Despite decades of scientific research, most addiction treatment in the United States still operates on outdated models that ignore what the evidence shows actually works. Families are often urged to follow a familiar path – inpatient treatment, 12-step programs, and abstinence-only approaches – without ever seeing proof that these methods lead to lasting recovery. Programs make sweeping claims of success while rarely backing them up with data, and too many people relapse or lose their lives as a result.
Understanding what evidence-based practice really means – and why it matters – is essential to building a treatment system that saves lives instead of failing them. This movement for reform is about more than new terminology; it’s about holding the industry accountable and ensuring that care reflects the best available science, clinical expertise, and patient needs.
This disconnect between science and practice isn’t just an abstract problem – it’s one families have been living with for decades. And it was those families, devastated by loss and determined to make sure others didn’t suffer the same fate, who helped spark a movement for change.
How Grieving Parents Sparked a Movement
Plagued by high death rates from opioid overdoses, parents began asking for evidence proving traditional treatment is effective. Why? Interventionists and AA friends told them to send their children to in-patient treatment followed by referral to AA, resulting too often in relapse and death. Some relatives moved beyond their grief and shame and began to question why the system failed their families. Their children were dying, and they demanded action.
These advocates became aligned with other groups providing new impetus to the reform movement to improve treatment outcomes in our justice and high-income populations.
As these families pushed for accountability, a new standard began to take shape – one built on research, professional expertise, and respect for the individual. That standard is known as evidence-based practice.
What “Evidence Based Practice” Really Means
The new Buzz word today. Every program now claims to follow evidence-based practices. And they can make this claim, because no government agency regulates marketing statements. (This includes success rates, by the way.) What exactly is an evidence-based practice? Google AI reports three key components of Evidence-Based Practice:
1. Start with Proven Science
This involves using findings from sound scientific research and systematic studies, such as randomized controlled trials and meta-analyses, to determine what interventions are effective.
- In the substance abuse field, this means certified drug testing to verify use.
Show me your drug tests – that is the first question to ask when claims of success are touted.
2. Trust Qualified Professionals
This includes the practitioner’s accumulated knowledge, skills, and experience gained through education and practice, which allows them to apply research evidence to unique patient situations.
- Note the word “clinical”.
The reference is to trained professionals with degrees from accredited institutions. Not your friend in AA, an AA sponsor, interventionist or other unaccredited program.
3. Center Treatment on the Individual
Treatment decisions must consider the individual’s unique personal values, cultural background, preferences, expectations, and circumstances to ensure the care is respectful and relevant to them.
- In practice this means using the six ASAM evaluation criteria.
Now required for all placements, these standards include listening to patient preference and identifying family support – a far cry from the current system.
(More on the ASAM criteria later).
Understanding the principles of evidence-based care is one thing. But finding programs that actually follow them is another. So where should families and advocates turn for trustworthy, research-backed information?
Where to Find Reliable, Evidence-Based Information
In accredited research organizations independent of any treatment center.
- Harvard’s Recovery Research Institute
- Yale’s School of Addiction Medicine
- National Institute on Drug Abuse
- Institute for Behavior and Health : New Paradigm for Recovery, for example on the high success rates for doctors
Don’t lose yourself in web searches selling quick fixes for a chronic disease.
With those standards in mind, it’s worth looking at what the science tells us about one of the most urgent issues of all: effective treatment for opioid addiction.
What the Evidence Says About Opioid Treatment
And what do evidenced-based practices conclude as to opioid treatment?
- The only effective treatment is medication – Suboxone and similar medications.
- These medications appear to be more effective in out-patient treatment than in-patient treatment.
Known as Medication Assisted Treatment, MAT has been bitterly opposed by abstinence only programs, some treatment centers and the DEA. Yet we read in a recent NYT article, The Pill Not Taken[1], that Suboxone was readily available in France in 1995 and within four years heroin deaths declined by 75%. In the US only 24% of opioid dependent people are prescribed Suboxone.[2]
Reading this information tears my heart out for all families and friends who needlessly lost loved ones. And it makes me angry – seeing the lost faces. It’s malpractice and it goes on today at the best treatment centers.
If you don’t believe me, read Broken Open by William Cope Moyers. He became addicted to pain pills while employed by Hazelden. He reports his work colleagues and AA connections in St Paul opposed MAT. Following their advice, he experienced months of agony until he tried MAT and was able to regain stable recovery.
So it continues on today – gross malpractice – harming countless families as they pay thousands for ineffective treatment. Unfortunately, some AA and Al-Anon members use their influence and power to actively oppose the new model and MAT, even when presented with research contradicting their views. These naysayers are abetted by in-patient treatment centers benefiting financially from relapsing patients.
Remember, AA co-founder Bill Wilson was not opposed to medications prescribed by physicians. And neither should you be. Let’s go with evidence from independent accredited institutions.
The evidence is clear – and yet, too often, ignored. Changing that reality requires more than new policies or programs; it demands a cultural shift in how we think about addiction treatment itself. Families, advocates, professionals, and policymakers all have a role to play in making sure care is guided by science, not tradition.
The science is no longer in question. We know what works – evidence-based practices guided by research, delivered by trained professionals, and shaped around the needs of each individual. What remains is the will to change. Families, advocates, and policymakers must continue to demand accountability and transparency from treatment providers, and we must reject approaches that rely on tradition over evidence. Only then can we build a system that truly saves lives rather than repeating the failures of the past.
[1] Sunday August 10, 2025 NYThttps://www.nytimes.com/2025/08/07/magazine/suboxone-buprenorphine-opioid-addiction-drugs.html
[2] https://www.cdc.gov/mmwr/volumes/73/wr/mm7325a1.htm