Addiction Medicine: Closing the Gap between Science and Practice

70.9

63.5 63.4 63.0 61.4

Family

Counseling

Supplementary

Medical Care

Mental Health

Care

Housing Vocational

Services

P E R C E N T

Source: CASA Columbia analysis of Friedmann et al (2004).

Figure 5.A

Addiction Treatment Patients' Perceived

Needs for Auxiliary Services

some point in their lives.^407 Homes are run
independently by the residents; there are no on-
site professional treatment providers. The
homes are supported financially by residents
who are required to pay the rent on time and
maintain their sobriety.* Contrary to a chronic
disease management approach, members who
relapse are expelled immediately from the house
and must demonstrate 30 days of sobriety before
reapplying for residence.^408 Residents are
expected to attend weekly meetings where house
issues are discussed and where they are
encouraged to attend mutual support
programs.^409

One study found that two years after completing
treatment and entering an Oxford House, current
and former residents were more successful at
decreasing their use of alcohol and other drugs
than those who completed treatment but simply
received standard aftercare referrals to outpatient
programs or self-help groups.^410 Over that
period, those who lived in an Oxford house were
less than half as likely as those who received
usual care to use any substance (31.3 percent vs.
64.8 percent), less likely to be currently facing
criminal charges (0.0 percent vs. 5.6 percent)
and more likely to be employed (76.1 percent vs.
48.6 percent) two years later. Only 15.6 percent
of participants who had lived in an Oxford
House for at least six months relapsed after two
years and residents ages 36 and younger
demonstrated a two-year relapse rate of only 6.7
percent.^411

Auxiliary Support Services ........................................................................................

Patients who complete treatment successfully
may find themselves facing relapse due to the
anxiety of coping with other health problems,
unemployment, child care, homelessness,
criminal justice and other social problems.^412
Matching patients with the services necessary to
address these problems decreases the risk of
relapse.^413

• New houses often are started with federal or state

loans stemming from the 1988 Anti-Drug Abuse Act;
the loans are paid back by the residents.

According to data from a national multi-site

study of a variety of treatment modalities, the

majority of treatment patients’ perceived a need

for auxiliary support services including family

counseling services (70.9 percent),

supplementary medical care (63.5 percent),

mental health care (63.4 percent), housing (63.0

percent) and vocational services (61.4

percent).^414 (Figure 5.A)

The perceived needs for supplementary medical,

including mental health, care underscore the

historic disconnect of addiction treatment from

medical care. Individuals who had their

perceived needs for vocational and housing

services met showed significant reductions in

illicit drug use.† 415

Evidence from a smaller study also

demonstrated that matching treatment patients

with services they need can decrease the severity

of their substance use.‡ Six-months after

enrolling in the study, patients who reported a

need for housing services and had their needs

matched experienced a greater reduction in their

substance use severity score compared to

patients with housing needs who were not

matched to services (50 percent vs. 23 percent

† Patients’ needs were determined by their rating of a

service as “somewhat or very important.” Because

patients were not randomly assigned to receive

services, the reductions in illicit drug use cannot be

linked directly to having their perceived service

needs met.

‡ As measured by the Addiction Severity Index.