A Geographic Perspective on Opioid Misuse: Substance Abuse Treatment Deserts in Southwestern Ohio

Background: The opioid crisis is one of the most pressing public health issues facing Ohio, with an impact uneven-ly distributed across the state. This work examined geographical barriers to substance abuse treatment in southwestern Ohio through examining geographical areas with limited access to substance abuse treatment services and identifying substance abuse treatment deserts. Methods: The study domain included the 13 counties in the Ohio Mental Health and Addiction Service's Cincinnati region. Publicly available substance use disorders treatment data were collected from government agency resources, pharmaceutical websites, and web searches. Substance abuse treatment deserts were defined as areas in the 13-county study area that were not within a 15-minute drive from a treatment center. Results: We found large portions of the study region that were considered a substance abuse treatment desert for methadone and naltrexone/buprenorphine clinics, behavioral health treatment centers, and both medicated assisted treatment (MAT) and behavioral health treatment combined. Out of the 2 017 337 total persons living in the 13-county study area, 17% (n = 342 872) live in a desert for all MAT and behavioral treatment. Similarly, 19.7% (n = 396 581) live in a desert for naltrexone/buprenorphine treatment, 60.9% (n = 1 227 560) live in a desert for methadone treatment, and 19.7% (n = 396 581) live in a desert for behavioral health treatment. Conclusion: We successfully defined substance abuse treatment deserts in southwestern Ohio, which will be useful for future research to determine its association with opioid-related health outcomes. This resource is publicly available online (https://doi.org/10.5281/zenodo.4011051).

Barriers to Building More Effective Treatments: Negative Interactions Among Smoking-Intervention Components

Meaningfully improved mental and behavioral health treatment is an unrealized dream. Across three factorial experiments, inferential tests in prior studies showed a pattern of negative interactions, suggesting that better clinical outcomes may be obtained when participants receive fewer rather than more intervention components. Furthermore, relatively few significant main effects were found in these experiments. Modeling suggested that negative interactions among components may account for these patterns. In this article, we evaluate factors that may contribute to such declining benefit: increased attentional or effort burden; components that produce their effects via the same capacity-limited mechanisms, making their effects subadditive; and a tipping-point phenomenon in which people near a hypothesized tipping point for change will benefit markedly from weak intervention and people far from the tipping point will benefit little from even strong intervention. New research should explore factors that cause negative interactions among components and constrain the development of more effective treatments.

Natural Recovery and Supportive Community Networks

The natural recovery process of “maturing out” appears to be an active process of renewal and growth, leading to transformative growth that involves the individual’s body, mind, and spiritual dimensions. If spontaneous or “maturing out” recovery accounts for about 4 to18% of the alcohol and other drug (AOD) challenges to the field of behavioral health treatment, how does one effectively partner with the other 82% who have alcohol and other drug issues? To answer this concern, we must ask a few more questions. (1) What developmental factors influence growth? (2) What social determinants of health enhance recovery? (3) What is a supportive community network? and (4) What constitutes evidence-based practice? When one only looks at the biological reasons for behavioral health challenges, the assumption is that getting well and overcoming deficiencies is a function of the individual rather than the system of care. This kind of narrow perspective has contributed to a behavioral health delivery system that continually struggles to provide an integrated, comprehensive care model. This restrictive thought process undermines individuals’ confidence to change and is unduly dismissive of community leaders’ efforts.

Initial Clinical Outcomes from NOCD Digital Behavioral Health Treatment of Obsessive-Compulsive Disorder Using Exposure and Response Prevention

Effective first-line treatments for obsessive-compulsive disorder (OCD) include exposure and response prevention (ERP) therapy. Despite extensive evidence of its efficacy in clinical studies and real-world samples, ERP is still underutilized as a treatment, likely due to access to care barriers such as the availability of adequately trained ERP therapists, geographical location, time, and cost. NOCD has created a digital behavioral health treatment for OCD using ERP delivered via teletherapy and between-session support. We examined preliminary treatment outcomes in a large naturalistic sample of 2069 adults, children, and adolescents with a primary OCD diagnosis. Treatment consisted of twice-weekly live teletherapy ERP for three weeks, followed by six weeks of once-weekly brief teletherapy check-ins. Assessments were conducted at baseline, after completion of three weeks of twice-weekly sessions, and at the end of the six weeks of brief check-ins. Treatment resulted in significant improvements, with a 45% mean reduction in OCD symptoms and a 71% response rate (≥35% reduction in OCD symptoms).Treatment also resulted in a significant, 43% reduction in depression, a 49% reduction in anxiety, and a 35% reduction in stress symptoms. Quality of life improved by a mean of 35%. The mean duration of treatment was approximately 11 weeks, and the total therapist time was approximately 11 hours, which is less than half the total time compared with standard once-weekly outpatient treatment. In sum, in this preliminary sample, NOCD’s treatment model for OCD, delivered in a readily-accessible format for patients, has demonstrated to be effective and efficient.