Dogma?

Tim Leighton takes on what he refers to as “Randomized Controlled Trial dogma.”

Keep in mind he’s writing from the U.K., where the treatment landscape is very different. To be sure, over the years various dogmas (12-step, psychiatrization, moral models, etc.) have stifled progress in effectively treating addictions. Unfortunately, some of the criticism of treatment and the recovery movement seem more like the assertion of a new dogma rather than constructive critical thinking.

What are dogmas for? They are doctrines which safeguard certain interests. People crave dogmatic authority because, as T.S. Eliot said, ‘human kind cannot bear too much reality’.

It is not hard to see what interests might be served by an insistence that only RCTs count as evidence in evaluating interventions for substance misuse problems. First, it saves a lot of time and effort, as this insistence precludes the necessity of evaluating more complex, difficult, often ambiguous evidence.

It serves commercial interests as it offers an opportunity to legitimate your product as ‘evidence-based’; it serves the interest of health-care rationing, as it severely curtails what will be made available; it serves the interest of many researchers and research institutes, particularly psychologists and medical researchers, who are trained in setting up and conducting randomised controlled trials, and who are keen to publish their work. It is much easier to get an RCT published in an addictions or psychology journal than any other kind of research (because of the orthodoxy – this may be changing, gradually).

Our field is in the view of quite a few people in the process of a paradigm shift. I agree. The thing about such a shift is that nobody can predict its exact form or timetable.

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