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Who Works at Recovery Residences?

Making the transition back to your normal life after completing an inpatient recovery program can feel scary and uncertain. It might help to know that there are recovery residences that can serve as intermediary steps to better support you as you make the move from intensive treatment to independent living. Knowing who works at these facilities can help you decide if one of these options is right for you.

Types of Recovery Residences

A recovery residence is just one of several elements that comprise the continuum of care for addiction. Not everyone chooses to make sober living arrangements but, for those who do, a recovery residence offers a substance-free place to live and an environment that can provide the extra support and resources for long-term recovery.

For some people, returning home after staying in a treatment program can be jarring and/or not in the best interest of continued recovery. Moving to a recovery residence is something to consider if you feel you need extra help staying sober before fully transitioning back into your community. Although most people who live in a sober living setting have been through formal treatment, some places will let you stay there independently of any rehabilitation stays or other treatment requirements. In other words, if you haven’t been to an inpatient treatment program but feel you need a safe alcohol- and drug-free living environment, one of these homes may be an option for you.

Recovery residences have been shown to be effective in terms of maintaining abstinence, reducing relapse, and bettering quality of life such as through improvements in employment/income and through reduced rates of incarceration.1,4,5,8

The National Alliance for Recovery Residences (NARR) identifies 4 different levels of support:4,7

  • Level I (Peer-Run)
  • Level II (Monitored)
  • Level III (Supervised)
  • Level IV (Service Provider)

All levels have a component of peer support, and each ascending level provides more structure and staff assistance than the one below. The type of residence you choose should match the type of support that best meets your current needs. Your treatment provider or therapist can work with you to determine which option is best.

However, generally speaking, the most common types of recovery residences are:

  • Sober living houses (SLH) offer no formal treatment services, although 12-step attendance is strongly encouraged.5,8 You can stay as long as you want, provided you abide by house rules and maintain your sobriety. Levels of support may vary, with some programs offering more staff and monitoring and others offering minimal supervision.9
  • Halfway houses offer a place to stay whether or not you are currently in a treatment program, although some history of formal treatment is often a requirement, and the length of stay is typically limited.5
  • Oxford Houses operate under their own model and are listed on the National Registry of Evidence-based Programs and Practice.8 They are single-sex residences that have no professional staff, are democratically run, and are self-supported.3 Even though there are no house managers, there are regional managers who may perform functions such as conducting training or collecting data.6 An average stay is about a year, although there is no limit to how long you can continue to live at the home as long as you remain alcohol- and drug-free. This is a good example of a level I residence.
  • Therapeutic communities offer a holistic approach that emphasizes the community, employs professionally trained staff, and offers structured treatment services.2 This is an example of a level IV residence.

Some residences might also be geared towards special populations such as women or individuals with co-occurring mental health issues.

Staff Positions and Responsibilities

The type of staff and associated responsibilities will vary from Level I to Level IV. For example, some houses are completely run by peers, with some residents taking on a leadership role (e.g., overseeing operations), whereas other homes employ licensed professionals.

Level I homes are completely peer-based and offer the least amount of support. Residents are responsible for self-monitoring and staying accountable to each other. They also perform all house upkeep and chores. This is an example of what an Oxford House living environment might look like.

Level II residences are monitored, meaning they have a house manager or senior resident to oversee operations, enforce rules, and help maintain structure.

Level III is referred to as supervised as it offers some clinical services and/or workshops or classes to teach various life skills. Staff may include house managers and certified staff or case managers.9

Level IV residences (therapeutic communities) have the highest level of structure and monitoring, and often utilize licensed treatment providers. This might include mental health providers, nurses, social workers, psychiatrists, and vocational counselors. Depending on the size, they may also employ maintenance or legal staff.2

As with the types of recovery residences, staff descriptions and responsibilities may vary based on which state they are in as well. For example, Florida, Arizona, and several other states have implemented specific requirements for house managers of recovery residences, such as participating in ongoing training.8

You might also find differences based on whether or not the recovery residence follows a “social model” approach. This approach emphasizes the role of community and learned skills in helping people to maintain recovery. As such, the types of relationships that promote recovery are peer-to-peer rather than peer-to-professional, so house staff may also be comprised of individuals in recovery.

How Staff Members Differ from Rehab Staff

Recovery residences are not treatment programs, and although recovery residences may be run by licensed professionals, some may have only a house manager who is in recovery, while others may be solely governed democratically by residents. This may be fine for you if that level of support matches your current needs. You can always ask potential homes any questions you have about the way the home is run, as well as staff roles and responsibilities (if applicable).

The Resident’s Role

As a resident, your biggest concern will be making sure you stay sober. If this rule is violated, you will likely be asked to leave, as your substance use could jeopardize the sobriety of other residents. The amount and types of rules and responsibilities will be different based on what level and type of recovery residence you choose. Your particular role may also vary based on your level of progress or length of stay.4 In other words, you may take on more of a leadership role or have more responsibility when you have been there longer and have shown that you have made progress in your recovery.

Sober living houses will likely require you to attend house meetings and participate in chores. There is also a strong emphasis on having a support network, so if you have been there longer you may be asked to serve as a mentor to others. If you are in a level 1 or 2 residence, you are more likely to be employed outside the home, whereas levels 3 and 4 involve participating in other recovery activities such as counseling or life skills training which may make working at a job more difficult.4

In democratically run facilities, such as Oxford Houses, each resident will take an equal interest in and responsibility for how the house is run. Residents have a lot of flexibility but also a great deal of personal responsibility and accountability.

Most levels will require or at least encourage involvement in a 12-step group, which can result in better recovery outcomes.4

Doing Your Research

Before making a decision on a recovery residence, it is crucial that you do your research, as some residences have been associated with serious abuses of power and unethical practices. You might start by looking online and searching for any review; if there are no obvious problems, you might want to talk to staff and ask a lot of questions. Here are some potential red flags:7

  • Facilities that are operating outside their scope of practice. This could mean having individuals provide services that should only be conducted by licensed professionals, or promoting staff when they aren’t ready or adequately trained.
  • Unethical financial practices such as offering free rent in exchange for going to a specific treatment program, insurance fraud, or accepting bartering for payment.
  • Breaches of confidentiality or sharing personal information without an individual’s consent.
  • Not having adequate rules or standards.

Other treatment providers may be able to give you recommendations on safe and ethical recovery residences; you may want to ask if they have any exclusive agreements with the places they are referring you to. These could be an indicator that the referral might not be in your best interest but rather benefits the person providing the referral. Ideally, you will enter a place with clear boundaries, financial transparency, uniformly applied rules, and fair and respectful treatment of residents.

References:
  1. Bergman, B.G., Hoeppner, B.B., Nelson, L.M., Slaymaker, V., & Kelly, J.F. (2015). The Effects of Continuing Care on Emerging Adult Outcomes Following Residential Addiction Treatment. Drug and Alcohol Dependence, 153, 207-214.
  2. Center for Substance Abuse Treatment. Treatment of Adolescents with Substance Use Disorders. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 1999. (Treatment Improvement Protocol (TIP) Series, No. 32.) Chapter 5—Therapeutic Communities
  3. Jason, L.A., & Ferrari, J.R. (2010). Oxford House Recovery Homes: Characteristics and effectiveness. Psychological Services, 7(2), 92-102.
  4. National Association of Recovery Residences. (2012). A primer on recovery residences: FAQ’s from the National Association of Recovery Residences.
  5. Polcin,D. L., Korcha, R., Bond, J., & Galloway, G. (2010). What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here? Journal of Psychoactive Drugs, 42(4), 425-433.
  6. Polcin,D., Mericle, A., Howell, J., Sheridan, D., & Christensen, J. (2014). Maximizing Social Model Principles in Residential Recovery Settings. Journal of Psychoactive Drugs, 46(5), 436-443.
  7. Sanders, B.F. & Sheridan, D. (2017). Risky business: the search for standards and ethics in sober living recovery residences [power point slides].
  8. The National Council for Behavioral Health. (n.d.). Building recovery: State policy guide for supporting recovery housing.
  9. National Association of Recovery Residences. (20110. Standard for Recovery Residences.