The challenge in regulating sober homes is that there are two very different categories of sober homes, and risks for unethical and exploitative behavior are very different between them. About half or just more of sober homes in Virginia are certified by Oxford House and operate independently according to that sober home model. They are self-run, self-supporting, totally nonprofit, and no one is in a position of authority. They also have major studies done on them that are in peer-reviewed publications that show 86.5% total abstinent rates after one year. In most addiction treatment program studies half or more of people have relapsed within six months. The remaining about half of sober homes in Virginia are for-profit, staffed, and/or owner operated and are certified by VARR. In these, there are people making money off the people living in the houses. In these, there are people who are in positions of authority over the people living in the houses. These models of sober homes have not been shown in research to have the high, longterm abstinence rates that have been shown in published research on Oxford House model.

What are the problems often seen in sober homes across the country, in Virginia, detailed in Parham Papers? They are all about money or authority. The profit motive is what motivates most of this abuse: patient brokering, financially exploiting addicts and their families, cramming too many people into a house, and other unethical behavior motivated by making money. The other problems are about staff/operators abusing their positions of authority to exploit or abuse vulnerable addicts. Those problems are sometimes rampant in sober homes when it’s a money-making model and when it’s a model that has people with questionable ethics given authority over residents of the homes. In the first category, the houses that run according to the Oxford House system, no one is making any money off the house and its members, other than a local landlord that charges normal market rent. In those sober homes, no staff are in authority of the residents. They make decisions democratically, manage the bills, enforce the rules, and help support other houses in the same community. There is no one who is in control who can abuse their power over residents. And in the research, it’s the fact that houses are democratic and run themselves that is why the longterm sober rates higher than any other addiction/recovery programs.  

There is a need for both models. There is a need for way more sober homes. But the reality is, all the bad behavior, abuse, exploitation that the state is concerned about to regulate are all things that happen in for profit, staffed houses, and based on the concept of how Oxford Houses operate those things can’t happen because there’s no one making money off the people or in authority over them. So if the state wants to make sure sober homes don’t have these bad behavior they need to recognize there needs to be a different approach to regulating each, with more focus on the ones that have the abuses. There are still things to monitor in nonprofit Oxford Houses. Because they don't have staff, sometimes get run down, and the state should want to make sure all sober homes provide a nice and safe environment. But the overwhelming majority of potential problems are about financial greed and abuse of power and those problems can’t exist in certified Oxford Houses. And because they are unstaffed, more regulation would be difficult for them in a way it is not in staffed ones.

Even in regard to the certifying organizations, one makes money off the houses, one does not. NARR affiliates charge certification and renewal fees of all their certified houses. Oxford House  does not make a penny from the individual houses. The NARR affiliate is run by all the people that are running the homes and making a lot of money, so they’re monitoring themselves while making all that money. Oxford House doesn’t have this conflict of interest because the people certifying and monitoring the homes aren’t running the homes or making money from the homes.

One prior comment said VARR is the best value for our states addiction epidemic, but that is not true. VARR costs the taxpayers over ten million dollars every year. Oxford House costs the tax payers about twenty times less than that. And for twenty times less, they get as many or more sober homes and their sober outcomes are higher.

To have good regulation the state needs to recognize the difference in those models and regulate money-making, staffed, business sober homes differently then evidence-based, nonprofit, non-business Oxford homes.