New Johns Hopkins research suggests that providing housing contingent on drug abstinence to inner-city opioid abusers leaving a detoxification program significantly increases their chances of remaining drug-free six months later.
Relapse rates for people leaving detox range from 65 to 80 percent one month after discharge, according to a report by the researchers published in the journal Addiction.
But, they say, those provided drug-free recovery housing coupled with an intensive day-treatment program may be up to 10 times more likely to stay abstinent than those released from detox with minimal assistance.
Even recovery housing alone, without therapy, was nearly five times as likely to keep people from returning to heroin, OxyContin and other opioids.
"Our research shows that providing recovery housing to opioid dependent people, with or without additional formalized treatment, results in much higher abstinence rates than detoxification alone," says study researcher Michelle Tuten, M.S.W., an assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. "These are people with a long history of failed treatment attempts and they need something more intensive than just a short stay in detox."
Tuten and her colleagues randomly assigned 243 opioid-dependent people in Baltimore who completed a three- to 14-day detox program to one of three groups: one whose members were provided recovery housing, paid for by the study for three months if the participant remained abstinent; a second whose members were provided recovery housing and also enrolled in a day-treatment program; and a third whose participants got information and referrals to community-based aftercare programs but who were not provided treatment. None of the 243 received opioid replacement medications such as methadone or buprenorphine.
For the groups in housing, the costs were covered for up to 90 days. Those in the day-treatment arm were expected to attend the program daily for the first three weeks, four days a week in weeks four through 12 and twice a week in the final 12 weeks of the 26-week program. Researchers assessed the participants' progress at one, three and six months.
After one month, 60 percent of those in the housing plus treatment group remained abstinent, 44 percent of those in the housing-only group were drug-free, and just five percent of those left on their own were still off drugs. Overall rates of abstinence during the study were 50 percent, 37 percent and 13 percent for the three groups, respectively. Those in the groups receiving housing continued to do much better at six months than those who did not receive housing, though relapse rates rose for them as the study progressed.
"After treatment ends, you see the effects decreasing over time," Tuten says. "It's hard to sustain the effects once treatment is removed. But it is important to keep in mind that these individuals have a chronic and relapsing disorder, and time in these housing programs does increase the likelihood of remaining abstinent."
Participants who started using drugs again were removed from recovery housing, Tuten reports. Those enrolled in day treatment stayed longer in recovery housing (an average of 50 days), compared to those provided housing alone (32 days). Participants were also more likely to stay in recovery housing for 60 days or more. And among those who stayed in recovery housing for more than 60 days, more than 50 percent were drug-free at six months. Participants in recovery housing were also more likely to be employed in the months after leaving detox, and to engage in recreational activities.
Tuten says the data suggest that abstinent-contingent housing is an effective way to prolong the time chronic substance abusers spend away from the neighborhoods and environments that triggered past drug use and it appears to encourage them to stay away from drugs longer.
Recovery housing is not cheap, she notes. The study paid $105 a week in rent for each participant. "The cost of housing is high, but it may be cost-effective compared to the medical and social costs associated with relapse," she says.
Other Hopkins researchers who were part of the study include Anthony DeFulio, Ph.D.; Hendree E. Jones, Ph.D.; and Maxine Stitzer, Ph.D.
The research was supported by the National Institutes of Health's National Institute on Drug Abuse.
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