Continuing our series on Measure 110, On January 4 we heard from Dr. Camille Cioffi. Dr. Cioffi is a Research Assistant Professor at the Prevention Science Institute at UO. Her research focuses on improving health, mental health, and substance use outcomes among people with substance use disorders who are pregnant and parenting with a particular focus on highly stigmatized populations including people experiencing homelessness and people who inject drugs. Dr. Cioffi presented an overview of what research data show about the methods of dealing with substance abuse and treatment for substance abuse disorders.
She said there is clear evidence of what does works and results in three of the four adults experiencing substance abuse disorders report being in recovery, a condition that affects about 1 in every 10 adults.
The “gold standard,” she said, is medication treatment. As an example, she said, methadone treatment makes it more likely that individuals will stay in some other treatment regimen. She said that even without other treatment, medication treatment is effective. Contingency management –offering incentives to stop using drugs, is also effective, particularly when used in conjunction with medication. Even where there is no approved medication treatment, she said it can prove effective.
Cognitive behavioral therapy (CBT), a common type of talk therapy (psychotherapy) involving work with a mental health counselor (psychotherapist or therapist) in a structured way, attending a limited number of sessions, can be effective for cannabis and alcohol related disorders, but is less effective for so-called hard drugs unless paired with medication management.
Finally, motivational interviewing is effective as a way to motivate other treatment modalities, but less effective as a standalone treatment.
She said that research indicated that any of these treatment approaches needs to be sustained over a significant period. She said that anything less than 30 days did not appear to be particularly effective, especially since there are generally other issues to be addressed in an individual who is under treatment for a substance abuse disorder.
Other methods of treatment, she said, are not supported by clear evidence of success. Simply telling people drugs are bad doesn’t seem to work, nor do short residential stays, particularly when not coupled with some other therapeutic approach. Involuntary treatment also cannot be documented as being effective. While she said there can be short term benefits from involuntary treatment, the research shows no consistent result. In some studies, it seems to have some benefit, in others there are negative effects. The most recent study, she said, out of Massachusetts, appeared to show worse outcomes from involuntary treatment.
Peer support services, like 12 step programs seem to be effective because increased social support can increase confidence and self-esteem. On challenge is that often the ancillary support services are not available unless prescribed by a mental health professional and for many drug users there is no access to insurance so no way these services can be paid for.
She said that there is no evidence that harm reduction services (access to safe needles, safe syringe programs, etc.) are effective, although they can be a way to reach out to users and persuade them to voluntarily enter some form of treatment.
The critical issue with any of these therapies, she said, is that there be some form of coordinated care. Simple referrals alone don’t work. There are too many steps to get people engaged in services without external support. It is important that there be professional help to assess the variety of problems the user faces and find ways to address each of the problems, not just drug use. One positive benefit of Measure 110, she said, is that it has sparked an increase in opportunities for coordination of care.
During the question and answer period Dr. Cioffi was asked directly about the impact of Measure 110 on substance abuse disorders. She said that under Measure 110, more of the evince based treatments, like peer support and crime reduction services were now receiving funding rather than relying solely on private grants. While the measure was designed to increase capacity for treatment, she said, there is still a need for funding more efforts to reach out to users. She also said that very little of the Measure 110 funding was going toward prevention.
Dr. Cioffi described a situation where the drug user finds themselves in an inescapable loop. Users turn to crime as a financial issue since they can’t find employment. But one of the reasons they can’t is they have no access to personal care resources, cannot get housing because of their drug use and can’t get help even if they want because they have no support network to help them find services. Frankly, she said, most drug users don’t even know the Measure 110 exists and don’t know how to access any of the available services.
- Cioffi was critical of the suggestions for 48 to 72 hour “holds” to help reduce use by providing a “window of change.” Many users, she said, often go at least 72 hours between uses and, in addition, find jail a more comfortable place than being on the street, particularly in winter. She was also critical of “forcible detox” saying it more likely that someone would use after release from a situation where they were forcibly detoxed.
To view Dr. Cioffi’s presentation, please click this link: City Club Presentation.
To view the entire program on You Tube, click this link: Measure 110 continued.