A Different Kind of Evidence

Some years ago, a noted research scientist was invited to speak at a local community forum on the subject of addiction. The presentation to more than one hundred interested citizens consisted of a sweeping overview of modern scientific studies on addiction and its clinical treatment. In the question and answer session that followed the presentation, a member of the audience posed a question about the effectiveness of recovery mutual aid groups like AA, NA, Women for Sobriety, and SMART Recovery. The speaker responded that there had been few randomized trials comparing the differences in long-term recovery outcomes between these individuals who had achieved recovery with and without mutual aid participation.  The scientist declared that no definitive scientific evidence yet existed on the effectiveness of such groups. Following this declaration, a most interesting thing happened. A man stood in the audience and said simply, “I am the evidence,” which was quickly followed by other men and women scattered through the room who, moved by the man’s declaration, also stood and echoed, “I am the evidence,” before quietly returning to their seats. This incident vividly portrays what Thomasina Borkman described in 1976 as the gulf and potential collision between scientific/professional knowledge and experiential knowledge.

The knowledge base of the alcohol and drug problems arena has evolved from one of folk wisdom to an emphasis on science and evidenced-based clinical practice. Today, any proposed intervention for addiction will quickly face the question, “Is this an evidence-based practice?” Such scrutiny is indeed a welcome trend given the long history of charlatanry and harm in the name of help within the history of addiction treatment. I have spent most of my adult life trying to elevate the quality of addiction treatment by helping conduct scientific studies of addiction recovery and translating the implications of such studies for addiction professionals and recovery support specialists. I say this to emphasize that what follows is not an anti-science diatribe aimed at justifying the status quo of addiction treatment.

Scientific studies can tell us much about recovery outcomes under the most ideal and controlled circumstances, but recovery is rarely achieved under such pristine conditions. The processes of addiction and addiction recovery are messy — confounded by all manner of co-existing conditions, innumerable internal and external obstacles, previously unknown internal and external assets, and unexplainable life-changing experiences (sometimes labeled “miracles”) that are difficult if not impossible to quantify and scientifically disentangle. And if there is anything science detests, it is messiness. Perhaps that is one reason that science has for so long avoided the subject of addiction recovery. It is far easier to catalogue addiction-related pathologies than to explain the process of human transformation that unfolds in addiction recovery. What is needed is a recovery-informed research agenda.

2014 Philadelphia Recovery Walk_Evidence.jpg