Medication Assisted Treatment for Opioid Addiction, Harm Reduction and Zero-Tolerance Sober Living Houses

As a recovering addict and alcoholic who has spent over 20 years in and out of treatment centers and programs, the rooms of AA/NA, jails and hospitals, on medication and off of it, spent over half of my adult life living in sober living houses, and who is now the Founder and Director of River Sober Living in Boise, ID – I have one prominent thought on recovery, a basic idea that pertains to the whole spectrum of what a person with substance use disorder experiences and what will work best for their recovery: It’s relative to the individual. There isn’t a single prescribed formula or program that works in the same way for everyone.

The roadmap that brings peace and respect into someone’s life and what gets them to the place where they aspire to be mentally, spiritually and physically in their recovery – is different compared to how every other person will accomplish what they set out to do in recovery. They may have similar or even the same goals, but the compass they use to accomplish them will most surely guide them down a unique path. Some basics may be in place, like working a 12-step program and finding a social support group, but the method of working the steps or finding like-minded people in recovery will be different because people are different, every sponsor, guide, mentor or coach is different, and the details that encapsulate a person’s life and makes it their own journey, history and thoughts - that may help sustain their sobriety, or destroy it - will be different than the person speaking and sitting next to them. The thoughts and emotions that must be addressed by a person wanting to fulfill their aspirations of long-term sobriety will be slightly, if not completely different than mine. The way I ultimately come to terms with my shattered sense-of-self and start to repair it – will not work for, maybe has not worked for, and may not even make sense to others in recovery.

Going deeper, what sobriety is to one man or woman, is not sobriety to the next.  This relates heavily to MAT (medication assisted treatment) for opioid addiction (predominantly: suboxone, methadone.) This is a complex subject and a catalyst to heated-discussions if you try to put recovery and sobriety into a static definition.

Is it sobriety? If taking a prescribed narcotic as instructed, in place of another narcotic, helps get a person off the streets, back into life, into their family’s lives, back into school, back to work, back to being a law-abiding citizen, back to truly living and not just merely surviving by thieving and manipulating – who’s to say that it’s not sobriety for that person? If it’s not your sobriety, then don’t take suboxone or methadone. Simple. No need for debate. I have my own personal sobriety, what it means to me and how I maintain it, but I choose to not tell others what theirs should be.

MAT opens the door to a discussion regarding “harm reduction”. 

“Harm reduction” is frequently discussed in my conversations with treatment centers, counselors and associates with other sober living houses. How does one best approach substance use disorder relapse, medication assisted treatment (suboxone, methadone) and understand the best practices, policies and procedures for a wide-array of recovery services?

An excerpt from The Harm Reduction Coalition’s definition of harm reduction is “a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use.”  This definition, as I understand it, could be applied to every treatment plan, living situation, family structure, legal process and penalty, etc.  Do I believe in harm reduction?  Most definitely, but not across the board. Where do you draw the line? Do you “harm reduce” someone in a situation that ultimately and adversely effects their family and/or everyone else in recovery around them? One must approach it on a case-by-case basis. Is a “harm reduction” environment the best policy for sober living houses? I believe it depends on what environment you are promising to your residents. 

River Sober Living has a zero-tolerance policy, and on a case-by-case basis, we will provide housing to individuals prescribed MAT, but they must sign an agreement stating that they will travel to their clinic or treatment center every day to take their prescription and sign a release of information for River’s Management. They cannot take possession of it outside of their prescribing facility and continue to be a resident of River Sober Living. This policy is put into place because MAT prescriptions are narcotics, they have illicit effects, they have street-value and they have a likelihood to be “diverted” (for uses and persons not prescribed it) far more than other psychotherapeutic drugs. Just a resident knowing that there is something in their house that will give them instant relief from emotional or physical turmoil – could set them off on a relapse. For an individual in recovery living at our house who is not prescribed MAT, MAT is not their program of sobriety and could be a liability to their sobriety. River Sober Living has the responsibility to provide a zero-tolerance sober living house – to the entire house.

In my experience (as a resident and an operator of sober living houses), I have had hundreds if not over a thousand conversations regarding a zero-tolerance sober living house policy with counselors, therapists, clinicians, clinical directors, law enforcement, prospective and current residents, housemates, house managers, family members of residents, and owners of other sober living houses. I am convinced that the zero-tolerance policy should not be compromised. If a person uses or drinks while they are living at one of our houses, even a little bit, inside or outside of our house, they must move out for a minimum of 30 days and then re-apply to become a resident again. Most everyone who I have spoken with supports the zero-tolerance sober living policy and understands why it holds its place outside of “harm reduction”.  This is where my aforementioned statement of the adverse effects to others in recovery who are living with them comes into play.

Every single potential or current resident of River Sober Living, and every resident I’ve ever lived with at zero-tolerance houses, has expressed to me that one of their main deciding factors of living at that house was the zero-tolerance policy. They want the accountability and safety, and they don’t want to live with housemates who continually relapse, or purposefully take advantage of 1st , 2nd, 3rd strike or case-by-case policies. They want a sober living house, not a sober living house where people don’t use or drink that much – but continue to live there. 

If you have 10 guys living together under a case-by-case relapse policy of any kind, in any given month you could conceivably have every one of the 10 residents relapsing, or even repeatedly relapsing in that time frame but still continue to live there. Would you still have an accountable sober living house, or a house where the policies themselves, and the housemates are a liability to each other’s sobriety? Most would say the latter. Our house doesn’t have clinical staff. We are not our resident’s case manager or counselor. Our Management is not qualified to decide anything other than if our residents are sober - or are they not. We have the responsibility to decide that is best for the house as a whole.

River is constantly searching for ways to improve upon existing policies and explore avenues that will best serve our residents. As being such, I am open to feedback on this topic and any others you’d like to address.

Thank you for your time and attention,

Brandt Gibson
Founder, Director
River Sober Living, Boise