Saturday, January 31, 2009

The American addiction treatment landscape

Nothing too exciting in the treatment facility survey. A few interesting contrasts between methadone providers and other providers:
  • Half (50 percent) of OTPs (opioid treatment programs) were operated by private for-profit organizations, compared to 29 percent of all substance abuse treatment facilities.
  • Facilities with OTPs providing substance abuse treatment services were most likely to offer outpatient treatment (94 percent), but least likely to offer residential (non-hospital) or hospital inpatient treatment (7 percent each).
Another interesting data point:
  • Over half (55 percent) of all OTPs provided both maintenance and detoxification. Thirty-seven percent provided maintenance only, and 8 percent provided detoxification only.
I don't know of any local programs offering detox. They're all maintenance. I wonder if they reported that they offer detox. There are either significant differences in OTPs in southeastern Michigan and the rest of the country, or there are differences between what they report offering and what they actually offer.

It also reported that 8% of facilities offer OTP, which is pretty stable. However, 23% of all clients received methadone (Am I reading that correctly?), up a little more than 2% over the last few years.

Comments on methadone posts here often complain that there is too little methadone treatment available, but what percentage of treatment seekers are opioid addicts and what percentage of those prefer methadone? Do they comprise more than 23% of all treatment seekers?

Another frequent complaint is that 95% of all treatment programs ram the 12 steps down clients throats. Here's a table that reports the clinical practices used by surveyed programs. 12-step approach was less popular than CBT and relapse prevention.

3 comments:

Anonymous said...

So you believe the opioid treatment providers lying about providing more detox than they do, but you don't think the people who say they offer something other than 12 steps are lying about doing that?

I would guess the truth is that many OTP's offer detox (and many discourage it strongly-- so it doesn't appear to the patients that they "really" offer it) and many providers offer CBT and MI but simultaneously push 12 step treatment so intensely as well that the patients feel the steps are being rammed down their throat.

Bottom line: we need service user survey data conducted in a neutral setting to get any real clue because everyone has anecdotes about 12-steps-only and detox discouragement and asking providers about these frowned-on practices is like having a judge ask an addict whether they want to get clean: you aren't going to get an honest response!

Jason Schwartz said...

Read the post again.

I said that the national data doesn't match my experience, and offered two possible explanations--one of which was that there are discrepancies between programs in SE Michigan and the rest of the country.

Anonymous said...

My guess is that the definition that a methadone provider uses for "providing detox" is different than the definition that an abstinence based program might use. If you are at a methadone clinic,in S.E. Michigan, and you stop paying they will provide you with detox all right, 5mg a day till you are done.If you are on a maintenance dose and you ask to be detoxed they might give you some resistance but they will do it.