An Agenda for Recovery Residence Stakeholders in the 21st Century
There are thousands of housing resources designed to support recovery – recovery residences – in the United States. In this policy statement, an expert panel reviews what is known about recovery residences, while identifying major gaps in the knowledge base. This overview results in a sprawling agenda that spans needs in recovery residence research, policy, and advocacy in the years to come.
WHAT PROBLEM DOES THIS STUDY ADDRESS?
One widely accepted definition for recovery from substance use disorder is a “voluntarily maintained lifestyle characterized by sobriety, personal health, and citizenship.” In parallel, recovery residences are “sober, safe, and healthy living environments that promote recovery from alcohol and other drug use, and associated problems.” From a theoretical perspective, recovery residences fit well in a recovery-oriented systems of care model, where a broad array of resources in both professional and nonprofessional settings are needed to support individuals seeking to initiate and sustain recovery. Said another way, recovery residences can help individuals build recovery capital, the physical and social resources on which people draw to maintain abstinence and enhance quality of life. While these community-based, housing resources are becoming increasingly accessible, the field faces several challenges, including lack of funding, low awareness regarding their existence and data critical to understanding their potential benefit, and resistance from individuals living in the communities where they are located (sometimes called “NIMBY”, or Not In My Back Yard). In this official policy statement from the Society for Community Research and Action (Division 27 of the American Psychological Association), in conjunction with the National Alliance (formerly Association) on Recovery Residences, or NARR, an expert panel of scientists highlights existing research, while spelling out a research agenda to address important lingering questions about the effectiveness and impact of these recovery support services, as well as offering recommendations for policy makers and clinical programs.
HOW WAS THIS STUDY CONDUCTED?
In this study, the panel members leveraged their expertise in recovery residence research and policy to develop a research agenda for the immediate future (consistent with “next steps” sections that are part of all Recovery Research Institute Bulletin summaries), while making relevant recommendations to policy makers, clinical program staff, and interested lay individuals.
WHAT DID THIS STUDY FIND?
Overall, the research to date shows that participation in recovery residences helps increase positive recovery outcomes (e.g., abstinence and employment) for individuals with a variety of demographic characteristics (e.g., women, Black vs. White individuals, those with co-occurring psychiatric in addition to substance use disorders). Residents may need to stay for 6 or more months to derive maximum benefit. Some evidence suggests the community at large benefits from the presence of recovery residences. At the time of this policy statement, evidence was not available on the cost-benefit of recovery residences. A study also highlighted in a Recovery Research Institute Bulletin summary shows, however, that Oxford Houses – one type of recovery residence –are able to promote financial savings both for individual members and for society at large (e.g., savings from less use of alcohol and other drug use, increased employment, reduced criminal activity).
The panel offers several recommendations related to recovery residences. They suggest increased funding from the National Institutes of Health (specifically the branches dedicated to alcohol and other drug research) for recovery residence research. Of note, the panel outlines four levels of support provided in recovery residences, with each level an increase in professional involvement and structure (see Figure below from the National Alliance of Recovery Residence). Research – and therefore our scientific knowledge base – on Levels I and II (peer-run and monitored recovery residences) is further along than research on levels III and IV (supervised and service provider recovery residences). In addition, they recommend further research on recovery residence participation in context of simultaneous engagement in other recovery support services. Regarding a policy agenda, they recommend agencies at local, state, and national levels support recovery residence networks. For example, several states have their own set of recovery residence standards (also detailed in Figure below by level of support), developed in conjunction with the National Alliance of Recovery Residences (e.g., Massachusetts Association of Sober Housing; MASH). The panel recognizes this progress and recommends further policy progress along these lines. Regarding a clinical agenda, the panel recommends education and training of clinicians in the scientific research on recovery residences. Finally, they suggest leveraging this growing body of research and policy progress to inform the public, in order to address stigma and discrimination focused on recovery residences (i.e., to reduce anti-recovery residence sentiment among other community members).
WHY IS THIS STUDY IMPORTANT?
This policy statement by the Society for Community Research and Action highlights what we know about recovery residences, and, just as importantly, what we need to know. The establishment of standards by the National Alliance of Recovery Residences, and the related push by some policy makers to adapt these standards to support recovery residences in their states are both noteworthy. In addition, the panel’s recommendation to evaluate recovery residences in context of other recovery support services was particularly compelling. Indeed, the substance use disorder treatment and recovery fields would benefit substantially from greater knowledge about how individuals should optimally engage in a variety of services (e.g., recovery residences, outpatient treatment, mutual-help groups, medications). Clinical staff could use this knowledge to identify how gaps in professional services might be shored up by community-based recovery residences to support individuals in, or seeking, recovery.
- This policy statement was based solely on the expertise of a select group of individuals. Of note, these individuals have been responsible for the bulk of the most rigorous research in the field. As such, the summary of existing research, and the research, policy, and clinical agenda they set is likely to be of great value to all relevant stakeholders.
- For individuals & families seeking recovery: This policy statement highlights the existing research on recovery residences – which generally shows them to be helpful resources – and describes the range of recovery residences available. If you (or your loved one) are considering a recovery residence as a way to support your recovery, you may wish to ask whether the residence adheres to National Alliance of Recovery Residence standards and, if you live in a state with its own guidelines, to ask about adherence to state guidelines as well.
- For scientists: This policy statement by the Society for Community Research and Action lays out a research agenda for scientists in this field. Of note, they recommend future directions including work examining recovery residence benefit in context of other recovery support services. Research assessing and evaluating the unique benefits of both professional (e.g., outpatient treatment) and non-professional options (e.g., mutual-help) would be an important contribution to the literature.
- For policy makers: This policy statement by the Society for Community Research and Action highlights the existing research on recovery residences – which generally shows them to be helpful resources – and describes the range of recovery residences available. Based on what is known, the expert panel recommends that agencies at several levels (e.g., local, national, etc.) provide funding, resources, and political support for local networks of recovery residences.
- For treatment professionals and treatment systems: This policy statement by the Society for Community Research and Action highlights the existing research on recovery residences – which generally shows them to be helpful resources – and describes the range of recovery residences available. Treatment program directors may wish to inform clinical staff about the scientific research related to recovery residences, while also seeking consultation from professional organizations that support clinicians in providing high-quality care to their patients (e.g., The Association for Addiction Professionals).