Interaction of Motivation and Psychiatric Symptoms on Substance Abuse Outcomes in Sober Living Houses

Abstract

Background: Studies show residents of sober living recovery houses (SLHs) make improvements in a variety of areas including alcohol and drug use, arrests, and employment. Longitudinal measures of motivation (assessed as costs and benefits of continuing sobriety) have been shown to be associated with alcohol and drug outcomes in SLHs. However, how motivation interacts with other potentially important factors, such as psychiatric severity, is unclear. Objective: The present study aimed to assess how perceived costs and benefits of sobriety among residents of SLHs differed by psychiatric severity. The study also aimed to assess how costs and benefits interacted with psychiatric severity to influence outcome. Methods: Two hundred forty-five residents of SLHs were assessed at baseline and 6, 12, and 18 months. Results: High psychiatric severity was associated with higher severity of alcohol and drug problems and higher perceived costs of sobriety at all data collection time points. Perceived costs and benefits of sobriety were strong predictors of alcohol and drug problems for participants with low psychiatric severity. Perceived costs, but not perceived benefits, predicted outcomes for residents with high psychiatric severity. Conclusions/Importance: High psychiatric severity is a serious impediment for some residents in SLHs. These individuals perceive sobriety as difficult and that perception is associated with worse outcome. Finding ways to decrease perceived costs and challenges to sustained sobriety among these individuals is essential as is collaboration with local mental health services. SLHs should consider whether additional onsite services or modifications of SLH operations might help this population.

Keywords :

• sober living house
• residential treatment
• recovery house
• psychiatric symptoms
• motivation
• brief symptom inventory

THE AUTHORS

Dr. Douglas Polcin, Ed.D., is a Senior Scientist at the Alcohol Research Group. His research interests include studies on sober living recovery homes, intensive motivational interviewing, supportive confrontation, and treatment for criminal justice offenders. Dr. Polcin has also worked as a clinician and supervisor in a variety of substance abuse and mental health programs since 1979.

Rachael Korcha, MA, is an associate scientist at the Alcohol Research Group. She has been a co-investigator on studies of sober living recovery homes and has been involved in a wide variety of additional epidemiology, clinical and qualitative projects.

Dr. Jason Bond, Ph.D., is a Senior Scientist and Biostatistician at the Alcohol Research Group. He has broad expertise in statistical analysis of large epidemiology datasets as well as analyses of complex longitudinal data.

GLOSSARY

• Addiction Severity Index Lite (ASI): The ASI is a standardized, structured interview that assesses problem severity in six areas: medical, employment/support, drug/alcohol, legal, family/social, and psychological.

• Brief Symptom Inventory: A 53-item measure that assesses severity of psychiatric symptoms on nine clinical scales as well as three global indices.

• Psychiatric Symptoms: Mental health problems such as depression, anxiety, paranoia, and hallucinations.

• Sober Living House: An alcohol- and drug-free living environment for persons recovering from alcohol or drug problems. The recovery approach emphasizes peer support and involvement in peer support groups such as Alcoholics Anonymous. On-site professional services are not offered but residents are free to pursue outside services as needed.