Continuum of Care, Recovery, and Sober Living
This article is written to inform and educate members of the sober living community, including recovery residence operators and those who live in or work in a sober house. The most common misconception regarding substance use recovery is all that is needed for long-term sobriety is detox and a brief inpatient stay. However, sustained recovery is not quite so simple.
While alcoholism was recognized as an illness in 1956, addiction was not recognized as such until 1987. Addiction is commonly known as a disease but is not the same as something like getting strep throat where your doctor writes an antibiotic prescription. Addiction is more akin to being diagnosed with diabetes and having a doctor prescribe diet changes, exercise, and blood sugar control in addition to your medicine.
Despite some disagreement amongst professionals, the American Medical Association (AMA) and the National Institute on Drug Abuse (NIDA) all agree that addiction is a disorder. Treatment is usually required for diseases, and successful addiction rehabilitation can necessitate additional assistance.
After being diagnosed with a drug use disorder, you can still live a happy and productive life, but you should avoid complacency in your recovery.
The continuum of care is not linear, movement in either direction will be dependent upon the individual and should never be treated with a one-size-fits-all approach.
Levels of Care within the Continuum
Even in a sober living setting, it is helpful to be aware of prevention services in your area. Getting a referral form a loved one may convince family or friends to consider their own substance use before it becomes a problem.
SBIRT: Screening Brief Intervention and Referral to Treatment
SBIRT is a method for providing early intervention and care to people who have or are at risk of developing drug use disorders.
- Screening determines the seriousness of drug abuse and the required standard of care.
- The brief intervention serves to increase knowledge and understanding about drug use, as well as inspiration for behavioral change.
- Referrals are for those who present as requiring more intensive treatment or specialist care.
Prevention programs are community-based initiatives aimed at preventing the use of alcohol, marijuana, and other drugs by children (ages pre-K to 18) and their families. Each initiative is focused on a particular municipality or neighborhood and is implemented by a group of coordinated community members who are interested in preventing drug abuse in their community.
Youth diversion programs are intended to help youth who have already started using drugs and engaging in risky behaviors. Activities such as street outreach and youth mobilization are part of these projects.
Acute Treatment Services (ATS) (Detox)
ATS programs are medically supervised detoxification facilities. Nursing care is provided 24 hours a day, seven days a week, under the supervision of a medical director, to track and treat an individual’s withdrawal from alcohol and other substances.
Priority individuals are those 18 and over who are at risk of experiencing an acute withdrawal from alcohol or other medications. Injection drug users, homeless people, pregnant mothers, and people with chronic medical conditions are among the high-risk priority groups. There are also a few detoxes for adolescents, such as the MYR (Motivation Youth in Recovery) program in Worcester.
A common mistake made by sober living operators is automatically telling a struggling resident that s/he must go to detox if they have used. After drinking, or using/abusing a substance, a resident should be referred for an assessment. The assessment will determine if detox is the right level of care. Other options might include Counseling, CSS, IOP, or residential (see below).
Transitional Support Services (TSS)
Transitional Support Services (TSS) are short-term residential support services for clients who need a stable and structured atmosphere to aid in their post-detoxification rehabilitation. These programs are intended to assist those who need services in the interim between acute treatment and residential recovery, outpatient treatment, or other forms of post-treatment care.
Eligible individuals are aged 18 and who are referred by a publicly funded ATS (detox) program, a homeless shelter, or a homeless outreach worker. Residents in sober living would not be referred to this level of care.
Residential Treatment over 30 Days
Individuals that have recently stopped using alcohol and/or other substances, have been medically stabilized, and are able to engage in a formal residential treatment program are eligible for residential treatment over 30 days. Recovery Homes, Social Model Homes, Therapeutic Communities, Specialized Residential Services for Women, Specialized Residential Services for Families, and Youth Residential Programs are all examples of residential treatment programs that last longer than 30 days. Sober living is not residential treatment.
Unlike sober living, recovery homes provide a structured, sober atmosphere. These programs place a strong emphasis on rehabilitation and care in a formal, therapeutic setting. Residents are encouraged to participate in community activities and to take advantage of community opportunities such as self-help groups and jobs. Some Recovery Homes provide enhanced programs for pregnant and post-partum women and their children, such as maternal and pediatric care planning.
Therapeutic Community (TC)
Therapeutic Communities provide a highly organized community that focuses on resident care and rehabilitation within the program’s parameters. Residents play an active role in this recovery method, which encourages them to take on new roles and become positive role models. Some Clinical Groups provide enhanced resources for pregnant and postpartum women and their children, such as maternal and pediatric care planning. TCs are more restrictive than other residential programs and in many areas, they are being phased out.
A sober living environment, peer therapy, and case management are all stressed in Social Model services. The goal of these services is to help residents foster a community of recovery, support, sharing, and positive role modeling among themselves. Residents are required to participate in the culture (through work, education, volunteer activities, etc.). Social model programs create a microcosm of the real world and encourage the residents to be as active in the process as thy are able.
For all three types of residential services, individuals, eighteen years and older who are in early recovery from alcohol and/or other drug addiction. Priority is given to people with disabilities, cultural and linguistic minorities, homeless individuals, injection drug users, persons involved with the criminal justice system and persons with or at risk for HIV/AIDS.
Furthermore, pregnant women in early recovery who need assistance in learning and sustaining life skills required for drug-free living are eligible for programs that provide specialized care for pregnant and postpartum women and their children.
Ambulatory Services are provided in community-based settings and involve attending scheduled appointments for counseling and treatment. For residents who are struggling in sober living, this may be the level of additional support they need to be successful.
Adults and teenagers, as well as their families and/or significant others, who are affected by the use of alcohol or other substances, may receive care through outpatient therapy. Clients are helped to build and sustain skills for a drug-free lifestyle. Assessment and recovery planning, as well as client, community, and family therapy, are also included in the services.
Eligibility: Someone who is concerned about a substance abuse issue, or a family member or significant other who is concerned about a substance abuse problem in someone else. Individuals must be medically stable and not in need of immediate hospitalization.
Day Treatment and Intensive Outpatient (IOP)
Intensive and day treatment Outpatient therapy is more rigorous than outpatient therapy. Person, community, and family therapy, relapse prevention, communicable disease prevention, case management, and promotion of the use of self-help groups are also part of the services, which provide each participant with multiple hours of counseling a day, up to four days a week. A resident who is in sober living should work closely with the house manager as they will likely need to limit their working hours.
Eligibility: Clients must be medically stable and need therapy more than once a week to stay stable.
Individuals with a history of drug abuse that need medication for mild to severe withdrawal symptoms may benefit from acupuncture and rehabilitation maintenance services. Restricted medical screening and intake, motivational counseling/case management, and acupuncture treatments are among the services offered.
Clients with mild to moderate withdrawal symptoms are eligible. Clients who need medically supervised detoxification do not use this service.
Compulsive Gambling Services
Compulsive Gaming Facilities are outpatient recovery programs for compulsive gamblers and their families. Client, family, and community therapy, as well as case management, are available through these programs. Sober living residents who struggle to pay rent may need a referral to gambling services.
Clients must meet the requirements for pathological gambling to be eligible.
Opioid Therapy is a medically supervised treatment program for people who are addicted to opiates like opioids or pain relievers who have a history of relapse. Medical and pharmacological treatments (such as methadone or buprenorphine) are combined with specialist outpatient counseling, schooling, and vocational services in opioid treatment programs. Services are available on a short-term and long-term basis. Managers of sober lining house should be aware of any resident who is receiving medically assisted opioid treatment and should have a protocol for addressing any issues (such as diversion). There should be protocols to address residents who have methadone take-home doses or buprenorphine (Suboxone) that do not call them out, violate their confidentiality, or make them feel targeted.
Aftercare/ Recovery Support Services
Case management is provided by aftercare/recovery support services that connect individuals and families to community resources such as self-help, housing, educational/vocational services, and jobs. This is another valuable resource for residents in sober living who may just need a little extra support.
Peer Recovery Support Centers
The Bureau of Substance Addiction Services of the Massachusetts Department of Public Health operates eight Peer Recovery Support Centers throughout the state. These centers, located in Brockton, Greenfield, Lawrence, Marlborough, Roxbury, South Boston, Whitinsville, and Worcester, offer a supportive space for people in recovery from drug abuse to support one another. Visit the Massachusetts Substance Use Helpline for more information on Peer Treatment Support Centers. Sober living residents who work may be able to connect afterhours and weekends at a peer recovery center.
Supportive Case Management
Supportive Case Management’s goal is to assist adults and/or families in recovery in achieving self-sufficiency. This goal is met by providing case management services in an alcohol and drug-free living atmosphere that reinforces rehabilitation by developing community-based resources to help people stay on track with their recovery goals. Supportive Housing and Community Housing services are the two styles of programs in this group. This may be an appropriate environment for a resident who has completed residential treatment but seems to struggle in sober living.
Community-Based Case Management
People will obtain assistance from community-based case management services during their rehabilitation and aftercare. Case management programs help clients gain access to care, provide direct resources to optimize treatment outcomes, and build community contacts and supports for long-term rehabilitation. Persons who are either not using or have trouble obtaining conventional drug use recovery services, as well as those who have a history of persistent relapse, are eligible. Knowing the history of sober living residents can help to get them services at this level to avoid more restrictive measures.