A Guide to Sober Living Homes

A bed in treatment can end before you have a place to sleep that is not the old one. A sober home is a place to live without alcohol or illicit drugs. It is not a hospital, and it is not a substitute for withdrawal care. SAMHSA's recovery-housing guide calls recovery housing a recovery support service designed by people in recovery. It says the setting itself is the service: a substance-free house that builds ordinary responsibility, peer support, and a daily routine. If you still need medical monitoring for alcohol or benzodiazepine withdrawal, start with the detox guide and the first-72-hours guide. Do not use a shared house as a detox ward.

If someone overdoses, has a seizure, or stops breathing, call 911. For a mental health crisis, call or text 988.

Four levels, one substance-free rule

The National Alliance for Recovery Residences (NARR) publishes a standard with four levels. NARR says all of them offer alcohol- and illicit-substance-free housing and use a social model. They differ by staffing, governance, and how much recovery support is on site.

Level I homes are peer-run and democratically governed. NARR names Oxford House as the best-known example. There is no paid on-site staff in the usual picture SAMHSA prints for this level. Support is peer to peer, with clinical care happening off site when someone needs it.

Level II homes are what many people mean by "sober living." NARR says a senior resident, often called a house manager and appointed by the owner, heads the house. Rules and peer accountability are the structure. Some Level II homes add light recovery support or life-skills help. They are still not licensed treatment in most states.

Level III homes are supervised. NARR says they provide weekly structured programming, such as recovery groups and life-skills work, with staff who are supervised, trained, or credentialed. Residents who need more support than a peer-run house are the intended group. NARR notes that a few states require a license because the services are more therapeutic.

Level IV homes add clinical addiction treatment to the social model. NARR says peer support is still part of the model. A treatment program that has no social-model element does not qualify, in NARR's definition, just because people sleep there. SAMHSA's table gives therapeutic communities as an example and says stays at this level are often shorter than at the other levels.

SAMHSA cites an estimate of 17,943 recovery homes in the United States in 2020. That is a research estimate in SAMHSA's guide, not a directory, and it does not say how many of those homes meet a standard.

Oxford House is a specific model

Oxford House, Inc. describes its houses as self-run and self-supported, with no house manager and no outside owner running daily life. Members elect officers for terms of six months. Each member has one vote. The traditions say 80 percent of the members must agree before a new person is accepted. Decisions otherwise use a simple majority.

The charter conditions Oxford House publishes are short. The house is run democratically. It is financially self-supporting. Anyone who drinks or uses drugs is expelled. Oxford House says there is no time limit on a stay. Someone in good standing may remain if they stay free of alcohol and other drugs, are not disruptive, and pay an equal share of expenses. The organization says the average stay is about a year, and that many members stay longer. There is no national rent figure. The share is whatever that house's expenses require, split by the members.

Oxford House is not the only legitimate model. A monitored Level II home can be a better fit for someone who wants a house manager. The mistake is to treat every "sober living" sign as an Oxford House, or as treatment.

Medication is allowed under SAMHSA's guidance

SAMHSA tells operators not to create barriers to prescribed medicines for behavioral or physical health. It names the FDA-approved medicines for opioid use disorder and alcohol use disorder, including buprenorphine, methadone, and naltrexone. NIDA describes those opioid medicines as treatments that reduce overdose deaths, not as a personal failing. A house that forces a taper so you can have a bed is rejecting guidance that SAMHSA wrote for this setting.

SAMHSA also says misuse and diversion are real risks, and it lists practical controls: lockboxes, medication counts with the resident present, training, and communication with the prescriber that respects privacy law. Asking about those controls is reasonable. Being told to stop the medicine is a different request. Read the medication FAQ before you agree.

SAMHSA's quality questions include whether naloxone is available. If the house cannot say where it is, that is a gap. The overdose guide explains what naloxone does and does not do.

What research is, and is not

SAMHSA's guide reports positive findings from specific studies. It cites a two-year comparison in which people who went to Oxford House after residential treatment had lower substance use (31.3 percent versus 64.8 percent) than people discharged to usual continuing care, along with higher income and lower incarceration in that study. It also cites a finding that 81.5 percent of more than 900 Oxford House residents reported no substance use over the following year. Those numbers belong to the studies SAMHSA cites. They are not a promise that a particular house will produce them, and they are not a reason to skip clinical care.

Certification and brokering

SAMHSA recommends that recovery homes be certified. It points to NARR's standard and to Oxford House's charter process, which it describes as being in effect for over 48 years. Ask to see a current certificate or charter, and ask which state's affiliate issued a NARR certificate if the home claims one. Absence of a certificate is not, by itself, proof of fraud. It does mean you have fewer outside checks.

SAMHSA tells operators to reject patient brokering. It describes brokering as paying a third party to procure residents, and it gives a grim example: someone already in recovery is pushed back into use and then referred into a program for a fee. Ask who gets paid if you move in, whether the house is tied to one treatment program, and what you owe if you leave in the first week. There is no national rent to copy down. See the rules in writing before you send money. SAMHSA's best practices include written policies and resident expectations.

If you are flying in to live at a house you have not seen, read the flying guide first. Get the address, the charter or certificate, and the medication policy before you travel.

How housing fits with treatment

Use housing as the living-environment piece of a plan, which is one of the six areas in the ASAM Criteria. The comparison guide explains that assessment. Outpatient counseling, an opioid treatment program, or continued buprenorphine can sit alongside a Level I or Level II house. If use starts again, the relapse guide covers the medical risks of the next few days, not shame.

FindTreatment.gov lists treatment programs, which is a different search from a room in a house. Calling (800) 653-9376 can help you sort a clinical program from a house. A referral conversation does not inspect a residence or hold a vacancy.

Additional Resources

Sources cited on this page:

• SAMHSA: Best Practices for Recovery Housing (PEP23-10-00-002)
• NARR: Recovery residence standards and levels
• Oxford House: The model
• Oxford House: House traditions
• Oxford House: Home
• NIDA: Medications for Opioid Use Disorder
• SAMHSA FindTreatment.gov
• 988 Suicide & Crisis Lifeline

Common Questions