Recovery homes provide inexpensive and accessible community-based support

Abstract

Substance abuse disorders (SUDs) create significant and pervasive health and economic burdens in the U.S. and the world. After primary treatment has ended, supportive social environments are critically important to prevent relapse and to sustain long-term sobriety. Although approaches to SUDs and treatment vary internationally, studies in the United States indicate that a major risk factor for SUD relapse are lack of social environments to support sustained remission from substance use after primary treatment has ended. Evidence suggests that abstinence is enhanced when individuals are embedded in drug-free settings that support abstinence. Longabaugh, Beattie, Noel, and Stout proposed a theory of social support that engages two processes: general social support, which affectspsychological functioning, and abstinence-specific social support, which supports ongoing abstinence from substance use.

Keywords:

• Recovery homes
• Oxford Houses
• social capital
• substance use disorders, community psychology

Introduction

Substance abuse disorders (SUDs) create significant and pervasive health and economic burdens in the U.S. and the world (Andlin-Sobocki & Rehm, 2005; SAMHSA, 2010; World Health Organization, 2002). After primary treatment has ended, supportive social environments are critically important to prevent relapse and to sustain long-term sobriety (Vaillant, 1995). Although approaches to SUDs and treatment vary internationally (Broekaert, Colpaert, Soyez, Vanderplasschen, & Vandevelde, 2007), studies in the United States indicate that a major risk factor for SUD relapse are lack of social environments to support sustained remission from substance use after primary treatment has ended (Jason, Davis, & Ferrari, 2007). Evidence suggests that abstinence is enhanced when individuals are embedded in drug-free settings that support abstinence (Clifford & Longabaugh, 1991; Jason, Olson, Ferrari, & Lo Sasso, 2006; Moos & Moos, 2006). Longabaugh, Beattie, Noel, Stout, and Malloy (1993) proposed a theory of social support that engages two processes: general social support, which affectspsychological functioning, and abstinence-specific social support, which supports ongoing abstinence from substance use.

In the U.S., community-based residential aftercare programs provide a place where general and abstinence-specific social support can be obtained after treatment has ended (Jason, Davis, et al., 2007). Housing and aftercare programs in safe, sober environments that provide continuous social support can protect against substance abuse relapse (Jason, Olson, et al., 2007; Moos & Moos, 2007). In addition to relapse prevention, residential communities for former substance users can reintegrate marginalized populations back into communities by providing stable housing, encouraging employment and gains in income, and reducing criminal recidivism (Jason, Olson, & Harvey, 2015; Jason, Davis, et al., 2007).

In our view, Oxford Houses (OH) represent a potentially cost-effective and scientifically illustrative community-based substance abuse aftercare model. OH is the world’s largest network of self-run recovery settings. Since its founding in 1975, OHs have grown to house approximately 20,000 people in over 2,400 OHs in the U.S. (Oxford House Inc., 2019). OHs are rented single family homes located in mainstream residential communities in which 7–12 same-gender individuals in SUD recovery live together. Residents agree to refrain from illicit drugs and alcohol, share house maintenance duties, make house-wide decisions democratically, and share all house expenses equally. Unlike state-funded or pay-for-service settings, any sober resident can live in an Oxford House as long as they remain abstinent. Unlike traditional therapeutic settings, there is no professional treatment or supervisory staff employed in an Oxford House; residents elect rotating officers (president, treasurer, secretary) and resolve disputes together. The operating costs of a self-run OH are much lower than professionally staffed settings (Olson et al., 2006). House-wide business meetings are held weekly to collect money, pay for common expenses, distribute and assign housekeeping chores, share resources, and to give every resident an opportunity to discuss issues affecting himself,herself, or the house. New residents entering any OH must interview with every resident, who then votes on whether to accept that person into the OH. All the procedures for operating an OH are documented and available for download at the Oxford House World Services, Inc. website (http://www.oxfordhouse.org).

OHs are well-studied with over 100 peer-reviewed studies published to date, as well as are listed on SAMHSA’s National Registry of Evidence-based Programs and Practices (SAMHSA, 2015). Three NIH-funded research studies on Oxford Houses in the U.S. have shown positive results for OH such as their promotion of sustained abstinence and fostering of community reentry of former substance abusers (Jason, Olson & Foli, 2008; Jason, Davis, et al., 2007; Jason, Olson, et al., 2007; 2015). The OH model has been created with children as co-residents, for veterans, ex-offenders, and have been culturally modified for Spanish-speaking and the hearing impaired (Alvarez, Adebanjo, Davidson, Jason, & Davis, 2006; Alvarez, Jason, Davis, Ferrari, & Olson, 2005; Belyaev-Glantsman, Jason, & Ferrari, 2009; d’Arlach, Olson, Jason, & Ferrari, 2006; Deaner, Jason, Aase, & Mueller, 2009; Flynn et al., 2006; Kidney, Alvarez, Jason, Ferrari, & Minich, 2011; Majer, Jason, Ferrari, & North, 2002). In a study in the U.S. comparing usual to culturally modified OHs (Spanish-speaking) with Latino/a Populations, results showed increased employment for the culturally modified OHs, and decreased drinking for non-culturally modified OHs (Jason et al., 2013).

The operating principles of an OH might “activate” four theoretical psychosocial processes that Moos (2011) proposes might protect against relapse in aftercare settings: social control, social learning, behavioral economics, and stress and coping. Social control processes emerge when the activities occurring within the setting enhances cohesion and mutual support among participants, establishes clear direction and common goals, and encourages non-coercive mutual monitoring and accountability (Moos, 2011). Based upon Bandura’s (1997) work on self-efficacy, social learning involves imitation of positive role models and following acceptable norms, and providing a milieu in which to observe and imitate positive, non-using behaviors. Behavioral economics theory (also called behavioral choice theory) is a cornerstone in community reinforcement approaches which is based on the etiology that SUDs develop out of patterns of reinforcements (Meyers & Miller, 2001). Stress and coping processes involve identifying and effectively managing stressors and high-risk situations, as well as developing effective coping strategies and building self-efficacy (Moos, 2011). Living in an Oxford House seems to engage both general and abstinent-specific social support processes by encouraging cooperation and participation in house maintenance and governance, while also encouraging abstinence-oriented mutual-help behavior and stress reduction among peers (Moos & Moos, 2007). The experience of shared living spaces and mutual dependence has shown to increase mutual-help participation and increased evaluations of social support (Humphreys, Mankowski, Moos, & Finney, 1999).

A prior themed issue on Oxford Houses in this journal was published in 2006 based on two large NIH-funded studies with Leonard Jason as P.I. and Joseph Ferrari as Co-P.I. (e.g., Brown, Davis, Jason, & Ferrari, 2006; Flynn et al., 2006; Ponitz, Olson, Jason, Davis, & Ferrari, 2006). That issue also contained smaller-scale studies of Oxford Houses (Jason, Davis, Olson, Ferrari, & Alvarez, 2006) as well as qualitative and quantitative data regarding intrapersonal variables (Davis, Dziekan, et al., 2006; Kim, Davis, Jason, & Ferrari, 2006). Those studies also included both local and national residents (d’Arlach et al., 2006) and contextual characteristics and policy implications (Braciszewski, Olson, Jason, & Ferrari, 2006; Ferrari, Jason, Blake, Davis, & Olson, 2006; Olson et al., 2006).

The current special issue reviews a series of investigations by a group of researchers who have been studying Oxford House recovery homes for 30 years. The articles provide a range of topics, including Soto-Nevarez et al.’s examination of the effects that substance using family members have on those working to maintain recovery from substance use disorder, Walt et al.’s examination of social cognitive and interpersonal variables that may be important factors to consider for women’s long-term recovery success; Jason et al.’s evaluation of the impact of COVID-19 on recovery homes; Hunter et al.’s article on the role of stigma and discrimination in the context of employment among those in recovery on women exiting from jail and prison, Jason et al.’s examination of medication assisted therapy in recovery homes, Abo et al.’s examination of a personality construct on formerly incarcerated residents of Oxford Houses, and Ursu et al.’s examination of factors that might encourage the development of Oxford Houses in Romania. There is a wide breadth of topics covered in these articles, indicating that the DePaul University’s thirty year effort to understand this innovative recovery setting has only begun to scratch the surface of findings, and there are abundant questions that investigators will be exploring in the future.

Disclosure statement

No potential conflict of interest was reported by the author(s).