Here’s a weekly question we pose to our resident advocacy professional, Joe Schrank. Joe’s been a social worker for 25 years and he also ran his own sober living house in Williamsburg, Brooklyn where – to his credit – no one died. But due to flimsy regulation enforcement, some sober living facilities do more harm than good. So that’s our topic today: Sober Living. Joe’s helpful responses to some obvious questions begin right below this bold paragraph.
1. Why do rehabs refer and recommend sober living facilities after treatment?
There are a few reasons rehabs refer patients to a sober living facility. Often, it’s the right thing clinically. There is a lot of literature out there about the length of stay in managed settings; the longer the stay, the better the outcome, but only to a point. In its purest form, if rehab is knee surgery, sober living is physical therapy. Surgery alone doesn’t make much sense for many people. The other not-so-pure reason for sober living is cover-your-ass. Rehabs know clients are a high-risk population and a referral to a sober living can mitigate potential lawsuits. There could be commerce reasons – “You refer to us, we refer to you.” In and of itself, sober living makes sense but, as with anything, the application of the intent matters.
2. Are they safe? Are they regulated?
Many sober livings are safe. Many are not. They aren’t regulated, which is a problem. When I launched one in New York City, I was all about compliance. I wanted to do everything by the book because it was a pioneering venture. I researched the regulations and pretty much begged the city to inspect me. Ultimately, a lady with the city said “Honey, if you want to live in a warehouse in Brooklyn with a bunch of drug addicts, be my guest.” Ultimately, I just followed the city guidelines for other group homes, which were pretty extensive. To me it speaks to the devaluing and marginalizing of folks with substance misuse issues. There are steep regulations and standards for elder care, Down Syndrome, all kinds of situations were people could benefit from communal living… but not for addiction. That attitude is harmful because a dwelling becomes a sober living facility when someone says it is, not when it is certified. Many are well meaning and likely a safe place, but many aren’t. How is the consumer to know?
3. Is that why so many people die there?
People die in sober livings for many reasons. First and foremost, substance misuse can be lethal. Another common reason is sober living operators providing a level of care for which they are ill-prepared. I have heard many times a sober living operator say, “We don’t allow that medication,” which can end up with an overdose. Most sober living operators require residents to recover in the same way they did, and that can be dangerous. It’s a soup of volatility and risk: mental health issues, family pressure, pathology, all under one roof. It’s very easy for the whole thing to become Lord of the Flies.
4. Why does Florida have so many of them?
Florida has a pretty low standard of care to operate treatment facilities. Rehab became a cottage industry there based on insurance reimbursements and ease of starting point. It just became the place for rehab. Why are there so many bands in Nashville? There is nothing particularly compelling about Florida as a recovery destination other than the reasons people go there anyway: get into the sun, get away from the cold. I think the marketing was framed as rehab/retreat/vacation. When it all started, Hazelden was one of the better known entities, and that’s a frozen tundra much of the year. I think people started trying to appeal to clients in a different way. There are likely many reasons why Florida became such a concentration of rehabs and sober livings.
5. Is it Florida’s fault? Can we blame the entire state for this (and many other horrible things about the state of our country)?
I’m not sure the current quagmire is Florida’s fault, but it certainly correlates to Floridian culture. Florida seems to have a high density of thieves and hustlers, many of whom seem to have taken their skills as drug dealers and applied them to the recovery industry. I guess it’s like red tide: they didn’t cause it, but they made it worse than it has to be.
6. What’s the alternative to a halfway house situation? Where do you find a safe space to stay after treatment?
Looking at a sober living online gives you diminishing returns. The websites are all effectively the same, and most don’t say much. They seem to like pastel colors, pictures of stacked rocks, arms stretched to a naturescape in triumph, presumably over addiction. On the other hand a referral from a trusted source is a good way to find a well-run and reputable sober living. I always strongly suggest a site visit. Meet the staff, meet the management. If it doesn’t feel right, it’s likely not. There are lines in the sand for me; “We don’t permit that medication,” would be an example of an unethical sober living compared with “We support the licensed physician’s protocols.” I hate “We have a zero tolerance policy for drug use.” I never understood how there could be no tolerance for having the problem for which you were seeking help. I think it’s important to find a community that is in line with your individual brand of recovery. If one is a 12-step purist, there’s a good sober living for you. If one is resistant to 12-step fundamentalism, something else may be in order. Most of sober living is about finding the right fit.
7. What does an ideal post-treatment situation look like?
Nothing about recovery is ideal, and that includes sober living. My experience is transitional living is where the rubber meets the road. Recovery can’t be theory, it must be lived. It’s just one of those things: you can’t learn to swim without swimming. Ideally a sober living has a well organized, dedicated and trained staff. There are norms, expectations, and clinical support. Accountability partnering matters; ultimately, you can’t lift weights for clients but you can stand over them and encourage them and make sure the bar doesn’t end up across their throat when they’re trying to press too many pounds. Ideal sober living is scaffolding around new recovery so individuals can make their mistakes without falling into the abyss.
8. What about these “marketers” I’ve heard so much about? What are they? I heard there are some real creeps and death merchants in Del Ray Beach.
Marketers are effectively liaisons between clients, referents, and the sober living facility. They may not be dangerous as a presence in a community that helps people get to sober living; the issue is the lack of ethics among some. I have witnessed horrors of marketers coercing vulnerable people, new to recovery, to change sober living facilities. It happens in rehab too and it’s wrong. The issue isn’t so much marketers – there are good and bad ones – the issue is more the profit margin that’s up for grabs. If we really wanted a better system there should be a public option for anyone wanting to be treated for substance misuse. It is true there are “non-profits” out there but there isn’t no profit, there are still the salaries of the executive team. A simple tax raise of .05/100 on beer could fund treatment and offer recovery services for all in need. This would not eliminate abuses but it would certainly help. I can hear people saying, “But you work in private treatment.” I’ll gladly teach and coach if the rehab-for-profit industry goes away. I look forward to being obsolete.
If you’ve got a question you’d like to ask me to Ask Joe, please reach out to firstname.lastname@example.org