Oxford House Research Articles

Self-harm on a specialist adult eating disorder unit: a retrospective cohort study of patient characteristics and outcomes

AimsDeliberate self-harm (DSH) is common but rarely studied among inpatients with eating disorders. We sought to investigate the frequency of DSH among inpatients in a specialist adult eating disorders unit, and the association of DSH with comorbidities and treatment outcomes. We also investigated changes in these parameters during the pandemic.MethodWe included the records of 70 patients consecutively admitted to Cotswold House in Oxford between April 2018 and November 2020. Data were analysed using Microsoft Excel using descriptive statistics. For comparisons, student T-tests were used for continuous variables and Chi-square tests used for categorical variables.Result99% of patients were female; their ages ranged from 17 to 67 years (mean 30.7). 81% had a primary diagnosis of anorexia nervosa, and 67% had a history of DSH prior to admission. There was a total of 100 incidences of DSH, of which 12% required transfer to a general hospital for medical treatment.Frequency of self-harm decreased with time throughout admission (17% self-harming on admission, vs 7% at discharge, p = 0.043).Compared to those with no history of DSH, patients who self-harmed during admission were more likely to be detained under the Mental Health Act (45% vs 17.4%, p = 0.003), and to have psychiatric comorbidities (85% vs 35%, p = 0.001). Patients whose self-harm required transfer for general hospital treatment had a lower mean discharge BMI (18.18kg/m2 vs 20.23kg/m2, p = 0.039), longer admission (105.9 days vs 78.1 days, p = 0.037), and gained weight at a slower rate (0.26kg/m2/week vs 0.43kg/m2/week, p = 0.048) than those who did not require transfer.During the pandemic, the frequency of DSH doubled on the ward. Overall outcomes were similar, however mean length of admission was lower during the pandemic (67.83 vs 89.94 days, p = 0.046), and patients regained weight more rapidly (0.43kg/m2/week vs 0.28kg/m2/week, p = 0.003) than prior to it.ConclusionSelf-harm during admission was seen in 29% of patients and was associated with the presence of comorbid psychiatric diagnoses. The frequency of DSH much reduced between admission and discharge, suggesting a beneficial effect of treatment. Medical transfer for DSH, considered as a proxy measure for severity, predicted poorer outcomes in weight restoration. We also noted an increase in rates of DSH during the pandemic, which may have resulted from a combination of increased psychosocial stressors and a reduction in admission capacity in eating disorder units.

‘Maybe this is the place for me:’ a qualitative study examining needs and length of stay in recovery house residents

ABSTRACT The current qualitative study recruited 10 first-time Oxford House residents to participate in semi-structured interviews to explore their needs and factors affecting their length of stay. Interviews were analyzed using the Interpretative Phenomenological Analysis (IPA) approach. Findings suggest lower-resourced residents are more likely than higher-resourced residents to achieve the therapeutic dose due to higher need fulfillment and the drawbacks associated with group living minimized. For higher-resourced residents, increasing investment in the house through the development of friendships with housemates and participation in service activities could increase their length of stay by increasing their investment in the house. Implications are discussed.

An Examination of Psychiatric Severity and Social Cohesion Outcomes within Oxford Houses.

It is estimated that nearly 20 million adults in the United States have a substance use disorder (SUD), and 8.4 million of those adults have a comorbid mental disorder. Roughly half of those adults with a SUD and a psychiatric comorbidity fail to receive adequate treatment for either the SUD or the mental disorder (combined or separately). However, this sub-population has shown positive treatment outcomes (e.g., improved quality of life and increased length of stay in a recovery home) when allotted the proper resources to treat the overlapping symptomologies associated with their multiple diagnoses. Many individuals with SUD and psychiatric comorbidity receive community-based support from recovery residences, a ubiquitous form of aftercare treatment in the United States. The aim of the present study was to investigate the relationship between psychiatric severity index scores (a proxy for psychiatric comorbidity that measures social functioning, impairment, symptoms, and behavior), length of stay in Oxford Houses (OHs), and quality of life. The present study found a significant negative relationship between length of stay and psychiatric severity scores, and between psychiatric severity scores and quality of life scores. Psychiatric severity was observed to predict decreased quality of life, while length of stay predicted decreased psychiatric severity. Psychiatric severity mediated the relationship between length of stay and quality of life based on house composition.

“This Program Helped Save Our Lives so We All Can Bond over That”: A Preliminary Study of the First Oxford House Collegiate Recovery Home

ABSTRACT College settings can be challenging environments for students recovering from substance use disorder. Collegiate Recovery Programs (CRP) have emerged on college campuses across the United States to help mitigate the risks recovering students face and to promote academic and recovery success. The current article describes the first collegiate recovery home to follow an Oxford House [OH] model, established at the University of North Carolina at Chapel Hill. In the present preliminary study, qualitative data were utilized to explore the strengths and challenges of this recovery model and students’ experiences in the OH collegiate recovery home. Key stakeholders in the creation of this collegiate recovery home (n =2), as well as current and former student participants (n = 6), were interviewed. The key stakeholders’ interviews revealed insights on the home’s creation, modifications made from the traditional OH model, and the challenges faced in implementing a collegiate recovery home. Rapid qualitative analysis of the interviews of residents revealed salient themes that describe students’ experiences within the collegiate recovery home: (1) resident social support, (2) connection to the student body, (3) anonymous status of the house, (4) lifestyle, (5) optimism, (6) self-independence, (7) Collegiate OH is essential for sobriety, and (8) UNC involvement and oversight. The implications of these findings for collegiate recovery homes are discussed, as well as suggestions for future studies.

Personal and environmental social capital predictors of relapse following departure from recovery homes

Substance use recovery homes represent the largest residential, community-based post-treatment option for those with substance use disorders in the United States. It is still unclear what unique factors predict relapse after residents leave such homes. This study presents results of a longitudinal study of 497 residents who departed from 42 Oxford House recovery houses. We hypothesized that the predictors of post-departure relapse would be a multi-item measure of latent recovery, length of stay, and reason for departure from the home (voluntary vs. involuntary). Predictor effects were estimated as part of a two-step model with two outcomes: (a) lack of follow-up data after departure from the house, and (b) the likelihood of relapse. Determinants of missing follow-up data included less education, less time in residence, and involuntary departure. Relapse was more likely for individuals who were younger, had involuntarily left the house, and had lower values on the latent recovery factor. The implications of these important factors related to relapse following departure from residential recovery home settings are discussed.

Network measures of advice-seeking and resource sharing are related to well-being in recovery homes

BackgroundThere is a need to better understand the extent to which social capital (reflected in social networks tapping friendship, financial support, advice/informational support) can aid recovery for those residents living in abstinence-based recovery homes. MethodsSocial network characteristics of 42 recovery homes (Oxford Houses) were examined, including friendship, willingness to loan money, and advice-seeking to assess the extent to which house network patterns were related to house-level resident measures of proximal recovery outcomes of well-being (e.g. social support, self-esteem, stress) and financial health (e.g. earned wages). ResultsWe found that the density of the willingness to loan money network within a house was positively associated with house-level earned wages, social support, and self-esteem, and negatively associated with stress. Conversely, the density of house advice-seeking relationships was positively related to house-level stress. ConclusionsHouses in which residents are willing to share resources with other members who may be in need showed higher rates of well-being at the house-level. Advice-seeking in itself may signal stress, as stress may motivate residents to seek advice from more peers. The implications of these findings are discussed.

Advice seeking and loaning of money related to relapse in recovery homes.

Recovery homes help individuals who have completed substance use treatment programs re-integrate back into the community. However, it is unclear what factors determine who will succeed in these settings and how these factors may be reinforced or undermined by the social interactions and social networks between residents living in the Oxford House recovery homes. In an effort to better understand these factors, the current study evaluated (a) the extent to which the density of social networks (i.e., friendship, willingness to loan money, and advice-seeking relationships) is associated with social capital (i.e., sense of community, quality of life, hopefulness, self-efficacy), and (b) whether the density of social networks predicts relapse over time. Among the findings, willingness to loan money was positively associated with all four individual-level social capital variables, suggesting that availability of instrumental resources may be important to ongoing recovery. To test whether these house-level social network factors then support recovery, a survival analysis was conducted, finding associations between relapse risk and the network densities over a 28-month span. In particular, more dense advice-seeking networks were associated with higher rates of relapse, suggesting that the advice-seeking might represent a sign of organisational house problems, with many residents unsure of issues related to their recovery. In contrast, more dense loaning networks were associated with less relapse, so willingness to lend money could be measuring a willingness to help those in need. The implications of these findings are discussed.

Social Network Cohesion among Veterans Living in Recovery Homes

Recovery homes for individuals with substance use disorders (SUD) called Oxford House (OH) have been shown to improve the prospects of a successful recovery across different sub-populations, and these homes may be particularly beneficial for veterans in recovery. An estimated 18% of OH residents are veterans; however, not much is known about their experiences living in these homes. Participants included 85 veterans and non-veterans living in 13 OHs located in different regions of the United States. Using social network analysis and multi-level modeling, we investigated whether the social networks of veterans residing with other veterans were more cohesive compared to veterans living with only non-veterans. Results indicated that veterans residing with other veterans had stronger relationships with other OH residents than veterans who reside with all non-veterans. The implications for theory and practice are discussed. Further research is needed to determine if greater social network cohesion leads to better recovery outcomes for veterans.

Homophily Effects Among Oxford House Residents Utilizing Medication Assisted Treatment

ABSTRACT The effects of social support among persons utilizing medication assisted treatment (MAT) living in abstinence-based recovery homes is not clearly understood, and there is a need to identify social process components that engender social support for this population. The present investigation examined whether homophily (i.e., living with/without fellow MAT residents) among recovery home residents would moderate the mediating effects of social support on the relationships between stress and two recovery outcomes (quality of life, abstinence self-efficacy) among a sample of persons utilizing MAT living in recovery homes (Oxford Houses) in the U.S. Moderated mediational analyses were conducted to test whether potential mediating effects were moderated by homophily. Mediating effects were observed in both models, but they were significant only through the moderator (homophily) in that social support buffered the effects of stress among MAT residents who lived with other MAT residents in their recovery homes. Findings suggest that homophily effects are related to social networking for persons utilizing MAT living in abstinence-based recovery homes.

Medications for Opioid Use Disorder Utilization Among Oxford House Residents

Medications for opioid use disorder (MOUD) and recovery homes that have traditionally served those not taking medications for their recovery are important resources for treating opioid use disorder. However, little is known whether such recovery homes are a good fit for persons utilizing MOUD, and whether residents' characteristics such as drug histories and the composition of recovery homes in terms MOUD and non-MOUD residents are related to attitudes toward MOUD. The present investigation examined characteristics of persons utilizing MOUD, and attitudes regarding MOUD utilization among residents living in recovery homes (Oxford Houses, OH) in the U.S. consisting of MOUD and non-MOUD residents. Residents living with others who were utilizing MOUD reported more favorable attitudes than residents who were not living with such residents, but this was observed only among residents whose primary drug of choice involved heroin or opioids. There were no significant differences observed in terms of abstinence rates, involvement in 12-step groups, or previous MOUD treatments between residents utilizing or not utilizing MOUD. Findings suggest that persons utilizing MOUD benefit by recovery homes such as OHs whose residents have favorable attitudes toward MOUD, especially when living with fellow residents who utilize MOUD.

The relationship of Oxford Houses across heterogeneous house and setting characteristics.

Oxford Houses (OH) are democratically run, self-funded, substance-use recovery homes that operate across the United States and internationally. Previous research shows the OHs are present in diverse neighborhoods. The current study examined the neighborhoods of 42 OHs located in Oregon, Texas, and North Carolina to better quantify and understand house and neighborhood characteristics that are related to relapse rates. Independent variables were participants' length of stay in OH, wages earned from employment, and income/education neighborhood characteristics. Neighborhood characteristics were related to relapse rates, with higher relapse rates occurring in neighborhoods with lower income and education levels. This finding supports the OH organization's premise that while OHs may work across community settings, they perform better in neighborhoods with higher average income and education levels. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Recovery home networks as social capital.

Ensuring recovery home residents' social integration into a home environment is important for preventing early dropout and facilitating sustained recovery. Social capital theory may provide an explanation for how recovery homes may protect residents and improve recovery rates. However, little is known about how social capital in recovery home environments is structured and accessed. Recovery homes may increase social capital by sharing bonds through friendships, lending money, and advice-seeking. The current study describes social network cross sectional data obtained from a study of 42 Oxford House recovery homes, in three locations in the US (North Carolina, Texas, and Oregon). The residents rated each member of their house on the dimensions of friendship, money loaning, and advice seeking to assess how each resident views one another on these dimensions. The research used baseline data from a larger longitudinal study, and although some data were presented for the full sample (APL, isolates, mean reciprocity and density), the results primarily focused on case studies for three of the participating Oxford Houses-with examples of low, median, and high "connected" houses respectively. Standard measures of network structures were calculated for each home. Although all Oxford Houses follow the same house rules, they were found to vary in network structure. Findings indicated a considerable range of interconnectedness among residents in these houses, with friendship being the most common relationship, willingness to lend money less common, and advice-seeking the least common. The findings on friendship, willingness to lend, and advice-seeking provide promising leads about what occurs among the social networks within these complex eco-systems, and may provide ways to better understand and facilitate resident social integration into these settings.

Tobacco Use among Recovery Home Residents: Vapers Less Confident to Quit.

Objectives: In this study, we provide estimates of the prevalence of tobacco use among residents in Oxford House (OH) recovery homes. We explore predictors for smoking cessation on future intentions to quit tobacco use, such as self-efficacy, motivation to quit, and level of nicotine dependence. We focus on examining smoking-related differences between 2 groups of tobacco users: (1) residents who only vape, and (2) residents who only smoke or who smoke and vape (ie, dual users). Methods: Data come from a research project examining the social networks of residents in OH homes at Wave 5 (N = 270) when questions were asked about tobacco use and cessation. We conducted multiple logistic regression analysis to assess the predictors on intentions to quit tobacco in the next 6 months. Results: Among residents, 60.4% report that they either smoke cigarettes, vape, or use both products. The odds of quitting are 92.5% lower for residents who only use e-cigarettes than for those who only smoke cigarettes or who smoke cigarettes and vape. Motivation to quit was associated with more than double the odds for self-efficacy on intentions to quit with odds ratios of 3.23 (95% CI: 1.81, 5.78; p = .00) and 1.47 (95% CI: 1.05, 2.07; p = .03) respectively. Conclusion: The high prevalence of smoking and vaping in this population makes it an important target for interventions.

Social Support among Oxford House Residents Utilizing Medication-Assisted Treatments

ABSTRACTSocial support is a resource frequently utilized by persons recovering from substance use disorders. However, little is known about the effects of social support among persons utilizing medication-assisted treatments (MATs) living in abstinence-based recovery homes. The present investigation examined whether social support would mediate the relationship between stress and two recovery outcomes (quality of life and abstinence self-efficacy) among a sample of residents living in Oxford House abstinence-based recovery homes in the U.S. Moderated mediational analyses were conducted to test whether potential mediating effects were influenced by whether residents were (or were not) utilizing MATs. Mediating effects were observed in both models, and these were not moderated by residents’ MAT status. Findings suggest abstinence-based recovery homes such as Oxford Houses provide valuable social support that helps persons utilizing MATs in their recovery.

A promising recovery housing model for American Indian communities.

In 2016, two Oxford House (OH) recovery homes were established for the Suquamish Tribal reservation. A group of researchers interviewed house members and key individuals responsible for the creation of these two unique OHs. Because American Indians are an at-risk population for substance use disorders, our study explored whether an OH-type recovery home model could be successfully adapted to this population, given the specific nature of tribal cultures. Findings indicated that the residents, composed of both American Indians and non-American Indians, found these OHs to be supportive of recovery in general and with the values of American Indians. The tribal community's positive attitudes toward these recovery homes may have been due to similarities between the Suquamish Tribal Government and OH's democratic structures, with all individuals having a voice in the decision making process. The overall findings suggest that these types of culturally modified recovery settings on American Indian tribal lands could be an important resource for individuals dealing with substance use disorders.

Census characteristics of Illinois sober living homes: A geographic information systems study

Recovery homes currently provide a supportive, cohesive setting following addiction treatment to thousands of individuals who often have the least resources and consequently a high risk of relapse. Such homes are particularly important regarding reducing inequality, particularly for those with substance use disorders exiting inpatient treatment or jail/prison, and many of these individuals have experienced homelessness and high rates of psychiatric co-morbidity. Yet, the success of these houses and their residents is likely related to the ability of the residents to obtain employment. This study geocoded data from 52 Oxford House recovery homes throughout Illinois. Data indicated that Oxford Houses in Illinois were often located in areas with the highest unemployment activity in the state. Placing homes in communities with higher job opportunities and employment rates could increase employment for individual residents and, subsequently, reduce inequality by increasing their odds of long term abstinence.

Quality of life as a predictor of social relationships in Oxford House

Improved access to housing and recovery support is a low-cost, high-potential opportunity to help people recovering from alcohol and substance use sustain their recoveries. Oxford House (OH) recovery homes represent a recovery-favorable social environment for at least some people, but it is still unclear which resident characteristics and relational dynamics affect the social integration of residents. In the current study, OH residents in three geographic locations completed a social network instrument and self-rated their quality of life (QOL). The instruments were administered to the current (per wave) residents of 42 OHs at three time points over a period of a year. Findings indicated that those with a higher QOL were more likely to form friendships with those with a lower QOL than with their similar QOL peers, and vice versa. This finding would not have been predicted based on relationship mechanisms typical of broader social contexts, where homophily (similarity-based assortativity) is common. The self-governance model that characterizes OH residences, in which success among residents is necessarily viewed as mutually dependent and therefore mutually beneficial, seems a likely explanation for our result. Specifically, and aligned with current knowledge about what works in peer oriented recovery, our results suggest the governance mechanisms of OH favor relationships between those more stable in their recovery and those who are at a higher risk of dropout or relapse. This study reveals a potential research avenue examining an important ingredient for the effectiveness of OH.

Gender Differences in the Association Between Romantic Relationships and Relapse Among Individuals in Early Recovery in Oxford House

ABSTRACTAlthough clear gender differences exist in the effect of romantic relationships on substance use, little empirical evidence is available about whether romantic relationships affect recovery differently for men and women. To test potential gender differences in associations of romantic partner relationships with relapse among Oxford House residents. Self-reported presence or absence of a romantic relationship among Oxford House residents ages 18–59 (N = 306) in early recovery was assessed at baseline and 4 months later, beginning in 2001. Odds of relapse over 8 months was assessed by the interaction of presence of romantic relationship at each occasion and gender. Relapse was most common among men in a relationship at baseline and follow-up and women not in a relationship at either occasion, occurring with significantly greater odds than women in a relationship at both times, after adjusting for days of sobriety at baseline (adjusted odds ratio [ORadjusted] = 3.50; 95% confidence interval [CI] [1.29, 9.51]; ORadjusted: 3.35; 95% CI [1.24, 9.10]). These findings provide initial empirical understanding of gender differences in the influence of romantic relationships in early recovery.

Recovery homes: A social network analysis of Oxford Houses for Native Americans

Social network data were collected among residents of an Oxford House (OH) recovery home, which was located on Suquamish Tribal territory. Data were collected on the social connections of eight male residents (including four Native Americans and four non–Native Americans) using a social network instrument. A number of social network relationship types were examined, including friendship, trust, and mentorship. Social network data assessed included diameter, reciprocity, the average path length, cohesion, density, transitivity, and centrality. Findings indicated that the OH provided residents a well-integrated network with multiple sources of friendship, trust, and mentors. This is of importance as recovery from substance abuse is facilitated when recovering individuals are provided stable and well-functioning networks that foster social support, access to resources, and mentorship.

Correction to: Oxford House Residents' Attitudes Toward Medication Assisted Treatment Use in Fellow Residents.

The original version of this article unfortunately contained a mistake in the author group, where co-authors Isabel Dovale, Noah Gelfman and Sarah Callahan were missed to include and Brandon Isler should be removed from the author group.