A consumer’s guide to research on substance use disorders (part 3)

A couple days ago, I explained the challenges of making sense of research and introduced 8 questions that will help readers evaluate evidence and relevance to their work, goals, and lives.

As if to drive the point home, I just saw a tweet by an advocacy group demanding access to “science-based treatment.” That sounds great, but what does that mean? And, how directly and completely does/can science speak to my needs, or the needs of my loved one or community? Unfortunately, it’s not as clear as many make it seem.

Yesterday, we looked at question one.

Question 2: Who were the subjects?

There is a wide spectrum of alcohol and other drug problems, with addiction on the most severe end and misuse on the less severe end. Further, there can even be considerable variety within a category. Additionally, there can be significant differences in where the subjects are found as well as their life experience or current conditions.

  • Where were the subjects found?
    • Community population – Are the study’s findings based on a sample from the community?
    • Clinical population – Are the study’s subjects drawn from a treatment population or treatment-seeking population? 
      • If they are a treatment population, what kind of treatment were they receiving? Methadone, office-based buprenorphine, outpatient, residential, case management, etc.?
    • Something else – Some studies draw subjects from medical clinics, child protection cases, college students, mental health clinics, professional monitoring programs, corrections settings, etc.
  • What were the demographics of the subjects?
    • Recovery capital
      • Are they high recovery capital clients with financial, social, family, environmental, or cultural resources to help them achieve AOD problem resolution?
      • Are they low recovery capital clients with few financial, social, family, environmental, or cultural resources to help them achieve AOD problem resolution?
    • Did the exclusionary criteria result in a group of subjects with a single problem? Meaning that they do not resemble real-world treatment populations? 
  • What kind of AOD problem did the subjects have?
    • Substance use disorders (SUD) – This model is based on the DSM-5 and includes a broad spectrum of substance use problems ranging from addiction to misuse. It also may include any substance. Look for specifiers like mild, moderate, and severe to get a better understanding of the population.
    • Words like “Dependence” or “Abuse” – DSM dependence constitutes a more severe substance use problem (it may, or may not, be addiction), while abuse is considered mild in severity.
    • Substance specific – Some studies include subjects with a particular substance problem, others include polysubstance users. Many recent studies looked specifically at people with prescription opioid problems.
    • Chronic vs acute – Some studies include subjects with long-term chronic problems,  while others may focus on populations with short-term acute problems.

Posts in this series: