Barriers to Transitioning from Residential Substance Abuse Treatment and Strategies to Reduce Them

Background:  Although residential substance abuse treatment has been shown to improve substance use and other outcomes (Haynes et al., 2007), relapse is common (Carter et al., 2008). Aftercare services help maintain the gains achieved during residential treatment (Sannibale et al., 2003). However, prior research suggests that only 14% of individuals attend outpatient services following residential treatment, and less than half participate in self-help programs (Etheridge et al., 1997). This paper fills a gap by exploring the process of transition from residential substance abuse treatment and factors that help and hinder individuals during the transition.

Methods: We conducted semi-structured, in-depth interviews with 20 professional staff from outpatient and residential substance abuse treatment programs and 51 individuals receiving residential treatment in central Virginia. All textual data, such as transcripts and field notes, were analyzed through a series of iterative readings and codings. Data were first analyzed by “open coding” to discover themes, ideas, and issues. Next, “focused coding” was used to determine which themes, ideas, and issues were repeated often and which represented unusual or particular patterns. The codes were then grouped into a final set of themes and subthemes. We triangulated findings from our qualitative data sources to identify areas of consistency and discrepancy between staff and resident perspectives.

Results:  Staff participants held a diverse range of management, clinical and administrative positions and reported working in their current position an average of 5.3 years. Among resident participants, the majority were male (55%) with an average age of 37 years. Approximately 47% of residents were white, 33% were Black, 14% were Latino, and 6% were American Indian. Seventy four percent of residents had co-occurring mental health needs and 93% reported prior incarceration in jail or prison. Staff and resident participants described barriers to transitioning from residential treatment, as well as strategies to enhance transitions. Most staff and residents reported such barriers to transition as insufficient resources for transportation, housing, employment and other basic needs, as well as a limited support network. Staff described a lack of coordination among services as a significant challenge. Many residential participants worried about relapsing post-discharge due to family/friends who continued to use. Additional challenges because of residents’ felony status and mental health needs were also common. Strategies perceived by staff and residents to assist in transitions included having a support system in place, including formal services, self-help groups and positive family and friend supports. Some residents expressed internal conflict with those family members and friends who are supportive yet have a negative influence on their recovery. Residents also described the need for community resources and informal supports to facilitate their recovery following residential treatment.

Conclusion and Implications: This study highlights the complexity and challenges of discharging individuals from residential substance abuse treatment, but also suggests strategies for addressing these challenges. Results from this study will inform the adaptation and pilot testing of an evidence-based assertive outreach and linkage program that will provide enhanced support for individuals transitioning from residential substance abuse treatment.