In the state of Ohio, anyone can open a recovery house.
In the continuum of care for a drug addict, a recovery house offers a bridge between abusing harmful intoxicants and learning how to live a sober life.
It is the place where addicts learn how to live among others without using or needing drugs in daily life.
But what happens behind the closed doors, and why are there no state regulations governing recovery houses?
Elyria City Council members raised the latter question recently as they contemplate granting a conditional-use permit to Sheffield-based Primary Purpose Center, which wants to buy the city’s former Health Department building at 202 Chestnut St. to open a 50-bed women’s recovery facility. The Elyria facility would mirror a men’s home Primary Purpose runs at the former Riveredge racquetball club on North Ridge Road.
Primary Purpose would not be the first recovery house in the city.
A Road to Hope has long been a part of Elyria, with homes on Irondale and Ninth streets.
Jeff Kamms, its executive director, said the community needs more recovery houses as the county grapples with the opioid crisis. He said A Road to Hope has grown in recent years because of increasing demand.
Kamms said A Road to Hope only scratches the surface in the number of beds needed in Lorain County to adequately support and address the opioid epidemic.
“We need at least four times the beds,” Kamms said. “We started 10 years ago with six beds, and our numbers are nine times that now. In 10 years, we have never been at a point in our organization when we have not had a waiting list.”
Rules on location
People leaving prisons or inpatient drug treatment facilities have long turned to temporary shelters as they ease their way back into society. Recovery housing adds wraparound services and peer mentoring to the support given to such people.
“Recovery housing, the kind we see today, is probably three to four years new in Ohio,” said Elaine Georgas, executive director of the Alcohol and Drug Addiction Services Board of Lorain County. “It kind of came on when there was more medication in treatment. People in treatment needed a safe, drug-free environment to start out their recovery journey.”
The statutes that dictate where and how a recovery house can open are mainly related to housing and zoning.
“Legally, I don’t know that most communities can keep them out,” said Ron Luce, president of Ohio Recovery Housing, a state affiliate of the National Alliance for Recovery Residences. “Essentially, you have to deal with fair housing issues. (The residents) are living essentially as a functioning family and as long as they don’t violate the codes or laws of the community, they can live in the community just like any other family.”
Luce said the Fair Housing Act covers substance abuse disorders under the disability designation. He said he has seen communities try to circumvent the laws by placing ordinances on the books limiting the number of unrelated people living in a home.
Tucked away in communities in Lorain County with growing frequency, recovery houses are becoming a part of the landscape. But people should not confuse them with detox, rehabilitation or other inpatient or outpatient clinical treatment programs.
Recovery houses are peer-run facilities where people live with others to learn how to be sober.
Georgas said she is familiar with three programs in Lorain County — Primary Purpose, A Road to Hope and Alpha House, which is a faith-based recovery house that recently opened in Oberlin.
“Those are what we know,” she said. “It’s possible there are private sober houses that we are not aware of. When you are independent, you are independent. We can’t forget those are just places where people live. There is no treatment on site.”
With Primary Purpose aiming to increase its Lorain County presence, the question of what is a good recovery house program has entered the conversation.
The LCADA Way, a Lorain-based nonprofit organization offering drug treatment, levied serious allegations against Primary Purpose in recent months. It ceased working with Primary Purpose as of December “due to material differences in governance, fiscal and client practices.”
The LCADA Way later filed a complaint with the Ohio Department of Mental Health and Addiction Services, claiming Primary Purposed billed The LCADA Way for improper resident stays and may have inappropriately used a client’s Electronic Balance Transfer card. The state agency has said it so far does not have enough details to warrant an investigation.
Tom Stuber, president and CEO of The LCADA Way, said the agency’s attorney is handling matters related to Primary Purpose and said he can longer comment on the recovery house program.
As the head of Ohio Recovery Housing, Luce acknowledges there is a difference between quality recovery houses and sober-living halfway houses that operate independently of national and state best practices.
While there isn’t a government agency to license a program, Luce said Ohio Recovery Housing stands as a well-respected peer-review organization that can weed out the problem places.
A Road to Hope is the cou nty’s only recovery house accredited through Ohio Recovery Housing.
“It means we meet all of the Ohio Recovery Housing and National Alliance for Recovery Residences standards,” Kamms said. “… Naturally, it gives us that sense of security that if you are holding that associate status that there is someone that has been involved in the accreditation process beyond just us saying we are a great program.”
Webb Boyle, co-founder and director of operations of Primary Purpose, said the organization finished its Ohio Recovery Housing application and is the process of scheduling the site visit that is the final step in the accreditation process. When asked why Primary Purpose sought the association with Ohio Recovery Housing, Webb said it was a voluntary decision because it’s what’s best for the program.
“I think eventually everyone will have to meet that housing standard if you want to survive in Ohio and it just gives you — funders and those looking at your program — that reassurance that you keep up-to-date with the standards.”
Luce said Primary Purpose is welcome to go through the process, but said earlier this month that he did not know enough about the organization to speak specifically about its operations.
The Ohio Department of Mental Health and Addiction Services has made significant investments in recovery housing as a key recovery support in the past few years, committing more than $15 million to expand sober housing options for Ohio residents by more than 1,000 beds statewide.
Eric R. Wandersleben, the agency’s spokesman, said there are well-documented benefits of recovery housing.
“Longitudinal studies of peer-run recovery homes have demonstrated that after 24 months, when compared to individuals who returned directly to their communities of origin after treatment, peer-run housing residents had significantly better outcomes,” he said in an email. “Chief among those outcomes are: decreased substance use, decreased rates of incarceration, higher rates of employment and increased income.”
Luce said the state doesn’t license recovery housing, but it dangles funding as a carrot to persuade affiliation with Ohio Recovery Housing.
“Right now in Ohio if you want state funding, you have to demonstrate you meet the requirements of ORH. So we do have some teeth,” he said. “We can’t force people to be a part of our organization, but if they want state funding they have to adhere to all of the ORH standards. To do all that and not be a part of the organization just means all they have really done is avoid paying the fees of association and get the advantages of networking within the organization.”
State funding is not the only way recovery houses stay afloat. Many recovery residences are nonprofit organizations that fund the residents through donations and other ways, Luce said. There are many variations, including subsidies from local Alcohol and Drug Addiction Services boards or self-pay upward of $500 per month.
“As you can guess, we don’t turn people away for not being able to pay,” he said.
Instead, Luce said the priority is recovery over revenue. Luce runs a men’s facility in Athens, and said his home often works with clients to ensure their stays are covered.
Most recovery houses cannot bill Medicaid because they offer no professional services provided by approved personnel.
Kamms said the association with Ohio Recovery Housing offers accountability and is why a lot of Alcohol and Drug Addiction Services boards across the state require that status for funding.
“Lorain County does not require that yet, but I know they are heading in that direction,” Kamms said.
Georgas said the local board will discuss such a requirement in the near future, but a majority of its funding designated for recovery housing already goes to A Road to Hope.
“Have we mandated it? Not yet. But we know some boards are doing it,” she said. “Three years ago, a lot of independents like A Road to Hope functioned with us. Now, ORH could be a valid benchmark for all of us. That’s not to discount the potential of other programs.”
Stereotypes against recovery
Even before Primary Purpose faced the scrutiny of The LCADA Way, it faced resistance from residents who do not want the program operating in their neighborhood.
“A residential treatment center will negatively affect housing values, potentially bring crime to the area, add traffic to the area and put a burden on emergency services,” wrote resident Diane Faltay in a Nov. 28 email to city officials obtained through a public records request. “Has the city investigated the negative effect this will have on this neighborhood? Surely, this is not the only option available for valuable downtown space.”
It is very common, said Luce, for residents to have strong reactions to having recovery housing in their neighborhood.
“They have these negative stereotypes in their heads, thinking these people are derelicts and dope fiends instead of seeing them as people in recovery,” he said. “So a lot of times, it is good to educate a community on what good recovery houses can add to their community. When they are well done, people find them to be good neighbors and the people living in the homes have an opportunity to gain positive interactions in the community and learn to function in that community.”
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