Sober Living: Why Less Clinical Sometimes Means More Recovery

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I got sober in 2010, but my education in addiction recovery started long before that.

For the better part of my teens and twenties, I was in and out of treatment—twenty-two centers in different states. Different philosophies. Different budgets. Different levels of professionalism. Some looked like high-end retreats with catered meals, beach trips, yoga instructors, and meditation gardens. Others were bare-bones white cinderblock detox units where getting an extra blanket felt like special treatment.

Somewhere around my third or fourth detox completion, I tried to end my life. I didn’t know how to live without drugs, and I didn’t know how to face what I had become—even after taking all the “right” steps in treatment. I woke up confused in a hospital in Wilmington, DE, after reconstructive surgery on my artery and nerves, and a blood transfusion. The shame I’d been carrying before I woke up now had a multiplier on it. This wasn’t a failure of the clinicians or the system. It was me—without the tools to carry life outside of a facility.

In every one of those programs, the language was the same. Completion. Successful discharge. Graduated the program. It didn’t matter whether I’d been there a week or three months—if I met the clinical requirements or my insurance ran out, my chart got stamped “success.” Those words never followed me out the door. Once the staff, schedules, and safety nets disappeared, “success” became harder to measure and even harder to keep.

Shot of a young man comforting his peer on the steps

The Part That’s Rarely Tracked

In most treatment settings, the scoring stops the day the client leaves. There’s no industry-wide standard for what “successful” recovery looks like sixty days later, six months later, or five years later.

The hardest part isn’t the thirty days inside a facility—it’s day 31. The first morning I woke up with no counselor checking in, I let out a sigh of relief. Freedom. Followed almost instantly by a silent panic. No colorful schedule mapping out my day by the hour. What am I going to eat today? How am I going to eat today? What do you mean everyone is still mad at me? I just did thirty days in rehab—everything isn’t forgiven and forgotten?

Now I’m standing on a boring sidewalk outside a job interview instead of in that quiet meditation garden. It’s here, in this space, that I’ve seen people either lean into the unknown or fold under the pressures of freedom. It broke me, over and over again. Almost like treatment was the easier part.

That gap between treatment and real independence is where most people stumble. Not because they learned nothing in treatment, but because treatment can’t replicate what it’s like to live sober in the chaos of everyday life. Treatment spends so much time on groups and setting boundaries, but—from what I’ve seen—very little on the realities of day-to-day living. How to face consequences. How to keep going when nobody’s looking.

Inpatient care can prepare you in theory. It can’t test you in reality. I’ve spent nearly fifteen years working with people in that in-between space—the one where the structure of treatment is gone, but the stability of long-term recovery hasn’t been built yet. That space isn’t a footnote. It’s where everything is decided.

The Revolving Door

Relapse rates spike after discharge. The data on that can’t be argued. But the system still calls it “success” if you make it to the end of your program. Why? Because completion is easy to measure, easy to fund, and easy to sell on paper. It checks the insurance box, looks great in an annual report, and keeps the lights on.

I’ve sat in offices where people say—not in their brochure, not to the families, but to each other—that the revolving door keeps the business alive. A steady flow of repeat intakes means a steady flow of billing. It’s not said with malice. It’s said like it’s simply how the machine works.

And there’s an unspoken perk for treatment centers: if someone fails after discharge, they can shrug and say, “That’s odd—they did so well when they were here.” Or, “What did you not do while you were out there?” The blame shifts off the program and lands squarely on the client. But if someone thrives? The center can take credit for “getting them started.” Rarely is there much acknowledgment for the role of sober living or the individual’s own grit—the narrative almost always circles back to, “They began with us.”

What’s missing is the part nobody wants to budget for—the follow-up. Calling the guy three weeks after discharge, not just to ask if he’s sober, but if he’s working, if he’s repairing a broken friendship, if he’s managed to get through a custody hearing without using. Tracking who makes it through the first stretch of unemployment, the first apartment lease, the first major argument with a partner. That kind of truth takes time and money, and most business models don’t make space for it. So “success” stays defined as a graduation, and the door keeps swinging.

In my world, that door isn’t a line on a spreadsheet or an insurance number. They’re people I know because I am one of them. They’re the ones who came back six times in a single year because they left treatment with a certificate and nowhere to live. They’re the mothers who hugged their kids and husbands at the rehab graduation, only to be blackout drunk before the weekend was over. These aren’t statistics. They’re people whose “successful completions” didn’t survive the first punch of real life.

Why “Less Clinical” Can Mean More Real

In that post-treatment gap, the safety net of clinical oversight has an expiration date. Therapists, doctors, case managers—they can be life-saving. But their authority ends the second the professional relationship does. And when that ends, so does the structure it gave you.

Peer-led recovery housing flips that on its head. Accountability doesn’t come in the form of a staff badge. It comes from the people sleeping down the hall. It’s your roommate confronting you for being loud and waking him up when he has to work early. The standards don’t live in a compliance manual. They live in the people you share a kitchen with.

In 2010, when I was in sober living in Arizona, I felt like the odd man out. Older. From the East Coast. Stuck in a house full of guys in their early twenties. I thought I was going to take over that house. But these “kids” didn’t let me be the version of me I thought I had to be. They broke my walls down—not with heart-to-hearts about my past, but with blunt, matter-of-fact accountability.

It was Ian, my 19-year-old house manager — no street cred, no cool war stories—who didn’t even turn away from his Xbox game to look at me to say, “I don’t like you. But I don’t have to like you to want to help you.” And that “help” wasn’t the kind I wanted. It came in the form of, If you want to live here, these are the things you need to do. If you don’t want to live here forever, get a job, save money, and move out. The way he said it, it wasn’t just advice. It was as if that was the only acceptable way to leave—the proper way. No disappearing in the middle of the night. No getting kicked out for acting like an idiot. You either did it right or you didn’t do it at all. And that’s what I did. Not perfectly. Not with precision. But I did it the right way.

That’s the thing about peer-driven accountability—it sticks. You don’t leave it behind when you move out. You take it into your own apartment, your next job, your marriage. I’ve used Ian’s line over and over through the years: “I don’t have to like you to try and help you.”

Unlike the clinical world, where feedback comes in case notes and progress reports, peer support happens in real time. You leave your laundry in the dryer, someone dumps it on your bed. You skip your chore, you get an earful at dinner. Someone relapses, the whole house feels it—not as a line in a chart, but as a void felt inside you and through the place you live. And in that environment, everyone focuses on the “why.” Here’s why we do these things. Here’s why working matters. Here’s why your family is upset. The lessons aren’t abstract—they’re tied directly to your life, your actions, and your consequences.

That’s why it works. It’s constant. It doesn’t care about insurance cycles or program phases. It’s built into the air you breathe while you’re there—and if you let it, it stays with you long after you’ve left.

The Limits of “Evidence-Based”

The recovery field loves numbers. Funders love them even more. But numbers only tell part of the story.

If “success” means completing treatment, the story stops the day someone walks out the door. If it means hitting three months sober, you get a snapshot—but that snapshot doesn’t tell you if they can make it through the first move to a new city, the first holiday alone, or the first time they have to sit across from someone using and not join in.

The things that kept me—and a lot of others—sober long-term don’t fit neatly on a chart. Paying rent on time. Keeping a steady job. Sitting down with my daughter after years of not being there. Making amends and then proving, over months and years, that those amends are real. None of it is flashy. It won’t make a grant proposal shine. But it’s the quiet work that holds recovery together.

I was the dad sitting in a car outside his ex’s house, heart pounding, finally getting to take his daughter for the afternoon. I’ve seen the guy who came in with nothing but a garbage bag of clothes end up paying his bills and covering rent without a single late fee. I’ve watched a woman who swore she’d never speak to her sister again stand in the kitchen, phone on speaker, laughing with her.

You can’t chart those moments. You have to see them. And the shift isn’t just in the action—it’s in the look on someone’s face when they realize they’re doing it. That’s when purpose and meaning settle in. Not in a binder full of outcomes. Not in a statistic on a whiteboard. But in the mess and rhythm of real life, one day after the next.

Why I Know This to Be True

I didn’t learn this in a classroom or read it in a journal article. I learned it by working with thousands of people—every background, every income level, every family dynamic.

When I finally got sober in 2010, it was in a treatment center in Arizona. But it wasn’t the slogans on the wall, or my “cool” counselor who swore and let me check my phone during sessions, that made the difference. It was my roommates in Room #9—Paul and Eric. They didn’t give me a treatment plan; they gave me an example. Their hope for a better life became mine. When they called me out on how I acted or thought, I actually listened—and changed. I followed them to sober living, and we kept going with what we’d started in Room #9.

Eric’s still my best friend to this day—I even officiated his wedding. Paul and I stayed close for a while, then life sent us in different directions. Years later, he overdosed. Both of them shaped the way I chose to move forward, to face my fears and consequences, and to do it sober. Eric and Paul… not “Doctor” or “Life Coach.”

I’ve seen people with every advantage relapse because they couldn’t handle life without constant supervision. I’ve seen people with nothing but a bed in a sober house and a few committed peers rebuild their lives—one day, one responsibility, one decision at a time.

Completing a program is a milestone, not a destination. Peer-driven environments give people more than the how—wake up, work, pay bills, show up—they give the why, because those actions build self-respect, stability, and trust.

That’s the work I’ve devoted my life to. And it’s why I’ll always believe that less clinical can sometimes mean more recovery.

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Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.

9 COMMENTS

  1. Thank you for explaining how things are over in the United States: I am very surprised that they consider successful completion as ‘success’ over there. There is at least a monitoring system here in the UK and they review success rates after 6 months and a year as well I believe, and they reveal a secret about recovery centres not just in America and the United States but the whole field globally: recovery rates for a single admission into a drug and rehab centre (detox followed by rehabilitation) is about 4% in any one admission cohort over a year, and the truth of the matter that no-body seems to notice or admit, and the whole propaganda of the recovery industry and drug/alcohol medicine and services all hide: we haven’t got the first clue what we’re doing with drug and alcohol addiction just as we don’t have a clue what we’re doing about mental health, which is why despite a life time of pain, effort and suffering, only a third of addicts will manage to die without an active addiction, and a third will actually be killed by their addiction. The other third will be killed by something else but will still be an addict when they die, and I have never known a long term addict who wants to be an addict. My personal experience is that if they give themselves completely to alcohol and heroin so they are drinking 24/7 or shooting recklessly 24/7 they won’t have time to be a long term addict before they end up killing themselves. I think probably blatant facts like this could be found in the data but somehow they never have the impact in the field that they ought to and aren’t made into scandalous headlines, but drug and alcohol deaths in the US and UK have been on a trend and often if not usually or always are at all time highs (they were for 9 years straight in the UK 2010-2019 but I don’t know the stats since).

    In one rehab I stayed at there were 32 people. I knew personally all of them and while I was there, 2 of them relapsed and died, shortly after another 2 and since 2 more. So six out of those 32 I know have died, and I have asked around and everyone I asked about of those 32 and found answers for had relapsed since. It is possible that there is someone that managed to get clean that I don’t know about but it’s also highly probable that more have died since that I also don’t know about, because I haven’t caught up with any of them for over a year, maybe two. So the stats and my experience betray the real ‘recovery’ prospects of modern rehab facilities today that nobody sees or notices and nobody admits, because if we did, we would realize what a grave problem we have on our hands, but also how urgent the problem is to solve and this urgency would have been the actual solution that would by now have saved many millions of lives.

    And the reason recovery rates are so low is because we radically misconstrue the problem. The problem is not the addictive relationship with a substance, for as we all know, the rule of addiction is to substitute one addiction for another, so it isn’t substance specific and quitting a substance therefore doesn’t actually solve the problem. The problem is the trauma and the consequences of that trauma which include the impacts of that trauma on human relationships like lack of trust and fear of intimacy, and addiction is part of that coping with the trauma, relationship problems and isolation that all come together. It is that whole problematic that is the issue, and if we take away the drug the usual thing that happens is another addiction forms – that is the typical experience of recovering addicts and data would set all this out very clearly. But the whole recovery sector globally treats the addictive behaviour as the only definite target of treatment. Rehabs do therapeutic work and help to rebuild social relationships while there, but this artificial environment of relationships with fellow addicts and a therapeutic environment does not reflect the social environments we have to go back to where there is not the support, community and is the same nexus of relationships and triggers, and if the work on the trauma and relationship/trust issues has not been significantly healed during rehab it is foolish of us to expect success because the problem was never merely my drinking or my use of heroin or crack or whatever it is. It is the suffering that lead to this need for the relief and escape that the drug provides, and if we saw this we would begin to understand that the problems that lead to psychosis or depression are the same kind of problems that lead not just to addiction, but also to homelessness and to trouble with or persecution by the police. I’ve had addiction, homelessness, what they call mental health, and persecution by the police which is ubiquitous among people in my home town. If you are my age and have a drink in your hand or a sleeping bag you will attract the attention of the police who will hassle, provoke and persecute you, and so society provides on the whole a hostile, judgemental and punitive attitude to the most traumatised and misunderstood children of this society. The reason why all these problems are such tragedies is not because they are intrinsically hopeless problems – it’s that society at large is largely scornful and at best indifferent about the lives and fates of people like us. And so isolation, addiction, suicide and death becomes our lot. And it’s in the interest of no-one in recovery and treatment services to admit this enormous failure that has transpired blatantly before their eyes.

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  2. Thank you for sharing your story. As I was reading it, it reminded me of what the “medical model” has as a deplorable goal, IMHO. The “medical model” is all about labeling people with their “life long incurable,” but “invalid,” DSM disorders, then neurotoxic poisoning their clients. And that satanic “medical model” is all about stealing hope from people, which I think is a deplorable goal.

    Thanks again for sharing your inspiring story about how a non-money based model, that’s not about stealing hope, works so much better … albeit it’s not profitable. But shouldn’t we human beings be trying to help and care for one another anyway, not only for profit?

    For goodness sakes, have you ever thought about the totally fraudulent aspect of the medical/pharmaceutical/insurance industrial complex’s payment system? A quick example, that hopefully will point out the fraud of it all.

    I was handed an “art manager” contract by a psychologist who wanted me to pay him, to paint for him, while he “managed” me (via a ‘take a % of gross’ aspect of the contract), after I gave him total control of all my money (via the ‘conservatorship contract’ aspect of that thievery contract).

    That’s actually the absurdity of how today’s US medical community charges the rest of us for their supposed “help.” In all honesty, it’s fraud.

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  3. Thank you for your honesty! I am just like you. Too many treatments to count. I had to go to prison behind my addiction. After release from the half way house I choose The 24 Hour Club in Dallas Texas because I knew the accountability factor would keep me safe along with all the mandated court IOP and probation. I knew The 24 would weed out those who were uninterested in recovery. That program starts you on the floor, moves you to a room, then there’s sober living apartments. You are held very accountable the whole time. It’s strict and requires discipline and rigorous action on the 12 steps or you can pack up and go. It also provides an opportunity to save money and have an actual life once your year is up. No rehab ever did that for me. No counselor either. The beautiful thing about The 24 Hour Club is that it is run by former residents. They even gave me a job cooking in the kitchen while I lived there. That is definitely the toughest and most rewarding job I have ever experienced. Cooking meals for close to 60 residents newly sober based of donations is an absolute challenge. Watching the new comers grow is the reward. The ones who stuck and stay, and the ones who passed away, the ones who relapsed and ran. They all hold a place in my heart. Recovery is hard and the rehabs don’t get it. Medication, groups, packets, so called counseling sessions never helped me any. Its merely a time to dry out and make money off us cash cows. Places like The 24 Hour Club got it right. Still standing after 55 years in it’s humble beings as a regular house that kept its door open and the floor of the meeting room available to crash with only one requirement. Stay sober fir 24 hours. That house is now a growing facility to this day. You are right. Sober living houses are the key. Real life situations regardless of who likes you or not. Those tough lessons I learned are in my heart and head today. They also do follow up with you once you’ve left to see how you are doing. I am still in touch with several of my fellow staff members and visit them often. I have a really great job and am living a semi normal life today. (No such thing as normal, especially for an addict!) I am closer to my family than ever and even get to be a grandma to my son’s kids. One of which was born while I was in prison. I am grateful my boys will never know that person. I am also that woman who lost touch with her sister and swore we’d never speak. Now we meet and speak regularly. I am forever grateful to Judge Francis and 4C, the program required after prison and The 24 Hour Club. And to people like you for your brutal honesty. The world is lacking in honesty specifically regarding recovery issues.

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  4. Your housemates held you accountable for your actions. That made you change. That’s the magic accountability.

    No one and nothing have ever held psychiatry accountable for the harms it causes.

    And that’s the reason it never changes for the better.

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  5. Pretty good, Tom!
    I’m not gonna try to push A.A. & the 12 Steps, but that’s what worked for me, decades ago now. On his deathbed, A.A. co-founder “Dr. Bob” said to “Bill W”, “Let’s not louse this thing up”, meaning “professionalism”. The so-called “recovery system” was designed to fail.
    Recovery means a life of sobriety, lived one day at a time.
    No “program”, or “facility”, or even all the money in the world, can provide that!
    Only a daily decision that we WANT RECOVERY, and the necessary thoughts daily actions to maintain that recovery, – that’s the ONLY WAY….and it need not cost a cent. That’s why our bogus “recovery industry” has such a high failure rate….

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  6. And I can’t help but wonder – I know quite a few on Surviving Antidepressants – who were given their psych drugs to help them with “recovery.” Usually neuroleptics (“anti-psychotics”) and often antidepressants, too.

    Not addressing the causes of addiction – but compounding the addiction with a dependance upon drugs which are more difficult to get off of than the addicting ones.

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