Peer Helping, Retention, and Relapse in Sober Living Houses

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Sober living houses (SLHs) are alcohol- and drug-free living environments for persons attempting to abstain from substances and develop a long-term program of recovery. Studies have shown residents in these homes make significant, sustained improvements in multiple areas of functioning, including abstinence from alcohol. One of the strongest and most consistent predictors of relapse is shorter retention in the house. Focus groups with SLH managers suggest peer helping enhances retention, commitment to the household, and commitment to recovery. Building upon an ongoing longitudinal study of SLHs, the proposed study will assess the relative impact of helping behaviors on retention, and in turn, on relapse. Initial aims will assess how relapse is affected by helping broadly conceived, including comparisons of giving versus receiving help and helping in relation to peers versus others (i.e., family and friends). We will also assess how relapse is affected by giving and receiving different types of help, such as instrumental versus emotional. The study will then test a novel path model suggesting that, because of the overarching culture of SLHs and the innate benefits of helping in recovery, helping others in recovery-related contexts (i.e., in the residence and in 12-step groups) will lead to stronger relationships with peers in recovery, improved self-esteem, a stronger commitment to abstinence, more focus on others, and improved recovery-related coping skills. We posit all of these effects will then reinforce helpers' commitment to the residence, resulting in longer retention. SLHs are ideal sites for the proposed study because the primary therapeutic influence involves peer support within an alcohol- and drug-free living environment. Because the current research on the relationship between helping and recovery focusses on alcohol problems, a current alcohol use disorder will be an inclusion criterion. The study will include qualitative interviews to inform study procedures and identify experiences of giving and receiving help that illuminate the path model. Individuals entering SLHs with alcohol use disorders (N=200) will be assessed on measures of helping, social networks, substance use, and severity of problems on the ASI. Because the rates of relapse are highest soon after entering the houses, we will conduct baseline and monthly assessments during the first three months and a final interview at 6 months. Significance of the study is high because SLHs and other types of recovery residences are experiencing rapid growth and data are needed on malleable factors that promote better outcomes. Further, this study will add to the narrowly focused literature on helping in recovery and will be the first to illustrate the pathways by which helping influences outcomes in SLHs. SLH providers will be able to use study findings to determine intervention points for enhancing retention and sustaining recovery among sober living residents.