By Leonard A. Jason, Amy A. Mericle, Douglas L. Polcin, and William L. White
Drug abuse and addiction are among the costliest of health problems, totaling approximately $428 billion annually. People recovering from substance abuse disorders face many obstacles in our current health care system. Dropout is common from detoxification and acute treatment programs, and many people who dropout relapse. This cycle often repeats many times with high personal and social costs. It has become increasingly clear that detoxification and short-term treatment programs are insufficient to ensure success; for most people with substance use disorders continued longer-term support following treatment is necessary. There are a number of community-based organizations that provide support to those following treatment, including self-help organizations such as AA. Unfortunately, groups such as AA do not provide needed housing, employment, or reliable sober-living environments. Halfway houses and therapeutic communities are one type of environmental support for many following substance abuse treatment. However, they have a number of limitations including length of stay, high cost, and required completion or involvement in some type of formal treatment.
In contrast, recovery residences are lower cost, community-based residential environments that require abstinence from substance use and abuse. Typically, residents can stay for as long as they want, but they are required to abstain from alcohol and illegal drug use and pay a modest rent to the recovery home owner. These residences go by a variety of different names (e.g., sober living houses, recovery homes, and Oxford Houses) and provide at a minimum peer-to-peer recovery support. Many recovery residences have staff to oversee operations and help link residents with treatment and other support services; some even provide these services directly to residents. Although the exact number of recovery residences is currently unknown, many thousands exist across the United States.
A small but growing body of research supports the effectiveness of recovery residences to promote abstinence and improve outcomes in a variety of other domains. Moreover, research generally finds that recovery residences don’t negatively affect neighborhoods and may even provide benefits to the communities in which they are located. Unfortunately, there continues to be formidable neighborhood and community opposition; operators often face barriers to obtaining funding to open and operate recovery residences. Critical stakeholders (e.g. health and human professionals, community leaders, and potential funders) are all too often unaware of the role that recovery residences can play in promoting long-term recovery.
The Affordable Care Act will have significant impact on the prevention and treatment of substance abuse disorders, including the integration of primary and behavioral health care, providing better screening, treatment, and referral practices to enhance behavioral health outcomes. These steps should result in a more chronic care-focused, integrated system that delivers better screening for at-risk individuals and services for relapse prevention. Recovery residences could play a major role in this new federal initiative to provide community-based support that could ensure more long term recovery following treatment.
Leonard A. Jason, professor of clinical and community psychology at DePaul University and director of the Center for Community Research, is the author of Principles of Social Change published by Oxford University Press. He has investigated the self-help recovery movement for the last 20 years. He is a member of the National Association of Recovery Residences Research Committee and has co-authored a policy paper on the role of recovery residences in promoting long-term recovery from addiction, which will be published in the American Journal of Community Psychology. Read his previous blog posts on the OUPblog.
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