Can horse therapy help those with substance issues complete treatment?

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Patients with substance use disorders enrolled in a study were more likely to complete treatment if horse-assisted therapy was involved, researchers report.

The study at Oslo University Hospital in Norway found that 44% of the patients completed their treatment when the horse element was involved, compared with 32% who completed the conventional therapy program, which had no equine component.

Unfortunately, some unforeseen challenges — the number of transfers to another treatment, variable attendance at the horse sessions, long temporary exits, and withdrawals which reduced the number of initial subjects — meant the differences in completion rates could not be considered statistically significant.

Francesca Gatti and her colleagues, writing in the journal Addiction Science & Clinical Practice, noted that treatment completion is the greatest challenge for the treatment of substance use disorders.

A previous investigation showed that complementary horse-assisted therapy was associated with higher retention in treatment and completion than standard treatment alone.

The study team set up a randomized controlled trial to learn more about the benefits of adding horse-assisted therapy for patients with substance use issues.

The researchers had intended enrolling 50 patients in residential treatment, randomly assigned to either conventional therapy, or conventional therapy with the additional equine element, which included ground and mounted work.

Only 37 participants were ultimately recruited from the residential substance use disorder treatment program at the Department of Addiction Treatment at Oslo University Hospital, which may have left the study underpowered.

Four of the initial 50 were found to be not eligible (they had previously taken part in the horse program), two did not return a signed consent form and seven withdrew their consent (five assigned to the equine group did not want to do the horse program, and two from the conventional therapy group were not happy doing the conventional program only).

Nevertheless, a higher percentage in the group that received horse therapy completed their treatment than those in the conventional treatment group.

“This observation encourages further investigation in a larger sample,” the authors wrote.

Further work in a larger clinical population is needed, they said. Observational studies with repeated measures may also be useful for investigating whether the horse element increased retention in treatment or rates of completion — two important factors for success.

The researchers, discussing their findings, said their hypothesis that the horse element would improve treatment retention and completion was based on recently published results from their own study group on a sample of 108 patients.

They suspect that the reduction in sample size from 50 to 37, and the fact that only 2 patients (11%) completed the 12 horse-related sessions, were the main cause of the lack of statistical significance in the results.

The study team comprised Gatti, Espen Walderhaug, Ann Kern-Godal, Jeanette Lysell and Espen Ajo Arnevik, all affiliated with the Department of Addiction Treatment at Oslo University Hospital.

Gatti, F., Walderhaug, E., Kern-Godal, A. et al. Complementary horse-assisted therapy for substance use disorders: a randomized controlled trial. Addict Sci Clin Pract 15, 7 (2020). https://doi.org/10.1186/s13722-020-0183-z

The study, published under a Creative Commons License, can be read here

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