Abstinence-contingent recovery housing and reinforcement-based treatment following opioid detoxification

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 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. Setting Out‐patient 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 < 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.