People seeking treatment for drug or alcohol use in North Carolina may struggle making an educated decision and receiving evidence-based care. Jennifer Carroll, associate professor of sociology and anthropology, believes people should choose what is best for them but admits this landscape is confusing. She is working to bring clarity.
Carroll says some treatment centers in the state offer care that is evidence-based while others operate more on anecdotal claims. “Our obligation as a society is to make sure that effective, evidence-based [treatment] options are readily available, and I don’t think we’ve fully succeeded at doing that,” she says.
To get a better understanding of the services offered in North Carolina, Carroll worked with two NC State graduate students and other researchers to devise a secret-shopper-type study. The students called all the residential treatment centers in the state, posing as someone with an opioid use disorder who was seeking treatment. Working from a script, they asked questions to collect data on the treatment approaches. Originally, the researchers were most interested in how many treatment centers offer methadone, but they were surprised by how many facilities require unpaid work as part of their treatment.
Some centers require as many as 40 to 60 hours of unpaid work each week in an agency-owned enterprise, such as a thrift store, moving company or lawn care business. These centers illustrate what Carroll calls “work therapy” — the notion that work is inherently therapeutic — and the profit from the labor goes to the centers and not the workers. But Carroll says there’s no scientific evidence showing that unpaid work improves treatment outcome.
The study also reveals that centers focused on work therapy are less likely to offer methadone, a treatment Carroll says reduces all-cause mortality by 50% for people with opioid use disorder. She hopes more state funding will make its way to evidence-based treatment. The first step of that is understanding the current landscape. Then, she says, “We need to start building this treatment infrastructure purposefully, deliberately.”
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