Macro Change Project MLT

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Dec 6, 2023

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1 An Assessment of Housing Insecurity Among Women Diagnosed with Severe Substance Use Disorders Who Complete Residential Treatment in Martin County, KY Melinda L. Thompson College of Social Work, University of Kentucky SW636 – 201 Social Work Practice Within Organizations and Communities I Kelly Zent September 22, 2023

2 An Assessment of Housing Insecurity Among Women Diagnosed with Severe Substance Use Disorders Upon Completion of Residential Treatment in Martin County, KY At any given time, within the small community of Inez, KY, up to 148 women diagnosed with severe substance use disorders are in residential treatment. These women have experienced catastrophic functional deficits that prevent them from functioning in various areas of their lives, including psychological, emotional, vocational, educational, and relational (Mee-Lee et al, 2013). The American Society of Addiction Medicine describes the residential treatment facility as being “habilitative rather than rehabilitative” due to the symptoms of the clients who enter treatment at this level of care (Mee-Lee et al, 2013). In the residential level of care, clients are either determined to be in the 3.5 LOC, which is Clinically Managed High Intensity Residential Treatment, or the 3.1 LOC, which is Clinically Managed Low Intensity Residential Treatment (Mee-Lee et al, 2013). In these levels of care, clients need help not only with substance use disorders, but also with either learning to function in society for the first time, or relearning a previous level of functioning (Mee-Lee et al, 2013). One of the most important aspects of the lives that these women will address is establishing stable housing. Often, these clients have come from chaotic homes, or no home at all. During their time in the residential facility, clients’ treatment teams will constantly assess how much recovery capital exists in their lives. These assessments usually reveal that the clients’ living environments are far too toxic for clients to be able to return to and maintain any progress they have made while in treatment. Residential treatment exists to give clients an opportunity to be removed from their current environments and be in a safe environment, free from the threat of substance presence,

3 and surrounded by intensive clinical services that address physical and behavioral health needs. Included in their services, clients are often assigned a targeted case manager who is vital in linking clients with resources to help them establish their sober life upon completion of residential treatment. In an ideal world, clients could be referred to sober living, where they share a living space with other people in early sobriety as they learn to navigate the world together as peers. Alternatively, TCMs could help clients find and establish government subsidized housing or affordable housing with understanding landlords. The Commonwealth of Kentucky launched a website that is designed to help anyone with a substance use disorder find supported housing through sober living facilities. You can input your geographic area and the website will generate a list of sober living houses that you can reach out to for help. If one goes to www.findrecoveryhousingnowky.org , then enters the zip code for Inez, KY, with a search radius of 25 miles, one will find that there are zero results found. Alternatively, if you go to www.findhelpnowky.org , and search for residential treatment facilities within 40 miles of Inez, KY, for women only, you will find that there are at least 10 facilities readily accepting patients. The overarching theme here is that while Eastern Kentucky is offering plenty of women with severe substance use disorders the opportunity to enter treatment, the prognosis for these women is not good, based on a variety of reasons, but mainly because of the lack of stable housing available to them upon completion of treatment. Not only is there a severe lack of transitional housing opportunities, but the local Housing & Urban Development (HUD) organizations use housing applications that immediately disqualify most of these women from finding affordable, government subsidized housing. The applications contain invasive questions about previous drug-related criminal charges by anyone

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4 in the proposed household as well as prior felony convictions. These applications leave no space for anyone with a substance use related criminal history to find stable affordable housing upon completion of treatment. This is extremely unfair to the women who are trying to improve their lives. Women leaving residential treatment in Eastern Kentucky are often left with one option, and that is to return to the environments where their substance use disorders thrived. Another potential option is to move to another area of the state where there are more opportunities. Often, though, this would take women further away from their upcoming court dates, check-ins with probation and parole, as well as visitation with their children. In 2021, the Kentucky State Police published drug-related arrest numbers by county (Crime in Kentucky, 2021). In Martin County and its four bordering counties, nearly 3,000 people were arrested and charged with drug-related crimes (Crime in Kentucky, 2021). That makes nearly 3,000 individuals and their households ineligible for subsidized housing in this area. These geographic and legal barriers make it difficult to give women the hope they need to pursue their recovery when they know that they are not going to be able to find stable housing upon completion of their treatment program. Their motivation for sobriety is negatively impacted, and often results in repeated returns to jail, hospitals, or treatment. Two solutions need to begin happening in Eastern Kentucky to support the women who are putting in the difficult work to become sober. First, more sober living houses need to be established. Second, the applications for government subsidized housing need to eliminate the questions that address drug-related charges.

5 Engagement To engage with the women in this population, it is vital that I meet them where they are, not only geographically, but also culturally and with humility (Netting et al, 2017). I live in Martin County, KY, and I worked for six months as a substance use counselor at Serenity House. While there, it became very apparent to me that viable, local housing options upon completion of residential treatment were nearly non-existent. The women who completed the Serenity House treatment program were often left with uncomfortable options for housing. Some returned to their homes shared with abusive partners or partners who actively used substances, while some moved in temporarily with family members or friends until they could find better options. I am in recovery from alcohol use myself, which builds a bridge of trust between women in substance use and myself. This places me in a unique situation where clients are more likely to open up to me because I have lived experience with a substance use disorder. These clients have usually experienced trauma or broken relationships that leave them reticent to trust others. Earning their trust is something I hold sacred because their trust does not come easily. An avenue of engagement that I will utilize is to listen to these clients and their personal perspectives on the housing insecurity in this area of Eastern Kentucky. I was fortunate to never have to look for transitional or subsidized housing, so my understanding of this issue is limited to what I can read about in printed resources and hear about from clients actually experiencing housing insecurity. While I can empathize with them to a degree, I need to hear their perspectives to gain a better understanding of how crucial it is to effect change in the housing insecurity issues of this area.

6 Specifically, I will utilize a survey questionnaire that gauges clients’ responses to the current iteration of subsidized housing applications as well as clients’ likelihood to use a local transitional living option, if it were available to them.

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7 References 2021 Crime in Kentucky. (n.d.). In Kentucky State Police . Retrieved February 19, 2023, from http://kentuckystatepolice.org/wp-content/uploads/2022/09/2021CrimeinKY.pdf Find Help Now . (n.d.). Findhelpnowky.org. Retrieved February 19, 2023, from http://www.findhelpnowky.org Find Recovery Housing Now . (n.d.). Www.findrecoveryhousingnowky.org. Retrieved February 19, 2023, from https://www.findrecoveryhousingnowky.org Mee-Lee, D., Shulman, G. D., Fishman, M., Gastfriend, D. R., Miller, M. M., Provence, S. M., & American Society Of Addiction Medicine. (2013). The ASAM criteria : treatment for addictive, substance-related, and co-occurring conditions (3rd ed., pp. 254–259). American Society Of Addiction Medicine. Netting, F. E., Kettner, P. M., McMurtry, S. L., & Thomas, M. L. (2017). Social Work Macro practice . Pearson.

Macro Change Project MLT

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