Drug-free housing more effective than detox programs

Recent research at Hopkins School of Medicine suggests that providing drug-free housing to opioid users upon their completion of a detoxification program can significantly improve their chances of remaining abstinent after six months.
For opioid dependent individuals seeking to become abstinent, enrolling in a detoxification program is often the first step taken. Here at the Hopkins Bayview Medical Center, an organized outpatient detox program provides detoxification from opiates and alcohol under medical supervision. This program also provides educational resources and information about referrals to follow-up programs.
However, surveys have shown that 65 to 80 percent of individuals who successfully complete a detoxification program relapse by one month. Participants who return to their homes after completing a program may be influenced by social and environmental cues, which can trigger relapse.
In Baltimore City, efforts to reduce the risk of relapse include the formation of recovery houses, available to recovering patients, as long as they pay rent, follow house rules and remain drug-free.
Michelle Tuten and her colleagues at Hopkins School of Medicine Department of Psychiatry and Behavioral Sciences sought to determine whether recovery housing contingent on the individual remaining drug-free is effective in sustaining abstinence in patients after they completed a detoxification program. In addition, they tested whether a day treatment program coupled with recovery housing could improve outcomes further.
Their report, recently published in the journal Addiction, shows strong evidence that providing individuals drug-free recovering housing and counseling for six months following detox increased their chances of remaining abstinent.
The researchers developed a randomized trial, in which they followed opioid-dependent individuals who had successfully completed a medication-assisted detoxification program at Hopkins Bayview Medical Campus. They assigned assigned 243 participants to one of three experimental groups and performed follow-up assessments for six months.
One group was given information about local resources and referrals to receive after-care substance treatment, which emulates the care that is currently given to those who complete a detoxification program. Another group was assigned to recovery housing following treatment completion, and were able to remain there for six months, given that they remained abstinent from drug use. The third group was also assigned to recovery housing, but also received reinforcement-based intensive out-patient treatment, which involves individual therapy sessions as well as regularly scheduled treatment activities.
The patients underwent follow-up assessments after one, three, and six months following their induction into one of the experimental conditions. Researchers found that 25.9% of patients who received access to both abstinence contingent recovery housing as well as reinforcement-based intensive out-patient treatment remained abstinent consistently throughout the six month period, whereas only 2.5% of those under the usual care condition did so. 12.3% of those who received housing without treatment remained abstinent for the entire six months without relapse, supporting the efficacy of abstinent-contingent recovery housing following detoxification.
Consistent with previous research, which has shown that longer participation in treatment programs results in more favorable outcomes such as long-term abstinence, this study provides strong support for the efficacy of enrollment in abstinent-contingent recovery housing. Opioid dependent individuals who are willing to consider recovery housing may be making a valuable investment in their road to recovery.