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Building on a rich history

December 14, 2012
by Beth Fisher, LCSW, LCAS, MAC, CCS
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A critical document that is newly released provides an unprecedented overview and analysis of the rapidly emerging field of recovery residences; it is aptly titled A Primer on Recovery Residences: FAQs from the National Association of Recovery Residences. Noted addictions and recovery researchers William White, Amy Mericle, PhD, Leonard Jason, PhD, and Doug Polcin, EdD, in conjunction with members of the National Association of Recovery Residences (NARR), have authored a comprehensive narrative and assessment of all types of recovery residences, heretofore known under a variety of terms (i.e., sober living, halfway houses, transition homes, extended care).

NARR has been instrumental in uniting a fragmented field utilizing the all-encompassing term “recovery residences.” This professional nomenclature accurately describes the residential modality of recovery support, and provides a bridge between the different types and levels of care provided in the residential setting. In the new primer, a recovery residence is cited as “a broad term describing a sober, safe, and healthy living environment that promotes recovery from alcohol and other drug use and associated problems. The purpose of a recovery residence is to provide a safe and healthy living environment to initiate and sustain recovery—defined as abstinence from alcohol and other non-prescribed drugs and improvement in one’s physical, mental, spiritual, and social well-being.”

The written collaboration with White, Mericle, Jason and Polcin provides documentation and analysis of the evolution of recovery residences; a thorough review of the history of recovery residences is included. The existence of recovery residences is certainly not new. The primer in fact traces the origins of recovery residences to the mid–1800s.

A description of the development of recovery residences includes early 19th century inebriate homes and religiously sponsored inebriate colonies; the establishment of homes, retreats and farms associated with Alcoholics Anonymous (AA) in the 1940s and 1950s; the halfway house movement of the 1950s; the growth and evolution of residential treatment programs (including 12-Step oriented Minnesota Model and California social model programs and therapeutic communities in the 1960s and 1970s); and the implementation of democratically governed, financially self-supported recovery residences such as the Oxford House network in the closing decades of the 20th century. Many of these historical models are still in evidence today in the residential continuum of services.

Never before has there existed a comprehensive reference paper addressing all levels of the residential spectrum. Recovery residences vary in the intensity and duration of support that they offer; services provided span from peer-to-peer recovery support (all recovery residences) to medical and counseling services (recovery residences that offer higher levels of support).

NARR has been a primary catalyst in professionalizing the residential field by developing a nomenclature that delineates tiers of residential support and services, as well as a national standard for monitoring and accrediting operations at all residential levels. Recovering addicts/alcoholics may receive services in a recovery residence ranging from the peer-run sober home (Level 1) all the way up to a residential program that also may provide treatment (Level 4). These levels collectively provide a spectrum of housing and support to best meet the unique and changing needs of individuals across the stages of long-term recovery.

Documentation in research

The primer suggests that evidence-based outcomes related to recovery residences show efficacy for this recovery modality, stating that “longitudinal studies of residents housed within each of the levels show improvements in a range of areas. When comparisons have been made between recovery residences and appropriate alternatives, the results have shown recovery homes yield comparable or better outcomes.”

However, there is a significant need for additional research on residential recovery homes, particularly those that fall under Levels 2 and 3. There have been widely publicized studies showing positive outcomes for the well-known Level 1 Oxford House programs. There also have been a large number of studies on therapeutic communities (TCs), best characterized as a Level 4 recovery residence. But much more research needs to be conducted on recovery residences overall.

Research going forward would ideally address:

    •    The essential components or “active ingredients” of recovery residences.
    •    The physical, organizational and social characteristics of the houses that are associated with the best recovery outcomes (e.g., the influence of such factors as size, architectural design, use of space, social climate within the houses, leadership, and operations).
    •    The prevalence and geographic distribution of all levels of recovery residences, and the differences in availability among urban, suburban and rural areas.
    •    Factors that promote the viability and sustainability of recovery residences.
    •    Long-term outcomes (five years or longer) of participation in recovery residence programs.

Without published research and evidence-based practice designations, licensed professionals, policy-makers and potential funders will continue to question the legitimacy of recovery residences and peer-based recovery.

Advocacy needs

The primer also identifies advocacy needs across the recovery residence levels. Laws pertaining to the regulation of recovery services and addiction treatment differ from state to state, and recovery residence levels range from clinical to non-clinical.

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