A Comparison of Reinforcement Based Treatment (RBT) versus RBT plus Recovery Housing (RBTRH).
Reinforcement-based treatment (RBT) plus recovery housing (RBTRH) improves outcomes for individuals with opioid use disorders. No studies have examined the efficacy of RBT in the absence of abstinent-contingent housing.



We compared highly similar participants from a study of outpatient RBT (RBT, n=55) and the RBTRH(n=80) arm of a randomized trial wherein participants received abstinent-contingent payment for recovery housing sponsored by the research program. Abstinence and employment outcomes were assessed at one, three, and six months. Regression was used to identify predictors of abstinence. Sensitivity analyses explored the impact of housing on outcomes.



RBT and RBTRHparticipants had similar abstinence and employment outcomes. Predictors of abstinence in the sample included recovery housing residence and employment. However, a distinct RBT sub-group emerged, as 33% of the sample accessed self-pay RH (RBTSPRH). Sensitivity analyses compared the two RH groups (self-pay and program-supported) to RBT outpatient treatment (RBT). The RBTSPRHand RBTRHgroups had similar abstinence outcomes, and both groups had superior abstinence outcomes compared to RBT. The RBTSPRHgroup had the most sustained effects relative to RBT, including higher abstinence rates, and more favorable employment outcomes at six months (ps<.05). The RBTSPRHgroup reported more days of employment compared to both the RBT and RBTRHgroups at three months (ps<.05).



Findings highlight the importance of recovery housing for promoting improved outcomes among RBT participants. Research is needed to explore the aspects of recovery housing versus outpatient treatment that are associated with improved outcomes in the population.
University of Maryland School of Social Work, 525 West Redwood Street, Baltimore, MD 21201, USA; Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Bayview Medical Center, G Building, Baltimore, MD 21224, USA. Electronic address: mtuten@ssw.umaryland.edu.
Michelle
M
Tuten
University of Maryland at College Park, Department of Psychology, Center for Addictions, Personality, and Emotion Research, 2103 Cole Field House, College Park, MD 20742, USA. Electronic address: jshadur@umd.edu.
Julia M
JM
Shadur
Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Bayview Medical Center, G Building, Baltimore, MD 21224, USA. Electronic address: mstitzer@jhmi.edu.
Maxine
M
Stitzer
The University of North Carolina at Chapel Hill, Department of Obstetrics and Gynecology, School of Medicine, Horizons Program, 127 Kingston Drive, Chapel Hill, NC 27514, USA; Johns Hopkins University, School of Medicine, Department of Psychiatry and Behavioral Sciences, Bayview Medical Center, G Building, Baltimore, MD 21224, USA.
Hendrée E
HE
Jones
D000328:Adult; D019970:Cocaine-Related Disorders / Q000534:rehabilitation / Q000628:therapy*; D004651:Employment; D005260:Female; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009293:Opioid-Related Disorders / Q000534:rehabilitation / Q000628:therapy*; D017063:Outcome Assessment, Health Care; D012054:Reinforcement, Psychology; D012114:Residential Treatment / Q000379:methods*
Cocaine use; Opioid use; Treatment outcomes