title: Is residential treatment effective for opioid use disorders? A longitudinal comparison of treatment outcomes among opioid dependent, opioid misusing, and non-opioid using emerging adults with substance use disorder.
abstract: BACKGROUND
  Opioid misuse and dependence rates among emerging adults have increased substantially. While office-based opioid treatments (e.g., buprenorphine/naloxone) have shown overall efficacy, discontinuation rates among emerging adults are high. Abstinence-based residential treatment may serve as a viable alternative, but has seldom been investigated in this age group.
  
  
  METHODS
  Emerging adults attending 12-step-oriented residential treatment (N=292; 18-24 years, 74% male, 95% White) were classified into opioid dependent (OD; 25%), opioid misuse (OM; 20%), and no opiate use (NO; 55%) groups. Paired t-tests and ANOVAs tested baseline differences and whether groups differed in their during-treatment response. Longitudinal multilevel models tested whether groups differed on substance use outcomes and treatment utilization during the year following the index treatment episode.
  
  
  RESULTS
  Despite a more severe clinical profile at baseline among OD, all groups experienced similar during-treatment increases on therapeutic targets (e.g., abstinence self-efficacy), while OD showed a greater decline in psychiatric symptoms. During follow-up relative to OM, both NO and OD had significantly greater Percent Days Abstinent, and significantly less cannabis use. OD attended significantly more outpatient treatment sessions than OM or NO; 29% of OD was completely abstinent at 12-month follow-up.
  
  
  CONCLUSIONS
  Findings here suggest that residential treatment may be helpful for emerging adults with opioid dependence. This benefit may be less prominent, though, among non-dependent opioid misusers. Randomized trials are needed to compare more directly the relative benefits of outpatient agonist-based treatment to abstinence-based, residential care in this vulnerable age-group, and to examine the feasibility of an integrated model.
authors.affiliation: Harvard Medical School, Department of Psychiatry, United States; Massachusetts General Hospital, United States; Cambridge Health Alliance, United States. Electronic address: zschuman@cha.harvard.edu.
authors.forename: Zev
authors.initials: Z
authors.lastname: Schuman-Olivier
authors.affiliation: Massachusetts General Hospital, United States.
authors.forename: M
authors.initials: M
authors.lastname: Claire Greene
authors.affiliation: Harvard Medical School, Department of Psychiatry, United States; Massachusetts General Hospital, United States.
authors.forename: Brandon G
authors.initials: BG
authors.lastname: Bergman
authors.affiliation: Harvard Medical School, Department of Psychiatry, United States; Massachusetts General Hospital, United States.
authors.forename: John F
authors.initials: JF
authors.lastname: Kelly
mesh_terms: D000293:Adolescent; D000701:Analgesics, Opioid / Q000009:adverse effects* / Q000627:therapeutic use; D002047:Buprenorphine / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009270:Naloxone / Q000627:therapeutic use; D009292:Narcotic Antagonists / Q000627:therapeutic use; D009293:Opioid-Related Disorders / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy*; D012114:Residential Treatment / Q000379:methods*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D000701:Analgesics, Opioid; D009292:Narcotic Antagonists; D009270:Naloxone; D002047:Buprenorphine
keywords: 12-Step residential; Abstinence; Emerging adult; Office-based opioid treatment; Opioid dependence; Youth