Two Worlds: Recovery & Evidence-based Therapies
How & Why They Exist Separately
There are many practical ways we know that clients with SUDs do not receive the sufficient amount of care or treatment for their concurrent issues [30][31][32]. Despite the significant positive outcome studies that indicate the effectiveness of evidence-based methods for most common mental health issues, including SUDs, there is an underutilization of these practices in most SUD treatment settings and psychotherapy practices [33][34][35][36][37][38][39][40][41][42][43][44][45]. There are specific reasons for the lack of implementation of evidence-based methods. For example, qualified evidence-based clinical social workers, psychologists, counselors, psychiatrists and other more comprehensively trained professionals who understand how to translate research to practice and effectively document research variables to monitor outcomes, are extremely lacking in the field of substance abuse treatment [46]. Most providers at residential and outpatient addiction based treatment settings lack specific higher education degrees, training, and supervision to address the mental health aspect of a person’s treatment [47][48]. This is not the fault of the individual provider. Substance abuse counselors are the primary therapists at most treatment centers and the educational standards and requirements for their license do not prepare them to assess, conduct ongoing research, or implement certain therapeutic practices [49]. Certified substance abuse counselors are also not required to hold a college level degree.
This is a limiting factor whose origin is based in the 12 Step recovery model (e.g. peer support) [50]. It could be said that these providers may not even be familiar with evidence-based practices to address their client’s SUD, as their credential and practice focuses primarily on the induction of a client into a 12 Step program and adoption and reinforcement of the “disease model” of addiction [51][52].
System Issue
Research has also suggested that another influential factor in the lack of services for this population is that in the field of substance abuse research, there is no agreement as to what Evidence-based criteria should be utilized. It could be inferred that even the most trained and educated providers and researchers may see addiction work and practice as a mystifying area of practice unworthy of pursuing. These findings do not even to take into consideration prejudices and stigmatizing beliefs by both healthcare professionals and the general public toward those with SUDs [53][54][55][56]. In essence, there are two worlds: the research based practitioner world that focuses solely on mental health issues and the recovery world of addiction treatment, whose research and ways of assessing and addressing these seem to focus on the medical model and psychosocial model (e.g. disease model and Medication-assisted treatments).
