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A new understanding of recovery residences

February 16, 2012
by Beth Fisher, LCSW, LCAS, MAC, CCS
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NARR standards delineate residential levels of support
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“Focusing on the subtle meaning of words—rejecting some while embracing others—is far more than a matter of shallow political correctness. It is about changing the way addicted and recovering people see themselves and are seen by others. It is about changing the language that affects social policies and is in turn affected by those policies. Changing language is a way to personally and culturally close one chapter in history and open another.”

William L. White, The Rhetoric of Recovery Advocacy: An Essay on the Power of Language

Recovery residences provide a vital tool for initiating and sustaining long-term recovery. They are desirable in their emphasis on structure and community in a recovery setting, their service provision over an extended period of time, and their cost-effectiveness.

Outcome studies show that the longer an individual remains in a recovery or treatment environment, the greater are her or his chances of sustaining recovery.1,2 Unfortunately, people in early recovery often are discharged from institutions or programs only to return to the environment where alcohol or other drug use triggers were experienced and addictive lifestyles were supported. Recovery residences provide a safe, healthy, community-based alternative for facilitating recovery at all stages of the recovery process.

Many convergent pathways to recovery exist, ranging from mutual support groups to professional treatment—each of which may be found in various types and levels of recovery residences. The residential spectrum offers a broad variety in terms of types of communities, intensity of structure, and degrees of services offered. Heretofore the field has lacked uniformity and precision of terms necessary to match presenting needs with the appropriate level of residential support.

The National Association of Recovery Residences (NARR) began in response to a call for residential providers across the service spectrum to create a uniform language and standards for all types of recovery residences. This association has attained a broad reach, finding commonality of standards, practice and language for the vast scope of residential operators. A seminal event of 2011 for the association was the adoption of a national standard for recovery residences, to include universal nomenclature.

Today, recovering addicts/alcoholics may engage with a wide spectrum of recovery residences, ranging from the peer-run sober home to the residential treatment program. Historically and geographically, different terms have been used to describe these residences: halfway house, extended care, three-quarter house, sober living, etc. These monikers lack uniformity and clarity, and the meaning of each often depends on the system or area of the country in which one operates.

The myriad of terms and services contributes to significant confusion about matching facilities to individual needs for those seeking recovery residences, affecting potential residents and their families, professionals in behavioral and physical healthcare, criminal justice workers, and coaches and supporters in the recovery community.

Recovery housing is the basic service provided by recovery residences that includes, at a minimum, recovery peer support. “Recovery residence” is an all-encompassing term that accurately describes the residential modality of recovery support, and provides a bridge for a field that historically has been fragmented.

Defining levels of support

Levels of residential support provide uniform terminology that delineates the range of offerings along the residential continuum. Written operating protocol comprised of community rules, ethical operational and administrative practices, and drug screening procedures are core standards applicable to all recovery residences, regardless of the form of home organization or level of support services offered.

The level titles that have been adopted by NARR are designed to be simple, descriptive and intuitive. Higher numbers correspond to higher degrees of service provision. This new residential matrix will afford those seeking recovery residences the ability to select the modality that best fits presenting needs.

Level 1: Peer-Run

Level 1 recovery residences offer supportive housing in a peer environment. These recovery residences are often referred to as “sober homes,” and are most often found in single-family residences. Oversight of residents is peer-based; residents are self-monitoring and accountable to one another.

The primary criterion for this living environment is a willingness to be abstinent from mood-altering substances. Self-help meetings and outside recovery support services are encouraged and utilized. Democratically elected leadership and weekly house meetings are a standard component of this level; chores and overall house functioning are processed within the community.

While there is no paid staff at this level of support, there is often an overseeing officer who facilitates admission to and discharges from the home, and is available in cases where house issues cannot be resolved internally. There are no in-house services offered at this level, except the benefit of living in a supportive community.

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I am now a licensed Master of Social Work and a Qualified Professional in Drug & Alcohol Counseling in Idaho, but much of that would have never been possible if it were not for the organizqation of peer run recovery "houses" known as Oxford Houses. Oxford has a huge presence in Washington state where I used to live and originally got sober. Without the structure and accountability of the Oxford house (when I had really no where else to go) I probably would be dead now. I tried to convince the State of Idaho Dept. of Health and Welfare to embrace and support the start up of Oxford houses in Idaho, but they would not do it. I believe that peer run houses can and do work if run like an Oxford House, which is on a democracy model, pres. , treas., and so on. When people messed up they were out of the house within 15 minutes, and only allowed back after a 30 day period of being out of the house and proof of recovery activities. It may not be for everyone, but it saved my life.
David M. Hansel, LMSW; Q.P./D.A.
Idaho Falls, Idaho

I agree that peer run residences play an important part in getting abstinent. The level of care strategy helps to reduce cost while offering residences to persons who do not have one or are in harmful living situations. The involvement of licensed professionals can be an adjunct or offered with supervised living circumstances. Due to the inordinate influence of the criminal justice system, many residential services are similar to jails. This is not appropriate treatment. If one needs jail, send them off to jail.So, I welcome innovations that give the maximum flexibility to service providers based on clinical issues, not detention status.

Bob Kajdan, M.A., CADC II
Hercules, Ca.

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