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The Role of Recovery Residences in Promoting Long‐Term Addiction Recovery
... Supportive Housing Environment -Access to living in a safe and stable recovery residence. Access to a sustainable housing environment that reinforces healthy behaviours is a critical component in reducing recidivism and relapse (Fontaine, 2013;Jason et al., 2013;Mallik & Visher, 2008;Mericle et al., 2015). Participants lived on the therapeutic campus and engaged in a suite of individualized services for an average of 6 to 18 months. ...
... Participants lived on the therapeutic campus and engaged in a suite of individualized services for an average of 6 to 18 months. Jason et al. (2013) relate that transitioning directly to a recovery-based environment immediately after release from incarceration promotes a stronger likelihood of abstinence self-efficacy than reintegrating back into former residences or unstable settings that lack oversight and support. Set Free Alaska's therapeutic campus provided a structured, therapeutic setting that facilitated a healthy transition to stable long-term housing, a robust sober community connection, and easy access to critical services. ...
Crime associated with problematic substance use remains a defining characteristic in the United States criminal justice system. In Alaska, a perennial leader in US criminal recidivism rates, thousands of formerly incarcerated individuals continue to commit crimes and misuse drugs and alcohol following their release from incarceration. The total cost of these crimes to victims and Alaska’s criminal justice system is over 6.25 million in cost savings and net economic benefits. Evaluation results indicate the model possesses significant potential to reduce criminal recidivism and should be further expanded and evaluated.
... They are especially important for individuals who cycle through substance use treatment programs, often failing to maintain sobriety because of their tenuous financial and social linkages to the mainstream community. 9,10 Unfortunately, residents of recovery homes frequently experience past criminal involvement, prior homelessness, and psychiatric comorbidity. 10 Therefore, the population represents a socio-demographic at-risk group with multiple comorbidities associated with a high prevalence of smoking tobacco, and a concomitant resistance to the prevalence declines seen for the general population. ...
... 9,10 Unfortunately, residents of recovery homes frequently experience past criminal involvement, prior homelessness, and psychiatric comorbidity. 10 Therefore, the population represents a socio-demographic at-risk group with multiple comorbidities associated with a high prevalence of smoking tobacco, and a concomitant resistance to the prevalence declines seen for the general population. 11 A commonly held belief among those with SUDs is that smoking cessation will increase their vulnerability in relapsing with drugs. ...
Objectives: In this study, we provide estimates of the prevalence of tobacco use among residents in Oxford House (OH) recovery homes. We explore predictors for smoking cessation on future intentions to quit tobacco use, such as self-efficacy, motivation to quit, and level of nicotine dependence. We focus on examining smoking-related differences between 2 groups of tobacco users: (1) residents who only vape, and (2) residents who only smoke or who smoke and vape (ie, dual users). Methods: Data come from a research project examining the social networks of residents in OH homes at Wave 5 (N = 270) when questions were asked about tobacco use and cessation. We conducted multiple logistic regression analysis to assess the predictors on intentions to quit tobacco in the next 6 months. Results: Among residents, 60.4% report that they either smoke cigarettes, vape, or use both products. The odds of quitting are 92.5% lower for residents who only use e-cigarettes than for those who only smoke cigarettes or who smoke cigarettes and vape. Motivation to quit was associated with more than double the odds for self-efficacy on intentions to quit with odds ratios of 3.23 (95% CI: 1.81, 5.78; p = .00) and 1.47 (95% CI: 1.05, 2.07; p = .03) respectively. Conclusion: The high prevalence of smoking and vaping in this population makes it an important target for interventions.
... Recovery housing (also commonly referred to as recovery residences) is an umbrella term referring to abstinence-based living environments that offer short-or long-term instrumental and social support for individuals seeking recovery from SUD (14). Recovery houses are distinct from housing offered within inpatient/residential treatment and offer a range of levels of support that have been organized, described, and certified (15). At one end of the spectrum, in addition to providing a safe living environment, they may offer a high degree of structure and onsite clinical services (level 4/type C). ...
Recovery housing, an abstinence-based living environment, is the most widely available form of substance use disorder (SUD) recovery support infrastructure. This systematic review characterized the randomized control trials (RCT) and quasi-experimental designs (QED) research on recovery housing. We conducted a search across PubMed, EMBASE, CINAHL, PsycINFO and CENTRAL published prior to February 2024. For inclusion, studies had to compare recovery housing alone to a non-recovery housing condition. Our search identified 5 eligible studies including 3 RCTs and 2 QEDs, across 11 reports. Participants Ns ranged from 150 to 470 and follow-up durations were 6-24 months. Recovery housing interventions performed better than continuing care as usual/no intervention on abstinence, income, employment, criminal charges and to a lesser extent incarceration. Recovery housing also performed better than comparative interventions delivered in other types of residential settings (e.g., therapeutic communities) on increasing alcohol abstinence and reducing days of substance use, while also increasing income and employment rates. An exception was in study samples that had high percentages of formerly incarcerated women (90% or more) where reduced substance use was the only benefit of recovery housing when compared to other types of residential interventions and was inconsistent when compared to continuing care as usual/no intervention. Moreover, recovery housing demonstrated higher cost effectiveness than continuing care as usual/no intervention and comparative interventions. Based on quantity, quality, and support for the service, the existing level of evidence for recovery housing is considered moderate. Expanding access to recovery housing may enhance outcomes for individuals with SUD, in general, while producing cost saving benefits, but given the small number of high quality studies additional comparative trials are needed. Also, future research should identify specific subgroups who may or may not benefit from recovery housing interventions and why, so as to develop and test suitably augmented housing models or identify helpful alternatives.
... All houses regardless of type are required to establish and provide a substance-free home-like environment, informed by the social model philosophy of recovery (Jason et al., 2013;Mericle et al., 2019). The social model of recovery is a philosophy that emphasizes the role of community in the life-long recovery process (Polcin et al., 2014). ...
Background
Recovery housing plays an important role in supporting individuals in their recovery by building recovery capital and providing stable living environments; however, the extent to which medications for opioid use disorder (MOUD), the gold standard for OUD treatment, are accepted in recovery housing settings is unclear. The purpose of this study, as part of a larger statewide evaluation of Missouri recovery homes, was to identify the extent to which Missouri recovery houses were accepting of methadone, buprenorphine, and naltrexone as well as the extent to which the acceptance of each medication was linked to whether the recovery home encouraged tapering off MOUDs.
Methods
Sixty-four recovery housing managers and/or staff, out of 66 eligible recovery homes in Missouri completed the survey.
Results
Results indicated that methadone was the least accepted medication for long-term use followed by buprenorphine and then naltrexone. Recovery houses that had significantly lower overall acceptance of methadone encouraged tapering; however, the overall acceptance for buprenorphine and naltrexone was not significantly related to the encouragement of tapering off MOUDs.
Conclusion
This work highlights the need to develop reliable instruments to measure and assess MOUD-capable recovery homes and to increase knowledge and acceptance of MOUD within recovery home settings.
... One type of recovery support service is the recovery residence, or a "safe, sober, and affordable environment that is supportive of recovery from alcohol and other drug disorders" (Jason et al. 2013). Recovery residences are referred to in a variety of ways, such as Oxford House, sober living house, recovery home, halfway house, sober house, or therapeutic community. ...
Recovery support services such as recovery housing assist individuals with increasing their access to social support, employment services, and systems of care. Lack of evidence-based practices and calls for increased oversight of these settings suggests a growing need for technical assistance and training for recovery residence owners and staff, yet little is known about their areas of greatest need for technical assistance. We developed and administered a survey to assess the technical assistance needs of recovery housing operators in the United States using a convenience sample of individuals who own or operate a recovery residence (N = 376). A total of 77 owners/operators completed the survey (20% response rate), representing urban, suburban, and rural communities. Differences were observed between number of owned residences: owners/operators of a single residence were interested in technical assistance on house-specific policies and linkage to established systems of care, whereas owners/operators of multiple residences were interested in technical assistance on building financial sustainability and incorporation of best practices into their recovery residences. As an increasing number of states move to implement voluntary certification or licensing for recovery residences, targeted training and technical assistance to owners/operators will facilitate the successful adoption of recovery residence best practices and quality standards.
... According to the National Alliance for Recovery Residences (NARR), recovery home residences span from low-to high-service intensity, with levels of support ranging from peer-operated residences (called level 1) to those with more professional support that offer a wide variety of treatment and recovery support services (called levels 2-4; Jason, Mericle, Polcin, & White, 2013). An example of level 1 or peer-operated residences are Oxford Houses (OHs), which are democratically-run, sober living houses with no limit on length of stay (Jason, Ferrari, Davis, & Olson, 2006). ...
There is a need to better understand improved recovery supportive services for those on Medication Assisted Treatment (MAT) for opioid use disorder (OUD) and, at the same time, enhance the available treatment interventions and positive long-term outcomes for this vulnerable population. A growing empirical literature supports the assertion that improved access to housing and recovery support is a low-cost, high-potential opportunity that could help former substance users who are utilizing MAT to sustain their recovery. Recovery home support could serve the populations that need them most, namely servicing a significant number of the enrolled in MAT programs. The two largest networks of recovery homes are staff run Traditional Recovery Homes (TRH) and self-run Oxford House Recovery Homes (OH). There is a need to better understand how substance users on MAT respond to recovery homes, as well as how those in recovery homes feel toward those on MAT and how any barriers to those utilizing MAT may be reduced. Recovery may be an outcome of the transactional process between the recovering individual and his/her social environment. In particular, how recovery houses can help people on MAT attain long-term recovery.
... Flynn et al. (2006) found that both living in a recovery home and participating in Narcotics Anonymous (NA) had a strong effect on who African Americans turned to for support. In another dataset, Jason, Mericle, Polcin, and White (2013) found increased rates of income from employment for Latinxs in recovery homes. ...
Recovery homes are a widespread community resource that might be utilized by some individuals with substance use disorders (SUD) and COVID-19. A growing collection of empirical literature suggests that housing can act as a low-cost recovery support system which could be effective in helping those with SUD sustain their recovery. Such settings could be already housing many residents affected by COVID-19. Many of these residents are at high risk for COVID-19 given their histories of SUD, homelessness, criminal justice involvement, and psychiatric comorbidity. Stable housing after treatment may decrease the risk of relapse to active addiction, and these types of settings may have important implications for those with housing insecurity who are at risk for being infected with COVID-19. Given the extensive network of community-based recovery homes, there is a need to better understand individual- and organizational-level responses to the COVID-19 pandemic among people in recovery homes as well as those managing and making referrals to the houses. At the present time, it is unclear what the effects of COVID-19 are on recovery home membership retention or dropout rates. This article attempts to provide a better understanding of the possible impact of COVID-19 on the infected and on recovery resources in general.
... RHs manifest varying intensities of structure and support for their residents, and are classified into four levels of support. 18 Level I homes are selfrun and do not include any external professional services. Level II homes often include a resident who is paid to oversee and maintain the home and to coordinate peer groups and services for residents. ...
Various community recovery support services help sustain positive behavior change for individuals with alcohol and drug use disorders. This article reviews the rationale, origins, emergence, prevalence, and empirical research on a variety of recovery support services in U.S. communities that may influence the likelihood of sustained recovery. The community recovery support services reviewed include recovery high schools, collegiate recovery programs, recovery homes, recovery coaches, and recovery community centers. Many individuals are not provided with the types of environmental supports needed to solidify and support their recovery, so there is a need for more research on who may be best suited for these services as well as when, why, and how they confer benefit.
... RHs manifest varying intensities of structure and support for their residents, and are classified into four levels of support. 18 Level I homes are selfrun and do not include any external professional services. Level II homes often include a resident who is paid to oversee and maintain the home and to coordinate peer groups and services for residents. ...
Various community recovery support services help sustain positive behavior change for individuals with alcohol and drug use disorders. This article reviews the rationale, origins, emergence, prevalence, and empirical research on a variety of recovery support services in U.S. communities that may influence the likelihood of sustained recovery. The community recovery support services reviewed include recovery high schools, collegiate recovery programs, recovery homes, recovery coaches, and recovery community centers. Many individuals are not provided with the types of environmental supports needed to solidify and support their recovery, so there is a need for more research on who may be best suited for these services as well as when, why, and how they confer benefit.
... (4) One type of recovery support service is the recovery residence (RR), or a "safe, sober, and affordable environment that is supportive of recovery from alcohol and other drug disorders." (5) RRs are referred to in a variety of ways, such as Oxford House, sober living house, recovery home, halfway house, sober house, or therapeutic community. A recent study estimated that approximately 18,000 RRs exist in the US (6), and a nationally representative survey of individuals in recovery from SUD found that 8.5% of people reported using a RR as part of their recovery pathway (7). ...
Background: Recovery support services such as recovery housing may assist individuals with increasing their access to social support, employment services, and systems of care. Lack of evidence-based practices and calls for increased oversight of these settings suggests a growing need for technical assistance and training for recovery residence owners and staff members, yet little is known about their areas of greatest technical assistance needs, and if there are differences between the needs of owners/operators of one recovery residence vs. owners/operators of multiple recovery residences.
Methods: We developed and administered a survey to assess the technical assistance needs of recovery housing operators in the United States using a convenience sample of individuals who own or operate a recovery residence (N= 376). The survey was disseminated electronically via e-mail using REDCap to collect survey responses. Descriptive statistics were used to describe the survey respondents, and bivariate analyses were conducted to test for differences in TA needs by the number of residences owned by the respondent (1 vs. 2+). Thematic analysis methods were used to analyze open text survey response items focusing on challenges, resources needed to overcome challenges, and community perception of recovery residences.
Results: A total of 77 owners/operators completed the survey (20% response rate), representing urban, suburban, and rural communities. Almost one-half (45%) of respondents were the owner of their residence(s), and more than half (56%) of the respondents reported that their residence was certified based on a set of national best practices for recovery housing. Differences were observed between number of owned residences; owners/operators of a single residence expressed greater interest in technical assistance on house-specific policies and linkage to established systems of care, whereas owners/operators of multiple residences were more interested in technical assistance on complex topics such as building financial sustainability, and incorporation of best practices into their recovery residences.
Conclusion: As an increasing number of states move to implement voluntary certification or licensing for recovery residences, targeted training and technical assistance to owners/operators will facilitate the successful adoption of recovery residence best practices and quality standards.
... According to the National Alliance of Recovery Residences (NARR), recovery homes can be grouped into one of the four levels of homes, with the first type involving CONTACT Leonard A. Jason ljason@depaul.edu Center for Community Research, DePaul University, 990 W. Fullerton Ave., Suite 3100, Chicago, IL 60614 homes that are peer-run; second level being monitored with at least one compensated position; third level having supervision, organizational hierarchy, and some certified staff; and the fourth level being through a service provider with clinical and administrative supervision, and credentialed staff (Jason, Mericle, Polcin, & White, 2013;NARR, 2011). There is some evidence that these homes are effective. ...
Recovery homes serve as an important resource for individuals in dealing with substance use disorders (SUD). Access to these community-based supports is critical for many individuals exiting inpatient SUD treatment facilities and criminal justice settings. Unfortunately, basic information about this large system of recovery homes is unavailable, such as the total number of recovery homes in the United States. Although existing databases are not comprehensive, we used available ones to tabulate the recovery homes in the United States and supplemented this with phone interviews from state SUD treatment experts. Based on this research, we estimate there are about 17,900 recovery homes in the United States, and about 1.2% of individuals with SUDs use recovery homes each year. There is a need to develop an accessible directory of recovery homes that provides their location, as well as available openings, house gender, and offered services.
... Safe and stable housing is integral to recovery (Substance Abuse and Mental Health Services Administration, 2012), but nearly a third (32%) of individuals entering substance abuse treatment report being marginally housed in the 30 days prior to treatment entry (Eyrich-Garg, Cacciola, Carise, Lynch, & McLellan, 2008). Recovery housing generally refers to supportive living environments (e.g., Oxford Houses™, sober living, sober homes, recovery homes, halfway houses) that promote recovery from alcohol, drug use, and associated problems (Jason, Mericle, Polcin, & White, 2013). Reviews of the evidence base for recovery housing suggest that it can indeed have positive effects on many aspects of recovery, ...
Safe and stable housing is integral to addiction recovery. Across numerous studies, recovery housing has been found to be associated with improvements in a variety of domains. Although procedures for operating some types of recovery housing have been manualized and national standards established, there are few empirical findings identifying which recovery residence characteristics may lead to improved outcomes. Using data from 330 newly admitted residents recruited from 49 sober living houses in California and re-contacted for 6- and 12-month follow-up interviews, this study examines the effects of organizational, operational, and programming characteristics on substance use, criminal justice, and employment outcomes. Results from multilevel analyses adjusting for resident demographics and length of stay indicate that organizational characteristics were associated with outcomes. Residents recruited from houses that were part of a larger organization or group of houses had increased odds of total abstinence (aOR = 3.98, p < 0.001) and drug abstinence (aOR = 3.19, p < 0.001). Residents recruited from houses that were affiliated with a treatment program had increased odds of employment (aOR = 2.92, p = 0.003). Operational characteristics such as where the house was located and whether the house required incoming residents to be sober for at least 30 days prior to entry were also related to improved outcomes, but additional work is needed to develop tools to assess and measure recovery housing characteristics and to better understand how these factors contribute to improved outcomes.
... Recovery communities are a less studied source of recovery support services for adolescents and include mutual support groups, recovery coaches, recovery residences, recovery high schools and collegiate re- covery programs, and recovery-focused social clubs. Substance use disorder treatment programs commonly refer adolescents to mutual support groups and in particular, Alcoholics Anonymous (AA) and Narcotics Anonymous (NA; Drug Strategies, 2003;Humphreys et al., 2004;Jainchill, 2000;Jason, Mericle, Polcin, & White, 2013;Kelly et al., 2016). Recovery coaches are newer to the field and help in- dividuals after treatment by offering support, consultation, motivation, feedback, skills training, and assistance in reducing barriers to needed services (Loveland & Boyle, 2005;White, 2009;White & Evans, 2014). ...
Research on continuing care treatment for adolescents following discharge from primary treatment has demonstrated benefit, yet treatment providers encounter multiple barriers in its implementation. Less formal recovery support following treatment is promising, but controlled trials of effectiveness are lacking. This study reports results of a randomized trial of recovery support provided by student volunteers via telephone to youth discharged from residential treatment. Both direct and indirect effects were predicted for proximal (pro-recovery peers, recovery management activities) and distal (AOD use and problems, AOD remission) outcomes.
Method
Prior to treatment discharge, participants were randomized to either 9 months of post-treatment Volunteer Recovery Support for Adolescents (VRSA; n = 201) or continuing care services as usual (SAU; n = 201) and assessed over 12 months post- discharge.
Results
There were significant direct effects for VRSA to have more involvement with pro-recovery peers and recovery management activities than SAU. VRSA also had significant indirect effects on reducing AOD use and problems and increasing remission via increases in pro-recovery peers and recovery management activities at 9- and 12-month assessments. Dose-response analyses demonstrated significant increments of improvement in proximal and distal outcomes as VRSA session completion rate increased, but effectiveness attenuated at the post-VRSA (12- month) follow-up assessment.
Conclusion
Findings suggest that VRSA is a promising option for post-treatment recovery support, especially in the higher dose range. Additional research is needed to test the feasibility of providing VRSA in the higher dose range to a larger proportion of intent to treat samples and extending VRSA duration.
... issues as well as the neuroscience of addiction (Jason, Mericle, et al., 2013). Furthermore, efforts to open and fund new recovery residences may be met with political and community resistance due to stigma or misunderstandings (Jason, Groh, et al., 2008). ...
This article evaluates how a plurality of research methods has served a
research program that has functioned in a much-needed area of research:
the role of housing and recovery residences in addiction recovery. The
review focuses on one mutually supportive recovery residence model, called
Oxford House, which represents more than 1,700 democratic,
self-governing residences. To date, there has been no comprehensive
evaluation of the research methods used with Oxford House or any other
recovery residence. In this article, research methods, including study
designs and data analyses, are summarized for 114 peer-reviewed empirical
studies that included data on Oxford Houses or Oxford House residents.
This review of a pluralistic research program can inform community
researchers about the value of recovery residences, the many ways in which
recovery residences may be assessed, and the benefits of using multiple
methods. Implications for future recovery residence research are discussed.
... There is growing evidence of the important role recovery residences such as SLHs play in promoting recovery from addiction (Jason, Mericle, Polcin, & White, 2013). For example, in a study tracking the functioning of 300 individuals residing in 20 different SLHs over an 18month period, Polcin et al. (2010a;2010b) found residents showed significant improvement on a wide variety of outcomes including reduced alcohol and drug use, alcohol-and drugrelated problems, psychiatric symptoms, unemployment, and arrests. ...
Sober living houses (SLHs) are alcohol and drug-free living environments for individuals in recovery. The goal of this study was to map the distribution of SLHs in Los Angeles (LA) County, California (N = 260) and examine neighborhood correlates of SLH density. Locations of SLHs were geocoded and linked to tract-level Census data as well as to publicly available information on alcohol outlets and recovery resources. Neighborhoods with SLHs differed from neighborhoods without them on measures of socioeconomic disadvantage and accessibility of recovery resources. In multivariate, spatially lagged hurdle models stratified by monthly fees charged (less than 1400/month or greater), minority composition, and accessibility of treatment were associated with the presence of affordable SLHs. Accessibility of treatment was also associated with the number of affordable SLHs in those neighborhoods. Higher median housing value and accessibility of treatment were associated with whether a neighborhood had high-cost SLHs, and lower population density was associated with the number of high-cost SLHs in those neighborhoods. Neighborhood factors are associated with the availability of SLHs, and research is needed to better understand how these factors affect resident outcomes, as well as how SLHs may affect neighborhoods over time.
... In both fields, a variety of services have emerged to help individuals in this process (Laudet & Humphreys, 2013;Whitley, Strickler, & Drake, 2012). One type of support service that has received renewed attention in the substance use treatment field is the recovery residence, generally defined as a sober, safe, and healthy living environment that promotes recovery from alcohol and drugs and associated problems (Jason, Mericle, Polcin, & White, 2013). counseling, case management, treatment planning, or a structure of daily activities. ...
Objective:
Sober living houses are alcohol- and drug-free recovery residences that help individuals with substance use disorders maintain long-term abstinence. Given the prevalence of co-occurring mental disorders among individuals entering substance use treatment, it is likely that many such residents are also contending with psychiatric symptoms, and it is unclear how these symptoms may affect their sobriety. This study sought to describe the prevalence and trajectories of different types of symptoms among sober living house residents and examine how these symptoms affect substance use outcomes.
Methods:
Data for this study were collected as part of a larger study on outcomes among sober living house residents in Northern California. The current study examined data from 300 residents in two housing groups; residents were interviewed upon entry and re-interviewed at 6-, 12-, and 18-month follow-ups. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI). General estimating equations tested changes in BSI global psychological distress and clinical symptom scales over time and examined the relationship between scale scores and substance use in longitudinal models controlling for demographics, length of stay, and psychiatric service utilization.
Results:
The average age of residents was 38.5 years (SD = 10.1) and they were mostly male (80%) and Caucasian (65%). Retention rates were high, with 90% (n = 269) participating in at least one follow-up interview. Overall psychological distress (Wald χ(2) = 7.99, df = 3, p = 0.046) and symptoms of depression (Wald χ(2) = 13.57, df = 3, p = 0.004) and phobic anxiety (Wald χ(2) = 7.89, df = 3, p = 0.048) significantly improved over time. In all models examining the relationship between BSI scale scores and substance use, rates of abstinence and days of use among those who reported using substances also improved over time. Overall distress (OR = 0.48, p<0.001) as well as higher scores on the somatization (OR = 0.56, p<0.001), depression (OR = 0.53, p<0.001), hostility (OR = 0.71, p = 0.006), and phobic anxiety (OR = 0.74, p = 0.012) subscales were significantly associated with a decreased likelihood of abstinence. Symptoms of somatization (B = 0.092, SE = 0.029, p = 0.002) were associated with an increase in the number of days substances were used among those who reported use.
Conclusions:
Psychological symptoms among sober living house residents improve over time, but they are risk factors for relapse, suggesting that additional support provided to residents with psychiatric symptoms could improve substance use outcomes.
... 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 providing affordable, alcohol-and drug-free living environments and peer support for recovery (Jason, Mericle, Polcin, & White, 2013). ...
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.
... They are active in promoting expansion of community based recovery and additional research to document outcomes. The Society of Community Research and Action (SCRA), Division 27 of the American Psychological Association has teamed up with NARR to develop a policy statement on the value of recovery residences in the United States (Jason, Mericle, Polcin & White, 2013). ...
Sober living houses (SLHs) are alcohol- and drug-free living environments that offer social support to persons attempting to abstain from alcohol and drugs. They use a peer-oriented, social model approach that emphasizes mutual support, financial self-sufficiency, and resident involvement in decision making and management of the facility. Although they represent an important response to the increasing call for more services that help sustain abstinence from drugs and alcohol over time, they are an under recognized and underutilized recovery resource. The purpose of this paper is to trace the evolution of sober living houses in California from the early influences of Alcoholics Anonymous (AA) in the 1930’s to the establishment of current SLH associations, such as the Sober Living Network in Southern California. The paper describes key events and policies that influenced SLHs. Although initial research on outcomes of SLH residents has been very encouraging, there is a need for more research to guide improvement of structure and operations. The paper concludes with a discussion of implications for the growth of recovery services and for community housing policy.
Social support systems are often the most important factor in initiating and sustaining recovery from substance use disorders (SUDs). The Phoenix is a non-profit organization whose mission is to create communities and host events that harness the transformational power of social connection to promote SUD recovery. Through online surveys and in-depth interviews, this study assessed factors related to support provision within Phoenix members’ social networks. Online surveys measured participants’ demographic information, when they started attending Phoenix programming, and how frequently they attended The Phoenix. During interviews participants were asked to identify who supports them in their recovery. For each network member listed, the participant indicated their relationship to the person, the person’s gender, if that person was in recovery, if that person was a Phoenix member, and how often that person provided support to the respondent (Never to Always). Multilevel modeling explored factors related to more support provision across 723 support dyads reported from 79 participants. Participants (n = 79; 76% non-Hispanic white; 48% male; Mage = 38.27 years) reported an average of 9.15 members in their support networks (range 2–15). After controlling for network size, Phoenix members reported the most support provision from mentors (β = 0.356, p = 0.001), people in recovery (β = 0.451, p < 0.001), and fellow Phoenix members (β = 0.303, p = 0 .001). The longer someone had been a member of The Phoenix, the more likely they were to report greater support provision from their network members (β = 0.064, p = 0.03). This study makes two important contributions. First, while it is understood that social support broadly defined is important for recovery, this study provides specific characteristics of social networks that could yield greater social support provision. Second, because findings show that fellow Phoenix members provided participants more support, and that participants who had been involved in The Phoenix for longer experienced greater support, this study suggests The Phoenix could be an effective environment for creating the needed support systems for recovery from SUDs. More rigorous study designs could empirically test participation in The Phoenix as a laudable strategy for combatting relapse and supporting long-term recovery from SUD.
Background:
Substance use disorder (SUD) is a public health crisis in the United States (U.S.), with the associated mortality rates at an all-time high. Having access to Recovery Housing (RH), and other Recovery Support Services (RSSs), supports the development of "recovery capital", the 'physical, social, human, and cultural resources' that can be drawn upon to initiate and help sustain long term recovery.
Objectives:
In this study, a scoping review of the literature was conducted to identify retention in Oxford Housing (OH) and other types of RH. Searching five databases, the search string strategy was developed to cast a broad net, using terms synonymous with "substance use disorder" and "recovery housing" to capture the highest number of relevant articles.
Results:
The initial search yielded 30,203 studies, with 22 studies retained and included in the final set. Overarching constructs included mental health, demographic factors, and social networks (6/22, 27.2% respectively), as well as house environment/house fit (5/22, 22.7%) and their respective impact on OH and RH retention.
Conclusions:
However, the individual and programmatic factors that lead to greater resident retention are not well understood. Future research efforts should be focused on further examination of these four factors, and other potential factors within the context of impacting OH and RH retention.
Background: While medications for opioid use disorder (MOUD) are effective in reducing overdoses, widespread adoption and implementation of MOUD remains inadequate. Innovative approaches to promote MOUD use and to support people in their medication-assisted recovery (MAR) are needed. Recovery residences that serve people taking MOUD are steadily growing in number, yet little is known about how MOUD and the MAR pathway is promoted within the recovery residence setting.Objectives: The purpose of this qualitative analysis was to describe how recovery residences facilitate MOUD initiation and support residents' MAR pathway.Methods: We conducted interviews with 93 residents (59.1% male; 38.7% female) living in recovery residences located in five Texas cities that served people taking medication for opioid use disorder.Results: We found that recovery residence staff addressed linkage to care gaps in their communities by connecting people who might benefit from MOUD to appropriate providers. Recovery residence staff also strengthened participants' community of MAR-supportive peers by hosting or connecting residents to Medication-Assisted Recovery Anonymous meetings. Additionally, recovery residences helped some residents overcome common logistical barriers (e.g. transportation issues, housing instability, distance to providers) that hinder MOUD access.Conclusion: Recovery residences that serve people taking MOUD are a well-positioned recovery support service to promote MOUD initiation and the MAR pathway.
Introduction
Central City Concern (CCC) operates several recovery housing sites in the Portland, Oregon metropolitan region, including the Blackburn Center (Blackburn) and the Richard L. Harris Building (Harris). This retrospective, observational study was designed to assess recovery housing's impact on inpatient detoxification readmission rates and healthcare utilization patterns.
Methods
Our study population consisted of individuals discharged from CCC's Hooper Detox Stabilization Center from June 2019 to September 2020. A total of 75 clients housed at Blackburn, 63 clients housed at Harris, and 57 clients discharged as unhoused were included in the study sample. Using logistic regression for each of the two recovery housing groups relative to the unhoused group, we examined differences in readmissions to inpatient detoxification after their qualifying discharge. We then used Difference-In-Difference model to compare the per member per year (PMPY) use of different domains of health care before and after their qualifying discharge.
Results
Compared to clients discharged as unhoused, Blackburn and Harris residents had lower risk of readmissions to inpatient detoxification treatment at 90- and 180-days post-discharge. Additionally, while the mean number of PMPY emergency department visits increased for clients discharged as unhoused in the post period, the average number of emergency department visits decreased for clients who obtained recovery housing at Blackburn (DiD=-3.65 PMPY, p-value=0.02) and at Harris (DiD=-3.87 PMPY, p-value=0.01).
Conclusion
Findings highlight the impact and importance of recovery housing for individuals managing a substance use disorder and the value of healthcare system and public sector investment housing like Blackburn and Harris.
Introduction
Both homelessness and substance use have increased in recent years. People experiencing homelessness (PEH) are at increased risk for health problems and early mortality, both of which can be exacerbated by substance use disorders (SUD). Specialty SUD treatment is likely needed to address substance use among PEH, and more than 232,000 PEH received treatment from U.S. publicly funded SUD programs in 2015. The objective of this paper is to develop a better understanding of the SUD services that PEH receive in publicly funded treatment programs by (1) describing the characteristics and needs of the PEH population served in publicly funded SUD treatment programs, compared to non-PEH populations; (2) determining if differences exist in treatment placement (level of care) for PEH and non-PEH; and (3) gauging how successful programs are in treating PEH compared to non-PEH.
Methods
Observational study using a two-way fixed effect model to determine associations among homelessness, retention, and outcomes among Medicaid beneficiaries receiving SUD treatment in California from 2016 to 2019 (n = 638,953). The study team used ordinary least squares (OLS) regression to measure the degree to which homelessness was associated with baseline characteristics, SUD services received, and treatment outcomes.
Results
PEH were significantly more likely than non-PEH to be having methamphetamine or heroin as their primary substance. PEH had greater frequency of primary substance use prior to entering treatment, greater ER and hospital utilization, more criminal justice involvement, and greater prevalence of mental health diagnoses and unemployment. PEH were 9.82% more likely than non-PEH to receive residential treatment and 7.11% less likely than non-PEH to receive treatment intensive outpatient modalities. Homelessness was associated with an 11.90% decrease in retention, and a 19.40% decrease in successful discharge status. These trends were consistent across outpatient, intensive outpatient, and residential modalities.
Conclusions
Developing SUD treatment capacity and housing supports can improve treatment outcomes for PEH. Potential strategies to improve SUD services for PEH include providing more contingency management, opioid pharmacotherapies, programming designed to treat individuals with co-occurring mental health disorders, and resources for housing options that can support PEH in their recovery.
Background
Recovery housing generally refers to alcohol- and drug-free living environments that provide peer support for those wanting to initiate and sustain recovery from alcohol and other drug (AOD) disorders. Despite a growing evidence base for recovery housing, relatively little research has focused on how recovery housing may benefit individuals accessing outpatient substance use treatment.
Methods
Using administrative and qualitative data from individuals attending an outpatient substance use treatment program in the Midwestern United States that provides recovery housing in a structured sober living environment, this mixed methods study sought to: (1) determine whether individuals who opted to live in structured sober living during outpatient treatment (N = 138) differed from those who did not (N = 842) on demographic, clinical, or service use characteristics; (2) examine whether living in structured sober living was associated with greater likelihood of satisfactory discharge and longer lengths of stay in outpatient treatment; and (3) explore what individuals (N = 7) who used the structured sober living during outpatient treatment were hoping to gain from the experience.
Results
Factors associated with the use of recovery housing during outpatient treatment in multivariate models included gender, age, and receiving more services across episodes of care. Living in structured sober housing was associated with greater likelihood of satisfactory discharge and longer length of stays in outpatient treatment. Focus group participants reported needing additional structure and recovery support, with many noting that structure and accountability, learning and practicing life, coping, and other recovery skills, as well as receiving social and emotional support from others were particularly beneficial aspects of the sober living environment.
Conclusions
Findings underscore the importance of safe and supportive housing during outpatient substance use treatment as well as the need for future research on how housing environments may affect engagement, retention, and outcomes among individuals accessing outpatient substance use treatment.
Background
Alcohol and drug treatment providers are increasingly emphasizing the role of long-term, community-based systems of care. A good example is Sober Living Houses (SLHs), which are peer operated alcohol- and drug-free living environments. Studies show residents of SLHs make significant improvements in multiple areas. However, little attention has been devoted to describing the critically important role of SLH managers who oversee these homes.
Methods
Thirty-five SLH managers completed interviews about the characteristics and operations of their houses, their activities as managers, and ways their own recovery was affected by their work.
Results
Managers reported widespread use of some but not all principles of social model recovery. Manager roles varied dramatically in terms of time spent managing houses, activities related to their roles, and training they received. Some reported extensive amounts of time proving support to residents, while others viewed their role as primarily administrative.
Conclusions
Research is needed to understand reasons for manager differences, optimal manager functioning, and manager training needs. Research is also needed to assess whether different house characteristics require different manager roles.
Full and partial opioid agonists and opioid antagonist medications play an important role in containing the opioid epidemic. However, these medications have not been used to their full extent. Recovery support services, such as recovery residences (RRs), also play a key role. RRs may increase an individual’s recovery capital, facilitate social support for abstinence, and foster a sense of community among residents. These processes may be critical for individuals with opioid use disorder (OUD). In combination these two recovery pathways have the potential to enhance one another and improve outcomes among residents with OUD. Barriers to doing so have resulted in a limited supply of residences that can support residents using opioid agonist and antagonist medications. This perspective describes key interpersonal and structural barriers to medication use among individuals with an OUD seeking support from a recovery residence and discusses measures for reducing these barriers. These measures include workforce development to address stigma and attitudinal barriers and enhancing residence capability to ensure resident safety and reduce potential diversion. The perspective also highlights the need for additional research to facilitate the identification of best practices to improve outcomes among residents treated with medications living in recovery residences.
Oxford Houses (OH) are democratically run, self-funded, substance-use recovery homes that operate across the United States and internationally. Previous research shows the OHs are present in diverse neighborhoods. The current study examined the neighborhoods of 42 OHs located in Oregon, Texas, and North Carolina to better quantify and understand house and neighborhood characteristics that are related to relapse rates. Independent variables were participants' length of stay in OH, wages earned from employment, and income/education neighborhood characteristics. Neighborhood characteristics were related to relapse rates, with higher relapse rates occurring in neighborhoods with lower income and education levels. This finding supports the OH organization's premise that while OHs may work across community settings, they perform better in neighborhoods with higher average income and education levels. (PsycINFO Database Record (c) 2020 APA, all rights reserved).
Background & Aims: Gay, bisexual, and other men who have sex with men (MSM) face distinct recovery challenges. This mixed-methods study examines the service needs and help-seeking pathways of MSM (N = 25) living in a group of recovery residences operated in Texas, one of which is a home specifically designated for gay and bisexual men.
Methods: Upon intake, adult MSM were recruited to complete an interview assessing the extent of their service needs as well as their recovery goals and expectations about their stay. Men were recruited regardless of whether they moved into the home designated for gay and bisexual men or into another one of the men’s homes.
Results: MSM in the sample reported high rates of health conditions, depression, victimization, and sex risk behaviors. A greater number of them entering the gay and bisexual men’s home reported being in recovery from amphetamine use, having a chronic medical problem, and being physically assaulted as an adult. The majority of MSM, regardless of home type, were seeking emotional and social support as well as accountability in their recovery home experience, but MSM in the gay and bisexual men’s home talked about emotion and social support most frequently and within the context of emotional safety.
Conclusions: MSM entering recovery housing have complex service needs. Recovery housing may play an important role in supporting recovery among MSM. Residences specifically for them could be tailored to address their unique needs by fostering connections to other sexual minorities in recovery and facilitating social identity transformation.
Recovery housing is a promising way to augment the substance use continuum of care, but we know little about the experiences of members of the lesbian, gay, bisexual, transgender, and queer (LGBTQ) community who live in them or about residences specifically for them. Within the LGBTQ community, gay, bisexual, and other men who have sex with men (MSM) often experience co-occurring syndemic conditions (e.g., trauma, depression, HIV) that present unique recovery challenges. Using qualitative data gathered from residents living in a recovery residence specifically for gay and bisexual men and from community key informants, we examine the experiences of men living in the home and factors that facilitate operating it. Findings highlight the need for residences that can address syndemic burden among gay and bisexual men in recovery and identify programmatic and community-level factors critical to operating residences for this population.
Background:
Gay, bisexual, and other men who have sex with men (MSM) face unique recovery challenges. Recovery housing may play an important role in improving outcomes among MSM, but little is known about their experiences in these settings.
Methods:
This study examined 3-month outcomes among MSM (N=22) living in a group of recovery residences in Texas, one of which is a home specifically designated for gay and bisexual men. Upon intake, adult MSM were recruited to participate in the study, which involved a baseline and 3-month phone interview and allowing study staff to access records maintained by the program about their stay.
Results:
At follow-up, only two (9.1%) reported used of any substances in the past 30 days. The vast majority (73%) had attended outpatient substance use treatment in the past three months, and 86% reported working for pay during the past 30 days. All participants reported attending four or more 12-step meetings in the past 30 days. Use of dysfunctional coping strategies significantly decreased, however so did scores on health-related quality of life.
Conclusions:
MSM have complex treatment needs. Recovery housing may help improve outcomes among MSM by bridging formal substance use treatment with community-based recovery support.
Recovery housing is a service delivery modality that simultaneously addresses the social support and housing needs of those in recovery from substance use disorders. This article describes a group of recovery homes in Texas (N = 10) representing a lesser-studied type of recovery housing, one which explicitly bridges treatment and peer support by providing a variety of recovery support services. All residents meet with a recovery coach, undergo regular drug screening, and have access to intensive outpatient treatment—a program that was developed specifically to support the needs of residents in the homes. Unlike the Oxford HouseTM model and California sober living houses, which are primarily financed through resident fees, these homes are supported through a mix of resident fees as well as private and public insurance. While adhering to some aspects of the social model of recovery, none of these homes would meet criteria to be considered a true social model program, largely because residents have a limited role in the governance of the homes. Residences like the ones in this study are not well-represented in the literature and more research is needed.
Abstract
Purpose: Roughly half a million persons in the United States are homeless on any given night and over a third of those individuals have significant alcohol/other drug (AOD) problems. Many are chronically homeless and in need of assistance for a variety of problems. However, the literature on housing services for this population has paid limited attention to comparative analyses contrasting different approaches. Approach: We examined the literature on housing models for homeless persons with AOD problems and critically analyzed how service settings and operations aligned with service goals. Findings: We found two predominant housing models that reflect different service goals: Sober Living Houses (SLHs) and Housing First (HF). SLHs are communally based living arrangements that draw on the principles of Alcoholics Anonymous. They emphasize a living environment that promotes abstinence and peer support for recovery. HF is based on the premise that many homeless persons with substance abuse problems will reject abstinence as a goal. Therefore, the HF focus is providing subsidized or free housing and optional professional services for substance abuse, psychiatric disorders and other problems. Practical Implications: If homeless service providers are to develop comprehensive systems for homeless persons with AOD problems, they need to consider important contrasts in housing models, including definitions of “recovery,” roles of peer support, facility management, roles for professional service, and the architectural designs that support the mission of each type of housing. Originality: This paper is the first to consider distinct consumer choices within homeless service systems and provide recommendations to improve each based upon an integrated analysis that considers how architecture and operations align with service goals.
Background:
Having a stable and safe place to live is integral to recovery from addiction. Recovery residences represent an important component in the substance use continuum of care, but research on them has been limited to certain types of recovery residences and has yet to examine quality of life among those who live in them.
Methods:
This study presents data on the characteristics of residents (N = 104) living in a stratified random sample of recovery homes in Philadelphia (N = 13) as well as data from a random subsample of residents (N = 27) who participated in 3-month follow-up interviews.
Results:
Residents in these homes reported deficits in a variety of aspects of their lives critical to helping them initiate and sustain their recovery; many (20%) reported living in a shelter or on the streets prior to moving in, 37% had less than a high school education, and only 26% reported currently working for pay. Although the majority of residents rated their quality of life as good or very good (74%), average physical health, social relationship, and environment domain scores measured by the WHO QOL-Bref were generally lower than scores found among community samples. At follow-up, all residents were housed and rates of substance use (7%), criminal justice involvement (0%), and employment (44%) in the past 30 days were encouraging. Quality of life domain scores were unchanged, with the exception of psychological health which decreased.
Conclusions:
These findings highlight the complex needs of residents living in Philadelphia recovery homes and the role that these homes play in maintaining residents in their early recovery. Studies with larger samples of residents followed up over longer periods of time are needed to assess the role that these homes may play in promoting long-term recovery and improving the wellbeing of the vulnerable population of individuals who live in them.
Housing options for people exiting homelessness and seeking recovery from substance use disorders are limited. Policies tend to favor low-demand models such as Housing First and Permanent Supportive Housing that do not require abstinence, but offer immediate housing placement based on consumer choice and separate housing from clinical services. While these models have proven effective in promoting housing retention, especially among individuals with a primary diagnosis of mental illness, evidence to support positive outcomes related to people with a primary or co-occurring substance use disorder are mixed. Recovery housing models provide abstinence-focused environments and integrated peer support, embedded within a recovery framework. Various models exist along a continuum from fully peer-run to clinically staffed residences. However, this continuum is typically separate from the homeless services system, and many barriers to integration persist. Recent national dialogues have begun to explore opportunities to integrate housing and substance use recovery approaches to meet the needs of people who need both types of support. This perspective paper argues that recovery housing is essential for supporting some homeless individuals and families. Within a comprehensive continuum based on choice, both recovery housing and low-demand models can support housing retention, reduce homelessness, promote recovery, and foster self-determination.
Objective:
States across the country are recognizing recovery housing, an abstinence-based living environment promoting recovery from alcohol and other drugs, as an important yet underrepresented choice within their housing and treatment continuums. However, strategies for bringing recovery housing to scale are not well known. Building upon broader quality improvement efforts in Ohio, this paper aims to identify barriers and facilitators to expanding recovery housing in Ohio by understanding the perspectives of relevant stakeholders.
Methods:
We conducted six recovery housing program site visits, 24 semi-structured key informant interviews with state and national researchers, policy makers, and stakeholder groups, and 16 focus groups with administrators and staff, residents, and local stakeholders including housing developers, advocates, and county and city policy makers (n = 113). Focus groups were disaggregated by stakeholder membership and guided by separate interview protocols. Transcripts were coded and analyzed to identify primary themes.
Results:
Most participants across stakeholder groups expressed a need to increase recovery housing supports within the state. Two facilitators and three barriers emerged as primary themes from the qualitative analysis. Facilitators included: (1) The ability of recovery housing programs to identify, connect, and collaborate with other recovery housing programs and service systems, an approach that increased a program's ability to refer, accept new clients, learn about programmatic and financial supports, and advocate for a space within the services continuum, and (2) Support from legislators and other local stakeholders to include recovery housing as a viable and necessary option. Barriers included: (1) variations in recovery housing definitions, language, and understanding that limited recovery housing provider's ability to connect with one another and be eligible for different streams of support, (2) availability of funds and ability to access them, and (3) restrictions in federal, state, and local regulations and codes.
Conclusions:
Although recovery housing is limited and has not been integrated into many housing and treatment continuums, there is growing consensus about its importance for various subpopulations. Developing consistent definitions, program models, funding streams, networks of recovery housing providers, and collaborations among recovery-oriented systems of care will reduce misperceptions and enhance the likelihood that recovery housing will be expanded.
Recovery residences provide safe and supportive housing to help individuals initiate and sustain recovery from substance abuse. They are a potentially important yet understudied component of the substance abuse continuum of care. Unlike other substance abuse treatment and service delivery options, recovery residences are largely privately owned and funded by the residents themselves, and we know little about how these residences open and the factors that influence their ability to stay open. Using qualitative data from interviews with recovery home operators (N = 21) in Philadelphia, this article explores what recovery home operators want to accomplish with their homes, how they try to do this, the obstacles they encounter in trying to run their homes, and why they keep at it. Themes highlight the potential of recovery residences as well as the challenges faced by those who operate them.
For many struggling with addiction, the ability to achieve stable recovery is often jeopardized by untenable housing or unsupportive living environments. Despite promising research on recovery residences, there are still significant gaps in the research on them. Using data collected from a stratified random sample of recovery homes in Philadelphia (N = 25), this study describes the organizational, operational, and programmatic characteristics of these homes and explores potential differences in these characteristics by funding source and gender of residents served. Although not licensed treatment providers, the majority of these homes operated in a recovery-oriented manner and offered a range of different services to their residents-all for a reasonable monthly fee (M = $340.40, SE = 18.60). Few differences emerged between homes that received funding from the Philadelphia Office of Addiction Services and those that did not or between those that served males as opposed to females. More research is needed to address resident outcomes and how Philadelphia recovery homes may compare with recovery residences in other parts of the country.
Today, almost 14,000 specialized addiction programs treat approximately two million individuals a year in the United States. This treatment spans a wide diversity of settings, levels of care, service philosophies, and techniques. However, most share an acute-care model of intervention, characterized by a single episode of self-contained and unlinked intervention focused on symptom reduction and delivered within a short timeframe. Impressions are given that long-term recovery should be achievable following such acute intervention. This model is now being challenged, and calls are increasing to extend the design of addiction treatment to a model of sustained recovery management that is comparable to how other chronic primary health disorders are effectively managed. Recovery management is a philosophy of organizing treatment and recovery supports to enhance early engagement, recovery initiation and maintenance, and the quality of personal/family life in the long-term. This chapter provides an overview of this book highlighting the theory, science, and practice of recovery management and exploring how it is being incorporated into larger “systems transformation” processes. This is the first academic text designed specifically to focus on recovery management as a philosophy of professional treatment and a framework for recovery management.
For more than 150 years, support for the personal resolution of severe and persistent alcohol and other drug problems in the United States has been provided through three mechanisms: family, kinship, and informal social networks; peer-based recovery mutual-aid societies; and professionally directed addiction treatment. This article: (1) briefly reviews the history of these traditional recovery supports, (2) describes the recent emergence of new recovery support institutions and a distinctive, all-inclusive culture of recovery, and (3) discusses the implications of these recent developments for the future of addiction treatment and recovery in the United States.
The success or failure of programs designed to address alcohol and drug problems can be profoundly influenced by the communities where they are located. Support from the community is vital for long term stability and conflict with the community can harm a program's reputation or even result in closure. This study examined the community context of sober living houses (SLHs) in one Northern California community by interviewing key stakeholder groups. SLHs are alcohol and drug free living environments for individuals attempting to abstain from substance use. Previous research on residents of SLHs showed they make long-term improvements on measures of substance use, psychiatric symptoms, arrests, and employment. Interviews were completed with house managers, neighbors, and key informants from local government and community organizations. Overall, stakeholders felt SLHs were necessary and had a positive impact on the community. It was emphasized that SLHs needed to practice a "good neighbor" policy that prohibited substance use and encouraged community service. Size and density of SLHs appeared to influence neighbor perceptions. For small (six residents or less), sparsely populated houses, a strategy of blending in with the neighborhood seemed to work. However, it was clear that larger, densely populated houses need to actively manage relationships with community stakeholders. Strategies for improving relationships with immediate neighbors, decreasing stigma, and broadening the leadership structure are discussed. Implications for a broad array of community based programs are discussed.
A major challenge facing many individuals attempting to abstain from substances is finding a stable living environment that supports sustained recovery. Sober living houses (SLHs) are alcohol- and drug-free living environments that support abstinence by emphasizing involvement in 12-step groups and social support for recovery. Among a number of advantages, they are financially self-sustaining and residents can stay as long as they wish. Although SLHs can be used as housing referrals after inpatient treatment, while clients attend outpatient treatment, after incarceration, or as an alternative to treatment, they have been understudied and underutilized.
To describe outcomes of SLH residents, we interviewed 245 individuals within 1week of entering SLHs and at 6-, 12-, and 18-month follow-up. Eighty-nine percent completed at least one follow-up interview. Outcomes included the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and measures of alcohol and drug use. Covariates included demographic characteristics, 12-step involvement, and substance use in the social network.
Regardless of referral source, improvements were noted on ASI scales (alcohol, drug, and employment), psychiatric severity on the BSI, arrests, and alcohol and drug use. Substance use in the social network predicted nearly all outcome measures. Involvement in 12-step groups predicted fewer arrests and lower alcohol and drug use.
Residents of SLHs made improvements in a variety of areas. Additional studies should use randomized designs to establish causal effects of SLHs. Results support the importance of key components of the recovery model used by SLHs: (a) involvement in 12-step groups and (b) developing social support systems with fewer alcohol and drug users.
Research on treatment outcome for addictive disorders indicates that a variety of interventions are effective. However, the progress clients make in treatment frequently is undermined by the lack of an alcohol and drug free living environment supporting sustained recovery. This introduction to a special edition on Oxford Houses suggests that treatment providers have not paid sufficient attention to the social environments where clients live after residential treatment or while attending outpatient programs. The paper begins with a description of the need for alcohol and drug free living environments. The history of communal living for recovering addicts and alcoholics is then reviewed and the Oxford House model emphasized as a recent and widespread communal living option for recovering persons. The structure and philosophy of Oxford Houses are presented along with recent outcome studies providing support for their effectiveness. Three different perspectives are presented as ways of conceptualizing how residents in Oxford Houses benefit: social context theory, self governance/self care, and peer affiliation/identification.
Oxford Houses are democratic, mutual help–oriented recovery homes for individuals with substance abuse histories. There are more than 1200 of these houses in the United States, and each home is operated independently by its residents, without help from professional staff.
In a recent experiment, 150 individuals in Illinois were randomly assigned to either an Oxford House or usual-care condition (i.e., outpatient treatment or self-help groups) after substance abuse treatment discharge. At the 24-month follow-up, those in the Oxford House condition compared with the usual-care condition had significantly lower substance use, significantly higher monthly income, and significantly lower incarceration rates.
Addiction Recovery Management: Theory, Research, and Practice is the first book on the recovery management approach to addiction treatment and post-treatment support services. Distinctive in combining theory, research, and practice within the same text, this ground-breaking title includes authors who are the major theoreticians, researchers, systems administrators, clinicians and recovery advocates who have developed the model. State-of-the art and the definitive text on the topic, Addiction Recovery Management: Theory, Research, and Practice is mandatory reading for clinicians and all professionals who work with patients in recovery or who are interested in the field.
The present study investigated the attitudes of neighborhood residents toward a particular type of substance abuse recovery home (i.e., Oxford House). Individuals who lived next to these recovery homes versus those who lived a block away were assessed regarding their attitudes toward substance abuse recovery homes and individuals in recovery. The vast majority of those living next to a self-run recovery home knew of the existence of these recovery homes, whereas most residents living a block away did not know of their existence. Findings suggest that well managed and well functioning substance abuse recovery homes, such as Oxford Houses, elicit constructive and positive attitudes toward individuals in recovery and recovery homes. © 2005 Wiley Periodicals, Inc. J Comm Psychol 33: 529–535, 2005.
Group homes sometimes face significant neighborhood opposition, and municipalities frequently use maximum occupancy laws to close down these homes. This study examined how the number of residents in Oxford House recovery homes impacted residents' outcomes. Larger homes (i.e., 8 or more residents) may reduce the cost per person and offer more opportunities to exchange positive social support, thus, it was predicted that larger Oxford Houses would exhibit improved outcomes compared to smaller homes. Regression analyses using data from 643 residents from 154 U.S. Oxford Houses indicated that larger House size predicted less criminal and aggressive behavior; additionally, length of abstinence was a partial mediator in these relationships. These findings have been used in court cases to argue against closing down larger Oxford Houses. 125 words.
There is a need to explore the processes of social support and self-efficacy change over time among individuals in recovery homes, and to assess the extent to which residents remain abstinent, obtain and maintain employment, refrain from criminal activity, and utilize health care systems both while within the and after leaving such settings.
Residents were recruited and interviewed at an initial baseline phase and then re-interviewed at three subsequent 4-month intervals.
Oxford Houses are recovery home residences for individuals with substance abuse and dependence problems who seek a supportive, democratic, mutual-help setting.
A national US sample of Oxford House residents (n=897: 604 men, 293 women).
Information was gathered on abstinence, social support, self-efficacy, employment, criminal history, and medical care utilization.
Change in cumulative abstinence was predicted by support for alcohol use, abstinence self-efficacy, and length of residency in OH (i.e., less than versus >or=6 months), even after controlling for initial time spent in OH.
Results suggest that receiving abstinence support, guidance, and information from recovery home members committed to the goal of long-term sobriety may enhance residents' abstinence self-efficacy and enable persons recovering from alcohol and other drug addiction to reduce the probability of a relapse.
Recovery management and recovery-oriented systems of care: Scientific rationale and promising practices
- W White
The National Association of Recovery Residences (with Fred Way serving as Liaison with Research Committee)
- L A Jason
- A A Mericle
- D L Polcin
- W L White
The Oxford House story: An interview with Paul Molloy
- W White