When the cure is not worth the cost

　　Thanks to research by the National Institutes of Health and academic scientists during the last three decades, we now have proven treatments for depression, addiction and other mental disorders. But all too often clinicians do not use them.
　　Without financial incentives to provide treatments that are known to work, many mental health professionals stick with what they know, or pick up on the latest fad, or even introduce their own untested innovations-which in turn are spread by testimonials and credulous news media coverage.
　　Take the well-known approach featured on the cable TV reality show Intervention aimed at getting addicts and alcoholics into treatment. Here, the family and sometimes the employer gather with a counselor, confront the addict and threaten to shun him or fire him if he doesn't enter a rehabilitation center. A 1999 study compared this style of intervention -which can backfire and lead to broken families-to a less confrontational approach known as community reinforcement and family training, which is aimed at helping the family nurture the addict's own motivation. 
　　More than twice as many families succeeded in getting their loved ones into treatment (64 percent) with the gentler approach than with standard intervention (30 percent). But no reality shows push the less dramatic method, and it is difficult to find clinicians who use it.
　　Similarly, one of the most common approaches to alcoholism treatment involves having counselors and fellow alcoholics confront patients and force them to identify themselves as alcoholics. But research finds that the more a counselor confronts, the more a patient drinks and the more likely he is to drop out of treatment. And no association between accepting the label alcoholic and quitting drinking has been found. Counselor empathy-not confrontation-is connected with recovery.
　　According to a review by the Institute of Medicine in 2006, only 10.5 percent of alcoholics received care consistent with scientific knowledge of the disorder; similarly, 43 percent of children in psychiatric hospitals are given antipsychotic medication despite not suffering from psychosis. Tough boot camps for troubled teenagers-which have been proven to be ineffective and potentially harmful-thrive, while multisystemic family therapy, which effectively treats teenagers at home, is available only through the juvenile justice system.
　　If we want to provide genuine help for the 33 million Americans with mental health and drug problems, giving more no-strings-attached money to providers via insurance mandates is not the answer. It is dangerous to blindly bolster useless and even harmful treatments while failing to support proven therapies. Coverage must be tied to outcomes and evidence. And payment should be dependent, at least in part, on health improvements, not just services received. We need parity in evidence-based treatment, not just in coverage.

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　　治疗与花费之间的不等

　　多亏了国家健康研究所和学院科学家们在过去三十年中的研究，现在我们拥有可以治疗抑郁症、上瘾症以及一些其他精神失常症状的方法。但很多时候临床医师却不使用这些方法。
　　没有金钱动力让他们提供有明确疗效的治疗方法，很多精神健康从业人员坚持使用他们所知道的方法，或采用最新潮流中提供的方法，甚至使用未经检验过的自创发明，而这些发明却通过证明信和媒体夸张的报道流传开来。
　　以有线电视真实现场秀intervention（干预）中提供的著名方法来说，这个方法是为了让瘾君子和酗酒者接受治疗。节目中，家人有时是公司雇主和咨询师一起面对上瘾者，威胁说如果他不参加康复治疗中心就赶走或开除他。一项1999年的调查把这种干预方法和比较温和的名为社区强化和家庭训练的方法进行比较，后者是为了帮助家庭来培养上瘾者自己戒掉不良嗜好的动力， 而前者可能会后院起火从而导致家庭破裂。
　　64%的家庭采用温和方法成功使得他们所爱的家人接受治疗，这是采用常规干预方法成功的家庭（30%）的两倍多。但没有任何真实秀节目推广这种温和的方法，也很难找到临床医师使用这种方法。
　　同样的，治疗酗酒最为普遍的一种方法就是让咨询师和其他酗酒者与病人面对面，强迫这些病人承认自己是酗酒者。但研究表明越是和咨询师接触，病人反而饮酒量越多，而且退出治疗的可能性越大。而且并未发现接受酗酒者的标签与戒酒有任何联系。咨询师的同情，而非与其接触，和恢复正常有关联。
　　根据一份2006年医药研究会的评论，只有10.5%的酗酒者得到结合精神失调相关的科学知识的照顾和治疗。同样，精神病院中43%的儿童获得不受精神病困扰的治疗方法。严厉的青少年劳教营，已证明其对帮助问题青少年没有疗效甚至有潜在危险，却时兴起来；相反，有效的在家中治疗青少年的多系统家庭治疗法 却只能在青少年犯罪体系中使用。
　　如果我们想为三千三百万有精神困扰和毒品困扰的美国人提供真正帮助的话，通过保险授权给予更多的金钱并非是答案。盲目的改善无用甚至有害的治疗方法却无法推广有效的治疗方法是很危险的。报道应与结果和证据紧密联系。报酬至少有一部分应当依据治疗效果而不仅是接受的服务来付出。我们需要与所付报酬等价的治疗，这种治疗是建立在医学证据之上而非媒体的报道。