Giving and receiving help in three contexts as predictors of alcohol outcomes in a longitudinal study of sober living house residents.

Introduction to the Special Issue: Architecture Enhances Mutual Aid in Sober Living Houses.

Background Sober living houses (SLHs) are peer-managed residences that require sobriety and household participation among residents who rent rooms on a monthly (indefinite) basis and otherwise live normal lives according to personal schedules and needs. The houses do not provide counseling or services, but regular attendance at 12-step or other types of mutual-help groups is generally required. Approximately 1000 sober living houses, members of two state-wide organizations, operate in California to serve a large and complex population. This presentation provides an overview of work conducted to date studying sober living houses in Northern and Southern California. Methods and results In a study of SLHs in Northern California, 300 residents were followed for 18 months after entry. Our research found that neighbors and key informants (e.g., criminal justice, housing and political officials) were highly supportive of SLHs. Findings showed resident improvement in a variety of areas, including drug and alcohol use, employment, psychiatric symptoms, and arrests, with improvements that were maintained over the course of the study period. Although residents on parole and probation had substance use reductions that were comparable to voluntary residents, they had far more problems maintaining employment, higher rates of re-arrest and incarceration, and lower attendance to self-help groups. An ongoing randomized clinical trial in Southern California (anticipated N = 330 residents; 50 houses) is currently examining the effectiveness of an intervention to improve access to services and reduce HIV risk among sober living house residents on parole or probation. Residents randomized to the treatment condition receive a Motivational Interviewing Case Management (MICM) intervention specifically targeted to the problems presented for each resident. The list of potential problems that MICM can address is extensive and aims to help in a variety of problem areas inclusive of: 1) adapting to the sober living house environment; 2) complying with parole and probation; 3) finding and maintaining work; 4) successfully accessing and retaining services; 5) addressing HIV risk, testing, and treatment; 6) mobilizing personal and informal resources; and 7) managing setbacks (e.g., relapse, loss of housing, loss of work). Study participants are being tracked over a 12-month time period and being assessed on criminal justice, HIV risk, and drug and alcohol outcomes. Conclusions Sober living houses play an important role in helping individuals in their recovery from substance abuse, and providing additional services in these houses (MICM) to increase access to formal services may further enhance outcomes for high-risk populations.

Reporting errors on combined use of caffeine and alcohol questions in a qualitative questionnaire

Cannabis use and alcohol and drug outcomes in a longitudinal sample of sober living house residents in California

BackgroundIn Tanzania, residential treatment centers for alcohol and other drugs, locally known as “sober houses,” play a critical role in the treatment of people living with a substance use disorder (SUD), but little is known about the services they offer and service users’ and providers’ perceptions of those services. We aimed to address these gaps in knowledge and to better understand where evidence-based interventions may be able to address gaps in service provision.Materials and methodsThis study used a mixed-methods approach across four sober houses in Dar es Salaam, Tanzania. We conducted 48 semi-structured interviews with a sub-sample of sober house service users (n = 38) and service providers (n = 10). Eighty-six (86) service users also completed a written survey to capture demographic information and assess knowledge of HIV and willingness to use HIV preventive care. All interviews were audio-recorded, translated into English, and then coded according to constructs developed with the Recovery Capital Framework. Following coding, a thematic analysis was conducted for the qualitative data using the framework developed by Braun and Clarke.ResultsService users were generally positive about the treatment they were receiving but identified gaps in health service provision related to HIV, as well as a lack of preparation to address the employment-related challenges they face in the community after completing treatment. Service providers largely agreed with users’ perceptions of needs and identified a lack of clinical personnel in sober houses and funding challenges as barriers to meeting these needs.ConclusionSober houses provide treatment services to Tanzanians with SUD that service users largely view as positive. This evaluation identified employment challenges after treatment completion and gaps related to HIV care in the sober house. Further research is needed to investigate how interventions can be adapted to the sober house setting to meet these needs.

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 vs. $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.

Affordable alcohol- and drug-free housing that supports recovery is limited in many areas. Sober living houses (SLHs) offer a unique living environment that supports abstinence and maintenance of a recovery lifestyle. Previous studies show that SLH residents make improvements on alcohol, drug and other problems that are maintained at 18-month follow-up (Polcin et al. 2010). However, for SLHs to maximize their impact they must recognize how they are viewed by community stakeholders and successfully address barriers. This pilot study recruited a convenience sample of two stakeholder groups, certified alcohol and drug counselors (N = 85) and licensed mental health therapists (N = 49), to explore knowledge and views about SLHs using an online survey. Therapists and counselors had similar views about SLHs, although counselors had more direct experience with them and were more knowledgeable. Both groups were highly supportive of increasing the role of SLHs to address addiction problems in their communities. Those who were most supportive had more knowledge about SLHs, agreed that alcohol and drug problems were caused by a physical disease, and agreed that successful recovery required an abstinent living environment. Both groups identified a variety of barriers, particularly social stigma. Recommendations are made for knowledge dissemination and decreasing barriers.

Cannabis use and alcohol-related outcomes among sober living house residents with alcohol use disorders.

Sober living houses for alcohol and drug dependence: 18-Month outcomes

Objective: Sustained abstinence for many alcohol- and drug-dependent persons might be enhanced by providing an alcohol- and drug-free living environment that supports recovery. Sober living houses (SLHs) are alcohol- and drug-free living environments for individuals attempting to maintain abstinence. Costs are covered by resident fees and residents can stay as long as they wish.Method: The present study examined 300 individuals who entered: (1) SLHs associated with an outpatient treatment program (N = 55) or (2) freestanding SLHs not affiliated with formal treatment (N = 245). A repeated-measure design examined alcohol, drug, and other problem areas at baseline, 6 months, and 12 months. Mixed model regressions were used to assess how problems changed for individuals within each type of SLH over the 3 time points.Results: Residents in both types of houses made significant reductions in the maximum number of days of substance use per month between baseline and 6 months and these reductions were maintained at 12 months. On Addiction Severity Index (ASI) scales that assessed alcohol, drug, employment, and legal problems residents either made significant improvement or maintained low baseline severity of problems at 6 and 12 months. On other measures, residents entered the houses with moderately high severity that did not improve (ASI Medical and Family/Social severity) or improved modestly (psychiatric symptoms on the Brief Symptom Inventory).Conclusion: Addiction recovery systems should recognize the potential utility of SLHs and examine the types of houses that are feasible in specific communities.

Background Sober living houses (SLHs) offer abstinence-based housing for individuals with alcohol or drug problems. Research shows residents of SLHs make improvements on measures of substance use and other problems. Length of stay (LOS) in the house is associated with outcomes. However, little is known about the reasons residents leave houses or how reasons are associated with outcomes. Methods Baseline interviews were conducted with individuals entering 48 SLHs in Los Angeles. Residents who left within 12 months completed a 12-month follow-up interview (N = 352) assessing reasons they left, abstinence, psychiatric symptoms, and housing status. Multilevel regression models assessed relationships between reasons and outcomes. Results The most commonly cited reason for leaving was wanting to live on one’s own or in a shared living situation with family or friends (45.7%), which was associated with increased odds of abstinence and fewer psychiatric symptoms. Leaving due to not liking something about the house (e.g., rules or living conditions) was the second most commonly cited reason for leaving (28.1%), but was not associated with any outcomes. Wanting to live on one’s own and did not get along with residents or the house manager were associated with favorable housing (i.e., stable housing or a different SLH). Conclusion Residents who leave SLHs to live more independently in the community may be better prepared than residents who leave for other reasons. Some residents may benefit from seeking stable housing in the community or in another SLH if they are not a good match for their current house.

Lack of a stable, alcohol- and drug-free living environment can b e a serious obstacle to sustained abstinence. Destructive living environments can derail recovery for even highly motivated individuals. Sober living houses (SLHs) are alcohol- and drug-free living environments for individuals attempting to abstain from alcohol and other drugs. They are not licensed or funded by state or local governments and the residents themselves pay for costs. The philosophy of recovery emphasizes 12- Step group attendance and peer support. We studied 300 individuals entering two different types of SLHs over an 18-month period. This article summarizes our published findings documenting resident improvement on measures of alcohol and drug use, employment, arrests, and psychiatric symptoms. Involvement in 12-Step groups and characteristics of the social network were strong predictors of outcome, reaffirming the importance of social and environmental factors in recovery. This article adds to our previous reports by providing a discussion of implications for treatment and criminal justice systems. We also describe the next steps in our research on SLHs, which will include: (1) an attempt to improve outcomes for residents referred from the criminal justice system and (2) a depiction of how attitudes of stakeholder groups create a community context that can facilitate and hinder the legitimacy of SLHs as a recovery modality.

Introduction Substance use disorders are reaching epidemic proportions among adolescents and young adults. While disturbed, insufficient sleep is known to be associated with substance use, little is known about the role of circadian misalignment in precipitating or perpetuating substance misuse. Methods The Penn State Child Cohort is a population-based sample of 700 children (Mdn=9y), who were followed-up 8 years later as adolescents (N=421, Mdn=16y) and 15 years later as young adults (N=492, Mdn=24y). In adolescence, a delayed sleep phase was defined as a 7-night actigraphy-measured mean sleep midpoint later than 4:00 AM, while an irregular circadian phase as a within-subjects standard deviation in sleep midpoint greater than 1 hour. Alcohol, tobacco, and drug use was ascertained by parent- and/or self-reports in adolescence, while alcohol, tobacco and marijuana use was ascertained by self-reports in young adulthood. Logistic regression models tested the association between delayed and irregular circadian phase with substance use adjusted for age, sex, race/ethnicity, BMI, SES, mental health problems and psychoactive medications. Results Adolescents with a delayed sleep phase (n=164) showed later bed and wakeup times, lower morningness scores and greater circadian phase irregularity. Cross-sectionally, a delayed sleep phase in adolescence was associated with 1.9-fold odds (95%CI=1.1–3.2) of alcohol, tobacco and/or drug use; specifically, the odds of alcohol and tobacco use associated with a delayed sleep phase were 1.9-fold (95%CI=1.1–3.4) and 2.4-fold (95%CI=1.1–5.3), respectively, while non-significant for drug use (n=28) for which mental health problems were among the strongest risk factors (OR=3.0, 95%CI=1.3–6.8). Longitudinally, an irregular circadian phase in adolescence was associated with 2.2-fold odds (95%CI=1.1–4.5) of alcohol, tobacco and/or marijuana use in young adulthood; specifically, the odds of alcohol use in young adulthood associated with an irregular circadian phase in adolescence were 1.9-fold (95%CI=1.1–3.5), while non-significant for tobacco (n=58) or marijuana use (n=76) for which mental health problems were the strongest risk factor (OR=2.2, 95%CI=1.3–3.7). Conclusion A delayed or irregular circadian phase in adolescence is associated with substance use, particularly alcohol use in the transition to adulthood. Beyond disturbed and insufficient sleep, circadian misalignment should become a target of early interventions to prevent substance use disorders. Support (if any) R01MH118308, R01HL136587, R01HL97165, R01HL63772, UL1TR000127

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.

PurposeHigh levels of adolescent substance use are linked to lower academic achievement, reduced schooling, and delinquency. We assess four types of out-of-school time (OST) contexts—unsupervised time with peers, sports, organized activities, and paid employment—in relation to tobacco, alcohol, and marijuana use at the end of high school. Other research has examined these OST contexts in isolation, limiting efforts to disentangle potentially confounded relations. MethodsLongitudinal data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 766) examined associations between different OST contexts during high school and substance use at the end of high school. ResultsUnsupervised time with peers increased the odds of tobacco, alcohol, and marijuana use, whereas sports increased the odds of alcohol use and decreased the odds of marijuana use. Paid employment increased the odds of tobacco and alcohol use. Unsupervised time with peers predicted increased amounts of tobacco, alcohol, and marijuana use, whereas sports predicted decreased amounts of tobacco and marijuana use and increased amounts of alcohol use at the end of high school. ConclusionsAlthough unsupervised time with peers, sports, and paid employment were differentially linked to the odds of substance use, only unsupervised time with peers and sports were significantly associated with the amounts of tobacco, alcohol, and marijuana use at the end of high school. These findings underscore the value of considering OST contexts in relation to strategies to promote adolescent health. Reducing unsupervised time with peers and increasing sports participation may have positive impacts on reducing substance use.