Residential rehabilitation for drug users: a review of 13 months' intake to a therapeutic community

Background. Residential rehabilitation based on 'therapeutic community' tre atment for drug users is a treatment option which is attractive to GPs and others referring drug users for treatment. Whilst there is evidence that ma intenance-based programmes for drug users are effective, there have been fe wer attempts to evaluate the effectiveness of abstinence-based programmes w hich are relatively more intensive and expensive interventions. Objective. This paper reports and evaluates the outcomes for 13 months' int ake of 138 drug users to a residential community. Methods. We carried out a retrospective cohort study using existing clinica l and residential record data. The setting is a residential rehabilitation centre run by the charity Phoenix House in Sheffield, UK, offering a 1-year programme for heroin addicts including community detoxification overseen b y primary care specialist doctors and residential rehabilitation. Participa nts were all patients who entered treatment between 1 February 1998 and 28 February 1999 inclusive. An analysis was carried out of clinical records an d other records kept by clinicians and staff at the centre. Outcome measure s were numbers of days of retention in treatment and reasons for departure, categorized as completed treatment, planned or unplanned departure and exp ulsion from the programme. For patients who underwent in-house detoxificati on, a further outcome measure was whether or not detoxification was complet e at discharge. Results. Heroin was the main drug of abuse in 85% of admissions. Mean lengt h of time for which individuals had been drug dependent was 8 years (range 1.3-20.1 years). The mean length of stay was 80.2 days (range 1-394, 95% co nfidence interval 61.8-98.6). Thirty-four individuals (25%) completed 90 da ys or more. No association was found between length of stay and age, sex, r oute of administration, polydrug use, length of time addicted or age of fir st addiction. Sixty-five per cent of those who received in-house detoxifica tion completed the detoxification period. When patients were classified as 'successes' or 'failures' by reason for departure from the programme, 94 (6 8.1%) were classified as failures and 18 (13.0%) as successes. Data were un available for 26 patients. Success was not associated with any characterist ic at entry apart from being drug free as opposed to requiring detoxificati on (P = 0.048, chi-square = 6.06, df = 2). Conclusion. This study shows overall low levels of programme completion and high levels of unplanned departure and eviction from the programme amongst these long-term drug users. On the other hand, the importance of abstinenc e for those who achieve it in residential rehabilitation should not be unde restimated, nor should the possibility that long-term outcomes are influenc ed by the learning process involved in the intervention. It may be possible to operate better selection procedures in order to optimize outcomes.