Recovery residences, such as Oxford Houses, are often a life-saving recovery support service for many, providing safe and supportive environments to stabilize and build optimism and resilience. This study is the most rigorous evaluation of Oxford Houses and recovery residences more generally to date.
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First developed in 1975, Oxford Houses are a type of abstinence-focused recovery residence that are democratically-run, where residents are entirely responsible for house decisions and maintenance. There are approximately 2,000 Oxford Houses in the U.S. and other countries, supporting 24,000 individuals per year. This series of studies by Jason and colleagues – the most rigorous to date on this topic – examined the effects of Oxford House participation on several recovery-related outcomes among individuals who attended residential substance use disorder treatment. This study sought to answer the questions:
Authors assessed 150 individuals discharged from residential substance use disorder treatment in Illinois every 6 months for 2 years (i.e., assessments at 6 months, 12 months, 18 months, and 24 months). Half of the group (n = 75) was randomly assigned to the Oxford House condition, and the other half (n = 75) were randomly assigned to usual continuing care (i.e., the usual professional or mutual-help organization services received after treatment).
Apart from the initial random assignment to each of these conditions, participants were free to engage in other recovery support services as they wished. Thus, after individuals assigned to the Oxford House condition were brought to one of 20 residences across the state, current members voted on whether they could become a resident, as per Oxford House policy. Only one research participant was rejected by vote initially, though research staff subsequently brought this person to another house, who approved his/her residence.
Of note, members were able to stay or leave the residence voluntarily – 95% moved out of their respective Oxford Houses at some point over the 2-year study, for example. For those assigned to usual continuing care, case managers at the treatment center referred individuals to different combinations of outpatient treatment, mutual-help, and other community resources. The majority of usual care participants lived in their own home, or the home of a spouse/partner, relative, or a friend (67%). Nearly 20% lived in a non-Oxford, professionally staffed recovery residence.
The groups were compared on four primary outcomes across the entire 2-year study period:
Given that individuals who are younger and/or have a co-occurring psychiatric disorder, often have poorer outcomes compared to older individuals and those with only a substance use disorder, respectively, authors also tested whether Oxford House participants did better or worse than usual care participants depending on their age (37+ years old versus 36 years old or younger) or whether they had a lifetime diagnosis of anxiety or mood disorder (according to the fourth edition of the diagnostic and statistical manual of mental disorders (DSM IV). Finally, just among Oxford House participants, they tested if individuals who stayed in the recovery residence for 6 or more months had better outcomes.
Oxford House and usual care participants were initially similar on the four primary outcomes (e.g., 6.7% in each group were abstinent before entering treatment) as well as on demographic characteristics, which is to be expected in a randomized trial of this size. Overall, 62% were women, and Black individuals were well represented, comprising 77% of the sample, compared to 11% White, and 8% Latino. The average participant had 12 years of education, corresponding with a high-school diploma, and 44% entered the study with a history of criminal justice system involvement. Six out of 10 participants had a co-occurring mood or anxiety disorder in their lifetime, while 28% reported a history of having taken psychiatric medication, 27% had attended inpatient substance use disorder treatment (before the residential treatment episode that preceded entry into the study), 28% attended outpatient treatment, and 8% had attempted suicide. Information regarding participants’ substance use history, including substance use disorder diagnosis, was not reported.
Oxford House participants had better outcomes over time across the board, even when models adjusted for participant gender, age, and the presence of a co-occurring psychiatric disorder. In addition, Oxford House participants also had greater increases in self-regulation over time.
Individual characteristics determined criminal charges, as younger participants fared better in Oxford Houses, and older participants without a co-occuring disorder did equally well in both Oxford House or usual care groups. For all three other study outcomes (including abstinence), Oxford House outperformed usual care regardless of age or diagnostic status.
Importantly, when looking only at Oxford House participants, individuals who stayed there for 6 or more months had much better abstinence rates (84 vs. 54%). This added benefit of a 6-month or longer stay was especially true for younger individuals. Employment is can be a particularly important outcome for young adults, and of note, 94% of younger patients with 6+ months in an Oxford House were employed at the 2-year follow-up vs. 56% who stayed for less than 6 months.
ARE OXFORD HOUSES COST EFFECTIVE?
The public health significance of these findings are further enhanced by data from a related study by the same research team, who evaluated cost-effectiveness of Oxford Houses in the same sample of individuals.
They examined 129 of the 150 individuals that had sufficient data to carry out the analyses.
Authors measured costs based on the following:
They measured financial benefits from both personal and societal perspectives based on the following:
This was even true despite greater average cost per each participant over 2 years ($3200 more). All told, the net benefit of being assigned to the Oxford House condition versus usual care was $29,000 per person during the 2-year study.
This series of studies on Oxford Houses by Jason and colleagues is the most rigorous evaluation of recovery residences to date. Overall, for individuals completing residential substance use disorder treatment, Oxford Houses provided substantially greater benefit over time, not only in terms of abstinence rates but also in employment and criminal justice outcomes.
Emerging adults (e.g., ages 18-29) are often at greater risk for relapse, in part due to their riskier social networks where alcohol and other drugs are more prevalent. Participation in an Oxford House for 6 months or more, may offer a substance-free community that helps promote engagement in recovery-related activities.
In another study specifically on 18-24 year old individuals who attended residential treatment, for example, recovery residence participation was uniquely related to better abstinence rates during the first post-treatment year, beyond participation in residential treatment, outpatient treatment, and mutual-help organizations. It is worth highlighting also that longer Oxford House stays in this study were associated with extremely high rates of employment for younger individuals, who may otherwise struggle to meet important adult milestones like financial independence.
Jason, L. A., Davis, M. I., & Ferrari, J. R. (2007). The need for substance abuse after-care: Longitudinal analysis of Oxford House. Addictive Behaviors, 32(4), 803-818.
Lo Sasso, A. T., Byro, E., Jason, L. A., Ferrari, J. R., & Olson, B. (2012). Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model. Evaluation and Program Planning, 35(1), 47-53.
l
First developed in 1975, Oxford Houses are a type of abstinence-focused recovery residence that are democratically-run, where residents are entirely responsible for house decisions and maintenance. There are approximately 2,000 Oxford Houses in the U.S. and other countries, supporting 24,000 individuals per year. This series of studies by Jason and colleagues – the most rigorous to date on this topic – examined the effects of Oxford House participation on several recovery-related outcomes among individuals who attended residential substance use disorder treatment. This study sought to answer the questions:
Authors assessed 150 individuals discharged from residential substance use disorder treatment in Illinois every 6 months for 2 years (i.e., assessments at 6 months, 12 months, 18 months, and 24 months). Half of the group (n = 75) was randomly assigned to the Oxford House condition, and the other half (n = 75) were randomly assigned to usual continuing care (i.e., the usual professional or mutual-help organization services received after treatment).
Apart from the initial random assignment to each of these conditions, participants were free to engage in other recovery support services as they wished. Thus, after individuals assigned to the Oxford House condition were brought to one of 20 residences across the state, current members voted on whether they could become a resident, as per Oxford House policy. Only one research participant was rejected by vote initially, though research staff subsequently brought this person to another house, who approved his/her residence.
Of note, members were able to stay or leave the residence voluntarily – 95% moved out of their respective Oxford Houses at some point over the 2-year study, for example. For those assigned to usual continuing care, case managers at the treatment center referred individuals to different combinations of outpatient treatment, mutual-help, and other community resources. The majority of usual care participants lived in their own home, or the home of a spouse/partner, relative, or a friend (67%). Nearly 20% lived in a non-Oxford, professionally staffed recovery residence.
The groups were compared on four primary outcomes across the entire 2-year study period:
Given that individuals who are younger and/or have a co-occurring psychiatric disorder, often have poorer outcomes compared to older individuals and those with only a substance use disorder, respectively, authors also tested whether Oxford House participants did better or worse than usual care participants depending on their age (37+ years old versus 36 years old or younger) or whether they had a lifetime diagnosis of anxiety or mood disorder (according to the fourth edition of the diagnostic and statistical manual of mental disorders (DSM IV). Finally, just among Oxford House participants, they tested if individuals who stayed in the recovery residence for 6 or more months had better outcomes.
Oxford House and usual care participants were initially similar on the four primary outcomes (e.g., 6.7% in each group were abstinent before entering treatment) as well as on demographic characteristics, which is to be expected in a randomized trial of this size. Overall, 62% were women, and Black individuals were well represented, comprising 77% of the sample, compared to 11% White, and 8% Latino. The average participant had 12 years of education, corresponding with a high-school diploma, and 44% entered the study with a history of criminal justice system involvement. Six out of 10 participants had a co-occurring mood or anxiety disorder in their lifetime, while 28% reported a history of having taken psychiatric medication, 27% had attended inpatient substance use disorder treatment (before the residential treatment episode that preceded entry into the study), 28% attended outpatient treatment, and 8% had attempted suicide. Information regarding participants’ substance use history, including substance use disorder diagnosis, was not reported.
Oxford House participants had better outcomes over time across the board, even when models adjusted for participant gender, age, and the presence of a co-occurring psychiatric disorder. In addition, Oxford House participants also had greater increases in self-regulation over time.
Individual characteristics determined criminal charges, as younger participants fared better in Oxford Houses, and older participants without a co-occuring disorder did equally well in both Oxford House or usual care groups. For all three other study outcomes (including abstinence), Oxford House outperformed usual care regardless of age or diagnostic status.
Importantly, when looking only at Oxford House participants, individuals who stayed there for 6 or more months had much better abstinence rates (84 vs. 54%). This added benefit of a 6-month or longer stay was especially true for younger individuals. Employment is can be a particularly important outcome for young adults, and of note, 94% of younger patients with 6+ months in an Oxford House were employed at the 2-year follow-up vs. 56% who stayed for less than 6 months.
ARE OXFORD HOUSES COST EFFECTIVE?
The public health significance of these findings are further enhanced by data from a related study by the same research team, who evaluated cost-effectiveness of Oxford Houses in the same sample of individuals.
They examined 129 of the 150 individuals that had sufficient data to carry out the analyses.
Authors measured costs based on the following:
They measured financial benefits from both personal and societal perspectives based on the following:
This was even true despite greater average cost per each participant over 2 years ($3200 more). All told, the net benefit of being assigned to the Oxford House condition versus usual care was $29,000 per person during the 2-year study.
This series of studies on Oxford Houses by Jason and colleagues is the most rigorous evaluation of recovery residences to date. Overall, for individuals completing residential substance use disorder treatment, Oxford Houses provided substantially greater benefit over time, not only in terms of abstinence rates but also in employment and criminal justice outcomes.
Emerging adults (e.g., ages 18-29) are often at greater risk for relapse, in part due to their riskier social networks where alcohol and other drugs are more prevalent. Participation in an Oxford House for 6 months or more, may offer a substance-free community that helps promote engagement in recovery-related activities.
In another study specifically on 18-24 year old individuals who attended residential treatment, for example, recovery residence participation was uniquely related to better abstinence rates during the first post-treatment year, beyond participation in residential treatment, outpatient treatment, and mutual-help organizations. It is worth highlighting also that longer Oxford House stays in this study were associated with extremely high rates of employment for younger individuals, who may otherwise struggle to meet important adult milestones like financial independence.
Jason, L. A., Davis, M. I., & Ferrari, J. R. (2007). The need for substance abuse after-care: Longitudinal analysis of Oxford House. Addictive Behaviors, 32(4), 803-818.
Lo Sasso, A. T., Byro, E., Jason, L. A., Ferrari, J. R., & Olson, B. (2012). Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model. Evaluation and Program Planning, 35(1), 47-53.
l
First developed in 1975, Oxford Houses are a type of abstinence-focused recovery residence that are democratically-run, where residents are entirely responsible for house decisions and maintenance. There are approximately 2,000 Oxford Houses in the U.S. and other countries, supporting 24,000 individuals per year. This series of studies by Jason and colleagues – the most rigorous to date on this topic – examined the effects of Oxford House participation on several recovery-related outcomes among individuals who attended residential substance use disorder treatment. This study sought to answer the questions:
Authors assessed 150 individuals discharged from residential substance use disorder treatment in Illinois every 6 months for 2 years (i.e., assessments at 6 months, 12 months, 18 months, and 24 months). Half of the group (n = 75) was randomly assigned to the Oxford House condition, and the other half (n = 75) were randomly assigned to usual continuing care (i.e., the usual professional or mutual-help organization services received after treatment).
Apart from the initial random assignment to each of these conditions, participants were free to engage in other recovery support services as they wished. Thus, after individuals assigned to the Oxford House condition were brought to one of 20 residences across the state, current members voted on whether they could become a resident, as per Oxford House policy. Only one research participant was rejected by vote initially, though research staff subsequently brought this person to another house, who approved his/her residence.
Of note, members were able to stay or leave the residence voluntarily – 95% moved out of their respective Oxford Houses at some point over the 2-year study, for example. For those assigned to usual continuing care, case managers at the treatment center referred individuals to different combinations of outpatient treatment, mutual-help, and other community resources. The majority of usual care participants lived in their own home, or the home of a spouse/partner, relative, or a friend (67%). Nearly 20% lived in a non-Oxford, professionally staffed recovery residence.
The groups were compared on four primary outcomes across the entire 2-year study period:
Given that individuals who are younger and/or have a co-occurring psychiatric disorder, often have poorer outcomes compared to older individuals and those with only a substance use disorder, respectively, authors also tested whether Oxford House participants did better or worse than usual care participants depending on their age (37+ years old versus 36 years old or younger) or whether they had a lifetime diagnosis of anxiety or mood disorder (according to the fourth edition of the diagnostic and statistical manual of mental disorders (DSM IV). Finally, just among Oxford House participants, they tested if individuals who stayed in the recovery residence for 6 or more months had better outcomes.
Oxford House and usual care participants were initially similar on the four primary outcomes (e.g., 6.7% in each group were abstinent before entering treatment) as well as on demographic characteristics, which is to be expected in a randomized trial of this size. Overall, 62% were women, and Black individuals were well represented, comprising 77% of the sample, compared to 11% White, and 8% Latino. The average participant had 12 years of education, corresponding with a high-school diploma, and 44% entered the study with a history of criminal justice system involvement. Six out of 10 participants had a co-occurring mood or anxiety disorder in their lifetime, while 28% reported a history of having taken psychiatric medication, 27% had attended inpatient substance use disorder treatment (before the residential treatment episode that preceded entry into the study), 28% attended outpatient treatment, and 8% had attempted suicide. Information regarding participants’ substance use history, including substance use disorder diagnosis, was not reported.
Oxford House participants had better outcomes over time across the board, even when models adjusted for participant gender, age, and the presence of a co-occurring psychiatric disorder. In addition, Oxford House participants also had greater increases in self-regulation over time.
Individual characteristics determined criminal charges, as younger participants fared better in Oxford Houses, and older participants without a co-occuring disorder did equally well in both Oxford House or usual care groups. For all three other study outcomes (including abstinence), Oxford House outperformed usual care regardless of age or diagnostic status.
Importantly, when looking only at Oxford House participants, individuals who stayed there for 6 or more months had much better abstinence rates (84 vs. 54%). This added benefit of a 6-month or longer stay was especially true for younger individuals. Employment is can be a particularly important outcome for young adults, and of note, 94% of younger patients with 6+ months in an Oxford House were employed at the 2-year follow-up vs. 56% who stayed for less than 6 months.
ARE OXFORD HOUSES COST EFFECTIVE?
The public health significance of these findings are further enhanced by data from a related study by the same research team, who evaluated cost-effectiveness of Oxford Houses in the same sample of individuals.
They examined 129 of the 150 individuals that had sufficient data to carry out the analyses.
Authors measured costs based on the following:
They measured financial benefits from both personal and societal perspectives based on the following:
This was even true despite greater average cost per each participant over 2 years ($3200 more). All told, the net benefit of being assigned to the Oxford House condition versus usual care was $29,000 per person during the 2-year study.
This series of studies on Oxford Houses by Jason and colleagues is the most rigorous evaluation of recovery residences to date. Overall, for individuals completing residential substance use disorder treatment, Oxford Houses provided substantially greater benefit over time, not only in terms of abstinence rates but also in employment and criminal justice outcomes.
Emerging adults (e.g., ages 18-29) are often at greater risk for relapse, in part due to their riskier social networks where alcohol and other drugs are more prevalent. Participation in an Oxford House for 6 months or more, may offer a substance-free community that helps promote engagement in recovery-related activities.
In another study specifically on 18-24 year old individuals who attended residential treatment, for example, recovery residence participation was uniquely related to better abstinence rates during the first post-treatment year, beyond participation in residential treatment, outpatient treatment, and mutual-help organizations. It is worth highlighting also that longer Oxford House stays in this study were associated with extremely high rates of employment for younger individuals, who may otherwise struggle to meet important adult milestones like financial independence.
Jason, L. A., Davis, M. I., & Ferrari, J. R. (2007). The need for substance abuse after-care: Longitudinal analysis of Oxford House. Addictive Behaviors, 32(4), 803-818.
Lo Sasso, A. T., Byro, E., Jason, L. A., Ferrari, J. R., & Olson, B. (2012). Benefits and costs associated with mutual-help community-based recovery homes: The Oxford House model. Evaluation and Program Planning, 35(1), 47-53.
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