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Sober Living & Medication-Assisted Treatment: Benefits & How to Find Them

April 18, 2022

Table of Contents

If you assumed that all sober living homes do not permit Medication-Assisted Treatment (MAT), you might be mistaken. Many sober living homes admit residents who are on MAT. Others that don't may soon be revising their policies, as government bureaus are increasingly encouraging sober living homes to open their doors to MAT residents.[1]

Why is MAT Use Controversial in a Sober Living Home?

A “sober living home” is a home, usually sponsored by the government or by NGOs, where patients who are in recovery can stay so long as they maintain sobriety. Sober housing works as a bridge connecting patients who are recently sober to resources to help them maintain that sobriety while still living independently in the community.[2] 

Many of these facilities require proof of sobriety in order to be a resident, and this might mean sobriety from all substances, including legally prescribed substances such as MAT.

However, most experts argue that MATs are legal treatments for a valid medical condition of SUD and should not be considered “substances” that would preclude their users from the benefits of sober living facilities. Most would argue that MAT helps individuals safely maintain their sobriety and thus should be permitted and even encouraged by supportive housing. Experts agree that MAT is not a drug substitution.[6] You're not swapping one problem for another when you use MAT. Instead, you're addressing your addiction in a real and powerful way. 

Logistical Challenges of Being on MAT while in a Sober Living Home

Some sober living facilities make the argument that they are just not set up to provide MAT for various logistical reasons. For example, some forms of MAT, such as liquid methadone, must be administered by licensed and qualified staff on a daily basis. The facility may not be able to legally distribute the methadone on site, and they may not be able to arrange transportation for you to a daily methadone facility.  Other facilities don't have staff available around the clock, and they may not allow you to keep over-the-counter medications in your room. If you need doses at night, they may not be able to provide them. Some other arguments include the concern that other residents who are completely abstinent might not want to live with others who are using MAT, and having opioids like methadone in the facility might tempt others to steal or misuse the medications. 

Here are some arguments that individuals might use in advocating for their ability to continue MAT therapy while in sober housing: 

"I don't use MAT to get high. I use it to avoid getting high."

In the past, MAT was associated with significant stigma.[3] Many people believed that recovery medications delivered a buzz, and some consider people who use MAT to not be “truly sober.” Most doctors are advocating for reappraisal of this assumption: people on MAT should be considered to be sober from illicit substances and should be supported by sober housing facilities to maintain their sobriety through MAT. 

"My doctor prescribed this medication for my recovery based on my preferences."

In studies, more than 40% of people in recovery asked for MAT.[4] As you built your recovery plan with your doctor, MAT was an essential part of that plan. Eliminating a therapy your doctor believes is best for you in order to keep your housing is not an ideal way to begin your life of recovery, and is not a choice patients should be forced to make.

"A sober home could help me use my MAT effectively."

Researchers hypothesize that the rigid structure of sober living homes may actually help people on MAT to remember to take their doses on time.[5] You may need someone to remind you to take your medications in the early stages of recovery. And you may need reminders that your MAT is helping, so you're not tempted to drop out of therapy. Sober living facilities often have rigid structure and rules, which can really help to create routine for patients adjusting to sober living and help them maintain their sobriety. 

Questions to Ask as You Search for a MAT Friendly Facility

Sober living homes often will accept you as a  resident if you are on MAT. But you will need to ask some specific questions to make sure they can adequately accommodate your needs while on MAT. Here are some questions to ask:

Is your form of MAT - Suboxone or Methadone - allowed? 

Usually patients are on either Suboxone or Methadone. In some states, only homes that offer Level 4 care can administer some forms of MAT on site.[7] If the facility does not offer MAT onsite, you will need to ensure that you can still get transportation to your methadone clinic on a daily basis. 

How will your MAT be delivered? 

Will you be able to keep your MAT with you in your room, or will you need someone on the staff to provide each dose? Can the staff meet your dosing schedule?

Could the facility use your MAT to expel You? 

Many sober homes test residents for drugs. Ensure that the facility you choose offers exceptions for MAT. As long as you are following your doctor's orders, you should not be asked to leave. 

Does the facility offer a safe place to store or guard medications? 

Make sure you will have a safe place to store your medications away from other residents. 

What else is required? 

Some sober homes ask people on Medication-Assisted Treatment to jump through a few extra hoops. You might be asked to go to more doctor's appointments, for example. Or you might need more frequent drug testing. Find out those details now and ensure you can live with the rules of your specific facility.

Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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Citations

  1. SAMHSA Guidelines for Recovery Housing Emphasize MAT. Alcoholism and Drug Abuse Weekly. https://onlinelibrary.wiley.com/doi/10.1002/adaw.32517. October 2019. Accessed April 2022.
  2. Addressing the Opioid Crisis Through Quality Recovery Housing. The Health Lawyer. https://heinonline.org/HOL/LandingPage?handle=hein.journals/healaw31&div=17&id=&page=. 2018-2019. Accessed April 2022. 
  3. Information About Medication-Assisted Treatment (MAT). U.S. Food and Drug Administration. https://www.fda.gov/drugs/information-drug-class/information-about-medication-assisted-treatment-mat. February 2019. Accessed April 2022. 
  4. Preferences for Aftercare Among Persons Seeking Short-Term Opioid Detoxification. Journal of Substance Abuse Treatment. https://www.sciencedirect.com/science/article/abs/pii/S0740547215001725. December 2019. Accessed April 2022.
  5. Lived Experiences of Oxford House Residents Prescribed Medication-Assisted Treatment. DePaul University. https://via.library.depaul.edu/csh_etd/406/. November 2021. Accessed April 2022. 
  6. MAT Medications, Counseling, and Related Conditions. Substance Abuse and Mental Health Services Administration. https://www.samhsa.gov/medication-assisted-treatment/medications-counseling-related-conditions. March 2022. Accessed April 2022. 
  7. A Primer on Recovery Residences: FAQs from the National Association of Recovery Residences. National Association of Recovery Residences. https://narronline.org/wp-content/uploads/2014/06/Primer-on-Recovery-Residences-09-20-2012a.pdf. September 2012. Accessed April 2022. 

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