Examining Recovery Status Trends over 7-Years for Men and Women Clients of a Substance Use Disorder Recovery Housing Program

• Author: TK Logan,Christopher J. McLouth,Jennifer Cole
• DOI: http://doi.org/10.1177/00220426221083654
• Published date: 01 October 2022
• Date: 01 October 2022
• Subject Matter: Articles

Article

Journal of Drug Issues

2022, Vol. 52(4) 527–546

© The Author(s) 2022

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DOI: 10.1177/00220426221083654

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Examining Recovery Status

Trends over 7-Years for Men

and Women Clients of a

Substance Use Disorder

Recovery Housing Program

TK Logan

1

, Christopher J. McLouth

1

, and Jennifer Cole

1

Abstract

Adults who are homeless and/or involved in the criminal justice system have signif‌icantly higher

risks of substance use disorders (SUD)s and they may have increased diff‌iculty initiating and

maintaining traditional SUD treatments. To address the needs of adults with SUDs who are

homeless/criminal justice system involved the Recovery Kentucky programs were established.

This study examined outcomes for this recovery housing program among an unduplicated

statewide sample of men (n=672) and women (n= 732) clients who entered the Recovery

Kentucky program and who were followed-up about 12 months after program entry across a

7-year period. Low, but similar rates of problem alcohol or illicit drug use at follow-up were found

across the 7-year period. Men had higher rates of return to use than women. Further, about 40%

of the clients had at least one recovery status vulnerability factor at follow-up each year of the

study with no differences by gender.

Keywords

recovery vulnerability, program outcomes, supportive housing

Introduction

Millions of individuals in the U.S. are arrested, incarcerated, or are on probation or parole at any

given time (Minton, Beatty, & Zeng, 2021;Oudekerk & Kaeble, 2021). Individuals on probation

and parole have substance use disorders (SUD)s between four and nine times higher than in-

dividuals not on community supervision (Fearn et al., 2016) and over half of state prisoners and

jail inmates have SUDs (Bronson, Stroop, Zimmer, & Berzofsky, 2020). Further, individuals on

probation/parole or those released from incarceration have signif‌icant unmet treatment needs and

1

University of Kentucky, Lexington, KY, USA

Corresponding Author:

TK Logan, Department of Behavioral Science, University of Kentucky 333 Waller Ave, Suite 480 Lexington, KY 40504,

USA.

Email: tklogan@uky.edu

are at risk of (re)incarceration (Fearn et al., 2016;Pew Charitable Trusts, 2018) particularly if these

individuals have economic vulnerabilities such as homelessness and unemployment (Fearn et al.,

2016). At the same time, there is a higher risk of SUDs among those who are homeless or at risk of

becoming homeless (Fleury et al., 2021;Ibabe, Stein, Nyamathi, & Bentler, 2014;Stringfellow

et al., 2016). A lack of safe and stable housing can increase the risk of substance use as well as

incarceration, while incarceration can increase the risk of homelessness (Chavira & Jason, 2017;

Cusack & Montgomery, 2017;Polcin, 2016). Individuals who are homeless and/or who involved

in the criminal justice system have multiple and complex needs that can make participation in

traditional substance use disorder (SUD) treatment programs diff‌icult (Chen, 2018;Kahn, Vest,

Kulak, Berdine, & Granf‌ield, 2019;Padgett, Tiderington, Tran Smith, Derejko, & Henwood,

2016;Priester et al., 2016;Tsai & Gu, 2019).

More specif‌ically, individuals with SUDs and economic vulnerabilities have multiple barriers

to SUD programs including limited transportation options, diff‌iculty paying for treatment, lack of

social support, and co-occurring mental health problems (Compton, Gfroerer, Conway, & Finger,

2014;Coohey, Easton, Kong, & Bockenstedt, 2015;Kahn et al., 2019;Lee et al., 2017;Peters,

Young, Rojas, & Gorey, 2017). Maintaining SUD program participation and recovery is more

diff‌icult without safe and stable housing (Jason, Olson, Ferrari, & Lo Sasso, 2006;Milby,

Schumacher, Wallace, Freedman, & Vuchinich,2005;Polcin, Korcha , Bond, & Galloway,2010a;

2010b;Reif et al., 2014;Shaham, Shalev, Lu, De Wit, & Stewart, 2003). Furthermore, individuals

with complex needs may have lower rates of SUD program initiation, higher program dropout

rates, lower participation in aftercare, and higher SUD program readmissions and/or relapse rates

(Creedon & Le Cook, 2016;Davidson et al., 2010;Jones, Campopiano, Baldwin, & McCance-

Katz, 2015). Thus, sustained and appropriate support, including stable housing, may facilitate

SUD recovery among vulnerable individuals (Polcin & Korcha, 2017;White, Boyle, & Loveland,

2003,2004).

To address the needs of vulnerable adults with SUD, Kentucky implemented a recovery

housing program called Recovery Kentucky, which is similar to a modif‌ied Therapeutic Com-

munity (TC) or sober living home (Fitzpatrick-Lewis et al., 2011;Leon, 1995;Logan et al., 2020;

Vanderplasschen et al., 2013). Recovery Kentucky provides supportive housing that promotes

education, personal and community accountability, vocational support, and an emphasis on 12-

step mutual-help participation in 17 programs throughout the state (Logan et al., 2020). There are

several unique features of Recovery Kentucky programs (Logan et al., 2020). More specif‌ically,

Recovery Kentucky is a joint collaborative with the Department for Local Government, The

Department of Corrections, and the Kentucky Housing Corporation, which developed and built

facilities solely devoted to the program model. Each facility was built to be home-like rather than

institutional, with the safety and comfort of participants in mind, and with devoted space for social

and recreational activities. Each facility was situated within a pre-selected geographic area as well

as within a specif‌ic community with services that can be utilized by clients. In fact, clients are

encouraged to use community-based services to facilitate knowledge and integration needed to

transition to long-term recovery (Kahn et al., 2019). The Recovery Kentucky program takes

clients about 6 months to complete, which is shorter than some TCs which can last up to 12–24

months and TCs have high dropout rates (Malivert, Fats´

eas, Denis, Langlois, & Auriacombe,

2012;Vanderplasschen et al., 2013). The Recovery Programs prioritize services for individuals

who are homeless, at risk of being homeless, and/or who have been involved in the criminal

justice system. Each Recovery Kentucky program has several phases including a Safe, Off-the-

Street phase (SOS) (3–7 days) and the Motivational I and II Tracks, which can last for 5–6

weeks, then participants enter into Phase I of the full recovery program, which lasts about 5–6

months. Although research shows that stable and safe housing contributes to longer stays in

programs, more limited research has focused on outcomes after participants exit these programs

528 Journal of Drug Issues 52(4)