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.