Five takeaways from Oregonian addiction series

Tuesday, January 20, 2015

In case you missed it, this letter to the editor, written by Central City Concern's executive director, Ed Blackburn, was published on OregonLive/The Oregonian on January 12, 2015. 

• • • 

1. We applaud The Oregonian's recent coverage of addictions in our community. Untreated addictions cause devastating trauma not only to individuals and their families, but to our community as a whole. As reporter Les Zaitz detailed, addictions are a significant economic burden to our state - an estimated $6 billion a year in lost work hours, treatment and public safety costs. The Affordable Care Act has increased potential access to care and it is time to provide more effective addiction treatment systems in Oregon.

2. It is also time to address public perceptions of seemingly low success rates for addiction treatment. The National Institute of Drug Addiction categorizes addiction as a chronic illness (similar to diabetes, hypertension and asthma) where relapse is common. As a chronic disease, treatment completion rates of 40-60 percent are widely acceptable among providers. Treatment can be challenging and success often takes multiple strategies along with a big dose of compassion and patience. Dr. A. Thomas McLellan conducted a literature review of chronic illnesses, including addictions, in 2009. In a JAMA article on the study, he stated:  "Medical adherence and relapse rates are similar across these illnesses. Drug dependence generally has been treated as if it were an acute illness... Drug dependence should be insured, treated and evaluated like other chronic illnesses."

3. Central City Concern's clients come to us with high rates of homelessness, severe addictions often complicated by mental illness and high unemployment. Yet even for this challenging population, treatment completion rates are improved when housing and supported employment services are included. Last year, we saw a 68 percent treatment completion rate in a group of 533 people who lived in Central City Concern housing with support of mentors while they received treatment. On average, of those who complete treatment and successfully transition to permanent housing in the community, more than 85 percent are still clean and sober and in housing 12 months later.  More affordable housing and supportive services can improve addiction treatment completion rates.

4. Central City Concern recognizes the state's reluctance to compare treatment programs. Programs often serve a wide range of clientele, treat different kinds of drug addictions with different costs of treatment, ie: outpatient vs inpatient. How do you compare a program that works with people just stabilizing after a long period of homelessness with a program serving healthy adults who have the full support of their families? Or populations where significant cultural barriers contribute to communication break-downs and delayed or poor service delivery? Better segmented data would likely prove more valuable.

5. Training of medical providers is critical to both identifying addictions and making appropriate referrals to programs where each individual has the best chance of success. Health Share of Oregon and the NW Addictions Transfer Technology Center at OHSU have embarked upon a year-long program to deliver focused trainings on these matters and our chief medical officer, Rachel Solotaroff, has been a leader in this effort. In addition to outreach visits to clinical and medical learning facilities in the coming year, this partnership will also convene a full-day March 6th conference "Addictions for Continuing Medical Education." We urge primary care providers, behavioral health specialists, addiction counselors and other health care workers to consider attending this important conference. Contact Health Share of Oregon for more information.

Ed Blackburn is executive director of Central City Concern.