Evidence Based Sober Living Houses: A Multi-level Analysis

摘要 药物依赖的治疗正在经历一种范式的转变，认识到急性护理的局限性 干预措施。越来越多的人达成共识，认为药物依赖是一种慢性疾病过程， 除了正规治疗外，还需要持续的关注。长期的专业治疗在一定程度上是令人望而却步的 因为降低成本仍然是私人和公共资助者的一个重要目标。的确有 因此，迫切需要确定能够帮助维持恢复的非专业干预措施 治疗，或者在某些情况下，可以作为它的替代方案。此应用程序构建在我们正在进行的和以前的 评估居住在清醒生活屋(SLH)中的个人的纵向结果的研究。最重要的 SLH的特点包括无酒精和毒品的生活环境以及对禁欲的社会支持。 SLH的资金主要来自居住费，大多数房屋的居民可以住多久就住多久。 仅在加利福尼亚州就有800多个SLH，但很少有研究评估结果。我们的研究 SLH显示，居民在各种结果上取得了显著的、持续的(18个月)改善， 包括酗酒和吸毒、逮捕、就业和其他职能领域。此应用程序建议 研究到目前为止我们的研究忽略的背景因素，包括身体、社会和组织 SLH的不同样本之间的特征及其所在的社区会影响 结果。评估的因素将包括房屋的社会环境、组织和领导 特征和建筑(例如，大小、空间布局、邻近邻居、安全性、房间使用和 设施的维护)。我们还考察了邻里特征的影响，如饮酒渠道 密度和接近度、活动空间、犯罪、社会经济地位、12步会议的密度和接近度， 治疗服务的密度和邻近程度，以及邻居和SLH居民之间的互动。焦点 与居民和房屋管理人员组成的小组将告知学习程序和理解的实施情况 量化的发现。程序将包括招募600人的样本，有目的地进入40人 洛杉矶县精选的SLH。主要结果将包括药物使用、艾滋病毒风险、逮捕和 就业。多层次建模将解析出个人、房屋和邻里之间的相对影响 影响6个月和12个月预后的因素。结果将提供有关房屋和社区的新数据 描述基于证据的SLH和开发基于以下方面的新标准的关键特征 科学发现。目前的复原之家组织，如全国复原之家联盟 (NARR)，标准主要基于实践经验和轶事报道。因此，有一种 迫切需要研究，以帮助他们发展循证的房屋环境和社区 地点。研究结果的传播对象将是研究人员、SLH运营商和SLH组织 标准的制定。

ABSTRACT Treatment for drug dependence is undergoing a paradigmatic shift that recognizes the limitations of acute care interventions. There is a growing consensus that drug dependence represents a chronic disease process that requires ongoing attention beyond formal treatment. Long-term professional treatment is prohibitive in part because reduction of cost continues to be an important goal among private and public funders. There is therefore an urgent need to identify non-professional interventions that can help sustain recovery after treatment, or in some cases, serve as an alternative to it. This application builds upon our ongoing and previous research assessing longitudinal outcomes of individuals residing in sober living houses (SLHs). The essential characteristics of SLHs include an alcohol and drug free living environment and social support for abstinence. SLHs are primarily financed through resident fees and residents in most houses can stay as long as they wish. There are over 800 SLHs in California alone, yet there are few studies assessing outcomes. Our research on SLHs shows that residents make significant, sustained (18-month) improvement on a variety of outcomes, including alcohol and drug use, arrests, employment, and other areas of functioning. This application proposes to study contextual factors neglected by our research to date, including how physical, social, and organizational characteristics among a heterogeneous sample of SLHs and the neighborhoods where they are located affect outcome. Factors assessed will include the social environment of houses, organizational and leadership characteristics, and architecture (e.g., size, spatial layout, proximity to neighbors, safety, use of rooms, and upkeep of the facility). We also examine the influence of neighborhood characteristics such as alcohol outlet density and proximity, activity spaces, crime, socioeconomic status, density and proximity of 12-step meetings, density and proximity of treatment services, and interactions between neighbors and SLH residents. Focus groups with residents and house managers will inform implementation of study procedures and understanding of quantitative findings. Procedures will include recruiting a sample of 600 individuals entering 40 purposively selected SLHs in Los Angeles County. Primary outcomes will include substance use, HIV risk, arrests, and employment. Multilevel modeling will parse out relative influences of individual, house, and neighborhood factors on outcome at 6 and 12 months. Results will provide new data on house and neighborhood characteristics that are critical for describing evidence-based SLHs and developing new standards based on scientific findings. Current recovery house organizations, such as the National Alliance of Recovery Residences (NARR), have standards primarily based on practical experience and anecdotal reports. There is therefore an urgent need for research that can help them develop evidence-based house environments and neighborhood locations. Dissemination of findings will target researchers, SLH operators, and SLH organizations involved in the creation of standards.