Residential treatment is still an important piece of the continuum

~ Jason Schwartz

locations-dawn-farmA newly published study makes a case for residential treatment for opioid addicts:

Opioid users were much more likely to benefit from residential treatment compared to alcohol users. In contrast, the opposite was true for those with marijuana as a primary substance of abuse—the degree of benefit offered by residential treatment was less than that for alcohol abusers. However, for cocaine and methamphetamine users, there was no moderation effect—the effect of treatment setting on treatment completion did not differ from alcohol abusers.

We speculate that for opioid abusers, the increased structure and cloistering of residential treatment provide some protection from the environmental and social triggers for relapse or that otherwise lead to the termination of treatment that outpatient treatment settings do not afford. Indeed, environmental risk characteristics in drug abusers’ residential neighborhoods, such as the presence of liquor stores and indicators of concentrated disadvantage at the neighborhood level, have been found to be associated with treatment non-continuity and relapse (Stahler et al., 2007, Stahler et al., 2009 and Mennis et al., 2012). Such environmental triggers may play a particularly substantial role for those addicted to opioids compared to those seeking treatment for marijuana abuse. Since opioid users have the lowest raw completion rates in general (Table 1), this finding that residential treatment makes a greater positive difference for opioid users than it does for any of the other substances represents an important result that merits further investigation. Given the current epidemic of opioid-related overdoses in the U.S., our results suggest that greater use of residential treatment should be explored for opioid users in particular.

Published by Jason Schwartz

I have been an addiction professional and social worker since 1994. I started blogging in 2005 as the Clinical Director at Dawn Farm. I no longer work at Dawn Farm and am now the Director of Behavioral Medicine at a community hospital, and a lecturer at Eastern Michigan University’s School of Social Work. Views expressed here are my own. Keep in mind that the field, the contexts in which the field operates, and my views have changed over time.

One thought on “Residential treatment is still an important piece of the continuum”

  1. The beauty of Medication Assisted Treatment, is the benefit of treating the patient IN THEIR HOME COMMUNITY, where in, all the conditioned cues reside. Equally, the family can be integrated, to whatever degree necessary, while the patient is learning about recovery, developing recovery connections and de-conditioning those inevitable cues that lead to cravings. In an outpatient setting, the patient is able to exercise the one thing that Dr. pavlov demonstrated, with his canine patient. The only way to de-condition cues, is to expose the subject to the cue and than not experience the reward. In residential settings, a pseudo environment has been established, in which, all the conditioned cues have been removed (assuming that the program is, as in most cases, out of the patient’s community as identified by Jason).
    If patients are intoxicated on opiates or in acute or post acute withdrawal, they make poor candidates for any kind of treatment, since they are either numb of focused on their addiction. Buprenorphine, allows the patient to achieve a sense of normalcy, while they begin to access emotions, de-condition cues, re-connect with family and create those important connections to people in recovery.
    What other disease, requires some finite amount of treatment tha,t arbitrarily, defines specified recovery times for all patients?
    Ironically, those “cloistered environments”, in fact, eliminate a patient’s opportunity to de-condition the very cues that Jason references. By having the treatment available, in the home community, the flood of cues can be mitigated by the support of peers, experiencing the same emotional and physical realities. A tremendous argument FOR outpatient treatment as the optimal treatment milieu for opiate dependent patients.

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