The architecture of recovery: two kinds of housing assistance for chronic homeless persons with substance use disorders (original) (raw)
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A model for sober housing during outpatient treatment
Journal of psychoactive drugs, 2009
Finding a living environment that supports recovery is a major challenge for many clients attending outpatient treatment. Yet it is important because family, friends, and roommates who encourage substance use or discourage recovery can undermine the progress made in treatment. Destructive living environments are most problematic for clients who have limited incomes and reside in urban areas where housing markets are tight. Individuals who are homeless face constant threats to their sobriety and often lack the stability necessary to attend treatment consistently. Options Recovery Services is an outpatient program in Berkeley, California that uses sober living houses (SLHs) to provide an alcohol and drug free living environment to clients while they attend the outpatient program. This paper describes the structure and processes of the houses along with six month outcome data on 46 residents. Improvements included the number of months using substances, maximum number of days of substance use per month, arrests, and employment. Seventy six percent of the residents remained in the house at least 5 months and 39% reported being employed at some point during the past 30 days. Outpatient programs should consider establishing SLHs for clients who lack a living environment supportive of sobriety.
2007
Individuals randomized to abstinence-contingent housing (Oxford House) exhibited superior outcomes at 24 months compared to individuals assigned to usual care (outpatient treatment or self-help groups). Compared to usual care, individuals in the housing condition exhibited significantly lower substance use (31.3% vs. 64.8%), significantly higher monthly income ($989 vs. $440) and significantly lower incarceration rates (3% vs. 9%). 4. Implications for Drug and Alcohol-Free Housing Housing in the present study consisted of rented, multi-bedroom dwellings in lowcrime, residential neighbourhoods. Reductions in criminal activity may have been partially attributable to the structure and location of housing. The authors advise that housing may offer benefits to other subgroups of individuals who are attempting to maintain abstinence, such as ex-offenders, individuals with psychiatric disorders, and those who are homeless. The Oxford House model illustrates the value of peer-based abstinence-contingent housing. 5. Evaluation of paper (research methodology, level of confidence, etc.) The study involved a randomized controlled trial of 150 individuals, with over 90% follow up over 24 months. Collateral information was obtained in order to confirm selfreported abstinence rates at 24 months. The design and execution of the research was robust. Designing and implementing research with this type of peer-run program is difficult and the long term collaborative relationship between the researchers and the program was seen as critical for the successful implementation of the project. It would be challenging to replicate these findings without a similar collaborative research model.
2002
Recent years have seen fundamental shifts in the objectives and delivery of assistance to the homeless. An early emphasis on emergency shelter and monetary housing assistance has been replaced by a focus on programs designed to blend shelter with an array of social services. In most instances, however, programs combining shelter and social services are designed as transitional; that is, they are intended to help homeless individuals and families move from a position of dependence to one where they can live "independently." The emphasis in transitional housing programs is on making homeless people "housing ready." This paper concerns the process of assessing "housing readiness" as observed during eighteen months of fieldwork in a federally supported transitional housing program for formerly homeless single adults. The detailed case study that follows supports three important findings. First, there was virtual unanimity among staff and residents that substance abuse was the cause of their homelessness and the key to its solution. Second, success within the program was defined and operationalized along very specific but well understood normative dimensions that have little to do with the material circumstances in which residents find themselves and everything to do with "recovery." Third, "recovery"-the key to housing readiness in this environment-was measured not by objective measures, i.e., number of months sober, but rather by what was widely referred to as one's "quality of sobriety," a subjective and consequently often hotly debated measure of attitude and outlook only loosely related to demonstrable abstinence from alcohol. This last finding, that ultimately housing readiness is a subjective judgment, both increases the
Journal of Psychoactive Drugs, 2012
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 improvementson alcohol, drug and other problems that are maintained at 18-month follow-up . 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 on-line 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.
Sober Living Houses: Potential Roles in Substance Abuse Services and Suggestions for Research
Substance Use & Misuse, 2001
Sober living houses' are alcohol-and drug-free residences for individuals attempting to establish or maintain sobriety. They offer no formal treatment services but do provide social support and an abstinent living environment. 'Sober living houses' have been used as aftercare placements for clients completing residential treatment, places for clients to live while attending outpatient treatment, or as stand-alone approaches for substance misuse problems. This article identifies areas of research needing attention and suggests that 'sober living houses' have the potential to play a stronger role in the continuum of substance misuse services.