Oregon Evidence-Based Rehab Programs Yield Flawed Success

SALEM, Ore. — Six years after a state mandate required publicly funded drug treatment programs to use evidence-based therapies, nearly 54 percent of Oregon’s budget for drug treatment services goes to programs that use proven techniques, according to a recent state report.

In 2003, Oregon legislators ordered state-funded addiction rehabilitation programs to start using techniques and therapies that were proved effective in studies in order to improve services for addicts. Now, such programs receive more than half of the state’s $94 million budget for rehabilitation services, up from 25 percent to 30 percent before the law’s passage, according to reports.

While most programs had some evidence-based practices before the mandate, public health officials have seen a surge in interest and awareness in them in the state’s more than 400 treatment programs.

Evidence-based therapies range from prescription medications — including naltrexone for alcohol dependence and buprenorphine for addiction to narcotics — to aggressive one-on-one counseling with patients to define reasons for addiction and set personal treatment goals.

Studies show that when clients participate in this method of counseling, known as the motivational interview, they stay in treatment longer than in many traditional programs which rely on lectures from a counselor, according to reports.

Other effective techniques include psychotherapy, which teaches addicts to expect and tolerate low moods, and cognitive behavior therapy, where clients learn to question behavioral cues that reinforce their habits and turn to creative interests and other non-drug activities instead of drugs or alcohol.

However, treatment programs still face challenges, including lack of funds to support research and no guidelines to standardize the treatment system.

Few treatment programs have evidence to show their effectiveness, as private clinics tend to not allow outside researchers to verify published success rates, and public programs direct state funds toward patient care rather than studies.

The field of addiction rehabilitation suffers from a lack of guidelines, officials say. Each program has a unique philosophy — as do individual counselors — resulting in a non-standardized system that does not track graduates from programs or publish the success rates of participants.

With more than 400 programs receiving state funds, treatment experts advise the creation of an integrated system that tracks patients at they graduate from rehabilitation programs to receiving outpatient services and defines clear expectations of treatment programs.

Most programs do not have a medical doctor on staff, limiting the use of evidence-based practices such as prescription medications, while others do not have the funding to receive long-term training from behavioral health experts.

Health officials have also noticed a rift between long-time treatment providers and those advocating the use of scientific practices in state treatment programs. To bridge the gap between what drug counselors are practicing and what studies show is effective, health experts are encouraging the combination of evidence-based practice and practice-based evidence — a method that allows programs and counselors to document results based on their own work.

Other states, such as Delaware, have started offering incentives to programs that meet certain benchmarks. Starting in 2001, Delaware’s Division of Substance Abuse and Mental Health offered clinics up to a 5 percent bonus if they retained a high percentage of clients each week and measured client success using urinalysis and everyday behavior in school, work and home.

The state’s rehabilitation programs were operating at 95 percent capacity by 2006, a 45 percent increase from 2001, according to a report published in the journal Health Policy last summer. A majority of patients (70 percent) were attending regular treatment sessions, an increase of 17 percent from 2001.