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

Objective: Treatment approaches used in community residential facilities fo r patients with substance use disorders were identified, and patients' part icipation in treatment and case-mix-adjusted one-year outcomes for substanc e use, symptoms, and functioning in facilities with different treatment app roaches were examined. Methods: A total of 2,376 patients with substance us e disorders treated ina representative sample of 88 community residential f acilities were assessed at entry to and discharge from the facility and at one-year follow-up. The community residential facilities were classified in to four types based on the major emphasis of the treatment program: therape utic community, psychosocial rehabilitation, 12-step, and undifferentiated. Results: Patients in programs that used the therapeutic community, psychos ocial rehabilitation, and 12-step approaches had comparable one-year outcom es in symptoms and functioning that were better than those of patients in u ndifferentiated programs. A more directed treatment orientation, a longer e pisode of care, and completion of care were independently related to better one-year outcomes. These findings held for patients with only substance us e disorders and for patients with both substance use and psychiatric disord ers. 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 speci alized care, community residential facilities need to develop and maintain more differentiated and distinctive treatment orientations.