Many seem to like my recently published book on addiction. Here's what I often get: "Dr. Ferentzy offers an interesting and challenging perspective ..." In such cases I will thank someone for their kind words, but then quickly counter: everything I wrote in that book is true; perspective is irrelevant.
Oh my! People do give me funny looks. Many of them think I'm joking, or that I should give it a rest. My personal arrogance notwithstanding, I see a problem here: it's as though the very suggestion that a fact can be identified is a sign of pathology. Truth can't exist - everything has to be a point of view, an experiential account.
So the addict in recovery says: "I might not know much, but I know what worked for me".
Sorry, Mr. Experience, but you don't have a clue. If 20 experts were to follow you around for ten years, and do nothing but study you, why you went this way instead of that way would still be debatable.
Here's the truth: in any one case, we don't know why someone got better.
Here's the issue (one of them anyway): the treatment system has a stake in this person's point of view: if he or she started doing better after treatment, the treatment was probably incidental (which is why random samples do almost as well as treatment samples). So buddy thinks that treatment - or the 12 Steps - is what got him clean. That's an experiential account, and it buttresses a lucrative (and ineffectual) treatment industry.
Recap: the person has no way of knowing what actually caused the self-destructive behavior to stop. Not even those twenty experts can generate that kind of certainty - such knowledge simply doesn't exist.
But that's what you get when it all comes down to perspective: not a humble grasp of our limits, but the arrogance of loudmouths who don't know jack.
And it does serve the "evil" system. Right wing politicians these days love all that post-modern gibberish - "Evidence of effectiveness, what's that? It's just an illusion. We're gonna get tough on crime, drugs and whatever - to hell with the "myth" of evidence".
No, we don't need more subjective tripe. We need to reclaim a respect for truth that the 20th century "deconstructed".
Just another thing the 20th century was wrong about.
Follow Dr. Peter Ferentzy on Twitter: www.twitter.com/PeterFerentzy
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You're quite right, addiction is the only disease in which otherwise clear-thinking people embrace anecdotes over clinical evidence.
The only evidence that really matters when it comes to evaluating any treatment approach is outcomes. And "outcomes" doesn't mean absolute sobriety, it means IMPROVED FUNCTIONING in life.
There are plenty of "outcome" studies that don't look at meaningful information. It isn't hard to objectively measure changes in income, clinical relapses, mortality, or legal complications of addictive use. Yet, such straightforward, objective, and meaningful outcomes are rarely measured in the evaluation of addiction treatments.
This is more of a problem in the US than in the UK, of course. On the British side of the pond, there is greater appreciation that methadone (or other opiod) maintenance produces improved outcomes for opiate-addicted clients. In the US, this approach is too-often reserved for otherwise "hopeless" cases -- and too many clients are shoe-horned into approaches with little (or zero) comparable evidence of efficacy. Fatal (but probably avoidable) relapses are all too common as a direct consequence.
This is not to say that medication is the only evidence-based or effective approach. Well-designed studies also show powerful beneficial effects from social interventions, such as residential placement in Oxford Houses, for example.
Keep up the good work!
Steve
Steve Coulter, MD
P