From personal tragedy to personal challenge: responses to stigma among sober living home residents and operators

How People in Recovery Manage the Stigma of Being an Alcoholic

Although stigma can jeopardize the recovery efforts of people who formerly misused substances, potentially leading to relapse, how people in recovery for alcoholism manage stigma has not been comprehensively or systematically examined. Using stigma management communication theory (SMC) and in-depth interviews of 22 adults in recovery, this investigation uncovered the six main strategies participants used to negotiate the stigma of being an alcoholic. Consistent with the tenets of SMC, interviewees accepted, evaded responsibility for, reduced offensiveness of, avoided, denied, and/or ignored/displayed the stigma, depending on whether they accepted or challenged that the stigma of being an alcoholic applied to themselves and/or the public's perception. Findings inform practical strategies to help individuals in recovery effectively manage stigma while sustaining their sobriety. The study also suggests ways programs such as Alcoholics Anonymous and treatment centers can use communication to break down recovery barriers.

The role of recovery housing during outpatient substance use treatment

BACKGROUND

Recovery 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.

METHODS

Using 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.

RESULTS

Factors 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.

CONCLUSIONS

Findings 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.

Assessing Technical Assistance Needs among Recovery Residence Operators in the United States

Recovery support services such as recovery housing assist individuals with increasing their access to social support, employment services, and systems of care. Lack of evidence-based practices and calls for increased oversight of these settings suggests a growing need for technical assistance and training for recovery residence owners and staff, yet little is known about their areas of greatest need for technical assistance. We developed and administered a survey to assess the technical assistance needs of recovery housing operators in the United States using a convenience sample of individuals who own or operate a recovery residence (N = 376). A total of 77 owners/operators completed the survey (20% response rate), representing urban, suburban, and rural communities. Differences were observed between number of owned residences: owners/operators of a single residence were interested in technical assistance on house-specific policies and linkage to established systems of care, whereas owners/operators of multiple residences were interested in technical assistance on building financial sustainability and incorporation of best practices into their recovery residences. As an increasing number of states move to implement voluntary certification or licensing for recovery residences, targeted training and technical assistance to owners/operators will facilitate the successful adoption of recovery residence best practices and quality standards.

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.

Role of recovery residences in criminal justice reform

Over the past decade there has been a clear consensus among drug policy researchers that the practice of incarcerating persons for drug offenses has been counterproductive. As a result, U.S. criminal justice policy is increasingly emphasizing alternative dispositions to incarceration for drug related arrests. In addition, large numbers of persons currently incarcerated for drug related offenses are being released into communities. However, there are serious questions about where these individuals are going to live once released and how they will access needed services. Residential recovery homes in the community are good options for those who wish to pursue abstinence from drugs. They provide a drug- and alcohol-free living environment along with social support for abstinence and successful functioning in the community. This paper reviews recent changes in drug policy the U.S. and describes the variety of recovery home options that are available to persons diverted or released from incarceration.

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.