Ah, Wondrous Science

Years ago I had a student who was immersed in all kinds of New Age beliefs. You name it, she believed in it. She once challenged me in class for dismissing faces and forms seen in clouds as a phenomenon called pareidolia, or seeing patterns where none exist. She believed otherwise, and held that cloud forms were some how revealing and prophetic. For the entire semester, we did battle over this and other similar issues. I pressed her again and again to show me some facts, not unsubstantiated beliefs. She couldn’t. Exasperated, she one day muttered, “God, how I hate facts.”

In a distant time before that, while working in one of those classic twenty-eight-day programs, relapse prevention was not apart of the basic programming—yes, it’s true. I recall listening to educated and experienced counselors express frustration over reports of clients relapsing shortly after discharge. Without relapse prevention knowledge, they were mystified as to the cause. That ignorance only intensified their frustration, which lead to the contentious and unethical practices of the time. I attempted to introduce relapse prevention ideas and was promptly shut down. Their reasoning was that such ideas would only entice our clients to relapse even more.   

These days, facts and relapse prevention knowledge (among others) are fused into all reputable treatment programs in the country. How did that come about? It came about as a result of science. Not only did it change how we did things, it changed attitudes. How does science do that? Well, that is the focus of this column. And it is way past due that we address the core of the “Research to Practice” column, which is science. Some of you may know a little about it, so this will be a review. Others have stood at a distance, so this is an invitation to step a bit closer. 

We first need to discuss a little problem. The sad truth is that science does not always change things. Some in our field prefer to stick tight to certain addiction beliefs or dogmas and nothing in the world is ever going to change that inflexibility. Some are just immovable.

To change requires us to believe in the scientific facts, no matter where they may lead. That can be a bumpy road given that scientific facts seem to support one idea or theory one year, and support something different the next year. This vacillating is actually science’s greatest strength. It changes with new research, while dogma doesn’t. Science and research tell us that last year’s theory didn’t quite hold up to the facts, it found something better so we need to move on. That’s strength, and within that strength is flexibility. It means we are discarding the ideas that don’t work and zeroing in on the ones that do. 

Search the literature and you will find a number of definitions for science. For our purposes we’ll consider science as a way to acquire trustworthy answers to questions about nature, which includes addiction. One metaphorical definition is that science separates noise from signal (Silver, 2015). In our clinical work, many client thoughts and behaviors, plus our own past, unsubstantial clinical beliefs, represent noise. Our job is to weed through all that noise and find out what’s really going on, or unearth the clinical signals. The point is to build a treatment plan on signal, not noise. 

To reach the pinnacles of scientific attributes is just plain hard work. But, the pay-off is rather remarkable in terms of improved clinical results, which outshines the many unsubstantiated psychology and addiction theories and practices in existence today (Norcross, Hogan, Koocher, 2008; Witkowski & Zatonski, 2015).

There is a variety of scientific attributes or traits, and all are high-class attributes to possess. Arguably, the bedrock of science is asking question after question, and there are no forbidden questions in science. Nothing is beyond probing; nothing is sacred (Sagan, 1995). If things become sacred, progress grinds to a halt. A good question will cause doubt in the established way of doing things. That is good—as an addiction professional we want to have a healthy dose of doubt. The way to resolve our doubt is to search the annals of science for better ways of assessing and doing things, or we can bury our heads deeper into dogma. This former point means progress, which questioning will bestow. Good questions and progress go hand-in-hand, which is rather remarkable. 

Another science thinking trait is accuracy (Paul & Elder, 2008). An often unspoken point in clinical addiction work is the need to ponder the accuracy of our intake assessments or individual sessions. Could these be loaded with errors and distortions? Building a treatment plan on errors and distortions is disastrous, if not unethical. Now, after reading that first question hopefully some of you thought, “Okay wise guy, how does one attain this accuracy prize?” Good, you asked a science-based question! One of the marks of a good scientist is someone who double-checks his or her results. That does not mean completing a clinical intake, writing up the report, and pronouncing it factual. No, if we want accuracy we need to take the time to recheck our clinical data. Good scientists also make sure they are using accurate equipment; in our case these are our psychometric-based tests and questionnaires, which hopefully have good validity and reliability ratings. Accuracy is also enhanced by comparing client information to supplementary information (e.g., family, legal, employment sources, etc.). All this is a start toward accuracy. 

Other scientific attributes include clarity, relevance, sufficient depth to really cover the complexities of addiction, and logic, such as asking if our clinical impressions make sense (Paul & Elder, 2008). Space constraints prohibit a closer examination of these and the other attributes. The point, however, is that change has come to our field and transformed some attitudes because many addiction professionals see the light and are adopting these science-thinking traits. As a result, we are getting better treatment outcomes. That’s pretty amazing. 

Inherent in this column has always been the ongoing contention between the clinical world and the scientific one. While science maintains that the results of research facts should be the final referee of clinical claims, many addiction counselors believe their subjective clinical experience should rank up there with the privileged status of science (Lilienfeld & O’Donohue, 2007). Once that type of mindset hardens, such folks tend to dismiss the relevance of assessment and treatment research in their daily practice. This is especially true if science conflicts with their so-called, homegrown clinical hunches, anecdotes, pure subjective experience or book sales.

In an old movie called Jerry Maguire (1996), one of the better lines is when the protagonist is talking to a star football player in the process of renegotiating a contract. The football player repeats the signature sentence of the movie, “Show me the money!” In science we should be saying, “Show me that data!” For those clinicians who stand by their intuitions, ask them that very question. 

This sentiment also applies to the seemingly endless debate in our field over which form of therapy is best for our clients, and which foundational theory is best to understand the nature of addiction. Debates will not settle these ongoing issues, science will. 

A major maxim in science calls for following the evidence wherever it leads. Parallel with that principle is that we should set out to find data that will change our mind about things (Myers, 2014). This principle is the exact opposite of following the theory wherever it leads us, and confirming our clinical hunches and gut feelings regardless of the data. 

It needs to be stated that there is a little issue with science language that often scares clinicians; science has few charismatic or captivating words or sentences and comes across rather technical. In clinical addiction meetings, we often hear counselors say, “I go with my gut” or “I go with my heart” as to how they will conduct an upcoming individual or group session. These and a flood of other sentiments always seem to have an emotional receptive ring to them, making them appealing. On the other hand, science sentences are admittedly sterile. Few get excited or pumped-up by statements like, “I am confident that I have accounted for the confounding variables in assessing this client accurately. The clinical research I am using with this client has sufficient validity for this particular case. From now on I will be using actuarial judgment to assess my clients.” Not exactly stirring, but that is the nature of the beast. 

Science needs to be precise, accurate, and truthful. If science were to revert to “go with my gut” or “go with my heart” type language, then precision, accuracy, and truthfulness would be compromised. And if those are compromised, client assessment practices and treatment selection will be as well. Science terms are a bit challenging, yet the pay-off is clarity and transparency that guide us through the fog of unsubstantiated ideas and clinical methods.

 

While some would argue that science is stuffy and arrogant, it can be riveting at times and it consistently ferments an open mind. Yes, science is incredulous to seemingly new theories and ideas, but should such ideas ever provide reliable evidence, science would soon become an ally. Consider the shift from addiction theories that proclaimed the core of addiction was a character deficit to modern neurological theories that explain that old deficit theory so much better. That latter research clears our heads of needless baggage to better assess what is really going on with a client. Clearly wondrous.   

At the same time there is forever a skeptical attitude to be found in science. The aforementioned “show me the data” is at the core of that skepticism. This posture filters all kinds of unwarranted ideas from infiltrating our field. That skepticism offers protection for our clients. Again, clearly wondrous. 

It also frees us from relying on simplistic slogans that vainly attempt to explain the complexity of addiction. Science forces us to think deeply, question, and with those tools conduct better treatment. Deep thinking and better outcomes versus one-dimensional, outdated ways are always wondrous.  

Science allows us to sift through the prejudices, wishful thinking, and the mistakes that clutter typical thought, which stifles and chokes new ideas (Taleff, 2006; McIntyre, 2015). What is so wondrous about that? Scientific discoveries open windows of fresh thought, and point in new innovative directions. Take a look at how our field has changed in the last forty years. Now that’s pretty wondrous. 

After nearly two decades writing for Counselor, this is my last “Research to Practice” column. I wish you well. 

Crowe, C., Brooks, J. L., Mark, L., Sakai, R. (Producers), & Crowe, C. (Director). (1996). Jerry Maguire [Motion picture]. United States: TriStar Pictures. 

Lilienfeld, S. C., & O’Donohue, W. T. (2007). What are the great ideas of clinical science and why do we need them? In S. C. Lilienfeld & W. T. O’Donohue (Eds.), The great ideas of clinical science. New York, NY: Routledge.

McIntyre, L. (2015). Respecting truth: Willful ignorance in the internet age. New York, NY: Routledge. 

Myers, P. (2014). The polestar. In J. Brockman (Ed.), What have you changed your mind about (p. 295–6). New York, NY: Harper Perennial. 

Norcross, J. C., Hogan, T. P., & Koocher, G. P. (2008). Clinician’s guide to evidence-based practices. New York, NY: Oxford University Press. 

Sagan, C. (1995). The demon-haunted world: Science as a candle in the dark. New York, NY: Random House.

Silver, N. (2015). The signal and the noise. New York, NY: Penguin.

Taleff, M. J. (2006). Critical thinking for addiction professionals. New York, NY: Springer.

Witkowski, T., & Zatonski, M. (2015). Psychology gone wrong: The dark sides of science and therapy. Boca Raton, FL: Brown Walker Press.