October 3, 2022

What to Expect in a Sober Living Home

A sober living home (SLH) is designed to help transition clients who are dually diagnosed with mental health and substance use disorders or those with a substance use disorder from higher levels of care (e.g., inpatient programs) down to a lower level of care. These homes also help them continue to practice the skills they acquired while in treatment. SLHs are grounded in principles taught by Alcoholics Anonymous and provide you with a community context that encourages attendance to 12-step meetings, insists on sobriety, and is purposefully designed to support peer-based recovery.1 SLHs address both social support needs as well as housing needs when you are recovering from substance use disorders.2

What You Can Expect in a Sober Living Program

There is this idea that the ‚Äúsetting is the service‚ÄĚ (i.e., the SLH is the service), which emphasizes the importance of the milieu as a social-model service whose physical architecture (i.e., the structure and design of the residential recovery setting) is a crucial silent partner in the recovery process.1¬†Expanding upon this theme that the facility itself is an active contributor to your recovery includes things such as SLHs being integral to the recovery experience, design, and use of these residences influence the recovery experience, and what you can expect to encounter while you utilize SLH services and continue your journey toward recovery.1

In this type of setting, peer support is defined as sharing interpersonal information and personal experiences, interacting to increase emotional and social well-being, and offering practical help.3 The ways in which peer support is established in these settings vary from facility to facility. For example, some facilities provide 12-step meetings on-site, while others require residents to attend 12-step or other self-help meetings out in the community.3

When at a sober living home or its derivative, it is very common to contribute to and be the recipient of peer support. Peer support is understood as the sharing of personal information and your experiences, interacting with housemates to increase social and emotional well-being, and offering practical help.3 Some of this happens naturally as you may be making a meal in the kitchen or relaxing in designated common areas. Sometimes this phenomenon is more contrived, occurring in the context of group counseling, on-site 12-step meetings, or even being required to attend similar meetings out in the community.3

Application and Eligibility

The Substance Abuse and Mental Health Services Administration (SAMHSA) recommends that acceptance and referrals to SLHs should not only occur prior to the referral and placement but should also be based on what gives you, the resident, the best chance for obtaining and maintaining recovery.4 SAMHSA further suggests that your circumstances should be matched to the house based on accurate assessments of your:4

  • Current recovery capital
  • Unique needs
  • Strengths
  • Challenges

Whether the referral source is a licensed clinician, law enforcement, or a concerned family member, they should have knowledge about you and be well-versed about the house’s entrance criteria as well as other relevant information to determine the appropriateness of fit:4

  • House culture (will include a level of adherence to outside meeting attendance, general living environment, the permissiveness of unhealthy behaviors, and peer‚Äôs investment in recovery)
  • Level of care (recovery supports provided and their type, nature, the intensity of therapeutic services delivered, and ability to address your needs)
  • Appropriate use of certified or trained peers with pertinent lived experience
  • Environment (may include neighborhood, external surrounding environments of the recovery home, and/or geographic area)
  • Physical living space
  • Nature of current established residents (this speaks to whether or not current residents are welcoming, also committed to sobriety, supportive, and are most residents employed)
  • Medication-assisted treatment (MAT) (in a house setting, this speaks to whether or not housing staff and peers that support MAT, will medication be monitored, and for peers with severe opioid use disorders, are peers with MAT experience available to their peers)
  • Housing staff‚Äôs level of professionalism and training (this will include their training and experience working with residents who are dually diagnosed or are in crisis and need intervention)
  • Reputation of the facility (things to consider are business practices, allegations of any fraud, abuse of residents, etc.)
  • Policy on relapse
  • Access to and availability of opioid-overdose reversal medication

Differences Between Traditional and High-Accountability Sober Living Homes

Recovery housing is frequently utilized after inpatient (residential) treatment, during or after outpatient treatment, or even as a complete alternative to treatment.2 Regardless of the name (e.g., sober living houses, recovery homes, sober living homes, Oxford Houses), SLHs are safe, healthy living, sober living environments that promote recovery.2 Central factors to recovery house models include:2, 3

  • Valuing peer support, mutual aid, and experiential knowledge (e.g., drawing on experience as a method of helping others through a unique transmittance of knowledge)
  • Active participation in your own recovery
  • Recovery that occurs during the moments of connections between you and other residents, rather than between you as a resident and a professional treatment provider
  • Residents who are both consumers and providers, giving and receiving help equally
  • Active participation in the overall functioning of the house that you reside
  • Involvement in AA or its derivatives creates a basic framework for recovery
  • Being in a sober environment that encourages support for abstinence
  • Able to treat alcohol use disorder, for example, which is interpreted as being the epicenter for reciprocal relationships between you, the individual, and your surrounding social unit

For example, National Alliance for Recovery Residences (NARR) developed standards of practice and levels of care provided by different residences.2 Residences specializing in recovery living ranges from being absolutely peer-managed operating out of a single-family home, which provides no formal services or treatment (e.g., Oxford House model), to models characterized by a more traditional substance use treatment orientation, which actively incorporates residents into the therapeutic and treatment process, and operate out of a larger residential facility.2

When discussing governance and oversight, peer-run residences, these SLHs are not licensed by treatment providers and are peer-run and democratically run, whereby treatment providers must be licensed in more formalized facilities.2

Types of Rules, Requirements, and Environment

A majority of SLHs are in neighborhoods that do not show evidence of being neglected, unsafe, disadvantaged, or obvious signs of selling or consuming substances.2 All houses will have rules of conduct and house rules with some variance. Generally, you can expect the following rules when residing at an SLH:2

  • You will undergo an orientation and will be given some form of a resident handbook, pamphlet, or summary of rules and expectations upon entry to the home.
  • You will see house rules clearly posted throughout the household.
  • You may or may not be provided food.
  • You may have daily chores assigned by a house manager.
  • You will attend weekly house meetings.
  • You are expected to abide by a curfew.
  • You may need to follow rules around spending the night outside the home and prohibitions against visitors during the day and/or spending the night.
  • You will have to follow rules regarding substance use on or off the premises.
  • You will learn about the consequences for minor infractions as well as major penalties that could result in being kicked out of housing.
  • Your house may actively attempt to link you with resources.
  • Your house request that all residents leave in the morning and return in the evening.

Each house is different, but typically speaking, you can expect to have roommates because houses usually maintain a census of 8-19 residents at all times.2 House managers will have their own rooms, and residents use shared bathrooms.2 You can socialize in common areas (TV/living room, dining/kitchen area, and patio/yard areas), and utilities and amenities are also available (air conditioning, washer/dryer, cable, parking for all residents, free Wi-Fi, garbage/storage space, a dishwasher, coffee, cleaning supplies, and TV’s in each room), but handicap and wheelchair accessibility is not a constant across different houses.2

Although it is more likely that you will be sharing a room with at least one other person, private bedrooms are important settings that contribute to your recovery because this specific personal space is where you can reflect on ‚Äúworking a program‚ÄĚ to achieve sobriety and increase your autonomy and independence.2

In California, as long as you are able to maintain your sobriety, you are permitted to stay indefinitely; caveats being some proscriptions that apply for non-payment of rent for those who use any substances on or off the premises that will result in termination of the lease, exhibit criminal or violent behavior, or are deemed mentally incompetent.2

Services, Either Affiliated or Offered in the Program

A soft service that residents can take advantage of is sharing in leadership roles to foster mutual responsibility (e.g., creating, implementing, and enforcing house rules) for the home as well as their peers.2 Governance decisions, however, are not made by residents, only staff.2

Although the following may not be offered directly through the sober living home, many SLHs are close to surrounding services they can take advantage of as they see fit:2

  • Churches
  • AA clubhouses
  • Community gardens
  • gyms/fitness centers
  • Restaurants
  • Salons/barber shops

Usually, there are no direct services provided by sober living homes, but some in largely working and middle-class neighborhoods did provide recovery support services that could be covered by insurance, such as professional recovery coaches and linkages to other treatment services.2

Rent and Other Costs

Recovery housing costs may be impacted by the professionalization and more expansive integration of recovery support and treatment services along with opportunities to cover costs.2 Recovery housing is an affordable option for you if you are still in the process of building financial and recovery capital vis a vis securing employment because expenses and responsibility of operating the house are shared.2 If organizations are operating SLHs, revenue is leveraged from insurance, and some individuals seeking this service receive funding through public resources (e.g., some programs), while others may pay out of pocket.2

On the other hand, Oxford Houses provide more of a long-term, homelike, residential environment free from substances, are financially self-sustaining by residents, but do not provide any in-house formal treatment services.3 Rather than having house managers, these housing platforms are externally supported by regional managers who assume the responsibility for the homes.3 In these settings, you will be required to attend 12-step groups and have some form of recovery plan.3

Oxford Houses, which have been found to be effective as aftercare services for those who have completed long-term residential treatment, have shown to have good longitudinal outcomes at four-month interval follow-ups.3

SLHs are a crucial part of treatment in general and recovery in particular. Although it is one part of the equation, housing does encapsulate four dimensions of recovery:5

  • Health, which means overcoming and/or managing mental health, medical, and/or substance use diseases and symptoms and simultaneously making healthy, informed decisions that buttress your desire to work towards your physical and emotional well-being
  • Home, meaning having a safe and stable place to not only live but thrive
  • Purpose specific to explicitly conducting meaningful daily activities (i.e., employment, family caretaking, school, creative endeavors, independence, income, volunteering, and access to community resources)
  • Community speaks to hope, love, friendship, and support that is provided in relationships and social networks

Positive outcomes result from the utilization of SLHs, such as decreased involvement in the criminal justice system, establishing employment, and abstaining from alcohol and substances.2

Call 800-661-1690 (Who Answers?) to find a sober living home near you. Talk to a treatment specialist at 800-661-1690 (Who Answers?) to discuss available sober living home options.

Resources

  1. Wittman, F., Architect, B.J., Polcin, D.L., Henderson, D. (2015). The Setting is the Service: How the Architecture of Sober Living Residences Supports Community Based Recovery. International Journal of Self Help and Self Care, 8(2), 189-225.
  2. Mericle, A.A., Polcin, D.L., Hemberg, J., & Miles, J. (2017). Recovery Housing: Evolving Models to Address Resident Needs. Journal of Psychoactive Drugs, 49(4), 352-361.
  3. Polcin, D., Mericle, A., Howell, J., Sheridan, D., & Christensen, J. (2014). Maximizing Social Model Principles in Residential Recovery Settings. Journal of Psychoactive Drugs, 46(5), 436-443.
  4. Substance Abuse and Mental Health Services Administration. (2018). Recovery Housing: Best Practices and Suggested Guidelines.
  5. Substance Abuse and Mental Health Services Administration. (2022). Recovery and Recovery Support.
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