High-Quality Recovery Housing: Legislation and Best Practices Law & Literature

Introduction

On October 24, 2018, the “Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for patients and Communities Act” was signed into law by President Donald Trump. The law mandates that the Secretary of Health and Human Services “identify or facilitate the development of best practices for operating recovery housing.” As a result of the mandate, SAMHSA published “Recovery Housing: Best Practices and Suggested Guidelines” with an official definition for Recovery Housing in 2019.

In 2021, the Legislative Analysis and Public Policy Association (LAPPA) published the “Model

Recovery Residence Certification Act” to assist states in the development of Recovery Housing certification legislation based on national standards “best practices.”

On December 29, 2022, President Joe Biden signed into law the “Excellence in Recovery Housing Act, 2023,” which was part of the Consolidated Appropriations Act, 2023, HR2617 Senate Appropriations. Sec. 1231 of the Act states, “Clarifying the role of SAMHSA in promoting the availability of high-quality recovery housing.” The Act also requires The Secretary (HHS) to “continue activities to identify, facilitate the development of, and periodically update consensus-based best practices, which may include model laws for implementing suggested minimum standards for operating, and promoting the availability

of, high-quality recovery housing.”

In October 2023, SAMHSA published “Best Practices for Recovery Housing.” HUD distributed the “Best Practices” document throughout the United States. One month later, November 2023, the American Society of Addiction Medicine (ASAM) published The ASAM Criteria 4th Edition with a chapter devoted to Recovery Support Services (RSS), including Recovery Housing as a RSS. This was a historic milestone for recovery housing operators, and treatment providers, alike. It was the first time ASAM included non-clinical services as recommended in the ASAM continuum.

Parenthetically, five collaborative leaders of the National Alliance for Recovery Residences (NARR) were co-authors of “The ASAM Criteria, 4th Edition” in developing “the recovery support services (RSS) standards for each level of care, relevant Dimensional Admission Criteria, and Chapter 15: Integrating Recovery Support Services.” (The ASAM Criteria, p. xvii).

Making The Case for High-Quality Recovery Housing Certification/Accreditation Legislation

"One of the four supportive elements of recovery includes safe and supportive housing. However, having a place to live does not in and of itself facilitate recovery. Upon departure from institutions and treatment programs, individuals with SUDs often return to living environments that do not promote recovery or, worse yet, promote substance use. For example, an individual's safety and recovery could be threatened if their housing situation is rife with substance use coercion -- a form of abuse targeted toward a person's

use of substances as part of a broader pattern of abuse and control -- and/or intimate partner violence (IPV)... As such, recovery residences should be differentiated from other types of supportive housing and can be understood as RSS (Recovery Support Services) embedded within housing." (The ASAM Criteria, p. 385).

"Recovery houses are safe, healthy, family-like substance free living environments that support individuals in recovery from addiction. While recovery residences vary widely in structure, all are centered on peer support connection to services that promote long-term recovery." (Best Practices for Recovery Housing,” p. 9 – SAMHSA).

"All recovery housing approaches are characterized by alcohol- and drug-free living environments that are grounded in the Social Model of Recovery, but they can differ in their governance or staffing models as well as whether they offer additional supports and services. (Best Practices For Recovery Housing,” p. 9 – SAMHSA).

"SAMHSA recommends recovery housing entities be certified. Certification is one noted remedy to address unethical and illegal practices in recovery housing. NARR has developed the most widely referenced national standards to ensure well-operated, ethical, and supportive recovery housing." (Best Practices for Recovery Housing,” p. 10 – SAMHSA).

"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).

"Recovery support is nonclinical social support that promotes recovery from substance use and/or mental health challenges and includes emotional, informational, instrumental, and affiliation support." (The ASAM Criteria, p. 383).

“Recovery residences are an important source of recovery support for many people. They 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, p. 383).

"For many people, treatment and recovery support are equally essential ingredients for successful long￾term recovery." (The ASAM Criteria, p. 383).

It is important to note that the “social-experiential model” is a peer-to-peer community-based approach in recovery, and the “foundation for all recovery residences” (NARR), rather than a clinical approach, individualized treatment plan, or protocol administered by a treatment practitioner.

Residents (not patients) in recovery housing are encouraged to engage in peer-to-peer interpersonal actions, share their personal “lived-experiences” in recovery, and seek social supports to encourage life-skills development, personal growth, and recovery dividend returns invested in recovery capital. Examples: Sponsor-mentor support, recovery meetings, supported employment, transportation assistance, financial management classes, educational opportunities, and social supports like food stamps, and legal

assistance. The list goes on and on in the accrual of recovery capital to nurture self-sustainability, and a long-term healthy sobriety and recovery for individuals that suffer from a substance use disorder, or co￾occurring mental health conditions.

How Effective Is High-Quality Recovery Housing?

“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).

High-Quality Recovery Housing Model Laws

In 2017, The National Council for Mental Wellbeing published, “Building Recovery: State Policy Guide for Supporting Recovery Housing.” This guide is an excellent resource that provides examples of “model laws for implementing suggested minimum standards for operating, and promoting the availability of high-quality recovery housing.” (Excellence in Recovery Housing Act – 2023, p. 3,108).

The National Council recommends the following to promote high-quality recovery housing throughout the United States: “In addition to a clear definition of what constitutes recovery housing, policies and legislation should require that recovery housing meets national quality standards. The National Council recommends that legislation require that recovery homes meet quality standards established in 2011 by NARR, and/or the Oxford House Model™. As long-tested standards, they provide a clear and measurable baseline for residences and also reduce the administrative effort needed to create standards on the state or local level.” (Building Recovery: State Policy Guide for Supporting Recovery Housing, p. 8).

The National Council further states, “NARR affiliates are trained to ensure that local NARR recovery homes adhere to these standards and can be an invaluable resource for states to ensure that recovery housing operators are meeting these requirements. This can significantly reduce the oversight and administrative burden for states and their local governments and is consistent with how states approach quality assurance for other types of supportive housing.” (Building Recovery: State Policy Guide for Supporting Recovery Housing, p. 8).

Prioritizing Recovery Housing: Legislation and Funding Initiatives

Building Recovery: State Policy Guide for Supporting Recovery Housing

National Council for Mental Wellbeing

1. Florida: "Created a voluntary recovery residence certification program based on NARR

standards. Licensed treatment providers are required to refer to certified recovery residences.” p. 23.

2. Ohio: "Ohio has one of the highest rates of drug overdose deaths in the country. In response, Ohio has pursued robust funding strategies that prioritize recovery housing: In Fiscal Years 2018-2019, Ohio has dedicated $3.5 million in state general revenue funding for recovery housing and $20 million in capital funds for recovery housing. This funding will support new homes, residents in recovery and the state NARR affiliate to provide training and technical assistance to ensure that local recovery housing meets national quality standards." p. 24.

3. Rhode Island: Certification required for referrals. Certification of Recovery Housing must

adhere to National Alliance for Recovery Residences (NARR) standards. “All referrals from state agencies or state-funded facilities shall be to certified houses, and only certified recovery housing facilities shall be eligible to receive state funding to deliver recovery housing services." p. 25.

4. Texas: Enacted the “Voluntary Accreditation of Recovery Housing Act” (H.B. No. 299) on

September 1, 2023, effective on September 1, 2025. Texas law requires a “recovery house” to be accredited to receive state funding: Chapter 369. Voluntary Accreditation of Recovery Housing Act, Sec. 469.009. FUNDING: “A recovery house that is not accredited by an accrediting organization in accordance with this chapter is ineligible for and may not receive state money.” Recovery housing in the state of Texas must be accredited by the National Alliance for Recovery Residences’ (NARR) state affiliate, or Oxford House to receive state funding. The Texas Recovery Oriented Housing Network (TROHN) is a subsidiary of Recovery People. TROHN is the state affiliate of the National Alliance for Recovery Residences (NARR).

5. Virginia: “The Code of Virginia § 37.2-431.1 provides that no person shall advertise, represent, or otherwise imply to the public that a recovery residence or other housing facility is a certified recovery residence unless it has been certified by the Virginia Department of Behavioral Health and Developmental Services (“DBHDS”). In accordance with the DBHDS regulation, Certified Recovery Residences [12VAC35-260], each location that an entity seeks to operate as a certified recovery residence must be accredited by or hold a charter from an accrediting entity and be credentialed by and included on the certification list maintained by DBHDS. The two accrediting entities are”:

A. Oxford Houses of Virginia

B. Virginia Association of Recovery Residences (VARR) – NARR state affiliate

Note: Twenty-one states currently have some form of NARR’s oversight/support model in recovery residence legislation: WA, OR, MT, CO, TX, OK, MN, MO, MI, OH, KY, AL, SC, FL, WV, VA, DE, MA, RI, VT, ME. Another four states are in development with state agency involvement. NM, MS, AR, and AK. AR already hasstate funding and support. The NM project is sponsored by the NM Society of Addiction Medicine. In MS, NARR is working directly with the state agency. It is abundantly clear that nearly half of the state governments in the United States have adopted or are in the process of adopting the NARR Standard, ethics and four levels/types of recovery residences.

“Recovery Residence” Defined by Tennessee

Code Annotated, Section 33-2-1401(7)

“’Recovery residence’ means a residence classified as a single family residence, as defined in § 13-24-102, or any other premise, place, or building that provides a substance-free living environment centered on supervised, monitored, or peer-led support that assists individuals in recovery from substance use disorder with services that promote long-term recovery, including direct connection to other peers in recovery, mutual support groups, and recovery support services but does not provide any medical or clinical services, treatment, or medication administration on-site except for verification of abstinence.”

There are two key components of note in the statute: (1) A recovery residence “provides a substance free living environment centered on supervised, monitored, or peer-led support…” This specific phrasing was lifted directly from the National Alliance for Recovery Residences (NARR) Levels/types I, II, and III recovery residences; and (2) a recovery residence in Tennessee “…does not provide any medical or clinical services, treatment, or medication administration on-site except for verification of abstinence.”

While Tennessee does not recognize NARR Level IV/type C (Clinical) recovery residences, all level IV/type C recovery residences (nationally) are based on the “social (experiential) model” of recovery while providing clinical services.

It should be understood that while all level IV/Type C recovery residences have licensed treatment components, “not all licensed treatment programs qualify as a social model-based RR (Recovery Residence) Type C.” (The ASAM Criteria, p. 387).

An “Alcohol and Drug Halfway House Treatment Facility” in Tennessee (a.k.a. “halfway house”) is an example of a type of licensed residential treatment facility that is not a social model-based recovery residence, and does not meet the statute definition of a

recovery residence in the state of Tennessee for two reasons:

(1) a recovery residence “… does not provide any medical or clinical services, treatment, or medication administration on-site except for verification of abstinence.”

(2) A “halfway house” based on treatment protocols rather than "grounded in the Social Model of Recovery” is a type of “supportive housing,” but it is not a recovery residence. (See “Best Practices For Recovery Housing,” Best Practice: 7, Establish a Clear Operational Definition, p. 9 – SAMHSA).

For more information regarding a proper understanding and implementation of the NARR/TN-ARR four levels/types of recovery residences of which three recovery residence levels/types (supervised, monitored, or peer-led support) are codified in Tennessee Code Annotated, Section 33-2-1401(7), recovery housing operators and/or recovery housing certification organizations may contact TN-ARR for training and understanding that the NARR levels/types of recovery residences are interwoven with The NARR Standard and ethics.

Conclusion

High-quality recovery housing is well defined in legislation, and consensus-based best practices: The federal government -- SAMHSA (Best Practices for Recovery Housing); the Legislative Analysis and Public Policy Association (LAPPA) (Model Recovery Residence Certification Act), funded by the Office of National Drug Control Policy, Executive Office of the President; the National Alliance For Recovery Residences (NARR) “the most widely referenced national standards to ensure well-operated, ethical, and supportive recovery housing." (Best Practices for Recovery Housing,” p. 10 – SAMHSA); the medical

community and addiction medicine (The ASAM Criteria, Treatment Criteria for Addictive, Substance Related, and Co-occurring Conditions); and the National Council for Mental Wellbeing (Building Recovery: State Policy Guide for Supporting Recovery).

NARR is the common denominator in all these (and more) aforementioned sources, having partnered with and guided these entities in policy development and advocating for high-quality standards in recovery housing through a national recovery housing certification network comprised of NARR state affiliates throughout the United States.

The only approved and official NARR state affiliate in Tennessee is the Tennessee Alliance of Recovery Residences (TN-ARR). As of March 2026, TN-ARR had 91 affiliate recovery residence operators that were certified, or in process of certification with 314 recovery residences, and 2,502 recovery beds in 34 cities/towns and 27 counties. TN-ARR will continue to advocate for state grant funding for operational, training and technical support, as well as dedicated funding for recovery housing operators, and crucial recovery support

services.

We will continue to carry the torch as a beacon of hope and guardians of high-quality standards and ethicsin recovery residences throughout the state of Tennessee, assuring that TN-ARR affiliates operate“substance-free living environment[s] centered on supervised, monitored, or peer-led support that assists individuals in recovery from substance use disorder with services that promote long-term recovery, including direct connection to other peers in recovery, mutual support groups, and recovery support services…” (Tennessee Code Annotated, Section 22-2-1401(7).

This is who we are! Come join us!

Kyle D. Duvall

TN-ARR Advocacy Chairman