This document discusses success factors for housing services for people recovering from opioid use disorder. It summarizes a study that identified the most important success factors through a consensus process. These include offering substance use disorder interventions, providing quality housing units, expert tenancy management, and integrated social services. The study then assessed 16 existing housing services based on these factors. It found the services varied in their tenant selection criteria, substance use disorder interventions provided, and achievement of the defined success factors. The conclusions emphasize the importance of considering tenant selection policies, intervention intensity, and developing a network of different housing service types to best support recovery.

1. applied strategic
Housing for people recovering from opioid
use disorder: success factors
Presented by Dr. Richard Littlewood
30 October 2016
WFTOD AATOD Presentation
applied strategic 1

2. Starting point
• Housing is an important factor in success for people
addressing SUD1,2.
• For many there are significant problems in accessing
housing, particularly on release from prison3,4.
• Restricted access to housing limits potential for recovery
• There is a need to deliver effective strategies to improve
access to housing for people with SUD
• Understanding success factors for housing for people
with SUD is important
applied strategic 2Source: 1Chartered Institute of Housing 2012: 2Milby JB, et al. Am J Public Health. 2010;100(5):913-918.
3Binswanger IA, et al. Addict Sci Clin Pract. 2012;7:3. 4Linton SL, et al.. MD. Drug Alcohol Depend.
2013;132(3):457-465.

3. Substance use disorder among homeless persons in the
UK is common
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39%
• 36% had recently
taken drugs (within
30 days)1
• Cannabis (64%),
prescription drugs
(29%) and heroin
(27%) reported 1
Source: 1. Homeless Link, ‘The Unhealthy State of the Homeless: Health Audit results 2014’. 2014
% of homeless
persons in the
UK take drugs/
recovering from
a drug problem1

4. Many starting SUD treatment have no access to stable
accommodation
• 9% of clients starting treatment for drug
dependence had ‘no fixed abode’1,2
• An additional 15% had other housing
problems: staying with friends or family,
or living in short-term hostel1
applied strategic 4Source: 1Public Health England, ’Drugs and Alcohol: Recovery resources’; 2 Shelter, ‘Spotlight on
Supporting Prison Leavers using substances’ 2015
9%
15%

5. Housing positively affects treatment outcomes in SUD
patients
Housing (v. standard ’after care’) is effective at improving
outcomes in people with history of SUD, positively
affecting:
• Drug and alcohol use 1,2,3
• Employment 1,3
• Psychiatric symptoms 1
• Incarceration rates 1,2,3
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Source: 1Reif et al. Psych. Serv. 65:3 2016. 2Douglas et al. J. Psychoactive Drugs. 42:4 2010. 3Paquette et
al. ‘Recovery Housing in the state of Ohio, June 2013

6. Aim
• Project completed to define critical success factors for
housing services aimed at people addressing SUD
• Assessment of 16 housing services started in the period
of research in NW England was conducted
• Results used to inform best practice
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7. Method
Step 1 – success factors
• “Delphi” style consensus among representatives from
16 recovery housing services in the study
• Identified and prioritized important success factors for
housing services
• Prioritized success factors can be used to assess/
compare the performance of housing services
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8. Method
Step 2: assessment
• Online survey and phone interviews were conducted
before and after 6 months working
• Participants assessed housing service performance
against ranked success factors from Step 1
• Defined type of housing service (tenancy selection and
SUD interventions)
• Recorded experiences in setting up the services
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9. Results: consensus process , key success factors
Rank Success factors for housing projects
1
• Interventions for SUD (for example, including
mutual aid) are offered
2 • Housing units of appropriate quality are available
3
• Expert, specialist tenancy management services
are in place
4
• Planning for special groups exists (on OST, using
illegal drugs, increased risk, such as history of
arson)
5
• Integrated social services are offered (including
activity programs/ training)
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10. • 16 housing services offered 254 units (a unit is accommodation for 1
person) during the period of 6 months
Results: activity
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Average occupancy across all housing services was 86%
Demand exceeded capacity in 31% of services.
Full capacity utilization was reached in 25% of services
86% of tenants came to housing on release from prison
44% of services housed only tenants released from prison

11. Results: consensus process
Success factors for housing services
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81
94
63
56
75
Offer
treatment
Provide
quality
Manage
tenants
Special
groups
Social
services
Achieved
by (%)
Success factors in decreasing order of ranked
importance

12. Tenant selection
Observations
Choose what type of service you want to be…
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SUD
interventions
High
intensity
Minimal/ No
services
Abstinence (no
OST)
3rd party
services
Not
selective
Selective
(no illicit
drugs)
Progressive
highly selective
for tenants,
high intensity
intervention.
Directive
Abstinence, OST permitted,
tenants engage with third party
services for SUD
Supportive
No selection for
drug use,
offering no/ low
level of
interventions

13. Tenant Selection
[% achieving
outcome, N=16]
What happened?
Tenant selection
31
38
3131
25
44
Complete
abstinence
Limited SUD
medication
No specified limit
Before
Realworld
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14. SUD
intervention
[% achieving
outcome,
N=16]
What happened?
Interventions for SUD
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56
44
0
19
50
31
High intensity
services
Structured referral No formal
arrangement
Realworld
Before

15. Discussion
Different types of housing services in networks is needed
• For housing services - there must be clear planning for
tenant selection (substance use) and interventions for
SUD
• Housing services will differ in their approach:
“progressive, directive or supportive”
• Different types of housing in a network must be
provided
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16. Conclusions
• The work defined success factors for housing services
supporting people aiming for SUD recovery
• These should be considered when measuring and
comparing success in recovery housing services
• Intensity of SUD intervention and criteria for tenant
selection must be considered by all new services
• Housing networks, ranging in selection criteria, are
likely to improve treatment outcomes for SUD
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