“The Gold Standard” and Related Considerations for a Maturing Science of Substance Abuse Treatment. Therapeutic Communities; A Case in Point

Abstract

The randomized control trial (RCT) is commonly celebrated as the “Gold Standard” of research designs. However, such evidentiary distinctions contain serious implications for the scientific acceptance, funding, and public perception of various treatments for substance abuse. This issue and related considerations are briefly discussed from the perspective of therapeutic community treatment and research.

Keywords:

• evidence, ideology, Gold Standard, maturation, therapeutic communities, treatment effectiveness

Notes

¹ The Cochrane Collaboration is an independent, nonprofit nongovernmental organization consisting of a group of more than 31,000 volunteers in more than 120 countries. The group conducts systematic reviews of randomized controlled trials of health-care interventions and some observational studies which it publishes in the Cochrane Library, internationally recognized as Cochrane summaries.

² See Recent reviews of the main findings and conclusions from multiple sources of outcome research in North America including multi program field effectiveness studies, single program studies, meta analytic statistical surveys and cost–benefit studies (De Leon 2010), as well as controlled and observational studies in Europe (Vanderplassen et al. 2013)

³ The NIDA surveys include the Drug Abuse Reporting Program (DARP); Treatment Outcome Prospective Study (TOPS); National Treatment Improvement Evaluation Survey (NTIES); Drug Abuse Treatment Outcome Study (DATOS). The National Treatment Outcome Research Study (NTORS), a United Kingdom multimodality survey reports findings similar to the NIDA surveys.

⁴ Some of the evidential issues discussed in this paper pertain to research on AA but the latter defines itself as support process rather than as a treatment process.

⁵ The reader is reminded that in addition to client related factors such as motivation/readiness, treatment effectiveness is dependent upon multiple influences e.g., treatment quality, funding and systems resources. The interested reader is referred to  Magura, S.  (2000),  (ed.) Special Issue on Program Quality In Substance Dependency Treatment, SUM, 34:12–14     for  a broad review of treatment quality issues.  Editor's note

Additional information

Notes on contributors

George De Leon

George De Leon, US, is an internationally recognized expert in the treatment of substance abuse, and acknowledged as the leading authority on treatment and research in therapeutic communities. He holds a Ph.D. Degree in psychology from Columbia University. He is founder of the Center for Therapeutic Community Research (CTCR), a founding member and former president of the American Psychological Association's Division 50 on Addictions and is Clinical Professor of Psychiatry at New York University School of Medicine. He has published over 170 scientific papers and chapters. He has authored and edited seven books and monographs including The Therapeutic Community: Theory, Model and Method, considered the definitive text in the field. His training videos are available on the Stages of Recovery and on the essential elements of the Therapeutic Community. Dr. De Leon is a recipient of national and international awards.