2000s

In the 2000s, recovery residences increasingly become part of the national dialog:

• A growing body of research – In the 2000s, many researchers began to focus on recovery housing. Their findings revealed that recovery housing increases abstinence, employment, and income, improves psychiatric symptoms, and decreases arrests and recidivism. This led to Oxford House and several Therapeutic Community models listed in the Substance Abuse and Mental Health Services Administration (SAMHSA’s) National Registry of Evidence-based Programs and Practices (NREPP). The NREPP was replaced with SAMHSA’s Policy Lab initiative, and in 2021, recovery housing was listed in its Evidenced-Based Practice Resource Center.

• National Alliance for Recovery Residences (NARR) – The modern recovery housing movement has been led by the National Alliance for Recovery Residences (NARR), which formed, developed a common language, an inclusive framework, and Levels of Support continuum in 2011. NARR published national standards and codes of ethics in 2012. NARR merged with the Association of Halfway House and Alcoholism Programs (AHHAP) in 2013, making it the largest and oldest organization of its kind. Whereas NARR curates best practices and sets national standards, it designates statewide affiliate organizations that certify recovery residences. NARR had state affiliates in over 30 states by 2021.

• Corrupt Business Practices – Starting in the 2010s, there was a sharp rise in unethical business practices between recovery housing and treatment and laboratories. Fueled by profits, these practices overtook some marketplaces, e.g., Florida, and spread to other states. Profits, marketplace pressure, and business consultants normalized these corrupt practices, which spread across the nation. This caught the attention of State and Congressional Legislators. These concerns were documented and informed by The President’s Commission on Combating Drug Addiction and The Opioid Crisis final report (2017), in a US Government Accountability Office (GAO) report on recovery housing (2018). The SUPPORT (2018) and the State Model Laws (2018 and 2021). Several federal and state laws related to patient brokering and recovery housing were filed and/or passed.

• Epidemics – Recovery residences were impacted by several epidemics and were forced to adapt quickly.
  • Synthetic Drugs – In the early 2000s, the prevalence of synthetic drug use (e.g., spice, k2, kratom, bath salts) increased. These substances were not detected with the standard point-of-care cups, so providers started using more expensive tests, including confirmation labs. These substances were often used by youth, and the average age of persons living in recovery homes dropped significantly. Some reported it to be between 20 and 23 years of age. To meet the higher needs of this population, recovery homes began offering more support.
  • Opioid Epidemic – According to the CDC, nearly 500,000 people died from an overdose involving any opioid (prescription and illicit) between 1999–2019. Opioid overdose deaths occurred in three waves. The first happened in the 1990s due to an increased prescribing of opioids. The second wave began in 2010, with rapid increases in overdose deaths involving heroin. The third wave began in 2013, with significant increases in overdose deaths involving synthetic opioids (especially illicit fentanyl). Many recovery housing providers struggled to support persons undergoing opioid agonist therapy (Suboxone and Methadone) because these medications had historically not been allowed in recovery housing.
  • COVID – The COVID pandemic required recovery homes to develop new universal precaution policies and procedures. As a result of physical distancing requirements, residential treatment capacity degreed, and many turned to recovery residences to gain recovery support.