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The Role of Recovery Residences in Promoting Long-term Addiction Recovery
SCRA is pleased to announce the adoption of our first public policy statement, The Role of Recovery Residences in Promoting Long-term Addiction Recovery. Recovery Residences are lower cost, community-based residential environments that require abstinence from substance use and abuse. The Society of Community Research and Action has developed, with the executive, advocacy and research committees of the National Association of Recovery Residences (NARR), a policy statement on the value of recovery residences in the United States.
A YouTube video is at the end of this policy statement, providing more information about recovery homes. The video can also be viewed here: http://youtu.be/YLodwGNChzw
This policy statement is an official statement of the Society for Community Research and Action, Division 27 of the American Psychological Association, and does not represent the position of the American Psychological Association or any of its other Divisions or subunits.
The Society of Community Research and Action – Community Psychology,
Division 27 of the American Psychological Association
The Role of Recovery Residences in Promoting Long-term Addiction Recovery
Addiction and the larger arena of alcohol and other drug (AOD) abuse and related problems exact an enormous toll on individuals, families, organizations, local neighborhoods, and whole communities in the United States. Although a great number of advances have been made in AOD treatment, far too few individuals who could benefit from treatment receive it, and many who do receive treatment will resume AOD use following their discharge from it. New recovery support institutions are emerging beyond the arenas of traditional addiction treatment to support individuals hoping to initiate and to sustain long term recovery from addiction. One promising mechanism is the recovery residence.
Recovery residences (e.g., sober living houses, recovery homes, and Oxford HousesTM) are sober, safe, and healthy living environments that promote recovery from AOD use and associated problems. At a minimum, recovery residences offer peer-to-peer recovery support with some providing professionally delivered clinical services all aimed at promoting abstinence-based, long-term recovery. Recovery residences are sober living environments, meaning that residents are expected to abstain from alcohol and illegal drug use. Each credentialed recovery residence publishes policies on relapse sanctions and readmission criteria and other rules governing group living. Recovery residences may require abstinence from particular types of medications according to individual policy. Although the exact number is currently unknown, many thousands exist in the United States.
A small but growing body of research supports the effectiveness of recovery residences in sustaining abstinence and promoting gains in a variety of other domains, and the National Association of Recovery Residences has developed guidelines to define levels of care and standards to ensure the quality of care received. Yet, despite these advances, recovery residences face innumerable challenges. Critical questions regarding the operations and effects of recovery residence participation remain unanswered, and research scientists wishing to study recovery residences face considerable funding challenges given the prevailing funding emphasis on the neuroscience of addiction. Efforts to establish or relocate recovery residences face challenges with start-up funding and often face considerable neighborhood and political opposition. Also of importance, many health and human professionals are unaware of recovery residences and their benefits on long-term recovery outcomes.
The Society of Community Research and Action (SCRA) has developed, with the executive, advocacy and research committees of the National Association of Recovery Residences (NARR), a policy statement on the value of recovery residences in the United States. This policy statement 1) describes the emergence and rapid growth of recovery residences as a new addiction recovery support institution, 2) highlights research to date on the positive effects of participation in a recovery residence on long-term addiction recovery and related outcomes, 3) champions a research agenda that would address many unanswered questions related to such participation, 4) advocates social policies (laws, regulations and funding guidelines) in which recovery residences can flourish, 5) supports programs of education and training to increase referrals to these new resources by health and human service professionals, and 6) promotes programs to educate local political leaders and the public about the value of recovery residences for individuals, families, and communities in the United States.
Addiction and the larger arena of alcohol and other drug (AOD) and related problems exact an enormous toll on individuals, families, organizations, local neighborhoods and whole communities in the United States. Since the mid-twentieth century, an elaborate network of professionally-directed addiction treatment programs has been funded to respond to these problems, but more than half of individuals treated in these institutions will resume AOD use following their discharge from treatment—most often in the first 90 days following discharge. Assertive continuing care and support is not a routine component of addiction treatment in the United States and only a small percentage of persons treated participate in post-treatment continuing care, which involves post-treatment monitoring and support. There are growing calls to shift acute care models of addiction treatment to models that emphasize sustained, post-treatment recovery management in order to elevate long-term recovery rates and enhance the quality of personal and family life in long-term recovery. Recovery management is a philosophical framework for organizing addiction treatment services to provide long-term recovery maintenance and quality-of-life enhancement for individuals and families affected by severe substance use disorders.
New recovery support institutions are emerging beyond the arenas of addiction treatment and recovery mutual aid societies to achieve these goals. By providing a physical and social world to recover within, these new institutions (e.g., recovery residences, recovery schools, recovery industries, recovery ministries, recovery community centers, recovery cafes, etc.), mark a major milestone in the history of recovery in the United States. One of the earliest to develop and one of the most important of these new institutions is the recovery residence.
Recovery residences (e.g., sober living houses, recovery homes, and Oxford HousesTM) are sober, safe, and healthy living environments that promote recovery from AOD use and associated problems. The number of recovery residences in the U.S. has grown dramatically in the past 25 years and have helped fill the void of community support between professionally-directed addiction treatment and peer-led recovery mutual aid societies. The purpose of a recovery residence is to provide a safe and healthy living environment to initiate and sustain recovery—defined as abstinence from alcohol and other non-prescribed drug use and improvement in one’s physical, mental, spiritual, and social wellbeing. Individuals build resources while living in a recovery residence that will continue to support their recovery as they transition to living independently and productively in the community. Although recovery is commonly believed to refer to abstinence and a general sense of quality of life, recovery is by no means a simple construct that has uniform definition (i.e., some individuals define it as abstinence only from their primary drug; or as use of alcohol, but no drugs; or as no use of “hard drugs” but use of marijuana, or allow for use of “medical marijuana.”)
There is growing consensus that recovery from severe substance use disorders involves three critical components: sobriety, improvement in global (physical, emotional, relational, spiritual) health, and citizenship (positive community reintegration). Recovery residences are abstinence-based environments that provide mutual support for these three elements of recovery -in contrast to "wet housing" that allows residents to use alcohol or other drugs or "damp housing" that discourages but does not exclude persons for using and that do not address these larger recovery processes.
A recent publication, A Primer on Recovery Residences in the United States (Jason, Mericle, Polcin, White, & the National Association of Recovery Residences, 2012), released by the National Association of Recovery Residences based on a review of all materials published on recovery residences to date found that:
Some recovery residences are designed specifically for individuals with certain needs (e.g., co-occurring addiction and severe mental illness, veterans, mothers with children); however, some recovery residences may not be equipped to adequately meet these residents’ needs. Individuals with specific service needs seeking recovery residences should ask the provider about how these needs can (or cannot) be addressed within a particular residence. It is still unclear if outcomes differ for people with co-occurring disorders (mental health, process addictions, major medical issues such as Hepatitis C or HIV) living in recovery residences.
Recovery residences are divided into Levels of Support based on the type as well as the intensity and duration of support that they offer. Services provided span from peer-to-peer recovery support (all recovery residences) to medical and counseling services (recovery residences offering higher levels of support). The National Association of Recovery Residence Standards defines minimum services for each Level of Support, but additional services may be provided at each level. Section 5 of the National Association of Recovery Residences Standards, included in A Primer on Recovery Residences in the United States, details the minimum required service elements for each Level of Support. National Association of Recovery Residence-certified recovery residences meet standards addressing safety from an administrative, operational, property, and good neighbors’ perspective. Recovery residences’ internal governance varies across National Association of Recovery Residence Levels of Support. Forms of governance range from democratically run by the residents to oversight by licensed professionals. The regulation of recovery residences vary from state to state, local government to local government, and model to model. In general, states regulate professional services and local governments regulate health and safety standards. Both state and local government regulation must adhere to federal laws and limits, such as the Americans with Disabilities Act and the Fair Housing Act.
The National Association of Recovery Residences, established in 2011, currently represents approximately 1,500 residences through its local organizational affiliates. The National Association of Recovery Residences advocates for recovery residences and their residents at the national and local levels. Members of the National Association of Recovery Residence maintain standards for recovery residences of all kinds across the four National Association of Recovery Residence Levels of Support, from Level 1 peer-operated residences to Level 4 residences offering a wide variety of treatment and recovery support services. Three additional recovery residence organizations exist with a national scope. The oldest is the Association of Halfway House Alcoholism Programs, founded in 1958, and all are now affiliated with the National Association of Recovery Residences. The members of the Association of Halfway House Alcoholism Program include all of the National Association of Recovery Residences Levels of Support. The Association of Halfway House Alcoholism Program’s residences operate in accordance with social model recovery principles. Oxford House Inc. was established in 1975 and supports Oxford Houses internationally. Oxford Houses are National Association of Recovery Residence Level 1, with each residence operated solely by the residents in accordance with Oxford House guidelines. Oxford House Inc. supports and promotes its model for peer-operated recovery residences through training, technical assistance, and access to startup financing. They also advocate for recovery housing rights and provide legal support to Oxford Houses involved in disputes with cities and towns over their right to exist. Treatment Communities of America (formerly Therapeutic Communities of America) represents more than 600 residential addiction treatment programs in the United States.
Recovery residences face innumerable challenges in spite of their rapid growth and positive findings on their effects on recovery outcomes. Critical questions regarding the operations and effects of recovery residence participation remain unanswered, and research scientists wishing to study recovery residences face considerable funding challenges given the prevailing funding emphasis on the neuroscience of addiction. Efforts to establish or relocate recovery residences face challenges with start-up funding and often face considerable neighborhood and political opposition. Also of importance, many health and human professionals are unaware of recovery residences and their benefits on long-term recovery outcomes.
In light of these findings and circumstances, the Society of Community Research and Action (SCRA):
1) Recommends that national, state, and local agencies support local networks of recovery residences. Specially, the SCRA calls upon:
2) Recommends enhanced funding for critical research related to recovery residences. The SCRA calls upon:
3) Recommends strategies to educate and train addiction treatment professionals and allied health and human services professionals on the value of recovery homes. The SCRA calls upon:
4) Recommends public education strategies that will address the stigma and misconceptions often attached to recovery homes and their residents. The SCRA calls upon:
Having reviewed the available scientific evidence on recovery residences, we believe these actions will play a significant role in elevating long-term addiction recovery outcomes in the United States and contribute to the quality of life of individuals, families and communities throughout the country.
The proposed policy statement was written by the National Association of Recovery Residences (NARR) research committee and approved by the NARR executive committee before submission to the SCRA. The NARR research members include Leonard A. Jason, PhD, Director, Center for Community Research, DePaul University; Amy A. Mericle, PhD, Research Scientist, Treatment Research Institute; Douglas L. Polcin, EdD, Senior Scientist, Alcohol Research Group; and William L. White, MA, Senior Research Consultant, Chestnut Health Systems.
Jason, L. A., Davis, M. I., & Ferrari, J. R. (2007). The need for substance abuse aftercare: Longitudinal analysis of oxford house. Addictive Behaviors, 32(4), 803-818. doi:10.1016/j.addbeh.2006.06.014
Jason, L. A., Groh, D. R., Durocher, M., Alvarez, J., Aase, D. M., & Ferrari, J. R. (2008). Counteracting “Not in My Backyard”: the positive effects of greater occupancy within mutual-help recovery homes. Journal of Community Psychology, 36(7), 947-958. doi: 10.1002/jcop.20259
Jason, L.A., Mericle, A.A., Polcin, D.L., White, W.L. & the National Association of Recovery Residences (with Fred Way serving as Liaison with Research Committee). (2012). A Primer on Recovery Residences in the United States.
Jason, L. A., Olson, B. D., Ferrari, J. R., & Lo Sasso, A. T. (2006). Communal housing settings enhance substance abuse recovery. American Journal of Public Health, 91, 1727-1729.
Jason, L. A., Roberts, K., & Olson, B. D. (2005). Attitudes toward recovery homes and residents: Does proximity make a difference? Journal of Community Psychology, 33(5), 529-535. doi:10.1002/jcop.20073
Kelly, J. & White, W. (Eds., 2011) Addiction recovery management: Theory, science and practice. New York: Springer Science.
Polcin, D. L. (2009). Communal-living settings for adults recovering from substance abuse. Journal of Groups in Addiction & Recovery, 4(1/2), 7-22. doi:10.1080/15560350802712355
Polcin, D. L., Henderson, D., Trocki, K., & Evans, K. (2012). Community context of sober living houses. Addiction Research & Theory, 20, 480-491. doi:10.3109/16066359.2012.665967
Polcin, D. L., Korcha, R. A., Bond, J., & Galloway, G. (2010). Sober living houses for alcohol and drug dependence: 18-month outcomes. Journal of Substance Abuse Treatment, 38(4), 356-365. doi:10.1016/j.jsat.2010.02.003
White, W. (2008). Recovery management and recovery-oriented systems of care: Scientific rationale and promising practices. Pittsburgh, PA: Northeast Addiction Technology Transfer Center, Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health & Mental Retardation Services
White, W. (2012). The Oxford House story: An interview with Paul Molloy. Posted at www.facesandvoicesofrecovery.org and www.williamwhitepapers.com.
White, W., Kelly, J. & Roth, J. (2012). New addiction recovery support institutions: Mobilizing support beyond professional addiction treatment and recovery mutual aid. Journal of Groups in Addiction & Recovery, 7(2-4), 297-317.