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

  1. Michelle Tuten1,*,
  2. Anthony DeFulio1,
  3. Hendrée E. Jones1,2,
  4. Maxine Stitzer3

Article first published online: 28 FEB 2012

DOI: 10.1111/j.1360-0443.2011.03750.x

Issue

Addiction

Addiction

Volume 107, Issue 5, pages 973–982, May 2012

Additional Information

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

Author Information

  1. 1

    Johns Hopkins University School of Medicine, Psychiatry and Behavioral Sciences, Baltimore, MD, USA,

  2. 2

    Research Triangle Institute (RTI) International, Research Triangle Park, NC, USA

  3. 3

    John Hopkins University School of Medicine, Behavioral Pharmacology Research Unit, Baltimore, MD, USA

*Michelle Tuten, Department of Psychiatry and Behavioral Sciences, Johns Hopkins Bayview Medical Center, Mason F. Lord Building, East Tower, Room 569A, Baltimore, MD 21224, USA. E-mail: mtuten@jhmi.edu

Publication History

  1. Issue published online: 4 APR 2012
  2. Article first published online: 28 FEB 2012
  3. Accepted manuscript online: 7 DEC 2011 08:53AM EST
  4. Submitted 28 March 2011; initial review completed 27 May 2011; final version accepted 28 November 2011

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Keywords:

  • Abstinence;
  • day treatment;
  • detoxification;
  • opioid;
  • reinforcement-based treatment;
  • recovery housing

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 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.

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