The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review

Andrade, Dominique de; Elphinston, Rachel A.; Quinn, Catherine; Allan, Julaine; Hides, Leanne

doi:10.1016/j.drugalcdep.2019.03.031

Cited by 73 publications

(89 citation statements)

References 33 publications

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“…The trial also sought to determine various biopsychosocial outcomes, extending beyond the commonly investigated substance use and dependence indicators. While a positive association between LOS and clinical improvements has been found in previous studies [17], results have often been limited by potential response bias due to high attrition rates [6,9]. The very low attrition rates in this study add more reliable support to the link between increased LOS and clinical improvements.…”

Section: Study Design Strengths and Limitationssupporting

confidence: 56%

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Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

Staiger

Liknaitzky

Lake

et al. 2020

JCM

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The Therapeutic Community (TC) model is considered an effective treatment for substance dependence, particularly for individuals with complex presentations. While a popular approach for this cohort across a number of countries, few studies have focussed on biopsychosocial and longer-term outcomes for this treatment modality. This study reports on substance use, dependence, and biopsychosocial outcomes up to 9 months post-exit from two TC sites. Methods: A longitudinal cohort study (n = 166) with two follow-up time points. Measures included substance use, dependence, subjective well-being, social functioning, and mental and physical health. Generalized Linear Models were employed to assess change over time. Results: At 9 months, 68% of participants reported complete 90-day drug abstinence. Alcohol frequency and quantity were reduced by over 50% at 9 months, with 32% of the sample recording 90-day abstinence at 9 months. Both alcohol and drug dependence scores were reduced by over 60%, and small to medium effect sizes were found for a range of psychosocial outcomes at 9 months follow-up, including a doubling of wellbeing scores, and a halving of psychiatric severity scores. Residents who remained in the TC for at least 9 months reported substantially better outcomes. Conclusions: With notably high study follow-up rates (over 90% at 9 months post-exit), these data demonstrate the value of the TC model in achieving substantial and sustained improvements in substance use and psychosocial outcomes for a cohort with severe substance dependence and complex presentations. Implications for optimal length of stay are discussed.

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Section: Study Design Strengths and Limitationssupporting

confidence: 56%

“…This study sought to determine substance use and biopsychosocial outcomes at 3 months and 9 months following TC treatment across two sites. Furthermore, the length of planned TC treatment generally varies between four weeks and 12 months [4][5][6]. This study sought to determine the role of length of stay in clinical outcomes.…”

Section: Introductionmentioning

confidence: 99%

Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

Staiger

Liknaitzky

Lake

et al. 2020

JCM

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“…A systematic review on the topic of residential rehabilitation concluded that best practice residential care for any substance use disorder should include continuity of care postdischarge. 36 A review on group treatment for substance use disorders found that group treatment compared to no treatment had a small effect on abstinence however group treatment did not have a significant effect on the frequency of substance use or substance use disorder symptoms 37 . Additionally, with regard to opioid use disorder, it has been reported that…”

Section: Discussionmentioning

confidence: 99%

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

Morgan¹,

Daniels²,

Subramaney³

2020

SAR

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Background: Given that fewer than 50% of countries provide Opioid Agonist Maintenance Therapies (OAMT), it is important to assess whether other substances act as a substitute for heroin in recovering heroin users who receive detoxification models of treatment. There is a dearth of prospective studies from low-and-middle-income countries evaluating these patterns of substance use. Methods: 300 heroin users from the Gauteng province of South Africa were assessed on entry into inpatient detoxification and then followed-up 3 and 9 months after leaving treatment. Treatment consisted of 1 week of detoxification followed by 6-8 weeks of psychosocial therapy. We measured the overall changes in the prevalence of heroin, alcohol and other drug use at baseline and postrehabilitation. Comparison of these outcomes at enrolment, 3 months and 9 months was performed by a Generalised Estimating Equation (GEE) with the outcome as the dependent variable, observation point as the independent variable, and participant as the repeated measure. Injecting status and treatment completion were included as covariates. We also measured the individual pathways between heroin and alcohol use in the 210 participants that were seen at all three timepoints. Results: Of the original cohort, 252 (84.0%) were re-interviewed at 3 months and 225 (75.0%) at 9 months. From baseline to 3 months, the proportion of past month heroin users decreased significantly to 65.5%; however, during this time, the proportion of past month alcohol users increased from 16.3% to 55.2% (p<0.0001). When assessing the pathways between heroin and alcohol use at an individual level, 55.4% (n-97) of those who were past month alcohol abstinent prior to rehabilitation were using alcohol at 3 months. From 3 to 9 months the proportion of heroin users increased to 72.4% (p<0.0001), and during this time, the proportion of alcohol users decreased. Conclusion: After detoxification, a significant reduction in heroin use was observed with a concomitant increase in alcohol consumption. Under these circumstances, alcohol may have acted as a substitute for heroin in the short term. The initial reduction in heroin use 3 months postrehabilitation was followed by increased consumption 6 months later. This observation supports the need for interventions to prevent, monitor and treat high levels of alcohol use in heroin users post detoxification. The provision of OAMT is a necessary consideration to address both the risk of increased alcohol intake as well as the decline in heroin abstinence rates.

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“…Therefore, cross-disciplinary research using different methodologies and designs is much needed to scrutinize substance abuse in respect of etiology, maintenance, consequences, abstinence and relapse. Generally speaking, empirical studies using quantitative methods are more common than research involving qualitative inquiry, analysis of secondary data and/or documentary inspection [16,39,40]. In fact, research based on a range of methods and designs is useful in enhancing our comprehension of the nature and impact of substance abuse from different perspectives.…”

Section: Researching Substance Abuse: Methods and Designsmentioning

confidence: 99%

“…When researching substance abuse and its harmful effects, researchers predominantly focus on certain social groups with a higher tendency towards substance taking and misuse, such as adolescents and male adults [13][14][15][16][17][18]. This is valid, as they may encounter various demanding life and social challenges, expectations, interpersonal alienation and biological impulses, all of which are relevant to the triggering of their initiation into drug experimentation as a form of self-medication.…”

Section: Substance Abuse and Different Social Groupsmentioning

confidence: 99%

Substance Abuse and Public Health: A Multilevel Perspective and Multiple Responses

Yeung

Tam

2020

IJERPH

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Substance abuse has been a thorny public health concern throughout human history. Manifestly, prevention and treatment are the two main strategies commonly adopted to tackle the problem of substance abuse. They are in fact cross-disciplinary, and they relate to the various domains of heredity, biology, psychology, cognitive science, family, social development and cultural structures. This special issue, “Substance Abuse, Environment and Public Health,” has published empirical studies from different regions and countries globally to enhance the international exchange of latest views and findings on the etiology, processes and influences of substance abuse across different domains, through which a multilevel perspective is considered more helpful for analyzing its complex nature, courses and consequences. This in turn suggests the possible need to employ multiple responses dynamically and integratively in the prevention and treatment of substance abuse.

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The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review

Cited by 73 publications

References 33 publications

Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

Longitudinal Substance Use and Biopsychosocial Outcomes Following Therapeutic Community Treatment for Substance Dependence

<p>An Inverse Relationship Between Alcohol and Heroin Use in Heroin Users Post Detoxification</p>

Substance Abuse and Public Health: A Multilevel Perspective and Multiple Responses

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