Complementary horse-assisted therapy for substance use disorders: a randomized controlled trial

Francesca Gatti,Jeanette Lysell,Ann Kern-Godal,Espen Walderhaug,Espen Ajo Arnevik

doi:10.1186/s13722-020-0183-z

Abstract

BackgroundTreatment completion is the greatest challenge for the treatment of substance use disorders (SUDs). A previous investigation showed that complementary horse-assisted therapy (cHAT) was associated with higher retention in treatment and completion than standard treatment alone. This randomized controlled trial further explored the benefits of cHAT for patients with SUDs.MethodsFifty patients in residential SUD treatment at the Department of Addiction Treatment, Oslo University Hospital, were randomly allocated to either cHAT (cHAT group) or treatment as usual alone (TAU-only group). The primary end-point was treatment completion. Secondary end-points were dropout, transfer to another treatment, and time in treatment.ResultsThe multinomial logistic regression analysis found no statistically significant association between intervention (cHAT) and treatment outcome (completion, dropout, transferred) among the 37 participants who were ultimately recruited to the study. Some unforeseen challenges were encountered in the study: a high number of subjects transferred to another treatment, variable attendance at cHAT sessions, and long temporary exits. Nevertheless, 44% of participants in the cHAT group completed their treatment, compared with 32% in the TAU-only group; this observation encourages further investigation in a larger sample.ConclusionsThough no association was identified between cHAT and treatment retention or completion, our study may have been underpowered. Further work in a larger clinical population is needed; observational studies with repeated measures may also be useful for investigating whether cHAT increases retention in treatment or rates of completion, two important factors for successful SUD treatment.Trial registration The trial was registered and approved on 14 October 2011 by the Regional Committee for Medical and Health Research Ethics with registration number 2011/1642 and registered at ClinicalTrials.gov on 21 February 2013 with registration number NCT01795755

Highlights

Treatment completion is the greatest challenge for the treatment of substance use disorders (SUDs)
Study participants’ characteristics As the result of the allocation process, 50 patients were assigned to one of the two treatment groups: the intervention, which consisted of horse-assisted therapy complementary to treatment as usual (n = 25, the complementary horse-assisted therapy (cHAT) group), and the control, which consisted of treatment as usual only (n = 25, the TAU-only group)
The hypothesis that cHAT would improve treatment retention and completion was based on recently published results from a study by our group on a sample of 108 patients, showing that the subjects in the cHAT programme (n = 65) were more likely to complete their treatment than those attending TAU-only

Summary

Introduction

Treatment completion is the greatest challenge for the treatment of substance use disorders (SUDs). A previous investigation showed that complementary horse-assisted therapy (cHAT) was associated with higher reten‐ tion in treatment and completion than standard treatment alone. This randomized controlled trial further explored the benefits of cHAT for patients with SUDs. Motivating patients to remain actively engaged and to complete their treatment is a long-standing and wellrecognized challenge in substance use disorder (SUD) treatment [1]. The prognosis for SUD patients with one or more comorbid conditions is generally poorer, with higher rates of treatment dropout and relapse [2]. Post-discharge follow-up and outpatient services have been found to be effective, but the risk of substance use disorder relapse remains high for many years [2]

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