What Makes a Good Recovery Residence? The Research is In.
What Makes a Good Recovery Residence? The Research is In.
Recovery residences, also known as sober living houses, have been demonstrated to improve a range of recovery outcomes and are extremely cost-effective, but little is known about the most significant residence attributes and practices. The current study investigated the links between recovery housing features (organizational, operational, and programming) and residents’ recovery outcomes in order to fill this knowledge vacuum (substance use, criminal justice involvement, employment).
WHAT PROBLEM DOES THIS STUDY ADDRESS?
Although safe housing is a vital part of recovery, nearly a third of people who enter addiction treatment report having an unstable living situation. Recovery houses, such as those cataloged in the Sober House Directory, provide a safe and supportive living environment as well as ongoing care that can help people recover more quickly. Although most sober living recovery homes do not offer regular activities or formal counseling, some do follow set standards and principles that encourage residents to participate in mutual support groups, implement house rules, and foster resident responsibility and communal learning. Recovery residences give participants the opportunity to create financial, social, and community-based recovery capital by providing affordable housing, peer support, and a resource-rich neighborhood. Positive recovery results (e.g., higher rates of employment, reduced substance use, and lower criminal behavior) have been found to last for up to 18 months in these continuing care institutions.
However, little research has explored the specific contributions of different aspects of recovery residences to these recovery outcomes. Given the wide range of recovery home models, a better understanding of facility characteristics and how they relate to recovery results can help to guide best practices and streamline recommendations and referrals. This study is one of the first to assess the relationships between recovery residence characteristics and residents’ recovery outcomes, guided by studies examining the organizational and management factors of treatment facilities and focusing on a high-risk population involved in the criminal justice system.
HOW WAS THIS STUDY CONDUCTED?
The purpose of this study was to explore the association between the characteristics of 330 sober living recovery residences (organizational, operational, and programmatic factors) and recovery from drug abuse outcomes (substance use, criminal justice, and employment outcomes). Residents were examined upon admission to 1 of 49 rehabilitation residences, namely sober living houses situated throughout California, and again six and twelve months later. Each sober living house was a member of the Sober Living Network, a not-for-profit organization that establishes housing standards for recovery households throughout the United States. A quarter of the houses were associated with a treatment program, and 69% were single-gender residences.
- Sober Living Network reports (e.g., official statistics on member houses, including resident sexuality, resident capacity, house fees, and geographic region);
- Interviews with house managers and owners (e.g., percentage of clients on supervised release, intake procedures, and whether the house had an onsite supervisor, a parole/probation referral program, or required 12-step meeting attendance) (e.g., demographics, recent substance use, criminal activity, employment).
These data were gathered as part of a larger randomized controlled trial examining the efficacy of brief motivational interviewing and case management on service utilization and recovery progress. Self-reported abstinence in the preceding six months was used to assess substance use outcomes (i.e., abstinence from alcohol, abstinence from other drugs, and overall abstinence from all substances). Criminal justice participation was defined as any self-reported arrest within the preceding six months, and employment was determined by the number of days worked within that time frame.
All participants were currently incarcerated (e.g., probation, drug court) and were either HIV + or had a lifetime history of at least one HIV risk behavior (i.e., Males who had intercourse with men, commercial sex work, injectable drug use, or unprotected sex with two or more partners in the preceding six months. The 6-month interview had a follow-up rate of 77% and the 12-month interview had a follow-up rate of 81%. Numerous racial and ethnic groups were represented (47% white, 24% black, 10% other/mixed race, and 19% Latino/Hispanic). Males made up the majority of participants (74 percent). Participants were on average 39 years old and around one-third had some college degree. To isolate the direct influence of resident characteristics on recovery outcomes, the authors statistically adjusted for participant demographics (gender, race/ethnicity, age, and education) and length of stay at the recovery residence (on average, 149 days). The authors compared six- and twelve-month recovery outcomes concurrently to get a sense of how participants fared during their first year of recovery housing. Analyses that are statistically controlled for the time of data collection.
WHAT RESULTS DID THIS STUDY OBTAIN?
characteristics of recovery residences in general, as well as resident outcomes.
32% of participating recovery residences had residents on parole or probation. 74% had a live-in manager, 30% offered food to residents, and 77% required residents to participate in the twelve – step meetings and submit to a drug test upon admission. On average, clinics required 41 days of abstinence before admission and the majority followed a 12-step model. Between the baseline and each following follow-up period, rates of abstinence and employment grew in general, while arrest rates fell in general.
Better recovery outcomes were seen in houses that were associated with a larger organization and served fewer inhabitants.
The likelihood of drug and alcohol abstinence was higher in housing that was part of an organization or bigger group of houses. Housing near a treatment facility was linked to a higher chance of total abstinence and employment. Facilities with referral relationships with parole and probation had a reduced chance of being arrested and a higher chance of finding work. Employment chances were lower in facilities with 21 or more residents, but higher in residences with 10 or less residents.
The house’s alcohol abstinence and employment rates differed depending on whatever Sober Living Network chapter (i.e., geographic region) it belonged to.
Residents in the San Fernando Valley/San Gabriel Valley Chapter and West LA Chapter housing exhibited a higher likelihood of abstinence from alcohol than residents in LA Metro Chapter housing. Housing in the West LA Chapter was similarly linked to a higher likelihood of employment.
The amount of abstinence varies depending on the cost of housing and the types of residents served.
Houses that charged more than $600 per month and catered to men enhanced the likelihood of abstinence from alcohol. Drug abstinence and total abstinence were more likely in houses with fewer individuals on parole/probation.
Better outcomes were linked to 12-step-oriented programs.
According to the house manager/operator, houses that were almost wholly or completely 12-step oriented had a higher possibility of total abstinence and employment.
The number of arrests and drug/alcohol abstention depended on the home rules and standards.
Prior to resident intake, requiring at least 30 days of abstinence was linked to a lower risk of arrest, whereas required AA/NA attendance was linked to a higher risk of abstinence.
A number of criteria were shown to be unrelated to recovery outcomes.
The presence of a manager on-site, the provision of meals to residents, the requirement of drug testing at intake, and the extent to which programs used a social model approach to recovery housing (peer-oriented recovery guided by the principles of mutual help) did not significantly predict recovery outcomes.
WHAT IMPLICATIONS DO THE RESULTS OF THE STUDY HAVE?
This research reveals that specific aspects of recovery residences are linked to better recovery outcomes, at least among the high-risk residents in the criminal justice system who took part in the study. In terms of organizational factors, this research reveals that recovery residences that are affiliated with bigger housing organizations, treatment programs, and parole/probation referral programs have higher recovery outcomes. Affiliations with these organizations may serve to promote increased implementation of operations and procedures that have therapeutic advantages for participants and/or better resident matching to their ideal housing environment, hence improving recovery outcomes. Affiliations with treatment institutions may help to ensure that transfers to recovery houses are as smooth as possible, with no gaps in care. Recovery houses with such ties may result in stronger ties amongst recovery support services, resulting in a more robust recovery-oriented care system. Providing a well-connected recovery infrastructure that serves the different needs of people with substance use disorders, including transitions during treatment, can improve recovery outcomes.
In terms of geography, the authors discovered that the sober living house’s location affects recovery outcomes, which could be due to disparities in community services. Accessibility to twelve – step meetings, other support groups, and extra mental and physical health care can help people recover. Better recovery results were also linked to houses that applied 12-step principles to a greater extent, highlighting the importance of peer support and mutual assistance in the recovery process.
It was discovered that when operational and program orientation factors were examined, demanding 30-day abstinence prior to recovery residence intake could reduce the risk of resident arrests. Drug testing at intake may have no effect on these or other recovery outcomes. The benefits of a low resident-to-staff ratio, with better focus and care offered to each individual, may be reflected in facilities housing a lower number of people having higher employment rates. Alternatively, facilities that accept a higher number of inhabitants may be able to charge less, making them a more reasonable choice and attracting a larger number of unemployed people. Although higher monthly charges, male-only residents, and fewer residents on parole/probation were associated with better substance use outcomes, these characteristics may have more to do with the residents serviced by specific rehabilitation residences and less to do with the houses themselves. Individuals who can afford more expensive accommodation, for example, may have greater recovery capital to begin with, boosting their chances of a successful recovery regardless of the facility’s monthly rate.
It’s vital to remember that these numbers don’t indicate whether or not observed associations are causative. It’s possible that these recovery outcomes are the result of specific recovery residence characteristics, or that houses with specific organizational and operating characteristics are more likely to serve specific populations, who are then more likely to find work, stay clean, and avoid criminal arrest. Nonetheless, the findings of this study lay a solid platform for future research into these features and their significance in recovery facilitation.
- Multiple recruitment sites (such as recovery residences) were occasionally affiliated with the same group. Though the authors did statistical analyses to show that it had little impact on outcomes, this could minimize differences between sites and bias outcomes in the long run.
- This research was carried out as part of a randomized controlled experiment. Clinical trial involvement has the potential to affect recovery results, even if condition assignment (no intervention or motivational interviewing and case management) was controlled for and outcomes were typically similar between conditions. Furthermore, data identifying the facilities were only acquired in part during interviews to determine their suitability as a recruiting site, leaving out key descriptive metrics of the facilities that could be crucial predictors of recovery results. More research into these aspects is needed.
- The authors were looking at a unique demographic of individuals who had been involved in the criminal justice system and were at a higher risk of contracting HIV/AIDS, the majority of whom were white males. Furthermore, all of the residences that were evaluated were in California. It’s unclear if these findings apply to other parts of the country.
- Individuals and families pursuing recovery: The study looked at the correlations between the quality of rehabilitation houses and residents’ outcomes. Though this study does not look at the direct effects of recovery residences on recovery outcomes, previous research on different forms of recovery housing has revealed that they can help (e.g., Oxford Houses). Nonetheless, recovery methods and models vary significantly amongst houses, and low-quality houses have received a lot of media attention. As a result, people and families looking for recovery housing may find this study valuable. According to the findings, homes with broader organization affiliations (e.g., parent organizations, treatment facilities, probation programs) and households that used a 12-step program had better outcomes. These features may promote standard house processes, encourage resident participation in recovery-focused mutual support programs, facilitate continuous care transitions, and ensure a good fit between residents and houses, all of which can aid in improving recovery outcomes. According to the authors, houses with fewer resident capacity, male-only residents, and fewer residents on parole/probation, as well as those charging higher house fees and requiring 30+ days of abstinence to become residents, all had better outcomes. However, it’s possible that these outcomes have less to do with the property and more to do with the people (e.g., individuals with these characteristics, who can afford more expensive housing with lower resident capacity, might enter a residence with more resources at their disposal). More research is needed to determine the direct impacts of facility characteristics on outcomes, but this study is an important first step toward understanding the qualities of recovery residences that may be most helpful to people in recovery.
- For treatment practitioners and systems: This research discovered a number of links between recovery residence characteristics and residents’ recovery results (substance use, criminal justice involvement, employment). Residences with a greater 12-step emphasis and affiliation with a bigger organization (e.g., parent organizations, treatment facilities, probation programs) were linked to better recovery outcomes. Parent programs could help to promote standard house procedures, ease resident-house matching, and smooth transfers to continued care, all of which would improve the odds of a successful recovery. This study implies that promoting or demanding 12-step participation as part of continuous care in a recovery residence is also advantageous, in keeping with the observed benefits of mutual support programs on recovery outcomes in general. Although the authors found that more expensive houses with lower resident capacity, male-only residents, and fewer residents on parole/probation had better recovery outcomes, individuals with these characteristics who can afford more expensive, lower-capacity housing may enter recovery residences with more recovery capital and an advantage for successful recovery. More research is needed to evaluate the direct effects of these facility and resident features, but this study is an essential first step toward understanding the qualities of recovery residences that may contribute to optimal recovery outcomes.
- For the benefit of scientists: The purpose of this study was to see if there were any links between the quality of the rehabilitation housing and the outcomes of the participants. The authors discovered that recovery apartments that were related to a bigger organization (e.g., parent organizations, treatment facilities, probation programs) and used 12-step programming had superior recovery outcomes. These characteristics may help to improve recovery outcomes by encouraging therapeutic home procedures, encouraging recovery-focused activities among residents, and accelerating patient-house matching and continuous care linkages and transitions. The authors also discovered that houses with fewer occupants, male-only residents, and fewer people on parole/probation, as well as households with higher housing costs and 30-day abstinence requirements, had better outcomes. However, it’s unclear if these results are due to housing or resident quality, because those who can afford more expensive housing with lower resident ability may enter ongoing care with more resources and, thus, a better chance of recovery. Furthermore, this study was undertaken as part of a randomized controlled trial with a special population of residents who had criminal justice involvement and were at high risk for HIV/AIDS, and all of the homes studied were in California. More research is needed to assess the direct impact of home characteristics on recovery outcomes and to see if the findings of this study apply to other populations with other drug use disorders and/or recovery residences in other states. Randomized controlled trials are also required to better understand the direct effects of housing, regardless of home variables.
- For policymakers to consider: This and other research studies provide crucial preliminary information regarding the programmatic characteristics of treatment and recovery centers that are most likely to produce the best results. Affiliations with parent programs and the introduction of mutual aid programs may enhance rehabilitation houses, according to this study. The study also discusses the importance of the residents served by the facilities, their features, and the facility’s location. However, because this study can not speak to cause and effect, the association between these characteristics and recovery results is somewhat hazy. More money is needed to better understand the organizational, operational, and programmatic characteristics that support efficient and successful recovery. Investigating these challenges can eventually aid in identifying necessary/unnecessary facility qualities, promoting efficient money allocation for optimal return and best practices, and elucidating how recovery houses might lessen the long-term financial burden associated with substance use disorder.
Mericle, A. A., Mahoney, E., Korcha, R., Delucchi, K., & Polcin, D. L. (2019). Sober living house characteristics: A multilevel analyses of factors associated with improved outcomes. Journal of Substance Abuse Treatment, 98, 28-38. doi: 10.1016/j.jsat.2018.12.004
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