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Moos R. How Can Treatment and Clients Inform and Influence Research on Substance Use Disorders. Paper presented at: Choice, Behavioural Economics, and Addiction Annual Conference; 2004 Nov 1; Brisbane, Australia.
According to prevailing opinion, advances in research shape and embellish clinical practice. In this view, research is the active, creative engine that powers the caboose of clinical care. More broadly, however, clinical care and research are like a closely interwoven fabric in which insights into the social context of clients and treatment inform our research endeavors, which eventually evolve to reflect the actual experience of everyday life. Psychosocial care for clients with addictive disorders is a case in point.Over the last 75 years, since the advent of formal psychological approaches to understand individuals with subsance use disorders, practicing clinicians and clients themselves have developed virtually all of the new intervention procedures in this area. These procedures include psychodynamic approaches, client-centered therapy, motivational interviewing, the therapeutic community, community reinforcement and social network approaches, the predominant cognitive emphasis in cognitive-behavioral treatment, and, of course, mutual support groups such as Alcoholics Anonymous and their offshoot, 12-step facilitation treatment.I take this perspective here and identify some issues that have important implications for the research questions we pose and the conceptual frameworks and methods we employ to answer them. First, I set out four principles, derived from our nascent understanding of the real world of clients and clinical practice, that exemplify advances in our effort to understand the processes underlying effective treatment and recovery. With these principles as background, I describe some unresolved clinical puzzles that point to promising avenues for future research.
