Community psychologists have given their imprimatur to recovery residences, moving the disorganized industry a step closer to recognition for quality. In a policy statement approved June 6 by the Society for Community Research and Action (SCRA) — Division 27 of the American Psychological Association (APA) — recovery residences are called a “promising mechanism” to sustain long-term recovery from addiction. But research into their effectiveness is sorely needed, as is federal funding, the policy states. Standards are also necessary because of a perception that many “sober homes” and similar places are operated below the radar of any quality control system.

Created in collaboration with the National Association of Recovery Residences (NARR), the policy statement calls for federal funding from the Substance Abuse and Mental Health Services Administration (SAMHSA) and the Department of Housing and Urban Development (HUD). The policy statement also calls on single state authorities to set up “loan funds” to support the development of recovery residences.

The policy statement will be published in the American Journal of Community Psychology, according to Leonard A. Jason, Ph.D., director of the Center for Community Research at DePaul University and lead author of the statement. Jason’s interest in recovery homes was spurred by a film he saw more than 20 years ago by Paul Molloy, founder of Oxford Houses. “I asked him if he’d like to have his work evaluated, with my help,” Jason told ADAW in an interview last week.

With William L. White, senior research consultant at Chestnut Health Systems, Jason worked on a primer on recovery residences, published last year. “This was a call to the field,” said Jason. “After we came out with the primer, we wanted to get this information out to a larger audience.” That’s where the idea of a policy statement came in, and over the past year the researchers worked with SCRA.

Recovery environment

NARR’s past president Beth Fisher worked closely with Jason and his colleagues on the primer. Noting that there is some tension between NARR and Oxford Houses, which doesn’t want another layer of regulation, Jason said that nevertheless there are many houses that have no guidelines at all. “Most of the dollars have been focused on treatment, and what community psychologists and others have said is that the environment that people go to after treatment is very important,” he said.

“SCRA’s policy statement on recovery residences will bring light and improve access to the spectrum of recovery-oriented living environments and services that many in recovery from AOD use need to start and sustain long-term recovery,” said Jason Howell, NARR president. “It is a shining example of how, together, the traditional addiction treatment and peer recovery support fields can holistically address the needs of person in recovery along a continuum of care.”

While it seems to make sense that living in a “sober home” would facilitate long-term recovery, “the reality is it’s much more complicated,” said Jason. “We think that there is a wealth of issues that are just unclear,” he said. “Who does this work for and how does it work?” For example, the house may have people who are mostly in their 40s and 50s. “They’re ready to change,” he said. “But if someone comes in who is 21 years old, that might not work at all.”

Another example is whether someone finds a friend in the recovery home. Oxford House studies have found that if people find a friend there, that’s “probably critical to outcome,” said Jason. “If you come into a house and nobody is a friend, that’s a very bad predictor.”

Research

The policy statement also calls for research funding from the National Institute on Alcohol Abuse and Alcoholism and the National Institute on Drug Abuse on recovery residences, “including randomized clinical trials, long term outcome studies, cost-effectiveness studies, and studies that isolate the most potent ingredients of the recovery residence model of recovery support.”

Outcome and cost-saving data from the four levels of recovery residences, as established by NARR, are needed for various populations, in comparison to or in combination with alternative approaches, according to the policy statement. “Without published research and evidence-based practice designations, licensed professionals and policymakers will continue to question the legitimacy of recovery residences and peer-based recovery.”

Standards

NARR should disseminate standards for recovery residences and “provide technical assistance for local organizations to meet these standards as a means of improving the quality of local recovery residences in the United States.” Standards are particularly important because of perceptions that relapse is common among residents, that the homes are in unsafe neighborhoods and that they exploit residents.

Indeed, unscrupulous sober home operators are able to set up shop and market themselves on the Internet, often to unsuspecting patients and even treatment providers, casting an unpleasant taint on the whole field (see ADAW, March 25). This is one of the main reasons for NARR’s stress on standards.

The SCRA also requested the APA to disseminate this policy document to APA members and other organizations, showing support for recovery residences, and certification organizations for addiction treatment to incorporate questions about recovery residences into certification exams.

Finally, the policy statement calls on the American Society of Addiction Medicine (ASAM) to formally recognize recovery residences as a level of care within its criteria — something that is unlikely to happen in the near future, as ASAM has just revised its criteria (see ADAW, May 27).

The policy statement was written by the NARR research committee and approved by the NARR executive committee before it was submitted to the SCRA. In addition to Jason and White, the NARR research committee members are Amy A. Mericle, Ph.D., research scientist at the Treatment Research Institute and Douglas L. Polcin, senior scientist at the Alcohol Research Group. 

The groups involved want to get the word out about recovery residences, but they also want to amass evidence that these work, and find out why. “Sociologists have been studying social networks for a long time,” said Jason, who stressed the “friends” aspect of housemates living in recovery. “But there are so many questions that are open, about costs and benefits, about matching.” With research and standards, the “sober home” field may continue to grow unfettered and without adequate patient protections, leading to its possible demise.

For a copy of the document, go to RecoveryResidences SCRA Policy.pdf.