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How long should a sober living stay be?

This is a question that has been asked many times, both by future sober living residents and by their loved ones. The short answer is that it depends on each individuals situation but that the longer the stay, the better chances at maintaining long term recovery. The reality here is that studies have repeatedly shown positive outcomes are directly linked to an adequate treatment length. The National Institute on Drug Abuse states that stays “less than 90 days is of limited effectiveness, and treatment lasting significantly longer is recommended for maintaining positive outcomes.” One of the biggest problems facing substance use disorder treatment providers is treatment dropout, as addiction is a chronic disease. This highlights the importance of having extended monitoring and support available for those coming out of a higher level of care, such as residential treatment.

Post Residential Treatment

Unfortunately the average stays in residential (inpatient) treatment centers tend to be quite short. The most common reason for this is that addiction treatment patients tend to be utilizing insurance benefits. Insurance companies are not known to love spending their money, and that holds true for substance use disorder treatment as well. They will typically cover anywhere from 14-28 days inpatient before dropping a client to a lower level of care. Inpatient substance abuse and mental health treatment programs are prohibitively expensive for many. Costs can vary dramatically, with a 30 day stay in treatment ranging anywhere from $5,000 to $80,000. This is why many people will not be able to stay for any longer than their health insurance will pay for.

Due to the short stays, there is a serious need for step down facilities such as a combination of a sober home and outpatient program to provide the additional time that the above referenced studies have shown are necessary for success. When a person comes out of inpatient treatment, the best option is for them to go to a sober living residence while attending an outpatient program. This gives them the support of having outpatient groups, therapy, and case management while also getting the support and accountability that a recovery home can offer.

After Outpatient

While outpatient treatment is incredibly helpful, they tend to have the same issue as residential/inpatient does with insurance only paying for so long. The number of days covered tends to be longer than an inpatient program but it still isn’t going to be long enough to comfortably tell someone they are ready to “get back to business as usual.”

Because of this, a sober living is essential for those in early recovery. So many life changes happen during and after treatment and it is important to take things step by step. At this phase in many people’s recovery they will be slowly stepping back into things such as school and work. These are added stressors that haven’t come up while in recovery yet. When someone is in a sober living they are able to come back to the house and talk about the feelings that may have come up. They can rely on a sober community of their peers to be there to support them from the moment they walk in the door. It has been found that involvement in this type of social environment, minimizing the amount of active alcoholics and addicts in the network, have a statistically significant impact on positive outcomes at 1 and 3 year follow ups.

In addition to the supportive environment, there is also the added accountability to take into consideration. Many people with substance use disorders tend to be quite impulsive in early recovery. Acting on these impulses can be disastrous and are a large cause of poor treatment outcomes. When someone is living in a sober home there is the accountability of knowing you will come home to regular drug and breath testing. This form of accountability can make the difference between being able to convince oneself that “nobody will know if I just have one drink/drug” and “This drink/drug is a bad idea.”

What does the science say?

In a comprehensive study performed in 2010, researchers interviewed 245 people within 1 week of entering a sober living, with follow up interviews at 6, 12, and 18 months. They utilized several tools to track outcomes, including the Addiction Severity Index (ASI), Brief Symptom Inventory (BSI), and measures of alcohol and drug use.

They found that improvements were noted on every diagnostic tool. It was clear that residents of sober living homes made improvements in all areas of their lives. The single largest factor they found in predicting future substance use was the amount of substance use in the social network. This highlights why sober living is so important!

The average length of stay was 5 months, though 42% stayed longer than 6 months. The researchers found that sober home stay lengths over 6 months had drastic improvements in the resident’s lives, with those improvements still holding true at the 12 and 18 month marks.

“Other outcome variables also showed significant levels of improvement by 6 months that did not decline at 12 and 18 months.”

“…outcomes at 12 and 18 months changed very little despite the lower number of individuals residing in SLH’s.”

Their research goes to show the drastic benefits stays in sober living can help. They also show that the NIDA recommendation of 3 months in treatment is well below what is needed for success. Because of the earlier mentioned limitations on treatment length, whether residential or outpatient, sober living stays of 6-18 months are going to be the most beneficial for those who are new in recovery. With the social network being one of the largest factors in someones recovery, there absolutely must be enough time for a positive network to be built.

References

Bond, J., Kaskutas, L. A., & Weisner, C. (2003). The persistent influence of social networks and alcoholics anonymous on abstinence. Journal of Studies on Alcohol, 64(4), 579–588. https://doi.org/10.15288/jsa.2003.64.579

Giorgi, A. (n.d.). How much does alcohol rehab usually cost? WebMD. Retrieved September 10, 2021, from https://www.webmd.com/connect-to-care/addiction-treatment-recovery/alcohol/how-much-does-alcohol-rehab-really-cost.

Mericle, A. A., Mahoney, E., Korcha, R., Delucchi, K., & Polcin, D. L. (2019). Sober living house characteristics: A multilevel analyses of factors associated with improved outcomes. Journal of Substance Abuse Treatment, 98, 28–38. https://doi.org/10.1016/j.jsat.2018.12.004

National Institute on Drug Abuse. (2020, June 3). How long does drug addiction treatment usually last? National Institute on Drug Abuse. Retrieved September 10, 2021, from https://www.drugabuse.gov/publications/principles-drug-addiction-treatment-research-based-guide-third-edition/frequently-asked-questions/how-long-does-drug-addiction-treatment-usually-last.

Polcin, D. L., Korcha, R., Bond, J., & Galloway, G. (2010). What did we learn from our study on sober living houses and where do we go from here? Journal of Psychoactive Drugs, 42(4), 425–433. https://doi.org/10.1080/02791072.2010.10400705