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.

Social Networks and Living Environments

The characteristics of one’s social network are strong predictors of alcohol and drug treatment outcome (e.g., Moos, 2007), and involvement in 12-Step programs such as Alcoholics Anonymous (AA) appears to be especially helpful (Bond, et al., 2003). Studies have also shown that the provision of housing that is supportive of recovery is important, particularly for individuals who are homeless or reside in destructive environments that encourage substance use (Braucht, et al., 1995). These findings indicate that individuals completing treatment who remain homeless or return to substance using environments are more prone to relapse than clients living in environments supportive of sobriety. Despite their importance, many individuals seeking to abstain from alcohol and drugs have difficulty establishing social support systems that reinforce sobriety, and they also have difficulty finding long-term, stable housing that is free of alcohol and drugs.

Characteristics of Sober Living Houses

The essential characteristics of contemporary SLHs include: an alcohol- and drug-free living environment for individuals attempting to establish or maintain abstinence from alcohol and drugs; no formal treatment services but either mandated or strongly encouraged attendance at 12-Step self-help groups such as AA; required compliance with house rules, such as maintaining abstinence, paying rent and other fees, participating in house chores and attending house meetings; resident responsibility for financing rent and other costs; and an invitation for residents to stay in the house as long as they wish, provided they comply with house rules (Polcin & Henderson, 2008). For a more detailed description of traditional SLHs and modified SLHs that are associated with outpatient treatment see Polcin, Korcha, Bond, Galloway & Lapp (2010).

SLHs have their origins in the state of California and most continue to be located there (Polcin & Henderson, 2008). It is difficult to ascertain the exact number of SLHs that exist because they are not formal treatment programs and are therefore outside the purview of state licensing agencies. However, in California, many SLHs are affiliated with coalitions or associations that monitor health, safety, quality and adherence to a peer-oriented model of recovery, such as the California Association of Addiction Recovery Resources (CAARR) or the Sober Living Network (SLN). More than 64 agencies affiliated with CAARR offer clean and sober living services. The SLN has over 500 individual houses among it membership.

There are similarities between SLHs and other residential facilities for substance abusers, such as “halfway houses.” Both are designed to promote recovery in a non-clinical, home-like environment. Still, there are important differences as well. Unlike most halfway houses, SLHs have the advantage of being financially selfsustaining through resident fees. Most residents meet their financial obligations through work, but others have access to family support or government entitlement programs such as social security income. A second difference is the residents of SLHs can stay as long as they wish, provided they meet their financial obligations and abide by the rules, such as maintaining abstinence from drugs and alcohol. Finally, there is typically no requirement about involvement in formal treatment for most SLHs. Individuals in halfway houses have usually completed residential treatment or are attending outpatient programs (Polcin & Henderson, 2008).

The Oxford Model

An alternate housing model for recovery from addiction that is similar to SLHs is the Oxford House Model (Jason, et al., 2006). There are a number of similarities between SLHs and Oxford Houses, including an emphasis on peer support for recovery, no provision of formal treatment services, a requirement that residents abstain from alcohol and drugs, financial self-sufficiency and an open-ended length of stay (Polcin & Borkman, 2008). Both are ordinary houses located in residentially zoned areas and fall under the protection of the Fair Housing Amendments Act of 1988 (FHAA) regarding the right to live in any residentially zoned area (Wittman, 2009). Residence in both types of houses is also protected by personal privacy provisions under the Fourth Amendment. The FHAA prohibits housing discrimination by allowing people with disabilities to live together for a shared purpose, such as mutually assisted recovery and maintenance of an abstinent lifestyle. For a more complete description of the zoning and legal issues that apply to Sober Living and Oxford Houses and recent challenges to these regulations, see Wittman (2009).

There are also a number of differences between the SLH and Oxford House models. First, SLHs have the option of requiring residents to attend 12-Step meetings as a condition of residency. Oxford Houses generally encourage but never mandate attendance at 12-Step meetings. Second, Oxford House rules require that each house be managed by a rotating democratically elected group of residents. SLHs vary in management styles, with some houses emphasizing peer management and leadership of the house and others relying on a “strong house manager” who is ultimately responsible to the owner/landlord. Third, Oxford Houses mandate a range of 6 to 10 members in each house, whereas the numbers of residents in SLHs vary widely depending on the house. Finally, because all Oxford Houses fall under the auspices of Oxford House Inc. they tend to be more homogenous than SLHs. Some SLHs are not part of any larger association and there is therefore more diversity in structure and operations between the houses.

Philosophy of Recovery in Sober Living Houses

Central to recovery in SLHs is involvement in 12-Step self-help groups (Polcin & Henderson, 2008). Residents are usually required to attend meetings and expected to be actively working a 12-Step recovery program (e.g.,obtain a sponsor, work the 12 steps, etc.). However, some houses will allow other types of activities that can substitute for 12-Step groups, provided they constitute a strategy for maintaining ongoing abstinence.

Developing a social network that supports ongoing sobriety is also an important component of the recovery model used in SLHs. Residents are encouraged to give and receive support and encouragement for recovery with fellow peers in the house. Residents who have been at the house longest and who have more time in recovery are usually encouraged to provide support to new residents. This type of “giving back” is consistent with a principle of recovery in 12-Step groups. Residents are also encouraged to avoid friends and family who might encourage them to use alcohol and drugs, particularly individuals with whom they have used substances in the past.

While some SLHs use a “strong manager” model where the owner or manager of the house develops and enforces the house rules, contemporary SLH associations such as CAARR and SLN emphasize a “social model approach” to managing houses that empowers residents by providing leadership positions and forums where they can have input into decision-making (Polcin & Henderson, 2008). Some houses have a “residents’ council,” which functions as a type of government for the house.

A Study of 18-Month Outcomes

This article reports on longitudinal outcomes for 245 SLH residents at six, 12 and 18 months. Primary outcomes included severity of drug and alcohol problems. Secondary outcomes included measures of employment, psychiatric, legal, medical and family problems. We hypothesized that residents who entered the SLHs with high problem severity would improve at six months and those improvements would be maintained at 12 and 18 months. Because some referrals came from controlled environments and some residents had already begun a recovery program before they entered the SLH, we expected that they would enter with lower problem severity and maintain that low severity at 6, 12 and 18 months. Because the philosophy of recovery in SLHs rests on the premise that it is crucial to build a social network that supports abstinence and actively work a 12-Step program of recovery, we expected measures of these two factors to correlate with outcomes across time points.

All study participants were recruited from Clean and Sober Transitional Living (CSTL) in Sacramento County, California. CSLT operates 16 freestanding SLHs (136-bed capacity) and is structured into two phases. The first (30 to 90 days) is designed to provide more limits and structure (e.g., curfews, mandatory 12-Step meeting attendance, shared rooms) to help residents successfully transition into the facility. The second phase allows for more autonomy (e.g., private rooms, fewer requirements for curfews and 12-Step attendance). A “residents’ congress” consisting of current residents and alumni help enforce house rules and provide input into the management of the houses. The cost at entry into the house is $695 per month, which includes family-style meals and utilities. About 90 percent of the residents use their own financial resources (e.g., employment earnings, savings, family resources or Social Security income) to meet housing costs. About 10 percent of the residents receive financial support from the Substance Abuse Services Coordinating Agency (SASCA), an agency created for graduates of drug treatment programs in the California Department of Corrections. For a more extensive description of CSLT see Polcin and Henderson (2008). For the study, 245 residents of CSLT were recruited during their first week after entering the house. To maximize our ability to generalize results we employed few inclusion/exclusion criteria: all study participants were age 18 or older and competent to provide informed consent. Most participants were men (77 percent) and most were white (72.5 percent).

Several measures were used to describe characteristics of participants when they entered the SLHs. These included:

 1. Demographic Characteristics such as age, gender, ethnicity, marital status and education.

2. DSM-IV Checklist for Past 12-Month Alcohol and Drug Dependence to assess substance use disorders over the past 12 months. Items are based on DSM-IV diagnostic criteria (American Psychiatric Association, 2000).

Additional measures were used to compare resident functioning when they entered the SLHs with follow up at 6, 12 and 18 months. Some assessments asked about relatively recent time periods, such as the Addiction Severity Index (ASI), which was used to show severity of problems in six different areas over the past 30 days. Other measures, including assessments of abstinence and frequency of substance use, assessed a six-month period of time.

1. Addiction Severity Index (ASI): The ASI is a standardized, structured interview that assesses problem severity in six areas: medical, employment/support, drug/alcohol, legal, family/social and psychological. The ASI measures a 30-day time period and provides scores between 0 and 1 for each problem area. Although the instrument includes a measure of psychiatric severity as well, we opted to use a more comprehensive measure for psychiatric symptoms which is described below.

2. Psychiatric symptoms: To assess current psychiatric severity we used the Brief Symptom Inventory (Derogatis & Melisaratos, 1983). Items ask a variety of questions about anxiety, depression and other types of psychiatric distress and are rated on a 5-point scale. The time period assessed is the past seven days, but the BSI has been shown to correlate with longstanding psychiatric disorders as well. We used the overall severity measure of the BSI, the Global Severity Index, as an overall measure of psychiatric severity.

3. Six-month measures of alcohol and drug use: These measures were taken from Gerstein, et al. (1994) and labeled six-month abstinence and peak density. Six-month abstinence was a dichotomous yes/no measure assessing any use of alcohol or drugs over the past six months. In addition to complete abstinence, we also wanted to understand patterns of substance use. Peak density was used to assess patterns of use and was defined as the number of days of any substance use (i.e., any alcohol or drug) during the month of highest use over the past six months. In order to assess if residents who relapsed nonetheless made improvement, we report findings for the entire sample as well as for residents who relapsed at some point over the 18 months of the study.

4. Additional 6-month assessments: Two additional measures were taken from Gerstein, et al. (1994). These included measures of arrests and days worked over the past six months.

 In addition to demonstrating favorable outcomes, we were interested in understanding if factors deemed essential to recovery in SLHs were associated with outcome. We therefore evaluated whether residents who were more involved in 12-Step groups and had fewer alcohol and drug users in their social networks had better outcomes.

Alcoholics Anonymous Affiliation Scale: This measure includes nine items and was developed by Humphreys, Kaskutas and Weisner (1998) to measure the strength of an individual’s affiliation with AA. The scale includes a number of items beyond attendance at meetings, including questions about sponsorship, spirituality and volunteer service positions at meetings. An overall scale score ranging from 0 to 9 is generated by summing the items.

2) Drinking and drug use status in the social network: These measures were taken from the Important People Instrument (Zywiak, et al., 2002). The instrument allows participants to identify up to 12 important people in his or her network whom they have had contact with in the past six months. Information on the type of relationship (e.g., spouse, friend), amount of contact over the past six months (e.g., daily, once or twice a week) and drug and alcohol use over the past six months (e.g., heavy user, light user, in recovery) was obtained for each person in the social network. The drinking status of the social network was calculated by multiplying the amount of contact by the drinking pattern of each network member, averaged across the network. The same method is applied to obtain the drug status of the network member; the amount of contact is multiplied by the pattern of drug use and averaged across network members.

Participants

Study participants were recruited and interviewed within their first week of entering the houses between January 2004 and July 2006 and interviewed again at 6-, 12- and 18-month followups. Interviews required about two hours and participants were paid $30 for the baseline interview and $50 for each of the follow-up interviews. All participants signed an informed consent to take part in the study and all were informed that their responses were confidential. Study procedures were approved by the Public Health Institute Institutional Review Board and a federal certificate of confidentiality was obtained, adding further protection to confidentiality.

To reach individuals for follow-up interviews we required them to provide contact information (e.g., phone number, address, e-mail, names of friends who might know their whereabouts, family members’ phone numbers, health service professionals from whom they received services, shelters they frequented and criminal justice personnel). Among the sample of 245, 89 percent participated in at least one follow-up interview. Follow-up rates for each time point included 72 percent at six months, 71 percent at 12 months and 73 percent at 18 months. To assess whether individuals that we located and interviewed at follow-up differed from those whom we were not able to locate we conducted baseline comparisons. Separate baseline comparisons were made for individuals interviewed and not interviewed at each time point. On each of these three comparisons we found no differences in terms of demographic characteristics, Addiction Severity Index scales (i.e., medical, legal, alcohol, drug, family and vocational), psychiatric symptoms and maximum number of days of substance use (alcohol or drugs) per month during the previous six months. Thus, the demographic characteristics and problem severity of individuals successfully followed up and lost at follow-up were not significantly different.

Most study participants were white (72 percent), male (77 percent) and middle age (mean=38, se=0.65). Over three-fourths had at least a high school education or GED and the average income from all sources the month before entering the SLH was $963 (se=$120). About half had never been married and slightly less (48 percent) had children under age 18. The most common referral source was self, family or friend (44 percent). Although 29 percent were referred through the criminal justice system, a much higher 42 percent indicated that they had been arrested at least once over the past six months. Over a third (35 percent) of the sample indicated that jail or prison had been their usual housing situation over the past six months and few reported any type of stable housing. Just 7 percent reported renting an apartment as their primary housing, while 23 percent reported staying with family or friends and 12 percent reported homeless as their primary living situation. The most common substances that residents were dependent on during the past year were methamphetamine (53 percent) and alcohol (49 percent).

Results

What follows is a summary of the main findings from the study. For a more detailed description of the measures and statistical analyses see Polcin, et al (2010).

Overall, retention in the SLHs was an area of strength. The average length of stay in the SLHs was over five months but that varied considerably. At the six-month time point, 42 percent were still residing in the SLHs. Residency dropped to 18 percent at 12 months and 16 percent at 18 months.

On all of our primary outcomes and some secondary outcomes as well, we found one of two patterns over time. One pattern involved residents entering the SLHs with moderate to high severity of problems, making significant improvements at 6 months and maintaining those improvements at 12 and 18 months. All of the baseline and six-month comparisons reported below were statistically significant at p<.05 or better. For a complete discussion of our analyses and statistical findings see Polcin, et al. (2010).

 Improvement Patterns

The pattern of improvement at 6 months and maintenance of that improvement at 12 and 18 months was most typically the pattern for variables measuring a six-month period of time. The other outcome pattern showed residents entering the SLHs with low severity of problems at baseline and then maintaining low severity at 6-, 12- and 18-month follow-up. This pattern was more typical for measures assessing a shorter time period, such as the Addiction Severity Index scales that assessed alcohol and drug severity.

An example of the first pattern included our measure of abstinence. During the six months before they entered the SLHs, 20 percent of the residents reported being abstinent from alcohol and drugs. That improved to 40 percent at six-month follow-up. Abstinence improved even more at 12-month follow- up (45 percent) and declined only a bit at 18 months (42 percent).

Peak density (i.e., maximum number of days of substance use during the month of highest use) showed a similar pattern. During the six months before entering the SLHs peak density was on average 19 days of use per month. That improved to 10 days of use at six and 12 months, and at 18 months there was only a bit of an increase (12 days). When we looked only at individuals who relapsed we found the same pattern, which indicates that despite their relapse their pattern of substance use was less severe.

Other variables that showed improvement between the baseline interview and six-month follow-up that were maintained at 12 and 18 months included ASI employment and arrests. At the time residents entered the SLHs they had an average score of 0.76 (se=0.02) on the ASI employment scale. That improved to 0.53 (se=0.02) at 6 months; 0.54 (se=0.03) at 12 months; and 0.59 (se=0.02) at 18 months. Although these scores indicate continuing concern about work and financial issues over the 18 months of the study, they also indicate significant improvement relative to baseline. The percent arrested during the six months before they entered the SLHs was 42 percent. That percent dropped to 26 percent at 6 months; 22 percent at 12 months; and 28 percent at 18 months. On our measure of psychiatric severity, the Brief Symptom Inventory Global Severity Index, we found significant improvement between baseline and six months. By 18 months psychiatric symptoms were worse than at six months, but the average GSI score nonetheless did maintain a statistical trend (p<.10) in the direction of improvement relative to baseline. However, the scores across all study time periods for the GSI ranged from 0.69 to 0.83, which indicates a moderate level of psychiatric distress throughout the study.

Variables that typified the other pattern of results, where resident entered with low severity at baseline and were able to maintain low severity at 6-, 12- and 18-month follow-up, included ASI alcohol, drug and legal scores. ASI scores range from 0 to 1.0, so the average score on alcohol severity at baseline (mean=0.16, se=0.02) and drug severity at baseline (mean=0.08, se=0.01) were relatively low. Because baseline severity was low, there was limited room to improve on these measures. Nevertheless, we found significant improvement at six months for both alcohol (mean=0.10, se=0.02) and drug (mean=0.05, se=0.01) scales. Those improvements were maintained at 12 and 18 months. Alcohol severity remained at 0.10 at 12 and 18 months, and drug severity also remained essentially unchanged, 0.06 at 12 and 18 months. On legal severity, residents entered with a relatively low mean of 0.11 (se=0.02) and that did not change to any significant extent over followup time points.

It should be noted that outcomes at 12 and 18 months changed very little from the six-month time point despite the lower number of individuals still residing in SLHs. While 42 percent of the sample were still living in the SLHs at six months, that declined to 18 percent at 12 months and 9 percent at 18 months.

Variables that were at relatively moderate to high severity levels that did not improve significantly over time included ASI family and medical scales. However, there was a trend for improvement at the 12-month time point for family severity, and all time points indicated less severity relative to baseline.

Outcome Predictions

In addition to tracking longitudinal changes over time, we were interested in factors that predicted outcome. These included demographic characteristics and factors related to the philosophy of recovery in SLHs, such as involvement in 12-Step groups and developing a social network supportive of abstinence. Therefore, to assess whether these factors were associated with outcome variables we conducted Generalized Estimating Equations. For a description of this analytic method and the data generated see Polcin, et al (2010).

Results of these analyses indicate that involvement in 12-Step groups was the strongest and most consistent predictor of good outcome. Higher levels of involvement in 12-Step groups were associated with better outcomes on six-month abstinence (p<.001), peak density (p<.001) and arrests (p<.01). We also examined how drinking and drug use in the participant’s social network related to outcomes. Heavier drinking and drug use in the participant’s social network was related to worse outcome on all alcohol and drug outcome measures, including abstinence, peak density and ASI alcohol and drug scales (p<.01 for all variables). In general, few demographic characteristics were related to outcome. The notable exception was the relationship between age and abstinence. Older age categories were over twice as likely to be abstinent than those age 18 to 28. Not surprising, residents with at least a high school diploma had lower ASI employment severity. However, they also were nearly twice as likely to be abstinent over the past six months and about half as likely to be arrested.

Overall, the findings show that significant improvements were made between baseline and six months on most primary outcomes and some secondary outcome as well. It is noteworthy that the improvements were generally maintained at 12 and 18 months even though nearly all participates had left by the 18-month interview. In addition, analyses showed that factors relevant to the recovery philosophy of SLHs (i.e., characteristics of the social network and 12-Step involvement) were associated with the outcome.

In the discussion below we first consider in more detail findings for outcome variables measuring a six-month period of time. We then address findings for variables measuring shorter time periods, such as the ASI scales.

We end with an analysis of how our findings support previous research emphasizing the importance of social factors in recovery and considerations for additional research.

Findings for Variables Measuring Six Months

Variables that measured a six-month period of time showed large improvements between the baseline interview and all follow-up time points. These included measures of alcohol and drug abstinence, peak density of substance use (days of use per month during the month of highest use), and arrests. Overall, the six-month period before entering the houses showed that residents were experiencing significant problems. For example, the vast majority (81 percent) reported some alcohol or drug use and peak density of substance use was on average 19 days per month. About half had not been employed at all during the six-month period and 42 percent had been arrested. Because these problem areas were high at baseline, there was room for improvement on these measures during subsequent assessments.

When we examined demographic factors, it was clear that improvements were being made by a variety of demographic groups. An exception included young age groups (18–28) having smaller proportions reporting abstinence over a six-month time period. One reason could be that the older age groups might have had more unsuccessful attempts to control their use and thus opted for a goal of complete abstinence. If younger residents have fewer failed attempts to control their use, they may be more likely than older residents to feel that controlled use is an attainable goal.

ASI and Brief Symptom Inventory

Measures that assessed a shorter time period, such as the ASI (one month) and Brief Symptom Inventory (seven days) showed more variability. For example, legal severity was relatively low at entry into the houses and did not change to any significant extent at 12 or 18 months. While some individuals entering the houses did not have any legal issues, and thus had low ASI legal severity scores, others had legal requirements to abstain from alcohol and drugs. Over a quarter of the sample was referred from the criminal justice system. However, by the time these individuals were entering SLHs their legal status may have been less of a concern because the most important decisions about there legal status were already decided. Typically, if they complied with SLH rules, such as abstinence, their legal issues were resolved.

Two additional ASI scales showed relatively low severity at entry into the houses (e.g., alcohol and drug and scales) nonetheless showed significant improvement between baseline and six months that was maintained at 12 and 18 months. The fact that residents had relatively low alcohol and drug severity at baseline is not surprising given that entry into the houses required some demonstrated motivation for recovery to be accepted as a resident. Many residents had already started attending 12-Step meetings or had come from controlled environments where access to substances would have been difficult (e.g., residential treatment or incarceration). In fact, over three-quarters of the sample spent some period of time in a controlled environment during the 30 days before they entered the facility.

On two scales measuring relatively short time periods (ASI employment and the Global Severity Index from the BSI), we found residents entered with high severity that improved at 6 months and was maintained at 12 months. For employment, significant improvement also persisted through the 18-month follow-up point. For the Global Severity Index, the level of psychiatric symptoms was no longer statistically significant (compared to baseline), but nonetheless continued as a clear statistical trend only slightly beyond the .05 level of significance.

It is not surprising that employment severity was relatively high at baseline given the demographic finding that over three-quarters of the sample spent some period of time in a controlled environment during the 30 days before they entered the facility. Whether the controlled environment was incarceration, residential treatment or some other facility it would have detracted from employment stability. In addition, nearly half of the sample reported no work at all over the six months before entering the program, so work was clearly an issue for many residents. Given that residents were expected to pay for rent and other fees, it was not surprising that employment severity improved.

It was interesting that the improvements seen at 6 months were generally maintained at 12 and 18 months despite the fact that the vast majority of residents had left the residence at 18 months. At 18 months there was no relationship between outcome and length of stay in the SLHs. These findings may be due to residents having on average about a five-month length of stay, which is well beyond the minimum three-month length of stay recommended by the National Institute on Drug Abuse (1999). Thus, a majority might have maximized their benefit by the time they left. However, it was also interesting that the relationship between social network variables (12-Step involvement and drug and alcohol use in the social network) continued across all follow-up time points. The findings might indicate that by the time residents decided to leave the SLH they had been successful in establishing social support for recovery outside the SLH and were able to maintain that support over time.

Social Support Influences

The findings that level of involvement in 12-Step groups and characteristics of the social network were related to outcome supports a growing body of literature emphasizing these factors in addiction outcome. For example, Bond, et al. (2003) studied a sample of individuals entering alcohol treatment and found that fewer numbers of heavy drinkers in the social network and higher level of involvement in 12-Step groups were associated with better drinking outcome at oneand three-year follow-up. Moos and Moos (2006) found similar results in a sample of treated and untreated individuals with alcohol use disorders who were followed up over 16 years. The researchers found people’s involvement in AA and access to more social support resources were associated with less drinking. In a review of outcome research in the drug and alcohol field Moos (2007) emphasized a number social support factors, all of which are relevant to AA, as important in recovery from addiction: social bonds that shield one from substance use, social rewards for prosocial behaviors that are inconsistent with substance use and social learning theory that involves individuals learning how to cope with stress and get needs met without alcohol and drug use.

In addition to supporting previous research on the social factors influencing recovery, the study findings also support the purported mechanisms of how SLHs are helpful (Polcin & Henderson, 2008). Central to the philosophy of recovery in SLHs is the notion that persons with substance use disorders need a sustained living environment (i.e., longer than that typically offered by inpatient treatment) that is free of alcohol and drugs and offers social support for sobriety. Results confirmed individuals with more alcohol and drug users in their social networks were more likely to have worse outcomes on most of our study variables. Also central to the recovery philosophy of SLHs is the notion that involvement in self-help groups is important. Study results showed that greater involvement in 12-Step groups resulted in better outcomes.

Residents of SLHs made improvements in a variety of areas. Results support the importance of key components of the recovery model used by SLHs: involvement in 12-Step groups and developing social support systems with fewer alcohol and drug users. Additional studies should compare residents in SLHs with similar individuals in other living environments.

SLHs offer an alcohol and drug abstinent living environment and social support for recovery for individuals attempting to abstain from alcohol and drug use. SLHs have advantages over formal treatment models because they are financially self-sustained through resident fees and residents can stay as long as they wish. The SLHs studied here served as referral sources for a wide variety of individuals with substance use disorders, including those completing inpatient treatment, attending outpatient programs, leaving incarceration and voluntarily seeking help outside the context of formal treatment. Examination of longitudinal outcomes showed that residents in SLHs made significant improvements in a variety of areas, including alcohol and drug use, employment, psychiatric severity, and arrests. As expected, residents who had social networks with less alcohol and drug use and those with higher involvement in 12-Step groups had better outcomes. The results reported here support the need for larger, controlled trials that compare outcomes of residents in SLHs with outcomes of individual in other living environments. Involvement in 12-Step groups and alcohol and drug use in the social network are important potential mechanisms to be assessed in a variety of living situations.

Acknowledgement: Supported by R01AA14030

Note: This article was adapted from an article that ran in the Journal of Substance Abuse Treatment (JSAT) in accordance with a partnership agreement between Counselor Magazine and JSAT to bridge the gap between research and clinical practice in the addiction field (Polcin, D.L., Korcha, R., Bond, J. & Galloway, G.P. (2010). Sober Living Houses for Alcohol and Drug Dependence: 18-Month Outcomes. Journal of Substance Abuse Treatment, 38(4) 356–365.).

Douglas L. Polcin, EdD, MFT is a senior scientist at the Alcohol Research Group. His research interests include peer helping, motivational interviewing, and supportive confrontation. He has over 30 years of clinical and supervision experience in addiction treatment.

Rachael Korcha, MA, is an associate scientist at the Alcohol Research Group. She has been involved in a wide variety of epidemiology and treatment studies. Her research interests include mental health functioning and substance use, motivation to change behavior, HIV risk, and alternative substance abuse treatment approaches.

Jason Bond, PhD, is a senior scientist and statistician at the Alcohol Research Group. He has been involved in a wide variety of epidemiology and treatment research, including studies that use multivariate modeling of longitudinal change.

Gantt Galloway, PharmD, is a scientist at the Addiction Pharmacology Research Laboratory at California Pacific Medical Center. He has over 20 years of research and clinical experience with alcoholics and other addicts. He has worked in a number of treatment settings, such as the Haight-Ashbury Free Clinic.

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3.26 Copyright (C) 2008 Compojoom.com / Copyright (C) 2007 Alain Georgette / Copyright (C) 2006 Frantisek Hliva. All rights reserved."