NARR Levels of Care: A Comprehensive Guide to Recovery Support

The National Alliance for Recovery Residences (NARR) has established a four-level classification system that provides a framework for understanding the spectrum of recovery housing options. Let's explore each level with examples to illustrate the different environments and services offered.

Level I: Peer-Run Residences

Level I recovery residences are democratically operated homes that provide a substance-free environment with minimal structure. These houses rely on peer support and shared responsibility among residents.

Key characteristics:

• Self-governed by residents
• No paid staff on site
• Peer accountability system
• Basic house rules
• Residents generally have established some recovery stability

Examples:

• Oxford Houses: The most well-known example, Oxford Houses operate as self-supporting, democratically run homes where residents share expenses and responsibilities. Each house has elected officers who serve limited terms.
• Sober Living Collectives: Groups of individuals in recovery who rent or purchase a home together and establish their own community guidelines.
• Recovery Cooperatives: Resident-operated homes where each member has equal voting rights and contributes to household management.

Level II: Monitored Residences

Level II recovery residences have more structure than Level I homes but still emphasize peer support. These homes typically have a house manager or senior resident who provides oversight.

Key characteristics:

• House manager or senior resident provides oversight
• Structured recovery environment
• More defined house rules and expectations
• May offer basic recovery support services
• Stronger connection to outside support services

Examples:

• Sober Living Homes: Monitored environments with a resident manager who enforces house rules and supports residents in their recovery journey.
• Community-Based Recovery Houses: Facilities that offer a structured living environment with regular house meetings and accountability systems.
• Transitional Housing Programs: Services for populations like veterans or formerly incarcerated individuals that provide monitoring and basic support as they rebuild their lives.

Level III: Supervised Residences

Level III recovery residences provide a more comprehensive level of support with organized recovery programming and supervised environments.

Key characteristics:

• Credentialed staff
• Structured recovery programming
• Life skills development
• Case management services
• Clinical services available through referral

Examples:

• Recovery Homes with Support Services: Facilities that provide regular recovery programming, life skills training, and employment assistance.
• Therapeutic Communities: Structured environments that emphasize personal accountability and community support with staff supervision.
• Specialized Recovery Programs: Supervised residences that focus on specific populations like women with children, veterans, or those with co-occurring disorders.

Level IV: Service Provider Residences

Level IV recovery residences offer the highest level of support, including clinical services integrated within the residential setting.

Key characteristics:

• Professional staff (including clinical providers)
• Clinical services delivered in-house
• Comprehensive recovery programming
• Structured daily activities
• Medication management

Examples:

• Clinical Recovery Centers: Licensed facilities that provide both housing and clinical treatment services under one roof.
• Medically Managed Residential Programs: Settings that offer medical monitoring along with comprehensive recovery support.
• Integrated Dual Diagnosis Treatment Facilities: Programs specifically designed for individuals with both substance use and mental health disorders that provide clinical care within a residential environment.

Each level of care serves a vital role in the continuum of recovery support, allowing individuals to access the appropriate environment based on their current needs and recovery capital. As a person progresses in their recovery journey, they may transition between different levels, eventually building the skills and stability needed for independent living.