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Galvin, Brian (2005) The National Documentation Centre on Drug Use. Drugnet Ireland, Issue 16, Winter 2005, pp. 18-19.

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Problem drug use and the evidence-based approach to treatment

In the next few issues of Drugnet Ireland we will be looking at the subject of evidence-based medicine (EBM) and its current and potential role in the treatment of problem drug use. This article provides a very brief overview of the concept of EBM and points to where the evidence can be found.

What is evidence-based medicine?

EBM is an approach to clinical decision making that relies heavily on high-quality research evidence. The definition below neatly describes the central principles of a practice which follows the EBM approach.

Evidence based clinical practice is an approach to clinical decision making in which the clinician uses the best evidence available, in consultation with the patient, to decide upon the option which suits that patient best.1

It is important to note here that an evidence-based approach is not simply an unmediated application of evidence from research; the experience and judgement of the clinician providing treatment and the expectations, needs and background of the patient, client or carer are also essential evidence and play a role in clinical decision making.

Where does the evidence come from?

Evidence-based practice relies on findings based on a number of research tools:

Systematic reviews identify all the research evidence on a topic, appraise it for quality and attempt to draw conclusions from the evidence available.

 

Randomised control trials are studies in which a group of subjects receiving an intervention is compared with a control group. Both groups are randomly selected.           

 

Cohort studies are those in which patients who presently have a certain condition and/or are receiving a particular treatment are followed up over time and compared with another group who are not affected by the condition or treatment under investigation.    

Other research tools include case-controlled studies and qualitative studies.

Where is the evidence found?

Databases

Finding evidence may involve searching a number of databases and other sources. The Cochrane Collaboration is responsible for synthesising evidence-based research in the form of systematic reviews, which are made available through the Cochrane Database of Systematic Reviews. There are also several bibliographic databases covering all the major medical and health fields. These include Medline, the database of the National Library of Medicine (USA); EMBASE, the Excerpta Medica Database; and PsycINFO, the database of the American Psychological Association. A database of particular relevance to the addictions field is ETOH, the Alcohol and Alcohol Problems Science Database of the US National Institute on Alcohol Abuse and Alcoholism. Unfortunately, this database is not currently being updated and, while it is still available online, for free, no new records have been added since 2004. Another very useful source is Clinical Evidence, an online directory published by the BMJ and updated monthly.           

Clinical guidelines

Clinical practice guidelines are another important facet of the knowledge base required by clinicians seeking evidence to support decisions. These guidelines are systematically developed statements designed to assist in patient and physician clinical decision making for specific clinical circumstances. They are prepared using clinical experience, expert knowledge and research evidence and developed using a consensual approach often involving treatment providers and patient groups as well as clinicians.

Examples of organisations that provide online access to clinical guidelines are the UK National Institute for Health and Clinical Excellence (www.nice.org.uk) and Canada’s CMA Infobase (http://mdm.ca/CPGSNEW/CPGS/INDEX.ASP).  Guidelines Finder is a special service available through the National Electronic Library for Health which holds details of over 1400 guidelines in the UK.

Practice guidelines for the medical treatment of problem substance use are readily available but this is, of course, only part of the picture. Finding guidelines which describe best practice in other forms of treatment, including psychosocial treatment, is much more difficult and this evidence is not often available through the sources outlined above.

Treatment approaches to problem drug use need to address more than the medical or physical manifestation of the problem but must also consider social, psychological, economic and other factors. It might appear that the principles of EBM, with its emphasis on providing support to clinical decision making, has limited applicability in the addictions field. However, the concept of EBM is receiving increasing attention in scholarly literature in the field. Furthermore, studies examining the efficacy and benefits of treatment programmes have identified the evidence-based approach as important in achieving successful outcomes.

Service providers and planners are well aware of the emphasis on efficiencies in health services and the need to demonstrate the economic benefits. A recent systematic review of American research on treatment for problem drug and alcohol use demonstrated that treatment programmes have produced significant social, economic and health benefits.2 The review found that reduction in drug and alcohol use, and consequent improvements in health and social function of the individual receiving treatment, are most marked when the treatment used is evidence based. This underlines the importance of ensuring that those responsible for designing, implementing and delivering treatment services have access to the evidence base.

Future issues of Drugnet Ireland will look at how the concept of EBM is treated in addiction literature and at the role of researchers, librarians and service planners in turning evidence into knowledge which can be used to reduce drug-related harm.

1.  Muir Gray JA (2003) Evidence based health care: how to make health policy and management decisions. 2nd edn. Edinburgh: Churchill Livingstone.

2. References to this study and other research and sources of evidence will be available with the online version of this article on the NDC website at www.hrb.ie/ndc.

 

Item Type
Article
Publication Type
Irish-related, Open Access, Article
Drug Type
All substances
Intervention Type
Education and training
Issue Title
Issue 16, Winter 2005
Date
October 2005
Page Range
pp. 18-19
Publisher
Health Research Board
Volume
Issue 16, Winter 2005
EndNote
Accession Number
HRB (Available)

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