Understanding What Helps People Stay in Recovery Housing

While Kentucky has seen a recent decline in drug overdose deaths according to the Kentucky Drug Overdose Annual Report, substance use disorder (SUD) remains a persistent public health concern, and recovery housing continues to be a key support for individuals on the path to long-term recovery.  But while recovery housing has proven effective in supporting individuals on their recovery journey, the factors that help people stay in recovery housing aren’t well understood. 

This motivated Joseph Ellis, MS, and Mira Mirzaian, MPH—researchers at the Kentucky Injury Prevention and Research Center (KIPRC)—to conduct a comprehensive scoping review of the literature on recovery housing retention, with a particular focus on Oxford House models.  The review examined more than 30,000 articles across five databases, identifying 22 studies that offered insight into the factors that contribute to individuals' ability to remain in recovery housing long-term. 

“The literature shows that the more time an individual is able to stay in recovery housing, the more likely they are to have a successful long-term recovery journey,” Ellis said. “But what isn’t talked about as much is what helps someone stay in recovery housing, and that’s what I wanted to better understand.” 

Ellis identified four recurring factors that influence whether someone remains in recovery housing: mental health, demographic factors, social networks, and the house environment. 

Each factor plays a distinct role in the experience of individuals in recovery housing. Mental health issues, for instance, often coexist with SUD and can significantly affect an individual's stability in a recovery housing program.  

“It isn’t really surprising that if someone is struggling with anxiety, depression, or other mental health conditions, they might leave a recovery house in search of relief, which could lead to resumption of substance use,” Ellis said. 

Demographic factors such as gender, age, and parenting status were also associated with retention in recovery housing. One particularly striking finding from the literature was a study indicating that men with children received more external support—such as financial assistance, help with childcare, and encouragement from family and social networks—than women in the same situation. This support was positively correlated with longer lengths of stay in Oxford Houses.   

In contrast, women with children often faced more barriers and less external support, which was associated with shorter stays.  The finding suggests that men with children may be in situations more conducive to sustained recovery, potentially due to factors like older age, higher education level, and greater financial stability.   

“You would expect women would have more support, given the hegemonic view that women are the caretakers of children,” Ellis said. “But in this study, the opposite was true.” 

Ellis said that feeling connected and supported, whether through access to childcare, emotional encouragement, or practical help like transportation, can make or break someone’s willingness or capacity to stay in recovery housing. 

“When that support is uneven or lacking, as it often is for women with children, it creates additional barriers that make long-term stability much harder to maintain,” he said. 

Having a strong social network within recovery housing plays a crucial role in retention.  

“Humans are social beings,” Ellis said. “If we don’t feel connected or supported, if we don’t feel like we belong, it becomes difficult to stay even in places designed to help.” 

Ellis explained that even something as simple as having one person to rely on—a friend, roommate, or house manager—can make a meaningful difference.  

“Just knowing someone would lend you five dollars if you needed it, that someone trusts you, that can mean a lot,” he said.  The house environment refers to the culture, safety, and dynamics within the recovery housing setting.  A safe, stable, and welcoming environment is essential for retention.  

“If you don’t feel safe or welcome where you live, you’re not going to stay,” Ellis said.  

Recovery Capital  

Underlying all four factors is the idea of recovery capital—the combination of physical, social, human, and cultural resources available to support someone in recovery.  

“The more resources a person can access and utilize, the more recovery capital they can build and the stronger their chances of sustaining recovery,” Ellis said. 

So, what can recovery housing programs and policymakers do with this information? 

According to Ellis, it starts with intentionally designing recovery housing to address these four key factors.   

“Programs should be making sure recovery housing residents have supportive social connections, feel like they belong, and are getting the mental health care they need,” he said. “Demographic factors tie into the availability of services, so housing staff need to link people to those services if they’re not readily available in the immediate area.” 

The Need for Future Research 

Although this study focused in part on Oxford House models—self-run, self-supported homes for individuals in recovery from SUD—Ellis believes the findings could apply more broadly.  

“There’s no reason these constructs couldn’t apply to other types of recovery housing as well,” he said. “The science isn’t there yet to generalize fully, but I believe these patterns could hold across housing models.” 

Ellis sees a need for future longitudinal studies that track individuals across different types of recovery housing and evaluate how specific programs and experiences align with these four retention constructs. 

“We need to log the specifics—housing features, personal histories, services received—and see how they correlate with someone’s length of stay,” he said. “That’s how we begin to fill in the gaps in the science.” 

Ultimately, Ellis hopes the study serves as a tool for both academic researchers and community-based practitioners. 

“I would like people to take away that research is making progress, but there is still a lot more work to be done,” he said. “I hope this study adds to the academic conversation and helps recovery programs create environments where people not only stay—but thrive.” 

KIPRC, a unique partnership between the Kentucky Department for Public Health (DPH) and CPH, serves both as an academic injury prevention research center and as the DPH’s designee or “bona fide agent” for statewide injury prevention and control, focusing on injury prevention translation and practice.   

This paper is supported by the Health Resources and Services Administration (HRSA) of the US Department of Health and Human Services (HHS). The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by HRSA, HHS, the Veterans Administration or the US Government. 

Joseph Ellis, Mira Mirzaian, Eleanor Sudduth, Maddison Ashworth, Robin Thompson, Dave Johnson, Lauren Robinson & Terry Bunn (10 Feb 2025): Identification of Retention in Oxford Houses and Other Types of Recovery Housing: A Scoping Review, Substance Use & Misuse, DOI: 10.1080/10826084.2024.2447935