The NARR levels are “big buckets,” meaning much variability exists within each level. Given changing market trends and state laws, “big buckets” allow for diversity, flexibility, and responsiveness in the marketplace while empowering consumer and referral agent choices. One level is not better than another. They are just different and serve different populations with different needs.
Level IV RR
Level IV Recovery Residences integrate the social and medical models using a combination of supervised peer and professional staff. In addition to peer-based recovery support and life skills development, they offer clinical addiction treatment services. While all Level IVs are licensed treatment, not all licensed treatments are Level IV Recovery Residences. Examples of Level IVs are Extended Aftercare, Therapeutic Communities as well as the ”Florida Models” that integrate social model recovery.
Level III RR
Level III Recovery Residences provide weekly, structured programming that includes peer-recovery support services (e.g., recovery and resiliency groups or person-centered recovery planning) and life skills development (e.g., job readiness or budgeting). Staff are supervised, trained or credentialed, and are often graduates of the program. Level IIIs are designed to support people who need extended lengths of support at a higher level of intensity than what Level Is and IIs provide. Level IIIs go by various names. They can be licensed or unlicensed, depending on state laws.
Level II RR
Level II Recovery Residences, often called sober homes or sober living, are alcohol- and drug-free recovery housing that use house standards, rules, and peer accountability to maintain safe, healthy, and structured living environments. Senior residents are often appointed as the head of the household, frequently called the House Manager. To serve higher need populations, such as transitional-aged youth with opioid use disorders, some Level IIIs have begun to add person-centered support and life skills development without the service intensity and staffing structure of Level IIIs.
Level I RR
Level I Recovery Residences are democratically run alcohol- and drug-free recovery homes. Oxford Houses ™ is the most widely known example and is included in SAMHSA’s National Registry of Evidence-based Programs and Practices (NREBPP). Level 2s, Level 1s maintain a recovery culture and community through behavioral standards, house rules, and peer accountability. The key difference is that Level 1s are democratically governed.