Beyond Afterthoughts: Building a True Recovery Continuum in Tennessee

Somewhere between surviving a crisis and establishing a fulfilling life in recovery, Tennesseans face a critical gap. At one end stands a formidable treatment system that can be lifesaving, intensive, and expertly led by clinicians and state partners. At the other, a vision of independent, long-term wellness. Yet what lies between them remains insufficiently recognized, underfunded, and structurally misunderstood. The missing link is certified recovery housing backed by recognized national standards. A recovery support service long treated like auxiliary scaffolding, when in fact, it is foundational architecture.

Despite perceptions, recovery rarely follows a neat, linear path from assessment to discharge. Clinical treatment can help stabilize an individual in crisis, but sustained recovery is a dynamic, adaptive process that unfolds in a community where structure, accountability, and hope are reinforced daily. It is in this unique space that high quality certified recovery residences excel, offering a blend of peer support, safety, evidence-based routine, and recovery-oriented culture.

Over the past two decades, Tennessee has demonstrated its commitment to supportive housing solutions. The Creating Homes Initiative (CHI), launched by state leadership, has transformed the landscape by marshaling $1.3 billion to create more than 36,000 supportive housing opportunities for residents facing behavioral health challenges. These are significant achievements, and thousands have found safety, support, and a fresh start as a result.

However, not every supportive housing bed is designed to promote long-term recovery from substance use.

The distinction between “supportive” and “recovery” housing is not semantic, it is, in practical terms, the difference between stability and transformation. Certified recovery housing operates under a peer-driven, abstinence-based model. It emphasizes social connection, governance by lived experience, and adherence to standards that foster genuine, measurable outcomes. These kinds of outcomes are not reliably produced by general supportive housing or temporary shelters.

Recovery housing, as formally defined by the National Alliance for Recovery Residences (NARR), consists of homes that vary in structure and professional involvement, but all share key elements: safety, community, accountability, and support. Certification, using the NARR framework and administered in Tennessee by TN-ARR, is not a ceremonial badge, but rather a proven safeguard. TN-ARR certified homes are evaluated against universally accepted benchmarks for operations, ethics, resident rights, and recovery orientation. This is a necessary distinction that should drive policy, investment, and public understanding. Developments in national addiction medicine standards underscore the urgency of this case.

The American Society of Addiction Medicine (ASAM), in its Fourth Edition Criteria, now formally recognizes recovery housing as a recommended and integral part of the clinical care continuum. For the first time, the “clinician’s bible” affirms that outcomes improve when people have access to safe, structured, peer-based living environments, especially in the months and years after leaving treatment. This update reflects a growing body of research demonstrating that individuals exiting even world-class clinical programs face heightened risk of relapse, hospitalization, or incarceration when discharged to unstable, unsupportive, or substance-permissive environments.

Yet, despite unanimous professional agreement on its necessity, Tennessee’s recovery housing remains structurally detached from mainstream funding. While clinical services are sustained by reimbursement mechanisms, grants, and dedicated infrastructure, recovery residences exist on precarious ground. The 2025 Fletcher Group survey reveals that most Tennessee recovery homes cover annual operating costs nearing $330,000 and largely through resident fees. Over 80% of operators identify lack of funding as their greatest existential risk. Many of these operators supplement personal funds, volunteer labor, or sporadic donations. Not because their work is any less vital than treatment, but because the system does not yet fully value it. This is not a sustainable formula for safety, quality, or expansion.

If Tennessee wishes to meet the real demands of its worsening overdose crisis, a 71% increase in five years, with one in six residents over age 12 meeting criteria for substance use disorder, then recovery housing must become as integral and reliably funded as the treatment services clinicians are trained to deliver.

Opponents sometimes argue that funding recovery housing is redundant, or that regulation will burden innovation or “grassroots” providers. The facts show otherwise. States that have paired funding with robust, enforced certification (often modeled on NARR standards) see decreased fraud and resident exploitation, increased public safety, and improved long-term outcomes, including the public purse. Florida’s use of voluntary certification as a prerequisite for public funding and self-referral is one example; Arizona’s less regulated system, by contrast, continues to struggle with oversight and effectiveness.

There are important synergies to be leveraged as SAMHSA and HUD now routinely emphasize, a comprehensive care continuum requires collaboration between housing, service delivery, and regulatory partners. The infrastructure to identify, support, and grow high quality recovery housing already exists in the certification process. What is urgently needed now is public investment in that system, so that providers are rewarded, not penalized, for providing best-practice, peer-led, highly accountable environments.

Failure to act carries steep costs. Waitlists grow, rural and underserved areas fall further behind, and Tennesseans in early recovery remain at disproportionate risk. This is not a gap to “patch up,” but a critical bridge to reinforce with clear standards, sustainable funding, and the unwavering commitment of state partners.

Clinicians, policy leaders, housing professionals, and recovery advocates all seek the same goal: long-term, meaningful outcomes for Tennesseans battling substance misuse. The evidence makes clear that nationally recognized certified recovery housing is indispensable for achieving those outcomes. ASAM’s endorsement is no mere symbolic gesture. It is a call to thoughtfully construct a broader system. One that funds, integrates, and sustains recovery homes with the same seriousness applied to treatment itself. We are not calling for a special favor, but for parity, recognition, and deliberate investment.

It is time for Tennessee to create a dedicated funding stream for certified recovery housing and the ongoing process of accountable, evidence-based certification. However, it is important to clarify that not all agencies listed as certifiers of recovery housing in Tennessee apply the same standards or truly function as certification organizations.

While the Department lists multiple bodies, including CARF, The Joint Commission, NSLA, RITNH, Oxford House, and The Tennessee Alliance of Recovery Residences, the reality is that standards, rigor, and legitimacy vary greatly.

CARF and The Joint Commission are respected clinical or medical facility accreditors, but they are not grounded in the social-model, peer-driven certification authored by NARR. Oxford House provides an independent charter system but is not a certifying body for the broader spectrum of homes. Some recently formed agencies lack clear national affiliation, transparent oversight, or proven quality assurance.

The National Alliance for Recovery Residences (NARR), with TN-ARR as its official Tennessee Affiliate, is the only organization recognized by national authorities, including ASAM, for setting, auditing, and upholding recovery residence standards tailored to peer-led environments.

For Tennessee to ensure safety, effectiveness, and transparency, funding and policy should prioritize certification explicitly grounded in these field-specific and nationally recognized standards, not merely the presence of a “certified” label.

The 2025 SAFE Act amendment takes an important step by establishing clear statewide minimum standards for certifying organizations. These include essential protections from drug and alcohol testing to fire safety, resident rights, financial transparency, and annual site inspections. However, while this new law creates a critical baseline, the real measure of quality recovery housing goes beyond legal checklists. TN-ARR incorporates every state-required standard but builds on them with nationally recognized best practices: documented governance, ongoing operator education, a strong peer-driven social model, routine audits, and engagement with both residents and the broader recovery community.

Simply meeting legal minimums might ensure compliance, living up to the NARR standard means striving for excellence and better outcomes. For Tennessee to lead, our funding and policy should prioritize homes and certification bodies whose standards are shaped by field-tested, national expertise, not just those who check the boxes.

Supporting both operational costs and ongoing oversight, training, and data collection through true certification will directly translate into lives saved, families reunited, and communities strengthened. It will also maximize the impact of every dollar already spent on emergency care, criminal justice, and treatment, the very definition of good stewardship.

The future of recovery in Tennessee is not a matter of chance, but of strategic choice. Those in leadership must see certified recovery housing not as an add-on, but as a launch pad for stability, health, and community re-integration.

By aligning funding and oversight with what research, clinicians, and lived experience collectively affirm, we can move from treating symptoms to supporting sustainable solutions.

If we hope to transform the state’s landscape, bridging the gap between surviving addiction and living in recovery, then certified recovery housing must finally be recognized and resourced as a pillar of Tennessee’s continuum. Only by building on the strengths of our existing programs, heeding the lessons of national best practices, and investing in the infrastructure that nurtures dignity and possibility can we ensure that no Tennessean is left under the bridge with nowhere to go.

The foundation has been laid. The standards are set. The evidence is clear. It’s time to fund the future of recovery housing in Tennessee, boldly, collaboratively, and with the conviction that recovery is not just possible, it is inevitable, given the right support.

Marlana Smartt-Byrge

TN-ARR Advocacy Committee Co-Chair