Substance Misuse Treatment and Recovery: Federal Guidance Needs to Address Work Arrangements for Those Living in Residential Facilities

By Thomas Costa

  Why GAO Did This Study Millions of Americans struggle with substance misuse. Some pursue treatment and recovery at over 3,660 residential facilities, according to 2020 HHS data. Some of these facilities may require residents to work. GAO was asked to review work practices at these facilities. This report examines (1) the prevalence of facility work and pay practices, (2) selected stakeholders’ views on the role of work in substance misuse treatment and recovery, and (3) the extent to which federal guidance and enforcement address work and pay at facilities. In March to June 2023 GAO surveyed a statistical sample of facilities and obtained generalizable responses from 96 licensed treatment facilities and 48 certified recovery residences. GAO visited facilities, some covertly, selected for geographic variation and other considerations; interviewed HHS and Department of Labor officials and selected stakeholders such as state substance misuse agency officials and researchers; and reviewed relevant federal laws, regulations, and agency documents. What GAO Recommends GAO recommends that HHS (1) develop a process to consult state substance misuse agencies about their guidance needs for incorporating work into treatment and recovery and (2) state in SUPTRS Block Grant documents if and when work requirements are acceptable as a condition of accessing services in residential treatment and recovery facilities. HHS agreed with GAO’s recommendations.