What is sober living, and how is it different from a treatment program?

Housing and treatment are different things

A treatment program provides clinical services such as assessment, counseling, group therapy, medication or withdrawal care, and holds the license or certification its state requires to do so. A sober living home provides a place to live with rules and, often, a house manager. Residents may attend treatment somewhere else during the day.

Arizona's health department draws the line clearly in its brochure comparing sober living homes with behavioral health residential facilities. It says a behavioral health residential facility is a health care institution that must provide treatment on site. A sober living home provides a supervised setting for people recovering from substance use disorders, and the only medical or clinical service allowed on site is drug and alcohol testing. The brochure also notes that in Arizona, sober living homes are not eligible for Medicaid or insurance reimbursement, while treatment facilities usually are.

The practical consequence is simple. If you or someone you love needs treatment, a sober living home on its own does not provide it. If you need a stable, alcohol-free and drug-free place to live while attending treatment or after finishing, sober living may help with that part.

Rules vary by state

There is no single national license for sober living. The examples below come from three states' official pages and show how differently the same kind of home can be treated. Check the rules in your own state.

In California, the Department of Health Care Services says on its licensing complaints page that it does not license, certify or investigate complaints against sober living or transitional living homes. It also says that a home providing even one treatment service, such as group sessions about recovery or relapse prevention, individual counseling or detoxification, should be licensed as a residential treatment program. DHCS says people can file a complaint if a sober living home is providing services that require a license.

In Arizona, state law requires sober living homes to be licensed by the Department of Health Services. Arizona's FAQ for sober living homes sets out requirements such as an on-site manager and naloxone in the home. The brochure notes that a home that provides a sober setting without supervision, or allows drug or alcohol use, is not a sober living home under the state's definition.

In Pennsylvania, the Department of Drug and Alcohol Programs says on its licensing page that recovery houses must be licensed if they receive funding or referrals from public sources. Other recovery houses may not need a state license.

Checking a home

Where a state licenses sober living, you can check. In Arizona, the health department says you can verify a sober living home's license through AZ Care Check if you know its name. The brochure notes that state law does not stop unlicensed places from calling themselves sober living homes, so the name alone does not tell you.

Where a state does not license sober living, ask the home directly about its rules, who runs it and whether it belongs to any certifying organization. Ask whether it provides any treatment services, and if it does, whether it holds the license your state requires for that.

Questions to ask a sober living home

Ask what the rent is, what it includes and how and when it is paid. Ask what happens to your deposit and rent if you leave early or are asked to leave.

Ask about the house rules: curfew, visitors, chores, drug and alcohol testing and what happens if someone drinks or uses. Ask who manages the house, whether they live there and how to raise a problem.

Ask whether residents taking prescribed medication, including medications for opioid or alcohol use disorder, can live there. Arizona's law requires licensed homes to allow residents on medication-assisted treatment to continue it. Other states and homes may differ, so ask before you move in.

When a home and a program are linked

Some treatment programs run their own sober living homes or recommend particular ones. That is not automatically a problem, but ask whether living there depends on continuing with that program's services, and whether the housing is billed to insurance or paid by you. If a home offers free rent or other incentives in exchange for attending a particular program, be cautious and ask why.

If you believe a home is providing treatment without a license, or residents' health or safety is at risk, you can raise it with the state agency that licenses treatment. In an emergency, call 911.