Abstinence-contingent recovery housing and reinforcement-based treatment following opioid detoxification
Version of Record online: 28 FEB 2012
© 2011 The Authors, Addiction © 2011 Society for the Study of Addiction
Volume 107, Issue 5, pages 973–982, May 2012
How to Cite
Tuten, M., DeFulio, A., Jones, H. E. and Stitzer, M. (2012), Abstinence-contingent recovery housing and reinforcement-based treatment following opioid detoxification. Addiction, 107: 973–982. doi: 10.1111/j.1360-0443.2011.03750.x
- Issue online: 4 APR 2012
- Version of Record online: 28 FEB 2012
- Accepted manuscript online: 7 DEC 2011 08:53AM EST
- Submitted 28 March 2011; initial review completed 27 May 2011; final version accepted 28 November 2011
- day treatment;
- reinforcement-based treatment;
- recovery housing
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.
Findings Overall rates of drug abstinence were 50% for RH + RBT, 37% for RH and 13% for UC (P < 0.001). At 6 months, RH + RBT participants remained more likely to meet abstinence criteria than UC participants (37% versus 20%, P = 0.016). 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 < 0.002).
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.