Monday, August 7, 2017

IDAA 2017 Snow Bird, UTAH - CME - Science of Recovery - Dr. Ray Baker

Dr. Ray Baker provided insights into the latest research into Recovery.  A lot of research had gone into addiction but this is the beginning of the study of the health after addiction. The research documents the success of recovery. Epidemiological research showed the percent of population serious problems and its significance. The research into what had worked for individuals to achieve recovery showed a variety of tools had been used. The importance of the treatment centres was highlighted as was the value of the 12 step programs.  Dr. Baker went on to discuss the importance of Recovery Capital especially as this related to response to treatment and prevention of relapse.
Even though I’m an addiction psychiatrist working in the field I am amazed at the cutting edge work that Dr. Baker highlights in his presentations. He’s known as a great clinician but his academic credentials, presentation skills and research are often not as well known. This is possibly because if you talk to him personally he’ll be more likely to talk about his family, or his increasing love of running.  I thoroughly enjoyed the presentation and have only poorly given a taste of it with a very few of the slides he used. I trust this will encourage others to catch a future presentation of Dr. Baker’s, watch for his coming book, and follow up on the references he has provided in the area of the Science of Recovery.
I’d personally been interested enough in the commonly misquoted Cochrane study which suggested 12 step programs weren’t beneficial to seek out the chief addiction medicine researchers for those Cochrane Studies at the ISAM presentation in Malaysia.
“We said it couldn’t be studied as a addiction ’treatment ‘ because it wasn’t simply a " treatment." It’s always misquoted.  We ourselves  recommend 12 step programs clinically.”  I remembered that conversation because the chief Cochrane researcher lamented that there wasn’t research to date to support the obvious evidence of the success of 12 step programs especially with regard to long term recovery.  I enjoyed that Dr. Baker had shown that studying Recovery as opposed to  Addiction Treatment supported what we all saw clinically.  Further by looking at the idea of Recovery Capital conceptually there was increasing opportunity to standardize and research aspects which we all know clinically are most relevant to treatment success.  I often have to point out that the Cochrane Studies were originally developed solely for the purpose of comparing one medication treatment to another  and as a tool are best when  limited to this narrow focus. Unfortunately, it’s easiest to show with a short weekly to months  pharmacological trial the benefit of one limited treatment compared with another.  Recovery by contrast is a concept of life change that shows increasingly over years. The cost of research selects in favour of an acute intervention but not so much for chronic conditions as addiction is.  Dr. Baker raised these issues and proposed solutions some of which included paradigmatic shifts in thinking about treatment.  I loved his use of lay persons as recovery coaches and recovery monitors to help get patients to meetings or to doctors appointments and follow up.
All round for me a highlight of the CME presentations this year. I see myself taking some of these ideas back to my clinical practice and changing the questions and recording I do in my continuing care of patients.

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