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WHAT WORKS

Evidence-Based Solutions to Ohio's Substance Abuse Crisis

You can swap out the addiction of choice over the last forty years since OCAAR began, but what will always remain is that human beings are subject to substance abuse disorder and nefarious forces will work to profit from it. But don't get the impression that this is a losing battle. While there is no single solution, a collection of initiatives have proven to work and make a dramatic difference.

 

Here we will provide evidence for the most promising initiatives and the latest news about emerging opportunities in our fight for recovery.

REDUCING STIGMA

You might be surprised to see reducing stigma as a proven and critical part of the fight against addiction, but it definitely is. Stigma plays a significant role in the outcomes of every other effort to promote recovery. Until we all understand that substance abuse disorder is a disease similar to cancer or diabetes, we will continue to unsuccessfully treat it like a moral failing.

 

Substance abuse disorder is widely recognized as a disease due to substantial evidence demonstrating its impact on brain function, behavior, and overall health. 

​Recognizing SUD as a disease fosters a more compassionate and effective approach to treatment, reducing stigma and encouraging individuals to seek necessary care.

Stigma prevents people from seeking help, fuels shame and isolation, leads to discrimination, misrepresents addiction as a moral failing, and reduces public support for policies.

Increased Willingness to Seek Treatment

  • Studies indicate that stigma is one of the primary barriers preventing individuals from seeking help for SUD. When stigma is reduced, individuals are more likely to acknowledge their challenges and pursue treatment. For example, a 2020 review in The Lancet found that public health campaigns to reduce stigma improved treatment uptake for SUD.

 

Improved Retention in Treatment

  • Lower stigma within healthcare settings leads to better patient engagement and retention. Research published in Substance Use & Misuse (2019) showed that patients in nonjudgmental, stigma-free environments were more likely to adhere to treatment plans and complete programs.

 

Enhanced Social Support

  • Reducing stigma improves relationships with family, friends, and community, providing essential emotional and practical support for recovery. A study in Addiction Research & Theory (2021) highlighted that social acceptance significantly increases the chances of sustained recovery.

Better Mental Health Outcomes

  • Stigma is linked to shame, low self-esteem, and depression, which can exacerbate substance use. Reducing stigma alleviates these mental health challenges, creating a foundation for successful recovery. A 2018 study in Psychiatric Services found that addressing internalized stigma improved recovery outcomes for individuals with SUD.

 

Improved Access to Harm Reduction Services

  • Communities that adopt stigma-reduction strategies, such as normalizing harm reduction services (e.g., syringe exchange programs or naloxone distribution), see reduced rates of overdose deaths and disease transmission, according to the Centers for Disease Control and Prevention (CDC).

MEDICALLY ASSISTED TREATMENT

Medication-Assisted Treatment (MAT) is widely recognized as an evidence-based approach to treating substance use disorders, particularly opioid and alcohol addictions. It combines medications with counseling and behavioral therapies to address the whole patient. Below is a summary of evidence and research supporting MAT's effectiveness:

Effectiveness of MAT for Opioid Use Disorder (MOUD)

  1. Reduction in Mortality

    • A meta-analysis published in The Lancet (2017) found that medications such as methadone and buprenorphine reduced mortality rates among individuals with OUD by 50% or more compared to those without treatment.

    • Studies show that people receiving MAT are less likely to die from overdoses than those who do not receive medication.

  2. Improved Retention in Treatment

    • Research in JAMA Psychiatry (2018) demonstrated that individuals receiving buprenorphine or methadone were significantly more likely to stay in treatment compared to those receiving non-medication therapies.

    • Methadone and buprenorphine have been shown to increase retention rates in treatment by stabilizing withdrawal symptoms and reducing cravings.

  3. Reduction in Illicit Drug Use

    • A systematic review in The Cochrane Library (2009) found that MAT significantly reduces heroin use among people with OUD compared to placebo or no medication.

Effectiveness of MAT for Alcohol Use Disorder (AUD)

  1. Medications

    • Naltrexone: Blocks the euphoric effects of alcohol and reduces cravings. A study in JAMA Psychiatry (2018) found that individuals using extended-release naltrexone had significantly fewer heavy drinking days.

    • Acamprosate: Helps maintain abstinence by reducing withdrawal symptoms. Evidence from The Cochrane Library (2014) indicates that acamprosate increases the likelihood of maintaining abstinence after detoxification.

    • Disulfiram: Creates an adverse reaction when alcohol is consumed, discouraging use. While less commonly prescribed, it has shown effectiveness in individuals highly motivated to quit drinking.

  2. Improved Treatment Outcomes

    • Combining medications with counseling and support improves abstinence rates and reduces relapse rates compared to therapy alone.

Broader Benefits of MAT

  1. Reduction in Disease Transmission

    • MAT has been linked to reductions in behaviors that spread infectious diseases, such as needle sharing, thereby reducing the prevalence of HIV and Hepatitis C.

  2. Decreased Criminal Activity

    • Studies in The New England Journal of Medicine (2018) show that individuals on MAT report fewer arrests and engagement in illegal activities compared to those without treatment.

  3. Cost-Effectiveness

    • MAT reduces healthcare costs by decreasing emergency room visits, hospitalizations, and criminal justice expenses. The National Institute on Drug Abuse (NIDA) highlights MAT as cost-effective in the long term.

HARM REDUCTION

Harm reduction is a public health approach aimed at minimizing the negative consequences of substance use without necessarily requiring abstinence. Numerous studies and real-world implementations provide strong evidence that harm reduction strategies are effective. 

Reduction in Overdose Deaths and Naloxone Distribution

  • A meta-analysis of community-based naloxone distribution programs showed a significant reduction in overdose mortality in areas where naloxone was widely available. (Walley et al., BMJ, 2013)

  • Studies estimate that widespread naloxone availability can reduce opioid overdose deaths by 30-40%. (Wheeler et al., CDC, 2015)

 

Supervised Consumption Sites (SCS)

  • In Vancouver, Canada, the Insite program recorded zero overdose deaths at its facility since opening in 2003. (Marshall et al., The Lancet, 2011)

  • A review of SCS worldwide found a 35% reduction in overdose deaths in areas surrounding these facilities. (Potier et al., Drug and Alcohol Dependence, 2014)

 

Reduced Infectious Disease Transmission with Syringe Services Programs (SSPs)

  • SSPs reduce HIV incidence by up to 50% among people who inject drugs (PWID). (MacArthur et al., The Lancet, 2014)

  • A CDC study showed that cities with SSPs experienced an 80% lower HIV transmission rate among PWID compared to cities without such programs. (CDC, 2016)

 

Safe Injection Practices:

  • Access to sterile equipment decreases Hepatitis C infection rates by 50%. (Des Jarlais et al., Addiction, 2009)

 

Improved Connection to Treatment Reduces Overdoses

  • Programs like Overdose Education and Naloxone Distribution (OEND) increase engagement with treatment services after overdose reversals. (Clark et al., Substance Abuse, 2014)

  • Studies show that supervised consumption site users are more likely to access detoxification and addiction treatment services. (Wood et al., Addiction, 2006)

 

Cost-Effectiveness of Syringe Services Programs

  • Every $1 spent on SSPs saves an estimated $6 in healthcare costs by preventing HIV and Hepatitis C infections. (Holtgrave et al., JAIDS, 1998)

 

Naloxone Programs:

  • Community-based naloxone programs are cost-effective, with studies estimating $438 per life-year saved. (Coffin and Sullivan, Annals of Internal Medicine, 2013)

 

Reduction in Public Drug Use through Supervised Consumption Sites

  • SCS reduce public drug use and improper syringe disposal, leading to cleaner streets and safer communities. (Wood et al., Canadian Medical Association Journal, 2004)

 

Decreased Criminal Justice Involvement with Syringe Services Programs

  • Participants are less likely to be arrested for drug-related offenses, fostering trust between law enforcement and communities. (Beletsky et al., American Journal of Public Health, 2013)

  • Portugal's harm reduction and decriminalization policies led to a 60% reduction in drug-related deaths and a significant decrease in drug-related crime since 2001. (Hughes and Stevens, The British Journal of Criminology, 2010)

 

Harm Reduction Interventions Improves Quality of Life

  • Participants in harm reduction programs report improved physical health, reduced stigma, and greater social stability. (Pauly et al., Harm Reduction Journal, 2013)​

RECOVERY SUPPORT COMMUNITIES

Recovery Support Communities (RCOs) are peer-based organizations providing social support, encouragement, and accountability, complementing formal treatment approaches.

Recovery Support Communities play a vital role in addiction recovery by fostering connection, accountability, and long-term sobriety. Their accessibility, cost-effectiveness, and demonstrated benefits make them an invaluable component of a comprehensive recovery strategy.

Social Support and Relapse Prevention

  • RCOs provide non-clinical recovery support through peer coaching, advocacy, and skill-building workshops.

  • Research from Journal of Substance Abuse Treatment (2015) indicates that individuals engaged with RCOs experience improved housing stability, employment rates, and overall quality of life.

  • Recovery communities foster a sense of belonging and reduce isolation, which is critical in preventing relapse.

  • A study in Addiction Research & Theory (2011) showed that individuals with strong social support networks, such as those provided by recovery groups, are significantly less likely to relapse.

  • Participation in RCOs helps individuals build coping strategies for triggers and stressors, further reducing the risk of relapse.

Psychological and Emotional Benefits

  • Recovery communities often lead to improved mental health outcomes, such as reduced symptoms of depression and anxiety, as shown in research from Substance Abuse and Rehabilitation (2015).

  • Provides a framework that instills hope and meaning, which are protective factors against addiction recurrence.

Accessibility and Cost-Effectiveness

  • Recovery Support Communities are widely accessible and often free, making them a cost-effective supplement to formal treatment.

  • Their flexibility allows individuals to engage with the community at varying levels of intensity based on need and availability.

Increased Treatment Retention

  • A study in Drug and Alcohol Dependence (2016) found that individuals who participate in mutual aid groups are more likely to adhere to formal treatment plans, enhancing overall success rates.

  • Ongoing engagement with recovery groups helps sustain the gains made during residential or outpatient treatment.

Ideal Environment for Peer Support

  • Certified Peer Supporters will find RCOs provide a work environment where their skills are valued and respected, improving outcomes for those they serve.

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