Mapping COVID vulnerability in relation to drug and alcohol recovery residence availability across the United States.

Recovery housing is an important resource for those in recovery from substance use disorders. Unfortunately, we know little about its relationship to key community health risk and protective factors, potentially limiting the role it could play as a broader health resource. Leveraging county-level data on recovery residences from the National Study of Treatment and Addiction Recovery Residences (NSTARR), this study used multilevel modeling to examine Community COVID Vulnerability Index (CCVI) scores as well as availability of COVID testing and vaccination sites in relation to recovery housing. CCVI composite scores were positively associated with recovery housing availability. Analyses using CCVI thematic sub-scores found that population density and number of churches were positively associated with recovery housing availability, while epidemiological factors and healthcare system factors were negatively associated with recovery housing availability. In counties with recovery housing, there also was a positive association between CCVI and both COVID testing and vaccination availability. Recovery residences tend to be located in areas of high COVID vulnerability, reflecting effective targeting in areas with higher population density, more housing risk factors, and other high-risk environments and signaling a key point of contact to address broader health issues among those in recovery from substance use disorders.

Development and initial findings from the Peer Recovery Coach (PRC) checklist: a new tool to assess the nature of peer recovery coaching service delivery.

Background: Peer recovery coaching is recovery support service for Substance Use Disorder (SUD) that emphasizes shared lived experience and social support. Though a promising intervention for SUD, differences in the roles, responsibilities, and operationalization of peer recovery coaching across studies make objective implementation and evaluation of this service a challenge.Objective: This study sought to develop a tool to better guide and operationalize peer recovery coaching service delivery. This study describes the initial development, acceptability, feasibility, and validity of this tool: The PRC Checklist.Methods: The PRC Checklist was conceptualized and operationalized by drawing from social support theory and recovery capital research. The PRC Checklist was utilized by PRCs in a pilot randomized controlled trial to demonstrate feasibility and acceptability. To further validate the PRC Checklist, recovery coaches (N = 16; 56% female) were recruited to complete a survey about their responsibilities and their perspectives on the content and potential utility of the PRC Checklist.Results: The PRC checklist used in the pilot study delineates personalized from generalized support and tracks 25 specific activities across three domains of support (i.e. socioemotional, informational, and instrumental). PRCs in the pilot study were able to use the PRC Checklist in all in-person initial baseline encounters and 96.4% of follow-up encounters. Qualitative information collected during project meetings was generally positive but also identified potential limitations to its use. All PRCs surveyed reported that they agreed that the PRC Checklist was helpful, encompassed the services they provided, represented a good idea, provided meaningful information, and would be easy to use. All five of the most common activities PRCs engaged in were reflected in the PRC Checklist.Conclusion: Capturing both personal and generalized support provided by PRCs, this work suggests that the PRC Checklist captures key activities engaged in and is a helpful tool for use in healthcare settings.

Measuring Architecture in Recovery Homes: Recovery Home Architecture Scale.

Background: The settings where we live shape our daily experiences and interactions. Social environment and physical setting characteristics may be particularly important in communal living services, such as recovery homes for alcohol and drug disorders. Objectives: This paper describes the measurement and mobilization of architectural characteristics in one type of recovery home, sober living houses (SLHs). The Recovery Home Architecture Scale (RHAS) is a 25-item measure comprised of six subscales designed to assess architecture in SLHs. Results: Using a sample of 528 individuals residing in 41 houses, we found the RHAS had good interrater reliability, factor structure, and internal consistency. The measure also showed modest construct validity. The RHAS was not associated with length of stay (LOS) but did interact with a measure of the social environment that predicted LOS, the Recovery Home Environment Scale (RHES). Conclusions: Future studies should include a more diverse sample of SLHs and assess how house management, recovery capital, and other factors work in concert with architecture.

Social Model Recovery and Recovery Housing.

Recovery housing is an important resource for many in their recovery from alcohol and other drug use disorders. Yet providers of recovery housing face a number of challenges. Many of these challenges are rooted in stigma and bias about recovery housing. The ability to describe the service and purported mechanisms of action vis-a-vis an overarching framework, approach, or orientation could also go a long way in adding credence to recovery housing as a service delivery mechanism. Several aspects of social model recovery are often explicitly built or organically reflected in how recovery housing operates, yet describing recovery housing in these terms often does little to demystify key features of recovery housing. To more fully cement social model recovery as the organizing framework for recovery housing this article aims to: review the history, current status, and evidence base for social model recovery; comment on challenges to implementing the social model in recovery housing; and delineate steps to overcome these challenges and establish an evidence base for social model recovery housing.

Psychometric Properties of the Recovery Home Environment Scale.

BACKGROUND: Recovery homes for persons with alcohol and drug problems provide an abstinent living environment and social support for recovery. Research shows residents in these homes make significant, sustained improvements. However, descriptions of recovery environments within the homes have been limited. PURPOSE: The current study assessed psychometric properties for the Recovery Home Environment Scale (RHES), which assessed social environments within one type of recovery home, sober living houses (SLHs). METHODS: 373 residents were interviewed at entry into the house, 1-month follow-up, and 6-month follow-up. Measures included the RHES, other measures of the social environment, days of substance use, and length of stay. RESULTS: Principal components analysis suggested the RHES was largely unidimensional. Exploratory factor analysis suggested items could be grouped into recovery support (3 items) and recovery skills (5 items). Cronbach's alphas for the full scale and the recovery support and recovery skills subscales were 0.91, 0.89, and 0.87, respectively. As hypothesized, construct validity of the RHES was supported by correlations with other measures of the social environment and predictive validity was supported by associations with length of stay and substance use. CONCLUSIONS: SLHs have been described as "the setting is the service." However, the field has lacked a way to capture characteristics of the social environment. The RHES represents a new way to measure the recovery environment by focusing on social interactions among residents within SLHs and shared activities in the community.

Harmful drinking, tobacco, and marijuana use in the 2000-2015 National Alcohol Surveys: Examining differential trends by sexual identity.

BACKGROUND: Population-based surveys document disparities in substance use among sexual minorities compared to heterosexuals, but few studies examine changes over time. This study compared changes in harmful drinking (including alcohol use disorders and high-intensity drinking), tobacco use, marijuana use, and simultaneous marijuana and alcohol co-use between heterosexual and sexual minority adults over a 15-year period. Methods: Gender-stratified logistic regression analyses using 4 waves of cross-sectional data from the National Alcohol Survey (2000, 2005, 2010, and 2015) were conducted to test overall trends over time and differences by sexual identity, as well as the interaction between survey year and sexual identity. Results: Among women, significant effects for sexual identity were present in all models, reflecting greater odds of use among sexual minorities across waves. Among men, significant effects for sexual identity were found for high-intensity drinking (reflecting less use among sexual minorities) as well as marijuana use and marijuana and alcohol co-use (reflecting more use among sexual minorities). For women and men, tobacco use generally decreased and both marijuana use and simultaneous marijuana and alcohol co-use increased during the study period. Although trends were largely driven by heterosexual respondents, only one instance of an interactive effect was found; reports of harmful drinking were generally stable over time among heterosexual women, but higher and more variable over time among sexual minority women. Conclusions: Findings highlight that differences in patterns of substance use by sexual identity persist and underscore the need for screening, prevention, and intervention, particularly for sexual minority women.

Resident and house manager perceptions of social environments in sober living houses: Associations with length of stay.

AIMS: Studies have shown persons living in recovery homes for drug and alcohol problems make significant, sustained improvements. However, there is limited information about factors associated with outcomes. This study examined how perceptions of social environment of one type of recovery home, sober living houses (SLHs), were associated with length of stay (LOS). METHODS: SLH residents and their house managers (N = 416) completed the recovery home environment scale (RHES) that assessed social model recovery characteristics and the community-oriented program evaluation scale (CPES) that evaluated perceptions of the program environment. RESULTS: Scales completed by residents predicted LOS, but those completed by house managers did not. Larger discrepancies between the two groups were associated with shorter LOS. The RHES was shown to be a stronger predictor of LOS than the CPES. CONCLUSION: Results highlight the importance of the social environment in SLHs, particularly those most closely aligned with social model recovery principles.

House Manager Roles in Sober Living Houses.

BACKGROUND: Alcohol and drug treatment providers are increasingly emphasizing the role of long-term, community-based systems of care. A good example is Sober Living Houses (SLHs), which are peer operated alcohol- and drug-free living environments. Studies show residents of SLHs make significant improvements in multiple areas. However, little attention has been devoted to describing the critically important role of SLH managers who oversee these homes. METHODS: Thirty-five SLH managers completed interviews about the characteristics and operations of their houses, their activities as managers, and ways their own recovery was affected by their work. RESULTS: Managers reported widespread use of some but not all principles of social model recovery. Manager roles varied dramatically in terms of time spent managing houses, activities related to their roles, and training they received. Some reported extensive amounts of time proving support to residents, while others viewed their role as primarily administrative. CONCLUSIONS: Research is needed to understand reasons for manager differences, optimal manager functioning, and manager training needs. Research is also needed to assess whether different house characteristics require different manager roles.

Variations by Education Status in Relationships Between Alcohol/Pregnancy Policies and Birth Outcomes and Prenatal Care Utilization: A Legal Epidemiology Study.

CONTEXT: Previous research finds that some state policies regarding alcohol use during pregnancy (alcohol/pregnancy policies) increase low birth weight (LBW) and preterm birth (PTB), decrease prenatal care utilization, and have inconclusive relationships with alcohol use during pregnancy. OBJECTIVE: This research examines whether effects of 8 alcohol/pregnancy policies vary by education status, hypothesizing that health benefits of policies will be concentrated among women with more education and health harms will be concentrated among women with less education. METHODS: This study uses 1972-2015 Vital Statistics data, 1985-2016 Behavioral Risk Factor Surveillance System data, policy data from National Institute on Alcohol Abuse and Alcoholism's Alcohol Policy Information System and original legal research, and state-level control variables. Analyses include multivariable logistic regressions with education-policy interaction terms as main predictors. RESULTS: The impact of alcohol/pregnancy policies varied by education status for PTB and LBW for all policies, for prenatal care use for some policies, and generally did not vary for alcohol use for any policy. Hypotheses were not supported. Five policies had adverse effects on PTB and LBW for high school graduates. Six policies had adverse effects on PTB and LBW for women with more than high school education. In contrast, 2 policies had beneficial effects on PTB and/or LBW for women with less than high school education. For prenatal care, patterns were generally similar, with adverse effects concentrated among women with more education and beneficial effects among women with less education. Although associations between policies and alcohol use during pregnancy varied by education, there was no clear pattern. CONCLUSIONS: Effects of alcohol/pregnancy policies on birth outcomes and prenatal care use vary by education status, with women with more education typically experiencing health harms and women with less education either not experiencing the harms or experiencing health benefits. New policy approaches that reduce harms related to alcohol use during pregnancy are needed. Public health professionals should take the lead on identifying and developing policy approaches that reduce harms related to alcohol use during pregnancy.

Recovery Home Environment Characteristics Associated with Recovery Capital.

BACKGROUND: Recovery capital refers to internal and external resources that facilitate recovery from alcohol and drug disorders. Examples include support from friends and family, access to health and other services, stable housing and finances, and internal assets, such as self-esteem and motivation. Recovery capital is receiving increased emphasis as an integral component of addiction services. However, there are a limited number of studies assessing recovery capital in different settings. METHODS: The current study assessed recovery capital among 363 individuals entering sober living recovery homes (SLHs) and showed how recovery capital was associated with individual and social environment characteristics of the houses. Individual characteristics were assessed shortly after residents entered the house (mean=17 days, sd=9.0). Approximately one month later, individuals were interviewed about their perceptions of the social environment within the household. We hypothesized residents' perceptions of social model characteristics within the household would be associated with higher recovery capital. RESULTS: Study findings showed individual characteristics associated with recovery capital included motivation, support from friends and family, and 12-step involvement. Perceptions of the social environment assessed by four subscales on the Community Oriented Program Evaluation Scale and a measure of social model characteristics were correlated with recovery capital. Regression analyses controlling for individual characteristics showed modest, but consistent associations with recovery capital. CONCLUSION: Even after relatively short periods of time in SLHs, resident perceptions of the social environment show associations with recovery capital. Additional research is needed to understand causal dynamics of this relationship and associations with outcome.

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.

Pathways to Recovery: Recovery housing models for men who have sex with men (MSM).

BACKGROUND & AIMS: Gay, bisexual, and other men who have sex with men (MSM) face distinct recovery challenges. This mixed-methods study examines the service needs and help-seeking pathways of MSM (N=25) living in a group of recovery residences operated in Texas, one of which is a home specifically designated for gay and bisexual men. METHODS: Upon intake, adult MSM were recruited to complete an interview assessing the extent of their service needs as well as their recovery goals and expectations about their stay. Men were recruited regardless of whether they moved into the home designated for gay and bisexual men or into another one of the men's homes. RESULTS: MSM in the sample reported high rates of health conditions, depression, victimization, and sex risk behaviors. A greater number of them entering the gay and bisexual men's home reported being in recovery from amphetamine use, having a chronic medical problem, and being physically assaulted as an adult. The majority of MSM, regardless of home type, were seeking emotional and social support as well as accountability in their recovery home experience, but MSM in the gay and bisexual men's home talked about emotion and social support most frequently and within the context of emotional safety. CONCLUSIONS: MSM entering recovery housing have complex service needs. Recovery housing may play an important role in supporting recovery among MSM. Residences specifically for them could be tailored to address their unique needs by fostering connections to other sexual minorities in recovery and facilitating social identity transformation.

Improving Recovery Outcomes among MSM: The Potential Role of Recovery Housing.

BACKGROUND: Gay, bisexual, and other men who have sex with men (MSM) face unique recovery challenges. Recovery housing may play an important role in improving outcomes among MSM, but little is known about their experiences in these settings. METHODS: This study examined 3-month outcomes among MSM (N=22) living in a group of recovery residences in Texas, one of which is a home specifically designated for gay and bisexual men. Upon intake, adult MSM were recruited to participate in the study, which involved a baseline and 3-month phone interview and allowing study staff to access records maintained by the program about their stay. RESULTS: At follow-up, only two (9.1%) reported used of any substances in the past 30 days. The vast majority (73%) had attended outpatient substance use treatment in the past three months, and 86% reported working for pay during the past 30 days. All participants reported attending four or more 12-step meetings in the past 30 days. Use of dysfunctional coping strategies significantly decreased, however so did scores on health-related quality of life. CONCLUSIONS: MSM have complex treatment needs. Recovery housing may help improve outcomes among MSM by bridging formal substance use treatment with community-based recovery support.

Independent and Interactive Effects of Neighborhood Disadvantage and Social Network Characteristics on Problem Drinking after Treatment.

Socioecological approaches to public health problems like addiction emphasize the importance of person-environment interactions. Neighborhood and social network characteristics may influence the likelihood of relapse among individuals in recovery, but these factors have been understudied, particularly with respect to conceptualizing social network characteristics as moderators of neighborhood disadvantage. Drawing from a larger prospective study of individuals recruited from outpatient treatment (N=451) and interviewed 1, 3, 5, and 7 years later, the aim of this study was to examine the independent and interactive effects of neighborhood and social network characteristics on continued problem drinking after treatment. Models using generalized estimating equations controlling for demographic and other risk factors found the number of heavy drinkers in one's network increases risk of relapse, with the effects being significantly stronger among those living in disadvantaged neighborhoods than among those in non-disadvantaged neighborhoods. No independent effects were found for neighborhood disadvantage or for the number of network members supporting reduced drinking. Future research is needed to examine potential protective factors in neighborhoods which may offset socioeconomic disadvantage as well as to investigate the functions that network members serve in helping to improve long-term treatment outcomes.

Motivational Interviewing Case Management (MICM) for Persons on Probation or Parole Entering Sober Living Houses.

The failure of incarceration as a response to drug offenses has resulted in new policies supporting community-based alternatives. One challenge has been finding appropriate housing for persons on probation and parole. Sober living houses (SLHs) are alcohol- and drug-free living environments that are increasingly being used as housing options for these individuals. The current study examined 6- and 12-month outcomes for 330 persons on probation or parole who entered 49 SLHs. Residents in 22 houses (n = 149 individuals) were randomly assigned to receive a "Motivational Interviewing Case Management" (MICM) intervention and residents in the other 27 houses (n = 181 individuals) received SLH residency as usual. At 6-and 12-month follow-up, both study conditions showed significant improvement relative to baseline on substance abuse, criminal justice, HIV risk, and employment outcomes. For persons who attended at least one MICM session, there were better criminal justice outcomes compared to the SLH as usual group.

Quality of life and the complex needs of recovery home residents.

BACKGROUND: Having a stable and safe place to live is integral to recovery from addiction. Recovery residences represent an important component in the substance use continuum of care, but research on them has been limited to certain types of recovery residences and has yet to examine quality of life among those who live in them. METHODS: This study presents data on the characteristics of residents (N = 104) living in a stratified random sample of recovery homes in Philadelphia (N = 13) as well as data from a random subsample of residents (N = 27) who participated in 3-month follow-up interviews. RESULTS: Residents in these homes reported deficits in a variety of aspects of their lives critical to helping them initiate and sustain their recovery; many (20%) reported living in a shelter or on the streets prior to moving in, 37% had less than a high school education, and only 26% reported currently working for pay. Although the majority of residents rated their quality of life as good or very good (74%), average physical health, social relationship, and environment domain scores measured by the World Health Organization Quality of Life (WHOQOL)-Bref were generally lower than scores found among community samples. At follow-up, all residents were housed and rates of substance use (7%), criminal justice involvement (0%), and employment (44%) in the past 30 days were encouraging. Quality of life domain scores were unchanged, with the exception of psychological health, which decreased. CONCLUSIONS: These findings highlight the complex needs of residents living in Philadelphia recovery homes and the role that these homes play in maintaining residents in their early recovery. Studies with larger samples of residents followed up over longer periods of time are needed to assess the role that these homes may play in promoting long-term recovery and improving the well-being of the vulnerable population of individuals who live in them.

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.

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.

A critical component of the continuum of care for substance use disorders: recovery homes in Philadelphia.

For many struggling with addiction, the ability to achieve stable recovery is often jeopardized by untenable housing or unsupportive living environments. Despite promising research on recovery residences, there are still significant gaps in the research on them. Using data collected from a stratified random sample of recovery homes in Philadelphia (N = 25), this study describes the organizational, operational, and programmatic characteristics of these homes and explores potential differences in these characteristics by funding source and gender of residents served. Although not licensed treatment providers, the majority of these homes operated in a recovery-oriented manner and offered a range of different services to their residents-all for a reasonable monthly fee (M = $340.40, SE = 18.60). Few differences emerged between homes that received funding from the Philadelphia Office of Addiction Services and those that did not or between those that served males as opposed to females. More research is needed to address resident outcomes and how Philadelphia recovery homes may compare with recovery residences in other parts of the country.

National Trends in Adolescent Substance Use Disorders and Treatment Availability: 2003-2010.

This study examines trends in adolescent substance use disorders (SUDs) and treatment utilization in the US using data from the National Household Survey on Drug Use and Health (NSDUH) and data from the National Survey of Substance Abuse Treatment Services (N-SSATS). Results indicate an overall decrease in the percent of adolescents meeting past year criteria for an alcohol or illicit drug disorder between 2003 and 2010, but the percent of adolescents meeting criteria who had not received any treatment in the past year was substantial and has remained stable since 2003. In 2010, less than 30% of facilities participating in the N-SSATS survey indicated that they offered special programming for adolescents, reflecting an overall decrease since 2003.