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Volume 52 Number 4 Fall 2019
Edited by Thomasina Borkman, George Mason University and Ronald Harvey, American University in Bulgaria
Written by Ronald Harvey, American University in Bulgaria
I am happy and honored to accept the chair duties of the Self-help and Mutual Support interest group. Tehseen Noorani has been instrumental in keeping the group alive and well over the past two years. I want to thank him for his service. I also wish to thank the members of the group for your continued interest and participation!
I would like to take this opportunity to introduce myself and my experiences doing research on self-help groups (SHGs) in Bulgaria.
I received my PhD in Community Psychology at DePaul University, Chicago, in 2014. My mentor and advisor is Lenny Jason. I did my U.S. research with residents of Oxford House (OH), which is a type of self-run recovery home (www.oxfordhouse.org). OH’s are for people who wish to remain abstinent from illicit drugs and alcohol. OH’s have no professional staff to run them and are small scale—typically 8 same-sex individuals living in an ordinary rented house located in middle class communities. Everyone pitches in equally on house chores and pays their fair share of the rent, making OHs far cheaper than many other kinds of interventions (Olson et al., 2006). All decisions affecting the house must be made democratically, including decisions on selecting and removing residents. Residents are required to participate in a self-directed recovery program, and any use of illicit drugs or alcohol means immediate expulsion from the house. So long as residents meet these requirements, they can live there as long as they wish.
There are currently over 2,500 OH’s operating in the United States providing over 20,000 beds (Oxford House Inc., 2019). These homes have been created not only for men and women, but also for residents with children, people with HIV, veterans, trans-gender individuals, and Spanish and hearing-impaired (Oxford House Inc., 2019).
OH’s are heavily influenced by and depend on the existence of SHGs, particularly Alcoholics Anonymous and Narcotics Anonymous, but are not directly affiliated with any SHGs. The founders of OH were members of these 12-step groups. The vast majority of OH residents attend SHGs as part of their recovery; about 45% of OH residents use some form of therapy or counseling in addition to SHGs (Oxford House Inc., 2019).
I am a Cold War kid, and I always wanted to work internationally and in former Communist countries in Eastern Europe of which Bulgaria is one. Through a series of random (but fortuitous) connections, I met a group of substance abuse treatment professionals in Bulgaria whilst on an extended summer holiday in 2007. I asked my Bulgarian colleagues about the state of SHGs in Bulgaria. My impression was that the social work-oriented treatment professionals in Bulgaria recommended SHGs to their clients, whereas others who were more clinically oriented tended to view SHGs with skepticism. Most treatment facilities used basic SHG principles as part of their group work, but in the public sphere, SHGs were still rather underground. There were some religious- and work-based sober living homes in Bulgaria (http://www.retobulgaria.org/) and some informal sober group living arrangements.
With the support of my Bulgarian collaborators, we decided to investigate the feasibility for creating OH-like settings in Bulgaria. I did two Fulbright research projects in Bulgaria: first in 2009 during the third year at DePaul as a Fulbright U.S. student (www.fulbrightonline.org), and in 2016 as a Fulbright scholar. The first project in 2009 was a 10-month project to perform a needs assessment and to determine what were the “essential ingredients” for creating and sustaining an OH anywhere in the world (Harvey, Mortensen, Aase, Jason, & Ferrari, 2013). These essential ingredients were: 1) housing; 2) residents willing to live together under the OH guidelines; 3) jobs and income for residents; 4) institutional support from local and federal governments; and 5) community support – not only from immediate neighbors, but also support from SHGs like AA or NA. Later I added a sixth ingredient: providing early, on-site leadership and guidance for starting houses to gain critical mass for sustainability. The 2016 Fulbright was a five-month project to document the steps needed to actually create an OH in Bulgaria.
When I was traveling through Bulgaria to talk to SHG members and treatment professionals, almost everyone we met in Bulgaria wished my project “good luck!” – meaning they thought it was a good idea but were skeptical. I was fortunate to meet with the leaders of the treatment program “Open Your Eyes,” an Orthodox Christian-based therapeutic community for drug treatment at St. Boris Church in the Asparuhovo region in Varna, Bulgaria (http://otvoriochi.org/). They also wished my project “good luck!” but they actually wanted to create an OH as a community-reintegration piece! Suddenly, my short five-month research project became an implementation project. I asked for and was granted a three-month extension with the generous support of the Bulgarian Fulbright Commission. We started an online fundraising campaign and raised $2,500 to pay for initial costs that would normally be paid for in the USA in a Revolving Loan Program (Oxford House Inc., 2019). We also translated into Bulgarian a version of Oxford House manual.
In keeping with the participatory action research (PAR) recommendations in Borkman & Schubert (1994), we spoke tofive former residents from “Open Your Eyes” who had or were about to complete their 9-month on-site treatment program. Two of these residents agreed to live in the house and volunteered to help select housing and furniture. We contacted a local property owner and selected a small, but comfortable cottage near the treatment site. We estimated rent, living expenses, and selected furnishings for the house. These residents nominated two additional recruits for the OH, and we interviewed them as a group. We also discussed and clarified ideas behind the OH model. These four residents asked me to act as an adviser and non-resident voting member as needed.Using the $2,500 funds, together we selected furniture and appliances, and prepared the house for move-in.
The residents named their house “Pioneer House,” which opened on August 1, 2016 with four male residents ranging in age from 26 to 33 years old, abstinence was four days to three months. All the residents were native Bulgarians who were employed, spoke at least basic English, and had graduated together from the “Open Your Eyes” 9-month program. All the residents agreed to follow the basic premise of the OH model: all house maintenance and expenses are to be shared among the residents; all residents are required to be free from alcohol and illicit drugs; and all decisions must be made democratically. However, none of these first four residents wanted to attend the few SHGs available in Varna, thus severely limiting the social resources available to them. This proved to be a crucial factor later in the project.
Picture 1: Opening ceremonies of Pioneer House with community partners and residents, Varna, Bulgaria.
After two months of relatively smooth operations, we were unable to fill empty beds: one because of relapse, and one as a voluntary return to the resident’s family. My Bulgarian collaborators and I could not convince local Bulgarians in treatment to even consider moving into Pioneer House in spite of the low cost, even when these potential residents knew they were going to return to a high-risk environment ranging from homelessness to friends and family who used alcohol or drugs. This revealed two important cultural differences between the USA and Bulgaria: in the U.S., contractual obligations in an OH agreement seem to offer an adequate level of assurance for relative strangers to live together in relative confidence. Friendships form in U.S. Oxford Houses later on, and in fact is the strongest factor in house retention and positive outcomes (Jason, Light, Stevens, & Beers, 2014). In Bulgaria, a relatively strong relationship and personal trust must be established before residents are willing to live together. The idea of living with unknown and untrusted strangers is not a realistic option in Bulgarian culture, even if the alternatives may be hostile to recovery.
The second major difference: U.S. and Bulgarian culture regarding SHGs and recovery are striking. In Bulgaria, SHGs are in their infancy. Twelve-step groups started in Bulgaria only after Soviet premier Mikhail Gorbachev’s glastnost or “openness” policies came to Bulgaria in 1989. Prior to this, all non-government community organizations were illegal. Even then, the first AA service convention was held in Bulgaria in 2017. Sofia, the capital and largest city in Bulgaria of 1.3 million, has about 30 meetings of AA, NA, and Al-Anon per week. In contrast, there are over 4,000 weekly meetings in the Chicago metropolitan area.
Unfortunately, we decided to end the Pioneer House project at the end of January, 2017. We could not fill out empty beds and the remaining residents preferred to live elsewhere. My PAR in Bulgaria continues, and we have thought of ways to perhaps overcome the limitations of OH-like settings here to include mandatory attendance at SHGs or to use improv comedy techniques to increase trust among potential residents.
My experience in Bulgaria made me realize how mainstream and influential SHGs are in America and how SHGs positively affect cultural attitudes towards recovery. After all, we elected (twice) a president (George W. Bush) who admitted openly to past drug and alcohol problems. Our entertainment features characters who are in struggling with and overcoming addictions, such as House of Cards, Flaked, This is Us, and Intervention. These positive attitudes – that recovery is possible, desirable, and that good things happen afterwards – is a great lesson from SHGs that currently does not exist in Bulgarian mainstream culture.
It is these kinds of insights about the impact of SHGs that makes me a committed international community psychologist. I believe that doing international work is one of the best ways to reveal and understand hidden contexts that we think we know, and to learn about how SHGs positively affect long-standing cultural attitudes.
Towards that end, I have reached out to my contacts throughout Eastern Europe to invite members of self-help and mutual support groups to participate in our quarterly calls, or to submit a column to the TCP and tell us about their experiences. I would like to encourage all of you to do the same! Please feel free to contact me at firstname.lastname@example.org, or the entire group at email@example.com.
Borkman, T., & Schubert, M. (1994). Chapter 2. Participatory action research as a strategy for studying self‐help groups internationally. Journal of Prevention & Intervention in the Community, 11(1), 45-68.
Harvey, R., Mortensen, J., Aase, D., Jason, L., & Ferrari, J. (2013). Factors Affecting the Sustainability of Self-Run Recovery Homes in the United States. [Journal ]. International Journal of Self-Help & Self-Care, 7(1), 99-109.
Jason, L. A., Davis, M. I., & Ferrari, J. R. (2007). The need for substance abuse after-care: A longitudinal analysis of Oxford House. Addictive Behaviors 32, 803–818.
Jason, L. A., Light, J. M., Stevens, E. B., & Beers, K. (2014). Dynamic social networks in recovery homes. American Journal of Community Psychology, 53, 324-334.
Moos, R. H. (2008). Active ingredients of substance use-focused self-help groups. Addiction, 103(3), 387-396.
Olson, B. D., Viola, J. J., Jason, L. A., Davis, M. I., Ferrari, J. R., & Rabin-Belyaev, O. (2006). Economic costs of Oxford House, inpatient treatment, and incarceration: A preliminary report. Journal of Prevention & Intervention in the Community, 31(1-2), 63-72. doi: 10.1300/J005v31n01_06
Oxford House Inc. (2019). Oxford House, Inc. Annual Report Fiscal Year 2018. Silver Spring, MD: Oxford House, Inc.