I’ve listened to the words of my friends, family members, and colleagues long enough to know that without the stability of a safe and healthy place to live--and the support of people around you--long term recovery from a substance use disorder can be illusive. With what we know about the changes in brain chemistry in response to alcohol and other drugs, it’s not surprising that when people leave treatment and go back to the same environments where they were using substances, reoccurrence happens more often than not.
So, what’s the solution? One might imagine a house, filled with people supporting you, relating to your challenges and sharing in your successes--where you can come home without fear of running into your drug of choice. Where perhaps employment, education, and legal support is available. Where you know you’re accountable to your neighbor. This sounds very much like recovery housing.
Recovery housing, defined by the National Alliance for Recovery Residences (NARR), offers sober, safe, and healthy living environments that at minimum provide peer-to-peer recovery support--with some providing professionally delivered clinical services aimed at promoting abstinence-based, long-term recovery. My colleague, Kristen Paquette, and I published two articles last spring in the Journal of Dual Diagnosis highlighting the critical role recovery housing plays in the community fabric of housing and recovery support services. One article reported on our work reviewing the status of recovery housing in Ohio and reporting lessons learned on how to best support and expand it. The other discusses the role that recovery housing can play in a housing continuum for people exiting homelessness. Both underline the importance of recovery housing as a choice for people in pursuit of sustained recovery.
While the number of recovery residences in the United States is unknown, there are many thousands operating as good neighbors, maintaining sober living environments and improving the outcomes for their residents. You may likely have a recovery residence in your community--possibly in your neighborhood--and not even know it. However, since many recovery residences operate independently of public funding and oversight, allowing residents to choose the best course for their own homes and recovery, unethical practices have tainted the model. Recent fraud and abuse has lead the New York City Council to pass 5 bills aimed at helping tenants of three-quarter houses get stable housing and curb interference in residents’ medical care. This past summer, Senators Warren, Hatch, and Rubio sent a letter to the Government Accountability Office to review oversight of sober living homes, and Representative Issa introduced a bill, the Safe Recovery and Community Empowerment Act, to regulate residential recovery facilities. While such regulation may be well intentioned, it could also cause barriers to housing choice, housing discrimination, and threaten the nature of these peer-lead homes.
And yet, with increasing concern over the expanding use of opioids and the recognition of the role these residences can play in long-term recovery, there is growing support for them. To date, 21 states have NARR affiliates--organizations certifying recovery residences in set quality standards. In late 2015, the U.S. Department of Housing and Urban Development released a policy brief on Recovery Housing, and the 2016 Surgeon General’s report on addiction lists recovery housing as an essential component of a recovery-oriented system of care. In fact, next week the Congressional Addiction, Treatment & Recovery Caucus is hosting a briefing on the topic.
We stand in an exciting time for recovery housing. Emerging research is beginning to build evidence that participation in these living environments reduces substance use and improves outcomes for residents. Federal agencies are paying more attention, opening doors for increased funding. I, for one, look forward to these movements, as it shines the light on these homes where--when run well--people are living in community together to make positive changes in each others’ lives. There’s beauty in that.
Learn more about the importance of recovery housing in a t3 podcast with staff from NARR on "The Opposite of Addiction is Connection."
Image by David Spinks (CC by 2.0).
