Recovery Housing and Drug Abuse Treatment Outcome

Reinforcement-Based Therapy (RBT) is an intensive outpatient substance abuse treatment that includes relapse prevention skills training, goal setting, help with finding employment and abstinence-contingent rent payment for recovery housing in the community. It is meant to provide motivation for continued abstinence while enhancing social stability. In this study, treatment was offered to inner city opiate and cocaine users immediately following a brief medically-supported residential detoxification. Previous research had shown that RBT produces 3- month outcomes superior to those for patients who are referred to outpatient treatment in the community. The present study compared outcomes for patients (N = 243) randomly assigned to receive abstinence-contingent recovery housing with (full RBT) or without additional intensive counseling or to receive usual care referral to outpatient treatment following detoxification. Outcomes were similar at 3- and 6-month follow-ups for those who received recovery housing with (full RBT) and without additional counseling and both these treatments were superior to usual care referral. Study findings support the efficacy of post-detoxification recovery housing with or without counseling for opiate and cocaine users.

Aims To conduct a randomized, controlled trial of abstinence-contingent recovery housing delivered with or without intensive day treatment among individuals exiting residential opioid detoxification. Design Random assignment to one of three conditions: recovery housing alone (RH), abstinence-contingent recovery housing with reinforcement-based treatment RBT (RH + RBT) or usual care (UC). RH and RH + RBT participants received 12 weeks of paid recovery housing contingent upon drug abstinence. RH + RBT participants also received 26 weeks of RBT, initiated concurrently with recovery housing. Assessments were conducted at 1, 3 and 6 months after treatment enrollment. Setting Out-patient drug-free substance abuse treatment program in Baltimore, Maryland. Participants Patients (n = 243) who completed medication-assisted opioid detoxification. Measurements Primary outcome was drug abstinence (opioid- and cocaine-negative urine and no self-reported opioid or cocaine use in the previous 30 days). Secondary outcomes included abstinence at all time-points (1, 3 and 6 months), days in recovery housing and employment.

Intensive counseling in a 5-day per week program plus abstinence-contingent rent payment in a community recovery house. Intervention lasts 12 weeks with follow-up at 12 and 24 weeks post treatment entry.

Abstinence-contingent payment for recovery housing rent in absence of any formal counseling. Intervention lasts 12 weeks with follow-up at 12 and 24 weeks post treatment entry.

Participants receive referral resources for community substance abuse counseling and recovery housing but no formal treatment or help with rent payments. All participate in follow-up data collection.

Participants receive 3 months of abstinence-contingent program-supported rent payment in community recovery housing. They also receive intensive outpatient counseling (both individual and group) focused on relapse prevention skills training, goal setting, employment seeking and recreational activities.

Participants are referred to an outpatient program of their choosing with an appointment made for them.

Participant may receive up to 3 months of abstinence-contingent rent payment in community recovery housing but is not invited to participate in intensive counseling.

Free in the community plus self report of no drug use in past 30 days verified with negative urine screen.

Inclusion Criteria: completes residential detoxification for use of opiates and/or cocaine willing to go to outpatient aftercare agrees to random assignment; signs informed consent Exclusion Criteria: moving out of town primary substance use does not include opiates or cocaine

Tuten M, DeFulio A, Jones HE, Stitzer M. Abstinence-contingent recovery housing and reinforcement-based treatment following opioid detoxification. Addiction. 2012 May;107(5):973-82. doi: 10.1111/j.1360-0443.2011.03750.x. Epub 2012 Feb 28.