Intervention variability predicts social rehabilitation indicators at discharge in long-term residential treatment.

The residential treatment model narrows the gap in substance use disorder’s network of assistance in Brazil by offering residential treatment to socially vulnerable populations. Due to a historical lack of evidence-based approaches, the government has established treatment guidelines and has been trying to implement training and monitoring methods.

This study analysed real-world data from the monitoring system implemented in the largest network of institutions receiving public funds in the State of Sao Paulo. Data came from 8,109 records of individuals admitted between 2014 and 2016 in 48 institutions.

Crack cocaine use was referred to by most of the sample, with the majority being single middle-aged men with a low level of education. More than half of the sample referred to not having any type of income and most of them were homeless upon admission. Regarding to participation in therapeutic activity, results shows that most participants experienced at least one activity, and almost all participants received individual psychosocial support. Results showed that less than half of the sample was exposed to at least one therapeutic activity from each of the recreational, spiritual, educational and selfcare intervention domains, as proposed by the national guidelines. Social rehabilitation, defined as achieving housing and self-support at discharge, was reported by 2 in 10 individuals, who stayed in treatment for an average of 82.6 days. Treatment duration and the diversity of the interventions offered were significantly associated with social rehabilitation at discharge, when combined and independent of each other. A dose-response trend was evident as the likelihood of achieving social rehabilitation at discharge twofold increased with permanence in treatment over 15 days. This association surged to eight times when individuals remained in residential treatment for at least 90 days regardless of how many domains of interventions these individuals were offered. The chances of social rehabilitation triplicated in a dose-response manner when residents were offered the full range of interventions, even when controlled by treatment duration.

Our findings confirmed the role of this model in promoting social rehabilitation to socially vulnerable, hard-to-treat individuals with crack cocaine use disorder. They also provide sufficient evidence to support the implementation and enforcement of current policies and regulations and might be able to promote its expansion and improvement. The recent growth in public investment toward therapeutic communities makes the monitoring and evaluation of their methodology a public health priority, urging for regulation policies and their enforcement. Our results can provide a fresh new approach to the residential treatment regulations and surveillance, paving the way for its replication elsewhere.