Engagement and retention in a motivational, discovery, and transitional track based substance use disorder recovery program: evaluation, facilitators and barriers

Abstract

Background

St. Matthew’s House® Justin’s Place® Recovery Program (JPRP) is a substance use disorder recovery housing program that employs Motivational, Discovery, and Transitional Tracks. This study examined whether resident retention, resumption of substance use, family relationship restoration, and acquisition of employment were associated with JPRP completion.

Methods

Secondary quantitative data from individuals with a substance use disorder who were accepted into the JPRP program and who stayed for at least one day (n = 447) was collected from January 1, 2022-August 31, 2024. Characteristics of the JPRP and its residents were identified. Logistic regression was utilized to determine the resident and programmatic variables associated with the odds a resident successfully completed the JPRP. Outcomes included employment readiness, employment status, housing status, and family relationships at JPRP completion. Alumni data was self-reported from a convenience sample.

Results

Of the 447 residents in the study, 68% entered Discovery Track (approximately 30 days), 38% entered Transitional Track (approximately 270 days), and 35% graduated from the JPRP. Discovery Track is considered to be the “engagement phase”; 302 residents (100%) were engaged in JPRP using day 1 of the Discovery Track as the denominator, and the 12-month retention rate was 51% based on the number of residents who entered Discovery Track, or 35% based on the number who entered Motivational Track. Being court-ordered (on probation) at JPRP intake (OR 3.355; CI 1.479, 7.61), participating in regular case management meetings (OR 9.47; CI 3.822, 23.476), and gaining employment while in the JPRP (OR 58.856; CI 26.087, 132.791) were associated with higher odds of successful JPRP completion. Of the residents who completed the JPRP, 59% were actively engaged alumni, and 76% had not returned to use.

Conclusion

Being court-ordered to attend a SUD program at JPRP intake, attending regular case management meetings, and gaining employment while in the JPRP were associated with successful JPRP completion. JPRP offerings of family restoration support, intensive case management, employment opportunities, and active alumni engagement have facilitated long-term recovery and reduced return to use.

Background

According to the 2024 National Survey on Drug Use and Health, 73.6 million persons used illicit drugs in the past year in 2023, and it is estimated that 48.4 million persons had a past year substance use disorder (SUD) (Substance Abuse and Mental Health Services Administration [SAMHSA], [1]). Of those with a SUD, 11.7 million people received SUD treatment, and of the 30.5 million persons who ever had a substance use problem, 22.2 million considered themselves to be in recovery or to have recovered.

Along with treatment, the high prevalence of substance use within the population requires evidence-based practices such as recovery housing that starts persons on the path to recovery in a safe living space. Recovery housing is considered by SAMHSA to be an evidence-based practice depicted by standards and service levels from the National Alliance for Recovery Residences (NARR) (SAMHSA, 2023). The 10 NARR best practices require a recovery house to 1) be recovery-centered; 2) promote person-centered strengths-based approaches; 3) incorporate the social model approach; 4) ensure quality, integrity, and safety; 5) integrate trauma-informed approaches; 6) establish a clear operational definition; 7) establish and share policies and procedures; 8) certify; 9) promote evidence-based practices; and 10) evaluate program effectiveness.

Recovery capital can be defined as the resources internal and external to an individual that can be drawn upon to initiate and sustain recovery from SUD [3]. Recovery capital resources include physical, social, cultural and human resources [3]. Within the physical resources domain, income, employment, transportation, and housing are primary resources or building blocks for recovery capital. Social resources include friends and family; cultural resources include ritual and activities; and human resources include skills and abilities among others.

St. Matthew’s House® Justin’s Place® Recovery Program (JPRP) is a recovery housing program for persons with SUDs that opened in 2010 in southwest Florida. The JPRP contains 154 beds for residents and comprises three recovery support tracks completed over the course of 12 months. The first recovery support track, Motivational Track, lasts approximately four weeks and consists of substance withdrawal management, crisis stabilization, health screening, mental health evaluation, work therapy (defined as unpaid chores in their onsite agricultural, and program/hospitality settings), identification document acquisition, homeless community service, personal recovery community establishment, and addressing powerlessness. Discovery Track, the second phase, lasts eight months and consists of relapse prevention, spirituality curriculum and associated activities, cognitive behavioral therapy, motivational enhancement, work therapy, 12-step meetings, and physical health and mental health treatment. The third phase, Transitional Track, lasts three months and includes workforce readiness training, paid part-time employment in the St. Matthew’s house organizational/social enterprises, continued spirituality curriculum and activities, and financial management classes. At the end of the 12-month JPRP, residents are offered alumni engagement opportunities. For up to two years after graduation, resident alumni can enroll in the JPRP Recovery for Life program to continue living on campus, obtain full-time employment, maintain church attendance and small group meetings, continue case management meetings and health assessments, and access further employment training and opportunities.

The purpose of this study was to identify the 1) characteristics of the JPRP and its residents; 2) resident and program factors associated with JPRP completion; and 3) self-reported alumni outcomes in a convenience sample of JPRP alumni.

Methods

Setting

We conducted a retrospective quantitative evaluation of the JPRP. The University of Kentucky’s Institutional Review Board approved the study through protocol #96709. Secondary quantitative data were collected from January 1, 2022-August 31, 2024.

Participants

Study participants were defined as individuals who were accepted into the JPRP program, deemed as “residents,” and who stayed for at least one day.

Inclusion criteria: 1) JPRP residents at least 18 years of age; 2) with a SUD (including alcohol, opioids, or stimulants); 3) can be on naltrexone/vivitrol Medications for Opioid Use Disorder (MOUD); and 4) can be on probation and/or court-ordered to attend the JPRP program.

Exclusion criteria: Individuals were excluded from the JPRP program and subsequent study if they 1) did not have a SUD; 2) were on methadone and buprenorphine MOUD (excluded due to extensive clinical monitoring since there is no licensed MOUD clinician is on staff); or 3) were under 18 years of age; 4) extensive violent behavior and sexual offender; and 5) have open legal cases involving forthcoming sentencing.

Program completion criteria: to graduate from the JPRP, the participant needs to follow program rules and policies that are standard guidelines found within the recovery-oriented system of care. For example, participants may stay in the program and graduate if 1) no alcohol or drugs are used; 2) no physical violence occurs; 3) they participate in program meetings and classes, and 4) they comply with curfews.

Resident data

To assess resident characteristics and factors associated with program completion, secondary quantitative data from residents who had a Motivation Track intake data and discharge date between January 1, 2022 and September 30, 2024 was acquired from JPRP staff. Final evaluation data included all residents who were admitted to the JPRP and 1) graduated, 2) received an allowable discharge, or 3) received an unallowable discharge.

Resident data fields included resident data from JPRPs missionTracker® software database and JPRP data reports. To obtain resident data from the missionTracker® resident software database, the study team reviewed existing data fields within the missionTracker® software and requested applicable data fields for analysis from JPRP staff, who provided the requested JPRP admissions record data for all eligible residents. Study data fields included resident demographics (age, gender, race, education), employment and income information, employment resources, legal status, health status, resident’s drug of choice, number of days retained in each JPRP track, JPRP outcome data (employment resources, employment acquisition, spiritual improvement (defined as regular church attendance), and referrals), and JPRP discharge reason.

The following definitions were used to identify resident disallowable discharge, allowable discharge, and JPRP completion:

1. Disallowable Discharge: “Arrested”, “Did not like JPRP rules and left”, “Did not return”, “Did not like the rules and left”, “Did not return at all”, “Failed drug/alcohol test”, “Failed a drug screening”, “Fighting”, “Non-compliant with JPRP Rules”, “Other”, “Other unapproved reason”, “Threatened, attacked, or assaulted staff”, “Was arrested or is in jail”, “Was noncompliant with JPRP rules”, “Was not appropriate for JPRP”, “Went to residential treatment facility”, “Went to the hospital or detox”, “Found another place to stay”, “Probation needs adjusted”, “Left to be with family” (and days stayed < 290 days), “Left to be with girlfriend” (and days stayed < 290 days)

2. Allowable Discharge: “Other approved reason”, “Transfer to other St. Matthew’s House facility”, “Transfer”, “Medical”, “Needed help St. Matthew’s could not give”, “Left to be with family” (and days stayed > 290 days), “Left to be with girlfriend” (and days stayed > 290 days)

3. JPRP Completion: “Graduated”, “Successfully completed”, “Completed the JPRP”

Counts and frequencies were calculated to assess resident demographic characteristics and resident programmatic characteristics. 2-sided t-tests were performed to test for the significance of differences in resident outcomes related to employment readiness, employment status, housing status, and family relationships. Holm’s multiple hypothesis test corrections were employed to correct for inflated Type 1 error rates arising from multiple hypothesis tests [4].

Logistic regression was utilized to determine the important resident and programmatic variables associated with the odds a resident successfully completed the JPRP. Odds ratios from the logistic regression were reported in addition to 95% confidence intervals. All quantitative analysis was conducted in Stata 18.0.

Alumni data

To assess self-reported alumni outcomes, secondary alumni data for those who graduated JPRP from January 1, 2023-September 30, 2024, and elected to become an engaged alumnus were used. A convenience sample of JPRP alumni data was obtained from JPRP staff. JPRP alumni were surveyed through phone calls, email, Facebook, and other social media channels at 1, 3, 6, 9, 12, and 18 months after JPRP completion. If an alumnus responded through any of the above channels, an alumni survey was completed through the above channels at any or all of those timepoints. Self-reported alumni data included the resident’s graduation date, their level of engagement in JPRP alumni events, return to substance use (defined as refraining from using the drug(s) that you are trying to avoid or recover from) and relinkage to recovery support services data, and JPRP reintegration data if return to use occurred. Mortality and incarceration status of JPRP alumni were also documented. Counts and frequencies were calculated to self-reported alumni outcomes.

Results

Characteristics of the JPRP and its residents

There were 447 residents included in the final study. The majority of residents were between the ages of 25 to 44 (57%), male (80%), and white (80%) (Table 1). Less than one-half of the residents (42%) had a high school diploma/GED, and few (13%) had a college degree. Few residents had any income source (16%) and few reported receiving Social Security income (11%) at the start of the JPRP. Approximately 38% of the residents had health insurance. Almost one-half of the residents were court ordered to attend, with 40% being on probation and 30% having pending legal action. 1-quarter of the residents had a co-occurring mental health condition. For primary drug of choice used prior to JPRP entry, one-quarter reported using alcohol (28%) or methamphetamine (26%), 21% used opioids and 11% used cocaine.

Table 1.

St. Matthew’s House® Justin’s Place® recovery program resident demographics at Intake

Demographic Variable	n (%)
Number Enrolled in St. Matthew’s House® Program at Intake	447 (100%)
Age (in years)
18–24	22 (5%)
25–34	105 (23%)
35–44	154 (34%)
45–54	84 (19%)
55+	82 (18%)
Gender
Female	62 (14%)
Male	385 (86%)
Race/Ethnicity
White	358 (80%)
Black, African American, or African	52 (12%)
Hispanic	32 (7%)
Asian	3 (1%)
Other	2 ( < 1%)
Highest Level of Education
High school diploma	189 (42%)
College degree	59 (13%)
Less than high school	199 (45%)
Income and Benefits
Has any income source	70 (16%)
Receives Social Security Income	49 (11%)
Has health insurance	169 (38%)
Other Background
Veteran	17 (4%)
Legal Status
Court ordered (on probation)	180 (40%)
Court ordered (pending legal action)	132 (30%)
Health Status
Has a chronic health condition	67 (15%)
Has a physical disability	40 (9%)
Has a developmental disability	13 (3%)
HIV/AIDs	11 (2%)
Has a mental health disorder	111 (25%)
Has a communicable disease	45 (10%)
Has a disabling condition	36 (8%)
Primary Drug of Choice
Alcohol	126 (28%)
Benzodiazepines	4 (1%)
Cocaine	48 (11%)
Cannabis	16 (4%)
Meth	118 (26%)
Multiple Substances	8 (2%)
Opioids	95 (21%)
MDMAΔ	3 (1%)
Unknown	27 (6%)

^Δ3,4-Methylenedioxymethamphetamine

In terms of programmatic characteristics, 43% of residents were provided a referral to another agency (partnering with other community agency providers for resident medical and other needs) while enrolled in the JPRP and 51% obtained all necessary identification (ID) like a state ID card, social security card, or birth certificate to gain employment (Table 2); at intake, most residents had at least one identification card to support employment readiness, with 61% having a photo ID card and 88% having a Social Security card. Approximately one-half (51%) of the JPRP residents were actively engaged in their case management plan. One resident died while in the JPRP and one resident was incarcerated while in the JPRP.

Table 2.

St. Matthew’s House® Justin’s Place® recovery program resident programmatic characteristics

Programmatic Variable	N = 477%)
“provided a referral to another agency while in our care” at least once	191 (43%)
“obtained the necessary identification (state ID, Social Security card, birth certificate, etc.) to gain employment”	230 (51%)
Recovery Management Plan Goals (“actively engaged in their case plan, which is evidenced by meeting their goals and participation in regular case management meetings”)
Yes	230 (51%)
No	217 (49%)
Deceased while in program (reason for leaving)	1 (0.2%)
Incarcerated while in program (reason for leaving)	1 (0.2%)
Recurrence of Substance Use
Yes	14 (3%)
No	433 (97%)
Length of Stay (mean days)	175.56 days
Retention
Allowable discharge	36 (8%)
Disallowable discharge from program	255 (57%)
Retained at program completion	155 (35%)
Total	447

The resident retention rate within the individual JPRP tracks and the overall JPRP retention rate were calculated. Of the 447 residents who were enrolled in the JPRP during the study period, 68% of residents were still enrolled in Discovery Track (approximately 30 days), 38% were enrolled in Transitional Track (approximately 270 days) and 35% graduated from the JPRP (Table 3). The Motivational Track is considered to be the ‘initiation phase’ of the JPRP. At the end of the Motivational Track, the Discovery Track is considered to be the “engagement phase’; 302 residents (100%) were engaged in JPRP using day 1 of the Discovery Track as the denominator. Six months and after in a recovery housing program is considered to be the “retention phase”. If the six-month “retention phase” endpoint is used (typical of recovery housing retention rate calculations) the six-month JPRP retention rate was 63%. Since JPRP is a 12-month program, the 12-month retention rate was 1) 51% based on the number of residents who were engaged in the JPRP (Discovery Track) or 2) 35% based on the number who initiated the JPRP (Motivational Track).

Table 3.

St. Matthew’s House® Justin’s Place® recovery program retention rates at each recovery track

Time (Days)	n	% of Baseline Intake (Motivational Track)	% of Previous Track	% of Baseline Discovery Track
Number enrolled in Motivational Track (0 days)	447	100%	100%	n/a
Number Enrolled in Discovery Track (~31 days)	302	68%	68%	100%
Number Enrolled at 6 Months (~180 days)	190	43%	63%	63%
Number Enrolled in Transitional Track (~270 days)	170	38%	89%	56%
Number Graduated from Recovery Program (~365 days)	155	35%	91%	51%

Resident and program factors associated with JPRP completion

Factors associated with the building of recovery capital were assessed for all residents in the JPRP and residents that successfully completed the JPRP (Table 4). At intake, 67% of residents indicated being unhoused and 16% of residents indicated being chronically unhoused. No resident was employed at the time of JPRP intake. At intake, 61% of residents had a state issued ID and 88% had a social security card.

Table 4.

St. Matthew’s House® Justin’s Place® recovery program resident recovery capital assessment at intake and completion

Recovery Capital Variable	Intake n (%)	Program Completion n (%)
Number of Individuals	447 (100%)	155 (35%)
Employment Readiness Resources
Has ID	272 (61%)	148 (95%)
Has a Social Security card	392 (88%)	148 (95%)
Housing History
Homeless at intake	299 (67%)	95 (61%)
Homelessness is chronic	72 (16%)	15 (10%)
Housed at graduation	N/A	155 (100%)
Employment
Employed	0 (0%)	138 (89%)
Religious Spirituality
Yes	N/A	147 (95%)
No	N/A	8 (5%)
Positive Family Relationship Restoration		n = 105
Yes	N/A	104 (99%)
No	N/A	1 (1%)
Active Alumni Status (n = 132 Program Grads)
Yes	N/A	92 (59%)
No	N/A	63 (41%)
Recovery Management Plan Goals
Yes	230 (51%)	146 (94%)
No	217 (49%)	9 (6%)

N/A = data not available

Of the residents that successfully completed the JPRP and graduated, 95% had obtained an ID card and a Social Security card at JPRP completion. All the residents that completed the JPRP were housed at JPRP completion, and 89% were employed at JPRP completion. Residents also indicated spiritual growth while in the JPRP (95%) at JPRP completion. Of JPRP graduates, 64% were active alumni after graduation.

Changes in the proportion of JPRP residents that were employment ready, housed, employed, and had positive family restoration were examined at intake and at JPRP completion (Table 5). The proportion of residents who were employment ready (had necessary identification resources for employment) increased from 50% at JPRP intake to 95% at JPRP completion (t = 11.26; 95% CI [0.372, 0.531]). The proportion of residents who were housed increased from 39% at JPRP intake to 100% at JPRP completion (t = 15.62 [0.535, 0.690]), and the proportion of residents who were employed increased from 0% at JPRP intake to 89% at JPRP completion (t = 35.36 [0.841, 0.940]). The proportion of residents with positive family relationships also increased from JPRP intake to JPRP completion, with 13% of residents having a positive family relationship at intake and 99% having a positive family relationship at JPRP completion (t = 24.98 [0.789, 0.925]).

Table 5.

St. Matthew’s House® Justin’s Place® recovery program changes in assessment of recovery capital

Factor	Intake (%)	Program Completion1 (%)	Test Statistics (95% CI)	p-value
Employment Ready (has ID)	50%	95%	11.26 (0.372, 0.531)	p < 0.01
Housed	39%	100%	15.62 (0.535, 0.690)	p < 0.01
Employed	0%	89%	35.36 (0.841, 0.940)	p < 0.01
Positive Family Relationship Restoration2	13%	98%	24.05 (0.777, 0.918)	p < 0.01

¹n = 155

²Complete data were available for n = 105

The factors associated with successful JPRP completion were determined using a logistic regression model. Being court-ordered to attend at JPRP intake, participating in regular case management meetings, and gaining employment while in the JPRP were associated with higher odds of successful JPRP completion (Table 6).

Table 6.

Determinants of successful st. Matthew’s House® Justin’s Place® recovery program completion estimated using logistic regression

Successful completion	Odds Ratio	95% C.I.
Age 45 or Older	0.991	0.427	2.301
Female	1.941	0.652	5.774
White	1.569	0.63	3.909
Court-ordered (On Probation)*	3.355	1.479	7.61
Mental Health Condition	0.579	0.243	1.38
Drug of Choice – Opioids	1.186	0.399	3.528
Drug of Choice – Meth	1.182	0.426	3.281
Drug of Choice – Alcohol	1.352	0.469	3.901
Participated in regular case management meetings**	9.472	3.822	23.476
Employed**	58.856	26.087	132.791

*p < 0.01, **p < 0.001

Self-reported alumni outcomes in a convenience sample of JPRP alumni

JPRP alumni outcomes were examined (Table 7). Of the residents who successfully completed the JPRP (n = 155), 59% were actively engaged alumni. The majority of the residents that completed the JPRP (76%) had not returned to use. Of the alumni who had a recurrence of substance use, 10% were subsequently substance-use free, 6% were reintegrated back into the JPRP, and 6% were offered reintegration but did not re-engage with services. Of the 92 active alumni, one alumnus died and two were incarcerated.

Table 7.

St. Matthew’s House® Justin’s Place® recovery program alumni outcomes

Outcome	n (%)
Actively engaged	92 (59%)
Nonreturn to use	118 (76%)
If recurrence, now substance free?	15 (10%)
Reintegration attempt	9 (6%)
Reintegration success?	9 (6%)
Death	1 (1%)
Incarceration	2 (1%)

Discussion

JPRP retention

JPRP residents had an average length of stay of 176 days (approximately six months), and the JPRP retention rate was 63% at 6 months (typical of recovery house retention rate calculations); 51% stayed through the 12-month completion of the JPRP (based on the number of residents who were engaged in the JPRP). Nearly all of the graduates were employed at the completion of the JPRP. In a study by Best et al. [5] of 50 recovery houses in Virginia, the lack of employment services and not meeting mental health needs were associated with being a barrier to recovery and not being retained in recovery housing.

A major recovery support offering of the JPRP is employment readiness and direct linkage to employment at the completion of the JPRP. The focus on preparing and linking persons with substance use disorder in recovery to employment opportunities is integral to building recovery capital and achieving and maintaining long-term recovery from substance use. JPRP also offers wrap-around community services for mental health treatment that are necessary for building recovery capital.

Factors associated with JPRP completion

The JPRP is effective in building recovery capital among residents and achieving long-term recovery of persons with SUDs. Obtaining employment, having access to regular case management meetings, and being court-ordered (on probation) were all associated with successful completion of the JPRP.

Employment is considered a physical component of recovery capital and engaging in it may support independence, build self-esteem through skill development, and foster positive relationships. In this study of a substance use recovery housing program, employment was found to be a significant factor associated with JPRP completion. In other studies of recovery housing programs, employment has primarily been measured as an outcome associated with completion of the program rather than considering it a factor potentially contributing to program completion. In a database review of the evidence for recovery housing by Reif et al. [6], the authors found the evidence for recovery housing as moderate with studies assessing employment as an outcome associated with program completion rather than a factor impacting program completion [6]. Despite the limited evidence documented for employment as a factor associated with program completion in recovery housing programs, evidence gathered from studies of SUD treatment programs has pointed to positive associations between employment engagement and abstinence. In a retrospective analysis of state records of individuals admitted to SUD treatment programs in Iowa, Sahker et al. [7] found employment growth during treatment was associated with increased likelihood of abstinence [7]. Additionally, a study by Petry et al. [8], with patients in an outpatient SUD clinic randomized to reinforcement interventions, those that completed job-related activities remained in treatment significantly longer and experienced abstinence for longer durations than those that did not complete job-related activities [8]. The evidence gained on employment acquisition for JPRP completion in this study further supports it being considered a critical program component for residents to achieve.

Regular case management meetings were imperative for the achievement of long-term SUD recovery. In a meta- analysis by Vanderplasschen et al. [9], the authors found that case management was associated with substance use disorder treatment retention and linkage with SUD recovery support services. Case managers’ caseloads are recommended not to exceed 15–30 residents maximum [10] and to include a team approach if the caseload is thought to be high at that level. Large programs like the JPRP may benefit by increased client engagement if the case manager caseload is lower since Broome et al. [11] found that smaller case manager workloads were more engaging for clients in SUD treatment.

Almost all of the residents with available family relationship restoration data formed lasting positive family relationships by the end of the JPRP. Help with restoring relationships was a major theme that emerged from interviews of women aged 25 to 65 in substance use recovery in a study by Gorvine et al. [12]. Das et al. [13] found that disturbed family relationships were associated with SUD recovery relapse. Last, Pettersen et al. [14] conducted semi-structured interviews with persons in recovery for at least five years and found that having a restorative relationship with a provider or a family member such as a sibling helped them to maintain their recovery.

Probation status was associated with JPRP completion. This finding is significant as St. Matthew’s House® JPRP fills a critical need of the corrections system to address and provide recovery housing to those with SUDs who are court-ordered (on probation) to attend. Dewey et al. [15] identified the lack of linkage between the criminal justice system and recovery houses as a barrier to recovery house access. Additionally, when individuals are court-ordered, there may be a sense of external accountability, increasing the likelihood to comply with program components and complete the program. In a study by Coviello et al. [16] assessing completion rates of community treatment among individuals court-ordered versus those attending voluntarily, authors found that those who were court-ordered were ten times more likely to complete treatment compared to those that attended treatment voluntarily [16].

As many recovery housing programs such as JPRP are privately owned and operated, they develop and implement their own policies pertaining to medication allowance. Many homes may not allow medications due to limited staffing for medication management or program philosophies, for example. At present, the JPRP does not allow buprenorphine. Individuals whose primary drug of choice was opioids had higher odds for an unallowable discharge. While not statistically significant, the JPRP might consider the inclusion of additional staff members or partners to implement interventions to address opioid cravings such as buprenorphine, an MOUD and/or biofeedback within their recovery program to provide supplemental recovery support for residents with opioid use disorders to minimize unallowable discharge incidents.

The results from this evaluation of the JPRP further contribute to the identification of factors associated with recovery housing program completion. At present, the evidence for recovery housing programs is considered moderate. There is a need for continued evaluation and consideration of the specific factors that are assessed in association with contributing to program completion as well as associated as a consequence of program completion.

JPRP alumni

Over one-half of the JPRP residents became active engaged alumni once the 12-month JPRP ended and they graduated. As active alumni, over three-quarters of the residents maintained their long-term recovery and remained free of substance use. These results indicate that the longer an individual is connected to a recovery program, the longer they may maintain their recovery from substance use. It has been estimated that five years in recovery is needed to maintain SUD recovery, and that the average number of recovery attempts is five [17]. There are a number of limitations of this research study. First, the study team did not have full access to all of the data fields within missionTracker®, therefore, potential additional factors to enhance and expand the research study could not be examined. Second, not all of the data fields were complete; alumni and family restoration data, as well as drug testing data, were not available for all residents. Third, there were limitations in the resident data collection process that could be due to inconsistent input of data by case managers, lack of training, or the cost of refining current data fields and adding new data fields. Finally, no data was collected on those who were not retained in the program. As such, the impacts of the program could be biased due to the absence of a comparison group.

Conclusions

Being court-ordered to attend at JPRP intake, participating in regular case management meetings, and gaining employment while in the JPRP were associated with successful JPRP completion. The JPRP has been effective in supporting its residents to achieve and maintain long-term recovery from SUD. JPRP offerings of family restoration support, intensive case management, links to employment opportunities, and active alumni engagement have facilitated long-term recovery and reduced return to use among its clients.

Abbreviations

ID

Identification

MOUD

Medications for Opioid Use Disorder

JPRP

Justin’s Place® Recovery Program

NARR

National Alliance for Recovery Residences

SAMHSA

Substance Abuse and Mental Health Services Administration

SUD

Substance use disorder

Author contributions

TLB, RT, and MA wrote the main manuscript. EF contributed to the design of the study and review of the manuscript.

Funding

Project funding was paid by St. Matthew’s House®.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethics approval and consent to participate

Ethics approval for this study was provided by the University of Kentucky Institutional Review Board with IRB determination of human subjects research (UK IRB Number 96709).

Consent for publication

Not applicable since this study utilized secondary data.

Competing interests

Funding for this study was provided by the St. Matthew’s House®, which could gain or lose financially from the publication of the manuscript now or in the future. They provided input into the evaluation through the provision of data and St. Matthew’s House® processes and procedures but did not influence the evaluation findings and generation of the manuscript. Analysis and interpretation of findings are of the authors alone.