First of its kind, the National Study of Treatment and Addiction Recovery Residences (NSTARR) was launched last year to identify the gaps in recovery housing research and provide a complete picture of the recovery residence landscape across all 50 states. Recently, the project received a supplemental award to look at how recovery residences are dealing with the effects of COVID-19.
To learn more about the project and its impact, we spoke with principal investigator and ARG scientist Amy Mericle.
Can you tell us a little bit about the NSTARR study and the progress you have made over the past 12 months?
The first year of the NSTARR project has been focused on developing a comprehensive database of all types of recovery residences across the country. By all types, I am referring to residences that may be entirely peer-run as well as those that may provide treatment or other types of recovery support services. Thus far, the database consists of roughly 10,000 unduplicated recovery residences. Residences in the database are geo-located so that the team can better describe the distribution and density of recovery housing in the US and merge this data with other contextual data to characterize the neighborhoods in which recovery residences are located.
We will also use this database to generate a random sample of recovery residences (N=800) whose operators will be invited to participate in a survey about the characteristics of their residence. To prepare for undertaking this survey, we have been consulting with our Study Experts to refine our survey and study procedures.
Our Study Experts (N=17) represent leaders in the treatment, recovery, housing, and recovery housing fields who have experience conducting related research or have a stake in knowing about the prevalence and nature of recovery residences across the nation. These study experts have been essential to ensuring that we will be collecting the most relevant information on recovery housing with our survey.
In addition to publishing information about the study in recovery-related newsletters and trade magazines, the NSTARR project also has supported efforts to provide researchers with critical information about recovery housing through publications in peer-reviewed journals:
Mericle, A. A., Karriker-Jaffe, K., Patterson, D., Mahoney, E., Cooperman, L., Polcin, D. L. (In press). Recovery in context: Sober living houses and the ecology of recovery. Journal of Community Psychology. Abstract or Full Text
Mericle, A. A., Sheridan, D., Howell, J., Braucht, G., Karriker-Jaffe, K., Polcin, D. L. (In press). Sheltering in place and social distancing when the services provided are housing and social support: The COVID-19 health crisis and recovery housing. Journal of Substance Abuse Treatment. Abstract or Full Text
Miles, J., Howell, J., Sheridan, D., Braucht, G., & Mericle, A.A. (2020). Supporting individuals using medications for opioid use disorder in recovery residences: Challenges and opportunities for addressing the opioid epidemic. The American Journal of Drug and Alcohol Abuse, 46(3), 266-272 Abstract or Full Text
What challenges have recovery houses faced during the ongoing COVID-19 pandemic?
The COVID-19 pandemic may be particularly harmful to the physical health and wellbeing of those in recovery from alcohol and other drug (AOD) disorders. In addition to being at increased risk due to compromised health from long histories of AOD use, alcohol consumption tends to increase during times of stress and uncertainty, which could increase risk for relapse. Among individuals in recovery, those living in recovery housing are among the most vulnerable, simply by virtue of needing additional recovery support or affordable housing.
Recovery housing is rooted in the social model of recovery, which emphasizes peer support in helping residents maintain their recovery. CDC guidance for the general public for managing COVID-19, as well as its guidance for shared or congregate housing providers have significant implications for residential recovery residences providing services to persons with AOD disorders. To help providers navigate this guidance, the National Alliance for Recovery Residences (NARR) has developed and distributed recovery-housing-specific resources and hosted forums to discuss recovery housing challenges. However, it is currently unknown the extent to which CDC guidance and other recovery-residence-specific recommendations are being implemented by recovery residences, and the nature of recovery housing could present challenges to operators implementing them.
The majority of recovery residences operate with almost no formal third-party payers to reimburse or offset costs of this service. This leaves most expenses to be paid by individual residents, who come into recovery housing with a host co-occurring problems, including chronic health conditions, histories of homelessness, and under-employment. As furloughs and work stoppages continue for non-essential workers, questions loom about whether and how residences are to remain financially viable. Closures of this vital resource could be particularly detrimental in geographic regions with high case rates and rural areas with fewer resources, exacerbating existing health disparities.
Can you talk about the aims of your new supplement award from NIH?
Recognizing the important role that recovery housing plays for vulnerable segments of those in recovery from AOD, as well as the challenges that providers may experience adopting safety guidance and remaining financially viable, the team submitted an application to supplement the NSTARR project to better understand how recovery residences are responding to the COVID-19 pandemic, and its impact on the availability of recovery housing.
This supplemental study has two aims: (1) To examine the extent to which CDC guidance and NARR best practice guidelines are being implemented in recovery residences, to identify residence and other contextual characteristics related to differential implementation, and to describe changes in implementation over time; (2) To examine how the pandemic has affected the availability and financial viability of recovery housing, to identify whether this impact differs by residence and other contextual factors, and to describe changes in availability and financial viability over time.
To address these aims, this new study will add questions to the survey administered to residences participating in the National Study of Treatment and Addiction Recovery Residence (NSTARR) project. These questions will query the extent to which the COVID-19 pandemic has affected sources of revenue for the residence, policies and practices, and programming for residents. An additional 200 randomly sampled residences (stratified by US Census Division) will be asked to complete a COVID-19-specific survey that also collects information on implementation of COVID-19 specific guidelines. These residences will be linked with US Census data, COVID-19 case rates, and other geo-located data for federally qualified health centers (FQHCs) and publicly-funded hospitals. They will also be resurveyed 6 and 12 months later to track changes over time. Finally, operators of residences that are no longer open will be asked to participate in a semi-structured interview about the role that COVID-19 may have played in the closure of the residence.
How do you hope the study will facilitate future research?
Although a growing body of research supports the effectiveness of recovery housing, the scientific literature on recovery housing is fragmented and focused on certain types of recovery housing or in specific geographic regions. Further, while treatment professionals and the recovery community have long witnessed the ability of recovery housing to support individuals initiating and sustaining recovery from substance use issues, recovery housing remains largely undervalued in the larger behavioral healthcare system.
The NSTARR study will provide much needed information about the availability and nature of recovery housing across the US. By developing a database of recovery residences and a survey to assess them, this study will provide a blueprint for ongoing surveillance that could be conducted at the state and/or national levels. The study will provide a foundation to conduct future studies collecting resident-level data to identify best practice as well as studies of comparative effectiveness, cost-effectiveness, and comparative cost-effectiveness–all studies advancing quality standards for recovery housing and improving health outcomes for those in recovery.
Thanks for taking the time to speak with us! We look forward to hearing more about the project and its outcomes.