Outcomes of four treatment approaches in community residential programs for patients with substance use disorders.

OBJECTIVE: Treatment approaches used in community residential facilities for patients with substance use disorders were identified, and patients' participation in treatment and case-mix-adjusted one-year outcomes for substance use, symptoms, and functioning in facilities with different treatment approaches were examined.
METHODS: A total of 2,376 patients with substance use disorders treated in a representative sample of 88 community residential facilities were assessed at entry to and discharge from the facility and at one-year follow-up. The community residential facilities were classified into four types based on the major emphasis of the treatment program: therapeutic community, psychosocial rehabilitation, 12-step, and undifferentiated.
RESULTS: Patients in programs that used the therapeutic community, psychosocial rehabilitation, and 12-step approaches had comparable one-year outcomes in symptoms and functioning that were better than those of patients in undifferentiated programs. A more directed treatment orientation, a longer episode of care, and completion of care were independently related to better one-year outcomes. These findings held for patients with only substance use disorders and for patients with both substance use and psychiatric disorders.
CONCLUSIONS: Community residential programs that have a more directed treatment orientation and that motivate patients to complete treatment have better substance use outcomes. As an increasingly important locus of specialized care, community residential facilities need to develop and maintain more differentiated and distinctive treatment orientations.