What did we learn from our study on sober living houses and where do we go from here?

Assessing a pilot scheme of intensive support and assertive linkage in levels of engagement, retention, and recovery capital for people in recovery housing using quasi-experimental methods

INTRODUCTION

Strong and ever-growing evidence highlights the effectiveness of recovery housing in supporting and sustaining substance use disorder (SUD) recovery, especially when augmented by intensive support that includes assertive linkages to community services. This study aims to evaluate a pilot intensive recovery support (IRS) intervention for individuals (n = 175) entering certified Level II and III recovery residences. These individuals met at least three out of five conditions (no health insurance; no driving license; substance use in the last 14 days; current unemployment; possession of less than $75 capital). The study assesses the impact of the IRS on engagement, retention, and changes in recovery capital, compared to the business-as-usual Standard Recovery Support (SRS) approach (n = 1758).

METHODS

The study employed quasi-experimental techniques to create weighted and balanced counterfactual groups. These groups, derived from the Recovery Capital assessment tool (REC-CAP), enabled comparison of outcomes between people receiving IRS and those undergoing SRS.

RESULTS

After reweighting for resident demographics, service needs, and barriers to recovery, those receiving IRS exhibited improved retention rates, reduced likelihood of disengagement, and growth in recovery capital after living in the residence for 6-9 months.

CONCLUSION

The results from this pilot intervention indicate that intensive recovery support, which integrates assertive community linkages and enhanced recovery coaching, outperforms a balanced counterfactual group in engagement, length of stay, and recovery capital growth. We suggest that this model may be particularly beneficial to those entering Level II and Level III recovery housing with lower levels of recovery capital at admission.

Six-month length of stay associated with better recovery outcomes among residents of sober living houses

Background: Sober living houses are designed for individuals in recovery to live with others in recovery, yet no guidelines exist for the time needed in a sober living house to significantly impact outcomes.Objectives: To examine how the length of stay in sober living houses is related to substance use and related outcomes, focusing on early discontinuation (length of stay less than six months) and stable residence (length of stay six months or longer).Methods: Baseline and 12-month data were collected from 455 sober living house residents (36% female). Longitudinal mixed models tested associations between early discontinuation vs. stable residence and abstinence, recovery capital, psychiatric, and legal outcomes. Final models were adjusted for resident demographics, treatment, 12-step attendance, use in social network, and psychiatric symptoms, with a random effect for house.Results: Both early discontinuers (n = 284) and stable residents (n = 171) improved significantly (Ps ≤ .05) between baseline and 12 months on all outcomes. Compared to early discontinuation, stable residence was related to 7.76% points more percent days abstinent (95% CI: 4.21, 11.31); 0.88 times fewer psychiatric symptoms (95% CI: 0.81, 0.94); 0.84 times fewer depression symptoms (95% CI: 0.76, 0.92); and lower odds of any DSM-SUD (OR = 0.65, 95% CI: 0.47, 0.89) and any legal problems (OR = 0.58, 95% CI: 0.40, 0.86).Conclusion: In this study of sober living houses in California, staying in a sober living house for at least six months was related to better outcomes than leaving before six months. Residents and providers should consider this in long-term recovery planning.

Grounding alcohol simulation models in empirical and theoretical alcohol research: a model for a Northern Plains population in the United States

The growing number of systems science simulation models for alcohol use (AU) are often disconnected from AU models within empirical and theoretical alcohol research. As AU prevention/intervention efforts are typically grounded in alcohol research, this disconnect may reduce policy testing results, impact, and implementation. We developed a simulation model guided by AU research (accounting for the multiple AU stages defined by AU behavior and risk for harm and diverse transitions between stages). Simulated projections were compared to historical data to evaluate model accuracy and potential policy leverage points for prevention and intervention at risky drinking (RD) and alcohol use disorder (AUD) stages. Results indicated prevention provided the greatest RD and AUD reduction; however, focusing exclusively on AUD prevention may not be effective for long-term change, given the continued increase in RD. This study makes a case for the strength and importance of aligning subject-based research with systems science simulation models.

Measuring Architecture in Recovery Homes: Recovery Home Architecture Scale

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.

Substance use and homelessness: A longitudinal interview study conducted during COVID-19 with implications for policy and practice

BACKGROUND

People who are homeless and using substances frequently encounter barriers to accessing support. This paper aims to inform policy and practice by analysing changes in the tobacco, alcohol and illicit drug use of people experiencing homelessness.

METHODS

Data derive from a qualitative longitudinal study (undertaken 2020/2021) and involving telephone interviews (n = 310) conducted with 34 people accommodated in two London hotels provided as part of a UK policy response to COVID-19. The hotels offered various supports, including opioid replacement therapy, prescribed alcohol, licensed nicotine replacement therapy, and e-cigarettes. Participants' substance use data were organised by Iterative Categorization and subjected to a content analysis to identify patterns and themes..

RESULTS

At entry to the hotel, 5/34 participants (14.7%) had never used alcohol nor illicit drugs; 10/34 (29.4%) had only ever used alcohol (mostly without a problem); 11/34 (32.4%) had ever used illicit drugs but without a problem; and 8/34 (23.5%) had ever had a problem with illicit drugs. Sub-groups had different socio-demographic characteristics, particularly regarding being/not being a UK national, sex, and homelessness duration. Tobacco smoking was common across all sub-groups (18/34; 52.9%). Participants were often anxious about living with others who were using substances, and some worried about their own substance use. Substance use was changeable, with more decreases than increases. Changes related to intrapersonal (psychological), interpersonal (social) and structural (resource-based) factors. For example, decreases were precipitated by people feeling motivated to change, separation from others who used drugs, and receiving treatment or support.

CONCLUSION

Findings indicate that various interventions and accommodation models may benefit people who are homeless and using substances. An initiative that combined shelter and basic amenities, pharmacological treatment, psychosocial support, and space where substances were not available and other people using substances could be avoided resulted in an overall reduction in substance use amongst those accommodated.

Examining Recovery Status Trends over 7-Years for Men and Women Clients of a Substance Use Disorder Recovery Housing Program

Adults who are homeless and/or involved in the criminal justice system have significantly higher risks of substance use disorders (SUD)s and they may have increased difficulty initiating and maintaining traditional SUD treatments. To address the needs of adults with SUDs who are homeless/criminal justice system involved the Recovery Kentucky programs were established. This study examined outcomes for this recovery housing program among an unduplicated statewide sample of men ( n=672) and women ( n = 732) clients who entered the Recovery Kentucky program and who were followed-up about 12 months after program entry across a 7-year period. Low, but similar rates of problem alcohol or illicit drug use at follow-up were found across the 7-year period. Men had higher rates of return to use than women. Further, about 40% of the clients had at least one recovery status vulnerability factor at follow-up each year of the study with no differences by gender.

Identifying the availability of recovery housing in the U.S.: The NSTARR project

BACKGROUND

Home is essential to recovery, and recovery housing can play an important role for individuals seeking a supportive environment. The National Study of Treatment and Addiction Recovery Residences (NSTARR) Project constitutes the largest and most diverse study of recovery housing to date. We describe the development of a national sampling frame to study recovery housing, as well as findings on availability and distribution of recovery housing across the U.S.

METHODS

Data from publicly available sources and lists maintained by entities tracking recovery housing were compiled. Residences for which locating information was available were geocoded and linked with U.S. Census data and drug and alcohol mortality data. We used hot spot analysis and multilevel models to describe the geographic distribution of recovery residences and assess whether residences are located in areas of high need.

RESULTS

The NSTARR database contains information on 10,358 residences operated by 3628 providers in all 50 states. Residences were more likely (p < 0.05) to be in urban areas and in counties with higher substance use mortality; they were less likely to be in economically disadvantaged areas. Recovery housing density also was greater in urban areas and areas with a greater proportion of non-White residents, but lower in economically disadvantaged areas.

CONCLUSIONS

Despite a wealth of research on some types of recovery housing, critical gaps in the field's understanding about the nature of recovery housing remain. The NSTARR Project represents an important first step to expand research on recovery housing across the country.

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.

Examining Recovery Status and Supports before and after Substance Abuse Disorder Treatment Among Clients Who Experienced Lifetime and Recent Firearm-Related Threats

Firearm-related risks have often been overlooked in the sequela of substance use and substance use disorders. This study compares adult substance abuse disorder treatment (SADT) clients who experienced recent ( n = 274) and lifetime ( n = 889) firearm threats to adults who were not threatened with a firearm ( n = 2029) before and 12 months after program entry. More men experienced firearm threats (38.8%) than women (34.2%). However, among those with any firearm threats, more women (27.2%) experienced firearm threats in the year before program entry than men (20.2%). Being threatened with a firearm was associated with increased economic vulnerability, criminal justice system involvement, mental health problems, and victimization both before and after SADT program entry. A higher number of adverse childhood experiences were associated with firearm threats and particularly recent firearm threats. Results of this study underscore the importance of screening for firearm-related risks in substance abuse disorder treatment programs.

Untangling the Complexities of Substance Use Initiation and Recovery: Client Reflections on Opioid Use Prevention and Recovery From a Social-Ecological Perspective

Background:

In Canada, the rate of opioid use, opioid use disorder (OUD), and associated mortality and morbidity are higher among Indigenous Peoples than the general population. Indigenous Peoples on medications for opioid use disorders (MOUD) often face distinct barriers that hinder their clinical progress, leading to treatment attrition.

Methods:

We used a social-ecological model to inquire into clients’ experiences with a history of treatment failure for OUD. We used exploratory qualitative research to engage 22 clients with a history of OUD treatment dropouts and who are currently on MOUD. In-depth, semi-structured interviews lasting an average of 30 minutes were conducted on-site.

Results:

We identified 4 themes from the study: (a) risk for substance use; (b) factors sustaining substance use; (c) factors leading to treatment, and (d) treatment failure and re-enrollment.

Conclusion:

Using a socio-ecological model helps to understand factors that influence an individual’s risk for OUD, decision to pursue treatment, and treatment outcomes. Furthermore, social ecological model also creates possibilities to develop supportive, multilevel interventions to prevent OUD risks and support for clients on MOUD. Such interventions include mitigating adverse childhood experiences, supporting families, and creating safe community environments.

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

AIMS

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).

METHODS

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.

RESULTS

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.

CONCLUSION

Results highlight the importance of the social environment in SLHs, particularly those most closely aligned with social model recovery principles.

"I wanted to close the chapter completely … and I feel like that [carrying naloxone] would keep it open a little bit": Refusal to carry naloxone among newly-abstinent opioid users and 12-step identity

BACKGROUND

12-step programs aim to address drug-related harms, like opioid overdose, via abstinence. However, abstaining from opioids can diminish tolerance, which increases risk for overdose death upon resumption. A recent study found that desire to abstain from drugs inhibited willingness to participate in take-home naloxone programming, which was linked to perceptions of harm reduction strategies being tied to drug use. In the present study, we uncovered a similar phenomenon occurring among newly-abstinent participants who were refusing to carry naloxone.

METHODS

This study is an analysis of broader qualitative data collected throughout Southern California among persons who use opioids, including those recently abstinent. Preliminary analysis revealed that those newly abstinent refused to accept naloxone at the end of interviews, and so we began probing about this (N=44). We used thematic analysis and author positionality to explicate the emergent phenomenon and applied social identity theory to conceptualize findings.

RESULTS

Mechanisms underlying naloxone refusal included its tie to a drug-using identity that newly-abstinent participants were attempting to retire. Carrying naloxone was also viewed as pointless due to doubt of witnessing an overdose again. Furthermore, the thought of being equipped with naloxone was not believed to be congruent with an abstinent identity, e.g. "me carrying it [naloxone] is making me feel like I'm going to be hanging out with people that are doing it [using drugs]."

CONCLUSION

Recent detoxification heightens vulnerability to overdose, which other newly-abstinent peers might be positioned to respond to as bonds are formed through 12-step identity formation. However, naloxone is often refused by this group due to perceived 12-step identity clash. While some treatment spaces distribute naloxone, 12-step identity associated behavioral expectations appear to conflict with this strategy. Reframing these disconnects is essential for expanding the lifesaving naloxone community safety net.

House Manager Roles in Sober Living Houses

Background

Alcohol and drug treatment providers are increasingly emphasizing the role of long-term, community-based systems of care. A good example is Sober Living Houses (SLHs), which are peer operated alcohol- and drug-free living environments. Studies show residents of SLHs make significant improvements in multiple areas. However, little attention has been devoted to describing the critically important role of SLH managers who oversee these homes.

Methods

Thirty-five SLH managers completed interviews about the characteristics and operations of their houses, their activities as managers, and ways their own recovery was affected by their work.

Results

Managers reported widespread use of some but not all principles of social model recovery. Manager roles varied dramatically in terms of time spent managing houses, activities related to their roles, and training they received. Some reported extensive amounts of time proving support to residents, while others viewed their role as primarily administrative.

Conclusions

Research is needed to understand reasons for manager differences, optimal manager functioning, and manager training needs. Research is also needed to assess whether different house characteristics require different manager roles.

Examining Recovery Program Participants by Gender: Program Completion, Relapse, and Multidimensional Status 12 Months After Program Entry

This study examined individual-level characteristics and factors associated with program completion, relapse, and multidimensional status at follow-up for 213 men and 248 women who entered one of 17 peer-led recovery programs and who completed a follow-up interview 12 months later. Study results found that although there were some significant gender differences at program entry among participants entering Recovery Kentucky, there were few gender differences at follow-up. In addition, although participants had significant psychosocial problems, polysubstance use patterns, and severe substance use disorder (SUD), the majority of both men and women reported completing the program (80.3%), a small minority reported relapse (9.5%), and about one third had worse multidimensional status about 12 months after program entry. Lower quality of life rating at program entry was associated with program completion and with better multidimensional status at follow-up. Study results suggest the recovery program provides an important option for some of the most vulnerable individuals with SUD.

Supporting individuals using medications for opioid use disorder in recovery residences: challenges and opportunities for addressing the opioid epidemic

Full and partial opioid agonists and opioid antagonist medications play an important role in containing the opioid epidemic. However, these medications have not been used to their full extent. Recovery support services, such as recovery residences (RRs), also play a key role. RRs may increase an individual's recovery capital, facilitate social support for abstinence, and foster a sense of community among residents. These processes may be critical for individuals with opioid use disorder (OUD). In combination these two recovery pathways have the potential to enhance one another and improve outcomes among residents with OUD. Barriers to doing so have resulted in a limited supply of residences that can support residents using opioid agonist and antagonist medications. This perspective describes key interpersonal and structural barriers to medication use among individuals with an OUD seeking support from a recovery residence and discusses measures for reducing these barriers. These measures include workforce development to address stigma and attitudinal barriers and enhancing residence capability to ensure resident safety and reduce potential diversion. The perspective also highlights the need for additional research to facilitate the identification of best practices to improve outcomes among residents treated with medications living in recovery residences.

Beneficial effects of motivational interviewing case management: A latent class analysis of recovery capital among sober living residents with criminal justice involvement

BACKGROUND

This secondary analysis uses data from a recent clinical trial conducted with probationers and parolees with substance use disorders (N = 330) residing in Sober Living Houses (SLHs). The treatment condition received Motivational Interviewing Case Management (MICM), while controls received usual care SLH residency. Both conditions improved on multiple domains, though residents randomized to MICM improved significantly more than usual care controls on criminal justice outcomes. Because MICM is designed to help ex-offenders attain more recovery capital (RC) in multiple domains, we hypothesized MICM participants that already possessed higher RC would show significantly greater improvement at follow-up than usual SLH residents with higher RC. Moreover, MICM and usual SLH residents with low RC would show no differences at 1-year follow-up.

METHODS

A latent class analysis (LCA) grouped participants into two patterns of RC: those with low RC and those with high RC. These classes were interacted with study condition to predict change on six Addiction Severity Indices (ASI) at follow-up.

RESULTS

MICM was more effective for the higher RC class, with greater improvement in drug, legal, and psychiatric outcomes for those who attended at least three MICM sessions. MICM was no more beneficial than usual care for those in a low RC class.

CONCLUSIONS

SLH operators should consider implementation of MICM for residents with more RC resources. Those with fewer recovery resources, such as a history of psychiatric problems or physical/sexual abuse, would benefit from a more intensive intervention to assist them with improving the amount and quality of their RC.

Sober living house characteristics: A multilevel analyses of factors associated with improved outcomes

Safe and stable housing is integral to addiction recovery. Across numerous studies, recovery housing has been found to be associated with improvements in a variety of domains. Although procedures for operating some types of recovery housing have been manualized and national standards established, there are few empirical findings identifying which recovery residence characteristics may lead to improved outcomes. Using data from 330 newly admitted residents recruited from 49 sober living houses in California and re-contacted for 6- and 12-month follow-up interviews, this study examines the effects of organizational, operational, and programming characteristics on substance use, criminal justice, and employment outcomes. Results from multilevel analyses adjusting for resident demographics and length of stay indicate that organizational characteristics were associated with outcomes. Residents recruited from houses that were part of a larger organization or group of houses had increased odds of total abstinence (aOR = 3.98, p < 0.001) and drug abstinence (aOR = 3.19, p < 0.001). Residents recruited from houses that were affiliated with a treatment program had increased odds of employment (aOR = 2.92, p = 0.003). Operational characteristics such as where the house was located and whether the house required incoming residents to be sober for at least 30 days prior to entry were also related to improved outcomes, but additional work is needed to develop tools to assess and measure recovery housing characteristics and to better understand how these factors contribute to improved outcomes.

Housing for People with Substance Use Disorders: One Size Does Not Fit All Tenants-Assessment of 16 Housing Services and Suggestions for Improvement Based on Real World Experience

Housing is an important factor for individuals addressing substance use disorders (SUD). This work compared aims and outcomes for new housing services and made suggestions for improvement. 16 new services were assessed over 6 months activity against factors identified as important. Services defined expected standards including (1) engagement with treatment for SUD, (2) restrictions on continuing substance use by tenants. After 6 months, 9 (56%) housing projects did not achieve planned standards and lowered criteria for inclusion. When setting up housing for people with SUD it is important to define clearly the nature of the intended service. Different types of housing programs in a network are needed to meet the evolving behaviour of tenants. One size does not fit all. Stable housing is important for people addressing SUD and these suggestions may increase the chance of providing a suitable foundation for people in need.

Housing Status, Psychiatric Symptoms, and Substance Abuse Outcomes Among Sober Living House Residents over 18 Months

Studies show individuals entering sober living recovery houses (SLHs) make significant, sustained improvement on measures of substance abuse problems, employment, and arrests. The current study assessed changes in housing status among SLH residents over 18 months and the relative influences of housing status and psychiatric distress on substance abuse outcomes. Two hundred forty one men and 58 women, all age 18 and older, were interviewed within their first week of entering 20 SLHs and again at 6-, 12-, and 18-month follow-up. Between entry into the SLHs and 18-month follow-up homelessness declined from 16% to 4%, marginal housing declined from 66% to 46%, and stable housing increased from 13% to 27%. Psychiatric severity was generally mild to moderate in severity, but nevertheless showed improvement over the 18-month study period. Multivariate models showed worse substance abuse outcomes for residents with higher psychiatric distress and unstable housing. Relative to persons with stable housing, those who were homeless or marginally housed had worse outcomes and those in SLHs had better outcomes. Overall, we conclude that individuals entering SLHs show improvement in housing status and psychiatric distress, both of which are associated with better substance abuse outcomes.

Problems and Service Needs Among Ex-Offenders with HIV Risk Behaviors Entering Sober Living Recovery Homes

There is currently a nationwide effort to decrease the number of persons who are incarcerated in jails and prisons. However, many ex-offenders on probation or parole do not have access to affordable housing and larger proportions have histories of HIV risk as well as substance abuse problems. In California, sober living houses (SLHs) are becoming an increasingly popular housing option for these individuals. Based largely on the principles of Alcoholics Anonymous (AA), SLHs require abstinence from alcohol and drugs and provide peer support for recovery. The current study examined the types of problems experienced among 330 ex-offenders with lifetime risk for HIV during the six months prior to entering SLHs. Nearly three fourths (74%) of all ex-offenders entering the houses had at least one HIV risk. The importance of housing was evident in the finding that housing status and participants' perceptions of their housing situation were associated with a variety of problem areas, including substance use, HIV risk, psychiatric severity, and legal problems. SLHs represent an important housing option for ex-offenders, but many residents may need additional services to address various problems.

Benefits of peer support groups in the treatment of addiction

Objective

Peer support can be defined as the process of giving and receiving nonprofessional, nonclinical assistance from individuals with similar conditions or circumstances to achieve long-term recovery from psychiatric, alcohol, and/or other drug-related problems. Recently, there has been a dramatic rise in the adoption of alternative forms of peer support services to assist recovery from substance use disorders; however, often peer support has not been separated out as a formalized intervention component and rigorously empirically tested, making it difficult to determine its effects. This article reports the results of a literature review that was undertaken to assess the effects of peer support groups, one aspect of peer support services, in the treatment of addiction.

Methods

The authors of this article searched electronic databases of relevant peer-reviewed research literature including PubMed and MedLINE.

Results

Ten studies met our minimum inclusion criteria, including randomized controlled trials or pre-/post-data studies, adult participants, inclusion of group format, substance use-related, and US-conducted studies published in 1999 or later. Studies demonstrated associated benefits in the following areas: 1) substance use, 2) treatment engagement, 3) human immunodeficiency virus/hepatitis C virus risk behaviors, and 4) secondary substance-related behaviors such as craving and self-efficacy. Limitations were noted on the relative lack of rigorously tested empirical studies within the literature and inability to disentangle the effects of the group treatment that is often included as a component of other services.

Conclusion

Peer support groups included in addiction treatment shows much promise; however, the limited data relevant to this topic diminish the ability to draw definitive conclusions. More rigorous research is needed in this area to further expand on this important line of research.

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.

Motivation to maintain sobriety among residents of sober living recovery homes

Background

The 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.

Methods

This 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.

Results

Focus 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.

Conclusion

In 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.

Maximizing social model principles in residential recovery settings

Peer support is integral to a variety of approaches to alcohol and drug problems. However, there is limited information about the best ways to facilitate it. The “social model” approach developed in California offers useful suggestions for facilitating peer support in residential recovery settings. Key principles include using 12-step or other mutual-help group strategies to create and facilitate a recovery environment, involving program participants in decision making and facility governance, using personal recovery experience as a way to help others, and emphasizing recovery as an interaction between the individual and their environment. Although limited in number, studies have shown favorable outcomes for social model programs. Knowledge about social model recovery and how to use it to facilitate peer support in residential recovery homes varies among providers. This article presents specific, practical suggestions for enhancing social model principles in ways that facilitate peer support in a range of recovery residences.

Effect of social relationships on antiretroviral medication adherence for people living with HIV and substance use disorders and transitioning from prison

BACKGROUND

This paper examines how family and social relations facilitate and inhibit adherence to antiretroviraltherapy (ART) for people living with HIV (PLH) who have underlying substance use disorders and are transitioningto the community post-incarceration.

METHODS

Combining the methods of inductive close reading and constantcomparison, we analyzed the data from 30 semi-structured interviews of PLH who had recently transitioned to thecommunity within the previous 90 days.

RESULTS

Three central themes were anticipated as important socialrelationships post-release: self-reported family, friends and clinicians. Among these, four sub-themes (social isolation, 'double jeopardy', search for belonging, and trust and respect) emerged, highlighting how they impacted ART adherence. Post-release, participants returned to resource-poor communities where they experienced socialisolation. ART adherence was enabled by having a purpose in life, which correlated with having robust family support structures. Many former prisoners felt that a chasm between them and their families existed, both because of HIV stigma and their addiction problems. In this context, relationships with untrustworthy friends from their druguse networks led to relapse of drug use and risky behaviors, jeopardizing participants' ART adherence and persistence. To avoid the double jeopardy, defined as seeking friends for support but who were also the ones who contributed to drug relapse, participants searched for new social anchors, which often included their healthcare providers who represented trusted and respected persons in their life.

CONCLUSIONS

While some former prisonersperceived doctors as uncaring and their relationships asymmetrical, positive relationships with these providers,when respect and trust was mutual, reinforced the participants' sense of belonging to what they called 'the world that don't do drugs' and motivated them to adhere to ART.

RECIPROCAL RESPONSIBILITY AND SOCIAL SUPPORT AMONG WOMEN IN SUBSTANCE USE RECOVERY

This study sought to identify individual- and house-level predictors of women's employment, education, and retention in self-run recovery homes. Data from a national study of 292 women in Oxford House, an international organization of recovery homes grounded on self-help/mutual aid and 12-step principles were analyzed. Results indicated that the house's Reciprocal Responsibility predicted number of days of paid work. Individual and house variables did not predict participation in education. The presence of recovery home members in personal social networks was statistically significant in predicting retention in the recovery home. Lastly, results indicated that number of days of paid work were not predictive of likelihood of substance use in the next 12 months. The findings of this study indicate that the ability to develop social networks and Reciprocal Responsibility in recovery homes can contribute to positive outcomes for women.

Recovery-oriented policy and care systems in the UK and USA

The concept of recovery has been an influence on addicted individuals for many decades. But only in the past 15 years has the concept had a purchase in the world of public policy. In the USA, federal and state officials have promulgated policies intended to foster 'recovery-oriented systems of care' and have ratified recovery-supportive laws and regulations. Though of more recent vintage and therefore less developed, recovery policy initiatives are also being implemented in the UK. The present paper describes recovery-oriented policy in both countries and highlights key evaluations of the recovery-oriented interventions.

Perceptions of sober living houses among addiction counselors and mental health therapists: knowledge, views and perceived barriers

Affordable alcohol- and drug-free housing that supports recovery is limited in many areas. Sober living houses (SLHs) offer a unique living environment that supports abstinence and maintenance of a recovery lifestyle. Previous studies show that SLH residents make improvements on alcohol, drug and other problems that are maintained at 18-month follow-up (Polcin et al. 2010). However, for SLHs to maximize their impact they must recognize how they are viewed by community stakeholders and successfully address barriers. This pilot study recruited a convenience sample of two stakeholder groups, certified alcohol and drug counselors (N = 85) and licensed mental health therapists (N = 49), to explore knowledge and views about SLHs using an online survey. Therapists and counselors had similar views about SLHs, although counselors had more direct experience with them and were more knowledgeable. Both groups were highly supportive of increasing the role of SLHs to address addiction problems in their communities. Those who were most supportive had more knowledge about SLHs, agreed that alcohol and drug problems were caused by a physical disease, and agreed that successful recovery required an abstinent living environment. Both groups identified a variety of barriers, particularly social stigma. Recommendations are made for knowledge dissemination and decreasing barriers.

Substance users' perspectives on helpful and unhelpful confrontation: implications for recovery

Substance users commonly face confrontations about their use from family, friends, peers, and professionals. Yet confrontation is controversial and not well understood. To better understand the effects of confrontation we conducted qualitative interviews with 38 substance users (82% male and 79% White) about their experiences of being confronted. Confrontation was defined as warnings about potential harm related to substance use. Results from coded transcripts indicated that helpful confrontations were those that were perceived as legitimate, offered hope and practical support, and were delivered by persons who were trusted and respected. Unhelpful confrontations were those that were perceived as hypocritical, overtly hostile, or occurring within embattled relationships. Experiences of directive, persistent confrontation varied. Limitations of the study include a small and relatively high functioning sample. We conclude that contextual factors are important in determining how confrontation is experienced. Larger studies with more diverse samples are warranted.