Community Impact on Adoption of Sober Living Houses

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DESCRIPTION (provided by applicant): Lack of affordable, substance-free housing for individuals with substance use disorders has major significance for public health systems. Research shows many of these individuals experience homelessness and become burdens to healthcare, social welfare, and criminal justice systems. Substance abusers who do have stable housing often reside in environments that support substance use rather than abstinence. Sober Living Houses (SLHs) are alcohol and drug free living environments that are an excellent, yet underutilized option for these individuals. Our current study of SLHs suggests that residents make improvement in a range of areas, including drug and alcohol use, employment, and arrests (Polcin & Henderson, 2008). This R21 (Exploratory) study will combine quantitative, qualitative, and architectural methods to understand community influences on adoption of this promising innovation in one community where it has been successfully established. Our rationale posits that translating promising interventions into community services requires more than demonstrating positive outcomes. The social context within which interventions are delivered must also be considered, particularly the level of knowledge, attitudes, and perceived barriers of various stakeholders. This study will assess community perceptions of SLHs by triangulating study methods and sources. One component of the study will include a survey of 150 human service professionals using self report questionnaires that assess attitudes and beliefs about SLHs. A second component will include in depth interviews with 16 SLH managers to explore their views on how community stakeholders influence SLHs, current and past barriers, and how barriers have been overcome. We will also interview neighbors (n=20) of 6 targeted SLHs to investigate the other side of the question: how SLHs have impacted the community. Key informant interviews will be conducted with local housing, health department, and city manager administrators (n=9). These interviews will target information about policy and political forces that have impacted SLHs. A third component of the study will include an architectural assessment of the houses to understand how physical and spatial characteristics directly and indirectly affect stakeholder groups. Hypotheses address stakeholder perceptions of SLHs as well as perceived barriers. Quantitative analysis will include OLS and logistic regression models. Qualitative analysis will use a modified grounded theory approach. Results depicting common and disparate themes of support for and barriers to SLHs within and across stakeholder groups will be described. Thus, the study will provide information to guide the content of translational efforts and identify where such efforts are needed most. It will also identify sources of support for SLHs that advocates can use to support their expansion. Different strategies may be needed for those who lack information about SLHs, have beliefs that they are not effective, have allegiances to other treatment approaches, have views that minimize social factors in recovery, and live in communities where public policy hinders expansion of SLHs. PUBLIC HEALTH RELEVANCE: This study will increase understanding about how to assess community context factors that impact whether research based interventions are successfully translated into the community. Results from our case study of SLHs in one community where they have flourished will provide data that can be used in the development of SLHs in other communities and translation of knowledge about SLHs to the public. Research findings will also illustrate how the different perspectives of different stakeholder groups may require different types of knowledge translation.