Recovery housing provides safe, sober residences that promote recovery from substance use. There is a wide range in recovery homes with varying levels of support, depending on the needs of the community members living in the house. Most offer a peer support system, and some offer clinical services and oversight provided by local agencies.
Addressing social determinants of health allows for mental health service delivery that recognizes the context that a person lives in. On a broader level, it helps deliver better care by breaking down societal barriers that create inequalities in our healthcare system -- such as poverty, stigma, and lack of access to education or healthcare.
Recovery housing is split into Levels of Support, defined by the National Alliance of Recovery Residences (NARR). Levels 1 and 2 tend to be peer-run or community-based, where individuals within the home hold each other accountable to house rules and recovery meetings. In Level 1 and 2 homes, the length of stay is usually open-ended, but can range from 90 days to several years. Level 3 recovery houses generally work with professional clinicians to deliver services, while Level 4 homes are typically run by a licensed substance use agency.
Recovery housing plays a crucial role in giving individuals a secure, supportive environment to begin their recovery. However, most states do not mandate a formal certification for recovery residences, which can lead to unethical practices that take advantage of a vulnerable population.
To help remedy this, in 2018, SAMHSA issued an official best practices and guidelines document for recovery homes. Foothold Technology’s senior advisor worked closely with SAMHSA representatives to develop these best practices. These guidelines help recovery house operators provide the most safe, healthy living environments possible for their residents. We’ve outlined the guidelines and best practices below.
All recovery homes should have a clear operational definition, which outlines the type and degree of services they offer. This includes describing the level of care they offer according to the NARR Levels of Support.
Recovering from substance use can be a difficult journey, involving a multitude of complex factors – including unresolved trauma and family history. Relapse rates can be as high as 40-60% according to NIDA. Operators of recovery homes should foster as much community support as possible, to help people maintain their recovery.
SAMHSA recommends that all house operators, staff, and certified peers be trained in co-occurring mental health diagnoses, and to understand the role that they play in increasing a person’s susceptibility for relapse.
Each potential residence and referral should be assessed to ensure that their needs, challenges, and goals are matched to the recovery home’s services and environment. This gives residents the best chance at safe, sustained recovery. Some things to consider include: house culture, Level of Care, the availability of Medication Assisted Treatment, relapse policy, and the geographic area surrounding the house.
It’s crucial that residents living in recovery houses have access to high-quality, evidence-based care. This can include Medication Assisted Treatment, evidence-based behavioral therapy, and peer recovery services.
SAMHSA recommends that policies and resident expectations are clearly documented, and explained to each staff member and resident. Recovery homes can consider creating a handbook and taking new residents through an orientation process to go over these policies.
Patient brokering, excessive lab test fees, excessive screenings, and misuse of medications are some of the ethical concerns facing recovery housing in the US. It’s crucial that recovery houses maintain the highest levels of ethical practice and prioritize the safety of their residents.
Residents come from all types of socioeconomic, cultural, and racial backgrounds. In order to promote a safe environment for all residents, staff should be trained to treat all individuals with respect regardless of differences.
As long as the proper confidentiality forms are signed, recovery homes should continue to communicate with a resident’s loved ones, treatment providers, criminal justice professionals, and peer recovery coaches.
Collecting data on the status and efficacy of recovery house programs will allow these residences to continue improving their services. It could also help recovery houses justify funding, obtain grants, and garner support from the local community.
Our employees are active in substance use treatment advocacy — working to promote the safe, ethical, and effective provision of housing for individuals in recovery.
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