Understanding the Community Context of Housing Services for Individuals in Recovery from Substance Use Disorder By Facility Spiritual-Orientation

Background: Spiritually oriented organizations have addressed the needs of marginalized people in communities throughout the history of the United States.  While studies have demonstrated that there are varying degrees of spiritual and religious characteristics in programs and services, what remains unclear is if we see these services cluster by community demographics. We examined the location and level of spiritual orientation in community-based recovery housing services in the Kansas City Metropolitan area. Our aim was to explore the level of service concentration by community demographics (race and income) and by spiritual orientation to understand housing disparities in low-income communities of color.

Methods: To create a comprehensive Census of agencies providing services along the addiction continuum of care, we collected information from September 2017 to March 2018 on existing services and triangulated information from four sources: (1) online survey, (2) stakeholder interviews, (3) agency web page followed-up by a brief telephone interview, and (4) publically available data. We identified and geocoded 109 recovery housing facilities to point locations within the 10-county Midwestern metropolitan region (covering 209 5-digit ZIP Code Tabulation Areas). Community variables were obtained from the American Community Survey 2016 5-year estimates at the ZCTA. To understand the level of spiritual orientation of each facility, the typology conceptualized by Sider and Unruh (2004) was used to rate the level of faith-orientation indicated or observed within each facility; the scale rated facilities from 1 (secular) to 6 (faith-permeated).

Results: Approximately 79% of ZTCAs had 0 housing options available across a 10-county region. Of the remaining 21% of ZCTAs, the number of housing facilities ranged from 1 to 7 facilities.  The facilities were predominantly secular (66.1%); however, a third of the sector aligned as faith-affiliated to faith permeated services (33.9%). Additionally, free services were predominantly observed among spiritually-oriented services (62.9%) compared to secular services (37.1%; χ2(1) = 19.200, p < .001). The number of facilities in communities with predominately people of color was significantly higher compared to communities with predominantly white residents (F (2,206) = 15.928, p < .001).  The number of spiritually oriented facilities was not found to be associated with the percent of residents by race or income.

Conclusions: These findings highlight housing appears to be geographically clustered within communities of color, typically within urbanized areas. While we did not observe geographic clustering within communities by spiritual orientation, faith-affiliated to faith-permeated recovery housing were found to make up a third of the housing options within the overall service sector.  This is important as the services provided by faith-based facilities were (1) found to typically be free of charge and (2) more likely to be faith-permeated, meaning that religious practices are embedded within the context of the service provision and required. In other words, free services come with a cost. Future studies would benefit from exploring potential differences in service structure and orientation across communities to better understand the reality of service access disparities.