NARR Levels Learning to Live Recovery from Substance Use: November 2015 NARR Levels Learning to Live Recovery from Substance Use: An Overview of Recovery Residence Philosophy, Research, and Outcomes

Person-driven recovery Housing Choice for persons with substance use disorders Recovery Housing Housing First Main-stream Housing Other

Recovery Residences Where peers learn to live recovery II Spectrum of sober, safe, and peer-supportive living environments and residential programs that promote addiction recovery Rooted in Social Model Recovery Philosophy Range in the type and intensity of services Options cost-effectively match the diverse and changing needs of residents Developed at the intersection of: III IV Recovery Treatment Housing Image: Venn diagram, depicting overlap of recovery, housing, and treatment.

I II III 170+ years of peers living together and supporting each other Earliest recorded recovery residence Mid-1900s Alcoholics anonymous houses Pioneer House, Hazel’s Den Association of Halfway House Alcoholism Programs (AHHAP) Late 1900s Oxford House, Inc., and regional organizations formed (CAARR, GARR, SLN…) in the 1970s Social Model Philosophy defined Early 2000s More regional organizations formed (e.g., Minnesota Association of Sober Homes, Connecticut Community for Addiction Recovery) Growth in capacity 2011 to present National Alliance for Recovery Residences (NARR) Merged with AHHAP in 2013 170+ years of peers living together and supporting each other I II III Image: Timeline of relevant dates in the history of recovery residences.

National Alliance for Recovery Residences (2015) 20 state affiliates at various stages of development Representing over 2,500 certified recovery residences Where over 25,000 people in recovery live Image: Map of the United States, depicting NARR affiliate and emerging states as of 2015.

Why a National Standard? Unification. Education. Quality Capacity. Standardized nomenclature allows for more productive and meaningful conversations Translates across states: different and changing laws Inclusive framework: Four levels of support Unites fragmented knowledge base Facilitates the collection and promotion of best practices Offers a blueprint to new capacity and quality capacity Equips researchers with comparative subjects Basis for a certification program I II III IV

Therapeutic Community Alcohol- and Other-Drug-Free Halfway vs. ¾ House Inclusive Framework: Recovery Residences 4 Levels of Support I II III IV Recovery House Therapeutic Community Sober House Extended Aftercare Residential Recovery Centers Sober Living Oxford House ¼ House What’s What?! Alcohol- and Other-Drug-Free Halfway vs. ¾ House

What am I paying for? Which is right for me? Inclusive Framework: Recovery Residences 4 Levels of Support I II III IV I What am I paying for? Which is right for me?

Levels Differ in Service Bundles I II III IV I II III IV Housing – safe, stable housing that is recovery supportive Social Model – sociocultural elements and structure that promote ubiquitous support, accountability, and connectedness Peer Recovery Support Formal one-on-one (e.g., coaching) Formal groups (e.g., support groups) Life skills e.g. job readiness, budgeting Trend: intensive outpatient/partial hospitalization + recovery residence Clinical

Peer-elected officers Levels Differ in Staffing I II III IV Peer-elected officers Senior resident/ peer house manager Supervision Supervision Staff supervision (e.g., ongoing skills development and support)

I II III IV One Size Does Not Fit All: Recovery residences a fit? If so, which is right for whom? I II III IV Recovery capital Disease(s) severity and complexity Stages of development, change, and recovery Person-driven choice Harsh reality: Local availability and affordability

Why a certification? More then just quantity, we need quality Public-facing mechanism that empowers choices and instills confidence: consumers, funders, referral agents, etc. Provides consumer protection and a grievance process Incentivizes fidelity to best practices (ideally through support and mentoring) rather than policing compliance (carrots versus sticks) Opt-in certification promotes quality without raising impediments to fair housing choice and complements (not replaces) existing regulation Cost-effective and flexible over time

NARR (2015) Domains, Core Principles, and Standards Administrative Operate with integrity Uphold resident rights Recovery-oriented Peer staffed and governed Recovery Support Promote health Provide a home Inspire purpose Cultivate community Architecture Promote recovery Promote health and safety Good Neighbor Good neighbors 37 Standards across the domains

NARR (2015) Domains, Core Principles, and Standards Administrative Operate with integrity Uphold resident rights Recovery-oriented Peer staffed and governed Recovery Support Promote health Provide a home Inspire purpose Cultivate community Architecture Promote recovery Promote health and safety Good Neighbor Good neighbors Substance Abuse and Mental Health Services Administration’s Supportive Domains of Recovery used to frame principles

NARR (2015) Domains, Core Principles, and Standards Administrative Operate with integrity Uphold resident rights Recovery-oriented Peer staffed and governed Recovery Support Promote health Provide a home Inspire purpose Cultivate community Architecture Promote recovery Promote health and safety Good Neighbor Good neighbors Social Model Philosophy added throughout the revised standard

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