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Treatments That Do Not Work

In recent years there has been an international effort in the addictions field to identify treatments and therapies that have been proven to work.  However, evidence-based practices have rarely identified practices that don’t work.  This two-stage study involved a panel of 75 experts who examined a list of 65 treatments currently practiced in addiction medicine. They rated them on a continuum from “not at all discredited” to “certainly discredited.” A Delphi methodology was used to achieve a professional consensus on discredited treatments.  (Delphi employs structured group communications in which experts develop a consensus by mail rather than gathering in-person for discussion.) An initial questionnaire began with the request to “rate the extent to which you view the treatment as discredited from ‘not at all discredited’ to ‘certainly discredited’ ” and included various criteria by which a treatment could be deemed discredited. Replies were pooled with those of the other experts. A second similar questionnaire was then sent, including the first round responses from the panel as a whole.  Anonymity was maintained throughout the process.

The experts considered 11 treatments as “certainly discredited” ranging from electrical stimulation of the head to use of stimulant medications. At the other end of the continuum, 5 treatments were considered “unlikely to be discredited.” These included Alcoholics Anonymous and Antabuse. The researchers raise a number of cautions in interpreting these findings. For example, a treatment for one purpose might be discredited for another (e.g., benzodiazepines effective for withdrawal but not for treatment), and all the experts hailed only from the United States.

Still the researchers believe that, “this study offers a cogent, positive first step in consensually identifying the “dark side” or “soft underbelly” of modern addiction treatment. As a counterbalance to the Evidence-Based Practice (EBP) movement that demonstrates effective treatments, they suggest an emphasis on the field discouraging discredited treatments.

(Norcross, JC, Koocher, GP, Fala, NC, Wexler, HK: 2010. What does not work? Expert consensus on discredited treatments in the addictions. Journal of Addiction Medicine 4: 174-180.)

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