This study examined the role played by aftercare following (mainly) inpatient community-based treatment in the outcomes of criminal ex-offenders with substance use disorders. Two hundred and seventy individuals who had been released from the criminal justice system were randomly assigned to either a Therapeutic Community (TC), recovery homes called Oxford Houses (OHs), or usual care settings (UA). The OHs and TCs are residential settings that emphasized socialization and abstinence from drugs and alcohol, but OHs do not include the formal therapeutic change interventions common to TCs, nor did they include any on-site access to drug abuse or health care professionals. UA involved what occurred naturally after completing treatment, which included staying with friends or family members, their own house or apartment, homeless shelters, or other settings. Longer lengths of stay in either the TCs or OHs were associated with increased employment, and reduced alcohol and drug use. Those assigned to the OH condition received more money from employment, worked more days, achieved higher continuous alcohol sobriety rates, and had more favorable cost-benefit ratios.
This study compared the social climate of peer-run homes for recovering substance abusers called Oxford House (OH) to that of a staffed residential therapeutic community (TC). Residents of OHs (N=70) and the TC (N=62) completed the Community Oriented Programs Environment Scales (COPES). OHs structurally differ on two primary dimensions from TCs in that they tend to be smaller and are self-run rather than professionally run. Findings indicated significantly higher Involvement, Support, Practical Orientation, Spontaneity, Autonomy, Order and Organization, and Program Clarity scores among the OH compared to TC residents. Additional analyses found the OH condition was higher Support, Personal Problem Orientation, and Order and Organization scores among women compared to men residents. These results suggested that these smaller OH self-run environments created a more involving and supportive social milieu than a larger staff-run TC. These findings are interpreted within Moos' (2007) four theoretical ingredients (i.e., social control, social learning, behavioral economics, and stress and coping), which help account for effective substance abuse treatment environments.
Although research shows treatment for alcohol and drug problems can be effective, persons without stable housing that supports recovery are at risk for relapse. Recovery residences (RRs) for drug and alcohol problems are a growing response to the need for alcohol- and drug-free living environments that support sustained recovery. Research on RRs offers an opportunity to examine how integration of these individuals into a supportive, empowering environment has beneficial impacts on substance use, housing, and other outcomes, as well as benefits for the surrounding community. Research can also lead to the identification of operations and practices within houses that maximize favorable outcomes for residents. However, research on RRs also presents significant obstacles and challenges. Based on our experiences conducting recovery home research for decades, we present suggestions for addressing some of the unique challenges encountered in this type of research.
Background This study used survival analysis to examine risk factors for substance abuse relapse among residents in Oxford Houses (OH) a national network of self-run, self-financed aftercare homes for individuals recovering from substance use disorders. Methods Participants who entered OH within 60 days of a one-year longitudinal study (N=268) were selected from of a nationally representative U.S. sample. Discrete-time survival analysis compared baseline risk of relapse to four hypothesized survival models that included time-invariant and time-varying factors across three subsequent time periods. Results The model predicting higher risk for more severe substance use disorders and psychiatric problems was supported. The hypothesized model that predicted time-varying increases in alcohol (but not drug) abstinence self-efficacy significantly affected risk of relapse. Hypothesized demographic and employment variables did not significantly predict relapse risk. Conclusions Results suggested that OH recovery homes may reduce relapse by providing closer monitoring and referring additional services to new residents with more severe prior addiction severity. Risk for relapse may also be reduced by enhancing abstinence self-efficacy for alcohol regardless of drug of choice.
Domestic and sexual violence (DSV) and substance use disorders (SUDs) co-occur at high rates among women. Yet, the extent to which sober living homes promote healing and recovery among women with histories of DSV and SUDs is unknown. The purpose of the proposed study was to examine this gap in the literature by conducting a pilot evaluation of the Support, Education, Empowerment, and Directions (SEEDs) program in Phoenix, Arizona. SEEDs is a trauma-informed, gender-responsive sober living home that provides transitional housing to women with histories of DSV and SUDs. Participants (N = 59) completed three surveys (baseline and 6 and 12 months) to determine how engagement with SEEDs predicted changes over time across several outcomes. Results suggest that SEEDs participants improved over time for primary (i.e., victimization, perpetration, and substance use) and other (i.e., posttraumatic stress, depressive symptoms, financial worries, and housing instability) outcomes. Sense of purpose, posttraumatic growth, and personal empowerment did not change over time. Length of stay and program involvement in SEEDs were the most consistent predictors of improvements at the 12-month follow-up. Finally, women who lived only at SEEDs throughout the course of the study fared better on most outcomes compared with women who lived places other than SEEDs during the study period. Although further experimental research is needed, preliminary research suggests that SEEDs is a promising approach to facilitate healing and recovery among women with histories of DSV and SUDs.
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