Recovery- Oriented Housing And Support Services’ Secret Ingredient: The Social Model

By Jason Howell NARR President

Social Model

Peers have been living together and supporting each other in recovery from substance use issues since the mid-1800s. This 170- year legacy has given rise to a diverse spectrum of sober, safe and recovery supportive living environments that are collectively called recovery residences. To varying degrees, recovery residences live at the intersection of recovery support, addiction treatment and housing. At a minimum, recovery residences house a functionally equivalent family of peers that utilize social model philosophies to create mutually supportive relationships promoting recovery from alcohol and other drugs. That being said, many recovery residence providers bundle additional recovery support, life skills development and/or clinical services to meet the diverse and changing needs of individuals starting and learning to sustain recovery. A growing body of evidences has established recovery residences as evidenced-based and promising practices.

While funding and legislative policies have greatly shaped the type and supply of recovery residences, most providers have relied on self-pay or recovery community supplemented revenue models.

This economic force has linked sustainable recovery residences to recovery outcomes such as improved health, employment and quality of life. Ironically, it is the family-like characteristics and self-sustaining nature of most recovery residences that results in them being “hidden in plain sight” from the perspective of the general population while remaining the worst kept secret from the perspective of the local recovery community. Recovery residences have been traditionally established by individuals and small nonprofit organizations in response to local needs. This has led to a highly fragmented field, with most operators lacking the means to access information on standards or best practices.

The National Alliance for Recovery Residences (NARR) is poised to change all of that. In 2011, NARR formed to codify residence standards based on national best practices, empower resident choices and promote addiction recovery through the use of well-run recovery residences from coast to coast. Drawing from the wisdom of experts and regional recovery residence organizations from 15 different states, NARR developed a standardized nomenclature that frames the diverse marketplace into four general residence types, known as levels of support.

This gave the recovery community the language and construct to compare and contrast recovery residences with each other, and across types of services that residences provide. Likely due to the economic forces and outcomes focus mentioned above, key characteristics across recovery residences became apparent regardless of where and when they were developed.

One such essential element is the use of Social Model Recovery Philosophies to create a culture of recovery — the heart and soul — that lives within a resident community. Implementation of social model principles varies across residences and levels of support,
but the core value of a peer-led recovery culture, in which individuals play a meaningful part in their own recovery and in the support of other’s recovery, remains the same.

In early recovery, individuals often have to change their environments, activities and the people with whom they associate because addictive lifestyles have a distinctive culture e.g. language, values, roles, rituals and relationships. A culture of addiction can initiate and perpetuate addictive lifestyles. Individuals can become as dependent on a culture of addiction as they are on the addictive substance. Some become so enmeshed in a culture of addiction that they may not know or see any other way of living.

Recovery lifestyles also have a distinctive culture: history, language, rituals, symbols, literature, and values. To untangle from an addictive lifestyle, individuals need to replace their culture of addiction with a culture of recovery. Social model programs, such as those found in recovery residences, teach people how to live recovery. Moreover, the social model provides organizations with a framework that delivers culturally competent services to persons starting and sustaining recovery.

NARR advocates for robust recovery-oriented systems of care, and within these systems of care, individuals should have access to a full spectrum of recovery residence options that cost effectively matches the needs of individuals. This includes the integration of peer-delivered recovery support along with clinical services at residences providing higher levels of support. The challenge is that these social model services are not easily evaluated by
consumers and are not usually valued by third-party payers. As a result, social model elements are often considered unnecessary and subsequently dropped. In the 1990s, Dr. Lee Ann Kaskutas documented this shift away from social model programming towards more billable clinical services in response to funding policy changes, despite research indicating that the utilization of social model recovery principles can improve outcomes at a lower cost.

Well into their second century of existence, self-pay and charitably funded recovery residences will continue to provide social model options to those who can find and afford them. The question remains whether and how policies can be aligned to expand the capacity and adoption of social model recovery philosophy across recovery-oriented housing, recovery support and treatment service options for those who desire them.