Commentary: The difference between sober homes and treatment facilities

The media, the “rehab” industry and even some attorneys and politicians conflate residential treatment facilities and sober-living homes, though there is a clear distinction between them.

The recent Daily Pilot coverage of the controversies in Costa Mesa propagates the confusion. Domiciles used for any type of addiction treatment are residential treatment facilities, as defined by the state, much like nursing homes and assisted living facilities.

Operators who advertise “rehab” treatment to clients (really patients), and provide housing to them contingent on such treatment, must obtain a state license and conform to state law regarding operation of single or integrated residential treatment facilities (as has been well clarified by recent state litigation against a local operator).

Sober-living homes are a distinctly different category from residential treatment facilities. As often referred to in state and other agency publications, sober-living homes need no license, because they are meant for individuals who are recovering after acute treatment and wish to live a communal lifestyle for support of ongoing sobriety.

The intent is for those individuals to transition to a normal life in the community, residing much like any family or group of friends sharing the responsibilities of a typical household. The individuals may choose who to live with and whether to see a therapist or physician, as needed.

Sober-living households can be located in residential neighborhoods, provided they conform to local zoning rules, much like any other communal or alternative family. Reasonable accommodation to override the local neighborhood zoning can be considered for any household at the discretion of the municipality.

Municipalities have responsibility for the health and safety of all their residents and thus are responsible for proper zoning with consideration given to overcrowding, the potential for the spread of communicable disease, effects of secondhand smoke, fire and traffic dangers, etc.

Municipalities dictate residential treatment facility locations through zoning. State law overrides municipal zoning laws, distinguishing commercial-versus-residential neighborhoods in only one instance — that of a licensed residential treatment facility housing six or fewer clients (patients) being permitted in even single-family zoned neighborhoods.

The U.S. Supreme Court has protected single-family zoning since 1939, presumably in order to maintain the character and integrity of neighborhoods, where residents become familiar with each other and weave a community fabric of life. What has changed is the legal definition of “family,” blood relation no longer being a requirement, but the concept of a stable household as a key element in the fabric of a neighborhood remains important to society.

The incursion into neighborhoods of commercial entities such as boarding homes, vacation rentals and recently AirBnB is a challenge to the essence of a residential neighborhood and to enforcement of municipal zoning ordinances — not much different from that posed by some blatantly commercial operations of sober-living homes. These are not true households but rather examples of individuals residing under a short-term contract with little or no choice of roommates, accountability to each other or relationship to their neighbors.

Given the widespread prevalence of mental health disorders (1 in 5 Americans will have such a diagnosis this year), including addiction, the need for access to proper treatment facilities is critical and unquestioned. This need includes consideration of appropriate facilities, qualified personnel and oversight, a calming therapeutic environment, the right of privacy and tactics for the eventual transitioning of the person to a healthy community lifestyle.

As a society, we must understand the role that healthcare providers, legislators and neighbors play in the continued support of those afflicted with mental health disorders, and those in recovery, while balancing the needs of all. Proper definitions are important to such understanding.

Dr. M. BRANT-ZAWADZKI practices medicine in Newport Beach.