Sober Living Research Articles

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

IntroductionSome evidence suggests that cannabis may be a safer substitute for other drugs. Historically, sober living houses (SLHs) have been abstinence-based environments designed for individuals in recovery to live with others in recovery. However, the evolving legal landscape around cannabis use has left SLH operators and managers in a difficult position regarding policies related to cannabis use among residents. The primary aim of this study was to examine how cannabis use relates to alcohol use, other drug use, and related problems among SLH residents. MethodsBaseline (N = 557), 6-month (n = 462), and 12-month (n = 457) data came from SLH residents living in 48 houses in Los Angeles, CA from 2018 to 2021. Longitudinal generalized estimating equation models tested associations between any past six-month cannabis use and alcohol and non-cannabis drug outcomes: any use, number of days of use, and any alcohol- or drug-related problems. Final models adjusted for baseline age, sex, race-and-ethnicity, inpatient substance use treatment, and alcohol/drug use days, and time-varying 12-step attendance and percent of social network using drugs/alcohol heavily. ResultsAt baseline, 107 (19.2 %) residents reported cannabis use in the past six months. At 12 months, 80 (17.5 %) residents reported cannabis use in the past six months. Across all timepoints, any vs. no past six-month cannabis use was related to significantly (P < 0.05) higher odds of past-month alcohol use (OR = 3.85, 95 % CI: 2.65, 5.59); more drinking days in the past six months (IRR = 1.76, 95 % CI: 1.40, 2.21); higher odds of alcohol problems (OR = 2.74, 95 % CI: 1.99, 3.76); higher odds of past-month drug use (OR = 10.41, 95 % CI: 6.37, 17.00); more drug use days in the past six months (IRR = 1.86, 95 % CI: 1.40, 2.49); and higher odds of drug problems (OR = 14.99, 95 % CI: 9.91, 22.68). ConclusionsDuring each assessment period, almost one-fifth of individuals residing in sample of California sober living houses report using cannabis in the past six months. Cannabis does not appear to work as a substitute for alcohol or other drugs in this population because cannabis use is related to increased risk of alcohol and other drug use and problems. SLH managers and operators should consider potential harm that could result from house policies that fail to address cannabis use.

Using Collaborative Governance to Regulate Sober Living Facilities: Structures and Strategies for Mitigating the Influence of Powerful Actors in Multi-Sectoral Networks

With the growing number of opioid-related deaths, many local governments are assembling collaborations with the goal of providing timely and tangible responses to the overdose epidemic. Although the purpose of such collaborations is to bring multi-sector stakeholders together to provide policy recommendations, the inclusion of organizations with divergent interests and differing levels of power can open the collaboration to capture by special interests. In this article, we use a mixed-method design to: a) investigate the network structure of a collaboration and b) identify the managerial strategies used to facilitate participation by diverse actors within a cross-sector task force convened to regulate sober living facilities.

Giving and Receiving Help Among Persons Entering Sober Living Houses

ABSTRACT Giving and receiving help are integral to creating the social environments necessary to support recovery. However, studies assessing the effects of helping behaviors have focused primarily on the benefits derived from giving help to others in 12-step programs and treatment. The current study examined the frequency of giving and receiving help among 188 persons entering sober living houses (SLHs), a type of recovery home that is common in California. Helping was assessed in three contexts: the SLH, 12-step meetings they attended, and interactions with their family and friends. Residents who gave help to others in one of these contexts tended to also receive help in that context. Residents who reported giving or receiving help in one context tended to report giving and receiving help in other contexts. Study findings suggest helping in recovery occurs in a broader, more reciprocal manner than currently conceptualized. Studies should address how giving and receiving help in different contexts affects recovery outcomes. Research is also needed to describe the determinants of giving and receiving help. Considerations for facilitating help among SLH residents are described.

Multilevel Effects of Environmental and Neighborhood Factors on Sober Living House Resident 12-Month Outcomes.

Sober living houses (SLHs) are abstinence-based environments designed for individuals in recovery to live with others in recovery. Research shows that SLHs help some individuals maintain recovery and that certain SLH-related factors may be particularly protective. Here we assess how SLH housing and neighborhood characteristics are related to abstinence and psychiatric symptoms over time. Baseline, 6-month, and 12-month data were collected from 557 SLH residents. Multilevel mixed models tested associations between house and neighborhood characteristics and individual-level percent days abstinent (PDA) and the number of psychiatric symptoms (measured with the Psychiatric Diagnostic Screening Questionnaire [PDSQ]) as outcomes. Final models adjusted for sex, age, and race/ethnicity; ratings of house characteristics; and objective measurements of neighborhood-level exposures. Both PDA and PDSQ improved significantly (ps ≤ .05) over time in both unadjusted and adjusted models. More self-help groups and fewer alcohol outlets within one mile were significantly protective for PDA, whereas walkability was significantly related to worse PDA and PDSQ (ps ≤ .05). For house-level factors, better ratings of house maintenance were related to significantly fewer psychiatric symptoms, whereas higher scores on SLH's safety measures and personal or residence identity were related to more psychiatric symptoms (ps ≤ .05). No house-level factor was significantly related to PDA. Neighborhood-level factors such as increased availability of self-help groups and fewer nearby alcohol outlets may increase abstinence among individuals living in SLHs. House-level factors related to better maintenance may also facilitate improved mental health.

Outcomes Among Sober Living House Residents Who Relapse: Role of Recovery Capital

ABSTRACT Studies show individuals living in residential recovery homes on average make significant improvements in multiple areas of functioning. Residents who achieve and maintain complete abstinence have particularly good outcomes. Residents who relapse after entering the houses have been studied minimally. The current study examined outcomes for 197 residents who relapsed within six months after entering sober living houses (SLHs), which is one type of residential recovery home that is common in California. Despite having relapsed, these residents made significant improvements between entry into the house and 6-month follow-up on measures of percent days abstinent from alcohol and drugs (PDA), psychiatric symptoms, severity of employment problems, and stable housing. Higher recovery capital predicted higher PDA (coefficient = 0.28, SE = 0.09, p = .001) and lower severity of employment problems (coefficient = −0.00, SE = 0.00, p = .007). Recovery capital showed a significant decrease between baseline and 6-month follow-up among persons who relapsed and were no longer living in the house. SLH providers can draw upon social model recovery principles to enhance recovery capital. However, residents should also seek other sources of recovery capital outside the SLH, which may be particularly important for individuals who leave the home.

Integrated cognitive behavioral treatment for substance use and depressive symptoms: a homeless case series and feasibility study

BackgroundHomelessness is associated with high prevalence of psychiatric disorders such as substance use disorders, including alcohol use disorder, and depression.MethodsThis case series and feasibility trial evaluated a novel integrated cognitive behavioral treatment (ICBT), which was adapted specifically for homeless individuals and developed to treat substance use and depressive symptoms simultaneously. The ICBT was delivered among four homeless individuals enrolled in the Treatment First program (a social services program where treatment is offered in conjunction with temporary transitional housing), who had access to stable and sober housing milieus.ResultsThe ICBT was rated high in expectancy of improvement, credibility, and satisfaction, with few treatment-related adverse events, and fairly high treatment retention. At 12 months follow-up, three of four participants were not homeless anymore. Some participants experienced short-term reductions in substance use and/or depressive symptoms.ConclusionsThe study provided preliminary support that the ICBT can be a feasible and potentially effective treatment for homeless individuals with substance use and/or depressive symptoms. However, the delivery format within the Treatment First program was not feasible. The ICBT could be offered within the social services Housing First program instead (where permanent housing is offered before treatment), or to non-homeless individuals.Trial registrationThe study was registered retrospectively at ClinicalTrials.gov (NCT05329181).

Life after sober house living for drug use recovery in Zanzibar: does normal life or re-addiction?

ABSTRACT Background The study aimed at assessing the extent to which recovered addicts and peoples recovered from sober houses reintegrate in the community life in Zanzibar. Methods The study applied a qualitative research design whereby Sober Living Homes (SLHs) operators provided 86 contacts of the recovered individuals. Researchers started to communicate with them for future interviews. Of the 86 recovered individuals, researchers managed to communicate with 62 respondents, of whom only 39 were found eligible for the interviews. However, only 26 participated in the research since 13 of the eligible candidates declined participation. Results and Discussions The results revealed that re-admission of the recovered individuals to SLHs persists, making drug use a public concern in Zanzibar. The study identified that community-negative attitudes toward recovery efforts, surrounding environment, easy access to drugs, lack self-awareness, lack of enough knowledge, lack of activities to do, life challenges and stress, friends, and own decision to start drug use again as the significant driving factors for the readmission to drugs. In addition, drug use among the recovered persists because the community pays less concern to the recoving individuals. Conclusion and Recommendations Community based factors are potential for complete recovery process from drug use among reintegrated drug users. The study recommends that the lovely welcoming of drug users after sober house life is very critical to the reintegration of these drug users into their community. Moreover, the study recommends the government to be fully committed to the struggle against drug use.

Resilience and Challenges Among Women With Histories of Addiction and Victimization Newly Admitted to a Sober Living Home: A Brief Report.

This study examined strengths (i.e., empowerment, purpose) and challenges (i.e., depressive and posttraumatic stress disorder symptomatology, financial and housing worries) experienced by women (N = 44) with histories of addiction and victimization newly admitted to a sober living home (SLH). Women had moderate to high levels of both strengths and challenges. In general, strengths and challenges were inversely related (e.g., higher purpose was related to lower depression), and challenges were positively related (e.g., higher financial worries were related to higher posttraumatic stress symptoms). The findings remind us that women entering SLHs have myriad needs and that comprehensive services drawing upon women's resilience are needed.

Pandemics Interlaced: The Impact of the COVID-19 Pandemic on the Wellbeing of Sober Living Home Residents.

This study aimed to discover how the COVID-19 pandemic altered the implementation of the social model of recovery in sober living homes (SLHs). Researchers analyzed associations between residents' feelings of interconnectedness, social service utilization, and relapse predictors throughout the pandemic. This study provides an understanding of how the COVID-19 pandemic impacted treatment of substance use disorder (SUD). This study used retrospective surveyed data from 105 SLH residents. Correlational analysis was used to determine the relationship between social service use, social connectivity, and relapse predictors at three different time points: February 2020, December 2020, and June 2021. Three residents underwent additional interviews. There was a decline in social service utilization from February 2020 to December 2020 with an associated decline in feelings of social connectivity. From December 2020 to June 2021, there was an increase in residents' use of social services with an associated increase in connectivity. There was a significant negative correlation between relapse predictors and number of supportive services used in February 2020 ( r = -0.217, P < 0.05) and in December 2020 ( r = -0.352, P < 0.001). In June 2020, there was a significant negative correlation between interconnectedness and relapse predictors ( r = -0.297, P < 0.05). The number of interviews was not sufficient for formal qualitative analysis. The results suggest the COVID-19 pandemic possibly interrupted the course of recovery in SLHs. These findings offer insight to how the pandemic impacted individuals recovering from SUD and suggest that SUD treatment professionals should develop interventions to enhance social connectivity to deploy in response to global stressors.

Do neighborhood characteristics of sober living houses impact recovery outcomes? A multilevel analysis of observational data from Los Angeles County.

To identify neighborhood factors associated with recovery outcomes for sober living house (SLH) residents. Six-month longitudinal data for new SLH residents (n=557) was linked with census tract data, services available, alcohol outlets, and Walk Scores® (0-100 score indicating access to neighborhood resources) for 48 SLHs in 44 neighborhoods in Los Angeles County. Non-significant neighborhood characteristics in separate regressions for all outcomes were residents' ratings of perceived risk, percentage of residences with access to a car, percentage of homes over $500,000, percentage of renter-occupied units, percentage with income less than $25,000, percentage that were non-white, the density of substance inpatient within 10 miles, and transit scores from Walk Score®. Multilevel regressions found outpatient substance abuse treatment and density of AA groups were positively associated with more abstinent days. No neighborhood variables were associated with psychiatric symptoms. Higher perceived neighborhood cohesion, lower crime ratings, and better transportation ratings were associated with higher recovery capital. Greater neighborhood densities of substance abuse services and AA groups may help residents achieve more days abstinent. While residents may achieve better substance use outcomes even with negative perceptions of the neighborhood, positive perceptions of the neighborhoods may help them acquire more recovery capital.

Measuring Architecture in Recovery Homes: Recovery Home Architecture Scale

ABSTRACT Background: The settings where we live shape our daily experiences and interactions. Social environment and physical setting characteristics may be particularly important in communal living services, such as recovery homes for alcohol and drug disorders. Objectives: This paper describes the measurement and mobilization of architectural characteristics in one type of recovery home, sober living houses (SLHs). The Recovery Home Architecture Scale (RHAS) is a 25-item measure comprised of six subscales designed to assess architecture in SLHs. Results: Using a sample of 528 individuals residing in 41 houses, we found the RHAS had good interrater reliability, factor structure, and internal consistency. The measure also showed modest construct validity. The RHAS was not associated with length of stay (LOS) but did interact with a measure of the social environment that predicted LOS, the Recovery Home Environment Scale (RHES). Conclusions: Future studies should include a more diverse sample of SLHs and assess how house management, recovery capital, and other factors work in concert with architecture.

The growth of recovery capital in clients of recovery residences in Florida, USA: a quantitative pilot study of changes in REC-CAP profile scores

BackgroundThere is a growing evidence base around predictors of retention and completion in a range of recovery residence models, particularly Oxford Houses and Sober Living Houses, and recovery housing is recognized as a clearly evidenced area of recovery intervention. The aim of the study was to quantitatively assess recovery capital in a sample of recovery residence clients.MethodThe study used a repeated measures self-completion of a standardized recovery capital instrument (REC-CAP) for clients retained across various houses within one Level 2 recovery residence provider whose program was based on a 12-step approach. While 823 clients participated in the baseline assessment, a sample of 267 clients was achieved for six-month follow-up interview, based on those retained in the residence. A logistic regression model examined factors associated with retention and a repeated measures marginal mixed model evaluated the factors associated with changes in recovery capital between the baseline and the follow-up assessment.ResultsMembers of the group that remained in recovery residences were more likely to be older with a record of high participation in recovery groups, with greater drop-out among younger residents, female residents and those with an identified housing need. For those retained to follow-up, greater recovery capital growth was associated with employment, higher levels of social support and more recovery group involvement, as well as age and a higher quality of life. The need for family support was shown to reduce levels of recovery capital. However, those younger people who were retained reported better recovery capital growth during the initial six months of residence.ConclusionThe key conclusion is that while recovery capital generally increases during a stay in a recovery residence, it does not do so consistently across the sample population. This has implications for how pathways to recovery group engagement are supported for women and young people and how social support (encompassing housing, employment and family issues) is provided to those populations during periods of residence. This suggests the potential need for training and guidance for house managers working with these groups.

Living in a Sober Living House: Conversations with Residents

Background: Twenty-one residents in a sober living facility in a medium sized Midwestern city were interviewed and were asked to talk about their experiences in selecting and residing in a sober living facility. Methods: Respondents were also asked to detail their thoughts about the efficacy of sober living and their ideas about successful recovery. Interviews were semi-structured in order to provide opportunity for in-depth responses. Results: Based on an analysis of the interview transcripts the following themes were presented for analysis and discussion: The role of early trauma, the strengths of sober living, the challenges to sober living and keys to sobriety. Discussion: Discussion of contradictions between present findings and the literature as well as recommendations for future research and practice are presented.

The role of recovery housing during outpatient substance use treatment

BackgroundRecovery housing generally refers to alcohol- and drug-free living environments that provide peer support for those wanting to initiate and sustain recovery from alcohol and other drug (AOD) disorders. Despite a growing evidence base for recovery housing, relatively little research has focused on how recovery housing may benefit individuals accessing outpatient substance use treatment. MethodsUsing administrative and qualitative data from individuals attending an outpatient substance use treatment program in the Midwestern United States that provides recovery housing in a structured sober living environment, this mixed methods study sought to: (1) determine whether individuals who opted to live in structured sober living during outpatient treatment (N = 138) differed from those who did not (N = 842) on demographic, clinical, or service use characteristics; (2) examine whether living in structured sober living was associated with greater likelihood of satisfactory discharge and longer lengths of stay in outpatient treatment; and (3) explore what individuals (N = 7) who used the structured sober living during outpatient treatment were hoping to gain from the experience. ResultsFactors associated with the use of recovery housing during outpatient treatment in multivariate models included gender, age, and receiving more services across episodes of care. Living in structured sober housing was associated with greater likelihood of satisfactory discharge and longer length of stays in outpatient treatment. Focus group participants reported needing additional structure and recovery support, with many noting that structure and accountability, learning and practicing life, coping, and other recovery skills, as well as receiving social and emotional support from others were particularly beneficial aspects of the sober living environment. ConclusionsFindings underscore the importance of safe and supportive housing during outpatient substance use treatment as well as the need for future research on how housing environments may affect engagement, retention, and outcomes among individuals accessing outpatient substance use treatment.

Understanding Knowledge of OT and Perceived Barriers to Service Among Owners of Sober Living Homes

Abstract Date Presented Accepted for AOTA INSPIRE 2021 but unable to be presented due to online event limitations. This study examined sober living home (SLH) owners' knowledge of OT and perceived barriers to implementing OT within SLHs. In this pretest–posttest survey, statistically significant median increase in knowledge of OT services (z = –3.512, p &amp;lt; .001) was detected from pretest to posttest. Most participants reported lack of finances as a barrier to using OT services. OTs can advocate and provide education to address barriers. Primary Author and Speaker: Gloria Farag Additional Authors and Speakers: Anna M. Quigg Contributing Authors: Michelle Jackson, Stacy Buckingham-Howes, Amanda Polton, and Monica Clement

The Elusive Recovery from Drug Addiction in Pemba: How Addicted Persons and their Families Cope

This article elucidates on how addiction affects family and how the latter copes while living with an addict. The article is based on a study whose objectives were to explore the factors influencing people to start using drugs and to learn the impacts of drug addiction on family members. It was found that many addicts started using drugs during their young ages mainly before the age of 30. Most of them started taking drugs due to curiosity, misconception, ignorance, or simply imitation of others under peer pressure. Exposure to certain social milieu such as availability of drugs or/and people using drug at the family and community level is one of the contributory factors. Different opinions with regard to the trend of people who abuse drugs are considered. It is shown that formal rehabilitation measures such as sober house were effective in rehabilitating drug addicts though many addicts opted to use these services as a last resort. We recommend that the public should be informed about the availability of sober houses and should be encouraged to use their services to deal with drug addiction problems.

Resident and house manager perceptions of social environments in sober living houses: Associations with length of stay.

Studies have shown persons living in recovery homes for drug and alcohol problems make significant, sustained improvements. However, there is limited information about factors associated with outcomes. This study examined how perceptions of social environment of one type of recovery home, sober living houses (SLHs), were associated with length of stay (LOS). SLH residents and their house managers (N = 416) completed the recovery home environment scale (RHES) that assessed social model recovery characteristics and the community-oriented program evaluation scale (CPES) that evaluated perceptions of the program environment. Scales completed by residents predicted LOS, but those completed by house managers did not. Larger discrepancies between the two groups were associated with shorter LOS. The RHES was shown to be a stronger predictor of LOS than the CPES. Results highlight the importance of the social environment in SLHs, particularly those most closely aligned with social model recovery principles.

Psychometric Properties of the Recovery Home Environment Scale

Background Recovery homes for persons with alcohol and drug problems provide an abstinent living environment and social support for recovery. Research shows residents in these homes make significant, sustained improvements. However, descriptions of recovery environments within the homes have been limited. Purpose The current study assessed psychometric properties for the Recovery Home Environment Scale (RHES), which assessed social environments within one type of recovery home, sober living houses (SLHs). Methods 373 residents were interviewed at entry into the house, 1-month follow-up, and 6-month follow-up. Measures included the RHES, other measures of the social environment, days of substance use, and length of stay. Results Principal components analysis suggested the RHES was largely unidimensional. Exploratory factor analysis suggested items could be grouped into recovery support (3 items) and recovery skills (5 items). Cronbach’s alphas for the full scale and the recovery support and recovery skills subscales were 0.91, 0.89, and 0.87, respectively. As hypothesized, construct validity of the RHES was supported by correlations with other measures of the social environment and predictive validity was supported by associations with length of stay and substance use. Conclusions SLHs have been described as “the setting is the service.” However, the field has lacked a way to capture characteristics of the social environment. The RHES represents a new way to measure the recovery environment by focusing on social interactions among residents within SLHs and shared activities in the community.

Post-traumatic Growth in Women With Histories of Addiction and Victimization Residing in a Sober Living Home.

Research consistently documents the deleterious sequelae of interpersonal trauma, including domestic and sexual violence (DSV). More recently, however, researchers and practitioners have focused on positive outcomes, such as post-traumatic growth (PTG), in survivors of DSV. Although research has begun to document the prevalence and correlates of PTG, no study to our knowledge has explored PTG in a sample of women with histories of addiction and victimization residing in a trauma-informed sober living home (SLH). The purpose of the current study was to examine this gap in the literature. Participants were 59 women (89.8% White; 86.4% heterosexual; mean age = 41.6) who completed a survey while residing in a SLH. Most women reported moderate to high levels of PTG. At the bivariate level PTG was related to less depression, post-traumatic stress disorder, and financial worries, and greater active coping, and sense of community. PTG was also related to the absence of past 6-month physical intimate partner violence. In regression analyses, PTG was related to less depression and greater sense of community. These data offer insights into modifiable factors such as fostering a sense of community while also promoting mental health treatment that could be the focus of interventions to increase PTG in women with histories of addiction and victimization residing in SLHs.

Recovery in context: Sober living houses and the ecology of recovery.

Sober living houses (SLHs) are an increasingly common element of the recovery support services landscape, yet little is known about their neighborhood context. This study describes neighborhoods in which SLHs are located and examines differences by house characteristics. SLHs in Los Angeles County (N = 297) were geocoded and linked with U.S. Census, alcohol outlet, recovery resources, and accessibility data. Regression analyses tested differences by house characteristics. Co-ed houses were in neighborhoods that were less ethnically diverse and farther away from recovery resources. Larger house capacity was associated with increased density of off-premise alcohol outlets but also increased proximity to treatment. Higher fees were associated with lower neighborhood disadvantage and off-premise alcohol outlet density but the greater distance from treatment programs and other recovery resources. House characteristics are associated with neighborhood factors that both support recovery and place residents at risk.