Residential Recovery: How the Recovering Addict Experiences It
Residential Addiction Recovery is built on the premise that a percentage of those with Substance Use Disorders who wish to end their addiction meet three characteristics:
1) they are healthy enough to withstand detox without medical intervention
2) the specific substances they use do not predicate medical intervention
3) they are free of co-occurring disorders that must be treated medically concurrently
The lack of a need for medical intervention leads to the potential for housing those in recovery in a residential setting, which should be less expensive and more comfortable than recovery in a clinical or "institutional" setting. Likewise, the number of hospital beds in California to handle inpatient addiction treatment is limited when compared with the demand.
It is safer and easier for those who are attempting recovery to live in an environment devoid of addicting substances. Hence, typical residential housing for those in recovery is referred to as “sober living,” as if the most important characteristic is the intended absence of alcohol and addicting drugs. Unfortunately, this description obscures several important dimensions of “sober living.”
1) they are healthy enough to withstand detox without medical intervention
2) the specific substances they use do not predicate medical intervention
3) they are free of co-occurring disorders that must be treated medically concurrently
The lack of a need for medical intervention leads to the potential for housing those in recovery in a residential setting, which should be less expensive and more comfortable than recovery in a clinical or "institutional" setting. Likewise, the number of hospital beds in California to handle inpatient addiction treatment is limited when compared with the demand.
It is safer and easier for those who are attempting recovery to live in an environment devoid of addicting substances. Hence, typical residential housing for those in recovery is referred to as “sober living,” as if the most important characteristic is the intended absence of alcohol and addicting drugs. Unfortunately, this description obscures several important dimensions of “sober living.”
One of the earliest steps for a person seeking active treatment is to meet with an intake coordinator who determines from the patient's history:
- whether they need detoxification,
- what type of center is qualified to help the patient, and
- what the plan of treatment would be.
Note that it is a conflict of interest for an Intake Coordinator associated with a Treatment Center to decide the Addict would be better served elsewhere. In Detox, the earliest stage of Recovery, the addict is either weaned off the addicting substances (by being provided with substitutes) or simply stops using them and consequently suffers symptoms of serious illness. In California, houses providing Detox services are supposed to be state licensed and have no more than 6 occupants, unless they have obtained a Conditional Use Permit from the city where they reside. Residential care services include checking regularly on the Recovering Addict while they are asleep. Residential care staff, who are not required to have para-medical training, are supposed to be on site around the clock. This phase typically lasts 1-3 weeks before the Recovering Addict is moved to a house with a lower level of supervision.
After Detox or if Detox isn’t needed, the Recovering Addict may commit to an intense level of “out-patient” treatment, nearly daily therapies, under a contract. The Residential Recovery phase typically involves all-waking-hours supervision to prevent relapse, which is one reason why it is not done from the person’s own home. Offsite treatment and residential living may be mixed together contractually, though a California state law passed in 2019, AB 919, now requires separate contracts. In some Residential Recovery, the Recovering Addict is under 24 x 7 supervision: their daily schedule is planned by the Treatment Center; they are transported to activities in a van; their meals are arranged by someone else; there is someone supervising them when they are in the residence; they have limited access to communicating with the outside world. In other forms of Residential Recovery, the Recovering Addict lives in a house that is referred to as a "Sober Living Home" and has less supervision/monitoring, but they are similarly dependent on various services offered by the landlord or the Treatment Center, including transportation. These services come at a steep price, as much as $3000+ per day per person. In some state-licensed houses, the Recovering Addict receives therapy on the premises and may or may not have the ability to come and go according to house rules. Because of the typically high cost of supervision and services provided, this stage of recovery typically lasts 30-90 days before the Recovering Addict moves to another type of residence.
A Recovering Addict COULD also skip out-patient treatment and move straight to a third phase: Independent, Cooperative Sober Living in a home without supervision, where the goal is reintegration with society and finding a job. In this model, the Recovering Addict has reached a maintenance level of recovery. They agree to a set of "house rules" as part of their tenancy agreement. They might attend AA, for example, which does not require a contract.
It is critical to understand that Residential Recovery is fundamentally different than Independent, Cooperative Sober Living. In Residential Recovery, the Recovering Addict is more vulnerable to relapse and victimization due to their weakened health.
- whether they need detoxification,
- what type of center is qualified to help the patient, and
- what the plan of treatment would be.
Note that it is a conflict of interest for an Intake Coordinator associated with a Treatment Center to decide the Addict would be better served elsewhere. In Detox, the earliest stage of Recovery, the addict is either weaned off the addicting substances (by being provided with substitutes) or simply stops using them and consequently suffers symptoms of serious illness. In California, houses providing Detox services are supposed to be state licensed and have no more than 6 occupants, unless they have obtained a Conditional Use Permit from the city where they reside. Residential care services include checking regularly on the Recovering Addict while they are asleep. Residential care staff, who are not required to have para-medical training, are supposed to be on site around the clock. This phase typically lasts 1-3 weeks before the Recovering Addict is moved to a house with a lower level of supervision.
After Detox or if Detox isn’t needed, the Recovering Addict may commit to an intense level of “out-patient” treatment, nearly daily therapies, under a contract. The Residential Recovery phase typically involves all-waking-hours supervision to prevent relapse, which is one reason why it is not done from the person’s own home. Offsite treatment and residential living may be mixed together contractually, though a California state law passed in 2019, AB 919, now requires separate contracts. In some Residential Recovery, the Recovering Addict is under 24 x 7 supervision: their daily schedule is planned by the Treatment Center; they are transported to activities in a van; their meals are arranged by someone else; there is someone supervising them when they are in the residence; they have limited access to communicating with the outside world. In other forms of Residential Recovery, the Recovering Addict lives in a house that is referred to as a "Sober Living Home" and has less supervision/monitoring, but they are similarly dependent on various services offered by the landlord or the Treatment Center, including transportation. These services come at a steep price, as much as $3000+ per day per person. In some state-licensed houses, the Recovering Addict receives therapy on the premises and may or may not have the ability to come and go according to house rules. Because of the typically high cost of supervision and services provided, this stage of recovery typically lasts 30-90 days before the Recovering Addict moves to another type of residence.
A Recovering Addict COULD also skip out-patient treatment and move straight to a third phase: Independent, Cooperative Sober Living in a home without supervision, where the goal is reintegration with society and finding a job. In this model, the Recovering Addict has reached a maintenance level of recovery. They agree to a set of "house rules" as part of their tenancy agreement. They might attend AA, for example, which does not require a contract.
It is critical to understand that Residential Recovery is fundamentally different than Independent, Cooperative Sober Living. In Residential Recovery, the Recovering Addict is more vulnerable to relapse and victimization due to their weakened health.