Critical Thinking for Addiction Professionals

By Michael J. Taleff | Go to book overview

sometimes try to infer that one thing caused another using weak arguments, which can lead to clinical and other problems. We outline a few to beware of.


X caused Y—When in Fact It Didn't

A causal fallacy seen all too often in the addiction field is making the wrong connection, and can best be illustrated by an example.

Tr eatment programs tend to attribute their effectiveness to certain underlying philosophies and methods. This is called an illusory connection. Why illusory? Because client improvement is erroneously connected to certain treatment strategies or program styles. The problem with such claims is that they never convincingly demonstrate that there is a direct connection between a particular intervention and recovery. No research has ever credibly indicated that intervention “x” caused outcome “y.” Even with the finest research designs and statistical methods, the best we seem to be able to do is to demonstrate certain correlations between a treatment and its outcome. That is, there is some relationship between “x” and “y”, but it is not causal.

Why this lack of cause and effect? Well, we can't say with any certainty that one specific thing actually causes another in terms of addiction treatment. There are too many other variables that influence outcome. In order to say there is a direct connection, one would have to control for all the social, psychological, and even biological influences that could have had as much to do with someone getting sober as the treatment program. Yes, there is good evidence that therapy works as opposed to no therapy. But trying to find out what it is within therapy that makes the difference is difficult.

Of the current counseling treatments available, none has been shown to be more effective than any other (Institute of Medicine, 1990). That conclusion was written more than a decade ago and is still valid today. Formal treatments work only marginally better than the natural (untreated) state of recovery (Seligman, 1993). Yet, many programs go to great pains to promote analysis, cognitive therapy, cognitive-behavioral therapy, community therapy, or whatever, as the most successful interventions available. One constantly hears, “How can you argue with success?” Well, this very perception is deficient (Dawes, 1994). Some people will get over a problem without treatment. Yet, a treatment program whose

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