Long-term Residential Programs Research Articles

Buprenorphine use among non-hospital residential programs

BackgroundThe purpose of this study is to investigate the use of buprenorphine within non-hospital residential programs. We hypothesize that programs offering long-term treatment will be less likely to accept or prescribe buprenorphine, but those that accept public insurance will demonstrate relative increased likelihood of buprenorphine availability. MethodThis study analyzed data from the 2021 National Substance Use and Mental Health Services Survey. The analytic sample (n=3654) included a subset of facilities that reported providing only substance use treatment, including three non-mutually exclusive service types: detox, short-term, and long-term. A logistic regression examined the association between buprenorphine availability and residential service type, holding constant characteristics associated with the outcome of interest. We then tested an interaction between public insurance and long-term service type on the outcome of interest. ResultsWhile long-term service type was associated with reduced odds of buprenorphine availability (OR=.288, p <.05), programs that both offered long-term residential programs and accepted public health insurance had 3.5 higher odds of accepting or prescribing buprenorphine (OR=4.586, p<.01) compared to long-term programs without public insurance. ImplicationsPatients who require treatment of longer duration may face barriers to buprenorphine availability; however, public insurance acceptance may increase odds of availability of buprenorphine among long-term programs.

“They just looked at me like I was human”: The experiences of parenting women and providers with substance use disorder treatment

BackgroundThe current US addiction treatment system does not effectively meet the needs of pregnant and parenting women with substance use disorder (SUD). The aim of this research was to identify barriers and facilitators to engagement and retention in SUD residential treatment for pregnant and parenting women. This research was part of a co-design process to collaboratively create a more patient-centered long-term residential program. Design and methodsThe study conducted semi-structured individual interviews with both parenting women with lived experience (WWLE) in residential SUD treatment and SUD treatment providers. Interviews aimed to elicit participants' experiences either receiving or providing care. The study team analyzed data in NVivo-12 using a deductive codebook based on the six principles of trauma informed care (TIC). ResultsWe conducted a total of 32 interviews (WWLE =13, SUD providers =19). The study identified four major themes: 1) peer relationships provide inspiration and diminish shame; 2) providing individuals safe space to stumble in recovery creates opportunities for growth and builds self-efficacy; 3) reasonable, clear boundaries create a structured, protective environment for early recovery; 4) nonjudgmental connections facilitate engagement and build trust. We identified small pivotal moments along the continuum of care that showed how the elements in the four themes enhanced engagement and retention in treatment. These interactions, along the care continuum, are either structural (workflow process) or relational (interpersonal). ConclusionThis research increases understanding of the interplay of the structural and relational barriers and facilitators to engagement and retention in treatment. These seemingly minor positive or negative interactions along the care continuum are pivotal to fully operationalizing TIC and optimizing women's engagement in treatment. Improvement strategies that integrate the voices of WWLE and collaboratively co-design a more patient-centered system are critical steps to improving engagement in SUD treatment and more equitable SUD treatment services.

Protocol for Outcome Evaluation of Ayahuasca-Assisted Addiction Treatment: The Case of Takiwasi Center.

The present study describes the protocol for the Ayahuasca Treatment Outcome Project (ATOP) with a special focus on the evaluation of addiction treatment services provided through Takiwasi Center, the first ATOP study site. The goal of the project is to assess treatment outcomes and understand the therapeutic mechanisms of an Ayahuasca-assisted, integrative treatment model for addiction rehabilitation in the Peruvian Amazon. The proposed intervention protocol highlights the significance of treatment setting in the design, delivery, and efficacy of an addiction rehabilitation program that involves the potent psychedelic tea known as Ayahuasca. After describing the context of the study, we put forth details about our mixed-methods approach to data collection and analysis, with which we seek to gain an understanding of why, how, and for whom this specific ayahuasca-assisted treatment program is effective across a range of outcomes. The ATOP protocol employs qualitative research methods as a means to determine which aspects of the setting are meaningful to clients and practitioners, and how this may correlate with outcome measures. This paper delineates the core principles, methods, and measures of the overall ATOP umbrella, then discusses the role of ATOP in the context of the literature on long-term residential programs. To conclude, we discuss the strengths and limitations of the protocol and the intended future of the project.

Postdischarge Outcomes of Adolescents Attending a Long-term Addiction Treatment Program

Objectives: The purpose of this study was to: (1) describe the alcohol and other drug use patterns among adolescents discharged from a unique long-term semiresidential treatment program in Canada; (2) compare graduates and nongraduates on alcohol and other drug use, and 12-step program attendance; and (3) evaluate the relationship between psychosocial outcomes and continuous abstinence during the 2 years following discharge from the program (ie, obtaining education, becoming employed, maintaining a steady relationship with a significant other, and less involvement in deviant behaviors). Materials and Methods: Fifty individuals (41 treatment graduates and 9 treatment nongraduates) were interviewed by telephone after discharge. The time interval between discharge from treatment and study interview ranged from 2 to 9 years, with a median of 5 years. Additional data for 48 participants were obtained from administrative records at the treatment program. Results: Among the overall sample, 50.0% were abstinent for the first 2 years postdischarge, and maintaining abstinence for 2 years was more prevalent among program graduates than nongraduates (58.5% vs. 11.1%). Nearly all relapses involved alcohol or cannabis. With the exception of being in a serious relationship, continuous abstinence was unrelated to other psychosocial variables. Conclusions: This specialized, long-term residential program yielded high continuous abstinence rates for program graduates, but intensive support during and following treatment discharge for these young adults is warranted to improve educational attainment and employment prospects, and decrease deviant behaviors following discharge. Additional research is needed to more fully understand the long-term outcomes of adolescents attending community-based drug treatment programs.

The effect of medications for opioid use disorder (MOUD) on residential treatment completion and retention in the US

BackgroundThis study examines whether MOUD increases treatment completion and retention in both short-term (ST) and long-term (LT) residential programs using a national dataset. MethodsData were extracted from the 2015–2017 TEDS-D (Treatment Episode Dataset-Discharge) datasets for opioid using adults in ST (n = 87,296) and LT (n = 66,623) residential treatment. Primary outcome variables were treatment completion and retention (ST: length of stay >10 days; LT: >90 days). Logistic regression estimated the effects of MOUD on the probability of treatment completion and retention separately for ST and LT residential treatment, controlling for individual background characteristics. ResultsOnly 18% of clients in residential treatment programs had MOUD in their treatment plans. For ST residential treatment, MOUD was associated with a 40% increased likelihood of treatment completion (OR = 1.404) and 34% increased retention (OR = 1.337). For LT residential treatment, MOUD was associated with a 26% reduced likelihood of treatment completion (OR = 0.743) and no significant increase in retention. Post hoc analysis suggests insurance coverage may be influencing outcomes. ConclusionsDespite MOUD being a standard of care for OUD, MOUD is particularly under-utilized in residential treatment. Further research should focus on how best to integrate MOUD within short-term residential treatment and to explore the potential viability of MOUD in long-term residential programs. Given the risk of overdose following residential treatment, for at least short-term residential programs, this setting may be advantageous for integrating psychosocial treatments with early MOUD engagement in a structured therapeutic environment as part of a long-term continuum of care recovery program.

Clinical Associations of Deliberate Self-Injury and Its Impact on the Outcome of Community-Based and Long-Term Inpatient Treatment for Personality Disorder

Background: Deliberate self-injury (DSI) is significantly associated with personality disorder (PD). There are gaps in our knowledge of DSI as an indicator of severity of psychopathology, as moderator of outcome and with regard to its response to different treatment programs and settings. Methods: We compare 2 samples of PD with (n = 59) and without (n = 64) DSI in terms of clinical presentation, response to psychosocial treatment and relative outcome when treated with specialist long-term residential and community-based programs. We test the assumption that DSI is an appropriate indicator for long-term inpatient care by contrasting the outcomes (symptom severity and DSI recidivism) of the 2 DSI sub-groups treated in the 2 different approaches. Results: PD with DSI had greater severity of presentation on a number of variables (early maternal separation, sexual abuse, axis-I comorbidities, suicidality and inpatient episodes) than PD without DSI. With regard to treatment response, we found a significant 3-way interaction between DSI, treatment model and outcome at 24-month follow-up. PD with DSI treated in a community-based program have significantly greater chances of improving on symptom severity and recidivism of self-injurious behaviour compared to PD with DSI treated in a long-term residential program. Conclusions: Although limitations in the study design invite caution in interpreting the results, the poor outcome of the inpatient DSI group suggests that explicit protocols for the management of DSI in inpatient settings may be beneficial and that the clinical indications for long-term inpatient treatment for severe and non-severe PD may require updating.

Are We Really Client-Centered? Using the Canadian Occupational Performance Measure to See How the Client's Goals Connect With the Goals of the Occupational Therapist

The Canadian Occupational Performance Measure was used as a tool to compare goals for intervention identified by seven clients living in a long-term residential program and diagnosed with schizophrenia, with their goals as identified by the occupational therapist. In-depth interviews were conducted in conjunction with the use of the Canadian Occupational Performance Measure. Data analysis revealed an overarching theme that described the clients' concerns as, “I want to accomplish goals outside of the residence program.” During the analysis, however, the data revealed that the occupational therapist primarily focused her attention on goals to be achieved within the residence program, emphasizing programming and symptom management as each client's priorities for intervention, rather than community involvement. The findings reveal how data from the Canadian Occupational Performance Measure was used to reveal client/therapist disconnect in goal setting and the need to continue to examine client-centered practices in mental health settings.

Drug Abuse by Adolescents: General Considerations

1. Ximena Sanchez-Samper, MD* 2. John R. Knight, MD* 1. *Center for Adolescent Substance Abuse Research, Children's Hospital Boston, Boston, Mass After completing this article, readers should be able to: 1. Discuss current trends in adolescent substance use and the specific substances used most commonly among 8th, 10th, and 12th graders. 2. Identify risk and protective factors, including genetic and environmental correlates, for the initiation of substance use in adolescents. 3. Discuss the most common concomitant mental health disorders and how they can affect the course of diagnosis and treatment for substance abuse. 4. Delineate the variety of treatment options available. 5. Describe the role of the pediatrician in educating patients and families on substance abuse prevention; performing screening and initial assessments; and providing support, brief counseling, or referrals for in-depth treatment. Adolescence is a time of physical, emotional, and psychological maturation as well as a period of searching for independence and experimentation. One area of experimentation associated with adolescence is substance use. (1) Although many adolescents experiment with drugs and alcohol from time to time without enduring problems, those who develop the disorders of substance abuse and dependence make substance use a major public health concern. The Monitoring the Future Study (MTFS) is a nationwide survey measuring smoking, drinking, and illicit drug use among nearly 50,000 8th, 10th, and 12th graders in more than 400 secondary schools in the United States each year. (2)(3) According to the 2006 overview of findings from the MTFS, approximately one fifth (21%) of today's 8th graders, more than one third (36%) of 10th graders, and nearly half (48%) of all 12th graders reported using an illicit drug at least once during their lifetimes. Despite a minimum legal age requirement to purchase alcohol, 6% of 8th graders, 19% of the 10th graders, and 30% of the 12th graders self-reported drunkenness during the month prior to being interviewed. (2)(3) Among the problems experienced by adolescents who use alcohol and drugs are …

Patient Satisfaction and Sustained Outcomes of Drug Abuse Treatment

The authors investigated the relationship between patients' self-rated satisfaction with treatment services during and shortly after treatment with their drug use outcomes at one year follow-up, using a US national panel survey of patients in 62 methadone, outpatient, short-term residential, and long-term residential programs. A favorable evaluation of treatment near the time of discharge had a significant positive relationship with drug use improvement outcomes approximately one year later, independent of the separately measured effects of treatment duration, counseling intensity, patient adherence to treatment protocols, pre-treatment drug use patterns, and other characteristics of patients and treatment programs.

Client consensus on beliefs about abstinence: Effects on substance abuse treatment outcomes

Organizational culture, as evinced by consensus regarding staff and client beliefs and values, has been shown to affect client engagement in residential substance abuse treatment. The present paper extends this work to treatment outcomes. Secondary analysis of data from a “Beliefs About Abstinence Scale,” used in the Drug Abuse Treatment Outcomes Study (DATOS), was conducted for 76 programs, including outpatient methadone treatment, outpatient drug-free, short-term inpatient, and long-term residential programs. Findings show that higher levels of client consensus after 1 month of treatment were associated with less use of drugs and alcohol at 1-year follow-up, after controlling for the mean of the scale score, gender, age, client substance use at baseline and treatment modality. The implications of the results for substance abuse treatment are discussed.

Adding Consumer-Providers to Intensive Case Management: Does It Improve Outcome?

Adding Consumer-Providers to Intensive Case Management: Does It Improve Outcome?

Schizophrenia and Co-Occurring Substance Use Disorder

Schizophrenia and Co-Occurring Substance Use Disorder

Do Mechanisms that Link Addiction Treatment Patients to Primary Care Influence Subsequent Utilization of Emergency and Hospital Care?

Patients with drug use disorders are heavy users of emergency department (ED) and inpatient hospital care. This study examines whether formal mechanisms to link addiction treatment patients to primary medical care, either directly on site or by off-site referral-when compared with an absence of said mechanisms-might reduce these patients' use of ED and hospital services after substance abuse treatment. We used longitudinal data from 6 methadone maintenance programs with 232 patients, 24 outpatient nonmethadone programs with 1202 patients, and 14 long-term residential programs with 679 patients in the National Treatment Improvement Evaluation Study. Multivariate logistic models controlling for health status and medical service utilization before treatment examined whether provision of medical services on- or off-site during treatment linkage led to reduced use of ED and hospital services in the year after treatment compared with no such provision. On-site delivery of primary care reduced subsequent ED and hospital use among patients in methadone maintenance and long-term residential compared with the nonlinkage condition but not in outpatient nonmethadone programs. Off-site referral for medical care reduced subsequent ED visits but not hospitalizations in long-term residential programs. These findings suggest that for some treatment modalities, stronger primary care linkage mechanisms decrease subsequent utilization of expensive ED and hospital services. Future study should examine the cost implications of these strong linkage mechanisms and ways to strengthen linkages to off-site medical care.

Family Contact and Recidivism: A Longitudinal Study of Adjudicated Delinquents in Residential Care

Families are critical to understanding and interrupting patterns of delinquent and criminal behavior. The objective of this study was to determine whether specific types of contact with family members are associated with a reduced risk of recidivism after a long-term residential program for juvenile delinquents. Family contact reports were analyzed for a random sample of 90 adjudicated delinquents released from a long-term residential facility in Michigan. Two years after their release from residential care, official arrest reports were provided by the Michigan State Police Department. Thirty-six percent of the youths were arrested at least once. Cox regression coefficients indicate that age, race, and family contact were related to subsequent involvement with the adult correctional system. In-home counseling, campus visits initiated by family members, and home visits initiated by the family service worker reduced the likelihood of recidivism. The implications for social work policy and practice are discussed.

Economic costs of residential substance abuse treatment for pregnant and parenting women and their children

This paper provides basic information about the economic cost of substance abuse treatment provided in 39 demonstration projects funded by the Center for Substance Abuse Treatment, in the Substance Abuse and Mental Health Services Administration, under its Residential Women and Children and Pregnant and Postpartum Women (RWC/PPW) programs. It integrates data assembled in two studies, a study of annual project implementation costs based on the CSAT-developed Substance Abuse Treatment Cost Analysis and Allocation Template (SATCAAT) and a cross-site study of other project and client characteristics. Findings indicate that the average economic cost of treating a woman and her infants and young children in this type of long-term residential program, in fiscal 1997 dollars, was $25,744. This cost had three components of roughly equal size: services for clients, services for clients' children, and housing. Clinical services were found to be highly front-loaded, being more intensive in the initial weeks of treatment than in later stabilization phases. Considerable project-to-project variation in average episode cost was observed, linked primarily to project differences in size/occupancy and in average client length of stay.

Legal Pressure, Treatment Readiness, and Engagement in Long-Term Residential Programs

Clients are less likely to drop out of residential drug treatment programs prematurely when they are either internally motivated (i.e., having a high level of treatment readiness) or externally pressured by the legal system to enter, participate, and remain in treatment. However, little is known about the combined impact these factors have on treatment engagement and retention. This study focused on a national sample of 2,194 clients admitted to 18 long-term residential facilities. Although there was no significant interaction effect, findings indicated that clients with higher levels of treatment readiness at intake stayed in treatment at least 90 days, regardless of legal pressure. Likewise, those under legal pressure (defined by legal status and supervisory pressures) remained in treatment longer, regardless of treatment readiness. However, motivational readiness for treatment accounted for the greatest improvements in retention and, unlike legal pressure, was related to indicators of therapeutic engagement.

Residential detoxification for substance abusers with HIV/AIDS. Walden House Detoxification Program.

Substance abusers with HIV/AIDS have a complex array of problems that are not easily addressed in outpatient or long-term residential programs. A new but promising treatment modality is residential detoxification for substance abusers with HIV/AIDS, such as described by this paper. The purpose of the program is profiled, as well as its general components and the aspects that address the special needs of HIV clients. Data indicating the successes and limitations of the program are presented, along with recommendations for further addressing the needs of substance abuses with HIV/AIDS.

Legal Pressure and Treatment Retention in a National Sample of Long-Term Residential Programs

This study examined the association between legal pressure and treatment retention in a national sample of 2,605 clients admitted to 18 long-term residential facilities that participated in the Drug Abuse Treatment Outcome Study (DATOS). Hierarchical linear models were used to assess the relationship of background factors and legal pressure with treatment participation for 90 days or longer. Two thirds of the sample entered residential treatment with moderate to high pressure from legal authorities, and they were significantly more likely than the low-pressure clients to stay 90 days or more. Moreover, the difference in retention between moderate-to-high-and low-pressure clients was even greater in programs with proportionally larger caseloads under legal surveillance. The criminal justice system (CJS) can influence treatment participation and retention, and it appears essential for the CJS and treatment programs to maintain an open and constructive relationship to maximize their potential combined impact.

Morning Support Group: Use of a Triweekly Support Group in Outpatient Treatment of Chemical Dependence

Alcohol and drug abuse treatment is a field that has evolved from early ineffective therapies through the birth of Alcoholics Anonymous to more recent professional treatment based on research and on clinical experience. Many of the clinical therapies now in use incorporate the concepts formed by Alcoholics Anonymous but expand on them to include exploration of personal issues. Whereas Alcoholics Anonymous offers a place to obtain support and to share one's experiences, professional treatment provides a chance to examine how one interacts with others; any current alcohol and drug professional knows that a client's interpersonal difficulties are often a ready excuse for him or her to drink. In early recovery, chemically dependent people require support and education about what they are experiencing and why. An early abstinence support group provides this and gives group members an opportunity to incorporate some structure into their often chaotic lives. Furthermore, in talking about what they are going through, clients experience relief from some of the power of the struggle. The support encompasses comfort, knowledge, normalization, and the realization that one is not unique in one's difficulties. In addition, the group labels these difficulties as a disease, thus easing the individual's responsibility for them; in doing this, such programs enhance self-esteem by abating the burden of failure. This article provides background in the field of alcohol and drug abuse treatment and describes the use of an early abstinence support group in an outpatient program. Research on the clients who passed through the group over the course of a 1 1/2-year period shows that this treatment can provide a solid foundation on which to build an ongoing recovery program. Ideas on the expansion and the application of this type of group to other sectors of mental health treatment are explored. Alcohol and Drug Treatment Remedies for chemical dependency are available in both the professional and the self-help sectors in the United States. There are a variety of professional treatment centers ranging from outpatient clinics to long-term residential programs. Although individual treatment is certainly a part of therapy, the treatment of choice for chemical dependency is group therapy (Matano & Yalom, 1991; Nace, 1987). There are essentially three types of treatment centers for alcohol and drug dependence: residential, day treatment, and outpatient. Residential treatment programs for chemical dependency provide a safe, intensive setting in which people who are dependent on alcohol or drugs can detoxify, meet others who are also trying to get clean, and remain abstinent without having easy access to temptation. Day treatment is a somewhat less restrictive alternative often used while waiting for a bed in a residential program, as aftercare, or when residential treatment is not appropriate (Evangelakis, 1974). Outpatient treatment is able to provide group, individual, and sometimes family treatment at lower cost. A commonality among many treatment centers tends to be Alcoholics Anonymous, and those treatment centers that integrate it tend to have high success rates (Bean, 1975a, 1975b, 1975c). Group therapy is the common treatment modality in all three types of treatment centers (Matano & Yalom, 1991; Nace, 1987). The purpose of alcohol and drug group therapy is to provide support, to serve as a role model for people who are often not used to functioning in public without the aid of alcohol and drugs, and to exert peer pressure in confronting denial (Matano & Yalom, 1991). For group therapy to be effective, the members must want to be there and should express in both words and actions their wish to be dean and sober before they enter the group (Nace, 1987). If they do not, the strength of their ambivalence can have a harmful effect on the group. Morning Support Group A Morning Support Group has been operating at Benton County Alcohol and Drug Treatment Program in Corvallis, Oregon, since 1980, when the county received a grant to offer day treatment to alcohol- and drug-abusing clients (personal communication with D. …

Boerum Hill: a private long-term residential program for former mental patients.

The author emphasizes the need for a wide variety of community living arrangements for former mental patients, and describes a private residential-care program he founded in New York City in 1966. The program includes the 196-bed Boerum Hill Home for Adults, which is certified by the state as a proprietary home and a community residence, and the Brooklyn Vocational Rehabilitation Institute, which conducts vocational training programs for former patients in clerical, food service, and home management areas. It also operates a 64-bed satellite-housing and apartment-living program. The problems and advantages of operating a proprietary home are discussed, as well as some of the broader issues involved in community care of former patients.