title: Abstinence-contingent recovery housing and reinforcement-based treatment following opioid detoxification.
abstract: OBJECTIVE
  To conduct a randomized, controlled trial of abstinence-contingent recovery housing delivered with or without intensive day treatment among individuals exiting residential opioid detoxification.
  
  
  METHODS
  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.
  
  
  METHODS
  Out-patient drug-free substance abuse treatment program in Baltimore, Maryland.
  
  
  METHODS
  Patients (n = 243) who completed medication-assisted opioid detoxification.
  
  
  METHODS
  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.
  
  
  RESULTS
  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.
authors.affiliation: Johns Hopkins University School of Medicine, Psychiatry and Behavioral Sciences, Baltimore, MD 21224, USA. mtuten@jhmi.edu
authors.forename: Michelle
authors.initials: M
authors.lastname: Tuten
authors.forename: Anthony
authors.initials: A
authors.lastname: DeFulio
authors.forename: Hendrée E
authors.initials: HE
authors.lastname: Jones
authors.forename: Maxine
authors.initials: M
authors.lastname: Stitzer
mesh_terms: D000293:Adolescent; D000328:Adult; D000553:Ambulatory Care / Q000379:methods* / Q000706:statistics & numerical data; D015142:Baltimore; D019970:Cocaine-Related Disorders / Q000534:rehabilitation; D003376:Counseling / Q000379:methods; D004651:Employment / Q000706:statistics & numerical data; D005500:Follow-Up Studies; D006208:Halfway Houses / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000534:rehabilitation*; D011613:Psychotherapy / Q000379:methods*; D012054:Reinforcement, Psychology; D012114:Residential Treatment; D055502:Secondary Prevention; D015813:Substance Abuse Detection; D016896:Treatment Outcome; D055815:Young Adult