Evidence Based Sober Living Houses: A Multi-level Analysis

摘要 药物依赖的治疗正在经历一个范式转变，认识到急性护理的局限性 干预措施。越来越多的人认为，药物依赖是一种慢性疾病， 需要持续的关注，而不仅仅是正规的治疗。长期的专业治疗在一定程度上是禁止的 因为降低成本仍然是私人和公共资助者的重要目标。有 因此，迫切需要确定非专业干预措施，以帮助维持恢复后， 治疗，或在某些情况下，作为它的替代。这个应用程序建立在我们正在进行的和以前的 研究评估了居住在清醒生活房屋（SLHs）中的个人的纵向结果。的基本 SLH的特征包括无酒精和毒品的生活环境以及对禁欲的社会支持。 SLH主要通过居民费提供资金，大多数房屋的居民可以想住多久就住多久。 仅在加州就有800多个SLH，但很少有研究评估结果。我们研究 SLH显示，住院医师在各种结果上都有显著的持续（18个月）改善， 包括酒精和毒品使用，逮捕，就业和其他功能领域。本申请提出 研究我们迄今为止的研究所忽视的环境因素，包括物理，社会和组织 异质样本的SLH和他们所在的社区之间的特征影响 结果。评估的因素将包括房屋的社会环境、组织和领导 特性和体系结构（例如，大小、空间布局、邻近邻居、安全性、房间的使用，以及 设施的维护）。我们还研究了邻里特征的影响，如酒精出口 密度和接近度，活动空间，犯罪，社会经济状况，12步会议的密度和接近度， 治疗服务的密度和接近程度，以及邻居和SLH居民之间的互动。重点 与居民和房屋管理人员的小组将告知研究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个 洛杉矶县的几个小家庭。主要结果将包括物质使用，艾滋病毒风险，逮捕， 就业多层次建模将解析出个人、房屋和邻里的相对影响 6个月和12个月时的结局因素。结果将提供有关房屋和邻里的新数据 这些特征对于描述基于证据的SLH和基于以下内容开发新标准至关重要： 科学发现。目前的恢复之家组织，如全国恢复住宅联盟 （NARR）的标准主要基于实际经验和轶事报告。因此， 迫切需要研究，可以帮助他们发展基于证据的房屋环境和邻里 地点研究结果的传播将针对研究人员、SLH运营商和参与以下活动的SLH组织： 创建标准。

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.