u 20101031 research and evaluation in addiction 20101031 research and... · Research and Evaluation in the Addiction Field Alfred Uhl SucFoDok Suchtpräventionsforschung und -dokumentation

Alfred Uhl Stavanger, 1.11.2010 1 von 115

Research and Evaluationin the Addiction Field

Alfred Uhl

SucFoDokSucFoDokSuchtprSuchtprääventionsforschungventionsforschungund und --dokumentationdokumentation

ANTONANTON--PROKSCHPROKSCH--INSTITUT INSTITUT

K L I N I K U MK L I N I K U M

A K A D E M I EA K A D E M I E

F O R S C H U N GF O R S C H U N G


(1)How it all started


1992 – 1997COST A6 Evaluation of Action against

Drug Abuse in Europe(PI: Ambros Uchtenhagen)

WG 1: Evaluation of Drug Policy and Policy ChangesWG 2: Evaluation of Primary PreventionWG 3: Evaluation of Treatment and RehabilitationWG 4: Development of Research Instruments andProtocols to Be Used in EvaluationWG 5: Evaluating Action against Drug-Related Delinquency

http://content.karger.com/ProdukteDB/produkte.asp?Aktion=ShowPDF&ArtikelNr=259105&Ausgabe=249621&ProduktNr=224233&filename=259105.pdf

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Goal of WP 2: collect examples of

“Evaluated Primary Prevention”in Europe

Just askparticipating countries

“Provide me with allexamples of evaluated

primary prevention projects” ?

MesserschmidtMesserschmidt (1736 (1736 -- 1783)1783)

What is “Primary Prevention” ?

What is “Evaluation” ?What do we want

to achieve “Goals” ?

How to measure “Effectiveness” ?


Evaluation of Primary Prevention in the Field of Illicit Drugs:

Definitions - Concepts - ProblemsUhl, A (1998)

in:Evaluation Research in Regard to Primary Prevention of Drug Abuse

Springer, A. & Uhl, A. (eds.)European Commission Social Sciences, 1998

www.api.or.at/akis/download.htm

http://www.api.or.at/akis/download.htm


contribution by Line Nersnæs

Department of Research and Health PromotionNorwegian Ministry of Health and Social

Affairs, Norway

Mia’s Diary: An Alcohol and Drug Primary Prevention Program for the Nordic

Countries


1992 – 1997The Austrian “Drug Information Materials”

Uhl, A.; Springer, A. (1997): 5 Jahre “Drogenkoffer” – Eine Evaluation der Situation in Wien. Forschungsbericht des LBISucht, Wien

• Only 2 teachers in Vienna had used the 8-day programme• The concept and design was not suited for school application• First evaluation lead to totally wrong results (EDDRA)


How should we proceed ?

ignore such problems ignore such problems …… …… or try to find solutionsor try to find solutions


Evaluation versus EvalopathySupport for Practical Improvement vs. Irrational Nuisance

Uhl A., 3rd Nordic Health Research Conference, Tampere, 2000

The desirable notion of developing promising prevention approaches and improving practical prevention work through well planned andmethodologically adequate research – regardless whether this research is labeled “evaluation” or not – often deteriorates to a ridiculous ritual of pseudo evaluation.

One could speak of “evalopathy” as a new form of mental disease spreading through the scientific community. A development producing output not good enough to learn anything from, but nevertheless drawing on scarce resources from practical work.

http://www.api.or.at/sp/download/lbidownload/tampevalpa.pdf



1993Foundation of EMCDDA

(European Monitoring Centre for Drugs and Drug Addiction)

Demand Reduction Section


The Limits of EvaluationUhl, A. (2000)

in:Evaluation - A Key Tool for Improving Drug Prevention

Neaman et al. (2000) EMCDDA Scientific Monograph, No 5

www.emcdda.europa.eu/html.cfm/index34013EN.html

http://www.emcdda.europa.eu/html.cfm/index34013EN.html


1999Start to develop Evaluation Standards

(German Society for Evaluation – DeGEval)

Wrong common-sense ideas:• Evaluation must be planned together with project planning • There has to be a clear goal defined before start• Only objective/standardized methods are legitimate• Evaluation must prove effectiveness (efficacy ???)• etc.


German Evaluation Standards

translated into EnglishEVALUATION STANDARDS

(DeGEval-Standards) German Society for Evaluation (2001)

www.degeval.de/calimero/tools/proxy.php?id=19084

http://www.degeval.de/calimero/tools/proxy.php?id=19084


(2)What is Prevention ?


Classification of PreventionFour-Column-Model

Prevention(extended sense)

TertiaryPrevention

HarmReduction

TertiaryPrevention

TherapyPrevention(narrower sense)

PrimaryPrevention

SecondaryPrevention

Repression

Specialresp.

IndividualPrevention

GeneralPrevention

Uhl, A.; Gruber, Ch. (2004): Suchtprävention. In: Brosch, R.; Mader, R. (Hrsg.): Sucht and Suchtbehandlung: Problematik and Therapie in Österreich. LexisNexis, Wien

Public Health Classification System

Gordon (1983), NIDAPrevention or Treatment ?


• primary preventioninterventions before signs of the index problem exist

• secondary preventioninterventions aiming at persons with elevated risks to develop an index problem

• tertiary preventiontreatment and relapse prevention after index problem manifestation

Public Health Classification System


• primary preventionaverting the occurrence of disease

• secondary prevention (only)halting the progression of a disease(Commission on Chronic Illness, 1957: Chronic Illness in the United States: Prevention of Chronic Illness – Volume 1. Harvard University Press, Cambridge)

• secondary / tertiary preventioncurative treatment / palliative treatment (Caplan, G., 1964: Principles of Preventive Psychiatry. Basic books, New York)

Physical Health System


Academic “Chinese Whispers“Only 20% of those, who cite read the original!

Simkin, M.V.; Roychowdhury V.P. (2003): Read before you cite! Complex Systems, 14, 269-274

“Potemkin Science” – Read before you cite?


Institute of Medicine Model (1994)

Mrazek, P.J.; Haggerty, R.J. (eds) (1994): Reducing Risks for Mental Disorders. Frontiers for PreventiveIntervention Research - report of the Committee on Prevention of Mental Disorders Division of BiobehavioralSciences and Mental Disorders Institute of Medicine. National Academy Press, Washington DC

Mental Health Classification System

Strasser (1978), EMCDDAPrevention or Treatment ?


• universal prevention (= primary prevention)aims at the whole population

• selective prevention (= secondary prevention)aims at groups with an elevated risk to develop the index problem

• indicated prevention (≠ tertiary prevention)aims at individuals at risk before index problem manifestation

Mental Health Classification System


dyslexia⇓school failure⇓depressive mood⇓substance abuse⇓addiction⇓i.v. drug use⇓HIV-infection

Treatment ⇒ Prevention⇓

“prevention”

is a

relational term

“treatment”is a

relational term

Is an action “treatment” or “prevention” ?


Why do you call grandma Why do you call grandma ““mamamama””??

Reification Fallacy misinterpreting an abstract term (here a relational term)

as something specific


dyslexia⇓school failure⇓depressive mood⇓substance abuse⇓addiction⇓i.v. drug use⇓HIV-infection

same intervention by …

speech therapist: therapy

teacher: teaching

substance abuse preventionist: prevention of substance abuse

health promoter:prevention of health problems

How call an intervention ?


• “prevention” as specific activity: Preventing what ?• “prevention” as global activity: What does it include ?• “prevention” as certain profession: Which professions ?

Semantic Confusion !

E.C. Escher 1960: Ascending & Descending


(3)What is Evaluation?


Term “Evaluation”(COST-A6-Workgroup)

• everyday contextproving effectiveness of the evaluand (= measure, technique, programme)(quite narrow – but mostly not feasible)

• professional contextassessing anything to understand the evaluand better:(rather modest – and always feasible)




Structure of a large Companyoriginal

• Administration• Research• Production• Advertisement• Sales

Goofy as new Boss


Structure of a large Companypragmatic solution

Gyro Gearloose

• Production (administrative Processes)• Production (of Research)• Production (of Goods)• Production (of Advertisement)• Production (of Sales)


Structure of a large Companyafter some time

• Production• Production• Production• Production• Production

Beispiel: Autowerkstatt

Jerry Lewis


„Tower of Babel “ Valckenborch (1595) in „old masters in Dresden“

Semantic Confusion !


DTME - classification of Evaluation(COST-A6-Workgroup)

• Data dimension (Type of data collection)structural dataprocess data – process evaluationexpected outcome data – outcome evaluationunexpected outcome datacontext data

• Time dimension (State of evaluand)concept phase = pre-formative phasedevelopment phase = formative phase – formative evaluationtesting phase = first summative phase – summative evaluationroutine phase = second summative phase

• Methodological dimensiondescriptionexplorationhypotheses testing

• Evaluator dimensioninternal evaluationexternal evaluation




Wrong Conceptions about Evaluation(Evaluation Standards – German Evaluation Society )

• Always plan evaluation prior to project start(commonly not feasible)

• Always have precisely predefined goals(commonly neither sensible nor feasible)

• Every evaluation has to prove effectiveness(usually neither sensible nor feasible)

• The evaluator has to judge the evaluand(sometimes explicitly ruled out – sometimes desired)

• Only standardized methods are legitimate(systematic, data-based and competent – but not standardized)




Wrong Conceptions about Evaluation(Evaluation Standards – German Evaluation Society)

• Always quantitative statistics and significance tests(understandable and criticisable – qualitative is accepted as well)

• Always for specific practical application(also gaining knowledge without intention to apply it)

• Always aim at emancipation and not control(not necessarily – but nice if feasible)

• Always guarantee transparency for all participants(not necessarily – but nice if feasible)




… aims at judging the Evaluation subject

• not judging directly

• systematic & realistic (not standardised)

• reproducible and criticisable

• data based

• competent

Professional Evaluation(Evaluation Standards – German Evaluation Society)




• Improving the evaluation object (= formative evaluation)

• Preparing decisions

• Gaining knowledge (without direct intention to application)

• Basis for judgements – but not necessarily judgement

Goals of Evaluation(Evaluation Standards – German Evaluation Society)




... is the pathological drive to evaluateeven if where it is not possibleand where it makes no sense;

with inadequate methodsand irrational goalsUhl, A. (2000): Evaluation vs. Evalopathy: Support for Practical Improvement vs. Irrational Nuisance

Evalopathy




Evalopathy turns into a new form of bureaucracy.The required documentation

prevents increasingly that the actual goals can be reached.

Evalopathy




(4)image of man, of society

and of the world


paternalistic-controlling approachPaternalism in the sense of “northern alcohol control policy”

Uhl, A. (2004): Wie viel Freiheit braucht Suchtprävention – wie viel Zwang verträgt sie?. In: Landschaftsverband Westfalen-Lippe: Tagungsband zur Tagung "Frühintervention – am Beispiel desBundesmodellprojektes FreD" vom 23.-25. Juni 2003 in Potsdam. Koordinationsstelle Sucht, Potsdam

Busch: Lehrer Lämpel

participatory-emancipatory approachHealth Promotion in line with the WHO-Ottawa-Charta


1944: Young trees have to be tied, 1944: Young trees have to be tied, in order to grow straight und and in order to grow straight und and do not turn into various directions. do not turn into various directions. And the same thing is true for young And the same thing is true for young humans.humans.Discipline has to be the ribbon, Discipline has to be the ribbon, tying them to beautiful straight tying them to beautiful straight growth.growth.””

Professor Brett (Lutz Professor Brett (Lutz GGöötztz))

paternalistic – controlling parenting

““Hot Rum Spiced WineHot Rum Spiced Wine””Germany 1944Germany 1944


I am afraid that very thorough parenting, produces only tiny fruit

G. Chr. Lichtenberg


This is what Astrid Lindgreen’s story tells us according to my opinion:

„One has to be taken serious as child, to turn into

a strong and brave adult with a mind of his own.“

Jasmin Wagner

participatory – emancipatory parenting

Pippi Longstocking: Astrid Lindgreen 1944


Two fields of meaning“health promotion” vs. “control strategies”

• democratic vs. paternalistic• emancipatory vs. controlling• promoting participation vs. obedience• empowerment vs. keeping in dependence

• salutogenesis vs. pathogenesis• resource orientation vs. deficit orientation

• individualisms vs. social control• ineffective vs. evidence based


(5)Advocacy against prevention

(and regular treatment)


Attack againstthe profession „prevention“

from two sides

„liberal“ drugs policy advocates „northern alcohol policy“(Good Templars invite to sobriety pledge Astrid Lindgren)


“liberal” drugs policy advocatesclaim „prevention“ causes excessive

public regulatory policy?

The Soft Control2006

The Adversity of Substance Abuse Prevention

2004

Popular buzzwords: „Nanny-State“, „Health Fascism“


1975 1995 2003

Alcohol Control Policy4 Main Publication

Central publications coining the positions of WHO & EU

2006


The books offer:

1. comprehensive literature views (+)

2. critical and well-founded analyses (+)

3. but over-simplifying conclusions supporting advocacy for a Northern European perspective (-)

Prevention and treatment are defined as “expensive and ineffective” – supply reduction as the “magic bullet”


per capita alcohol consumption in Austria1955 – 1973 – 2007

20% reduction

per capita alcohol per year in population older than 14 years

real alcohol pricesreduced by about 50%since 1973


e.g. European Convergence


Alcopops taxes and consumptionDevelopment in Austria vs. Germany(always less than 1% of market)

Before introducing Alcopops Tax in Germany 2004

Austria Germany Austria


(6)The myth of

“Evidence Based Policy”levels of evidence


What is „evidence“ ?• solid evidence: (well proven)• circumstantial evidence: (in court: facts but no confession)• self-evidence: (needs no explanation)• anecdotal evidence: (based on one or a few observations)• hearsay evidence: (rumour)• shaky evidence: (unreliable)• religious evidence (revelation)• to give evidence: (contest in court)• medical evidence: (diagnostic report)• conflicting evidence: (one position must be wrong)


Misunderstanding “Evidence-based”(on purpose ???)

“Evidence based medicine is theconscientious, explicit, and judicious use ofcurrent best evidence in making decisionsabout the care of individual patients. …Evidence based medicine is not restricted to randomised trials and meta-analyses”.

Sackett et al. (1996): Editorial: Evidence Based Medicine: What it is and what it isn't. British Medical Journal, 312, 71-72)

… but a wrong conception is commonly impliedDavid L Sackett


Levels of Evidence

1 systematic review of randomised trials2 randomised trials 3 quasi-experimental studies4 non-experimental studies5 expert-opinion

Phillips, B.; Ball, C.; Sackett, D.; Badenoch, D.; Straus, S.; Haynes, B.; Dawes, M. (2001): Levels of Evidence. Oxford Centre for Evidence-based Medicine, Utrecht


20062003

results are primarily level 3 and 4 but level 1 and 2 evidence is insinuated

(randomised trials are mostly infeasible in the field)


Concerning overestimating the feasibility of randomized trials

Smith, G.; Pell, J. (2003): Parachute Use to Prevent Death and Major Trauma Related to Gravitational Challenge: Systematic Review of Randomised Controlled Trials. British Medical Journal, 327, 1459-1461

We think that everyone might benefit if the most radical protagonists of evidence based medicine organized and

participated in a double blind, randomized, placebo controlled, crossover trial of the parachute.


Certain words are magic words blocking our thinking, making it virtually impossible to grasp what they actually stand for.

This works based on a simple scheme:The words do not denote what they suggest and hide what they actually indicate. This peculiar delusion works, due to the principle of“Performative Self-immunisation”.

Persons using these terms have inevitably won, since rejecting the terms is only possible at the cost of self-destruction. Nobody can afford to be suspected of being against measuring effectiveness, improving quality, considering cost-effectiveness – and related to evidence-based policies – to be against using the best available evidence.Liessmann, K.P. (2009): Theorie der Unbildung Die Irrtümer der Wissensgesellschaft (2. Auflage). Piper, München

Performative Self-immunisation


(7)The myth of

“Evidence Based Policy”ethics


… but ethical statements:„what should be“cannot be derived from empirical facts:„what is”

(Naturalistic Fallacy)

questionable truism:We need an “evidence based policy“

David Hume George Edward Moore

Hume, D. (1911): A Treatise of Human Nature. J. M. Dent & Sons Ltd., London; Original: First Edition (1740) Thomas Longman, LondonMoore, G.E. (1960): Principa Ethica. University Press, Cambridge; Original: First Edition (1903)


Prohibition of divorce Right of husband to discipline his wife

Effective and cheap measure to reduce broken home situations for children e.g. are …


Effectivenessis a necessary, but not a sufficient conditionto implement a measure!


“Evidence Based Policy”… if understood as many do …is a contradiction in itself – an oxymoron

(like „deafening silence“)


(8)Limits of Evaluating Substance

Abuse Prevention (SAP)

Alfred Uhl Stavanger, 1.11.2010 65 von 11565 von 60 Alfred Uhl:

Problems in evaluating SAP

long-term perspective

• significant effects after 3 months• no effects after one year



specific effects

Uhl, A. (1998): Evaluation of Primary Prevention in the Field of Illicit Drugs: Definitions – Concepts - Problems. In: Springer, A.; Uhl, A. (eds.): Evaluation Research in Regard to Primary Prevention of Drug Abuse. A COST-A6 Publication. European Commission Social Sciences, Brussels

• short-term treatment effects• Long-term health problems• Long-term substance abuse problems

Power dilemma:Life-time-prevalence 1%minimum sample-size 360.000



many competing Influences

In an open systemwe cannot controlthe other variables …

… what we can know is very limited



Generativity: non-linear effects

Uhl, A. (2000): The Limits of Evaluation. In: Neaman, R.; Nilson, M.; Solberg, U.: Evaluation - A Key Tool for Improving Drug Prevention. EMCDDA Scientific Monograph Series, No 5, Lisbon)

Commonly we face no homogeneous effectsbut chaotic effects

Chaos Theory, Catastrophe Theory,Complexity Theory


Sir Francis Galton 1822 – 1911Galton, F. (1886): Regression Towards Mediocrity in Hereditary Stature. The Journal of the Anthropological Institute of Great Britain and Ireland, 15, 246-263


Statistical Regression



“Parrott Effect” & “Pseudo Attitudes”

Uhl, A. (2000): Non-Problematic Use' - 'Problematic Use': A Paradox. In: Springer, A.; Uhl, A. (eds.): Illicit Drugs: Patterns of Use - Patterns of Response. Proceedings of the 10th Annual ESSD Conference on Drug Use and Drug Policy in Europe. Studienverlag, Innsbruck

Surrogate variables (proxies) areoften problematic

It is naïve to expect that a parrot trained to say: “I hate bananas”, will not touch bananas in the future.

e.g. verbalised attitude towards cannabisvs. actual attitude



Criterion “use” instead of “abuse”

Uhl, A. (2000): Non-Problematic Use' - 'Problematic Use': A Paradox. In: Springer, A.; Uhl, A. (eds.):Illicit Drugs: Patterns of Use - Patterns of Response. Proceedings of the 10th Annual ESSD Conference on Drug Use and Drug Policy in Europe. Studienverlag, Innsbruck

Surrogate variables (proxies) areoften problematic

An increase in use may correspondwith a decrease of abuse.



Asking subjects why they do something

Gerd Gigerenzer (2008): Gut Feelings: The Intelligence of the Unconscious, Penguin Books.Nisbett, R.E; Wilson, T.D. (1977): Telling More Than We Can Know: Verbal Reports on Mental Processes. Psychological Review, 84, 3, 231-259

Most of our behaviours and emotions occur unconsciously – based on something that we could call intuition.

external observers are oftenbetter in explaining behaviour.

Burrhus Frederic Skinner Sigmund Freud



Programmes and Manuals

The effective elements of preventionare soft skills (= communication skills)– but they are hard to assess and differ from individual to individual.

Uhl, A. & Springer, A. (1997): 5 Jahre “Drogenkoffer”Eine Evaluation der Situation in Wien. Forschungsbericht des LBISucht, Wien


Research methodology resembles grammar: Errors everybody makes, turn into new rules ...

(feely based on André Malraux – about Politics)


It is difficult to get a man to It is difficult to get a man to understand something understand something when his salary depends when his salary depends on his not understanding it.on his not understanding it.

UptonUpton SinclairSinclair

Stock Broker (2009)Stock Broker (2009)


(9)Gestalt Skills


gestalt – compare two persons

• man• divorced• three children• no university education• has alcohol problem• started problematic drinking 10 years ago• several unsuccessful attempts towards abstinence


gestalt – recognising structures

…, that the experienced driver has access to «Super signs»: for him a certain traffic situation is not a conglomerate of

many isolated features that need to be considered separately, but a «Gestalt», just like the face of a friend...

Dörner, D. (2003): Die Logik des Misslingens Strategisches Denken in komplexen Situationen, erweiterte Neuausgabe. Rowohlt, Reinbek bei Hamburg


Aoccdrnig to rscheearch at an Elingsh uinervtisy, it deosn't mttaer in waht oredr the ltteers in a wrod are,

the olny iprmoetnt tihng is taht frist and lsat ltteer are at the rghit pclae.

The rset can be a toatl mses and you can sitll raed it wouthit porbelm.

Tihs is bcuseae we do not raed ervey lteter by itslefbut the wrod as a wlohe

gestalt – reading words


Gestalt – automatic causal interpretation

Thinking in causal chains, is genetically predetermined.Riedl (1978/79)

Riedl, R. (1978/79): Über die Biologie des Ursachendenkens - ein evolutionistischer, systemkritischer Versuch. Mannheimer Forum, Boehringer


Hindsight Bias

When we attempt to understand past events, we implicitly test the hypotheses or rules we use both to interpret and to anticipate the world

around us. If, in hindsight, we systematically underestimate the surprises that the past held and holds for us, we are subjecting those hypotheses

to inordinately weak tests and, presumably, finding little reason to change them. Thus the very outcome knowledge which gives us the

feeling that we understand what the past was all about may prevent us from learning anything about it.

Protecting ourselves against this bias requires some understanding of the psychological processes involved in its creation.(Fischhoff, 1980 )

Fischhoff (1980): For Those Condemned to Study the Past: Reflections on Historical Judgment. New Directions for Methodology of Social and Behavioral Science, 4, 79-93


Usually: no matter what we receive in incoherent und non-interpretable data we interpret them ad hoc in a way, supporting our convictions.

Hindsight Bias


Empirism without theory

Here are my data!I don’t know what they

mean!


In developing models and theories we have to use our skills and logic

(and systematic observation)

Confirmation must be deductive !!!

Conclusion concerning Gestalt


(10)assumptions – reasoning –

evidence


Evidence base: Focus on empirical data ???

faith/ assumption… that science does not only produce knowledge,

but that much is based on beliefs ...… is not wrong , but unavoidable.

(Kritz et al., 1990)

Kritz, J.; Lück, H. E.; Heidbrink, H. (1990): Erkenntnis- und Wissenschaftstheorie. Leske, Opladen

Pope Pope RatzingerRatzinger Galileo Galileo GalileiGalilei

logic / theorywe observe daily,

that the sun moves around earth- to comprehend , that this is incorrect,

we need theoretical thinkingin models


Lactating and alcohol inadequate analogy

Messerschmidt Scharknarr

1. If pregnant women drink this dangerous for the child (FAS)

2. Assumption: Alcohol while lactating must be a problem as well(The child drinks along!)

3. „Mothers drinking alcohol should pump the milk before drinking“ (DHS, 1011)

DHS (1011) Alkohol weniger ist besser. http://www.aktionswoche-alkohol.de/hintergrund-alkohol/schwangerschaft.htmlPaulos, J. A. (1988): Innumeracy: Mathematical Illiteracy and its Consequences. Penguin, London

Inability to check plausibility through calculating = „Innumeracy“

http://www.aktionswoche-alkohol.de/hintergrund-alkohol/schwangerschaft.html


lactating and alcohol

70kg body weight of mother1,5% of body weight as drink

e.g. 1 litre beer (5 Vol.-% alcohol)1 : 50 dilution

beer : blood ~ mother’s milk0,1 Vol.-% alcohol in blood (0,8g/kg)0,1 Vol.-% alcohol in mother’s milk (0,8g/kg)


1 : 50 1 : 50

double dilution1 : 2500

The baby has 0,0016 g/kg around 5%of physiological level of 0,03 g/kg

Uhl et al. (2009): Handbuch: Alkohol - Österreich: Zahlen, Daten, Fakten, Trends 2009. dritte überarbeitete und ergänzte Auflage. BMG, WienPfannhauser (2004): Alkohol: Freund oder Feind? Aspekte der Lebensmittelchemie, Vortrag am ÖGE - Symposium "Alkoholprävention"

am 19. September. Technische Universität Graz, Institut für Lebensmittelchemie und -technologie, Graz


What is 0,8g alcohol / kilogram?

1 x 3 x 6 hours: 7-8 x 3-5 x

6x 6x 6x


Is drinking and lactating dangerous?

William Hogarth. Gin Lane. 1751. Engraving. The British Museum, London, UK.


Other questionable results

• economic costs of addiction• death through substance use (e.g. alcohol) • spontaneous remission of addiction• higher vulnerability of females to alcohol • international statistics: number drug related

deaths, rate of liver cirrhoses• survey data• etc.


(11)modern epistemology


development of man

trust doubt wisdom

Pre-puberty puberty post-puberty


development in epistemology

believe in revelationbelieve in research and technology –

to overcome believes

scepticism realism

Pre-modern age modern age Post-modern age


Post-modern disillusionmentNature … is an exorable and unfriendly judge of a scientists work. It never says "yes" to a theory, in the most favourable cases it says “maybe," and in the great majority of cases simply “no".Albert Einstein in Dukas & Hoffmann, 1979, “Albert Einstein – The Human Side”, Princeton University Press, Princeton, New Jersey)

We discover slowly – and without fully realising the situation – that all arguments about in favour of realistic every day convictions and scientific theories are circular; they assume what they want to prove.Paul K. Feyerabend (1978) ”Scientific Realism and Authority in Research”)

“Nature will tell you a direct lie if she can!”Arthur Bloch (1985) “Murphy's Law Complete”, Methuan, London


(logical) positivism is dead

Karl PopperKarl Popper

Logical positivism is dead: Who is the offender? I am afraid I have to take responsibility for it.

Popper, K. R. (1979): Unended Quest. An Intellectual Autobiography, Fontana, London


Inner model of reality(conscious or intuitive)

We develop conscious and unconscious inner causal models of reality,

helping us to predict intuitively or reasoning which effects our

behaviour will have.

assumptions – hypotheses – faithreasoning – theory – logic

experience – observations – empirical data


hermeneutic process

The hermeneutic process contains a paradox: What is to be understood, must be previously understood somehow.

I get 10% at IKEAHow much is this in Euro ?

Without experience/knowledge we cannot interpret the ultrasonic scan of an embryo.

Nonsense questions make evident, that improving our knowledge requires previous knowledge.


adequate conception of research

puzzle solving divergent approachhermeneutic spiral trial and error

dialectic


The most important result from brain research:„We have a brain and …

… we should use it !“


(12)problem research organisation


The public prefers to listen to scientists who give confident answers to questions and make confident predictions … So …the experts who talk publicly about politically contentious questions tend to speak more clearly than they think.

They make confident predictions about the future, and end up believing their own predictions. Their predictions become dogmas which they do not question. …

That is why heretics who question the dogmas are needed.

Freeman Dyson (2007): Many Colored Glass:, University of Virginia Press, 2007

Klaus Maria Brandauer as Mephisto


Problems of research funding

financing image as expert interest in gaining true knowledge


Problems of research fundingad financing:research results are products that need to be sold.Mostly research is no hobby – researchers must live from it.

ad experts:Experts are commonly individuals giving, providing information so often that they have no time to inform themselves.

ad interest in gaining true knowledge: For most researchers interest in gaining true knowledge is like a precious jewel – they can’t afford it.


(12)Outlook


If we fail to do all things, when we don‘t know the reason for them or if we are unable to justify them, we would probably soon be dead.

Friedrich Hayek (1996): Die verhängnisvolle Anmaßung

Messerschmidt: Ill humoured man


We need a different perspective, more realism and more honesty

• Priority of ethics to so called “evidence base”

• Priority of support to coercion –it is more appreciated and more effective

• Correct information is an obligation – needing no justification

• Almost all programs & materials are useful if used by skilled individuals – but they do not work by themselves



• Sufficient knowledge of social psychology and psychotherapy theory, e.g. reactance, dissonance,(MI), model learning, participation, motivation, etc.

• Importance of pedagogical skills: experience and training (supervision, competent team)

• Conditions to develop emotionally stable and to acquire life skills – make problems less likely



• Realism concerning the so called “failure to prove effectiveness”

• Realism concerning evaluation and quality control (mostly formative evaluation)

• Making use of our gestalt skills


We should not blindly trust all claims!


Not everything we do makes sense !


critical rationalismKarl Popper

Rationality can be explained as openness for criticism - as readiness to allow being criticised and as urge to criticise oneselfKarl Popper Ausgangspunkte

cross-thinking – scepticism – self-critics


Wisdom is perceiving all things to be important but nothing totally serious.Arthur Schnitzler


Thanks for your attention !


For discussionemancipatory-participatory vs. paternalistic-controlling

evidence based myth

ethics and logic vs. empirical data

pseudo evaluation – evalopathy

research organization – financing / experts / knowledge

criticism – cross thinking – heretics

hermeneutic spiral – dialectics – trial/error

Gestalt phenomenon / soft skills – deductive approach

empirical nonsense – hindsight bias

Documents

u 20101031 research and evaluation in addiction 20101031 research and... · Research and Evaluation in the Addiction Field Alfred Uhl SucFoDok Suchtpräventionsforschung und -dokumentation