1	"Leonard A" Leonard A. Jason, Ph.D.
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3	Oxford Houses Self-governing recovery homes Rental housing 6-10 recovering people in a house No residency time limits Rules Pay equal share of rent and expenses Zero tolerance -- Expulsion for alcohol or drug use Follow house rules decided by majority house vote
4	"Grassroots movement" Grassroots movement Founded in 1975 by Paul Molloy now over 1,200 Oxford Houses within 40 states about 10,000 individuals The network of Oxford Houses is Self-administered and operated
5	Possible Active Ingredients A substance-free environment without restrictions on length of stay opportunity to live away from relapse triggers might help residents remain substance-free Encouragement to spend time with one another might develop interpersonal networks that support abstinence
6	"Residents held accountable for their..." Residents held accountable for their behavior by peers in recovery residents must pay rent contribute to the maintenance of the home refrain from engaging in disruptive behaviors If residents are disruptive fined required meet with other residents to address their difficulties If problems persist residents placed on a “contract” specify needed behavior changes
7	"Expectations for appropriate behavior plus..." Expectations for appropriate behavior plus consequences such as fines and contracts might provide contingencies that help individuals in recovery develop interpersonal and other life skills Oxford House residents encouraged utilize 12-step groups might contribute to long-term sobriety among individuals in recovery
8	First Pilot Study: Characteristics of Residents Data collected in 11 states Consistent with studies from substance abuse programs 53% never married 58% Caucasian 78% male 71% at least high school education 69% employed 64% had experienced homelessness Jason, Ferrrari, Groessl & Dvorchak (1997)
9	Second Pilot Study: Illinois Oxford Houses 11 Oxford Houses (OH) were opened in Illinois beginning in 1992 Interviews conducted with 132 residents who had recently entered the houses
10	Findings Reasons for choosing to reside in an OH Fellowship and a structured setting where successful substance abuse outcomes were enforced Residents said this setting: allowed fellowship with similar others stability in their life a period of time for personal growth and change Jason, Ferrari et al. (1997)
11	Gender Differences Women more likely: reported sexual abuse diagnosed with eating disorders engaged in writing bad checks prior to recovery sought OH for a structured and safe setting Men more likely: engaged in drug sales and theft entered OHs as an attempt to rebuild relationships Ferrari, Curtin-Davis, Dvorchak, & Jason (1997)
12	Other Characteristics 82% residents had previous history of criminal involvement 76% used 12-step programs Most able to maintain employment Jason, Ferrari, Smith et al. (1997); Nealon -Woods, Ferrari, & Jason (1995)
13	Two Year Follow-up 62% positive outcomes remained in the house or left on good terms Those with lower pessimism scores stayed longer than those with higher pessimism Older residents longer stays than younger residents Length of stay positively related to increases in Perceived Sense of Community Bishop, Jason, Ferrari, & Huang (1998); Bishop, Chertok, & Jason (1997)
14	Third Pilot Study: St. Louis OH Sample Psychiatric Diagnoses 58% Antisocial Personality Disorder 39% Mood disorders 35% Post Traumatic Stress Disorder 52% reported two or more psychiatric disorders 21% had no psychiatric disorder other than substance abuse 6 month Follow-up: 69% had positive outcomes remained residents or left the house on good terms Majer, Jason, Ferrari & North (2002)
15	2 NIH Grant Supported Studies (1999-2006) NIAAA study randomized outcome study within the state of Illinois comparing outcomes of Oxford Houses and usual post-treatment residence NIDA study longitudinal design national sample of Oxford House residents
16	NIAAA Study Participants just completing substance abuse treatment Randomly assigned to either an Oxford House or Usual Care condition 150 of 154 approached individuals agreed to participate All participants assigned to Oxford House condition were accepted
17	Design Participants were interviewed every 6 months for a 24 month period (Four waves) Across the 24-month assessment Oxford House, 89% Usual care, 86%
18	Hierarchical Linear Modeling (HLM) Examined repeated measures data over time nested within individual (i.e., person-level characteristics such as demographic and condition-related variables) Dependent variables included substance abuse related outcomes employment status outcomes criminal activity outcomes
19	Outcomes at 24-month Follow-up OH compared to Usual care group higher abstinence rates (69% vs 35%) An important person in each participant’s support network confirmed the participant’s level of abstinence at the 24 month follow-up higher monthly income ($989 vs $440) lower incarceration rates (3% vs 9%) Jason, Olson, Ferrari, & LoSasso (2006)
20	Custody Issues Oxford House condition 14 women were able to obtain custody of their children 1 woman lost custody Usual care condition 6 women gained custody of their children 2 women lost custody of their children.
21	Effects of Residing in an OH for 6 or More Months at 24 Month Follow-up OH residents with ≥ 6 months compared to < 6 months living in an OH Higher abstinence (84% vs 54%) Higher employment rates (85% vs 68%) Higher self-regulation scores Jason, Olson, Ferrari, Majer, Alvarez, & Stout (2006)
22	24 Month Abstinence Rates
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25	NIDA Funded Study Examined the processes of social support, self-efficacy, and abstinence Explored in a national sample of Oxford House residents (n = 897) Residents were recruited and interviewed at an initial baseline phase then re-interviewed at three subsequent 4-month intervals (waves)
26	Completion Wave 4 Contacted a random sample of the participant's most important people vast majority of collateral reports consistent with participants’ self reports of abstinence
27	Wave 4 Outcomes 13.5% had relapsed Employment income significantly increased from $794 to $942 per month 80% of participants employed Incarceration less than 5% Jason, Davis, Ferrari, & Anderson (in press)
28	Predictors of Cumulative Abstinence Staying in OH at least 6 months was related to increased self-efficacy and maintaining abstinence Results are consistent with partial mediational process
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32	Similarities Among Oxford Houses Oxford Houses across diverse regions of US residents were found to live in rather similar dwellings Houses were generally located in mid to high SES few intoxicated persons, drug dealers, or homeless few empty lots, pawnshops, or bars/pubs nearby public transportation was available streets and neighborhoods were clean well lit at night Ferrari, Jason, Sasser, Davis, & Olson (2006)
33	International Similarities US vs Australia OHs Neighborhoods of Oxford Houses similar community amenities grocery stores churches medical clinics Ferrari, Jason, Blake, Davis, & Olson (2006)
34	Observations at Weekly OH Meetings Observed interactions during business meetings at 29 Illinois Oxford Houses Policies and organizational issues Action plans included strategies to correct a resident’s problem behavior Developing an action plan was related to receiving emotional support Voting was associated with lower conflict and increased communications involving action plans Jason, Ferrari, Freeland, Danielewicz, & Olson (2006)
35	OH vs Therapeutic Communities Both prohibited: self-injurious behaviors physical self-harm setting destructive acts destroying site property or possessions of others OHs more liberal sleeping late in the morning or staying out late at night going away for a weekend having “private time” in their locked room with guests have their own personal possessions (pictures, furniture) Ferrari, Jason, Davis, Olson, & Alvarez (2004)
36	OH versus Criminal Justice OH residents compared to clients from traditional inpatient criminal justice programs No significant differences: education job history criminal history drug use Oleniczak, Olabode-Dada, Viola, Davis, Olson, Ferrari, & Jason (2002)
37	OH vs Attending AA History of serving time in jail 83% of OH members 55% for the 12-step members 12-step members with convictions lower optimism and less confident that they could remain abstinent Oxford House members with and without convictions similar levels of optimism and beliefs they could remain abstinent Majer, Jason, & Olson (2004)
38	OH and Criminal/Aggressive Behaviors 6 months or longer living in an OH associated with lower levels criminal and aggressive behaviors Aase, Jason, Olson, Majer, Ferrari, Davis, & Virtue (2006)
39	Women in Oxford House 90% used alcohol and cocaine for over 10 years 67% had experienced depression 46% had attempted suicide 95% had experienced some form of past trauma Despite these severe past histories highest Sense of Community scores of any group ever examined with this measure Olson, Curtis, Jason, Ferrari, Horin, Davis, Flynn, & Alvarez (2003)
40	OHs for Women and Women with Children Good leaders had the following qualities: knowledge of rules good role models without being overbearing or bossy compassionate, open-minded, and listened to others Women in the houses viewed children with a sense of responsibility regardless of whether or not the child were their own Children had a positive effect on house members D’Arlach, Olson, Jason, & Ferrari (2006); Davis, Dziekan, Horin, Jason, Ferrari, & Olson (2006)
41	Psychiatric Co-Occurring Conditions Psychiatric severity over a one-year period No significant differences residents with high versus low baseline psychiatric severity number of days in outpatient residential psychiatric treatments abstinence rates Majer, Jason, North, Davis, Olson, Ferrari, Aase, & Molloy (2006)
42	Medical Care Needs 292 female and 604 male residents of OH those not employed used medical care more often those who used pharmaceutical drugs used medical care more often Ponitz, Olson, Jason, Davis, Ferrari (2006)
43	"Neighbors next to an OH..." Neighbors next to an OH and a block away Property values not significantly different Those who lived next to an OH versus had significantly more positive attitudes: concerning the importance of substance abusing individuals being able to live in residential neighborhoods about the importance of neighbors providing a supportive environment to those in recovery regarding attitudes of a self-run recovery home on their block Jason, Roberts, & Olson (2005)
44	OH Resident Involvement Significant correlation between the length of time staying in an OH and involvement in the community 86% of residents felt that living in the Oxford House increased their likelihood of involvement in their neighborhoods OH residents reported spending 10.6 hours per week on neighborhood involvement 35% were involved in mentoring others in recovery 44% were involved in administering and running support groups. 56% were involved in educating the community about the OH 36% were involved in educating the community on recovery in general
45	"Involvement in community initiatives" Involvement in community initiatives: 39% of participants reported involvement in informing or advising agencies or local leaders 32% reported involvement in community anti-drug campaigns 16% speaking at political events 30% attending community meetings 21% public hearings and forums Jason, Schober & Olson (2006)
46	Dissemination of Oxford Houses Significant expansion of houses when states employed an outreach worker to provide technical assistance Jason, Braciszewski, Olson & Ferrari (2005)
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48	Conclusions
49	After treatment for substance abuse Many clients return to former high-risk environments or stressful family situations Returning to these settings without a network of people to support abstinence increases chances of relapse
50	Self-governed, Structured Aftercare settings Like Oxford Houses Important public policy implications for stabilizing individuals with substance abuse histories
51	"More information on these studies..." More information on these studies is available at: http://condor.depaul.edu/~ljason/oxford