1. 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

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

3. Recovery Residences Where peers learn to live recoveryII
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.

4. 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.

5. 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.

6. 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

7. 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

8. 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?

9. 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

10. 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)

11. 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

12. 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

13. 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

14. 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

15. 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

16. NARR Levels