Therapy or threat? Inadvertent exposure to alcohol and illicit drug cues in the neighbourhoods of sober living homes

Alcohol retail outlets and other environmental cues can contribute to relapse among individuals recovering from substance abuse. Sober living homes are residences designed to strengthen abstinence from substances, in part by helping residents develop skills for coping with cues and other stressors. Between January 2009 and March 2010, we conducted 10 focus groups with 68 adults aged 18 and over who lived in or operated any of 35 sober living homes in Los Angeles County, California. A stratified purposive sampling strategy was used to recruit sober living home residents and operators. The study aim was to assess how residents responded to the neighbourhood alcohol and drug cues they encountered in their daily lives. The focus group transcripts were analysed using the constructs of approach coping' and avoidance coping'. Findings suggest that the sober living homes helped residents cope with cue exposure through social rules and processes such as chaperones and evening curfews, as well as the presence of peer support for managing the conflictive thoughts and emotions that result from cue exposure. The examples of avoidance coping' and approach coping' identified in the transcripts were more often behavioural than cognitive. For example, residents described efforts they made to increase their physical distance from (i.e. avoid) neighbours who used substances. Whereas some participants believed that living in areas with high levels of drug use and trafficking was a time bomb' for relapse, others suggested that cue exposure could actually strengthen their ability to remain abstinent (approach coping'). The approach/avoidance coping construct did not account for the experiences of all residents. Several participants expressed indifference towards cues while performing daily routines and pursuing important recovery goals. The threat of alcohol and drug cues may be mitigated by recovery-oriented homes that support coping on an individualised, as-needed basis.