewis DC, O’Brien CP, et al.: Drug Dependence, a Chronic Medical Illness: Implications for treatment, insurance and outcomes evaluation. JAMA 284:1689–1695, 2000

    Article  CAS  PubMed  Google Scholar 

  50. Kooyman M: The Different Aspects of Addiction and the Therapeutic Community Approach. Paper presented at the 12th EFTC Conference in Ljubljana, Slovenia, June 6, 2007

  51. Marsh DC, Fair BR: Addiction treatment in Vancouver. International Journal of Drug Policy 17:137–141, 2006

    Article  Google Scholar 

  52. Braidotti R: Feminist epistemology after postmodernism: Critiquing science, technology and globalisation. Interdisciplinary Science Reviews 32:65–74, 2007

    Google Scholar 

  53. Fisher P, Goodley D: The linear medical model of disability: Mothers of disabled babies resist with counter-narratives. Sociology of Health & Illness 29:66–81, 2007

    Article  Google Scholar 

  54. Roets G, Van de Perre D, Van Hove G, et al.: One for All–All for One! An account of the joint fight for human rights by Flemish Musketeers and their Tinker Ladies. British Journal of Learning Disabilities 32:54–64, 2004

    Article  Google Scholar 

  55. Broekaert E: What future for the Therapeutic Community in the field of addiction? A view from Europe. Addiction 101:1677–1678, 2006

    Article  PubMed  Google Scholar 

  56. De Maeyer J, Vanderplasschen W, Broekaert E: Exploratory study on drug users’ perspectives on quality of life: More than health-related quality of life? Social Indicators Research 90:107–126, 2009

    Article  Google Scholar 

  57. Broekaert E, Vanderplasschen W: Towards the integration of treatment systems for substance abusers: Report on the second international symposium on substance abuse treatment and special target groups. Journal of Psychoactive Drugs 35:237–345, 2003

    PubMed  Google Scholar 

  58. van den Brink W, Hendriks VM, Blanken P, et al.: Medical prescription of heroin to treatment resistant heroin addicts: Two randomised controlled trials. British Medical Journal 327:310B–312B, 2003

    Article  PubMed  Google Scholar 

  59. Verthein U, Bonorden-Kleij K, Degkwitz P, et al.: Long-term effects of heroin-assisted treatment in Germany. Addiction 103:960–966, 2008

    Article  PubMed  Google Scholar 

  60. Green RT: Constitutional jurisprudence—Reviving praxis in public administration. Administration & Society 24:3–21, 1992

    Article  Google Scholar 

  61. Gieles F: Conflict en Contact. Een onderzoek naar handelingsmogelijkheden voor groepsleiders bij botsingen en conflicten in de dagelijkse leefsituatie. Proefschrift Universiteit Groningen, 1992

  62. Garfinkel F: Studies in Ethnomethodology. Englewood Cliffs, NJ, Prentice Hall, 1967

    Google Scholar 

  63. Capra F: The Tao of Physics: An Exploration of the Parallels Between Modern Physics and Eastern Mysticism. Berkeley, CA, Shambhala Publications, 1975

    Google Scholar 

  64. Brent SB: Prigogine’s model for self-organization in no equilibrium systems: Its relevance for developmental psychology. Human Development 21:374–387, 1978

    Article  Google Scholar 

  65. Rucker R: Oneindigheid, filosofie en wetenschap van het oneindige. Amsterdam, Contact, 1986

    Google Scholar 

  66. Hesse M, Vanderplasschen W, Rapp RC, et al.: Case management for persons with substance use disorders. Cochrane Database of Systematic Reviews 4:1–82, 2007

    Google Scholar 

  67. Vanderplasschen W, Wolf J, Rapp RC, et al.: Effectiveness of different models of case management for substance-abusing populations. Journal of Psychoactive Drugs 39:81–93, 2007

    PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Orthopedagogics, Ghent University, Henri Dunantlaan 2, 9000, Ghent, Belgium

    Eric Broekaert, Wouter Vanderplasschen & Kathy Colpaert

  2. Association for Alcohol and Other Drug Problems (VAD), Vanderlindenstraat 15, 1030, Brussels, Belgium

    Mieke Autrique

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  1. Eric Broekaert
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  2. Mieke Autrique
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  3. Wouter Vanderplasschen
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  4. Kathy Colpaert
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Correspondence to Eric Broekaert.

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Broekaert, E., Autrique, M., Vanderplasschen, W. et al. ‘The Human Prerogative’: A Critical Analysis of Evidence-Based and Other Paradigms of Care in Substance Abuse Treatment. Psychiatr Q 81, 227–238 (2010). https://doi.org/10.1007/s11126-010-9132-4

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