It has often been claimed that the historical development of addiction care reflects ideological, political, and economical changes, and/or shifting therapeutic crazes, constantly failing to live up to what they offer, rather than the continuous march of progress in science. During the past decades, however, evidence-based practice (EBP) has become a well established doctrine in many parts of the health and welfare field, including addiction care. A recent example of this is the National guidelines for addiction care and treatment, issued by the Swedish National Board of Health and Welfare in spring 2007. According to the most eager proponents, the acceptance of the EBP doctrine will bring an end to ideological and religious beliefs, self-assured convictions, and pure guesswork as a ground for treatment practice, replacing them with valid empirical facts and certain scientific proof. However, these claims have not gone uncontested, and some have claimed the new doctrine to represent just another “promise for the future” that will never be fulfilled. For one thing, evidence-based medicine (EBM), which is often described as the root of EBP, typically distinguishes three important sources for informing practice, namely dependable clinical experience, external scientific proof, and patients’ needs and wishes. However, many critics have claimed that EBP in the general welfare field has often come to mean “based on RCT studies”, thus considering mainly or only one of these sources. To a large extent, this critique can be claimed to be valid in the case of the Swedish National guidelines. Other objections that have been directed at these guidelines have concerned flawed and partly contradictory scientific underpinning, partial lack of references for conclusions drawn, inconsistencies with regard to the use of various review methods and so on. Valid as these objections may be claimed to be, this contribution will rather scrutinize the same guidelines from the point of view of the practice field. Based on an appraisal of (i) the historical role of the treatment system, (ii) the predominating views of the character of the problems attended to, (iii) who the clients cared for by the system are, (iv) the typical modus operandi of the same system, and (v) what we know about how recovery from addiction problems actually comes about, some obvious problems and drawbacks, but also some potential benefits of the new guidelines will be highlighted.
Presentation vid 10th International Symposium on Substance Abuse Treatment: Reforms, ideology and best practise
Oslo, 1-3 October 2007