A Comparison of Reinforcement Based Treatment (RBT) versus RBT plus Recovery Housing (RBT^RH)

Objectives Reinforcement-based treatment (RBT) plus recovery housing (RBT^RH) improves outcomes for individuals with opioid use disorders. No studies have examined the efficacy of RBT in the absence of abstinent-contingent housing. Methods We compared highly similar participants from a study of outpatient RBT (RBT, n = 55) and the RBT^RH (n = 80) arm of a randomized trial wherein participants received abstinent-contingent payment for recovery housing sponsored by the research program. Abstinence and employment outcomes were assessed at one, three, and six months. Regression was used to identify predictors of abstinence. Sensitivity analyses explored the impact of housing on outcomes. Results RBT and RBT^RH participants had similar abstinence and employment outcomes. Predictors of abstinence in the sample included recovery housing residence and employment. However, a distinct RBT sub-group emerged, as 33% of the sample accessed self-pay RH (RBT^SPRH). Sensitivity analyses compared the two RH groups (self-pay and program-supported) to RBT outpatient treatment (RBT). The RBT^SPRH and RBT^RH groups had similar abstinence outcomes, and both groups had superior abstinence outcomes compared to RBT. The RBT^SPRH group had the most sustained effects relative to RBT, including higher abstinence rates, and more favorable employment outcomes at six months (ps < .05). The RBT^SPRH group reported more days of employment compared to both the RBT and RBT^RH groups at three months (ps < .05). Conclusions Findings highlight the importance of recovery housing for promoting improved outcomes among RBT participants. Research is needed to explore the aspects of recovery housing versus outpatient treatment that are associated with improved outcomes in the population.