342 -Recovery Residences-What They Are and Effectiveness
Counselor Toolbox

 
 
00:00 / 59:03
 
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Primer on
Recovery Residences
Instructor: Dr. Dawn-Elise Snipes
Executive Director, AllCEUs Counselor Education
What is a Recovery Residence
~ “Recovery residence” (RR) is a broad term describing a sober, safe, and healthy living environment that promotes recovery from alcohol and other drug use and associated problems.
~ RRs offer peer-to-peer recovery support with some providing professionally delivered clinical services all aimed at promoting long-term recovery and improvement in physical, mental, spiritual, and social wellbeing that will support their recovery as they transition to living independently

Effectiveness
~ The primary studies on Oxford Houses (e.g., Jason, Davis, Ferrari, & Anderson, 2007; Jason, Olson, Ferrari, & Lo Sasso, 2006) interviewed residents at 12- and 24-month follow-up.
~ A study of sober living houses in California (Polcin, et al., 2010) interviewed residents at 18-month follow up.
~ These studies documented significant longitudinal improvements including gains in employment, family and social functioning, psychological and emotional well-being, as well as reductions in criminal involvement.
~ Social support for recovery, recovery self-efficacy, and length of stay (6 months or longer) predicted change in cumulative recovery

Levels
~ Recovery residences are divided into Levels of Support based on the type as well as the intensity and duration of support that they offer.
~ Level I-Peer-Run: Democratically run, drug screens, house meetings, self-help
~ Level II – Monitored: House manager, peer run groups in addition to Level I activities

Levels
~ Level III- Supervised: Employ paid staff who provide on-site services, such as linkage to resources in the community. There is administrative oversight for service providers, state licensing, emphasis on life skill development. A recovery approach that has become known as
~ The “Florida model” combines intensive outpatient or day treatment services with residence in a sober living house.
~ Level IV- Service Provider: Residential treatment programs that are more structured than level III and that provide a variety of on-site clinical services (Therapeutic communities)

Phases within Levels
~ Many residences define levels of recovery progress within the resident community which correspond with time in the residence, recovery progress as assessed by peers and/or staff, and the degree to which residence behavioral requirements have been met.
~ Each level or phase is typically accompanied by an increase in privileges, greater personal autonomy, exemption from certain requirements of previous phases, and possibly different physical accommodation choices.
~ Many residences with this type of system often pair later phase residents with new arrivals in a sort of “buddy system.”

Phases cont…
~ A blackout period is required in the initial phase of some recovery residences in which the new resident is required to break communication with the outside world or with their natural supports in order to stabilize and focus on their recovery.
~ Many residences limit the activities for new residents for a length of time after admission. These restrictions might include always being accompanied by a more senior resident when outside the home, limits to contacts with family or friends, and expectations for a higher degree of involvement in recovery support activities.

Length of Stay
~ Level 1 and 2 are open ended (on average 1-3 years)
~ Level 3 and 4 RRs average 3-9 months

RRs and the Community
~ NARR-certified recovery residences meet standards addressing safety from an administrative, operational, property, and good neighbors perspective
~ Preferred location
~ In residential areas that provide RR residents an opportunity to integrate into the community and provide community members an opportunity to learn about rrs.
~ Accessible, affordable rental housing in areas offering amenities for daily life (shopping, transportation, employment, medical)
~ Community needs to be free of drug dealing and criminal activity
~ Federal law protecting persons in recovery as a protected class under the federal Fair Housing Act and its amendments (see 42 U.S.C. §§ 3601-3619)

Funding
~ RRs are historically self-funded, eventually become self-sustainable, and utilize community of volunteers.
~ Start-up costs are typically covered by the housing provider, an Angel Investor, or a nonprofit.
~ As a part of their recovery process, residents are expected to work, pay rent, and support the house
~ Each house averages 10 residents

Regulation
~ National: NARR
~ State:
~ State Association of Recovery Residences
~ State Regulating Boards

RR Services and Activities
~ Entry into a recovery residence usually involves an application/personal interview.
~ Residents can expect to pay monthly fees and sign an agreement committing themselves to a minimum length of stay and adhering to clearly stated house rules that support the recovery of the individual and the community.
~ Typically, there is a refundable deposit and a non-refundable administration fee required on or before move-in.
~ There also may be additional fees or fines clearly listed in the agreement for things like extra services or late payments
~ Some residences require concurrent participation outpatient treatment
RR Services and Activities
~ Recovery residences support various abstinence-based pathways to recovery, and each residence focuses on one or more particular pathway. People seeking support for a specific, culturally congruent path to recovery should determine what recovery activities are required before accepting a placement.
~ Although they cannot provide medication management, Levels 1, 2, and 3 can use
~ Policies and procedures around the self-management of medications and the eligibility of individuals taking specific medications to live in the house

Social Model Approach
~ There is an emphasis on drawing on knowledge gained through one’s recovery experience to help others.
~ Recovery operates via connections between residents, not between an individual resident and a professional caregiver.
~ All residents are consumers and providers, both giving and receiving help.
~ Mutual support provides the basic framework for recovery.
~ A positive environment that encourages support for recovery is crucial.
~ Disorders are viewed as being centered in the reciprocal relationship between the individual and his or her surrounding social unit

Social Model Approach of RRs
~ The social model approach shifts the focus to the household/family and community environment as a way to foster a culture of recovery.
~ Residents are invited to draw on the strengths of the household and utilize peer support to shed their addictive lifestyle and reconstruct their self-identity as a person in recovery.
~ Social learning of communication, relationship and coping skills
~ Social support
~ Life skills

Social Model Approach of RRs
~ Developing a recovery lifestyle is conceptualized among residents as more than avoiding addictive substances and improving personal health, it is characterized by
~ Citizenship — the importance of living one’s life with regard and respect for those around you
~ Doing one’s fair share in terms of contributing to the household as a recovery environment
~ Recognizing how one’s behavior affects that environment is a key tenet across all social model programs

Social Model cont…
~ Mandatory house meetings offer opportunities for residents and staff to understand and discuss issues from a social model perspective and reinforce a recovery oriented culture
~ When interactions in house meetings are limited to a sole focus or the meeting gets bogged down in interpersonal struggles, shift the discussion toward a broader, social model perspective.
~ How does this issue impact the overall house?
~ How can house members be mobilized to address the issue?
~ Should we discuss changes in house rules or operations to address the issue?
~ How would such changes affect the recovery culture of the household?

Summary
~ Recovery residences are a necessary resource for people who are needing a safe place to reside whether they are leaving treatment or not
~ Recovery residences range from peer led organizations to therapeutic communities
~ Research has shown improved treatment outcomes at 12, 18 and 24 months for people who lived in a recovery residence
~ Recovery residences operate on a social model helping people learn how to create and maintain a healthy environment and relationships.