Reasons for choosing sober living houses and their associations with substance use recovery outcomes.

Background: Sober living houses (SLHs) offer abstinence-based housing for people in recovery. Studies have shown that these supportive environments are associated with positive outcomes, yet little is known about why residents choose SLHs and their relationship to recovery outcomes. Methods: Longitudinal data were collected from SLH residents who completed an interview six months after baseline (N = 462). Participants rated the importance of eight reasons for choosing SLHs. Multilevel models assessed whether reasons for choosing were associated with outcomes abstinence on the Timeline Followback, psychiatric distress via the Psychiatric Diagnostic Screening Questionnaire (PDSQ), employment problems severity on Addiction Severity Index (ASI), and length of stay (LOS). Results: The most frequently cited reasons residents chose SLHs were affordability (74.4 %) and wanting to live with others in recovery (63.2 %). Reasons for choosing were not associated with neither LOS nor abstinence, except for not wanting to live with others in recovery predicting abstinence from all drugs except marijuana. Choosing SLHs due to affordability was associated with less psychiatric distress; no other place to live was associated with increased psychiatric distress (Ps < 0.05). Severity of employment problems was associated with choosing SLHs based on location, transportation, and someone else paying fees (Ps < 0.01). Conclusion: Residents seek entry into SLHs to live affordably with others in recovery. Those who had no other option had greater psychiatric distress, thus supporting findings of housing instability being related to mental health. Reasons for choosing related to employment problems severity may reflect how concerns about employment impact housing choices.

Six-month length of stay associated with better recovery outcomes among residents of sober living houses.

Background: Sober living houses are designed for individuals in recovery to live with others in recovery, yet no guidelines exist for the time needed in a sober living house to significantly impact outcomes.Objectives: To examine how the length of stay in sober living houses is related to substance use and related outcomes, focusing on early discontinuation (length of stay less than six months) and stable residence (length of stay six months or longer).Methods: Baseline and 12-month data were collected from 455 sober living house residents (36% female). Longitudinal mixed models tested associations between early discontinuation vs. stable residence and abstinence, recovery capital, psychiatric, and legal outcomes. Final models were adjusted for resident demographics, treatment, 12-step attendance, use in social network, and psychiatric symptoms, with a random effect for house.Results: Both early discontinuers (n = 284) and stable residents (n = 171) improved significantly (Ps ≤ .05) between baseline and 12 months on all outcomes. Compared to early discontinuation, stable residence was related to 7.76% points more percent days abstinent (95% CI: 4.21, 11.31); 0.88 times fewer psychiatric symptoms (95% CI: 0.81, 0.94); 0.84 times fewer depression symptoms (95% CI: 0.76, 0.92); and lower odds of any DSM-SUD (OR = 0.65, 95% CI: 0.47, 0.89) and any legal problems (OR = 0.58, 95% CI: 0.40, 0.86).Conclusion: In this study of sober living houses in California, staying in a sober living house for at least six months was related to better outcomes than leaving before six months. Residents and providers should consider this in long-term recovery planning.

Do neighborhood characteristics of sober living houses impact recovery outcomes? A multilevel analysis of observational data from Los Angeles County.

OBJECTIVE: To identify neighborhood factors associated with recovery outcomes for sober living house (SLH) residents. METHODS: Six-month longitudinal data for new SLH residents (n = 557) was linked with census tract data, services available, alcohol outlets, and Walk Scores® (0-100 score indicating access to neighborhood resources) for 48 SLHs in 44 neighborhoods in Los Angeles County. RESULTS: Non-significant neighborhood characteristics in separate regressions for all outcomes were residents' ratings of perceived risk, percentage of residences with access to a car, percentage of homes over $500,000, percentage of renter-occupied units, percentage with income less than $25,000, percentage that were non-white, the density of substance inpatient within 10 miles, and transit scores from Walk Score®. Multilevel regressions found outpatient substance abuse treatment and density of AA groups were positively associated with more abstinent days. No neighborhood variables were associated with psychiatric symptoms. Higher perceived neighborhood cohesion, lower crime ratings, and better transportation ratings were associated with higher recovery capital. CONCLUSION: Greater neighborhood densities of substance abuse services and AA groups may help residents achieve more days abstinent. While residents may achieve better substance use outcomes even with negative perceptions of the neighborhood, positive perceptions of the neighborhoods may help them acquire more recovery capital.

Recovery in context: Sober living houses and the ecology of recovery.

Sober living houses (SLHs) are an increasingly common element of the recovery support services landscape, yet little is known about their neighborhood context. This study describes neighborhoods in which SLHs are located and examines differences by house characteristics. SLHs in Los Angeles County (N = 297) were geocoded and linked with U.S. Census, alcohol outlet, recovery resources, and accessibility data. Regression analyses tested differences by house characteristics. Co-ed houses were in neighborhoods that were less ethnically diverse and farther away from recovery resources. Larger house capacity was associated with increased density of off-premise alcohol outlets but also increased proximity to treatment. Higher fees were associated with lower neighborhood disadvantage and off-premise alcohol outlet density but the greater distance from treatment programs and other recovery resources. House characteristics are associated with neighborhood factors that both support recovery and place residents at risk.

Beneficial effects of motivational interviewing case management: A latent class analysis of recovery capital among sober living residents with criminal justice involvement.

BACKGROUND: This secondary analysis uses data from a recent clinical trial conducted with probationers and parolees with substance use disorders (N = 330) residing in Sober Living Houses (SLHs). The treatment condition received Motivational Interviewing Case Management (MICM), while controls received usual care SLH residency. Both conditions improved on multiple domains, though residents randomized to MICM improved significantly more than usual care controls on criminal justice outcomes. Because MICM is designed to help ex-offenders attain more recovery capital (RC) in multiple domains, we hypothesized MICM participants that already possessed higher RC would show significantly greater improvement at follow-up than usual SLH residents with higher RC. Moreover, MICM and usual SLH residents with low RC would show no differences at 1-year follow-up. METHODS: A latent class analysis (LCA) grouped participants into two patterns of RC: those with low RC and those with high RC. These classes were interacted with study condition to predict change on six Addiction Severity Indices (ASI) at follow-up. RESULTS: MICM was more effective for the higher RC class, with greater improvement in drug, legal, and psychiatric outcomes for those who attended at least three MICM sessions. MICM was no more beneficial than usual care for those in a low RC class. CONCLUSIONS: SLH operators should consider implementation of MICM for residents with more RC resources. Those with fewer recovery resources, such as a history of psychiatric problems or physical/sexual abuse, would benefit from a more intensive intervention to assist them with improving the amount and quality of their RC.

Sober living house characteristics: A multilevel analyses of factors associated with improved outcomes.

Safe and stable housing is integral to addiction recovery. Across numerous studies, recovery housing has been found to be associated with improvements in a variety of domains. Although procedures for operating some types of recovery housing have been manualized and national standards established, there are few empirical findings identifying which recovery residence characteristics may lead to improved outcomes. Using data from 330 newly admitted residents recruited from 49 sober living houses in California and re-contacted for 6- and 12-month follow-up interviews, this study examines the effects of organizational, operational, and programming characteristics on substance use, criminal justice, and employment outcomes. Results from multilevel analyses adjusting for resident demographics and length of stay indicate that organizational characteristics were associated with outcomes. Residents recruited from houses that were part of a larger organization or group of houses had increased odds of total abstinence (aOR = 3.98, p < 0.001) and drug abstinence (aOR = 3.19, p < 0.001). Residents recruited from houses that were affiliated with a treatment program had increased odds of employment (aOR = 2.92, p = 0.003). Operational characteristics such as where the house was located and whether the house required incoming residents to be sober for at least 30 days prior to entry were also related to improved outcomes, but additional work is needed to develop tools to assess and measure recovery housing characteristics and to better understand how these factors contribute to improved outcomes.

Distribution and Neighborhood Correlates of Sober Living House Locations in Los Angeles.

Sober living houses (SLHs) are alcohol and drug-free living environments for individuals in recovery. The goal of this study was to map the distribution of SLHs in Los Angeles (LA) County, California (N = 260) and examine neighborhood correlates of SLH density. Locations of SLHs were geocoded and linked to tract-level Census data as well as to publicly available information on alcohol outlets and recovery resources. Neighborhoods with SLHs differed from neighborhoods without them on measures of socioeconomic disadvantage and accessibility of recovery resources. In multivariate, spatially lagged hurdle models stratified by monthly fees charged (less than $1400/month vs. $1400/month or greater), minority composition, and accessibility of treatment were associated with the presence of affordable SLHs. Accessibility of treatment was also associated with the number of affordable SLHs in those neighborhoods. Higher median housing value and accessibility of treatment were associated with whether a neighborhood had high-cost SLHs, and lower population density was associated with the number of high-cost SLHs in those neighborhoods. Neighborhood factors are associated with the availability of SLHs, and research is needed to better understand how these factors affect resident outcomes, as well as how SLHs may affect neighborhoods over time.

Prevalence and Trajectories of Psychiatric Symptoms Among Sober Living House Residents.

OBJECTIVE: Sober living houses are alcohol- and drug-free recovery residences that help individuals with substance use disorders maintain long-term abstinence. Given the prevalence of co-occurring mental disorders among individuals entering substance use treatment, it is likely that many such residents are also contending with psychiatric symptoms, and it is unclear how these symptoms may affect their sobriety. This study sought to describe the prevalence and trajectories of different types of symptoms among sober living house residents and examine how these symptoms affect substance use outcomes. METHODS: Data for this study were collected as part of a larger study on outcomes among sober living house residents in Northern California. The current study examined data from 300 residents in two housing groups; residents were interviewed upon entry and re-interviewed at 6-, 12-, and 18-month follow-ups. Psychiatric symptoms were assessed using the Brief Symptom Inventory (BSI). General estimating equations tested changes in BSI global psychological distress and clinical symptom scales over time and examined the relationship between scale scores and substance use in longitudinal models controlling for demographics, length of stay, and psychiatric service utilization. RESULTS: The average age of residents was 38.5 years (SD = 10.1) and they were mostly male (80%) and Caucasian (65%). Retention rates were high, with 90% (n = 269) participating in at least one follow-up interview. Overall psychological distress (Wald χ(2) = 7.99, df = 3, p = .046), symptoms of depression (Wald χ(2) = 13.57, df = 3, p = .004), and phobic anxiety (Wald χ(2) = 7.89, df = 3, p = .048) significantly improved over time. In all models examining the relationship between BSI scale scores and substance use, rates of abstinence and days of use among those who reported using substances also improved over time. Overall distress (OR = 0.48, p < .001) as well as higher scores on the somatization (OR = 0.56, p < .001), depression (OR = 0.53, p < .001), hostility (OR = 0.71, p = .006), and phobic anxiety (OR = 0.74, p = .012) subscales were significantly associated with a decreased likelihood of abstinence. Symptoms of somatization (B = 0.092, SE = 0.029, p = .002) were associated with an increase in the number of days substances were used among those who reported use. CONCLUSIONS: Psychological symptoms among sober living house residents improve over time, but they are risk factors for relapse, suggesting that additional support provided to residents with psychiatric symptoms could improve substance use outcomes.

The Evolution of Peer Run Sober Housing as a Recovery Resource for California Communities.

Sober living houses (SLHs) are alcohol- and drug-free living environments that offer social support to persons attempting to abstain from alcohol and drugs. They use a peer-oriented, social model approach that emphasizes mutual support, financial self-sufficiency, and resident involvement in decision making and management of the facility. Although they represent an important response to the increasing call for more services that help sustain abstinence from drugs and alcohol over time, they are an under recognized and underutilized recovery resource. The purpose of this paper is to trace the evolution of sober living houses in California from the early influences of Alcoholics Anonymous (AA) in the 1930's to the establishment of current SLH associations, such as the Sober Living Network in Southern California. The paper describes key events and policies that influenced SLHs. Although initial research on outcomes of SLH residents has been very encouraging, there is a need for more research to guide improvement of structure and operations. The paper concludes with a discussion of implications for the growth of recovery services and for community housing policy.

Community Context of Sober Living Houses.

The success or failure of programs designed to address alcohol and drug problems can be profoundly influenced by the communities where they are located. Support from the community is vital for long term stability and conflict with the community can harm a program's reputation or even result in closure. This study examined the community context of sober living houses (SLHs) in one Northern California community by interviewing key stakeholder groups. SLHs are alcohol and drug free living environments for individuals attempting to abstain from substance use. Previous research on residents of SLHs showed they make long-term improvements on measures of substance use, psychiatric symptoms, arrests, and employment. Interviews were completed with house managers, neighbors, and key informants from local government and community organizations. Overall, stakeholders felt SLHs were necessary and had a positive impact on the community. It was emphasized that SLHs needed to practice a "good neighbor" policy that prohibited substance use and encouraged community service. Size and density of SLHs appeared to influence neighbor perceptions. For small (six residents or less), sparsely populated houses, a strategy of blending in with the neighborhood seemed to work. However, it was clear that larger, densely populated houses need to actively manage relationships with community stakeholders. Strategies for improving relationships with immediate neighbors, decreasing stigma, and broadening the leadership structure are discussed. Implications for a broad array of community based programs are discussed.

Gender Differences in Psychiatric Symptoms among Methamphetamine Dependent Residents in Sober Living Houses.

OBJECTIVES: Although psychiatric symptoms among methamphetamine (MA) dependent individuals have been studied in treatment programs, they have not been examined in services designed to support sustained recovery in the community (e.g. sober living houses). In addition, some disorders more common among women, such as somatoform and bulimia, have been understudied among MA dependent individuals. This study aimed to examine psychiatric symptom differences between MA dependent men and women who we entering sober living houses (SLHs). METHODS: Two hundred forty five individuals were interviewed within one week of entering SLHs. Instruments included a DSM IV based measure for MA dependence, a psychiatric screen (the Psychiatric Diagnostic Screening Questionnaire), demographics, recent substance use and recent use of services. RESULTS: Of the 245 participants, 103 men and 25 women met criteria for MA dependence. Womenwith MA dependence reported more psychiatric symptoms than men. They also trended toward reporting more psychiatric symptoms than non-MA dependent women. For men, psychiatric symptoms did not vary between those with and without MA dependence. Some understudied disorders (e.g., somatoform) had large proportions of women meeting the screening criteria. CONCLUSIONS: Additional research is needed on understudied psychiatric disorders that are common among MA dependent women. SLH's should consider ways to address psychiatric symptoms among MA dependent individuals, especially women. Strategies could include increasing linkages with professional mental health services as well as developing peer oriented strategies for managing symptoms.