Recovery Housing and
The National Drug
Control Strategy
David K. Mineta
Deputy Director, Demand Reduction
Office of National Drug Control Policy (ONDCP)
Presented at the 2014 NARR Annual Board & Affiliates Meeting
St. Paul, MN
June 7, 2014
A
st
21
Century Drug Policy
• Stop drug use before it starts, and intervene early
(prevention, early intervention)
• Integrate with other sectors (primary care, campus
health centers, etc.) using SBIRT
• Expand access to treatment, including medication
(buprenorphine, methadone, naltrexone)
• Raise awareness of addiction and recovery
• Expand access to recovery support services
• Prevent & reverse overdose
Housing in the National
Drug Control Strategy
• Expand access to recovery support services,
including recovery housing.
– Profiles of promising Public Housing Authority
reentry programs, many including recovery
housing, are in development.
• Eliminate barriers to recovery, including
Federal policies, rules, and practices that
impede access to recovery housing and other
recovery support services.
The Need
• In 2012, 22.2 million Americans aged 12 or older had a past
year substance use disorder.1
• Nearly 1 out 5 (18.9 percent) of young adults aged 18 to 25 had
a past year substance use disorder.1
• Long “addiction careers,” multiple episodes of treatment, and a
median of nine years from first contact with public treatment
system to one year of abstinence.2
• Overdose epidemic: More than 38,000 drug overdose deaths in
2010, approximately 22,000 involving RX drugs (76 percent of
RX overdoses from opioids).3
1
SAMHSA (2013). Results from the 2012 National Survey on Drug Use and Health: Summary of National Findings.
2
Dennis, M.L. et al. (2007). The duration and correlates of addiction and treatment careers. Journal of Substance Abuse Treatment. 28
Suppl 1:S51-62.
3 CDC,
2012.
National Center for Health Statistics. Multiple Cause of Death 1999-2010 on CDC WONDER Online Database. Extracted May 1,
SAMHSA Recovery Framework
Recovery Housing Supports All Four SAMHSA Dimensions of Recovery
Dimensions of Recovery
1. Health: overcoming or
2. Home: a stable place to live.
managing one’s disease(s) or
symptoms—for example, abstaining
from use of alcohol, illicit drugs, and
non-prescribed medications …
making informed, healthy choices.
3. Purpose: meaningful daily
4. Community: relationships and
activities, such as a job, school,
volunteerism, family caretaking, or
creative endeavors, and the
independence, income and
resources to participate in society.
social networks that provide support,
friendship, love, and hope.
Source of SAMHSA Dimensions: http://blog.samhsa.gov/2012/03/23/defintion-of-recovery-updated/
What We Know
• Recovery housing (RH) produces positive outcomes:
– Among residents of an RH linked with OP treatment, 68 percent were
abstinent at 6 and 12 months, and 46 percent were abstinent at 18 months.1
– An RH-only model achieved 40 percent at 6 months , 45 percent at
12 months, and 42 percent at 18 months.2
• Research indicates that recovery housing can improve
recovery outcomes:
– Oxford House (OH) residence associated with abstinence from alcohol and
drugs, improved employment and legal outcomes.3
– OH residents who stayed 6 months or more had significantly better outcomes
than those who did not.4
– Recovery housing (RH) combined with RBT and RH alone produced
significantly better outcomes than usual care among a sample of opioid
dependent clients.5
1
Jason, L. et al. (2007). The need for substance abuse after-care: Longitudinal analysis of Oxford House. Addictive Behaviors. 32: 803-818.
Jason, L. et al. (2007). An examination of main and interactive effects of substance abuse recovery housing on multiple indicators of adjustment.
Addiction. 2007 July ; 102(7): 1114–1121.
3 Tuten, M. et al. (2012). Abstinence-Contingent Recovery Housing and Reinforcement Based Treatment Following Opioid Detoxification. Addiction.
107(5): 973–982.
4 Policin, D.L. et al. (2010). What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here? Journal of Psychoactive Drugs.
42(4): 425–433.
5 Policin, D.L. et al. (2010). Sober Living Houses for Alcohol and Drug Dependence: 18-Month Outcomes. Journal of Substance Abuse Treatment. 38(4):
356-365.
2
What We Need to Know
• What recovery housing (RH) models are currently in use?
• What is the best way of classifying models for
practical/clinical and research purposes?
• What is the relative effectiveness of various RH models?
• Can models be matched with populations?
• What is the relative effectiveness and cost-effectiveness
of RH offered in conjunction with various other services?
• Is there a relationship between how RH is paid for and its
effectiveness?
• What our options for creating recovery housing in
federally subsidized settings, such as public housing
authorities.
Challenges
• Developing local & municipal government partners,
communities, and neighborhoods.
• Standards:
– Staffing, physical plant/safety (building code), siting/zoning, owner
operator requirements
– Cost/reimbursement
– NIMBYism
• Expanding partnerships with CJS, state and local
substance abuse and mental health authorities, and
segments of health care system.
• Developing and evaluating public and private
reimbursement mechanisms.
• Leveraging Federal housing programs to expand
capacity.
• Integrating people in medication-assisted treatment.
Q & A / Discussion
David K. Mineta
Deputy Director, Demand Reduction
Office of National Drug Control Policy
dmineta@ondcp.eop.gov
WhiteHouse.gov/ONDCP