Barriers and facilitators to recovery support interventions in US Rural Recovery Houses: Implementing the SMART life skills program

As substance use disorder continues to impact millions of Americans, various recovery support treatment and service modalities are being developed, evaluated, and refined for effectiveness. Recovery housing provides substance-free living environments for individuals in recovery and can offer a variety of services and structured programs for residents. One such program that has the potential to enhance resident outcomes is the Self-Management and Recovery Training (SMART) Successful Life Skills program (SLS), a 12-session curriculum that uses a mix of behavioral tools and aspects of the social model of recovery employed by standard mutual aid groups. In this paper, we discuss the implementation barriers and facilitators of a 3-year initiative that aimed to implement SLS in 100 rural recovery houses across the U.S. During this initiative, the study team faced significant barriers in recruitment and program implementation. Recruitment barriers included the unknown landscape of recovery housing, stigma and mistrust in research, inconsistent staffing models, and differing treatment philosophies. Further, access to technology, technical literacy, time constraints for both residents and recovery house staff, and staff turnover created a difficult environment to successfully implement and evaluate the impact of the SLS program. Numerous solutions were employed to overcome implementation and recruitment barriers in recovery housing such as multiple contact methods, collaboration, stakeholder engagement, financial/material support, evaluation flexibility and adaptability, and transparency.