Sober Living Homes Are Too "Clean"

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Sober Living Homes Are Too "Clean"

By Anne M. Fletcher 07/21/13

I was heartened by Matthew Perry's openness about addiction—but then dismayed by his sober living home's backward thinking on maintenance drugs. Such policies are illegal, as well as unethical.

Image: 
perry sober house.png
Matthew Perry's heart may be in the right place—but his sober living home's MAT
policies are not.

When people tell me stories about sober homes and their restrictive policies about medication-assisted treatment (MAT)—specifically, denying access to those who use Suboxone and methadone—I feel the way Peter Finch did in the 1976 film Network, when he implored viewers to shout, “I’m mad as hell and I’m not going to take this anymore!”

While writing my book Inside Rehab, and in queries I continue to receive, I found that people are all too often denied or never offered the very medications that studies show will help them remain in recovery. Consider the recent death of 31-year-old Cory Monteith, attributed to a toxic heroin-alcohol combo. While we don’t know for certain about his aftercare plans, he reportedly went to two rehabs (Betty Ford and Crossroads) that told me they don’t send patients home on MAT. But that’s what rehab and sober living facilities should be all about: helping people stay sober. 

When I saw Matthew Perry’s recent “My Life as an Addict” story on the cover of People, I was pleased that yet another celebrity had “come out” about his past troubles with alcohol and drugs, and shared the good news about turning his life around.

I heard about sober homes that engaged in such degrading rule-violation policies as making clients wear signs around their necks or sit on crates.

Better still, Perry has put his name behind important causes, becoming a “passionate advocate” for drug courts and having recently turned his Malibu mansion into an exclusive sober living home, offering 12-step workshops, home-cooked meals, 24-hour on-site management and regular drug testing.

However, my positive vibes turned to dismay when, after checking out the plush Perry House at its website, I sent in a query via their “contact” page, asking whether they admit residents on addiction medications, specifically mentioning Suboxone and methadone, which are important for opioid addiction—and not just for “detox”, but for many people on a long-term basis. The response I received was as follows: 

“We would not allow Suboxone or methadone since they would ‘pee dirty’ for opiates. … Anything that makes a UA come up positive would be a problem.”

So I wrote back to the manager, indicating that if they chose to do things differently, they could be leaders in the sober housing field. I also shared the following (and got no response): 

“It's unfortunate when this is denied, because dozens of studies have shown that Suboxone and methadone not only decrease the chance of relapse but they lower death rates in opioid addiction. I'm wondering how many places know that it's really illegal to deny people on MAT sober housing. This is stated in a government brochure available from SAMHSA's website:

p. 13: "The Fair Housing Act (FHA) makes it illegal to discriminate in housing and real estate transactions because of someone’s disability. People in MAT are protected from housing discrimination under the FHA—just as are people with other disabilities. … Housing discrimination related to MAT sometimes arises in the context of residences for individuals in recovery. Individuals who live or want to live in halfway houses, recovery homes or other residences for individuals in recovery are sometimes excluded because of their participation in MAT. This is illegal even though this type of discrimination occurs with some frequency." 

Lord knows we need more well-run sober living facilities. As a recent Salon report found, sober homes are largely unregulated and often present poor living conditions. Their policies and management can be highly variable, with some run like boot camps.

While researching my book, I heard about sober homes that engaged in such degrading rule-violation policies as making clients wear signs around their necks or sit on crates. And it’s not unusual for clients to be required to go to 12-Step meetings when they should be allowed to choose their own form of support. There do not appear to be any standards for managers or staff either, who may simply be people in recovery, with no training or knowledge beyond that. The rights of individuals applying to live in or who are already residing in sober living facilities need protection against discrimination, abuse, and arbitrary or capricious actions.

Anyone who works in the field of addiction treatment is aware of the growing view that serious substance use disorders should be viewed like other chronic illnesses, such as diabetes, that warrant more than just a short-term burst of treatment. Sober living facilities can help with the transition from intensive treatment back to the real world. The forthcoming “Policy Statement: The Role of Recovery Residences in Promoting Long-Term Addiction Recovery” to be published in the American Journal of Community Psychology by DePaul University’s Leonard Jason, PhD, and several other leading experts in the field concludes, “A small but growing body of research supports the effectiveness of recovery residences in sustaining abstinence and promoting gains in a variety of other domains.” 

Also, a number of experts I interviewed for my book feel the combination of going to intensive outpatient treatment while living in a well-run sober home can be a better model than residential rehab for many people. James McKay, PhD, director of the Center on the Continuum of Care in the Addictions at Philadelphia’s Treatment Research Institute said, “When a sober home works well, it’s a longer stay than in a residential program. You get six months rather than twenty-eight days for a fraction of the cost.” But again, being well-run is a “big if.”

If Perry wants to help others in an optimal way, he’ll recognize science-based treatment approaches and that there are many different paths to recovery.

So what’s up with denial of sober housing to people on Suboxone and methadone? Beth Fisher, LCSW, Executive Director of Hope Homes and past president of the National Alliance for Recovery Residences, an organization that has adopted national operating standards for sober living facilities, said that homes allowing MAT are difficult to find. (I checked with a number of experts, and they all said that there are no national data on the number of facilities that will admit clients on MAT.)

Fisher added that the argument that these medications will make clients “pee dirty” is one that can be gotten around with tests that are more sophisticated than just “peeing in a cup.” But they cost a bit more. (A glance at the Perry House website suggests that they could spring for the more expensive testing.) She also stressed the need for residences to have strict standards for MAT clients—for instance, Suboxone and methadone should be kept in a lockbox because they can be abused when taken inappropriately.

Over the course of the past few months, I’ve been helping the father of a young man with a long history of opioid addiction find quality residential treatment, which they eventually did. But afterward, they found that not one sober home in a large metropolitan area would take clients on Suboxone. With difficulty, they finally located one, but in another community. The father considered a lawsuit against some of the facilities that refused MAT clients. He said, “It’s just speculation on my part, but [the peeing dirty argument] appears to be simply an excuse to keep people on medication out.” 

Mark Willenbring, MD, director of the Alltyr treatment system in St. Paul, Minnesota, and former director of the Division of Treatment and Recovery Research at the National Institute on Alcohol Abuse and Alcoholism agreed: “It's just an indirect way of saying you don’t think people taking opioid therapy are ‘sober.’ So it's better to stay addicted and possibly die rather than ‘be dirty’ but alive, happy and productive.” Willenbring maintains that we need to see MAT as we do insulin for people with diabetes, and I agree. 

Tom Horvath, PhD, owner and director of the Practical Recovery treatment facilities in San Diego, said, “It’s extremely frustrating to individuals who have achieved stability in recovery using Suboxone when they’re told they’re ‘not really in recovery’ and therefore not eligible for a sober home. They’re faced with the choice of not having sober living or not having Suboxone.”

As a person in long-term recovery from an alcohol use disorder, I see revelations like Perry’s as bolstering the growing movement to break the silence about addiction, which hopefully will help to vanquish some of the stigma surrounding it. But if he wants to help others in an optimal way, he’ll lead the charge by recognizing science-based treatment approaches and that there are many different paths to recovery—paths that include MAT for as long as someone needs it. 

Anne M. Fletcher (@annemfletcher) is a columnist for The Fix, and the author of Inside Rehab: The Surprising Truth About Addiction Treatment—and How to Get Help That Works (Viking, Feb. 2013) and Sober for Good: New Solutions for Drinking Problems—Advice From Those Who Have Succeeded (Houghton/Harcourt, 2001).

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