Bringing Medication into a Sober Living Home

Modern sober living homes allow residents to live in a drug-free environment, practice behavioral changes they made in rehabilitation, and have greater personal freedom to attend work, school, or social functions. However, sober living homes are not medical facilities, and they do not provide medical services like doctors’ visits, therapy appointments, and medication dispensation.

Many sober living homes are still wary of prescription medicines, especially medication-assisted treatment (MAT) to manage withdrawal or cravings. This is because many sober living facilities associate MAT with the prescription drug addiction epidemic, especially the opioid overdose epidemic, which per the Centers for Disease Control and Prevention (CDC), kills 91 people every day.

Although MAT is an important part of recovery, if it is not managed well, buprenorphine and methadone may be abused instead of other substances. In fact, methadone is one of the most abused opioid drugs. The National Survey on Drug Use and Health (NSDUH) found, in 2014, that 6.5 million people abused prescription drugs for non-medical reasons in the month prior to the survey.

However, taking buprenorphine or methadone with a doctor’s supervision and prescription can be an important step to ending opioid addiction. Other medications, like benzodiazepines or antidepressants, are also important parts of treating co-occurring mental illnesses and substance abuse, as mental illness and addiction often go hand in hand. This has led some specialists to accuse sober living homes of being “too clean,” because they put some individuals in recovery at a greater risk for relapse by denying them important prescription medications to treat underlying conditions.

Sober Living Homes Vary in Attitudes Toward Medication

Because there are new nationwide standards or laws governing sober living homes, the kinds of medications that they allow inside can vary widely. For example, the National Association of Recovery Residences (NARR), a nonprofit organization that provides standards and accreditation to sober living homes which voluntarily apply for membership, has not issued formal guidance, but sides with medical professionals who focus on MAT as harm reduction. The organization stated in an article that they would allow individual sober homes to determine guidelines, as long as the process involved a taper so individuals eventually no longer need the medications.

Other sober living home organizations believe that the important focus of this kind of housing should be to maintain a stable, drug-free residence for tenants. Those at risk of abusing medications may steal from other residents, which creates an unsafe environment. By definition, sober homes are not medical facilities, so they do not have ways of managing medication on their own.

Medications for specific, chronic health conditions may be allowed into the home. The top five most prescribed medications in the US include drugs to treat:

• Hypothyroidism
• High cholesterol
• Asthma or bronchospasms
• Acid reflux
• Diabetes

Other medications that are often prescribed include attention deficit hyperactivity disorder (ADHD) medicines, drugs that interact with the GABA receptors (like alcohol or benzodiazepines also do), antidepressants, insomnia treatments, and painkillers. All these medications are diverted and abused by millions of people in the United States. As a result, they may not be allowed in sober living homes due to the risk of theft, abuse, and relapse.

Treating Mental and Physical Illnesses Alongside Substance Abuse

Finding a compromise will be important for the future of sober living homes. A survey of organized sober living homes in California found that residents struggled with mental health problems but rarely took medication. If medications are needed but not taken, this increases a person’s risk of relapse.

Among survey participants, the following mental health issues were reported:

• Social phobias: 46 percent
• Generalized anxiety: 41 percent
• Post-traumatic stress disorder: 38 percent
• Major depression: 35 percent
• Other psychiatric disorders: 30 percent

Only 12 percent of surveyed residents reported attending psychotherapy sessions to treat their mental health, and only 30 percent reported receiving prescription medicine to help with these conditions. The co-occurrence of mental illness and substance abuse is becoming better understood, so in the future, sober living homes may find ways to support specific populations, such as those with co-occurring disorders, while protecting those who are recovering from prescription drug abuse.