Content uploaded by Douglas Polcin
Author content
All content in this area was uploaded by Douglas Polcin on Dec 10, 2015
Content may be subject to copyright.
Challenges and Rewards of Conducting Research on Recovery
Residences for Alcohol and Drug Disorders
Douglas L. Polcin, Ed.D.1,*, Amy Mericle, Ph.D.1, Sarah Callahan, M.A.2, Ronald Harvey,
Ph.D.2, and Leonard A. Jason, Ph.D.2
1Alcohol Research Group, Public Health Institute, 6475 Christie Avenue, Suite 400, Emeryville,
CA 94608-1010
2DePaul University, Center for Community Research, 990 W. Fullerton Ave., Chicago, IL
60614-3504 990
Abstract
Although research shows treatment for alcohol and drug problems can be effective, persons
without stable housing that supports recovery are at risk for relapse. Recovery residences (RRs)
for drug and alcohol problems are a growing response to the need for alcohol- and drug-free living
environments that support sustained recovery. Research on RRs offers an opportunity to examine
how integration of these individuals into a supportive, empowering environment has beneficial
impacts on substance use, housing, and other outcomes, as well as benefits for the surrounding
community. Research can also lead to the identification of operations and practices within houses
that maximize favorable outcomes for residents. However, research on RRs also presents
significant obstacles and challenges. Based on our experiences conducting recovery home research
for decades, we present suggestions for addressing some of the unique challenges encountered in
this type of research.
Keywords
Recovery Residence; Recovery Home; Oxford House; Sober Living House
Introduction
Research over the past several decades has shown a consistent albeit moderate impact of
treatment on substance use disorders (National Institute on Drug Abuse, 2012). One factor
affecting the success of treatment is the availability of recovery capital, which includes the
economic and social resources necessary to access help, initiate abstinence, and maintain a
recovery lifestyle (Cloud & Granfield, 2008; Laudet & White, 2008). Individuals with
substance use disorders who are unemployed, do not have stable housing, or are involved in
the criminal justice system are particularly vulnerable given their limited access to recovery
capital. RRs, such as Oxford Houses™ (OHs), sober living houses (SLHs), and other types
of recovery homes for alcohol and drug problems can help increase recovery capital by
*Corresponding Author. Phone (510) 597-3440, Fax (510) 985-6459, DPolcin@aol.com.
HHS Public Access
Author manuscript
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
providing affordable, alcohol- and drug-free living environments and peer support for
recovery (Jason, Mericle, Polcin, & White, 2013).
Types of Recovery Residences
There are different types of recovery residence models that vary in terms of administration,
services offered, type of residence, and staffing. The National Association of Recovery
Residences (National Association of Recovery Residences, 2012) is an organization that
provides advocacy and standards for RRs and has devised four levels of RRs based on these
factors. All levels provide an abstinent living environment and social support for recovery
within a communal living arrangement. Level I residences are democratically run by
resident peers, offer no on-site services, are small facilities located in residential
neighborhoods, and do not employ on-site staff. Resident fees usually cover financing of
these homes and residents are free to live there as long as they wish. OH’s are good
examples of these residences. Level II residences are similar to level I houses in most
respects, but they typically have an on-site house manager who oversees house operations.
The manager is typically paid or receives reduced rent but is considered a recovering peer,
not a professional service provider. Good examples of these residences are SLHs, many of
which are located in California. A key difference between level III houses and the first two
levels is that they often offer on-site recovery support and other services and employ paid
staff. Some of the recovery homes in Philadelphia studied by Mericle, Miles, Cacciola and
Howell (2014) are could be considered Level III residences. Level IV houses tend to have an
organizational hierarchy, offer on-site clinical services delivered by certified and licensed
professionals, and are often larger facilities licensed as treatment programs.
This paper primarily addresses research conducted on the first three levels because they have
been studied less than level IV residences. RRs present unique challenges, including
recruitment of individuals across multiple sites, describing common and unique
characteristics of individual homes, tracking participants for follow-up interviews, enlisting
homes as partners in research, and implementing the most appropriate research designs.
Our collective experiences studying recovery homes draw primarily upon research
conducted on three types of recovery homes: Oxford Houses (OHs), California Sober Living
Houses (SLHs) and a mix of level II and III recovery homes in Philadelphia. OHs are a good
example of level I homes. They began as a grassroots movement in the late 1970’s and have
seen continued growth over the past four decades. Currently, there are over 1,700 houses
nationwide. Research on OHs has been conducted by a team from DePaul University over
the past several decades and they have documented favorable outcomes relative to control
groups for persons who entered OHs after leaving treatment and criminal justice institutions
(Jason, Olson, Ferrari, & Lo Sasso, 2006; Jason, Olson, & Harvey, 2015; Jason, Salina, &
Ram, in press). An additional study documented good outcomes for persons who were
current residents and followed up over three 4-month intervals (Jason, Davis, & Ferrari,
2007). The OH network is the only level I or level II RR model that has been endorsed by
SAMSHA as being effective as an aftercare service for persons completing long-term
therapeutic community treatment (see the Substance Abuse and Mental Health Services
Administration National Registry of Evidence-Based Programs and Practices (Substance
Polcin et al. Page 2
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Abuse and Mental Health Services Administration, 2013). Although outcome studies of
SLHs and other types of level II RRs have been conducted, there is a need for randomized
designs that would make them eligible for the SAMSHA endorsement. There have been a
number of randomized trials over the past decade supporting the effectiveness of level III
and IV residences (e.g. (Cheng, Lin, Kasprow, & Rosenheck, 2007; Greenwood, Woods,
Guydish, & Bein, 2001; Milby, Schumacher, Wallace, Freedman, & Vuchinich, 2005;
Sacks, Chaple, Sacks, McKendrick, & Cleland, 2012).
California SLHs are the predominant recovery residence model in California and are good
examples of level II houses. The earliest forms of SLHs emerged in the 1940’s in response
to housing need among groups of persons attending Alcoholics Anonymous (Wittman &
Polcin, 2014). There are currently about 800 homes in California associated with two
different organizations, the Sober Living Network and the California Association of
Addiction Recovery Resources. A team of researchers at the Alcohol Research Group has
conducted studies on SLHs over the past decade. Using an “intent to treat” design assessing
all individuals entering SLHs over an 18-month time period, researchers documented
significant improvement in multiple areas of functioning (e.g., reduced substance use,
reduced arrests, increased employment) that were maintained over the 18-month time period
(Polcin, Korcha, Bond, & Galloway, 2010a; Polcin, Korcha, Bond, & Galloway, 2010b).
These studies are the only investigations of level I or level II houses to assess longitudinal
outcomes for the heterogeneous mix of all individuals who are referred to recovery houses
from multiple referral sources. Previous longitudinal studies have focused on specific
subgroups, such as persons entering residences after completing long-term residential
treatment (Jason et al., 2006).
A final group of researchers examining RRs studied recovery homes in Philadelphia
(Mericle, Miles, Cacciola, & Howell, 2014; Mericle, Miles, & Cacciola, 2015). These
residences differed from OHs and SLHs in that some were publicly financed, had limits on
how long residents could stay, and offered a variety of on-site services. Researchers
documented that these houses generally fit into level II and III houses and used a peer
oriented “social model” approach to recovery to varying degrees.
Despite their increasing numbers and potential influence, relatively few research teams
beyond the aforementioned groups have studied RRs. One aim of this paper is to discuss the
rewards of engaging in this work in terms of the beneficial impact that RRs can have on
individuals struggling with substance abuse and housing instability. We also identify the
important role that RRs can play in systems of care for persons with substance abuse
disorders.
We suggest there is a balance in this work between maintaining an objective, scientific
perspective and recognizing how the personal experiences and reactions we have as we as
we interact with participants motivates us to do this work. A second aim is to identify the
obstacles and challenges we have encountered during our research on RRs and ways of
handling these issues that can help prepare future researchers for this work.
Polcin et al. Page 3
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Recovery housing as a priority for addiction research
After decades of emphasizing acute care and brief intervention models for treating persons
with alcohol and drug disorders, researchers, policymakers and providers are increasingly
focusing on services that can help individuals sustain long-term recovery in the community
(McLellan, 2002; Scott, Dennis, Laudet, Funk, & Simeone, 2011). A major problem with
acute care interventions is that the improvements made during treatment are often short-
lived, particularly if the individual does not have access to an alcohol and drug free-living
environment that supports recovery. Many of the strategies to improve continuing care
services after treatment have included ongoing case monitoring and phone based
interventions (Dennis, Scott, & Funk, 2003; McLellan, McKay, Forman, Cacciola, & Kemp,
2005; McKay, 2005). However, we posit that a critically important component of successful
long-term recovery is access to an alcohol- and drug-free living environment that includes
social support for recovery. RRs are good examples of these types of services and they are
rapidly increasing in numbers (National Association of Recovery Residences, 2012).
However, only a few research teams have engaged in studying resident outcomes.
Although research has been conducted on self-help groups such as Alcoholics Anonymous
(Ye & Kaskutas, 2009), only a few research teams have examined RRs. Many treatment and
research professionals have limited knowledge about them and these types of services
receive scarce if any attention in graduate training programs. When grant applications to
study RRs are submitted to funding sources reviewers may have limited knowledge about
them and a variety of incorrect assumptions. It is therefore critical for applicants to clearly
describe the organization and operations of the RRs to be studied along with the potential
benefits to residents. Because they are less familiar to reviewers, applicants have an
opportunity to highlight innovation. There is a clear need for more dissemination of
information about RRs as an adjunct or alternative to treatment. There is also a need for
more dissemination of the growing evidence base for RRs.
When researchers decide to study RRs, they face a variety of potential obstacles. In addition
to the difficulty acquiring funding, there are problems such as identifying the population of
recovery homes from which to sample, recruiting residences, characterizing different types
of residences, enlisting residents as partners in research, tracking research participants for
follow-up interviews, and considerations for research measures and designs. Suggestions for
addressing these issues are discussed below based on our experience studying RRs for over
a decade. We also discuss some intrinsic personal rewards in this work that go beyond the
satisfaction garnered by addressing gaps in service delivery and research.
Identifying and Sampling Recovery Residences
A unique challenge to studying RRs is that, compared substance abuse treatment, they are a
less well-understood phenomena and information to characterize and identify them is still
evolving. Treatment programs that are licensed by states are typically readily identifiable.
However, recovery residences are usually not licensed and therefore harder to identify. That
being said, a number of strides have been made with respect to defining RRs, delineating
different types of them, and identifying where they are located--factors integral to
Polcin et al. Page 4
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
highlighting the potential uniqueness of a particular study and to addressing the
generalizability and impact of findings from the study.
For a number of years, Oxford House, Inc. has maintained a directory of houses and
operated a website providing information about the OH model as well as a listing of houses
that can be searched by state. These resources have proved to be invaluable to researchers in
terms of locating and recruiting houses into research studies. The formation of the National
Alliance for Recovery Residences (NARR) has represented an important step forward for
non-OH residences. Standards developed by NARR (National Association of Recovery
Residences, 2012) categorize different types of RRs (including OHs) based on their
organizational structure, physical characteristics, staffing, and services provided. In addition
to providing a framework for understanding RRs, NARR provides support to statewide and
regional affiliate organizations in their efforts to certify that residences operating within
their geographic purview do so in accordance with the NARR standards. The NARR website
lists states with RR organizations affiliated with NARR. Unfortunately, there is currently no
national directory of residences implementing the NARR standards—a substantial
impediment to research on non-OH RRs. However, many state-level affiliates of NARR,
such as the Georgia Association of Recovery Residences and California’s Sober Living
Network, do maintain a listing of certified residences which can be used to identify potential
research sites. However, a significant challenge noted by Mericle, Miles & Cacciola (2015)
is that some RRs close after short periods of time and some of these residences later reopen
or relocate, which makes them difficult to track. In addition, residences that are not affiliated
with any recovery residence organization are difficult to study because there is no systematic
way to know of their existence. Generalization of research from studies of homes associated
with recovery house organizations that monitor quality to non-affiliated homes is
questionable at best.
Engaging Recovery Residences as Partners in Research
Locating RRs and developing a sampling plan is only a first step. Enlisting the support of
decision makers and key stakeholders is a critically important step in the research process
(Henderson, Sword, Niccols, & Dobbins, 2014; Ross, Lavis, Rodriguez, Woodside, &
Denis, 2003), and studying RRs and those who live in them requires the support and
involvement of those in charge of running them. Because RRs vary in their organizational
structure and staffing, this may be one person or it may be a variety of individuals, and
identifying critical gatekeepers can often be a challenge. However, prior to embarking on a
study, it is critical to identify who does what within a particular residence and who else may
be involved in decisions that are made in the residence; “buy-in” is essential at every level.
The successful implementation of studies on OHs illustrates the importance of RRs having
an organizational structure that supports research. OHs are part of a national organization
that has local chapters within states. Chapters include volunteers and in some states paid
staff who help new houses successfully launch their homes and implement standards
required of all OHs. Chapters are also available to help homes that are struggling with
difficult internal issues (e.g., noncompliance with house rules and regulations, dropout, etc.)
or responding to pressures from the surrounding community. OH staff and volunteers at the
Polcin et al. Page 5
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
national and chapter level have been instrumental in supporting research by educating
consumers about its importance and encouraging resident participation in studies. In
addition, each year there is an annual OH conference where staff, volunteers, residents, and
researchers come together to celebrate recovery and share information, experiences, ideas,
research results, and plans for the future. Interaction among these groups helps generate new
research ideas, interpret the meaning and practical implications of research findings, and
disseminate findings within the organization.
Regardless of organizational support, it is critical to engage those in the residence
overseeing the day-to-day operations of it. These individuals may be most knowledgeable
about what actually happens in the residence (as opposed to what may written in a manual or
brochure), and they are the gatekeepers to the residents living there. Although directors or
clinical staff in treatment programs may have had some prior exposure to research or
training in research methods as part of their formal education, it is unlikely that the person in
charge of the operations of the residence has had these experiences (Mericle et al., 2015).
Given the constraints of resources available to RRs and their operators, it is important to
understand the limitations of their ability to coordinate research protocols and to take this
into account when designing studies. Although failure to adhere to study procedures may
seem like resistance, it is more likely the case that the researcher needs to do more education
about why the procedures are necessary and to provide more support to the person in charge
of the residence to ensure that the research procedures can be carried out.
Individuals in the upper-tier of the organizational hierarchy must be clear about their role in
the research. It is important for these individuals to understand that the purpose of scientific
research is to answer important questions. They need to understand that research is often
theory-based and hypothesis-driven, meaning that researchers have ideas about potential
outcomes of the research, but that a hallmark of scientific research is objectivity, meaning
that researchers should strive to be distanced from what they study so that findings depend
on the nature of what was studied rather than on the beliefs and values of the researcher
(Payne & Payne, 2004). Individuals who own and operate RRs understandably have strong
beliefs about the value of what they are doing as well as a financial stake in being able to
claim that scientific evidence supports it. Researchers can feel considerable pressure to
report only findings that support RRs and ignore or minimize negative findings. To the
degree that this occurs, data that could be used to improve RRs and delineate their role
within larger recovery systems can get lost. The inherent difference in perspectives can
potentially create obstacles in the research process, particularly if the owner/operator is
unfamiliar with research and the need for it to be objective. However, those who own/
operate RRs help people successfully recovery from addiction, often in the face of
tremendous obstacle and barriers (Mericle, Miles, & Way, 2015). It important to underscore
that research provides information that can be used to validate the areas of strength of RRs,
but it can also be used to point out issues that need attention to improve operations and, most
importantly, resident outcomes.
Polcin et al. Page 6
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Addressing Specific Issues
Research on RRs entails all of the challenges of community-based research, starting with the
selection of research methods that will result in collection of valid and generalizable data.
Beyond that, there are specific considerations for coordination of activities across multiple
research sites, locating study participants for research interviews, and utilizing personal
experiences as a way to understand the impact of RRs on residents’ lives. The issues
discussed below and the suggestions for addressing them are based on our collective
experiences studying RRs for the past two decades.
Study Designs
RRs emerged organically as grassroots movements among persons in recovery and that
history has implication for selection of optimal research designs. In a variety of publications
Borkman and colleagues (Borkman, 1999; Borkman, Kaskutas, Room, Bryan, & Barrows,
1998) pointed out that mutual help services that are based on peer support cannot be
adequately understood from the vantage point of researchers and professionals alone.
Understanding the rationale for these services, their operations, and ways they are helpful
must draw on the experiences and views of participants. Our research on RRs has
demonstrated a pluralistic research program designed to understand the many facets of
RRs, including resident experiences and perceptions as well quantification of resident
outcomes. Qualitative methods have included focus groups, qualitative interviews, and
observation of the physical and social characteristics of houses. These methods have helped
us understand not only what is occurring in RRs, but also how and why, which has provided
information that has informed the development of formal hypotheses addressing outcomes
and mechanisms of action.
Quantitative studies that test a priori hypotheses have used different designs, each with
strengths and weaknesses. Randomized designs that compare outcomes of individuals
receiving different services have the advantage of showing causality. Such designs have
been used to study samples of persons entering RRs after leaving controlled environments
such as residential treatment (Jason et al., 2007) and criminal justice incarceration (Jason et
al., 2015). Randomization has also been used to study an add-on intervention, (motivational
interviewing case management) after individuals enter RRs (Polcin, in press). In the first two
instances the RRs operated as a type of aftercare or post-release intervention after release
from a controlled environment. In the other randomized study, the add-on intervention is
being studied in terms of effects on outcome, not the effects of the RRs.
There have been no randomized trials that included samples of all persons entering RRs.
Such studies would include individuals without recent residential treatment or incarceration.
As described elsewhere (Polcin, in press), there would be a number of challenges in such
studies. Refusal rates for participation in the research would likely be much higher than that
of persons leaving a controlled environment, which would create problems with
generalization of results.
Unlike residential treatment or criminal justice populations, there is no readily available
comparison group (e.g., aftercare or probation or parole as usual). These limitations indicate
Polcin et al. Page 7
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
that there is an important role for descriptive longitudinal and other quasi-experimental
studies that document outcomes over time. Although such designs do not prove that the
improvements residents make are due to their residence in a RR, there are a variety of
assessment strategies that can be used to increase confidence about the role of RRs in
influencing outcomes (Polcin, in press). These include multivariate techniques that can parse
out the relative influence of various factors in predicting outcome over time, testing whether
theoretically relevant variables are significant predictors of outcome, and conducting
propensity score matching (PSM) analyses. PSM estimates the effect of an intervention by
controlling covariates that predict receiving the treatment versus not receiving it. The
challenge of using this procedure in research on RRs is that it can be difficult to identify all
of the potential factors that might influence entry into a recovery residence. For a more
complete description of PSM methods see Ye and Kaskutas (2009).
Coordination of Study Procedures
A major challenge in RR research is coordination of research procedures across multiple
houses in different locations. Houses can vary by size, mix of residents, services offered,
location, and neighborhood characteristics. There are many types of recruitment strategies
that researchers can pursue, but they need to pay careful attention to their selection of
houses, types of residents within houses, and nesting effects of individuals within houses. In
general, researchers either need to recruit enough houses to implement multilevel designs
that assess house differences of ensure that all houses are similar enough to make
differences inconsequential. Whatever is decided, specification of the houses sampled and
the limitations of that sample need to be explicit in the dissemination of findings.
There can also be significant logistical issues related to the fieldwork when recruiting
residents from multiple houses, particularly when these houses are not in close proximity to
one another. For example, in an ongoing study of RRs in Los Angeles researchers travel to
and from the homes to conduct research interviews and deliver an add-on intervention that is
part of the study has been time consuming due to traffic congestion and the large geographic
area. There can also be challenges in terms of finding an appropriate place to meet to
conduct research interviews. Houses often do not have offices and ensuring sufficient
privacy can be an issue. This contrasts markedly with studies that take place at treatment
programs where office space may be readily available. Potential options that researchers can
consider to address these issues include renting additional office spaces near houses,
pursuing part-time rental space from existing programs located near houses, conducting
research and intervention interviews by phone when in-person meetings are not feasible and
meeting with residents in public places when they provide sufficient privacy (e.g., coffee
shop or park).
Participant Retention
Longitudinal designs are essential to assessing resident outcomes. Barriers to collecting
longitudinal data on substance abusing and recovering populations include transient and
precarious housing situations, difficulty obtaining accurate contact information from
government and public databases, and a lack of familiarity with the communities in which
participants reside (Gilliss et al., 2001). Following up with individuals in RRs poses
Polcin et al. Page 8
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
additional challenges because many are involved in the criminal justice system. Because
many come directly from incarceration or from residential treatment, they do not have a
stable address where they can be located after they leave the RR. In addition, many have
been cut off from family and friends during incarceration, which limits the number of
persons that researchers can contact to locate participants. Despite these challenges, those
researching RRs have generally been able to achieve acceptable follow-up rates even when
residents were followed for more than a year after their baseline interviews (Jason et al.,
2006; Jason et al., 2015; Polcin, Korcha, Bond, & Galloway, 2010a).
A number of resources have been developed to increase follow-up rates with substance
abusing and recovering populations (Hall et al., 2003) (Scott, 2004). We have found these
all to be invaluable resources. However, some things that we have found particularly useful
are rapport-building at recruitment, extensive collection of collateral contacts (family
members and friends of the participants who may be more likely to own property, have cell
phones, social networking accounts, or online presences, and be easier to reach), provision
of trinkets (e.g., a key chain, pen, calendar), use of graduated incentives, maintaining contact
between interviews, use of social media, ongoing and rotating use of multiple paid and
publicly available databases, and employing culturally competent trackers. Although there
are generally no set lengths-of-stay in RRs, they are typically used by residents as a step on
the way to living independently on their own or back with their own families. As such, the
researcher may be recruiting from the RR but that may not where the resident will be at
follow-up.
During the recruitment process, researchers need to ensure that residents understand that
participation in the research involves follow-up contacts (regardless of where the resident
may be living). Residents who will not be available for follow-ups or are unwilling to
provide personal and collateral contact information may not be appropriate for the research
study. Providing residents with a trinket that includes a way to get in touch with researchers
at the outset can serve as a reminder about the study and that researchers will be following
up with them. Including study information on a project website or social media page
(Mychasiuk & Benzies, 2012) can also facilitate the resident contacting the researcher with
updates to their locating information. Researcher-initiated contact between interviews (at a
set midway point or via birthday and holiday cards) is another useful way to keep residents
engaged with the study and to verify or collect additional contact information for when their
follow-up interview is actually due. We have also had success using paid and publicly
available data bases. However, it is important to note that many databases scan real property
records, credit reports, and published telephone records, and transient and at-risk individuals
are less likely to purchase property or take out lines of credit which can often limit the
relevance of these databases. Thus, it is important to include a variety of free and paid
databases. Table 1 identifies resources that we have found helpful using a regular rotation to
ensure collection of the most current information (Callahan & Jason, 2013).
It is critical to employ research staff who have familiarity with the neighborhoods in which
participants and collaterals reside. Attending recovery oriented community events and
meetings can be a way to locate some study participants. However, research staff must be
Polcin et al. Page 9
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
willing and able to engage with residents and their collaterals in the community wherever
that may be.
Rewards of Recovery Residence Research
Despite the challenges involved in conducting research on RRs, we want to remark on the
importance of this work and the personal gratification that comes with it. The research
conducted thus far on RRs underscores immense promise for this work and the favorable
results that we have found for individuals with limited resources have been personally
gratifying. For example, many individuals with substance use disorders have found
themselves in criminal justice settings and our work has shown that RRs can be useful
resources for many of these individuals (Jason et al., 2015; Polcin, 2006). In addition, we are
currently developing interventions that can enhance recovery homes so they are more
responsive to the needs of ex-offenders (Polcin, Korcha, Bond & Galloway, 2010c).
Research staff working with residents referred from the criminal justice system hear
remarkable stories of recovery and successful adaptation to the community after months or
even years of incarceration. Even as an objective researcher, it is difficult not to be moved
by stories of residents in these houses who are going gains in employment, reconciling with
family members and friends, and getting a second chance to accomplish so many things that
fell to the way side when addiction took hold of their lives.
Documenting resident successes leaves many researchers with a sense of personal
gratification of doing the work; it is a reminder that those in the most need can achieve
remarkable transformations in spite of the systemic and personal challenges they face.
However, we also hear about the struggles and hassles of everyday life, and also tragedy and
setbacks, such as rearrests and re-incarceration. Accurate documentation of ways that
residents are struggling can nevertheless be helpful because we are providing information
about the limitations of RRs and areas where they may need to be improved. Researchers
can play vitally important roles in terms of articulating how RRs should be used, what type
of RR is best for different types of individuals, and ways residences might be improved. Our
motivation to study RRs is enhanced by the commitment of RR operators and providers who
so passionately, and despite great obstacles, open or otherwise foster recovery communities
in their houses (Mericle et al., in press) (Troutman, 2014). Researchers can support their
efforts by disseminating studies showing favorable resident outcomes and support from local
neighbors and communities (Jason, Roberts, & Olson, 2005; Polcin, Henderson, Trocki,
Evans, & Wittman, 2012).
Expanding Research on RRs
A recent review of the evidence base for recovery housing noted that, although studies have
consistently shown positive outcomes, replication of study findings with greater specificity
and in more settings is needed (Reif et al., 2014). There is an urgent need to expand the
evidence base on RRs to include research on various types of RRs and in various geographic
locations. In addition to increasing the focus and geographic diversity of studies, studies
must also begin to address more nuanced questions about RRs—questions moving beyond
whether RRs work but how they work and what type of recovery residence works best for
Polcin et al. Page 10
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
whom. Although some cost-benefit analyses on recovery residences have been favorable (Lo
Sasso, Byro, Jason, Ferrari, & Olson, 2012), there is a need for more research in this area
that can be used to influence policymakers to fund recovery houses. Addressing these types
of questions will lead to the development of evidence-based practices for RRs more
generally and to enhancements to services for more vulnerable, potentially harder to serve,
populations in particular.
One issue needing more attention is the question about the length of time in the home that is
necessary for different residents to maximize beneficial outcome. For some residents who
prematurely leave RRs, dropout leads to relapse. We do not yet know which recovery home
characteristics are associated with optimal lengths of stay and sustained recovery. To
address these important questions, research is needed that conceptualizes recovery homes as
evolving social networks that vary in their ability create and maintain residents’ social
integration. We need to better understand how social networks within the homes help
residents remain long enough to learn how to maintain their sobriety. These dynamics could
then be linked to changes in mediating outcomes such as abstinence self-efficacy, house
dropout, costs and benefits, and, ultimately, relapse or continued abstinence. In addition,
many persons residing in RRs have a variety of problems in addition to substance abuse,
such as homelessness, past criminal justice involvement, and other chronic illnesses.
Therefore, researchers with these interests have samples of persons living in RRs that can be
recruited for their investigations.
Research must also address how RRs should be integrated into the existing formal service
delivery system. RRs provide recovery-supportive housing but have historically operated
outside the formal substance abuse and housing continua of care. Reviews highlighting the
need for and the effectiveness of recovery support services (Laudet & Humphreys, 2013)
have included RRs in their discussions of how the acute-care approach substance abuse
treatment needs to expand into a more recovery-oriented system of care, but barriers to
funding recovery support services persist, potentially limiting the promulgation of these
services. These types of discussions are particularly timely given recent changes in funding
of substance abuse treatment more generally with the passage of the Mental Health Parity
and Addiction Equity Act and the Affordable Care Act (McLellan & Woodworth, 2014).
Similar discussions need to be taking place within the housing services system about how
RRs fit within programs administered by the US Department of Housing and Urban
Development (HUD). Work in this area would be enhanced by research highlighting the
housing needs and housing outcomes of those living in RRs and by economic evaluations of
RRs.
Conclusion
Although the number of RRs are rapidly growing, many addiction treatment practitioners
have limited knowledge about them. Even fewer researchers know about them and the
number of investigative teams studying them are limited. Because RRs are not well
understood among potential funding agencies it can be a challenge to acquire the resources
needed to study them. One way of addressing this challenge in grant applications is to
emphasize the innovation and underutilization of RRs. The case for the significance of
Polcin et al. Page 11
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
studying RRs can be framed in terms of a response to the growing trend in the addiction
field to emphasize services in the community that can help sustain long-term recovery.
We have reviewed a variety of challenges facing researchers who undertake in this work
along with ways these challenges can be and have been addressed. In addition to funding
issues, we have discussed considerations for research designs, coordinating research
procedures across multiple sites, and finding residents for follow up interviews. Of
particular importance is forming a collaborative alliance with RR organizations and the
individuals in leadership positions within houses. RRs emerged as a grassroots movement
rather than a professional derived intervention and understanding their operations and the
ways they are beneficial to residents requires input from providers and residents.
This paper has identified several ways to look at the rewards of this work. First, collection of
objective data on operations and outcomes is gratifying because it highlights the utility and
effectiveness of RRs as a substance abuse service that can address one of the most urgent
goals confronting the field, sustaining long-term recovery. Second, it is equally gratifying to
identify limitations and areas where RRs can be improved because this will ultimately
improve services delivered in RRs and resident outcomes. It can be difficult for providers to
confront these limitations. We are only beginning the process of describing the limitations of
RRs and identifying what type of resident is best for what type of RR. However, there are
potentially enormous rewards for RRs and the researchers who provide objective data that
can be used to target different types of RRs to specific resident characteristics and modify
operations to maximize resident outcomes. Perhaps the most rewarding aspect of this work
comes from our interactions with residents. The stories they share with us about their
struggles with addiction, celebrations of recovery, and hopes for the future are compelling.
Fully aware of how challenging this can be, we hope that other researchers will join us in
this important and rewarding research on RRs so that the field can better meet the diverse
and ongoing needs of individuals in recovery from addiction.
Acknowledgement
Supported by NIDA grant DA034973 (PI, Polcin) and NIDA grant DA019935 (PI, Jason)
REFERENCES
Borkman, T. Understanding Self-help/Mutual Aid: Experiential learning in the commons. New
Brunswick, NJ: Rutgers University Press; 1999.
Borkman TJ, Kaskutas LA, Room J, Bryan K, Barrows D. An historical and developmental analysis of
social model programs. Journal of Substance Abuse Treatment. 1998; 15(1):7–17. [PubMed:
9534122]
Callahan S, Jason LA. Strategies to minimize attrition in longitudinal research. The Community
Psychologist. 2013; 46(1):32–35.
Cheng A-L, Lin H, Kasprow W, Rosenheck RA. Impact of supported housing on clinical outcomes
analysis of a randomized trial using multiple imputation technique. The Journal of Nervous and
Mental Disease. 2007; 195(1):83–88. [PubMed: 17220745]
Cloud W, Granfield R. Conceptualizing recovery capital: Expansion of a theoretical construct.
Substance use & misuse. 2008; 43(12–13):1971–1986.
Polcin et al. Page 12
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Dennis M, Scott CK, Funk R. An experimental evaluation of recovery management checkups (RMC)
for people with chronic substance use disorders. Evaluation and Program Planning. 2003; 26(3):
339–352.
Gilliss CL, Lee KA, Gutierrez Y, Taylor D, Beyene Y, Neuhaus J, Murrell N. Recruitment and
retention of minority women into community-based longitudinal research. Journal of Women's
Health and Gender-Based Medicine. 2001; 10(1):77–85. [PubMed: 11224947]
Greenwood GL, Woods WJ, Guydish J, Bein E. Relapse outcomes in a randomized trial of residential
and day drug abuse treatment. Journal of Substance Abuse Treatment. 2001; 20(1):15–23.
[PubMed: 11239724]
Hall, EA.; Zuniga, R.; Cartier, J.; Anglin, MD.; Danila, B.; Ryan, T.; Mantius, K. 2nd ed.. Los
Angeles, CA: UCLA Integrated Substance Abuse Programs; 2003. Staying in Touch: A fieldwork
manual of tracking procedures for locating substance abusers in follow-up studies; p. 180Archived
by WebCite® at http://www.webcitation.org/6ED9MmI2u [Accessed: 2013-02-05]
Henderson J, Sword W, Niccols A, Dobbins M. Implementing stakeholder-informed research in the
substance abuse treatment sector: Strategies used by Connections, a Canadian knowledge
translation and exchange project. Substance Abuse Treatment, Prevention and Policy. 2014; 9(21)
Jason LA, Davis MI, Ferrari JR. The need for substance abuse after-care: longitudinal analysis of
Oxford House. Addictive Behaviors. 2007; 32(4):803–818. [PubMed: 16843612]
Jason LA, Mericle AA, Polcin DL, White WL. The role of recovery residences in promoting long-term
addiction recovery. American Journal of Community Psychology. 2013; 52(3–4):406–411.
Jason LA, Olson BD, Ferrari JR, Lo Sasso AT. Communal housing settings enhance substance abuse
recovery. American Journal of Public Health. 2006; 96(10):1727–1729. [PubMed: 17008561]
Jason LA, Olson BD, Harvey R. Evaluating alternative aftercare models for ex-offenders. Journal of
Drug Issues. 2015; 45(1):53–68. [PubMed: 25641984]
Jason LA, Roberts K, Olson BD. Attitudes toward recovery homes and residents: does proximity make
a difference. Journal of Community Psychology. 2005; 33(5):529–535.
Jason LA, Salina D, Ram D. Oxford Recovery Housing: length of stay correlated with improved
outcomes for women previously involved with the criminal justice system [DOI:
10.1080/08897077.2015.1037946]. Substance Abuse. (in press). [PubMed: 25962090]
Laudet AB, Humphreys K. Promoting recovery in an evolving context: what do we know and what do
we need to know about recovery support services? Journal of Substance Abuse Treatment. 2013;
45(1):126–133. [PubMed: 23506781]
Laudet AB, White WL. Recovery capital as prospective predictor of sustained recovery, life
satisfaction, and stress among former poly-substance users. Substance Use and Misuse. 2008;
43(1):27–54. [PubMed: 18189204]
Lo Sasso AT, Byro E, Jason LA, Ferrari JR, Olson B. Benefits and costs associated with mutual-help
community-based recovery homes: the Oxford House model. Evaluation and Program Planning.
2012; 35(1):47–53. [PubMed: 22054524]
McKay JR. Is there a case for extended interventions for alcohol and drug use disorders? Addiction.
2005; 100(11):1594–1610. [PubMed: 16277622]
McLellan AT. [Editorial] Have we evaluated addiction treatment correctly? Implications from a
chronic care perspective. Addiction. 2002; 97(3):249–252. [PubMed: 11964098]
McLellan AT, McKay JR, Forman R, Cacciola JS, Kemp J. Reconsidering the evaluation of addiction
treatment: from retrospective follow-up to concurrent recovery monitoring. Addiction. 2005;
100(4):447–458. [PubMed: 15784059]
McLellan AT, Woodworth AM. The affordable care act and treatment for 'Substance Use Disorders:'
implications of ending segregated behavioral healthcare. Journal of Substance Abuse Treatment.
2014; 46(5):541–545. [PubMed: 24679908]
Mericle AA, Miles J, Cacciola J. A critical component of the substance abuse continuum of care:
recovery homes in Philadelphia. Journal of Psychoactive Drugs. 2015; 47(1):80–90. [PubMed:
25715076]
Mericle AA, Miles J, Cacciola J, Howell J. Adherence to the social model approach in Philadelphia
recovery homes. International Journal of Self Help and Self are. 2014; 8(2):259–275.
Polcin et al. Page 13
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Mericle AA, Miles J, Way F. Recovery residences and providing safe and supportive housing for
individuals overcoming addiction. Journal of Drug Issues. 2015; 45(4):368–384.
Milby JB, Schumacher JE, Wallace D, Freedman MJ, Vuchinich RE. To house or not to house: the
effects of providing housing to homeless substance abusers in treatment. American Journal of
Public Health. 2005; 95(7):1259–1265. [PubMed: 15983278]
Mychasiuk R, Benzies K. Facebook: an effective tool for participant retention in longitudinal research.
Child: Care, Health and Development. 2012; 38(5):753–756.
National Association of Recovery Residences. Atlanta, GA: 2012. A primer on recovery residences:
FAQ; p. 46Archived by WebCite® at http://www.webcitation.org/6B7e01VSk [Accessed:
2012-10-02]
National Institute on Drug Abuse. Principles of Drug Addiction Treatment: A research-based guide.
Third Edition. Baltimore, MD: National Institute on Drug Abuse, National Institutes of Health;
2012. p. 76(NIH Publication No. 12–4180) Archived by WebCite® at http://www.webcitation.org/
6MpROYx6t [Accessed: 2014-01-22]
Payne, G.; Payne, J. Key Concepts in Social Research. Thousand Oaks, CA: Sage Publications, Inc.;
2004.
Polcin DL. What about Sober Living Houses for parolees? Criminal Justice Studies. 2006; 19(3):291–
300.
Polcin DL. How should we study residential recovery homes? Therapeutic Communities. 36(3) (in
press).
Polcin DL, Henderson D, Trocki K, Evans K, Wittman F. Community context of Sober Living Houses.
Addiction Research and Theory. 2012; 20(6):480–491. [PubMed: 24478615]
Polcin DL, Korcha R, Bond J, Galloway GP. Sober living houses for alcohol and drug dependence: 18-
month outcomes. Journal of Substance Abuse Treatment. 2010a; 38(4):356–365.
Polcin DL, Korcha R, Bond J, Galloway G. Eighteen-month outcomes for clients receiving combined
outpatient treatment and sober living houses. Journal of Substance Use. 2010b; 15(5):352–366.
Polcin DL, Korcha R, Bond J, Galloway G. What did we learn from our study on sober living houses
and where do we go from here? Journal of Psychoactive Drugs. 2010c; 42(4):425–433.
Reif S, George P, Braude L, Dougherty RH, Daniels AS, Ghose SS, Delphin-Rittmon ME. Recovery
housing: assessing the evidence. Psychiatric Services. 2014; 65(3):295–300. [PubMed: 24141911]
Ross S, Lavis J, Rodriguez C, Woodside J, Denis J-L. Partnership experiences: involving decision-
makers in the research process. Journal of Health Services Research and Policy. 2003; 8 Suppl.
2:26–34. [PubMed: 14596745]
Sacks S, Chaple M, Sacks JY, McKendrick K, Cleland CM. Randomized trial of a reentry modified
therapeutic community for offenders with co-occurring disorders: crime outcomes. Journal of
Substance Abuse Treatment. 2012; 42(3):247–259. [PubMed: 21943810]
Scott CK. A replicable model for achieving over 90% follow-up rates in longitudinal studies of
substance abusers. Drug and Alcohol Dependence. 2004; 74(1):21–36. [PubMed: 15072804]
Scott CK, Dennis ML, Laudet A, Funk RR, Simeone RS. Surviving drug addiction: the effect of
treatment and abstinence on mortality. American Journal of Public Health. 2011; 101(4):737–744.
[PubMed: 21330586]
Substance Abuse and Mental Health Services Administration. Rockville, MD: 2013. SAMHSA's
National Registry of Evidence-based Programs and Practices. Archived by WebCite® at http://
www.webcitation.org/6FPqQlEy4 [Accessed: 2013-03-26]
Troutman D. My life as the developer of Sober Living Homes: an experience report. International
Journal of Self Help and Self Care. 2014; 8(2):227–238.
Wittman FD, Polcin DL. The evolution of peer run sober housing as a recovery resource for California
communities. International Journal of Self Help and Self Care. 2014; 8(2):157–187. [PubMed:
25477748]
Ye Y, Kaskutas LA. Using propensity scores to adjust for selection bias when assessing the
effectiveness of Alcoholics Anonymous in observational studies. Drug and Alcohol Dependence.
2009; 104(1–2):56–64. [PubMed: 19457623]
Polcin et al. Page 14
J Drug Issues. Author manuscript.
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Author Manuscript Author Manuscript Author Manuscript Author Manuscript
Polcin et al. Page 15
Table 1
Online Resources.
Government Databases
Pacer.gov
Cookcountyassessor.gov
Vinelink.gov
Publicrecordcenter.com(portal to nationwide state and federal databases)
Property records
Ssnvalidator.com(social security number validator)
Skipmax.com
Masterfiles.com
Merlindata.com
Social Networking
Whatsmyipaddress.com
Tracersinfo.com
Didtheyreadit.com
Melissadata.com
Facebook, linkdin: You may search a telephone number on these networking sites to find accounts linked to that number.
J Drug Issues. Author manuscript.
