by Philip Ward MSW --- Patricia Corbett Ward MA

Evidence based is currently our industry’s buzzword for “good”. While obviously well intended, the overuse of this term has proven problematic because its meaning has been colloquialized; thus effectively losing its meaning. Evidenced based was never meant to be used as a blanket statement. When the term is used out of context its meaning is lost within each individual’s own definition. The problem as I see it is that evidence based is often viewed as a stamp of approval; rather than a result of empirically validated research.

An evidence base is a result that occurs after testing processes within the context of similar variables. If the same results occur when using the same variables such as circumstances, similar individuals, same processes, then the process is considered to be validated through testing. The operative term is fidelity; as in accuracy with regard to the original experiment. Reliable determines how well questions consistently give accurate info. Valid is when questions assess what you intended to assess. A lack of understanding the process of empirical validation can result in an inappropriate generalization to all similar circumstances (e.g., theory X is evidenced based and so it can be used to treat all addicts). At face value the generalized application of a theory is wrong because people, circumstances, and processes vary greatly. The term evidenced based has become slang for good within the addictions treatment industry and thus has lost the intent of its original meaning.

Another common occurrence is that individuals will take pieces of a theory and apply the concept without fidelity to the original process. A typical example of this is the “stages of change” which is liberally applied without connection to the original “transtheoretical model” or “Motivational interviewing”. While the original models are evidence based the piece meal use of elements of the model is not.

When inappropriately applied the concept of evidence based information may serve to produce negative or iatrogenic results rather than positive outcomes.

Training has suffered from the same false validation by being advertised as evidenced based. Having the words evidenced based in a training title is not a guaranty of quality. The question here is whether the information presented or the training itself is evidenced based. Training that is evidenced based would logically be grounded in educational best practice research. It is more likely that the term is used as a validation of the information presented rather than the training process itself. If training processes are not grounded in content and audience specific best practice research then the outcomes they produce are suspect because they cannot be effectively measured.

A review of training processes undertaken on an international level indicates that education theory is consistently not integrated into instructional practice.

My review studied addictions specific instruction across the United States, Europe, and Australia and I consistently found that instructional practitioners do not ground their instruction in educational theory. The consumer of educational services would be well served to question educators around their understanding and use of education theory.

Field specific research is critical for validating our industries practices as safe and effective. The only way that our field will move forward as a professionally recognized body is through the development of industry specific research. Practice itself should be grounded in theories that have been tested and found to be effective. We should be open to having consumers of our services question the evidence base behind our practices.

My anecdotal observations regarding the use of the term evidence based has brought a cause for concern because it appears to have become a catch all phrase thus losing its literal meaning.