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Sober Housing is a Potent, Cost-Effective Treatment for Addiction

A Report to AODAAC, Treatment Committee
Steven T. Coulter, MD, Chairman
SteveMDFP@gmail.com
October, 2006

The October 2006 issue of The American Journal of Public Health includes a DePaul University study on the effectiveness of Oxford House placement for graduates of addiction treatment programs (Jason et al, 2006). An Oxford house is a group home of people recovering from addiction. There is no staff; residents supervise each other's recovery. Since the only major cost for this arrangement is the rental expense of the house, this is a low-cost, long-term approach to supporting sobriety for those addicted to alcohol or other drugs.

The Oxford House movement was born here in Montgomery County. In the 1970's, a county-funded halfway house lost its budget. The residents decided the house was working too well for them to leave, and so they simply started paying the landlord rent on their own. The arrangement worked well, despite the lack of any staff. With some evangelical zeal, they started a non-profit organization to spread the concept. Today, there are 1200 Oxford houses in the US (see http://www.oxfordhouse.org).

Clinicians "in the field" have long recognized that such living arrangements can be a highly effective support to those in recovery. Until the publication of the study mentioned above, however, there was no published measure of the effectiveness of such placements. The results of the study are impressive enough to put many (far more expensive) treatment options to shame. At 24 months:

- rates of substance abuse were lower, at 31.3%, versus 64.8%, a 52% reduction
- monthly income was higher, $ 989, versus $ 440, more than doubled
- incarceration rates were lower, 3%, versus 9%, only a third as many were incarcerated.

This "treatment" approach is inexpensive; these results are too good to ignore. Investing a modest amount of money to create placement slots in such housing could enhance the operations of other aspects of our county's "continuum of care." Many of the existing operations suffer from long waiting lists. For some of our clients on waiting lists, an Oxford house-like placement would suffice, permitting better access for others that need higher intensity care. Those individuals placed here would clearly be less likely to relapse; therefore reducing the numbers of repeat clients who cycle through our system over and over. In addition, some of our programs have great difficulty placing clients at discharge. A set of dedicated, low-cost placement slots would allow shorter lengths of stay (at, e.g., ARTC or ARCC), thus permitting these existing services to treat more patients per year.

In such an arrangement, clients in such housing would presumably pay rent on a sliding scale according to income, up to a maximum of the market value of the housing they occupy. This should provide revenue to offset the bulk of the operating expense, while ensuring that clients who are or become disabled or unemployed are not made homeless.

The closest comparable program we currently run is probably Lawrence Court. With a typical census of around 20 at Lawrence Court and an annual budget of $336,000, a placement there costs roughly $1,400 per client per month (which does not include any rental expense, since the property is owned by the county). Even though an Oxford house-like placement would presumably entail rental expense, the net cost after revenue should be well under $300 per client per month.

At least two local non-profits have been operating sober housing under this model for several years already. Community Ministries of Rockville (CMR, http://www.cmrocks.org) has been running Hope Housing with a HUD grant. Community Ministry of Montgomery County (CMMC, http://www.communityministrymc.org) has been operating a parallel program. The funding stream for these programs is through Montgomery County Coalition for the Homeless (http://www.mcch.net). These three organizations are already partners with Montgomery County in providing services to the needy.

Estimates of benefits for relapse, income, and incarceration in the Hope Housing programs seem to match or exceed the results from the DePaul University study. The CMR program operates with a single full-time manager/director/case-manager for a census of about 21 clients, with some administrative support from the rest of the organization.

Options for incorporating this model into the County's continuum of care might include replicating the Hope Housing model, assisting with the creation of new Oxford houses (existing Oxford houses in the county tend to operate at full occupancy already), or contracting with an agency such as CMR to expand existing operations to include county-funded beds. The treatment committee suggests that DHHS should consider issuing an RFP (request for proposals) to implement one or more of these options for providing sober housing. The Chairman of this Committee will be happy to assist with advising the County Council on the merits of funding this proposal.

Reference:

Jason, LA et al. Communal Housing Settings Enhance Substance Abuse Recovery. American Journal of Public Health. October, 2006. Vol 96, No 10. Pp 1727 - 1729. Abstract at:

http://www.ajph.org/cgi/content/abstract/96/10/1727

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