Evidence-Based Approach 

Evidence to Support Residential Supportive Treatment Findings

Introduction

Bed-based treatment programs provide structured environments for individuals with substance use disorders (SUD). This synthesis reviews five literature reviews that examine the effectiveness of these programs, focusing on their characteristics, outcomes, and the broader context in Ontario.

Characteristics of the Reviews

The literature reviews vary in methodologies and scopes:

• Community-Based Intensive Treatment: This review highlighted mechanisms that contribute to positive treatment outcomes, including the need for belonging, finding meaning in life, and self-determination theory. Incorporating culturally relevant practices, such as traditional healing, enhances effectiveness.

• General Findings: Most residential treatment programs show improvements across several domains, including reduced substance use, enhanced mental health, better social relationships, and overall well-being.

• Evidence Ratings: Recovery housing evidence was rated as moderate, with mixed outcomes concerning substance use, psychiatric symptoms, and social functioning. Some studies indicated positive results, while others found no significant differences compared to outpatient treatments.

Evidence on Effectiveness

The overall effectiveness of residential treatment for SUDs is generally positive, although evidence strength varies:

• Critical Factors for Success: De Salis et al. (2023) identified three key elements supporting successful treatment outcomes:

  • Sense of belonging

  • Finding meaning in life

  • Principles of self-determination

These findings suggest that residential programs are most effective when they foster personal growth, emotional connection, and a sense of purpose.

• Culturally Relevant Treatment: Toombs et al. (2022) examined bed-based treatment for Indigenous populations, finding that culturally relevant treatment models with community-based approaches yield better outcomes than standard programs, significantly increasing engagement and recovery success.

• Systematic Review Findings: Andrade et al. (2019) concluded that residential treatment generally improves substance use, mental health, and social functioning. Integration of mental health support and continuity of care post-discharge are critical for sustaining long-term recovery.

• CADTH Review: The 2019 CADTH review found limited quality evidence for the effectiveness of residential treatment programs but suggested that such programs might be equally or more effective than less intensive treatments.

• Recovery Housing: Reif et al. (2014a) rated recovery housing evidence as moderate, showing positive impacts on substance use and social functioning despite mixed findings due to variability in program models.

Ontario Context

Ongoing efforts in Ontario aim to enhance the quality of bed-based treatment programs:

• AMHO Position Paper (2019): Emphasizes the need for evidence-based standards, removal of exclusion criteria (e.g., for opioid substitution therapy), and multidisciplinary care models to address complex cases. Consistent funding and standardized approaches are crucial for quality care.

• Environmental Scan (Ali et al., 2023): Highlights challenges such as regional disparities in service availability and inconsistent access to Opioid Agonist Therapy (OAT), underscoring the need for standardized programs and improved system coordination.

Conclusion

The CRISM (2023) Guidelines indicate that while evidence supports the effectiveness of bed-based treatment programs in reducing substance use and improving health and social outcomes, there is insufficient evidence to assert that inpatient treatment is more effective than other approaches, including community-based services.

Critical success factors include fostering belonging, meaning, and self-determination through cultural adaptations. Community-based non-bed programs can be equally effective, emphasizing the importance of thorough assessment and matching for bed-based treatment. Despite varying evidence quality, community bed-based treatment services are vital within the continuum of care, especially when clients are well-assessed and matched. Integration with mental health services and ensuring continuity of care post-discharge are essential. The ASAM criteria further highlight key factors to consider when recommending bed-based treatment programs.

References

Addictions and Mental Health Ontario (AMHO). (2019, June 3). Residential treatment of adult substance use disorders: Position paper. AMHO.

Ali, F., Law, J., Russell, C., Bozinoff, N., & Rush, B. (2023). An environmental scan of residential treatment service provision in Ontario. Substance Abuse Treatment, Prevention, and Policy, 18(73). https://doi.org/10.1186/s13011-023-00586-3

American Society of Addiction Medicine. (2022). The ASAM criteria. https://www.asam.org/asam-criteria

CADTH. (2019, January). Residential treatment for substance use disorder (CADTH rapid response report: Summary with critical appraisal). Ottawa, Canada: CADTH.

Canadian Research Initiative in Substance Misuse (CRISM). (2023). Canadian guideline for the clinical management of high-risk drinking and alcohol use disorder. https://www.helpwithdrinking.ca

de Andrade, D., Elphinston, R. A., Quinn, C., Allan, J., & Hides, L. (2019). The effectiveness of residential treatment services for individuals with substance use disorders: A systematic review. Drug and Alcohol Dependence, 201, 227–235. https://doi.org/10.1016/j.drugalcdep.2019.03.031

De Salis, H. F., Martin, R., Mansoor, Z., Newton-Howes, G., & Bell, E. (2023). A realist review of residential treatment for adults with substance use disorder. Drug and Alcohol Review, 42(4), 827–842. https://doi.org/10.1111/dar.13615

Reif, S., George, P., Braude, L., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014a). Recovery housing: Assessing the evidence. Psychiatric Services (Washington, D.C.), 65(3), 295–300. https://doi.org/10.1176/appi.ps.201300243

Reif, S., George, P., Braude, L., Dougherty, R. H., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014b). Residential treatment for individuals with substance use disorders: Assessing the evidence. Psychiatric Services (Washington, D.C.), 65(3), 301–312. https://doi.org/10.1176/appi.ps.201300242

Rush, B. R., & Needs-Based Planning Project Team. (2023). National needs-based planning project core services framework (Version 1.0). Needs-Based Planning Project. https://needsbasedplanning.ca

Toombs, E., Marshall, N., & Mushquash, C. J. (2021). Residential and non-residential substance use treatment within Indigenous populations: A systematic review. Journal of Ethnicity in Substance Abuse, 20(2), 316–341. https://doi.org/10.1080/15332640.2019.1622478