Oxford house recovery homes: Characteristics and effectiveness.

After treatment for substance abuse, whether by prison, hospital-based treatment programs, or therapeutic communities, many patients return to former high-risk environments or stressful family situations. Returning to these settings without a network of people to support abstinence increases chances of relapse (Jason, Olson & Foli, 2008). As a consequence, alcohol and substance use recidivism following treatment is high for both men and women (Montgomery et al., 1993). Alternative approaches need to be explored, such as abstinence-specific social support settings (Vaillant, 2003). Self-governed settings may offer several benefits as they require minimal costs because residents pay for their own expenses (including housing and food). Recovering substance abusers living in these types of settings may develop a strong sense of bonding with similar others who share common abstinence goals. Receiving abstinence support, guidance, and information from recovery home members committed to the goal of long-term sobriety and abstinence may reduce the probability of a relapse (Jason, Ferrari, Davis & Olson, 2006). This experience might provide residents with peers who model effective coping skills, be resources for information on how to maintain abstinence, and act as advocates for sobriety. Oxford Houses are single-sex adult dwellings, yet some allow residents to live with minor children. Individual members are expected to pay monthly rent and assist with chores. They are one of the largest self-help residential programs in the US. Unlike other aftercare residential programs, such as halfway houses, Oxford House has no prescribed length of stay for residents and there is no professional staff. Each House operates democratically with majority rule regarding most policies, and an 80% majority for accepting membership (Oxford House Manual, 2006). Residents must follow three simple rules: pay rent and contribute to the maintenance of the home, abstain from using alcohol and other drugs, and avoid disruptive behavior. Violation of the above rules results in eviction from the House (Oxford House Manual). As of 2008, there were 321 women’s Oxford Houses with 2,337 women, and 982 men’s Oxford Houses with 7,487 men, for a total of 1,303 houses serving 9,824 people (Oxford House, 2008). There were Oxford Houses in 42 states and 383 cities in the US. Of the residents, 18% were veterans, and 91% were working with average monthly earnings of $1,480. Most residents had been addicted to drugs or drugs and alcohol (73%) whereas 27% had been addicted to only alcohol. Regarding race, 54% were White, 42% were Black, and 4% were other. Regarding marital status, 45% had been never married, 18% were separated, 33% were divorced, and only 4% were married. Fifty-three percent of residents reported prior homelessness for an average time of 6 months. In addition, 76% had been in for an average of 13 months. The average length of stay in an Oxford House was 10.1 months. The average cost per person per week was $98.75. There appear to be considerable standardization of locations of Oxford Houses as well as what occurs in these settings (Ferrari, Groh & Jason, 2009). Ferrari, Jason, Sasser et al. (2006) studied 55 Oxford Houses across three diverse regions of the U.S and found that regardless of geographic location, Oxford Houses were rather similar in size and amenities that were available to residents (e.g. room air-conditioners, a utility room for laundry, a communal lounge for televisions, comfortable furniture in communal living areas. Observers (with high inter-rater reliability) noted that public transportation was available near the houses, and the streets and neighborhoods were clean and well-lit. These results, in fact, were replicated in Australian Oxford Houses (Ferrari, Jason, Blake et al., 2006). Jason et al. (2003) used interviews and observations to better understand governance issues in the Oxford Houses. They found that residents utilized a number of strategies to confront behavioral issues, including imposing fines for not completing house duties, discussing interpersonal conflicts and behaviors such as isolation at business meetings, and developing behavioral contracts. Houses also implemented rewarding events for achieving goals. The Oxford House model of treatment for substance abuse issues is an intriguing concept based on self-governance and mutual support. The self-governing policies described above help create and nurture abstinence-specific social support networks. In the absence of professional staff, residents are forced to develop rules and policies, learn to self-govern, and assume positions of leadership within their houses. The democratic feature of the Oxford House program differentiates it from other types of residential care settings and recovery homes, where rules and sanctions for infractions may exist, but with less explicit efforts to encourage a supportive milieu Limited research, however, is available regarding how Oxford House settings compare to other treatments. Using cross sectional data, Ferrari, Jason, Davis, Olson, and Alvarez (2004) compared the operational policies of 55 Oxford Houses to those of 14 Therapeutic Communities (TCs). Neither type of facility permitted self-injurious behaviors (e.g., physical self-harm or misuse of medication) or destructive acts (e.g., destroying site property or others’ possessions). Oxford Houses, however, were significantly more liberal in permitting residents personal liberties compared to the TC facilities. For example, Oxford Houses permitted greater flexibility in terms of residents’ smoking in their rooms, sleeping late in the morning or staying out late at night, going away for a weekend, and having “private time” in their locked room with guests. Oxford Houses also were more likely than TCs to allow residents to have personal possessions (e.g., pictures, furniture) within the dwelling (Ferrari, Jason, Sasser et al., 2006). Unfortunately, there have not been any outcome studies comparing TCs with Oxford Houses, although the first author currently has a NIDA funded study that is exploring this issue. There is considerable evidence for the effectiveness of TCs (DeLeon, & Rosenthal, 1989). Substantial reductions in recidivism rates have been found when in-prison Therapeutic Communities (TCs) are combined with community transition programs (Hiller, Knight, & Simpson, 1999; Wexler et al., 1996). As an example, Inciardi et al. (2004) found that at a five year follow-up, those individuals who participated in a combined TC and work release program had significantly less drug use and were significantly less likely to be re-incarcerated compared to those individuals in just the TC program or a no-treatment control group. Unfortunately, these TC programs often create a financial burden on society, and are not available to all that need them. Also, therapeutic community residents may stay only for a limited time before many return to former high-risk environments or stressful family situations (Goldsmith, 1992). Limited research is also available comparing Oxford Houses versus more traditional recovery homes, which also tend to have supervising staff and less democratic self-governing principles. Harvey (2009) recently found that Oxford House residents had higher scores on social climate scales Involvement, Support, and Practical Orientation, Spontaneity, Autonomy, Order and Organization, and Program Clarity measures compared to a traditional recovery home. This study did not provide outcome data regarding residents’ experiences living in these recovery communities. Few methodologically sound studies have emerged in the area of traditional recovery homes. In one of the few recovery home longitudinal studies, Polcin (2006) found that 51% of recovery home residents were abstinent from drugs and alcohol at a six-month follow-up. Regrettably, there are few studies reporting differential outcome data contrasting recovery home and therapeutic community residential treatments for substance abuse. In part, this is due to the fact that it is hard to provide systemic long-term outcome data on these hard to reach, highly recidivist populations. The present article addresses the primary outcome studies conducted on one form of recovery home called Oxford House. We also examine whether settings such as Oxford Houses have an impact on their greater community. Finally, the implications for how clinicians might work with these types of community support settings will be reviewed.