Recovery Homes Research Articles

Recovery Housing: Evolving Models to Address Resident Needs

ABSTRACTRecovery housing is a service delivery modality that simultaneously addresses the social support and housing needs of those in recovery from substance use disorders. This article describes a group of recovery homes in Texas (N = 10) representing a lesser-studied type of recovery housing, one which explicitly bridges treatment and peer support by providing a variety of recovery support services. All residents meet with a recovery coach, undergo regular drug screening, and have access to intensive outpatient treatment—a program that was developed specifically to support the needs of residents in the homes. Unlike the Oxford HouseTM model and California sober living houses, which are primarily financed through resident fees, these homes are supported through a mix of resident fees as well as private and public insurance. While adhering to some aspects of the social model of recovery, none of these homes would meet criteria to be considered a true social model program, largely because residents have a limited role in the governance of the homes. Residences like the ones in this study are not well-represented in the literature and more research is needed.

The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders

BackgroundThe federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between behavioral health and medical health insurance benefits among the commercially insured. This study determines whether MHPAEA was associated with increased BH expenditures and utilization among a population with substance use disorder (SUD) diagnoses. MethodsClaims and eligibility data from 5,987,776 enrollees, 2008–2013, were obtained from a national, commercial, managed behavioral health organization. An interrupted time series study design with segmented regression analysis estimated time trends of per-member-per-month (PMPM) spending and use before (2008–2009), during (2010), and after (2011−2013) MHPAEA compliance. The study sample contained individuals with drug or alcohol use disorder diagnosis during study period (N=2,716,473 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual, group and family psychotherapy, and structured outpatient care); intermediate care utilization (day treatment; recovery home and residential); and inpatient utilization. ResultsStarting at the beginning of the post-parity period, MHPAEA was associated with increased levels of PMPM total and plan spending ($25.80 [p=0.01]; $28.33 [p=0.00], respectively), as well as the number of PMPM assessment/evaluation, individual psychotherapy, and group psychotherapy visits, and inpatient days (0.01 visits [p=0.01]; 0.02 visits [p=0.01]; 0.01 visits [p=0.03]; 0.01days [p=0.01], respectively). Following these initial level changes, MHPAEA was also associated with monthly increases in PMPM total, plan, and patent out-of-pocket spending ($2.56/month [p=0.00]; $2.25/month [p=0.00]; $0.27 [p=0.03], respectively), as well as structured outpatient visits and inpatient days (0.0012 visits/month [p=0.01]; 0.0012days/month [p=0.00]). ConclusionMHPAEA was associated with modest increases in total, plan, and patient out-of-pocket spending and outpatient and inpatient utilization. These increases, while modest in magnitude, are larger in magnitude than increases detected among a sample of all enrollees (i.e. not only those with SUD diagnoses).

Relationship Themes Present between Parents and Children in Recovery Homes

ABSTRACTApproximately 12.5% of children have a parent with a substance use disorder. These children are likely to experience developmental delays, especially if they are placed into foster care. Oxford House recovery homes provide a useful setting that allows children to live with their parents after treatment for substance use. A sample of parents and their children who lived in Oxford Houses were interviewed, using mixed methods, and the outcomes suggest that Oxford Houses may provide a stable and supportive setting for parents and their children.

Growing recovery home operator advises broad search for funding

Alcoholism & Drug Abuse WeeklyVolume 28, Issue 41 p. 1-8 Articles Growing recovery home operator advises broad search for funding Gary Enos, Gary EnosSearch for more papers by this author Gary Enos, Gary EnosSearch for more papers by this author First published: 21 October 2016 https://doi.org/10.1002/adaw.30745Citations: 2Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article.Citing Literature Volume28, Issue41Special Issue: Special Issue: Innovations24 October 2016Pages 1-8 RelatedInformation

Meta-analysis of indoor temperatures in new-build housing

ABSTRACTDespite growing concerns about overheating, a lack of evidence exists on the scale of the problem, particularly in contemporary UK housing. This paper presents the results of a meta-analysis of indoor temperatures in selected low-energy housing. Temperature data recorded at five-minute intervals in 60 dwellings across 19 demonstration projects (2012–14) were collated and analysed to investigate the prevalence of overheating. Findings evidence high summertime temperatures, with 27% of living rooms exceeding 28°C during August. Based on the Chartered Institution of Building Services Engineers (CIBSE) threshold of 5% annual occupied hours > 25°C, 57% of bedrooms and 75% of living rooms were classified as having overheated. Overall, 30% of living rooms exceeded the adaptive comfort threshold of > 3% occupied hours ΔT ≥ 1 K. The results suggest a fundamental relationship between ventilation and indoor temperatures. The higher minimum and average summertime temperatures observed in mechanical ventilation with heat recovery (MVHR) homes (p < 0.05) and lower temperature range (p < 0.001) suggest the need for greater attention to adequate summertime ventilation provision in airtight homes. The results demonstrate a high prevalence of overheating in exemplary housing, indicating the need for greater efforts to ensure the effective implementation of strategies to minimize overheating and improve ventilation in low-energy homes.

Substance Abuse Treatment Patients in Housing Programs Respond to Contingency Management Interventions

Use of homeless and transitional housing (e.g., recovery homes) programs can be associated with success in substance abuse treatment, perhaps because many of these programs encourage or mandate sobriety. In this study, we examined whether contingency management (CM) protocols that use tangible incentives for submission of drug-free specimens or other specific behaviors are effective for treatment-seeking substance abusers whose behavior may also be shaped by housing programs. Of 355 participants in randomized trials of CM, 56 (16%) reported using transitional housing during the 12-week treatment period. Main and interaction effects of housing status and treatment condition were evaluated for the primary substance abuse treatment outcomes: a) longest duration of abstinence from alcohol, cocaine, and opioids, b) percentage of samples submitted that were negative for these substances, and c) treatment retention. After controlling for demographic and clinical characteristics, those who accessed housing programs submitted a higher percentage of negative samples (75%) compared to those who did not access housing programs (67%). Housing status groups did not differ in terms of longest duration of abstinence (accessed housing: M=3.1 weeks, SE=0.6; did not access housing: M=3.9 weeks, SE=0.3) or retention in substance abuse treatment (accessed housing: M=6.4 weeks, SE=0.6; did not access housing: M=6.6 weeks, SE=0.3). Regardless of housing status, CM was associated with longer durations of abstinence and treatment retention. No interactive effects of housing and treatment condition were observed (p>.05). Results suggest that those who accessed housing programs during substance abuse treatment benefit from CM to a comparable degree as their peers who did not use such programs. These effects suggest that CM remains appropriate for those accessing housing in community-based programs.

Collectivism and individualism in Latino recovery homes

ABSTRACTResearch indicates that Latinos underutilize substance abuse interventions; cultural variables may contribute to difficulties accessing and completing treatment for this group. As a result, there is a need to understand the role of cultural constructs in treatment outcomes. The purpose of this study was to investigate how levels of collectivism (COL) and individualism (IND) relate to length of stay and relapse outcomes in self-run recovery homes. We compared Latinos in several culturally modified recovery Oxford Houses to Latinos in traditional recovery Oxford Houses. By examining COL and IND in the OH model, we explored whether aspects of COL and IND led to longer lengths of stay and better substance use outcomes. We hypothesized that higher levels of COL would predict longer stays in an Oxford House and less relapse. COL did not have a main effect on length of stay. However, COL had a significant interaction effect with house type such that COL was positively correlated with length of stay in traditional houses and negatively correlated with length of stay in the culturally modified condition; that is, those with higher collectivism tended to stay longer in traditional houses. When we investigated COL, length of stay, and substance use, COL was negatively correlated with relapse in the culturally modified houses and positively correlated with relapse in the traditional houses. In other words, those with higher COL spent less time and had less relapse in the culturally modified compared to the traditional Oxford Houses. The implications of these findings are discussed.

The Relationship of Sense of Community and Trust to Hope.

Settings that that have ecological variables that instill hope might be particularly effective for treating individuals with substance use disorders. More specifically, trust and sense of community could be of importance in the fostering of hope among individuals in recovery from substance use disorders. Our study included a sample of individuals who were living in or had lived in Oxford House recovery homes. We found both sense of community and trust are ecological aspects of settings that had important influences on hope, as an engaged individual tends to value trust relationships. Perceptions of the house operating effectively was positively related to an individual's assessment of the house as a good setting, but the house was not perceived to be as effective when the residents were not invested in the setting. The sense of community Self factor was the best predictor of hope, suggesting that an individual's personal investment in their house community are related to their hopefulness in terms of goal attainment and opportunities. Associations of hopefulness, personal commitment, and a supportive ecology provide evidence that an individual's perspective on recovery encompasses personal, environmental, and temporal perceptions.

A Mathematical Framework for the Complex System Approach to Group Dynamics: The Case of Recovery House Social Integration.

The complex system conception of group social dynamics often involves not only changing individual characteristics, but also changing within-group relationships. Recent advances in stochastic dynamic network modeling allow these interdependencies to be modeled from data. This methodology is discussed within a context of other mathematical and statistical approaches that have been or could be applied to study the temporal evolution of relationships and behaviors within small- to medium-sized groups. An example model is presented, based on a pilot study of five Oxford House recovery homes, sober living environments for individuals following release from acute substance abuse treatment. This model demonstrates how dynamic network modeling can be applied to such systems, examines and discusses several options for pooling, and shows how results are interpreted in line with complex system concepts. Results suggest that this approach (a) is a credible modeling framework for studying group dynamics even with limited data, (b) improves upon the most common alternatives, and (c) is especially well-suited to complex system conceptions. Continuing improvements in stochastic models and associated software may finally lead to mainstream use of these techniques for the study of group dynamics, a shift already occurring in related fields of behavioral science.

Interaction of Motivation and Social Support on Abstinence among Recovery Home Residents.

The impetus to abstain from alcohol and drugs is especially robust when individuals seek help. However, motivation to continue abstinence during ongoing recovery is less understood. The present study assessed how social support interacted with motivation to affect abstinence over an 18-monthe time period. A sample of 289 residents entering residential recovery homes were recruited and followed at 6-, 12-, and 18-months. Motivation was measured as the perceived costs and benefits of abstinence. Five social influence measures were used to assess interactive effects with costs and benefits on abstinence. Perceived costs and benefits of abstinence were robust predictors of abstinence over the 18 month assessment period. Two social support factors interacted with perceived benefits to influence abstinence: 12-step involvement and number of persons in the social network. Suggestions are made for recovery services to influence perceived costs, benefits, and social network characteristics.

Oxford recovery housing: Length of stay correlated with improved outcomes for women previously involved with the criminal justice system

ABSTRACTBackground: Housing plays a crucial role in providing resources for and aiding an individual's reentry into the community following incarceration and substance use treatment. As such, this study examined the influence of recovery homes on a sample of former female substance-using women with criminal justice involvement. Methods: Two hundred women who had been involved with the criminal justice system within the preceding 2 years were recruited from multiple sites in metropolitan Chicago. These women were assigned to either 1 of 2 conditions: Oxford House (OH) recovery homes or usual aftercare (UA). Results: Those with longer stays in OH (6 months or more) had better outcomes in terms of alcohol and drug use, employment, and self-efficacy than those with shorter stays. Outcomes for those who stayed in OH were not appreciably different than the UA condition on substance use and employment, but fewer deaths occurred for those in the OH condition. Conclusions: Findings suggest that length of stay of 6 or more months is critical for those in recovery homes, but it is important for us to better understand the processes through which longer stays influence better outcomes.

"In-house" versus "home" rehabilitation programme following cardiac surgery: A service evaluation

Cardiac rehabilitation is the process by which patients with cardiac disease are supported to achieve optimal physical and psychosocial health. Exercise training is a core element of cardiac rehabilitation. At our institution, there are two different rehabilitation programmes available to patients who have undergone cardiac surgery: Firstly, there is the in-house (IH) hospital-based programme, secondly, the Road to Recovery (R2R) home programme.

Challenges and Rewards of Conducting Research on Recovery Residences for Alcohol and Drug Disorders.

Although research shows treatment for alcohol and drug problems can be effective, persons without stable housing that supports recovery are at risk for relapse. Recovery residences (RRs) for drug and alcohol problems are a growing response to the need for alcohol- and drug-free living environments that support sustained recovery. Research on RRs offers an opportunity to examine how integration of these individuals into a supportive, empowering environment has beneficial impacts on substance use, housing, and other outcomes, as well as benefits for the surrounding community. Research can also lead to the identification of operations and practices within houses that maximize favorable outcomes for residents. However, research on RRs also presents significant obstacles and challenges. Based on our experiences conducting recovery home research for decades, we present suggestions for addressing some of the unique challenges encountered in this type of research.

How Should We Study Residential Recovery Homes?

Persons with serious alcohol and drug problems who are attempting to maintain abstinence often lack an alcohol and drug free living environment that supports sustained recovery. Residential recovery homes, called "sober living houses" in California, are alcohol and drug-free living environments that offer long-term support for persons with addictive disorders. They do not offer formal treatment services but usually encourage or mandate attendance at self-help recovery groups such as Alcoholics Anonymous. This paper weighs the strengths and weaknesses of different research designs for studying residential recovery homes. Alternatives to randomized designs that are able to capture "real world" data that are readily generalized are described and understudied topics are identified. A significant limitation of traditional randomized designs is they eliminate mutual selection processes between prospective residents and recovery home residents and staff. Naturalistic research designs have the advantage of including mutual selection processes and there are methods available for limiting self-selection bias. Qualitative methods should be used to identify factors that residents experience as helpful that can then be studied further. Innovative studies are needed to investigate how outcomes are affected by architectural characteristics of the houses and resident interactions with the surrounding community. Use of the recommended strategies could lead to findings that are more informative, intuitively appealing, and interpretable. Recovery homes and similar programs will be more responsive to consumers. This paper represents one of the first to review various options for studying recovery homes and to provide suggestions for new studies.

Motivation to maintain sobriety among residents of sober living recovery homes.

BackgroundThe study of motivation in the substance abuse field has typically examined the extent to which substance users want to quit or reduce substance use. Less frequently examined is the desire to maintain sobriety after achieving abstinence. The current study examined motivation to maintain sobriety among residents of sober living houses (SLHs), a type of recovery home for individuals with alcohol and drug problems. Previous research on this population showed favorable longitudinal outcomes over 18 months. Resident views about the costs of not using substances (ie, the difficulties encountered when not using), as well as the perceived benefits of not using, were strong predictors of substance use outcomes.MethodsThis study adds to these findings by conducting two focus groups with individuals familiar with the structure and day-to-day operations of SLHs, including administrators of SLH organizations, owners, and peer managers.ResultsFocus group results supported the importance of costs and benefits as motivational forces influencing abstinence. However, participants also emphasized characteristics of the sober living recovery environment as important factors influencing motivation. Interactions among recovering peers offer unique opportunities for feeling understood, recognizing vulnerability in others, identifying with the recovery processes of others, receiving supportive confrontation, and engaging in mutual accountability. These experiences are important elements of motivation that become activated by involvement in the SLH environment and are difficult to replicate outside of that context.ConclusionIn addition to recognizing how motivation can be enhanced by addressing costs and benefits experienced by individuals, operators of recovery homes need to understand motivation as a function of the recovery home social environment. Additional studies are needed on motivation as a longitudinal construct in a variety of peer-oriented environments. Studies are also needed to better specify interactions within SLHs that increase and hinder motivation among different types of residents.

Recovery Residences and Providing Safe and Supportive Housing for Individuals Overcoming Addiction

Recovery residences provide safe and supportive housing to help individuals initiate and sustain recovery from substance abuse. They are a potentially important yet understudied component of the substance abuse continuum of care. Unlike other substance abuse treatment and service delivery options, recovery residences are largely privately owned and funded by the residents themselves, and we know little about how these residences open and the factors that influence their ability to stay open. Using qualitative data from interviews with recovery home operators ( N = 21) in Philadelphia, this article explores what recovery home operators want to accomplish with their homes, how they try to do this, the obstacles they encounter in trying to run their homes, and why they keep at it. Themes highlight the potential of recovery residences as well as the challenges faced by those who operate them.

Co-occurring substance abuse and mental health problems among homeless persons: Suggestions for research and practice

Communities throughout the U.S. are struggling to find solutions for serious and persistent homelessness. Alcohol and drug problems can be causes and consequences of homelessness, as well as co-occurring problems that complicate efforts to succeed in finding stable housing. Two prominent service models exist, one known as “Housing First” takes a harm reduction approach and the other known as the “linear” model typically supports a goal of abstinence from alcohol and drugs. Despite their popularity, the research supporting these models suffers from methodological problems and inconsistent findings. One purpose of this paper is to describe systematic reviews of the homelessness services literature, which illustrate weaknesses in research designs and inconsistent conclusions about the effectiveness of current models. Problems among some of the seminal studies on homelessness include poorly defined inclusion and exclusion criteria, inadequate measures of alcohol and drug use, unspecified or poorly implemented comparison conditions, and lack of procedures documenting adherence to service models. Several recent papers have suggested broader based approaches for homeless services that integrate alternatives and respond better to consumer needs. Practical considerations for implementing a broader system of services are described and peer-managed recovery homes are presented as examples of services that address some of the gaps in current approaches. Three issues are identified that need more attention from researchers: (1) improving upon the methodological limitations in current studies, (2) assessing the impact of broader based, integrated services on outcome, and (3) assessing approaches to the service needs of homeless persons involved in the criminal justice system.

Engagement and disengagement in mutual-help addiction recovery housing: a test of affective events theory.

This study tested an affective events theory (AET) model in the Oxford House network of recovery homes. Residents' congruence with their home (P-E fit) was hypothesized to directly influence behavior that supported the house and other residents-citizenship behavior. We further hypothesized P-E fit would be related to member intentions to leave, with attitudes toward the home mediating that relationship. To assess this, we administered a cross-sectional national survey to 296 residents of 83 randomly selected Oxford Houses. Although the AET model demonstrated good fit with the data, an alternative model fit better. This alternative model suggested an additional indirect relationship between P-E fit and citizenship mediated by attitudes. Results suggested affective experiences such as feeling like one fits with a community may influence engagement and disengagement. There appears to be a direct influence of fit on citizenship behavior and an indirect influence of fit through recovery home attitudes on both citizenship and intentions to leave the home. We conclude affective experiences could be important for community engagement and disengagement but AET may need to integrate cognitive dissonance theory.

Patient-centered care coordination: a qualitative study of the lived experience of residents in Philadelphia recovery homes

Background Individuals struggling with a substance use disorder often have a variety of co-occurring service needs that go unmet due to the difficulty in coordinating these services. As the substance use treatment system moves toward treating addiction as a chronic disease, it will be necessary to develop models for the coordination of general medical and addiction treatment services, coupled with a number of social services. Patient-centered care models are one way of improving care coordination by incorporating the goals as expressed by the patient into the treatment plan, which is then coordinated by all members of the treatment team to surround the patient with all necessary resources [1]. Recovery residences, such as recovery homes in Philadelphia, Pennsylvania, could represent a potentially important mechanism for such coordination that is patient centered by providing a stable, supportive, living environment that promotes access to a variety of community-based resources.

A Critical Component of the Continuum of Care for Substance Use Disorders: Recovery Homes in Philadelphia

For many struggling with addiction, the ability to achieve stable recovery is often jeopardized by untenable housing or unsupportive living environments. Despite promising research on recovery residences, there are still significant gaps in the research on them. Using data collected from a stratified random sample of recovery homes in Philadelphia (N = 25), this study describes the organizational, operational, and programmatic characteristics of these homes and explores potential differences in these characteristics by funding source and gender of residents served. Although not licensed treatment providers, the majority of these homes operated in a recovery-oriented manner and offered a range of different services to their residents—all for a reasonable monthly fee (M = $340.40, SE = 18.60). Few differences emerged between homes that received funding from the Philadelphia Office of Addiction Services and those that did not or between those that served males as opposed to females. More research is needed to address resident outcomes and how Philadelphia recovery homes may compare with recovery residences in other parts of the country.