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Mahoney E, Subbaraman M, Mericle AA, Polcin DL. Reasons for choosing sober living houses and their associations with substance use recovery outcomes. Addict Behav Rep 2024; 20:100557. [PMID: 39027409 PMCID: PMC11252607 DOI: 10.1016/j.abrep.2024.100557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 05/14/2024] [Accepted: 06/07/2024] [Indexed: 07/20/2024] Open
Abstract
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.
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Affiliation(s)
- Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, United States
| | - Meenakshi Subbaraman
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, United States
| | - Amy A. Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, CA, United States
| | - Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, United States
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Dewey JM, Bell JS, Konchak JN, Hinami K, Watson DP. "A lot of moving parts": Recovery home challenges linking and housing individuals with criminal legal system involvement. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 166:209473. [PMID: 39106919 DOI: 10.1016/j.josat.2024.209473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/31/2024] [Accepted: 07/29/2024] [Indexed: 08/09/2024]
Abstract
INTRODUCTION There are high rates of substance use disorder (SUD) among people released from carceral settings and, upon release, many of these people also face unstable housing situations, posing challenges to connecting with resources to facilitate SUD recovery. Recovery homes provide a temporary sober living environment for those seeking both SUD recovery and transition back to the community after carceral release. However, successful recovery home placement for this population can prove difficult, and there is a need for research to identify ways to overcome them. METHODS The current qualitative study seeks to understand barriers to recovery home access for people leaving carceral settings and identify potential best practices for overcoming these barriers from the perspective of recovery home directors. The study conducted semi-structured interviews at two data collection points with eight recovery home directors from sites participating in a housing linkage and placement intervention pilot. The research team used qualitative software to identify and organize directors' experiences and practices in housing and supporting this population. RESULTS Recovery home directors identified significant barriers to linkage from carceral settings, including difficulties communicating and coordinating placement with potential residents while still incarcerated. Interviews also revealed approaches recovery home directors take to improve recovery home placement, such as sharing information and resources with carceral settings prior to release and helping residents avoid reincarceration by managing relationships with court agents and parole. CONCLUSION Recovery resident directors have considerable insight into the most significant placement challenges faced by recovery homes upon carceral release as well as experience with potential solutions for overcoming them. Directors can be the key to direct seamless support and continuity of care for criminal legal system involved individuals through coordination with jails, prisons, and other community resources. Directors can also play a significant role in the successful completion of probation and parole by helping residents avoid further issues with the legal system. These directors view working cooperatively with residents as an effective approach to ensuring clients adhere to court orders and are successful in recovery and reentry.
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Affiliation(s)
- Jodie M Dewey
- Chestnut Health System's Lighthouse Institute, 221 W. Walton Street, Chicago, IL 60610, United States of America.
| | - Justin S Bell
- Chestnut Health System's Lighthouse Institute, 221 W. Walton Street, Chicago, IL 60610, United States of America
| | | | - Keiki Hinami
- Cook County Health, 1950 W. Polk Street, Chicago, IL 60612, United States of America
| | - Dennis P Watson
- Chestnut Health System's Lighthouse Institute, 221 W. Walton Street, Chicago, IL 60610, United States of America
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Gallardo KR, Zoschke IN, Stewart HLN, Wilkerson JM, Henry EA, McCurdy SA. Supporting medication-assisted recovery in recovery residences: staff support, managing built environment threats, and building a supportive network. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2024:1-9. [PMID: 39382549 DOI: 10.1080/00952990.2024.2401983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 07/10/2024] [Accepted: 09/04/2024] [Indexed: 10/10/2024]
Abstract
Background: While medications for opioid use disorder (MOUD) are effective in reducing overdoses, widespread adoption and implementation of MOUD remains inadequate. Innovative approaches to promote MOUD use and to support people in their medication-assisted recovery (MAR) are needed. Recovery residences that serve people taking MOUD are steadily growing in number, yet little is known about how MOUD and the MAR pathway is promoted within the recovery residence setting.Objectives: The purpose of this qualitative analysis was to describe how recovery residences facilitate MOUD initiation and support residents' MAR pathway.Methods: We conducted interviews with 93 residents (59.1% male; 38.7% female) living in recovery residences located in five Texas cities that served people taking medication for opioid use disorder.Results: We found that recovery residence staff addressed linkage to care gaps in their communities by connecting people who might benefit from MOUD to appropriate providers. Recovery residence staff also strengthened participants' community of MAR-supportive peers by hosting or connecting residents to Medication-Assisted Recovery Anonymous meetings. Additionally, recovery residences helped some residents overcome common logistical barriers (e.g. transportation issues, housing instability, distance to providers) that hinder MOUD access.Conclusion: Recovery residences that serve people taking MOUD are a well-positioned recovery support service to promote MOUD initiation and the MAR pathway.
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Affiliation(s)
- Kathryn R Gallardo
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - I Niles Zoschke
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Hannah L N Stewart
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - J Michael Wilkerson
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | | | - Sheryl A McCurdy
- School of Public Health, The University of Texas Health Science Center at Houston, Houston, TX, USA
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Gallardo KR, Wilkerson JM, Stewart HLN, Zoschke IN, Fredriksen Isaacs C, McCurdy SA. "Being here is saving my life": Resident experiences of living in recovery residences for people taking medication for an opioid use disorder. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2024; 158:209242. [PMID: 38061632 DOI: 10.1016/j.josat.2023.209242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 08/11/2023] [Accepted: 11/30/2023] [Indexed: 12/25/2023]
Abstract
INTRODUCTION Medications for opioid use disorder (MOUD) are an effective treatment for addressing opioid use disorder. Despite MOUD's demonstrated effectiveness, MOUD-related stigma is prevalent throughout many recovery communities and subsequently limits persons taking MOUD access to recovery supports, including recovery housing. While recovery residences that serve people taking MOUD could be a critical recovery support, they are limited in number and understudied. METHODS We conducted in-depth interviews with 47 residents in medication-assisted recovery (MAR) living in 11 Texas-based recovery residences serving people taking MOUD to characterize residents' experiences and understand the impact that these homes had on their recovery. RESULTS We found that many participants could not previously access recovery housing and other recovery supports due to MOUD-related stigma, thus recovery homes that supported people in MAR were considered a groundbreaking opportunity. Recovery residences provided participants with a space in which they did not feel judged for taking MOUD, which facilitated participants' connections with their fellow housemates. Subsequently, participants no longer had to hide their MAR pathway and could be transparent about taking MOUD among their recovery residence community. Last, recovery homes provided a supportive environment in which participants' internalized MOUD-related stigma could evolve into acceptance of their MAR pathway. CONCLUSIONS Recovery residences that serve people in MAR provide a supportive, safe, nonjudgmental recovery environment in which residents develop relationships with other peers taking MOUD, share openly about their MAR, and are empowered to embrace their recovery pathway. These findings highlight the need for more recovery residences that are supportive of people taking MOUD as part of their recovery.
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Affiliation(s)
- Kathryn R Gallardo
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America.
| | - J Michael Wilkerson
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Hannah L N Stewart
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - I Niles Zoschke
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Cameron Fredriksen Isaacs
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
| | - Sheryl A McCurdy
- The University of Texas Health Science Center at Houston, School of Public Health, United States of America
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Subbaraman MS, Mahoney E, Mericle A, Polcin D. Six-month length of stay associated with better recovery outcomes among residents of sober living houses. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:675-683. [PMID: 37782760 DOI: 10.1080/00952990.2023.2245123] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 08/02/2023] [Indexed: 10/04/2023]
Abstract
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.
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Affiliation(s)
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, USA
| | - Amy Mericle
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, USA
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Douglas Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, USA
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Polcin DL, Mahoney E, Subbaraman M, Mericle AA. Giving and Receiving Help among Persons Entering Sober Living Houses. ALCOHOLISM TREATMENT QUARTERLY 2023; 41:488-503. [PMID: 37982020 PMCID: PMC10655961 DOI: 10.1080/07347324.2023.2242801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2023]
Abstract
Giving and receiving help are integral to creating the social environments necessary to support recovery. However, studies assessing the effects of helping behaviors have focused primarily on the benefits derived from giving help to others in 12-step programs and treatment. The current study examined the frequency of giving and receiving help among 188 persons entering sober living houses (SLHs), a type of recovery home that is common in California. Helping was assessed in three contexts: the SLH, 12-step meetings they attended, and interactions with their family and friends. Residents who gave help to others in one of these contexts tended to also receive help in that context. Residents who reported giving or receiving help in one context tended to report giving and receiving help in other contexts. Study findings suggest helping in recovery occurs in a broader, more reciprocal manner than currently conceptualized. Studies should address how giving and receiving help in different contexts affects recovery outcomes. Research is also needed to describe the determinants of giving and receiving help. Considerations for facilitating help among SLH residents are described.
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Affiliation(s)
- Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Meenakshi Subbaraman
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Amy A. Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California
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Noonan G, Glenn J. Pandemics Interlaced: The Impact of the COVID-19 Pandemic on the Wellbeing of Sober Living Home Residents. J Addict Med 2023; 17:e211-e216. [PMID: 37579090 PMCID: PMC10417211 DOI: 10.1097/adm.0000000000001127] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 11/18/2022] [Indexed: 02/03/2023]
Abstract
OBJECTIVES This study aimed to discover how the COVID-19 pandemic altered the implementation of the social model of recovery in sober living homes (SLHs). Researchers analyzed associations between residents' feelings of interconnectedness, social service utilization, and relapse predictors throughout the pandemic. This study provides an understanding of how the COVID-19 pandemic impacted treatment of substance use disorder (SUD). METHODS This study used retrospective surveyed data from 105 SLH residents. Correlational analysis was used to determine the relationship between social service use, social connectivity, and relapse predictors at three different time points: February 2020, December 2020, and June 2021. Three residents underwent additional interviews. RESULTS There was a decline in social service utilization from February 2020 to December 2020 with an associated decline in feelings of social connectivity. From December 2020 to June 2021, there was an increase in residents' use of social services with an associated increase in connectivity. There was a significant negative correlation between relapse predictors and number of supportive services used in February 2020 ( r = -0.217, P < 0.05) and in December 2020 ( r = -0.352, P < 0.001). In June 2020, there was a significant negative correlation between interconnectedness and relapse predictors ( r = -0.297, P < 0.05). The number of interviews was not sufficient for formal qualitative analysis. CONCLUSIONS The results suggest the COVID-19 pandemic possibly interrupted the course of recovery in SLHs. These findings offer insight to how the pandemic impacted individuals recovering from SUD and suggest that SUD treatment professionals should develop interventions to enhance social connectivity to deploy in response to global stressors.
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Mericle AA, Howell J, Borkman T, Subbaraman MS, Sanders BF, Polcin DL. Social Model Recovery and Recovery Housing. ADDICTION RESEARCH & THEORY 2023; 31:370-377. [PMID: 37928886 PMCID: PMC10624396 DOI: 10.1080/16066359.2023.2179996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 02/09/2023] [Indexed: 11/07/2023]
Abstract
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.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group at the Public Health Institute
| | | | | | | | | | - Douglas L Polcin
- Behavioral Health and Recovery Studies at the Public Health Institute
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Polcin DL, Mericle AA, Braucht GS, Wittman FD. Moving Social Model Recovery Forward: Recent Research on Sober Living Houses. ALCOHOLISM TREATMENT QUARTERLY 2023; 41:173-186. [PMID: 37125214 PMCID: PMC10139742 DOI: 10.1080/07347324.2023.2167528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Social model recovery is a peer centered approach to alcohol and drug problems that is gaining increased attention. This approach is well-suited to services in residential settings and typically includes living in a shared alcohol- and drug-free living environment where residents give and receive personal and recovery support. Sober Living Houses (SLHs) are recovery residences that explicitly use a social model approach. This paper describes recent research on SLHs, including new measures designed to assess their social and physical environments. We conclude that our understanding of social model is rapidly evolving to include broader, more complex factors associated with outcomes.
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Affiliation(s)
- Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA
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Mahoney E, Karriker-Jaffe KJ, Mericle AA, Patterson D, Polcin DL, Subbaraman M, Witbrodt J. Do neighborhood characteristics of sober living houses impact recovery outcomes? A multilevel analysis of observational data from Los Angeles County. Health Place 2023; 79:102951. [PMID: 36535073 PMCID: PMC9928842 DOI: 10.1016/j.healthplace.2022.102951] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 11/22/2022] [Accepted: 11/23/2022] [Indexed: 12/23/2022]
Abstract
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.
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Affiliation(s)
- Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, USA.
| | | | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Deidre Patterson
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Douglas L Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, USA
| | - Meenakshi Subbaraman
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, CA, USA
| | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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Alcohol, tobacco and drug use among adults experiencing homelessness in Accra, Ghana: A cross-sectional study of risk levels and associated factors. PLoS One 2023; 18:e0281107. [PMID: 36877700 PMCID: PMC9987824 DOI: 10.1371/journal.pone.0281107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/16/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana. METHODS 305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression. RESULTS Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001). CONCLUSIONS Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.
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Polcin DL, Mahoney E, Witbrodt J, Mericle AA, Subbaraman M, Wittman FD. Measuring Architecture in Recovery Homes: Recovery Home Architecture Scale. Subst Use Misuse 2023; 58:103-110. [PMID: 36437776 PMCID: PMC10064876 DOI: 10.1080/10826084.2022.2148484] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
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.
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Affiliation(s)
- Douglas L Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California, USA
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California, USA
| | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
| | - Meenakshi Subbaraman
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California, USA
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Miles J, Mericle A, Ritter G, Reif S. Association of facility characteristics and substance use disorder outcomes at discharge from residential treatment. J Subst Abuse Treat 2022; 136:108664. [PMID: 34840041 PMCID: PMC8940653 DOI: 10.1016/j.jsat.2021.108664] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/03/2021] [Accepted: 11/10/2021] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Individuals with substance use disorder (SUD) may benefit from services and supports delivered in residential settings. Prior research in this area has primarily focused on individual-level factors that affect outcomes, with little focus on the relationship between facility-level characteristics and treatment outcomes. METHODS Administrative data from 2713 individuals with an index enrollment in publicly funded residential treatment in Massachusetts during 2015 were linked with facility-level survey data from 33 treatment providers. This study conducted multilevel linear and logisitc regression analysis, adjusting for resident demographic, socioeconomic, and substance use history and severity, to examine relationships between facility-level characteristics, treatment duration and completion, and housing and employment status at discharge. RESULTS Residents stayed longer when they made and enforced rules (β = 30.22, p = 0.006). Residents were less likely to complete treatment as the number of non-clinical services increased (aOR = 0.918, p = 0.029), or in facilities where residents ate together family style (aOR = 0.485, p = 0.039). Being employed at discharge was more likely when house meetings were held less than once per week (aOR = 3.37, p = 0.005) and less likely when held more than once per week (aOR = 0.385, p = 0.038). CONCLUSION Overall, increased resident governance and fewer contingencies for successful treatment participation were associated with positive treatment outcomes. Future research should examine the internal processes of residential settings, including peer-to-peer interactions, to better understand how within-residence features affect outcomes.
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Affiliation(s)
- Jennifer Miles
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA.
| | - Amy Mericle
- Alcohol Research Group at the Public Health Institute, Emeryville, CA 94608, USA
| | - Grant Ritter
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
| | - Sharon Reif
- Heller School for Social Policy and Management, Brandeis University, Waltham, MA 02453, USA
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Wood CA, Duello A, Miles J, Lohmann B, Gochez-Kerr T, Richardson K, Anderson-Harper R, Winograd RP. Acceptance of medications for opioid use disorder in recovery housing programs in Missouri. J Subst Abuse Treat 2022; 138:108747. [DOI: 10.1016/j.jsat.2022.108747] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Revised: 01/05/2022] [Accepted: 02/14/2022] [Indexed: 01/20/2023]
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Mahoney E, Witbrodt J, Mericle AA, Polcin DL. Resident and house manager perceptions of social environments in sober living houses: Associations with length of stay. JOURNAL OF COMMUNITY PSYCHOLOGY 2021; 49:2959-2971. [PMID: 34076263 PMCID: PMC8380640 DOI: 10.1002/jcop.22620] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Revised: 05/10/2021] [Accepted: 05/11/2021] [Indexed: 06/12/2023]
Abstract
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.
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Affiliation(s)
- Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Amy A. Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Douglas L. Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
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Trangenstein PJ, Greenfield TK, Karriker-Jaffe KJ. Interested constituents: identifying groups to mobilize in community organizing efforts to strengthen alcohol control policies. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2021; 47:393-401. [PMID: 33734822 DOI: 10.1080/00952990.2020.1870690] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Policy support research identifies demographic profiles of those who support policies, but community organizers aim to mobilize groups with an existing structure. Thus, identifying established groups that support alcohol policies may aid organizing efforts.Objective: This paper calculates prevalence and odds of policy support among three potential constituency groups (i.e., religious affiliation, persons harmed by others' drinking, and persons in recovery from alcohol) for three policies: alcohol tax increases, banning alcohol in corner stores, and universal coverage for alcohol treatment.Methods: Using the 2014-15 National Alcohol Survey (n = 3,444; 1,457 male, 1,987 female) and logistic regression, this study explores associations between constituency groups and policy support.Results: Support was higher for the individual-level strategy of alcohol treatment (80.8%) than raising taxes (27.5%) and banning sales in corner stores (52.2%). Support for taxes was higher among persons who valued religion highly (vs not; aOR = 1.46, p < .01), persons harmed by others' drinking (vs not; aOR = 1.71, p < .001), and persons in recovery (vs. not; aOR = 1.76, p = .02); Catholics had lower odds of support for taxes (vs no denomination; aOR = 0.63, p = .01). Persons who valued religion highly (aOR = 1.53, p < .001), Protestants (aOR = 1.63, p < .01), Catholics (aOR = 1.46, p = .03), and persons with other religious denominations (aOR = 2.17, p = .02) had higher odds of supporting bans in corner stores. Only those in recovery showed greater support for treatment (aOR = 3.20, p < .001).Conclusion: Overall, support was lower for population-wide approaches, but results revealed constituency groups that supported these policies. These groups may be allies to organizers who seek to reduce population-level alcohol consumption and harms.
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Affiliation(s)
- Pamela J Trangenstein
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Abstract
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.
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Affiliation(s)
- Douglas L Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California, USA
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California, USA
| | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California, USA
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Polcin DL, Mahoney E, Wittman F, Sheridan D, Mericle AA. Understanding challenges for recovery homes during COVID-19. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2020; 93:102986. [PMID: 33127280 PMCID: PMC7566762 DOI: 10.1016/j.drugpo.2020.102986] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 08/08/2020] [Accepted: 10/01/2020] [Indexed: 11/16/2022]
Abstract
Understanding the effects of COVID-19 mitigation for persons in group living environments is of critical importance to limiting the spread of the virus. In the U.S., residential recovery homes for persons with alcohol and drug disorders are good examples of high-risk environments where virus mitigation procedures are essential. The National Alliance for Recovery Residences (NARR) has taken recommendations developed by the Center for Disease Control (CDC) and applied them to recovery home settings. This paper describes how COVID-19 mitigation efforts in recovery homes may be influenced by two factors. First, while some houses are licensed by states with rigorous health and safety standards, others are not licensed and are subject to less oversight. These homes may be more inconsistent in adhering to mitigation standards. Second, to varying degrees, recovery homes use a social model approach to recovery that contrasts with mitigation procedures such as social distancing and stay-at-home orders. This paper provides examples of ways recovery homes have been forced to adjust to the competing demands of mitigation efforts and social model recovery. The paper also identifies multiple questions that could be addressed by provider-researcher coalitions to inform how social model recovery can navigate forward during the era of COVID-19. As we move forward during the era of COVID-19, providers are encouraged to remember that recovery homes have a history of resilience facing adversity and in fact have their origins in grassroots responses to the challenges of their times.
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Affiliation(s)
- Douglas L Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, 4383 Fallbrook Road, Concord, California 64521.
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, 4383 Fallbrook Road, Concord, California 64521
| | | | - Dave Sheridan
- National Alliance of Recovery Residences, St. Paul, Minnesota
| | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California
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Mericle AA, Sheridan D, Howell J, Braucht GS, Karriker-Jaffe K, Polcin DL. Sheltering in place and social distancing when the services provided are housing and social support: The COVID-19 health crisis and recovery housing. J Subst Abuse Treat 2020; 119:108094. [PMID: 32868142 PMCID: PMC7395628 DOI: 10.1016/j.jsat.2020.108094] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 07/07/2020] [Accepted: 07/27/2020] [Indexed: 11/17/2022]
Abstract
Recovery housing is a vital service for individuals with substance use disorders who need both recovery support and safe housing. Recovery housing is a residential service, and it relies heavily on social support provided by peers both within the residence and in outside mutual help groups. As such, efforts to keep residents safe from SARS CoV-2, the virus that causes the illness COVID-19, pose a number of challenges to social distancing. Further, residents are some of the more vulnerable individuals in recovery. They are more likely to have co-occurring health conditions that place them at risk for COVID-19, and they often have risk factors such as employment in low-wage jobs that increase their potential for negative economic impacts of the pandemic. Since most recovery housing operates outside formal substance use treatment, residents who pay out-of-pocket for services largely support these residences. Comprehensive support for those using, as well as those providing and ensuring the quality of recovery housing, is needed to ensure the viability of recovery housing. Recovery housing provides recovery support in a residential setting, serving highly-vulnerable individuals with substance use disorders. Efforts are underway to develop best practices for protecting residents and the peer-support community from COVID-19. Most recovery residences are not part of the formal substance use treatment system. Without adequate support for recovery housing, those who provide this service will be hampered in their ability to respond to increased resident needs.
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Affiliation(s)
- Amy A Mericle
- Alcohol Research Group, Public Health Institute, United States of America.
| | - Dave Sheridan
- National Alliance for Recovery Residences, United States of America
| | - Jason Howell
- National Alliance for Recovery Residences, United States of America
| | - George S Braucht
- National Alliance for Recovery Residences, United States of America
| | | | - Douglas L Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, United States of America
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Abstract
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.
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Affiliation(s)
- Douglas L Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California
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Polcin DL, Mahoney E, Witbrodt J, Mericle AA. Recovery Home Environment Characteristics Associated with Recovery Capital. JOURNAL OF DRUG ISSUES 2020; 51:253-267. [PMID: 34650312 DOI: 10.1177/0022042620978393] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Affiliation(s)
- Douglas L Polcin
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Elizabeth Mahoney
- Behavioral Health and Recovery Studies, Public Health Institute, Oakland, California
| | - Jane Witbrodt
- Alcohol Research Group, Public Health Institute, Emeryville, California
| | - Amy A Mericle
- Alcohol Research Group, Public Health Institute, Emeryville, California
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22
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Beneficial effects of motivational interviewing case management: A latent class analysis of recovery capital among sober living residents with criminal justice involvement. Drug Alcohol Depend 2019; 200:124-132. [PMID: 31128464 PMCID: PMC8529644 DOI: 10.1016/j.drugalcdep.2019.03.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 03/08/2019] [Accepted: 03/12/2019] [Indexed: 11/22/2022]
Abstract
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.
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Doogan NJ, Light JM, Stevens EB, Jason LA. Quality of life as a predictor of social relationships in Oxford House. J Subst Abuse Treat 2019; 101:79-87. [PMID: 31174717 DOI: 10.1016/j.jsat.2019.03.006] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Revised: 02/06/2019] [Accepted: 03/20/2019] [Indexed: 10/27/2022]
Abstract
Improved access to housing and recovery support is a low-cost, high-potential opportunity to help people recovering from alcohol and substance use sustain their recoveries. Oxford House (OH) recovery homes represent a recovery-favorable social environment for at least some people, but it is still unclear which resident characteristics and relational dynamics affect the social integration of residents. In the current study, OH residents in three geographic locations completed a social network instrument and self-rated their quality of life (QOL). The instruments were administered to the current (per wave) residents of 42 OHs at three time points over a period of a year. Findings indicated that those with a higher QOL were more likely to form friendships with those with a lower QOL than with their similar QOL peers, and vice versa. This finding would not have been predicted based on relationship mechanisms typical of broader social contexts, where homophily (similarity-based assortativity) is common. The self-governance model that characterizes OH residences, in which success among residents is necessarily viewed as mutually dependent and therefore mutually beneficial, seems a likely explanation for our result. Specifically, and aligned with current knowledge about what works in peer oriented recovery, our results suggest the governance mechanisms of OH favor relationships between those more stable in their recovery and those who are at a higher risk of dropout or relapse. This study reveals a potential research avenue examining an important ingredient for the effectiveness of OH.
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Affiliation(s)
- Nathan J Doogan
- Ohio Colleges of Medicine Government Resource Center, The Ohio State University, 150 Pressey Hall, 1070 Carmack Road, Columbus, OH 43210, United States of America
| | - John M Light
- Oregon Research Institute, 1776 Millrace Dr., Eugene, OR 97403, United States of America
| | - Edward B Stevens
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614-3504, United States of America
| | - Leonard A Jason
- Center for Community Research, DePaul University, 990 W. Fullerton Ave., Chicago, IL 60614-3504, United States of America.
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Polcin DL. Role of recovery residences in criminal justice reform. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 53:32-36. [PMID: 29278830 DOI: 10.1016/j.drugpo.2017.10.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/17/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
Over the past decade there has been a clear consensus among drug policy researchers that the practice of incarcerating persons for drug offenses has been counterproductive. As a result, U.S. criminal justice policy is increasingly emphasizing alternative dispositions to incarceration for drug related arrests. In addition, large numbers of persons currently incarcerated for drug related offenses are being released into communities. However, there are serious questions about where these individuals are going to live once released and how they will access needed services. Residential recovery homes in the community are good options for those who wish to pursue abstinence from drugs. They provide a drug- and alcohol-free living environment along with social support for abstinence and successful functioning in the community. This paper reviews recent changes in drug policy the U.S. and describes the variety of recovery home options that are available to persons diverted or released from incarceration.
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Wittman FD, Polcin DL, Sheridan D. The Architecture of Recovery: Two Kinds of Housing Assistance for Chronic Homeless Persons with Substance Use Disorders. DRUGS AND ALCOHOL TODAY 2017; 17:157-167. [PMID: 29057007 DOI: 10.1108/dat-12-2016-0032] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Roughly half a million persons in the United States are homeless on any given night and over a third of those individuals have significant alcohol/other drug (AOD) problems. Many are chronically homeless and in need of assistance for a variety of problems. However, the literature on housing services for this population has paid limited attention to comparative analyses contrasting different approaches. APPROACH We examined the literature on housing models for homeless persons with AOD problems and critically analyzed how service settings and operations aligned with service goals. FINDINGS We found two predominant housing models that reflect different service goals: Sober Living Houses (SLHs) and Housing First (HF). SLHs are communally based living arrangements that draw on the principles of Alcoholics Anonymous. They emphasize a living environment that promotes abstinence and peer support for recovery. HF is based on the premise that many homeless persons with substance abuse problems will reject abstinence as a goal. Therefore, the HF focus is providing subsidized or free housing and optional professional services for substance abuse, psychiatric disorders and other problems. PRACTICAL IMPLICATIONS If homeless service providers are to develop comprehensive systems for homeless persons with AOD problems, they need to consider important contrasts in housing models, including definitions of "recovery," roles of peer support, facility management, roles for professional service, and the architectural designs that support the mission of each type of housing. ORIGINALITY This paper is the first to consider distinct consumer choices within homeless service systems and provide recommendations to improve each based upon an integrated analysis that considers how architecture and operations align with service goals.
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Affiliation(s)
- Friedner D Wittman
- President, CLEW Associates, Berkeley, California; Affiliate Scientist, Alcohol Research Group, Public Health Institute, Emeryville California
| | - Douglas L Polcin
- Senior Scientist, Alcohol Research Group, Public Health Institute, Oakland, California
| | - Dave Sheridan
- Executive Director, Sober Living Network, Los Angeles, California
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Housing Status, Psychiatric Symptoms, and Substance Abuse Outcomes Among Sober Living House Residents over 18 Months. ADDICTIVE DISORDERS & THEIR TREATMENT 2017; 16:138-150. [PMID: 29056875 DOI: 10.1097/adt.0000000000000105] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Studies show individuals entering sober living recovery houses (SLHs) make significant, sustained improvement on measures of substance abuse problems, employment, and arrests. The current study assessed changes in housing status among SLH residents over 18 months and the relative influences of housing status and psychiatric distress on substance abuse outcomes. Two hundred forty one men and 58 women, all age 18 and older, were interviewed within their first week of entering 20 SLHs and again at 6-, 12-, and 18-month follow-up. Between entry into the SLHs and 18-month follow-up homelessness declined from 16% to 4%, marginal housing declined from 66% to 46%, and stable housing increased from 13% to 27%. Psychiatric severity was generally mild to moderate in severity, but nevertheless showed improvement over the 18-month study period. Multivariate models showed worse substance abuse outcomes for residents with higher psychiatric distress and unstable housing. Relative to persons with stable housing, those who were homeless or marginally housed had worse outcomes and those in SLHs had better outcomes. Overall, we conclude that individuals entering SLHs show improvement in housing status and psychiatric distress, both of which are associated with better substance abuse outcomes.
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Polcin DL, Korcha R, Mericle AA, Mahoney E, Hemberg J. Problems and Service Needs Among Ex-Offenders with HIV Risk Behaviors Entering Sober Living Recovery Homes. CRIMINAL JUSTICE STUDIES (ABINGDON, ENGLAND) 2017; 30:381-400. [PMID: 29200972 PMCID: PMC5703424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There is currently a nationwide effort to decrease the number of persons who are incarcerated in jails and prisons. However, many ex-offenders on probation or parole do not have access to affordable housing and larger proportions have histories of HIV risk as well as substance abuse problems. In California, sober living houses (SLHs) are becoming an increasingly popular housing option for these individuals. Based largely on the principles of Alcoholics Anonymous (AA), SLHs require abstinence from alcohol and drugs and provide peer support for recovery. The current study examined the types of problems experienced among 330 ex-offenders with lifetime risk for HIV during the six months prior to entering SLHs. Nearly three fourths (74%) of all ex-offenders entering the houses had at least one HIV risk. The importance of housing was evident in the finding that housing status and participants' perceptions of their housing situation were associated with a variety of problem areas, including substance use, HIV risk, psychiatric severity, and legal problems. SLHs represent an important housing option for ex-offenders, but many residents may need additional services to address various problems.
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Affiliation(s)
- Douglas L Polcin
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
| | - Rachael Korcha
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
| | - Amy A Mericle
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
| | - Elizabeth Mahoney
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
| | - Jordana Hemberg
- Public Health Institute, Alcohol Research Group, 6001 Shellmound St #450, Emeryville, CA 94608, 510-898-5800, 925-381-6782
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Mericle AA, Polcin DL, Hemberg J, Miles J. Recovery Housing: Evolving Models to Address Resident Needs. J Psychoactive Drugs 2017; 49:352-361. [PMID: 28657823 DOI: 10.1080/02791072.2017.1342154] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Recovery housing is a service delivery modality that simultaneously addresses the social support and housing needs of those in recovery from substance use disorders. This article describes a group of recovery homes in Texas (N = 10) representing a lesser-studied type of recovery housing, one which explicitly bridges treatment and peer support by providing a variety of recovery support services. All residents meet with a recovery coach, undergo regular drug screening, and have access to intensive outpatient treatment-a program that was developed specifically to support the needs of residents in the homes. Unlike the Oxford HouseTM model and California sober living houses, which are primarily financed through resident fees, these homes are supported through a mix of resident fees as well as private and public insurance. While adhering to some aspects of the social model of recovery, none of these homes would meet criteria to be considered a true social model program, largely because residents have a limited role in the governance of the homes. Residences like the ones in this study are not well-represented in the literature and more research is needed.
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Affiliation(s)
- Amy A Mericle
- a Research Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Douglas L Polcin
- b Senior Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jordana Hemberg
- c Research Associate , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jennifer Miles
- d Doctoral Candidate , The Heller School for Social Policy and Management, Brandeis University , Waltham , MA , USA
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Polcin DL, Witbrodt J, Korcha R, Gupta S, Mericle AA. Course of Psychiatric Symptoms and Abstinence among Methamphetamine-Dependent Persons in Sober Living Recovery Homes. J Psychoactive Drugs 2016; 48:173-80. [PMID: 27184803 DOI: 10.1080/02791072.2016.1180466] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Although studies of co-occurring psychiatric disorders among methamphetamine (MA)-dependent persons have been conducted in treatment programs, none have examined them in service settings used to sustain long-term recovery, such as sober living houses (SLHs). METHODS Residents entering SLHs (N = 243) were interviewed within two weeks and at 6-, 12-, and 18-month follow-up. Measures assessed psychiatric symptoms using the Brief Symptom Inventory (BSI), past-year drug and alcohol dependence, and abstinence over six-month time periods. RESULTS Overall, severity of psychiatric symptoms on the BSI was similar among MA-dependent and other dependent residents. Global psychiatric severity, depression, and somatization scales on the BSI predicted abstinence for both groups. However, phobic anxiety and hostility scales were associated with abstinence for MA-dependent residents but not for those dependent on other substances. CONCLUSION The similarity of psychiatric symptoms among persons with and without MA dependence in SLHs is different from what studies have found in treatment programs. The association between psychiatric symptoms and abstinence for both groups suggests SLHs should consider provision of on- or off-site mental health services. Additional research is needed to understand why phobic anxiety and hostility are associated with abstinence among MA-dependent residents but not those dependent on other substances.
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Affiliation(s)
- Douglas L Polcin
- a Senior Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Jane Witbrodt
- b Associate Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Rachael Korcha
- b Associate Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Shalika Gupta
- c Research Associate , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
| | - Amy A Mericle
- d Scientist , Alcohol Research Group, Public Health Institute , Emeryville , CA , USA
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Abstract
Housing options for people exiting homelessness and seeking recovery from substance use disorders are limited. Policies tend to favor low-demand models such as housing first and permanent supportive housing that do not require abstinence, but offer immediate housing placement based on consumer choice and separate housing from clinical services. While these models have proven effective in promoting housing retention, especially among individuals with a primary diagnosis of mental illness, evidence to support positive outcomes related to people with a primary or co-occurring substance use disorder are mixed. Recovery housing models provide abstinence-focused environments and integrated peer support embedded within a recovery framework. Various models exist along a continuum from fully peer-run to clinically staffed residences. However, this continuum is typically separate from the homeless services system, and many barriers to integration persist. Recent national dialogues have begun to explore opportunities to integrate housing and substance use recovery approaches to meet the needs of people who need both types of support. This perspective paper argues that recovery housing is essential for supporting some homeless individuals and families. Within a comprehensive continuum based on choice, both recovery housing and low-demand models can support housing retention, reduce homelessness, promote recovery, and foster self-determination.
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Abstract
OBJECTIVE States across the country are recognizing recovery housing, an abstinence-based living environment promoting recovery from alcohol and other drugs, as an important yet underrepresented choice within their housing and treatment continuums. However, strategies for bringing recovery housing to scale are not well known. Building upon broader quality improvement efforts in Ohio, this paper aims to identify barriers and facilitators to expanding recovery housing in Ohio by understanding the perspectives of relevant stakeholders. METHODS We conducted 6 recovery housing program site visits; 24 semi-structured key informant interviews with state and national researchers, policy makers, and stakeholder groups; and 16 focus groups with administrators and staff, residents, and local stakeholders including housing developers, advocates, and county and city policy makers (n = 113). Focus groups were disaggregated by stakeholder membership and guided by separate interview protocols. Transcripts were coded and analyzed to identify primary themes. RESULTS Most participants across stakeholder groups expressed a need to increase recovery housing supports within the state. Two facilitators and three barriers emerged as primary themes from the qualitative analysis. Facilitators included (1) the ability of recovery housing programs to identify, connect, and collaborate with other recovery housing programs and service systems, an approach that increased a program's ability to refer, accept new clients, learn about programmatic and financial supports, and advocate for a space within the services continuum, and (2) support from legislators and other local stakeholders to include recovery housing as a viable and necessary option. Barriers included (1) variations in recovery housing definitions, language, and understanding that limited recovery housing providers' ability to connect with one another and be eligible for different streams of support, (2) availability of funds and ability to access them, and (3) restrictions in federal, state, and local regulations and codes. CONCLUSIONS Although recovery housing is limited and has not been integrated into many housing and treatment continuums, there is growing consensus about its importance for various subpopulations. Developing consistent definitions, program models, funding streams, networks of recovery housing providers, and collaborations among recovery-oriented systems of care will reduce misperceptions and enhance the likelihood that recovery housing will be expanded.
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Polcin D, Korcha R, Gupta S, Subbaraman MS, Mericle AA. Prevalence and Trajectories of Psychiatric Symptoms Among Sober Living House Residents. J Dual Diagn 2016; 12:175-84. [PMID: 27082699 PMCID: PMC4914417 DOI: 10.1080/15504263.2016.1172910] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
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.
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Affiliation(s)
- Doug Polcin
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | - Rachael Korcha
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | - Shalika Gupta
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
| | | | - Amy A Mericle
- a Alcohol Research Group, Public Health Institute , Emeryville , California , USA
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Polcin DL, Korcha R. Motivation to maintain sobriety among residents of sober living recovery homes. Subst Abuse Rehabil 2015; 6:103-11. [PMID: 26392791 PMCID: PMC4574796 DOI: 10.2147/sar.s89361] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Background The study of motivation in the substance abuse field has typically examined the extent to which substance users want to quit or reduce substance use. Less frequently examined is the desire to maintain sobriety after achieving abstinence. The current study examined motivation to maintain sobriety among residents of sober living houses (SLHs), a type of recovery home for individuals with alcohol and drug problems. Previous research on this population showed favorable longitudinal outcomes over 18 months. Resident views about the costs of not using substances (ie, the difficulties encountered when not using), as well as the perceived benefits of not using, were strong predictors of substance use outcomes. Methods This study adds to these findings by conducting two focus groups with individuals familiar with the structure and day-to-day operations of SLHs, including administrators of SLH organizations, owners, and peer managers. Results Focus group results supported the importance of costs and benefits as motivational forces influencing abstinence. However, participants also emphasized characteristics of the sober living recovery environment as important factors influencing motivation. Interactions among recovering peers offer unique opportunities for feeling understood, recognizing vulnerability in others, identifying with the recovery processes of others, receiving supportive confrontation, and engaging in mutual accountability. These experiences are important elements of motivation that become activated by involvement in the SLH environment and are difficult to replicate outside of that context. Conclusion In addition to recognizing how motivation can be enhanced by addressing costs and benefits experienced by individuals, operators of recovery homes need to understand motivation as a function of the recovery home social environment. Additional studies are needed on motivation as a longitudinal construct in a variety of peer-oriented environments. Studies are also needed to better specify interactions within SLHs that increase and hinder motivation among different types of residents.
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Affiliation(s)
- Douglas L Polcin
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
| | - Rachael Korcha
- Alcohol Research Group, Public Health Institute, Emeryville, CA, USA
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Polcin DL. Co-occurring Substance Abuse and Mental Health Problems among Homeless Persons: Suggestions for Research and Practice. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2015; 25:1-10. [PMID: 27092027 PMCID: PMC4833089 DOI: 10.1179/1573658x15y.0000000004] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
Communities throughout the U.S. are struggling to find solutions for serious and persistent homelessness. Alcohol and drug problems can be causes and consequences of homelessness, as well as co-occurring problems that complicate efforts to succeed in finding stable housing. Two prominent service models exist, one known as "Housing First" takes a harm reduction approach and the other known as the "linear" model typically supports a goal of abstinence from alcohol and drugs. Despite their popularity, the research supporting these models suffers from methodological problems and inconsistent findings. One purpose of this paper is to describe systematic reviews of the homelessness services literature, which illustrate weaknesses in research designs and inconsistent conclusions about the effectiveness of current models. Problems among some of the seminal studies on homelessness include poorly defined inclusion and exclusion criteria, inadequate measures of alcohol and drug use, unspecified or poorly implemented comparison conditions, and lack of procedures documenting adherence to service models. Several recent papers have suggested broader based approaches for homeless services that integrate alternatives and respond better to consumer needs. Practical considerations for implementing a broader system of services are described and peer managed recovery homes are presented as examples of services that address some of the gaps in current approaches. Three issues are identified that need more attention from researchers: 1) improving upon the methodological limitations in current studies, 2) assessing the impact of broader based, integrated services on outcome, and 3) assessing approaches to the service needs of homeless persons involved in the criminal justice system.
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