Abstinence‐contingent recovery housing and reinforcement‐based treatment following opioid detoxification

Abstract

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 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 Outpatient 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. Findings Overall rates of drug abstinence were 50% for RH+RBT, 37% for RH, and 13% for UC (p < .001). At 6 months, RH+RBT participants remained more likely to meet abstinence criteria than UC participants (37% vs. 20%, p = .016). Length of stay in recovery housing mediated abstinence outcomes and was longer in RH+RBT (49.5 days) than in RH (32.2 days; p < .002). Conclusions Abstinence-contingent recovery housing improves abstinence in opioid-dependent adults following medication-assisted detoxification. The addition of intensive ‘reinforcement-based treatment’ behavioural counseling further improves treatment outcomes in part by promoting longer recovery house stays.

Recovery Housing: Assessing the Evidence

“…No meta-analyses or research reviews on recovery housing were found. We identified five articles describing RCTs that compared some version of recovery housing to some control condition (4,(11)(12)(13)(14) and one quasi-experimental study with a within-group, repeatedmeasures design (15). However, four of the five articles describing RCTs reported on the same base study; therefore, only three distinct studies on this topic met the inclusion criteria.…”

“…Two studies indicated that outcomes were better with longer stays in the recovery house (12,14). In addition, several studies indicated that success in the recovery house may also depend on other client characteristics, such as involvement in a 12-step program, age, or a diagnosis of posttraumatic stress disorder (11)(12)(13).…”

Management of opioid use disorders: a national clinical practice guideline

“…Moderate-quality evidence indicates that this approach, when administered without linkage to long-term addiction treatment and care, is associated with elevated risk of relapse, HIV and hepatitis C transmission, and death from drug overdose. [66][67][68] Patients should be clearly informed of the known risks of withdrawal management alone and engaged in discussion about other treatment options corresponding to their individual needs and circumstances.…”

Implementing Reinforcement-Based Treatment (RBT) for Substance Use Disorders within child protective service systems in Europe

“…[38][39][40] These studies have demonstrated superior abstinence rates for clients receiving RBT for as long as six months following treatment. As noted, there also is preliminary evidence for the effectiveness of a home-based version of RBT delivered within MST-CAN.…”