Changes in services and structure in community residential treatment facilities for substance abuse patients

Objective: This study examined the extent to which community residential fa cilities that contract with the Department of Veterans Affairs (VA) to trea t substance abuse patients are providing more services and structure to mee t the needs of a client population with increasingly severe problems, Metho ds: A nationwide sample of 249 community residential facilities with VA con tracts was surveyed in 1995 and again in 1998, Results: In 1998 facilities were more likely than they were in 1995 to have psychiatrists and psycholog ists available to patients as well as specialized counseling and psychoeduc ational, rehabilitation, and medical services. Facilities also provided mor e social and recreational activities, and more structure was provided by di scouraging patients' choice of individual daily living patterns. In 1998 th e facilities were more likely to admit dual diagnosis patients, those with substance use disorders and psychiatric disorders. Programs that changed to ward accepting dual diagnosis patients had more services and structure than programs that consistently accepted only substance abuse patients, Conclus ions: Community residential facilities that contract with VA are responding appropriately to an increasingly ill patient population by providing more services and structure.