It Takes a Community to Recover

Neighbourhoods matter for health and wellbeing. They are a fundamental setting for personal growth and development, social support and community integration, and public and private service delivery. There is a wealth of social scientific evidence that supports the claim that individual health and social wellbeing is promoted by diverse, inclusive and affordable neighborhoods with an abundance of services and amenities that people need. Many neighborhoods have harnessed these ideas and created neighborhood-level initiatives to support positive change in their communities. The description below outlines one such initiative.

At Home in Highlands: Enriching by Welcoming

At Home in Highlands (AHiH) is a group of like-minded residents living in the Highlands neighborhood in Edmonton, Alberta. Group members came together more than 8 years ago over conversations about welcome, hospitality, housing options, diversity, and inclusion. Over the years, these conversations have sparked a number of neighbourhood-level interventions ranging from community potluck dinners, coordinating volunteerism, and relationship-building with businesses, faith communities and nonprofit organizations operating in Highlands. These conversations have also resulted in partnerships with supporting agencies, advocacy with residential home builders, and research funded by the City of Edmonton. Today AHiH is a formal program of the Highlands Community League.

As the AHiH initiative formalized into an official program of the local community league, broad impact areas began to crystalize. These included the promotion of neighborhood diversity, the strengthening of neighborhood supports and services, reconciliation with Indigenous peoples of Canada, and the promotion of neighborhood social connection (see Figure 1). A core belief of AHiH is that social connection and belonging is vital to individual health and community wellbeing. Importantly, AHiH recognizes that neighbors have diverse, sometimes complex, circumstances and lived experiences and it is therefore necessary to be inclusive and responsive to their needs.

Figure 1. AHiH Impact Areas

AHiH has organized some of its work through collaboration and partnership with social agencies that have been operating in the neighborhood for decades. One example is its partnership with Recovery Acres, an agency operating in the Highlands neighborhood that provides residential treatment in a safe and sober living environment for men and women with a history of addiction who are motivated to change. AHiH group members have been directly involved in supporting recovery in Highlands through meaningful relationships with Recovery Acres clients and staff. In doing so, AHiH has endeavored to make Highlands a welcoming place that enables sustained personal recovery. In this regard, a fundamental belief expressed by AHiH members is that we all, whether you are a person in recovery or a neighbour offering support, benefit from hearing the stories of others, especially among diverse peoples. Labels (e.g. “recovery”) fade, stigmas dissolve, and the inherent value of each person becomes evident and appreciated. Those that society often devalues become valued neighbours and contributors to the flourishing of the entire community.

Social connection and belonging at the neighborhood level are vital resources in processes of mental health recovery. The importance of connection and belonging has encouraged the placement of treatment and recovery programs in community settings, a strategy that is supported by evidence. This is outlined below.

Mental Health Recovery, the Social Model of Recovery, and the Importance of Place

Today, mental health treatment is largely organized around the promotion of personal recovery, a deeply personal process of finding meaning and rebuilding a fulfilling life despite the restrictions of an illness. A seminal scholarly review of mental health literature by Leamy et al. (2011) linked mental health recovery with a number of key characteristics. In this regard, recovery can be conceived as a personal journey: an individualized, multidimensional, active, non-linear, gradual, trial and error process that can occur with or without professional intervention in stages or phases but never without struggle. Hence, a healing and supportive environment is integral to recovery.

This environmental dimension of recovery has long been a focus of mental health professionals, many of whom now conceive recovery as an ecological process. In this regard, recovery is a product of the dynamic interaction between the individual and their environment wherein individuals draw on internal and external resources to change how they understand themselves (first order change) and others see them (second order change). As Onken et al. (2007, 19) write:

Recovery relies not only on the individual’s emerging sense of integrity and purpose (first

order change) but also on society’s increasing ability to acknowledge and support that integrity and purpose (second order change).

Building on this idea of recovery as an ecological process, Leamy et al. (2011) specify five broad recovery processes (described by the acronym CHIME): connectedness, hope and optimism about the future, identity, meaning in life, and empowerment. In each of these domains, recovery is an intrinsically relational process; while it is experienced as a subjective, inward-looking process, personal recovery is highly contingent upon interpersonal, place-based relationships (Price-Robertson et al. 2017).

The ecological nature of recovery, and the distinct role of the surrounding physical, social and cultural environment, is particularly salient with regard to the more specific experience of addiction recovery where the social model of recovery has long been a central paradigm. This model emerged out of the traditions of Alcoholics Anonymous and mutual aid/peer support (Mericle et al. 2023). According to Polcin et al. (2023, 174), the social model of recovery views addiction and recovery as “occurring via a reciprocal interaction between the individual and his or her social environment” and “acknowledges the personal responsibility for recovery as well as the importance of mutual aid (i.e., interdependence with others).” Relatedly, Zemore et al. (2023) point to four “core” elements of the addiction recovery process: a process of growth or development; being honest with oneself; taking responsibility for the things one can change; and reacting in a more balanced way. Each of these processes are context dependent. In their examination of recovery narratives, Bellaert et al. (2023) identified three contextual elements: interpersonal relationships, enabling and disabling places, and socioeconomic factors.

Under the social model of recovery, mutual aid and peer support groups have, for many decades, developed recovery housing as a residential treatment option for people with substance use problems (Mericle et al. 2023). Sometimes called recovery homes, recovery residences, or sober living homes, these environments provide a safe and healthy living environment where individuals can provide support for one another as each works on their recovery journey in a non-clinical, neighborhood setting. Ultimately, the effectiveness of recovery housing in aiding personal recovery is contingent upon its place in the wider substance use continuum of care and the extent to which clients can reconnect with family, employment and wider community networks.

Exploring the Impact of AHiH: Early Insights

In November 2023, the AHiH research project team met with three former Recovery Acres clients who participated in AHiH activities and formed relationships with AHiH members. The purpose of this meeting was to develop an understanding of how clients interact with AHiH and whether AHiH has contributed to individual recovery journeys.

All three individuals had completed residential treatment for substance use problems, had lived in sober living homes, and were now living independently in the community. The conversation covered a range of different topics including how each person came to be involved with AHiH, what kinds of activities they participated in, their relationship to community, and whether there were important moments in their journeys.

All three individuals spoke to specific recovery processes that were formative in their experience. Three in particular stand out. First, all three individuals expressed a strong sense of purpose and renewed sense of personal integrity. Individuals spoke passionately about experiencing a moment of clarity, before entering treatment, when they recognized that they were heading towards premature death and instead “chose life.” This was an important “turning point” in their lives, one that is itself indicative of the emergence of a sense of purpose, seeing life as meaningful, and being honest with oneself, all of which are important processes of recovery identified in the literature above.

Second, all three individuals spoke adamantly about feeling supported by AHiH members. More specifically, individuals stated that AHiH activities, such as monthly potluck dinners at the community hall, made each person feel welcomed and part of the community. As individuals discussed their participation in activities it was clear that interpersonal relationships with AHiH members were of great value and importance. These relationships were meaningful because AHiH members were dependable, trustworthy, non-judgmental, and open to being vulnerable themselves.

Third, individuals expressed that they felt empowered by their involvement in AHiH and through their relationships with AHiH members. This was evident in the recognition of their strengths (“my cup is not empty”), feeling more in control over their lives, feeling part of the community and a desire and willingness to give back to the group and the community.

While it is affirming to acknowledge these positive impacts and experiences it is important not to lose sight of challenging socio-economic factors and disabling environments that remained and were still prominent in each individual’s lives. For all three, this was the first time having a stable home, and yet housing was still stressful and was a formidable challenge. One of the principal challenges was the cost of housing relative to incomes. In addition, the adequacy of housing was particularly poor. Individuals spoke of longstanding issues with pests and difficulty finding remedies with landlords. The location of housing presented challenges as well. The Highlands neighborhood and surrounding area provided relatively poor access to healthy foods. Finally, the landlord screening process for rental housing was stressful. Many of the routine, standard questions posed by landlords were demeaning and triggering. Completing the application processes was reported to be a negative experience.

Key Takeaways and Recommendations

This analysis is an early examination of the impacts of the AHiH initiative. Much more engagement and reflection is needed in order to develop a fuller understanding of the impact that this group is having on individual recovery journeys. A few preliminary takeaways are of value:

People living in community-based recovery housing are committed to purposeful change and are putting an immense amount of work into regaining control, rebuilding a sense of identity, and supporting their peers on similar journeys.
Trust appeared to be of the utmost importance in relationship-building. Individuals valued authentic relationships that were genuine and non-judgmental.
Landlords and other service providers need to take a trauma-informed approach in the delivery of services. Individuals have often experienced significant trauma and it is therefore necessary to be sensitive, inclusive and responsive to their needs.
Do not underestimate the value and importance of seemingly small things, words of encouragement, sharing a meal.

References

Bellaert, L., Ruysscher, CD., Martinelli, TF., Vander Laenen, F., Sinclair, D. and Vanderplasschen, W. (2023) “The Ambiguous Nature of Contextual Dynamics During Drug Addiction Recovery: A Qualitative Study of Personal Narratives.” Journal of Drug Issues Vol. 0(0): 1–20

Leamy, M., Bird, V., Le Boutillier, C., Williams, J., & Slade, M. (2011). “Conceptual framework for

personal recovery in mental health: Systematic review and narrative synthesis.” The British

Journal of Psychiatry, 199(6), 445–452. doi:10.1192/bjp.bp.110.083733

Mericle, A., Howell, J., Borkman, T., Subbaraman, M., Sanders, B., & Polcin, D. (2023) “Social model recovery and recovery housing.” Addiction Research & Theory, 31:5, 370-377, DOI: 10.1080/16066359.2023.2179996

Onken SJ, Craig CM, Ridgway P, Ralph RO, Cook JA. (2007) “An analysis of the definitions and elements of recovery: a review of the literature.” Psychiatric Rehabilitation Journal 31: 9–22.

Polcin, D., Mericle, A., Braucht, G. & Wittman, F. (2023) “Moving Social Model Recovery Forward: Recent Research on Sober Living Houses.” Alcoholism Treatment Quarterly, 41:2, 173-186, DOI: 10.1080/07347324.2023.2167528

Zemore, S., Ziemer, K., Gilbert, P., Karno, M., and Kaskutas, L. (2023) “Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From the What is Recovery? Study” Substance Abuse: Research and Treatment Volume 17: 1–12

Price-Robertson, R., Obradovic, A. & Morgan, B. (2017) “Relational recovery: beyond individualism in the recovery approach.” Advances in Mental Health, 15:2, 108-120, DOI: 10.1080/18387357.2016.1243014
Zemore, S., Ziemer, K., Gilbert, P., Karno, M., and Kaskutas, L. (2023) “Understanding the Shared Meaning of Recovery From Substance Use Disorders: New Findings From the What is Recovery? Study” Substance Abuse: Research and Treatment Volume 17: 1–12

This blog is authored by

Joshua Evans, PhD (he/him)
Associate Professor of Human Geography
Department of Earth and Atmospheric Sciences
University of Alberta