METHODSMETHODS

Sample

• n=245• Women, 24% • White, 72% • Average age, 36.5 • Never married, 51%

Referral Sources (%)

12-Month DSM-IV Substance Dependence Prior to Entering the Residence (%)

ProcedureAll residents entering the SLH’s were invited to participate in the study using an “intent to treat” procedure. Participants were interviewed within the first 2 weeks in the residence and re-interviewed at 6-month follow-up. Interviews lasted approximately 2 hours.

Measures

Outcome Measures• Addiction Severity Index

(medical, alcohol, drug, legal, employment and family/social) • Number of days used alcohol past month• Number of days used drug of choice past month • Brief Symptom Inventory: Global Severity Index

Services Desired and Services Received “Services Desired and Received” (Hser et. al., 1999) is an instrument that assesses different services residents desired at baseline and received at 6-months. Services desired was rated 0 (Not at all) to 4 (Very much). Services received were coded received or not received.

SOBER LIVING HOUSES FOR SUBSTANCE USE DISORDERS:SOBER LIVING HOUSES FOR SUBSTANCE USE DISORDERS:Do Residents Receive the Services They Need?Do Residents Receive the Services They Need?

CONCLUSIONSCONCLUSIONS

At Least half of the residents entering SLH’s indicated a high desire to receive services in a number of areas: medical, medication, individual counseling, group counseling, vocational training/job placement finding permanent housing, recreation and self help groups.

Desire for services declines modestly at 6-month follow-up. At least half or the respondents at 6 months indicated a high desire for medical, medication, finding permanent housing, recreation and self help groups. There were significant associations between types of services residents desired at baseline and 6 months and their level of problem severity in those areas (i.e., medical, family, employment and psychiatric).

In most service areas, those with a “High Desire” for a service had larger proportions receiving it than those who expressed “Some Desire”.

Service areas with larger proportions of “High Desire” respondents receiving the service included: self help groups, medical treatment, medication, recreation, and individual counseling.

Service areas with large proportions of “High Desire” respondents not receiving the service included: vocational training/job placement, family counseling, GED preparation, money management, legal assistance, and assistance finding permanent housing.

An overall ratio of services received/services desired was associated with number of days of alcohol use during the past 30 days but not other outcome measures (e.g., 6-month measures of substance use, ASI scales, 30 day drug use and psychiatric severity).

Findings here suggest that SLH's could be more responsive to resident needs by developing more linkages with the services that are highly desired by residents but infrequently accessed.

Additional research using a larger sample will examine how receipt of services within specific areas correlates with outcome measures within those areas.

ABSTRACTABSTRACT

Sober Living Houses (SLH's) are alcohol- and drug-free living environments for individuals attempting to maintain sobriety. They offer no formal treatment services but, rather, provide a social model living environment that emphasizes peer support and involvement in mutual help groups, such as Alcoholics Anonymous. Previous analyses comparing baseline and 6-month follow-up showed that residents of SLH's significantly reduce substance use, alcohol and drug problem severity, arrests, psychiatric symptoms, and unemployment. Remaining, however, is the important question of whether residents access auxiliary services for the variety of problems frequently associated with substance abuse (e.g., medical, psychiatric, family,

vocational, legal, housing, etc).

This analysis used the Services Desired/Received measure of Hser et. al. (1999) to assess different services residents desired at baseline and received over the next 6 months. The sample included 245 residents in 16 SLH's in Northern California (76% male, 72% white). At baseline, at least half of the residents indicated a “high desire” for 8 of the 14 service areas assessed. At 6 months, at least half indicated a “high desire” for 5 of the 14 service areas. In most service areas there was only a modest decrease in level of desire from baseline to 6 months. Findings indicated significant associations between types of services residents desired at baseline and their level of problem severity in those areas (i.e., medical, family, employment and psychiatric). In most service areas, those with a “high desire” for the service had larger proportions receiving it than those who expressed “some” desire. Some service areas had large proportions of residents who received services they desired: medical, medications (including psychiatric medications and methadone), mutual help groups, and recreation. Other areas had large proportions not receiving services they desired: vocational training/ job placement, family counseling, GED preparation, money management, legal services, and assistance finding permanent housing. An overall ratio of services received / services desired was associated with number of days of alcohol use during the past 30 days but not other outcome measures (e.g., 6-month measures of substance use, ASI scales, 30-day drug use and psychiatric severity).

Additional research using a larger sample will examine how receipt of services within specific areas correlates with outcome measures within those areas. Findings here suggest that SLH's could be more responsive to resident needs by developing more linkages with the services that are highly desired by residents but infrequently accessed.

AcknowledgmentsAcknowledgments

Research Staff Data collection Site

Gantt Galloway, Pharm.D. Clean and Sober Transitional Living (CSTL)Diane Henderson, B.A. Fair Oaks, CaliforniaLaura Jones, M.A.Joanna Knight, B.A.Rebecca SaulsburySara Shopkow, M.P.H

This study was supported by a grant from the National Institute on Alcohol Abuse and Alcoholism

(R01 AA014030)

BACKGROUNDBACKGROUND

What Are Sober Living Houses?• Alcohol-and drug-free living environments• Self supported• Social model recovery philosophy• Can be used in conjunction with formal treatment or as an alternative

The “Evaluation of Sober Living Houses” Project• 5-year longitudinal study• 300 sober living residents, 2 agencies, 21 Sober Living Houses• Recruited within first week of entering the house• In person interviews at baseline, 6, 12, and 18 months

Baseline to 6-Month Improvements of Sober Living House Residents Reported in Previous Analyses

• Alcohol and drugs Use• ASI alcohol severity• ASI drug severity• ASI work severity• Psychiatric problems• Arrests• Unemployment  

Previous finding reported:Polcin, D. L. (2006). Where are clients going to live? Sober Living House options. Workshop: New Services Research from the Alcohol Research Group. Reengineering Our System of Services: Developing and Implementing a Comprehensive and Integrated Continuum of Services. California State Department of Alcohol and Drug Problems, Sacramento, CA, September 6–8.

Douglas L. Polcin, Ed.D. & Rachael Korcha, M.A., Alcohol Research Group, Emeryville, CADouglas L. Polcin, Ed.D. & Rachael Korcha, M.A., Alcohol Research Group, Emeryville, CA

Relationship between Services Received/Desired Ratio and OutcomeRelationship between Services Received/Desired Ratio and Outcome

Two variables were computed to assess a ratio of services received / services desired. The first, Baseline Ratio, used services received at 6 months over services desired at baseline. The second, 6-month Ratio, used services received at 6 months over services desired at 6 months. These variables were then correlated with a variety of outcome measures, including ASI scales (medical, legal, drug, alcohol, employment, and family/social), Brief Symptom Inventory Global score of psychiatric severity, 2 broad measures of substance use measuring a 6-month period (number of months used any substances and Peak Density of use during month of highest use), and number of days of alcohol and primary drug use over the past 30 days. Baseline ratio showed a trend with number of days of alcohol use at 6 months such that a higher ratio associated with lower number of days of alcohol use over the past 30 days (r= -0.16, p =0.06). The 6-month Ratio had a significant relationship with number of days of alcohol use in the same direction (r= -0.19, p =0.03). Other comparisons with outcome measures were not significant.

Service No Desire Some Desire High Desire No Desire Some Desire High Desire

Medical 10 21 70 8 15 78

Medication 37 12 52 30 12 58

Individual Counseling 12 38 50 17 38 45

Group Counseling 7 35 58 25 36 39

Family Counseling 34 34 32 48 27 25

Vocational Training/Job Placement 25 21 54 38 14 49

GED Preparation 66 13 21 69 12 19

Legal Assistance 28 28 44 32 27 42

Finding Housing 13 16 71 19 22 59

Money Management 21 30 49 20 37 43

Recreation 10 31 59 13 37 50

Self Help Groups 1 15 84 4 21 75

Anger Management 39 32 29 45 25 29

Assertiveness Training 33 25 42 39 25 35

High Desire = service is much desired or very much desired

Baseline (n=245)

6-month (n=132)

Table 1. Services Desired at Baseline and 6-month Follow-up (%)

Note: Services Desired was assessed on a 5-point scale ranging from 0 (not at all) to 4 (very much).

No Desire = service is not at all desired

Some Desire = service is desired a little or some

Measure n % n % n % n % n % n %

ASI Medical

Medical 23 30 50 40 168 49 9 22 19 16 100 43^

Medication 88 28 29 52 126 56*** 38 18 16 25 75 51**

ASI Family

Family Counseling 82 21 84 30 78 42* 62 21 35 23 33 33

ASI Employment

Handling Money 51 49 72 47 118 42 25 16 48 31 55 11*

Work/Job Counseling 61 28 51 45 129 53** 47 11 18 28 63 24

Obtaining GED 161 34 30 70 50 66*** 87 16 16 19 25 32

ASI Legal

Legal Assistance 68 24 68 31 108 37 41 12 35 17 54 32

Continuous Measuren x (S.E) n x (S.E) n x (S.E) n x (S.E) n x (S.E) n x (S.E)

BSI

Individual Counseling 28 .55 (.10)

91 .77 (.07 )

123 .92 (.08)*

22 .32 (.07)

49 .60 (.08)

59 .74 (.10)*

Group Counseling 18 .81 (.16)

83 .85 (.09 )

141 .81 (.07)

32 .45 (.09)

47 .65 (.08)

51 .70 (.10)

Medication 88 .66 (.07)

28 .85 (.15 )

126 .93 (.08)*

39 .40 (.09)

16 .76 (.20)

75 .70 (.07)*

Some Desire High Desire

Table 2.  Relationship between Dichotomous ASI Problem Severity Measures (Low versus High) and

Level of Services Desired within Specific Domains at Baseline and 6-months  

Baseline 6-month

* p <0.05, ** p <0 .01, *** p <0.001, ^ cell count too small

Note: Chi Square tests of significance within specific services were used for categorical variables. Analysis of Variance F Tests for continuous variables

No Desire Some Desire High Desire

% High Severity % High Severity

No Desire

Service

n % n % n % n %

Medical 26 50 92 70 19 32 100 71***

Medication 13 31 68 74 16 38 75 77**

Individual Counseling 53 43 63 57 49 37 59 68**

Group Counseling 45 42 79 51 47 45 51 67

Family Counseling 44 2 43 14* 35 9 33 12

Vocational Training/Job Placement 30 17 69 17 18 22 63 21

GED Preparation 14 0 23 4 16 0 25 4

Legal Assistance 39 10 52 21 35 6 54 30

Finding Housing 18 28 94 32 29 31 77 33

Money Management 47 19 61 13 48 19 56 16

Recreation 36 50 83 64 48 50 65 69*

Self Help Groups 15 80 114 96* 27 89 98 99

Anger Management 36 19 44 43* 33 36 38 45

Assertiveness Training 36 6 54 20^ 33 9 46 26

Note: Comparisons of services received (received/ not received) by desire (some versus high) used Chi Square Analysis.

^ p =0.05, * p <0.05, ** p <0 .01, *** p <0 .001

Table 3. Percent Who Received Services at 6-month Follow-up by Desire.

Desire at Baseline Desire at 6-month

Some Desire High Desire Some Desire High Desire

0

5

10

15

20

25Legal

Frnd/Fam

Self

Inpt/Res

0

10

20

30

40

50 Meth

Alcohol

Marijuana

Cocaine