(130) Recovery Housing Without Abstinence Requirements: Outcomes of a Low-Threshold Pilot

Background & Introduction: ASAM Criteria considers recovery residences (RRs) an important component of the continuum of care. RRs are home or home-like settings which allow people with substance use disorder to pursue stability. However, most models require abstinence, which present difficulties for individuals with clinical complexity and limit access to non-abstinence or medication-based recovery pathways. Low-threshold RRs remove abstinence requirements and integrate harm reduction principles but are an under-assessed approach. The current program evaluation investigated outcomes and implementation characteristics of a low-threshold RR in Cook County, Illinois. The primary aims were to assess changes in residents’ recovery-related outcomes and quality of life and to examine implementation of core program components.

Methods: A mixed-methods study was conducted to assess the first nine months of the pilot program’s implementation (October 2024–June 2025). Surveys were administered to residents (n = 23) at baseline and 90 days. Qualitative data was collected through interviews and focus groups with staff and residents, and from resident case note data. Descriptive statistics analyzed change across timepoints. A hybrid deductive-inductive approach was used to analyze qualitative data, integrating emergent themes to identify barriers and facilitators to program delivery.

Results: Despite high baseline levels of marginalization and instability, residents demonstrated meaningful improvements across multiple domains. Safer use practices increased, including greater naloxone access. Medication for opioid use disorder engagement increased from 6 residents at baseline to 15 residents by 30 days. Quality-of-life improvements were observed in multiple domains, including relationships (+12.3 points on a 100-point scale) and environment (+7.1 points). Case note data indicated progress toward individualized goals, including transportation, employment, and healthcare access. Qualitative findings highlighted several implementation facilitators contributing to observed outcomes: consistent, patient-centered staff support, a strong referral network with healthcare providers, and a community-oriented housing environment. Residents reported feeling more stable and willing to engage with services because housing was not contingent on abstinence.

Conclusion & Discussion: Results provide preliminary evidence that low-threshold RRs are a feasible and promising model within the SUD continuum of care. Findings indicate that housing models grounded in harm reduction may lower barriers to engagement and promote continuity of care, particularly for individuals not well served by traditional services. Future research is needed to evaluate low-threshold RRs long-term and, if successful, develop strategies to scale and sustain services. Limitations include a small sample size, absence of a comparison group, and reliance on descriptive analyses. Results reflect early outcomes from a single pilot site and may not generalize to all settings.

References: • Gallardo KR, Wilkerson JM, Stewart HLN, Zoschke IN, Fredriksen Isaacs C, McCurdy SA. “Being here is saving my life”: Resident experiences of living in recovery residences for people taking medication for an opioid use disorder. J Subst Use Addict Treat. 2024;158:209242. doi:10.1016/j.josat.2023.209242
• Guido MR, Hauschild MH, Tookes HE, Bartholomew TS, Suarez E. Limited acceptance of buprenorphine in recovery residences in South Florida: A secret shopper survey. Journal of Substance Use & Addiction Treatment. 2025;168. doi:10.1016/j.josat.2024.209535
• Substance Abuse and Mental Health Services Administration. Low Barrier Models of Care for Substance Use Disorders. SAMHSA; 2023.
• Zaragoza S, Silcox J, Rapisarda S, et al. Developing a Comprehensive Inventory to Define Harm Reduction Housing. Published online October 15, 2024. doi:https://doi.org/10.21203/rs.3.rs-4999367/v1