They still face the sting of unwelcoming neighbors and the stigma from bad-apple operators in their own ranks, but overwhelming evidence suggests that these may be the best times yet for recovery residences in the continuum of services for addictions.
In developments ranging from Ohio legislators' commitment of cash to Florida home operators' rush to embrace standards of quality, sober home operators are changing the language of treatment and recovery. They also are transitioning in many communities from ugly stepchild to bona fide partner with treatment facilities.
To some, the present and future success of recovery residences comes down to simple math. Research strongly suggests that 30 days in treatment does not a recovery make, but public and private payment systems are not positioned to finance extended stays in intensive treatment services. Enter the recovery residence that serves as a bridge between highly supervised treatment and a full return to community living.
“Recovery homes partly have grown out of the fact of limited treatment capacity,” says Lori Criss, associate director of the Ohio Council of Behavioral Health and Family Service Providers, which despite not representing sober homes directly was closely involved in advocating passage of landmark legislation for Ohio sober homes last year. “People need a safe place to extend their recovery.”
Given that it has been only five years since a small but committed group of sober home leaders formed a national organization for the cause (NARR, the National Alliance for Recovery Residences), the movement is demonstrating significant maturity in its relationships with primary treatment and with policy-makers.
“There is a very active effort on the part of treatment centers to collaborate with us,” says Beth Sanders (the former Beth Fisher), NARR's president emeritus and the executive director of Hope Homes Recovery Services with operations in three Southeast states. “The progressive treatment centers out there are starting with recovery planning from day one.”
In Ohio, treatment organizations under the auspices of the Ohio Council were instrumental in the effort to encourage more housing options for individuals with substance use disorders. Criss says this occurred as part of a three-pronged initiative that also examined employment services and recovery coaching. Research from a state legislative committee identified recovery housing as an important component of what was working in communities to combat addiction, and momentum built for the legislation that was adopted last year.
Under the law, every county in Ohio must have recovery housing as part of its continuum of support for addictions, Criss says. Legislators committed an initial $10 million in funding to assist in the effort, with half devoted to home construction/remodeling and the rest for operations.
Now the state has an organization representing recovery residences, called Ohio Recovery Housing; it has become a NARR affiliate. NARR president Jason Howell, executive director of the Texas-based recovery support and awareness organization SoberHood, says NARR now has 18 state affiliates whose members encompass a total of about 2,500 homes across the country (that of course represents a small fraction of the number of operations calling themselves recovery residences or sober homes, in this largely unregulated sector of the field).
Most of the homes in NARR affiliate chapters operate at the less-intensive Levels 1 and 2 of the four-level classification system that NARR has promulgated to assist providers in matching the level of support to resident need (see descriptions at end of article).
In some ways, the shortage areas for high-quality sober homes mirror the most deficient areas in primary treatment. Howell, who established the first recovery residence for the gay and lesbian population, says other groups that remain underserved in sober living options include women with children, the physically handicapped, and Spanish-speaking populations. Sanders adds that recovery residences remain few and far between in rural communities.
Another prominent trend finds the average age of sober home residents dropping dramatically, believed to be fueled largely by the widespread opioid crisis. Sanders says that in 1996, the average age of Hope Homes residents was 32; last year it was 24. But the programs still serve a wide age range, with Sanders saying the oldest Hope Homes resident ever housed was 84. For all persons served, “We offer the benefit of time,” she says.
Recovering individuals have been choosing to live together in an effort to stay sober ever since the early days of Alcoholics Anonymous (AA) members meeting in church basements and building group support. But when the influence of third-party payers began to dominate the treatment field, the emphasis in research and funding gravitated to developing a medical model of support. John Lehman, president of the Florida Association of Recovery Residences (FARR) and a leading advocate of operational standards for recovery homes, believes insurers could serve as a key driver for development of a vibrant recovery residence community nationally.
“Third-party payers are now caring about outcomes,” says Lehman. “They had tools to cap risk before, but with the Affordable Care Act and parity, they don't have that anymore.” Now they will have to encourage strategies that work, but in a cost-effective way.