Alison Knopf, the award-winning journalist and editor of Alcoholism & Drug Abuse Weekly (ADAW), recently published an article highlighting SAMHSA’s new guidelines for recovery housing, which includes MAT/Medication Assisted Treatment. In her story entitled “SAMHSA guidelines for recovery housing emphasize MAT,” she writes:

If there’s any question about the appropriateness of medication‐assisted treatment (MAT) using methadone and buprenorphine for recovery housing residents, it has been settled by the most recent report from the federal government: Don’t ban it, and, furthermore, do it.
 
Best practices for operating recovery housing are a key part of the Substance Use‐Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) Act, under Subtitle D, “Ensuring Access to Quality Sober Living (SEC. 7031).” The law mandates the Department of Health and Human Services to identify or facilitate the development of best practices, and the Substance Abuse and Mental Health Services Administration (SAMHSA) issued this report last week.
 
The document is focused on MAT for opioid use disorders, because the SUPPORT Act is only for opioid use disorders.
 
“This document is intended to serve as a guidance tool for states, governing bodies, treatment providers, recovery house operators, and other interested stakeholders to improve the health of their citizens related to substance use issues,” according to the executive summary.
 
The document constitutes guidelines. There are no provisions for the federal government to enforce or monitor these—except for SAMHSA funding, which can be based on state evaluations and adherence to these guidelines.
 
This report identifies 10 principles to help define safe, effective and legal recovery housing.
 
What is recovery housing? It’s not just housing; it’s an intervention that is meant to help a recovering person access a safe and healthy living space “while supplying the requisite recovery and peer supports,” the report states. Under the SUPPORT legislation, it also has to be “free from alcohol and illicit drug use and centered upon peer supports and connection to services that promote sustained recovery from substance use disorders,” according to SAMHSA.

The SAMHSA report, “Recovery Housing: Best Practices and Suggested Guidelines” specifically adopts NARR’s (National Alliance of Recovery Residences) levels of housing and appears to incorporate NARR’s MAT guide, “Helping Recovery Residences Adapt to Support People with Medication-Assisted Recovery”.

It is our hope that one day soon, eventually, the inevitable obvious conclusion will be reached – the recovery “journey” may start with treatment, but sustained recovery and the ability to be free of dependency upon substances takes long-term community support, in a community of fellow peers. For some, this includes both short term and long term use of MAT, depending upon each individual’s chemistry and needs.

But is also begs the question – cities that are effectively banning sober living by creating mandatory spacing requirements are doing so under the guise of preventing a “de facto social service district.”  What is a “de facto social service district?” Who has determined with evidence and study that a concentration of NARR level approved/certified housing is BAD for people in recovery? What if it actually helps, and these spacing requirements (ex. 1,000 feet between each home) actually hinder recovery???

Using the same assumptive reasoning in treatment, the abstinence-only approach has worked in the past, and continues to work for many (though mostly people with Alcohol Use Disorders primarily). Using MAT has a stigma attached to it (rightfully and understandably so) because the thought is that we are merely substituting one drug for another, not forcing the patient to fully confront their inner demons and move to the next level of emotional independence.  But the science says otherwise.

While we also understand that Big Pharma clearly has played a role in having MAT become synonymous with “treatment,” causing many to be suspicious and cynical of these supposed positive outcome studies, the larger picture is the need for recovery residences to learn how to incorporate MAT into their housing policies and procedures because MAT is here to stay.

While some housing providers continue to insist they have the right to deny residency to a patient/client on MAT, legal observers in this niche space have suggested that denying a patient residency because they are on MAT may actually violate the Fair Housing Act (FHA) and the Americans with Disabilities Act (ADA) based upon discrimination of a protected class based upon their medical condition alone.

We have written on this topic for years, and the antagonism between the two sides (for and against) remains strong.  However, there is now more than sufficient evidence and science of the efficacy of using MAT as useful tool to jumpstart many people’s recovery, and to sustain in long into sober living.