Efficacy of Recovery Housing In Ameliorating Substance Use Disorder

 INTRODUCTION

“Substance use disorder (SUD) is characterized by continued substance use despite harmful consequences including clinically significant impairment and/or distress. It remains one of the world’s greatest public health problems, with 48 million people living with SUD in the United States, with more than 1 in 100 experiencing this worldwide. In the United States, drugs contribute to around 300 fatal overdose deaths per day and excessive alcohol use contributes to 480 deaths per day. In addition to high mortality rates, SUD is associated with a loss of approximately 25 disability-adjusted life years per affected person. The economic cost of illicit drug use and excessive alcohol use in the United States is over 400 billion annually.”

“Despite the immense global impact of SUD, this condition has a relatively good prognosis, with 70–75% of people seeking SUD recovery eventually achieving sustained SUD remission.”

“A rapidly growing literature highlights the importance for longitudinal care and management of SUD, consistent with care models for other chronic health conditions. This literature indicates that SUD relapse risk is significantly ameliorated by long-term recovery support that extends beyond current standard SUD-care practices like medically managed withdrawal and 28-day residential treatment programs. Although many forms of ongoing support may benefit individuals seeking SUD recovery, one of the most important and widely available is recovery housing.”

“Recovery housing (also commonly referred to as recovery residences) is an umbrella term referring to abstinence-based living environments that offer short- or long-term instrumental and social support for individuals seeking recovery from SUD. Recovery houses are distinct from housing offered within inpatient/residential treatment and offer a range of levels of support that have been organized, described, and certified.”  (Vilsaint CL, Tansey AG, Hennessy EA, Eddie D, Hoffman LA and Kelly JF (2025) Recovery housing for substance use disorder: a systematic review. Front. Public Health 13:1506412. doi: 10.3389/fpubh.2025.1506412).

“High-quality recovery residences provide affordable choices that support outpatient and other forms of community-based treatment. As recovery services shift from an acute care model to sustained recovery management, it is important that the recovery residence field be visible and vocal in discussions regarding funding and reimbursement issues… Recovery residences have proven to be effective in reducing homelessness for persons with substance use disorders.  The community model inherent in all levels facilitates access to sustaining recovery practices, while offering a preferable alternative to traditional shelters.” 

“Recovery residences also offer a positive option for the criminal justice system. Community-based alternatives such as recovery residences are poised to curb the flow of people into jails and prisons via drug court and other front-end programs, while also serving as key re-entry resources for inmates, of whom 75% report that substances were associated with their incarceration.”  

(A New Understanding of Recovery Residences, The Rhetoric of Recovery Advocacy:  An Essay on the Power of Language, William L. White).

Additionally, recovery residences “enable the individual to continue building recovery capital and addressing barriers to recovery while providing safe and healthy environments in which skills vital for sustaining recovery are learned and practiced.  Many recovery residences utilize social model programs of recovery to guide their organization and services.  The norms of a recovering community are a type of milieu, which acts as a therapeutic method; this therapeutic milieu reinforces the skills, attitudes, outlooks, and self-concepts needed for a sustained recovery."  (The ASAM Criteria – Treatment Criteria for Addictive, Substance-Related, and Co-occurring Conditions, 4^th Edition, P. 383).

The Value of Recovery Housing -- Virginia Research Study

“A 2025 Frontiers in Public Health systematic review found that recovery housing, compared to standard continuing care, delivers consistent benefits such as higher abstinence rates, improved employment, income, and reduced criminal charges especially over longer-term stays of 6 to 24 months.”

“Meanwhile, an observational study of nearly 2,000 residents in Virginia-certified recovery residences revealed:  ‘Retention for 6–18 months is essential to establish and maintain positive discharge outcomes,’ particularly among people with recent criminal justice system involvement.  These data underscore a consistent truth: sustained engagement in a structured recovery environment dramatically improves outcomes.”  (https://medium.com/@g3recovery9/virginia-research-in-2025-reinforces-the-value-of-recovery-housing-03e6a9fd3b11)

How Effective Is Recovery Housing In Ameliorating Drug Overdose?

“In July 20I7 the city of Delray Beach Florida required certification for all recovery residences housing 4 or more unrelated individuals. A year later after this rule was implemented the city of Delray Beach witnessed a significant 60% decline in overdoses from 635 to 245. The city of Delray Beach also saw another 48% decrease in overdoses for the most recent year since this ordinance became law.” (Recovery Housing: Best Practices and Suggested Guidelines, P. 7 -- SAMHSA).

An Economic Impact Study:  Ohio Recovery Housing (ORH) Return on Investment

“Over the course of 15 years, a representative ORH-certified organization in Ohio serves approximately 480 residents. The total present value of economic benefits is approximately

$119 million. Of these benefits, approximately 3% are due to avoided criminal justice costs ($3.2 million), 3% are due to avoided healthcare costs ($3.1 million), 9% are due to avoided productivity costs ($10.7 million), and 85% are due to other benefits in the form of reduced premature mortality and morbidity ($102.3 million). The present value of total costs is approximately $2.7 million. The present value of the net benefits (i.e., the total benefits minus the total costs) is approximately $116 million over 15 years. The total return on investment of the organization over the course of 15 years is $42.60 per dollar invested.”

“Even under the most conservative modelling of recovery involving a 5-year time lag of benefits, the net benefits of the organization are positive at $79 million and the return on investment is $29 per dollar invested.”

“Despite limitations, ensuring that the supply of recovery support services, such as quality recovery residences are available to residents in Ohio with SUD is imperative to reduce the morbidity and mortality associated with SUD. Recovery housing is a critical resource in responding to health-related social need that may have duplicative impacts if accessed – representing a potential door to accessing other recovery supports. Future work should aim to engage a more representative group of recovery housing operators on the importance of measuring the impacts of the service they provide and its potential associated cost-savings.”

(The Fletcher Group Rural Center of Excellence – Fletcher Group Economic Calculator Results Report Prepared For:  Ohio Recovery Housing – June 2024, PP. 5 & 9.  Ashworth M, Johnson D, Meyer G, Thompson R. Fletcher Group Economic Calculator. Fletcher Group, Inc.; 2023.  https://www.fletchergroup.org/2023/10/02/economic-calculator/).  For questions, please contact Dr. Madison Ashworth (mashworth@fletchergroup.org).

SUMMARY

The efficacy of high-quality recovery housing in ameliorating substance use disorder, opioid use disorder and co-occurring mental health conditions is well established.  Federal, state and local governments that provide dedicated funding for recovery housing and embedded recovery support services as an investment “in promoting the availability of high-quality recovery housing” (See: “Excellence in Recovery Housing Act”) have experienced exponential returns on their investment as a result of avoided criminal justice costs, healthcare costs, avoided productivity costs and benefits in the form of reduced premature mortality and morbidity (Ohio Recovery Housing Report) in addition to a reduction in recidivism to homelessness.  “As recovery services shift from an acute care model to sustained recovery management” (White), NARR is leading the way in promoting high-quality certified recovery residences to meet the need: 

“First and foremost, our primary mission is to serve the interests of individuals seeking recovery in safe, supportive and well-managed recovery residences. We developed, and maintain, the only widely-adopted national standards for best practices in the operation of recovery housing. We have considerable expertise in the area of state recovery housing regulation, having assisted several legislatures and SUD agencies in other states develop or improve their legislative and administrative support frameworks. We co-authored, with the National Council for Mental Wellbeing, the definitive state policy guide for state governments on the regulation of recovery housing, which outlines a regulatory and support framework that has been adopted, in whole or in substantial part, by 20 states to date. NARR and Oxford House collaborated with the Substance Abuse and Mental Health Services Administration (SAMHSA) in the development of their recovery housing best practices publication. NARR was consulted by and collaborated with the American Society of Addiction Medicine (ASAM) in the development of the fourth edition of The ASAM Criteria, the publication that defines SUD treatment program components and assessment criteria nationally. Five members of the NARR leadership team are credited chapter co-authors. As a result of our joint work, ASAM now includes recovery residences in its continuum of SUD treatment and recovery support services, using NARR’s terminology, definition of recovery housing, our taxonomy for levels (now types) of residential supports, and recommendations for integrating recovery residences into the formerly clinical-only continuum.”

“Our policy advocacy at the federal level is responsible for important elements of the SUPPORT Act (2018), Excellence in Recovery Housing Act (2023), and HUD’s Recovery Housing Program that provides funding to states for recovery housing expansion. We also collaborated with other national and state government stakeholders in the development of model state recovery housing laws in a project sponsored by the White House Office of National Drug Control Policy. We are currently part of multiple SAMHSA initiatives focusing on better integration between harm reduction and recovery housing, design of new comprehensive service models, and new approaches to funding recovery housing and other recovery support services. We also have relationships with the US Department of Justice and HUD’s civil rights division on fair housing issues.” (Dave Sheridan, NARR Executive Director).

CONCLUSION

“SAMHSA strongly supports the use of recovery housing as a key recovery support strategy to assist individuals living with substance use and/or co-occurring mental health disorder in achieving and sustaining recovery. Providing individuals with a safe and stable place to live can potentially be the foundation for a lifetime in recovery. It is critical that recovery housing programs function with sound, ethical, and effective standards and guidelines which center on a safe, healthy living environment where individuals gain access to community supports and recovery support services to advance their recovery… Recovery housing that meets nationally recognized standards (e.g., Oxford House, Inc. and NARR) are evidence-based practices." (Best Practices for Recovery Housing,” P. 10 -- SAMHSA). 

States that have invested in the NARR “regulatory framework that has been adopted, in whole or in substantial part, by 20 states to date” (Sheridan) are reaping the benefits and  dividend returns on investments in local and state government cost-savings, and, more importantly, an incalculable return on investment in the life-saving services provided in high-quality certified recovery housing for individuals seeking hope, healing and wholeness in recovery from substance use disorder, opioid use disorder, and co-occurring mental health conditions. 

Kyle Duvall

TN-ARR Advocacy Chairman