Abstract
Substance use and carceral system involvement are often connected, highlighting the need for substance use disorder recovery support services among those leaving carceral facilities. However, no prior study has examined whether recovery housing and carceral facilities are co-located. Using data from the National Study of Addiction and Treatment Recovery Residences (2020-2021, N = 10,358), we examined availability of recovery housing proximate to carceral facilities. Results show that recovery residences are often collocated with state and federal prisons and detention centers in the US. Specifically, the odds of having any recovery housing are 74% higher and recovery housing density is 35% higher in counties with versus without state prisons (ps < 0.001). Findings for federal prisons were similar. Future studies involving individuals with SUD who are leaving carceral facilities should examine factors facilitating and inhibiting access to recovery housing as well as how recovery housing affects the communities in which they are located.
Substance use disorders (SUDs) are common among individuals involved in the carceral system, with an estimated 65% percent of the United States prison population having an active SUD (National Institute on Drug Abuse, 2020). Given that formerly incarcerated individuals with SUD may be more likely to return to incarceration than those without SUD (Kopak et al., 2019; Magee et al., 2021), helping individuals in the carceral system recover from SUD is particularly important for preventing recidivism. In addition to addressing SUD upon release from custody, securing housing after incarceration can be difficult. Formerly incarcerated individuals are 7–13 times more likely to experience homelessness than the general public, with one study finding that 203 out of every 10,000 formerly incarcerated people were homeless (Couloute, 2018). Data from the Bureau of Justice Statistics also show that 63% of individuals in state prisons are incarcerated more than 100 miles away from their families. This suggests that people might need additional housing support upon release (Rabuy & Kopf, 2015). Thus, SUD recovery housing located near prisons can provide both housing and recovery support options for these individuals facing some of the highest barriers to successful reentry. However, no prior study has examined whether recovery housing and carceral facilities are co-located, which is the purpose of this investigation.
Background
Efficacy of Recovery Residences for Individuals Involved in the Carceral System
Recovery residences are safe and healthy residential environments in which skills vital for sustaining recovery are learned and practiced in a home-like setting (National Alliance for Recovery Residences, 2018). Each residence develops its own policies on relapse sanctions, readmission criteria, and other rules (Jason et al., 2013). Although they can vary in the amount of structure and levels of support offered, recovery residences are commonly used after inpatient or residential treatment (Reif et al., 2014) and by people released from carceral facilities (Polcin, 2006, 2018). While recovery residences go by different names, they have some common elements, including facilitation of mutual aid, pro-social bonds, and peer support, which all provide critical recovery support (Jason et al., 2013).
Involvement in therapeutic communities (De Leon, 1988; Martin et al., 1995; Prendergast et al., 2004), Oxford Houses (Jason et al., 2015, 2016), and sober living houses (Polcin, 2018; Polcin et al., 2017) are all linked to better outcomes among individuals involved with the carceral system. For example, a study of 200 formerly incarcerated women living in Oxford Houses found that those with longer stays in an Oxford House (six months or more) had less alcohol and drug use and higher likelihood of employment at the two-year follow-up than those with shorter stays (Jason et al., 2016). Another study of 330 individuals on parole or probation showed significant improvements relative to baseline on substance abuse, legal problems, HIV risk, and employment outcomes after twelve months of living in a sober living house (Polcin et al., 2017).
Recovery Residence Locations
Where recovery residences are located can affect risk exposures and resources available to residents. For example, a recent study of the associations between neighborhood characteristics and outcomes of sober living house residents found that a variety of different neighborhood factors (e.g., greater density of treatment and mutual help groups, as well as perceived neighborhood cohesion, lower crime, and better transportation) were associated with higher percent days abstinent and greater recovery capital (Mahoney et al., 2023). Understanding the context of recovery housing may also lead to a better understanding of the readiness of a community to support those in recovery (Ashford et al., 2020) as well as highlighting how recovery housing might strengthen communities (Callahan et al., 2021; Mericle et al., 2020). More fundamentally, however, understanding where recovery residences are located can address key questions about availability of and access to this component of the service delivery system (Penchansky & Thomas, 1981). For example, a recent, comprehensive national study of more than 10,000 recovery residences found that these residences were less likely to be located in rural areas and that the number of recovery residences (housing density) declined as the proportion of residents with low incomes increased (Mericle et al., 2022). This study also found that recovery residences were more likely to be in counties with higher substance use mortality, suggesting that recovery residences are often located in areas with high need (Mericle et al., 2022).
Study Rationale and Aims
Despite research supporting recovery housing as a resource for formerly incarcerated individuals with SUD, the availability of recovery housing in the U.S. for formerly incarcerated individuals has not been documented, potentially leaving a vital resource for this population under-identified. Furthermore, the U.S. Federal Bureau of Prisons has residential reentry contracts for facilities that provide housing and services specifically to those involved in the justice system (US Department of Justice, 2024; Federal Bureau of Prisons. (n.d.)). Thus, assessing the availability of recovery residences in counties with state and federal carceral facilities is crucial to answering the question of whether individuals leaving them may have access to this resource. Using data from the National Study of Addiction and Treatment Recovery Residences (NSTARR) project and U.S. Census, the primary aim of this study is to examine availability of recovery housing in areas with state prisons and those with federal prisons or detention centers compared to areas without these carceral facilities. We do not have hypotheses for this aim as there have been no studies that have examined similar research questions. Given prior findings regarding a paucity of recovery residences in rural areas (Mericle et al., 2022), a secondary aim is to examine how rurality is related to recovery housing once the relationship between carceral facilities and recovery housing has been accounted for. We hypothesize that recovery residences will be less likely to be found in rural areas.
Methods
Data
This is a descriptive study that uses cross-sectional data from the NSTARR (Mericle et al., 2022) project, the U.S. Census (U.S. Census Bureau, 2021), the U.S. Department of Agriculture (USDA; U.S. Department of Agriculture, Economic Research Service, 2020), and the (American Community Survey 2015-2019 5-Year Data Release). Though estimates have been put forth (Jason et al., 2020), the actual number of recovery residences in the U.S. is unknown, as this component of the substance use delivery service system is not tracked in the same way as treatment facilities. The NSTARR database represents the most systematically collected and comprehensive resource on where recovery residences are located heretofore compiled. NSTARR database creation took place from January 2020 – April 2021. As of that time, the NSTARR database contained information on 10,358 residences operated by 3628 providers in all 50 states; approximately 13% of identified residences were not included in these analyses due to missing county information. Contents of the NSTARR database were aggregated using publicly available sources and lists maintained by entities tracking recovery housing. Mericle et al. (2022) provides further details on the NSTARR database methodology.
Recovery residence data housing data for 3142 U.S. counties came from the NSTARR database. We geocoded recovery residence locations using ArcGIS (version 10.8.1; ESRI, 2020). Of the 10,358 houses in the NSTARR database, 60.8% were geocoded at the street level and 25.6% at the ZIP code level, with 13.6% remaining unmatched due to missing address information. Using spatial joins, we assigned county codes to each geocoded address and linked these with county-level data on the presence of state prisons, federal prisons, and federal detention centers identified through the 2020 U.S. Census (U.S. Census Bureau, 2021). Census data were used because there is no comprehensive list of all prisons and jails in the U.S. However, U.S. Census data on group housing do not identify all counties with jail facilities, thereby restricting our focus to counties with state and/or federal carceral facilities. To identify counties with state prisons and/or federal facilities, we used the number of incarcerated individuals living in a county as a proxy for the presence of a carceral facility in the county. Based on population estimates for residents of group quarters, we identified 799 counties (25%) with state prisons and 173 counties (6%) with federal carceral facilities (either federal prisons or federal detention centers). We included state and federal carceral facilities for adults, and we excluded military disciplinary barracks and military jails, as well as local and municipal carceral facilities, correctional residential facilities, and facilities for juveniles. Most (72%) counties had neither a state nor federal carceral facility for adults.
We then linked recovery housing and prison data with data on county-level urbanicity and demographic characteristics. County urbanicity was determined using the USDA’s 2013 Rural-Urban Continuum Codes (U.S. Department of Agriculture, Economic Research Service, 2020). These codes distinguish metropolitan counties by population size and nonmetropolitan counties by both degree of urbanization and adjacency to a metro area. We classified areas as urban (RUCC 1–3), adjacent rural (RUCC 4, 6, 8), or non-adjacent rural (RUCC 5, 7, 9), as in previous work (Mericle et al., 2022).
County demographic characteristics came from the 2015-2019 American Community Survey (U.S. Census Bureau, 2020), which were the latest data available for small areas (including some rural counties with low population counts). We included county-level proportion (%) population below 150% of federal poverty level, median rent ($), proportion of vacant homes, proportion of renter-occupied housing units, proportion of Latino residents, proportion of Black residents, and population density per square mile. These metrics were chosen to replicate what was used in the initial publication on national recovery housing availability from the NSTARR study (Mericle et al., 2022).
Statistical Analyses
We first examined recovery housing and county demographics descriptively for the sample overall, then stratified by counties with and without state prisons and stratified by counties with and without federal carceral facilities. We tested hypotheses regarding associations between recovery housing and carceral facilities using mixed-effects logistic and negative binomial regressions. Our outcome, recovery housing availability, was operationalized as a dichotomous indicator of any recovery housing (vs. none) in each county and as a count of recovery residences in each county with at least one recovery residence. We used the dichotomous indicator and basic count variable as outcomes in separate regression models, with the presence of carceral facilities (versus none) in the county as the primary exposure. Logistic regression, which yields odds ratios (ORs), was used for the dichotomous outcome and negative binomial regression, which yields incidence rate ratios (IRRs), was used for the counst outcome. Separate regression models included indicators of any state prisons and any federal carceral facilities as independent exposure variables. Because recovery residence availability has been linked to a range of neighborhood factors, adjusted mixed-effect regression models also accounted for county-level urbanicity, proportion (%) population below 150% of federal poverty level, median rent ($), proportion of vacant homes, proportion of renter-occupied housing units, proportion of Latino residents, proportion of Black residents, and population density (per square mile) as covariates, with a random effect for state and adjustment for clustering at the state level.
Results
County-Level Descriptives, Overall and by Prison Status (N = 3142 Counties).
aFPL = Federal Poverty Level.
*p < .05; **p < .01; ***p < .001.
Multi-Level Regressions Showing Associations Between Criminal Justice Facility Locations and County-Level Recovery Housing Availability, (N = 3142 Counties).
aIn counties with at least one recovery residence (n=929 counties)
bFPL = Federal Poverty Level
cOR = Odds Ratio, SE = Standard Error, CI = Confidence Interval
*p<.05, **p<.01, ***p<.001
Discussion
Using national data on more than 10,000 recovery residences with county-level geocoded data on likely locations of carceral facilities, we found that recovery housing is more likely located in counties with either a state and/or federal carceral facility. These results are encouraging, because individuals with a history of SUD leaving incarceration need places to live that can support their recovery. The collocation of recovery residences and federal carceral facilities may be due to contracts from the Federal Bureau of Prisons to support these facilities nationally (Federal Bureau of Prisons, n.d.). Still, data also show significantly lower odds of any recovery housing and significantly fewer recovery residences in rural versus urban counties. Individuals leaving prisons in rural counties face unique difficulties, as rural areas have fewer accessible services and programs to support both community re-entry after incarceration and recovery from SUD, making transition to the community more challenging (Tillson et al., 2022). Rural areas often lack many types of infrastructure, including housing and recovery support, so recovery housing adjacent to prisons in rural areas could serve multiple supportive roles for those who stay in the local community upon release. Future studies should identify barriers to the establishment of recovery housing and other resources in rural areas such that access to recovery support services can be increased.
Given the high recidivism rates for those with incarceration experiences (California State Auditor, 2019), stakeholders and policymakers have focused more on providing long-term residential therapeutic communities within carceral facilities than on examining community resources like recovery housing (Polcin et al., 2018). An understudied area of research is housing after incarceration, particularly how housing affects access to treatment and recovery for formerly incarcerated individuals (Reed et al., 2014; Stopka et al., 2022). For example, a qualitative study examining treatment continuity for medications to treat opioid use disorder post-release from jail noted lack of shelter as a substantial barrier to treatment continuity (Stopka et al., 2022). Interviews with key stakeholders, recovery professionals, and community members similarly have emphasized safe and affordable housing as critical for promoting recovery and reducing recidivism (Reed et al., 2014).
Still, concentrating recovery residences in communities with carceral facilities is a complicated issue. On the positive side, availability of proximal recovery housing options provides those being released from incarceration an awareness that such housing exists, and in some cases, the local carceral facilities can help someone gain access into a recovery residence. On the negative side, the collocation symbolizes the net-widening that occurs with mass incarceration policies, where recovery housing becomes incorrectly viewed as merely an extension of the prison system and not as a health-related facility with benefits for many types of residents. Confounding this problem is a possibility that individuals who participate in recovery residences may be concerned that these residences are a stigmatized extension of the legal system instead of a safe and sober place to live. Additional stigma can arise if recovery residence owners violate neighborhood zoning restrictions or fail to be transparent about the use of their property as a recovery residence. More research is needed to understand who participates in recovery housing, how fellow neighborhood residents view recovery residences, and perspectives on whether the houses are part of the legal system, part of the health care system, or both.
Limitations, Implications for Policy, and Directions for Future Research
The NSTARR database includes information on more than 10,000 recovery residences, yet some residences may be missing and the prevalence of recovery housing may be underestimated. Additionally, while the NSTARR database was created to facilitate collecting survey data from a state-stratified random sample of recovery residences and was updated throughout the survey recruitment period, the geocoded recovery housing data used for these analyses was collected during January 2020 – April 2021. Furthermore, residences sourced from the Oxford House website and SAMHSA Treatment Locator (Substance Abuse and Mental Health Services Administration, 2018) had the most complete data, so findings may best apply to these residences.
Because U.S. Census data was used to identify whether a county had different types of carceral facilities, we do not have data on distance between recovery residences and specific carceral facilities. Research in this area would be helpful for advancing the field. Another limitation to Census data on group housing is that it fails to identify all counties with local and municipal jails. Future studies should examine how recovery houses are collocated with local jails as well as the extent to which diversion courts coordinate with recovery housing. Closer examination of proximity and distance would be facilitated by comprehensive lists of different types of carceral facilities across the country that could enable roadway-based estimation of travel times to recovery housing locations most proximate to these facilities. Unfortunately, there is presently no easily accessible, no-cost, comprehensive list of these facilities with actual addresses in one site or database (National Institute of Corrections, 2022).
Finally, while these data show how availability of recovery housing coincides with carceral facilities, they do not offer evidence for the effectiveness of recovery housing for formerly incarcerated individuals, nor do they detail access to recovery residences in terms of the number of individuals that might be able to participate after leaving incarceration. Future studies might examine how recovery residences compare to other housing options, especially those that do not require abstinence, among individuals leaving carceral facilities. Further research also could assess additional outcomes such as overdose mortality and crime rates in communities where recovery housing is located.
Conclusion
Recovery residences are often collocated with state and federal prisons and detention centers in the US. This study is one of the first to examine the geographical collocation of recovery housing and incarceration facilities, and there is much more to learn about how recovery housing can facilitate sobriety and reduced recidivism for people who have been incarcerated. To increase access and availability for this population, future studies should identify barriers to operating recovery housing in communities, particularly in rural areas. Future studies should also examine the impacts that recovery housing can bring at the community level.
Footnotes
Acknowledgements
The funding agencies had no role in the writing of the report or the decision to submit the paper for publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Preliminary findings from this work were presented in a poster session at the 2022 annual meeting of the College on Problems of Drug Dependence in Minneapolis, MN.
Declaration of Conflicting Interests
The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
Funding
The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: Work on this manuscript was funded the National Institute on Alcohol Abuse and Alcoholism (NIAAA) to the Public Health Institute (R01AA027782; Mericle, PI) and the National Institute on Drug Abuse (NIDA) to George Mason University (U2CDA050097; Taxman, MPI).
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