A major challenge facing many individuals attempting recovery from substance use disorders is finding a stable living environment that supports abstinence. Sober living houses (SLHs) are alcohol- and drugfree living environments for individuals who are attempting to maintain abstinence and develop a recovery-oriented lifestyle (Polcin & Henderson, 2008). Despite research showing that living environments supportive of recovery are associated with better outcome (e.g., Braucht, et al., 1995), SLHs have been largely overlooked by policymakers and researchers. This article represents a first step toward correcting this oversight. After reviewing selected studies that show alcohol and drug use is associated with characteristics of social networks and living environments, SLHs are introduced as an underutilized resource for alcohol- and drug-free housing. The article further describes an exploratory investigation of outcomes for 245 individuals entering SLHs. We also examined factors that we considered important in predicting outcome, such as 12-Step involvement and substance use in the social network.

In recent years, much attention has been directed toward developing a workforce of treatment professionals who are prepared to serve an increasingly diverse client population.

Monica McGoldrick (1998) was on the cutting edge of these discussions when she advocated for moving marginalized cultural experiences into the center of our awareness as helping professionals. She challenged America’s value system and the hierarchical structures that define clients’ lives along the lines of race, gender, culture and class, and in turn, determine the definitions of normality, problems and services for clients. Freddy Paniagua (2005) tasked himself with the development of a single integrative work that would offer practical guidelines—basic dos and don’ts—to practitioners working with African American, Asian, Hispanic and Native American clients in U.S. provider systems. Garrett McAuliffe (2008) called for counselors to have “a consistent readiness to identify the cultural dimensions of clients’ lives and a subsequent integration of culture into counseling work”, and he advocated for this readiness to be demonstrated in accessibility, assessment and intervention.

First, I am a Caucasian, born and raised in New York City. So, it is a bit audacious for me to be writing about working with Asians. However, for the past 30 years I have worked in many Asian countries, assisting them in the development of 12-Step programs and addiction treatment. So, that’s the context in which I am writing.

Second, Asians constitute 50 percent of the world’s population. Between the populations of China and India alone, they constitute 40 percent of the world’s population. It would be inappropriate to speak of “Asian culture,” and pretend that there is homogeneity. For example, Indonesia alone consists of 13,000 islands, with 200 million people. Thus, it is an error to try to categorize such a vast population in generalized statements.

For the past nine years, the articles in this column of Counselor have sought to educate addiction professionals about the rich history of addiction treatment and recovery in America and to highlight emerging trends that are of historical import. We have often noted history’s propensity to repeat itself, but viewing all events in terms of these cycles can blind us to that which is fundamentally new. 

For almost three centuries, people recovering from severe alcohol and other drug problems have created healing sanctuaries to share their experience, strength and hope and to meet specific needs they faced in initiating and sustaining their recovery journeys.  History suggests that when a vacuum of unmet needs reaches critical mass, recovering people, their families and visionary professionals coalesce into movements that birth new structures of recovery support. That critical mass — spawned in great part by the restigmatization, demedicalization and recriminalization of addiction in the 1980s and 1990s — has been reached again, and the resulting scope and depth of recovery community building activities in America is without historical precedent.

Being given choices of institutions, levels of care, treatment goals/methods, service personnel, and service duration has historically not been part of the personal experience of addiction treatment in the United States. This article describes why addiction treatment professionals have been reticent to offer choices to their alcohol and drug dependent clients and why that philosophy is now undergoing reevaluation.  

Dr. Jekyl and Mr. Hyde

Addiction treatment has, for more than 150 years, been more a process of professional diagnosis, direction, and indoctrination, than a process of guided self-reflection and self-change. Since the advent of program accreditation standards in the 1970s, clients entering addiction treatment have been asked to sign a treatment plan. This ritual has conveyed the illusion of participation and choice, but anyone familiar with the process knows that the choices available to clients have, until recently, been narrowly prescribed by each program’s treatment philosophy, available levels of care, coercive dictates from referral sources, or by the external care managers who governed reimbursement decisions. Another factor concerning limited choice in addiction treatment is the perception that those entering addiction treatment have lost the power of choice; that the state of addiction is the very antithesis of choice (Michael Flaherty, personal communication).