Certification of Mass. sober homes expected to protect consumers

Sober homes are in the process of getting certified in Massachusetts, and under a new law the state Department of Public Health has contracted with organizations to train entities to conduct inspections and process certifications. Certification is voluntary, but under the law, treatment providers receiving state funding are not allowed to refer patients to any sober home that is not certified.

The two organizations that will be doing the training for certification are the Massachusetts Association for Sober Housing (MASH) and the Massachusetts Recovery Homes Collaborative (part of the Gavin Foundation).

One important distinction to point out for people not from the Commonwealth: The terms “sober home” and “recovery residence” mean two completely different things in Massachusetts. Recovery residences are a licensed level of care in the state, with mandated minimum staffing, and typically are part of a treatment continuum that goes from detoxification (if needed) to step-down care with transitional support services, and then to a recovery residence.

Sober homes, on the other hand, are not licensed or funded by the state. Historically, they have been like “whatever anybody wanted them to be,” says Vicker V. DiGravio III, president and CEO of the Association for Behavioral Healthcare (ABH), a statewide behavioral health providers association. DiGravio says ABH, which has members that operate sober homes, strongly supports the new law.

“For years, there have been some bad actors who have tainted not just the sober home industry but the treatment industry,” he says. “There are some who are basically just landlords renting out apartments.” They may be hosting a 12-Step group, but that does not make them a sober home.

The need for sober homes is driven by people coming out of the treatment system who have struggled with finding safe, affordable housing, says DiGravio. ABH members have been working to make sure these individuals have access to stable housing, he says.

Housing, not treatment

By definition, sober homes in Massachusetts do not provide treatment, which is why they are not licensed by the state. But certification is meant to guarantee a measure of protection for clients.

We spoke with Hilary Jacobs, who was director of the Massachusetts Bureau of Substance Abuse Services for much of the time when this law was prepared (the Department of Public Health did not reply to Addiction Professional's request for comments). Now vice president of Addiction Treatment Services at Lahey Health Behavioral Services in Danvers, Mass., Jacobs explains that the legislature had requested a report on whether sober homes could be regulated. The report, released two years ago, stated that sober homes can’t be regulated for a variety of reasons—mainly because even though it is “alcohol and drug free” housing, it is still housing.

This led to the current certification system, which Jacobs supports “because it provides some minimum standards that protect the consumer, who relies on this kind of housing in the community.” Lahey, as a vendor, can refer only to sober homes that are certified, notes Jacobs. A similar law is now in the process of being implemented in Florida.

Sometimes, consumers in Massachusetts don’t understand the difference between a recovery residence—the state-licensed entity—and a sober home, Jacobs says. “Unsuspecting people think they are one in the same,” she says. Without certification, unethical operators of sober homes can present themselves as providing treatment. The new law offers a way of letting people—especially parents—know that there will be hot water, and what the fee structure is.

Training effort

Fred Way Jr., president of the Pennsylvania Association of Recovery Residences, gives an example of how sober home certification helps in his home state. Way, who is project manager for the National Alliance for Recovery Residences (NARR) on the Massachusetts training, recalls that a mother whose son was at a non-certified sober home in Pennsylvania called him. There were no dishes or utensils in the home. She called Way and asked if there was anything he could do. There was: He contacted her with information about a different sober home that was certified.

“Years ago that option wouldn’t have been there,” Way tells Addiction Professional. “You would just have treatment centers looking for a bed, not asking what kind of bed, and then referring someone’s son or daughter to a place nobody knew anything about.”

Way explains that the Massachusetts training is based on the NARR standards, edited to fit Massachusetts, which opted for certifying only the sober homes that operate at level 2 of NARR's four-level structure. Way has experience, as he started a similar program in Philadelphia in 2011.

NARR doesn’t certify recovery homes itself, but trains the entities that ultimately will be an affiliate to NARR. Way says that entity in Massachusetts probably will be MASH.

So far, 12 sober homes in the state have been certified, with 35 more applications pending, according to news reports. Nobody is sure how exactly many sober homes there are in the Commonwealth, and how many of these would merit certification, but our sources say there may be as many as 400 putting themselves forward now as being sober homes.

The requirement that treatment providers refer only to certified homes will not be implemented until there are enough certified sober homes to answer the need, but already the training is having an effect, says Way. He is conducting training sessions in Boston, and interest is great, he says, with people coming from as far as the Berkshires to learn how to run high-quality sober homes.

As for concerns about neighborhoods not wanting sober homes, that has not been a problem, maybe because of the extent of the opioid crisis; Massachusetts has been one of the hardest-hit states in the country. There have been no NIMBY (not in my back yard) problems in Massachusetts, says Way. “I was there in January to certify the first two homes, and I didn’t find any problems,” he says.