Residential Addiction Treatment Research Articles

Psychometric evaluation of the Dutch version of the patient-reported experience measure for addiction treatment (PREMAT-NL).

Patient-centred care has become increasingly important in health care. Patient-reported experience measures (PREM) are used to measure patient experiences in health care, but the availability of psychometrically validated PREMs is limited. The Patient Reported Experience Measure in Addiction Treatment (PREMAT) is a PREM developed with extensive service user input to assess the experiences of people in residential addiction treatment services. In this study we aimed to evaluate the psychometric properties of the Dutch translation of the PREMAT, the PREMAT-NL. Ninety-three participants completed the PREMAT-NL approximately 45 days after starting addiction treatment as part of a naturalistic prospective multi-centre study in Belgium. We examined the factorial structure using principal component analysis with Promax oblique rotation and assessed the internal consistencies of the subscales and total score using Cronbach's α. Additionally, we explored the relationship of PREMAT-NL scores with demographic and clinical variables. The PREMAT-NL had a four-factor structure, with good internal consistencies of the subscales (Cronbach's α >0.70) and excellent internal consistency of the total score (Cronbach's α = 0.94). The PREMAT-NL total score was negatively skewed, and four score categories were proposed based on z-scores. PREMAT-NL scores correlated weakly with the type of treatment centre (r = 0.21, p < 0.05) and with previously received treatment for addiction (r = -0.25, p < 0.05). Although the factor structure and thus the appropriate use of subscales need further investigation, the findings of this study support the use of the PREMAT-NL total score as a valid and reliable PREM to evaluate residential addiction treatment services.

Factors Influencing Maternal Substance Use and Recovery in the Perinatal Period.

Substance use disorders (SUD) in the perinatal period have risen dramatically over the past 2 decades. Substance use disorders can have deleterious effects on maternal-infant health. Recovery can improve quality of life but can be challenging for women with SUD in the perinatal period. It is important for health care providers to have an understanding of factors associated with maternal substance use and recovery. The purpose of this qualitative review was to identify factors influencing substance use and recovery in women with SUD in the perinatal period. A systematic search was conducted using the databases of CINAHL, PsycINFO, and PubMed along with a manual search of Google Scholar. The studies were assessed using criteria from the Joanna Briggs Institute's critical appraisal checklist for qualitative research. Findings from 16 qualitative studies were synthesized. Six descriptive subthemes identifying factors influencing substance use and recovery were revealed: (1) Infant Care, (2) Stigma, (3) Social Settings Involving Substance Use, (4) Internalized Stigma and Mental Health Symptoms, (5) Addiction Concerns, and (6) Coping Abilities. Participants described external and internal factors that influenced their substance use and recovery. The findings suggest health care providers refer women to residential addiction treatment, use destigmatizing language, promote access to peer services, and provide trauma-informed care.

Self-Reported Sobriety Labels: Perspectives from Alumni of Inpatient Addiction Treatment.

There is a lack of consensus in the addiction field as to how to refer to alumni of residential treatment who no longer use substances or who reduce their use. In the literature, this label and broader identity are typically discussed in technical (amount and frequency of use) or social terms (environment and social network changes). The current paper seeks to simplify the discussion by focusing on personal labels without complex technical or social considerations. Alumni of an inpatient addiction treatment facility were asked how they refer to themselves regarding their sobriety status post-discharge. Forty-nine patients were contacted 3 months post-discharge from a residential inpatient addiction treatment (men = 67%; Mage = 47.75 years). The patients completed a post-discharge assessment that was conducted by a trained research assistant over a 20-minute video call. The current study focused on a "sobriety label" measure in which patients indicated what they want to be called. Patients also explained why they chose their answer in an open-ended question. Most patients identified as in recovery (n = 29; 59.18%) followed by a sober person (n = 7; 14.29%) and four other responses. No alum selected the in remission option, which is notably a common way to refer to patients who no longer use substances. The current study adds a critical patient/alumni perspective to the existing body of literature and serves as a call to action for researchers to add a similar "sobriety label" measure to future assessments, studies, and batteries in effort to bring consistency to the labels, definitions, and identities that are published. This methodology of understanding how this population identifies will create uniformity in future literature and decrease the stigma surrounding addiction.

Using Latent Profile Analysis to Characterize Clinical Heterogeneity and Impulsivity in a Large Residential Addiction Treatment Program

Objectives: Clinical heterogeneity among patients in addiction treatment settings represents a challenge as most of the treatment programs are designed to treat substance use disorders (SUD) generally rather than offering more tailored approaches addressing individual patient needs. Systematic characterization of clinical heterogeneity may permit more individualized care paths toward improving outcomes. Methods: Data were collected from a large inpatient SUD treatment program between April 2018 and March 2020 (n = 1519). Latent profile analysis (LPA) was applied to identify latent clusters based on differences in substance use and co-occurring depression, anxiety, and post-traumatic stress disorder. Results: Five distinct profiles emerged: Profile 1 (38%) exhibited the lowest substance use and lowest psychiatric severity (Overall Low); Profile 2 (39%) exhibited high alcohol and psychiatric severity; Profile 3 (13%) exhibited high opioid severity and low psychiatric severity. Profile 4 (8%) exhibited high cannabis use and high psychiatric severity, and profile 5 (3%) exhibited high polysubstance use other than alcohol and cannabis use. The latter two profiles were younger and exhibited higher self-regulatory deficits. The (High Alc/high psych) and the (High Cann/Psych) profiles exhibited differentially higher psychiatric severity. Profiles showing high polysubstance use, as well as high cannabis use and high psychiatric severity, showed significantly higher impulsive behavior than the others. Conclusions: LPA revealed five clusters of patients varying substantially in terms of SUD and psychiatric severity. Addressing common features of clinical heterogeneity for tailored care paths in a personalized treatment approach may improve treatment outcomes.

For addicted teens, residential treatment is scarce and expensive

Residential addiction treatment for teens is limited and expensive, according to a study published in Health Affairs last month. For the study, “Treatment In The US: Uneven Access, Waitlists, And High Costs” — which was funded by the National Institute on Drug Abuse (NIDA) — Caroline King, M.D., and colleagues used the FindTreatment.gov database maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) and a search analytics company to find 354 centers that claim to provide residential addiction treatment services to people under age 18. The researchers then contacted them.

Beds for teens are scarce and expensive: NIDA study

Residential addiction treatment for teens is limited and expensive, according to a study published in Health Affairs last week. For the study, “Treatment In The US: Uneven Access, Waitlists, And High Costs” — which was funded by the National Institute on Drug Abuse (NIDA) — Caroline King, M.D. and colleagues used the FindTreatment.gov database maintained by the Substance Abuse and Mental Health Services Administration (SAMHSA) and a search analytics company to find 354 centers that claim to provide residential addiction treatment services to people under age 18. The researchers then contacted them.

Adolescent Residential Addiction Treatment In The US: Uneven Access, Waitlists, And High Costs.

Drug overdose deaths among adolescents are increasing in the United States. Residential treatment facilities are one treatment option for adolescents with substance use disorders, yet little is known about their accessibility or cost. Using the Substance Abuse and Mental Health Services Administration's treatment locator and search engine advertising data, we identified 160 residential addiction treatment facilities that treated adolescents with opioid use disorder as of December 2022. We called facilities while role-playing as the aunt or uncle of a sixteen-year-old child with a recent nonfatal overdose, to inquire about policies and costs. Eighty-seven facilities (54.4percent) had a bed immediately available. Among sites with a waitlist, the mean wait time for a bed was 28.4 days. Of facilities providing cost information, the mean cost of treatment per day was $878. Daily costs among for-profit facilities were triple those of nonprofit facilities. Half of facilities required up-front payment by self-pay patients. The mean up-front cost was $28,731. We were unable to identify any facilities for adolescents in ten states or Washington, D.C. Access to adolescent residential addiction treatment centers in the United States is limited and costly.

An environmental scan of residential treatment service provision in Ontario

BackgroundOntario has one of the highest rates of substance-related harms in Canada. Residential treatment programs in the province provide a variety of in-house treatment services to support the needs of individuals with substance use disorders (SUD). However, these programs are not standardized, often varying in the type, quality, and availability of services offered, including evidence-based interventions such as Opioid Agonist Treatment (OAT). Local treatment systems are also rather fragmented and complex to navigate, creating barriers for potential services users to identify and make informed choices on available treatment options.MethodsBetween May to August 2023, we conducted an environmental scan to capture available information on all publicly-funded residential treatment programs in Ontario using the ConnexOntario service portal, a government-funded, health services information platform. Data were captured on organization name, geographical location, program description, program type (residential addictions treatment or supportive recovery programs), eligibility criteria, target population, the program’s OAT policies, number of available beds, minimum and maximum length of stay, projected wait times, funding source, and associated fees for program admission. Data were extracted and organized by geographic region, and findings were presented descriptively.ResultsA total of 102 residential addiction treatment programs and 36 residential supportive recovery programs in Ontario were identified. The scan noted substantial regional variations in program availability and wait times, along with a lack of programs tailored to unique populations such as women, youth, and Indigenous peoples. There is also a paucity of publicly-available information on program offerings, including detailed specifics on OAT policies within residential treatment programs that are crucial to ensuring that the services being offered are safe and grounded in evidence-based practice.ConclusionsFindings from the scan highlight notable gaps in program types, offerings, and availability among residential treatment programs in the province, including a lack of standardization on OAT policies across programs. Efforts should be made to ensure access to treatment-specific program information relevant to potential service users and to enhance coordinated access to residential treatment services in the province.

Psychotherapy Incorporating Equine Interaction as a Complementary Therapeutic Intervention for Young Adults in a Residential Treatment Program during the COVID-19 Pandemic

Substance use disorder has become an epidemic in the young adult population across the United States, and these numbers rose during the COVID-19 pandemic. Psychotherapy incorporating equine interaction has emerged to show promise in the mental health community as a complementary form of therapy for this age group and offered a viable treatment option during the pandemic due to the outdoor nature of the treatment environment. However, research concerning its use within a residential treatment program was lacking. The objective of this study was to evaluate the efficacy of psychotherapy incorporating equine interaction in a residential treatment program during the COVID-19 pandemic for developing an emotionally safe environment for learning for young adults. Participants (ages 18–25 years) were those in a substance abuse residential treatment program utilizing psychotherapy incorporating equine interaction during the COVID-19 pandemic. Participants were involved in weekly equine therapy for 2–7 weeks. Participants were divided according to length of stay at the residential facility and participation level with equine interactive activities. Assessment of emotional safety and long-term memory development was performed at the beginning and end of the treatment program. The development of memories centered around equine information that was covered during the treatment program. Semantic memory was assessed using a self-reporting knowledge exam and procedural memory was assessed using a skill evaluation. Emotional safety was determined using a self-reporting survey instrument. Paired t-tests determined significant improvement in emotional safety (p = 0.02) and semantic (p = 0.01) and procedural (p = 0.00) memory for all participants by the end of the program. The one-way analysis of variance indicated length of stay and participation level were not significant indicators of emotional safety (length of stay: p = 0.91, participation level: p = 0.98) and semantic (length of stay: p = 0.09, participation level: p = 0.60) and procedural (length of stay: p = 0.25, participation level: p = 0.09) memory development. These results suggest psychotherapy incorporating equine interaction was an efficient complementary therapeutic intervention for developing emotional safety and encouraging learning in a young-adult residential addiction treatment program during the COVID-19 pandemic.

Pilot randomized controlled trial of a brief strategy to prevent suicide after discharge from residential addiction treatment

IntroductionVeterans are at greater risk for suicide and veterans with substance use disorder (SUD) have an even greater risk. Little research has looked into brief interventions to prevent suicide in this population in residential substance use treatment programs. MethodWe conducted a pilot, randomized controlled trial of a brief suicide prevention strategy called Veterans Affairs Brief Intervention and Contact Program (VA BIC) in patients participating in the Residential Recovery Center (RRC) SUD 28-day program and deemed at risk for suicide. We measured changes in symptoms at 1-, 3-, and 6-months. We looked at social connectedness, suicidal ideation, hopelessness, thwarted belongingness, perceived burdensomeness, and treatment engagement. ResultsThe study enrolled twenty patients. One participant withdrew immediately after baseline. We found that adherence to VA BIC components was high, as 100 % of patients (N = 10) completed 70 % or more of the VA BIC visits. Furthermore, 80 % of intervention group patients (N = 8) completed all VA BIC components. During the six-month follow-up, suicidal ideation improved in patients assigned to VA BIC, while it worsened in the standard care arm. Similarly, patients assigned to VA BIC reported a reduction in perceived burdensomeness over the six-month follow-up period while it worsened in the standard care arm. Additionally, VA BIC may modestly improve treatment engagement in the first month postdischarge. ConclusionWe were able to recruit and enroll patients from a residential SUD treatment program into a clinical trial of the VA BIC intervention. Our preliminary results suggest that VA BIC may be useful in reducing suicidal ideation and perceived burdensomeness in patients who are discharged from residential SUD treatment programs and increasing treatment engagement. Future trials of VA BIC should determine whether VA BIC can reduce the risk of suicide in patients who are discharged from residential SUD treatment programs.

Treatments Used Among Adolescent Residential Addiction Treatment Facilities in the US, 2022

This study surveyed US adolescent residential addiction treatment facilities to assess treatments used for adolescents younger than 18 years seeking treatment for opioid use disorder.

Critical Success Factors of Street Haven's Residential Addictions Treatment Program for Women.

Street Haven's residential addictions treatment program offers a 90-day residential treatment program to highly vulnerable women who suffer from significant health and social care complexity, including homelessness, experience with gender-based violence, mental illness and chronic diseases. Despite the complexity of the needs of the clients, the program supports recovery, greater housing and enhanced overall well-being for the women it serves. The critical factors contributing to the success of the program include client readiness, pre-treatment programming, group-based programming, evidence-based programming, harm reduction approaches and a whole-person approach. These factors are essential for achieving programming outcomes and continuing the recovery journey post-discharge.

Residential addiction treatment providers: Identifying the role of social context in worker health and turnover

Increased lethality and availability of addictive substances has strained US addiction treatment services, further exacerbating workforce shortages in these settings. The emotional and physical health toll of providing treatment may contribute to shortages. This community-initiated qualitative study aimed to identify conditions that affect provider health and turnover in residential addiction treatment from a Total Worker Health® perspective. Providers (direct service, supervisors, leaders) working in nonprofit residential treatment facilities in Massachusetts were recruited by role and geography to participate in interviews and focus groups. NVivo12 facilitated coding and analysis. 25% of transcripts were double coded to assess interrater reliability and coding consistency (mean Kappa = 0.82). Providers (N = 49) participated in 33 interviews and 4 focus groups. Many participants reported personal addiction histories. Analysis revealed how socio-contextual factors originating outside of residential facilities were dominant influences on “downstream” working conditions, worker health, staff turnover, and by extension, client care. Four primary socio-contextual themes surfaced:1) Changes in type and potency of substances and client need not reliably accompanied by shifts in treatment practices; 2) challenges balancing state requirements and state-provided resources; 3) influence of structural discrimination and addiction stigma on pay and professional advancement; and 4) geographic location of facilities shape work and quality of life. Results were used to develop a conceptual model for residential addiction treatment to illustrate pathways by which ecological factors interact to affect provider health and turnover. Findings indicate that protecting health and wellbeing of providers—many of whom are in addiction recovery themselves— is integral to improving addiction treatment. From this workforce's perspective, recent changes in socio-contextual factors have intensified already challenging working conditions (job demands, pay, advancement), negatively impacting worker health, turnover, and client care. Any interventions to improve treatment outcomes or working conditions in nonprofit addiction facilities must consider larger socio-contextual factors influencing these organizations.

The association of chronic pain and opioid withdrawal in men and women with opioid use disorder

BackgroundApproximately 2.7 million individuals in the United States had an opioid use disorder (OUD) in 2020. Chronic pain may exacerbate opioid withdrawal severity, yet most research on opioid withdrawal has not collected data on chronic pain status. Moreover, there is limited evidence that women tend to experience greater opioid withdrawal severity than men, but large, confirmatory studies on this topic have not been published. The goal of this study was to examine the roles of chronic pain and gender on opioid withdrawal severity using a large, multi-site database. MethodsData were collected from N = 1252 individuals with OUD entering eight residential addiction treatment facilities. Demographic, drug use behaviors, and chronic pain status were collected at treatment intake, and self-reported opioid withdrawal and craving were measured at intake and 1–3 days, 4–6 days, and 7–9 days after intake. Regression analyses were used to predict withdrawal and craving severity at intake and across the four timepoints. ResultsAt intake, withdrawal was higher in persons who were older, had greater SUD severity, women, had chronic pain, and used > 1 substance (p-values ≤.007) and craving was higher in persons with greater SUD severity (p < .001) and women (p = .033). Withdrawal remained higher in women and persons with chronic pain across timepoints but decreased at a similar rate relative to comparators. ConclusionsWomen and persons with chronic pain would benefit from earlier engagement in treatment and may require a more intensive strategy to mitigate opioid withdrawal in early treatment.

Residential treatment and medication treatment for opioid use disorder: The role of state Medicaid innovations in advancing the field

BackgroundMortality due to opioid use continues to increase; effective strategies to improve access to treatment for opioid use disorder (OUD) are needed. While OUD medications exist, they are used infrequently and often not available in residential addiction treatment settings. CMS provides expanded opportunities for Medicaid reimbursement of treatment in residential facilities and requires states that request Medicaid SUD Waivers to provide a full continuum of care including medication treatment. The objective of this study was to assess how states facilitate access to OUD medications in residential settings and whether Medicaid requirements play a role. MethodsUsing a legal mapping framework, across the 50 states and DC, we abstracted data from state regulations in 2019 - 2020 and Medicaid Section 1115(a) demonstration applications. We examined the temporal relationship between state regulations regarding medication-assisted treatment for OUD in residential settings and Section 1115(a) demonstrations. ResultsWe identified variation in regulations regarding medication treatment for OUD in residential settings and possible spillover effects of the CMS requirements for Medicaid SUD Waivers. In 18 states with relevant regulations, regulatory approaches include identifying opioid medication treatment as a right, requiring access to OUD medication treatment, and establishing other requirements. 25 of 30 states with approved Section 1115(a) demonstrations included explicit requirements for OUD medication treatment access. Four states updated OUD medication treatment regulations for residential treatment settings within a year of applying for a Section 1115(a) demonstration. ConclusionsState regulations and Medicaid program requirements are policy levers to facilitate OUD medication treatment access.

Community trial evaluating the integration of Indigenous healing practices and a harm reduction approach with principles of seeking safety in an Indigenous residential treatment program in northern Ontario

ObjectiveOur primary objective was to evaluate how the Indigenous Healing and Seeking Safety (IHSS) model impacted residential addiction treatment program completion rates. Our secondary objective was to evaluate health service use 6 months before and 6 months after residential treatment for clients who attended the program before and after implementing IHSS.MethodsWe observed clients of the Benbowopka Residential Treatment before IHSS implementation (from April 2013 to March 31, 2016) and after IHSS implementation (from January 1, 2018 – March 31, 2020). The program data were linked to health administration data, including the Ontario Health Insurance Plan (OHIP) physician billing, the Registered Persons Database (RPDB), the National Ambulatory Care Reporting System (NACRS), and the Discharge Database (DAD). Chi-square tests were used to compare patient characteristics in the no-IHSS and IHSS groups. We used logistic regression to estimate the association between IHSS and treatment completion. We used generalized estimating equation (GEE) regression model to evaluate health service use (including primary care visits, ED visits overall and for substance use, hospitalizations and mental health visits), Results: There were 266 patients in the no-IHSS group and 136 in the IHSS group. After adjusting for individual characteristics, we observed that IHSS was associated with increased program completion rates (odds ratio = 1.95, 95% CI 1.02-3.70). There was no significant association between IHSS patients’ health service use at time one or time two. Primary care visits time 1: aOR 0.55, 95%CI 0.72-1.13, time 2: aOR 1.13, 95%CI 0.79-1.23; ED visits overall time 1: aOR 0.91, 95%CI 0.67-1.23, time 2: aOR 1.06, 95%CI 0.75-1.50; ED visits for substance use time 1: aOR 0.81, 95%CI 0.47-1.39, time 2: aOR 0.79, 95%CI 0.37-1.54; Hospitalizations time 1: aOR 0.78, 95%CI 0.41-1.47, time 2: aOR 0.76, 95%CI 0.32-1.80; Mental health visits time 1: aOR 0.66, 95%CI 0.46-0.96, time 2: aOR 0.92 95%CI 0.7-1.40.ConclusionsOur results indicate that IHSS positively influenced program completion but had no significant effect on health service use.Trial registrationThis study was registered with clinicaltrials.gov (identifier number NCT04604574). First registration 10/27/2020.

Validity and reliability of the short version of the UPPS-P impulsive Behavior Scale in patients with substance use disorders

ABSTRACT Background Impulsivity is a construct that is part of most theories of personality, and has been associated with psychiatric disorders, substance use and emotion regulation. Objective To evaluate the psychometric properties of the short version of the UPPS-P Impulsive Behavior Scale in adulthood substance users. Method Multi-site cross-sectional study. The UPPS-P short version was given to 246 participants in residential addiction treatment centers in Mexico. For external validity, emotion regulation, substance use, and the dual diagnostic scales were administered. Results The five-factor model (negative urgency, positive urgency, lack of premeditation, lack of perseverance and sensation seeking) had the best goodness-of-fit indices. Good reliability scores (omega coefficient) were obtained in all dimensions, as well as external validity with emotion regulation, substance use and psychiatric symptoms (anxiety, depression and attention deficit and hyperactivity disorder). Conclusions The UPPS-P short version showed good psychometric properties in a Mexican sample and thus can be considered a useful and practical tool in clinical and research contexts.

Leader in substance use treatment moves into residential mental health

One of the most nationally prominent names in residential addiction treatment services is venturing into residential care for patients with a primary mental health disorder. West Palm Beach, Florida‐based Hanley Center opened an eight‐bed residential mental health program late last month.

Traditional Amazonian medicine in addiction treatment: Qualitative results

Traditional Amazonian medicine, and in particular the psychoactive substance ayahuasca, has generated significant research interest along with the recent revival of psychedelic medicine. Previously we published within-treatment quantitative results from a residential addiction treatment centre that predominately employs Peruvian traditional Amazonian medicine, and here we follow up that work with a qualitative study of within-treatment patient experiences. Open-ended interviews with 9 inpatients were conducted from 2014 to 2015, and later analysed using thematic analysis. Our findings support the possibility of therapeutic effects from Amazonian medicine, but also highlight the complexity of Amazonian medical practices, suggesting that the richness of such traditions should not be reduced to the use of ayahuasca only.

Treatment of Opioid Use Disorder in Canadian Psychosocial Addiction Programs: A National Survey of Policy, Attitudes, and Practice.

ObjectiveTo describe current approaches in treatment of opioid use disorder (OUD) within Canadian psychosocial outpatient, day, and residential addiction treatment programs, with an emphasis on the use of opioid agonist therapy (OAT).MethodAn online census survey was conducted in English and French of Canadian psychosocial addiction treatment programs (N = 214).ResultsPrograms estimated that 25% of their clients have OUD. A slight majority of programs provide some type of specialized services to clients with OUD (58%), most frequently providing or facilitating access to OAT but also specialized counselling, case management, education, and harm reduction services.Most programs reported that they admitted clients on OAT (88%) and only a minority expected or encouraged clients to taper (14%) or discontinue (6%). Programs focusing on client abstinence as the treatment goal were more likely to expect or encourage tapering or discontinuation than programs that focus on helping clients achieve personal consumption goals. Of programs that did not currently facilitate OAT, 44% indicated that they would provide OAT, but lacked the necessary accreditation, physician support, or other resources. No philosophical objections to OAT were noted.OAT initiation was provided by 30% of programs, 23% referred to another service within their organization, and 29% referred to a service outside their organization. The remaining 18% did not facilitate OAT initiation at all, ranging from 0% in Quebec to 23% in the Prairies. Overdose response kits were provided by 86% of programs. The majority not providing kits indicated willingness if policy support and resources were provided (67%).ConclusionsOverall, the results demonstrate that psychosocial programs provide some specialized services for OUD but desire further support specifically to provide OAT, including training, knowledge, and the expertise of individuals qualified to prescribe and dispense OAT. Many psychosocial treatment programs expressed a need for staff and resources for this purpose.