EVIDENCE AT LAST, PART 2

I’ve now spent some time reflecting on the recent news that I posted about on the recent scientific study published by Reid Hester and his coworkers. As a scientist myself this is usually a good thing to do to gain a better perspective on what the real meaning or interpretation of the information might reflect.

It might be interesting for you all to know how I at least look at a scientific paper. The first thing I do is carefully read the abstract to see if it looks interesting and reasonably valid as far as the hypothesis and the conclusions go. If so, I then will read the rest of the paper. When I do this I carefully again consider the hypothesis, then the methods which have been used to analyze it and finally the results and conclusions that the authors draw from it. After that I can then think about the situation and see how relevant and important I think the work may or may not be.

Then there is interpretation. This is subjective. The author of the paper will offer his but I get to make my own too which might or not agree. Two people looking at the same data can reach different interpretations and that’s the fun of it. So that is what I’m doing here. So here is what I think.

In this instance I think the work is important. That being said then I can go further. We could look at this in one of two ways. Frst is, it really didn’t show anything other than the fact that all three methods seem to improve results based on historic controls. What that basically means is someone who wants to recover will do so.And there is real evidence that supports that idea . It is well known in scientific circles that as many as half of people recover from any form of substance abuse basically based on their own decisions to change and thus do so. This is called spontaneous or natural recovery. Parenthetically, this number is high since the majority of people are not seriously physiologically addicted and this fact is often not mentioned in discussions. If your misuse is of reasonably short duration and circumstances of benefit of quitting start to seriously outweigh those of using, then you just may do it on your own. This is vastly simplified of course but you get the picture. If you are seriously addicted, you most likely will need some form of help—but there is no way to know the difference. So if you think you have a problem, and help is available, like Smart, why not get it. Seems simple enough.This is also why recovery rates seem so high with SR,even tho there is no data that shows that directly. Well that is til now.

However there’s another way to look at these results – and is the way I do. And that is that this is really the first scientific valid information that supports the use of the smart recovery tools and principles as compared to the historic controls – which in this instance are the participants in the study themselves – and that seems to me information really worth savoring.

The real problem with the study of course  that there is really no concrete external control. The reasons for this are several, the most prominent of which is it would not be ethical to either randomize someone to a group of people who received no help or instead randomized to a group that they basically didn’t want to go to in the first place. Anyone solicited to possibly participate in this study was already motivated to first try to improve their behavior and wanted to do it using the smart recovery program. thus the gold standard of excellence in scientific studies involving clinical trial, the randomized controlled trial or RCT was not possible. Nor will it ever be possible. So we have to go with what tools we have in order to try to gain a body of evidence which supports the things that we believe in – such as smart recovery concepts.

An investigator or interpreter always needs to be mindful of the fact that he may be biased. I would have to confess that I am biased about the fact that what we do in smart make sense and therefore is likely to be effective. Stepping away from that however I still think that the data presented here is important and needs to be utilized.

Another thing an investigator must consider and discuss in the paper—as well as an outside interpreter like me in this instance is to recognize its limitations. So right off we must recognize  that this is a limited study with a small number of people. Thus the results really only pertain to them and hence there is some danger in trying to draw more sweeping conclusions about the population of people that may be interested in recovery in general.

The second thing is its time dimension. Three months is an extremely short time of follow up. 6 month data will come but after that??  Who knows? We do know that for the more serious addicted the change process and the neuroplasticity changes take far longer- years by some estimates. So we have to be careful here. Yet we do know also that if an addict can sustain recovery for 6 months he has  been significantly long in the process and his chances of success are reasonable. I don’t put a number here because there is no good data. But data about 6 months as described here is better than no data which is what we had before.

The study population was skewed towards women. Who knows why that is and its relevance I don’t understand at all. Good news for women I suppose, but the numbers here for women are far higher than at SR meetings where only about a third are women.

Another limitation is socio- economic. The study as well as Smart itself is made up of reasonably well educated people of a higher economic nature than the population at large that is the addicted population in general. WE don’t see many in the 15 to 25 year old range so who knows about them... Yes I have seen many in the younger and lesser socioeconomic categories and yes they seem to do as well as the others, but that hardly stands as fact.

All that being said however I think this is work which encourages both those of us who are actively working in the program as well as those who might be interested in coming and giving it a try to proceed.

Also of importance is the data that show the number of meetings that a person attends bears direct relationship to their success rate. This especially pertains to face-to-face meetings which is not entirely unexpected. My own bias is that face-to-face meetings because of all the subtle cues and nuances present in that environment are additive...

Although the Overcoming Addictions (OA) computer based interactive format did not show an additive effect. This is disappointing of course but just because the study didn’t show it does not mean repeat not mean that the online program is without merit. I have actually taken this course and as a result, I believe it will enhance motivation and knowledge of the program. And when it becomes available I will recommend it

Finally, the three endpoints that were used in this study were percent days abstinent, mean number of drinks consumed per day, and drug and alcohol related problems as reported by the participant and a significant other are indeed good ones. However we do not know about other desired results of recovery that those of us who have experienced it have found such as clarity of thinking and better feelings about the quality of life. Seems logical they will follow but we still don’t know that.

In conclusion therefore I think I will be justified in saying, if ever asked, “Does smart recovery work?” the following is justified: “Smart Recovery is a science-based program etc., now with new evidence’s which supports its efficacy"