Asking the right questions in the right way: the need for a shift in research on psychological treatments for addiction

Aim To identify possible reasons for the disappointingly negative results of methodologically rigorous controlled trials of psychological treatments in the addictions field. Method A selective overview of the literature on addictive behaviour change. Findings Eight failings of existing research are described: failing to account for the outcome equivalence paradox; neglecting relationships in favour of techniques; failing to integrate treatment research and research on unaided change; imposing an inappropriate time-scale on the change process; failing to take a systems or social network view; ignoring therapists' tacit theories; not including the patient's view; and displaying an ignorance of modern developments in the philosophy of science. Conclusion Treatment research has been asking the wrong questions in the wrong way. Three necessary shifts in ways of conducting research are proposed: (i) the field should stop studying named techniques and focus instead on change processes; (ii) change processes should be studied within the broader, longer-acting systems of which treatment is part; and (iii) science in the field should be brought up to date by acknowledging a variety of sources of useful knowledge.