Recovery Housing and Drug Abuse Treatment Outcome
Condition: Mental and Behavioral Disorders Due to Use of Cocaine: Harmful Use; Opiate Addiction
MeSH terms: Substance-Related Disorders; Opioid-Related Disorders; Behavior, Addictive
Study type: Interventional

Summary: 
      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.
    

Detailed description: 
      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.
    

Intervention name(s): Recovery Housing plus Counseling; Usual Care Referral; Recovery Housing Only
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): 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.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: addiction; substance abuse treatment; aftercare; outpatient counseling; opiates; cocaine