Asking the right questions in the right way: The need for a shift in research on psychological treatments for addiction

Abstract

Aim: To identify possible reasons for the disappointingly negative results of methodologically rigorous controlled trials of psychological treatments in the addictions field. Method: A selective overview of the literature on addictive behaviour change. Findings: Eight failings of existing research are described: failing to account for the outcome equivalence paradox; neglecting relationships in favour of techniques; failing to integrate treatment research and research on unaided change; imposing an inappropriate time-scale on the change process; failing to take a systems or social network view; ignoring therapists' tacit theories; not including the patient's view; and displaying an ignorance of modern developments in the philosophy of science. Conclusion: Treatment research has been asking the wrong questions in the wrong way. Three necessary shifts in ways of conducting research are proposed: (i) the field should stop studying named techniques and focus instead on change processes; (ii) change processes should be studied within the broader, longer-acting systems of which treatment is part; and (iii) science in the field should be brought up to date by acknowledging a variety of sources of useful knowledge. © 2008 The Author.