Can Hobbies in Residential Treatment Prevent Treatment Dropout?

For many individuals with substance dependence (or moderate to severe substance use disorder [SUD] based on the current DSM-5 criteria), treatment is needed to facilitate SUD remission.

Importantly though, how long an individual stays in treatment and whether they successfully complete the program are strong predictors of positive outcomes.

Several factors predict treatment drop-out including but not limited to less education, minority ethnicity, unemployment, history of arrest, and co-occurring psychiatric symptoms and disorders.

Decker and colleagues posited that their original treatment add-on, called Natural Recovery (not to be confused with the unrelated “natural recovery” described by Sobell & Sobell, among others, meaning recovery from SUD without the aid of formal treatment), would improve treatment retention and completion in a sample of male veterans attending residential SUD treatment. The program was designed as a patient-centered, peer-driven alternative to more didactic, professionalized forms of relapse prevention that facilitated engagement in a recovery-supportive hobby.

In this pilot study, 643 patients were able to self-select into one of the hobby groups, horticulture (n = 101) or music/art (n = 30) or both (n = 8), or into a comparison psychoeducational lecture condition (n = 512). The Natural Recovery program included 1-hour group therapy for 14 weeks, and supported engagement in the respective activity 4 hours per weekend.

Although how the novel program would be effective was not formally tested, authors theorized that group discussion and learning, associating pleasurable activities with discussions of SUD recovery, and providing individuals with opportunities to participate in fun activities that confer relatively little relapse risk would enhance treatment completion and satisfaction.

Groups had variable demographic compositions. Caucasians, homeless individuals, and those with primary alcohol dependence were more likely to select into the Natural Recovery groups than the comparison condition. Partially consistent with hypotheses, authors found that participants in both Natural Recovery groups had longer treatment stays than those in the comparison condition (89 and 90 days for horticulture and art/music, respectively versus 74 days).


The Natural Recovery participants were also more likely to successfully complete treatment overall, though only those in the horticulture group – not those in the art/music group – had higher treatment completion rates than comparison.


Similarly, horticulture but not art/music participation (relative to comparison) predicted better treatment completion independent of other predictors of treatment completion, some of which are mentioned above (e.g., no co-occurring Axis I psychiatric disorder). Importantly, those with co-occurring Axis I (e.g., mood and anxiety) and Axis II (personality) disorders were more likely to complete treatment if in the Horticulture versus comparison group (79% versus 65% for Axis I and 89% versus 53% for Axis II). Patient satisfaction was similar in the Natural Recovery and comparison conditions.


Enhancing treatment engagement and completion can improve rates of SUD recovery and remission.

While co-occurring psychiatric disorders can lead to premature drop-out, in the absence of integrating high-quality psychiatric treatment into standard SUD care, Decker and colleagues provide preliminary evidence that incorporating a structured, prosocial, and peer-led activity group into residential care may boost treatment adherence for this vulnerable sub-group and for treatment seekers more broadly.

In parallel, we can speculate that this study further suggests participation in fun, sober activities as facilitators of increased recovery motivation and positive outcomes. Although unclear whether we would obtain similar findings if patients were randomized to treatment condition – precluding an assessment of whether Natural Recovery is an efficacious treatment – self-selection into specialized groups is an appropriate proxy for residential treatment as it typically occurs in the community making these activity groups promising add-on interventions for residential SUD care.



Decker, K. P., Peglow, S. L., & Samples, C. R. (2014). Participation in a novel treatment component during residential substance use treatment is associated with improved outcome: a pilot study. Addiction science & clinical practice, 9(1), 7.