A Descriptive Look at the Mission, Obstacles, & Strategies Used by the Operators of Recovery Residencies

A growing body of research has found that recovery residencies are a useful peer-based recovery support option for substance use disorder. Little is known, however, descriptively regarding the priorities of the home operators. This study outlined how the operators of these homes describe their mission, obstacles, and strategies using a qualitative investigation.

WHAT PROBLEM DOES THIS STUDY ADDRESS?

Recovery residences are considered safe and supportive living environments that encourage recovery from substance use disorder and related problems. Recovery residences offer peer-based support for long-term recovery, often require a goal of abstinence, and some residences integrate professional support as well. There is a growing body of research showing recovery residencies are empirically supported continuing care options for substance use disorder. For example, a longitudinal study suggests that the Oxford House model, one type of recovery residence, may help its members reduce substance use, increase monthly income, and reduce incarceration rates more than usual continuing care conditions (e.g., Jason et al., 2006). Given the majority are privately owned, at the time of this study there was still a considerable knowledge-gap in what the organizational goals and strategies are according to the home operators (e.g., owner or director of the home).

The aim of this study by Mericle and colleagues was to learn more about what recovery residence home operators aim to accomplish by opening a residency, barriers they encounter, and approaches they use to navigate the identified barriers.

HOW WAS THIS STUDY CONDUCTED?

This study used qualitative data from in-person interviews with recovery home operators. Operators were someone who could serve as the site contact for this study (e.g., the owner, director, manager, etc.). As part of a larger study funded by the Pennsylvania Department of Health, an initial pool of 229 homes stratified by gender of clients served and funding source (i.e., equally representative) were used to select the final 21 homes included in this study.

WHAT DID THIS STUDY FIND?

The operators reported that the mission of their recovery home was more broad than supporting residents efforts to sustain abstinence. As displayed in Figure 1, fostering personal growth and development and providing a safe and supportive living environment are the most commonly reported missions.

Mission Goals from 21 Recovery Residences Fostering growth and personal development

Emotional/spiritual	16
Education/vocational	15
Interpersonal relations	10
Health and well-being	3
Other	7
Providing a safe and supportive living environment	14
Addressing substance use	11
Affordable housing	2
Advocacy for individuals in recovery	1

The figure below shows the programming strategies used to accomplish the missions detailed in the above figure. Cultivating social relationships and a supportive environment along with monitoring are the most frequently used approaches to facilitate the mission.

Programming Goals from 21 Recovery Residencies

Cultivating social relationships and a supportive environment	10
Monitoring	8
Service linkages	6
Self-help involvement	3
Spirituality	2
Other	2

The most frequently mentioned obstacles pertained to running the organization, residents, and other community level challenges which are summarized in Figure 3.

Organizational obstacles
Funding	16	33
Staffing	5	7
Licensing	3	5
Other	1	2

Resident obstacles
Stage of change	13	26
Problems with authority	5	7
Social skills/interpersonal relations	2	4
Other	5	5

Community obstacles
NIMBY (not in my backyard) attitudes	11	15
Politics	2	3
Other obstacles	2	2

Operational strategies to address obstacles such as being a good neighbor and networking are presented in the figure below.

Operational strategies
Good neighbor	11	23
Networking	8	11
Fundraising	6	10
On the “down low”	5	8
Employment	5	5
Professionalizing	3	5

*** “down low” means keeping a low profile in the neighborhood

The operators also discussed their strategies for personal survival such as helping others and feeling like their work was a labor of love as shown in the figure below.

Personal survival strategies
Helping others	14	18
Labor of love/not about the money	10	15
Success stories	9	11
Keeps me clean	6	6
Other	1	1

WHY IS THIS STUDY IMPORTANT?

This qualitative study was important because although other studies have established the degree to which recovery residencies are effective at reducing substance use and related outcomes, not as much is known in terms of the structural goals, obstacles, and strategies encountered by the operators of the homes. The findings here suggest that operators of recovery homes in Philadelphia are aiming to do more than just provide residents with a safe house and help ensure abstinence; they are aiming to foster emotional, spiritual, educational, and interpersonal growth. These quality of life goals that extend beyond abstinence align with other definitions of recovery from substance use disorder. This work adds to the growing body of research that is starting to firmly place recovery residencies on the continuum of care for substance use disorder.

LIMITATIONS

As with all qualitative research there are limitations inherit in the design. The information is meant to describe the mission, strategies, and obstacles from the perspective of the home operator.
Given the sampling strategy was representative of Philadelphia recovery residencies in terms of funding source and gender, the findings may have generalizability to the mission and obstacles encountered by recovery residencies in the Philadelphia area.

NEXT STEPS

The next steps are to determine exactly which missions and strategies relate to better resident outcomes in terms of abstinence and improved quality of life indicators such as employment, social support, personal growth, and mental health. Then, recovery researchers can evaluate whether adding these new strategies to existing recovery residences ultimately help improve resident outcomes and can lead to a “best practices” type of recovery residence model.

BOTTOM LINE

For individuals & families seeking recovery: This qualitative study of 21 operators of recovery residencies found that fostering growth and personal development are among the top mission priorities. Programming activities that cultivate social relationships and a supportive monitored environment are the types of strategies used to achieve the mission. As indicated by the results for obstacles, the recovery residence model may be a better fit for individuals with high readiness for change and high levels of commitment to sobriety. There is a growing body of research suggesting that recovery residencies have the potential to be an empirically supported peer-based option on the continuum of care for substance use disorder.
For scientists: The results from this qualitative study of the mission, obstacles, and strategies used by recovery resident operators should be used to inform an empirical study. It would be useful to identify the ingredients of a model of “best practices” to address the mission, obstacles, and strategies that promote improved resident outcomes in terms of continued abstinence and increased recovery capital.
For policy makers: Recovery residences are a promising tool to expand the continuum of care for substance use disorders. This study adds to the growing body of research on them and will hopefully lead to the development of strategies to ensure that recovery home operators have the training, oversight, and funding they need to foster resident abstinence, substance use disorder remission, and improved quality of life. Consider working with the National Alliance of Recovery Residencies to improve and monitor quality care standards in recovery residencies.
For treatment professionals and treatment systems: This qualitative study of recovery residencies shows the emphases that operators place on recovery from substance use disorder beyond abstinence through their mission and strategies. Recovery residencies offer a peer-based safe and supportive living environment and have been shown to reduce substance use, increase monthly income, and reduce incarceration rates more than referral to usual continuing care conditions following residential treatment. As such, recovery residencies are a useful option on the continuum of care for people during or following professional treatment.