Scott Hillegass went to three different inpatient treatment facilities in the past two and half years as he tried to get help with his addiction. In between, he would stay in recovery houses to try and live soberly, but the houses weren’t always conducive to that lifestyle.

“There were a lot of guys in that house,” Hillegass said. ”I think the capacity was 21. It was really like a public place.”

The house also forced Hillegass and other residents to spend at least nine hours out of the house looking for a job, which led to many temptations.

“You had to go straight on the job search, right out of rehab,” he said. “So you'd be out for nine hours a day just walking around, which was I think toxic.”

For Hillegass and many others in recovery, a safe, sober environment to live while getting back on their feet from a battle with addiction is essential. But they’re not always easy to find or properly regulated, putting people seeking help at risk when they're most vulnerable and leading to relapse, or, in some cases, overdose and death.

Regulating such homes, however, has posed challenges to lawmakers and homeowners, who have struggled to identify and define them.

It’s recovery houses like the ones Hillegass ended up in that prompted Gov. Tom Wolf to sign legislation in December requiring all recovery houses that get referrals from state-funded treatment providers and/or state and county funding to become certified through the state’s Department of Drug and Alcohol Programs.

“What was occurring over the last couple of years, given the growth of the epidemic here, was that we started to hear a lot of complaints about recovery houses being operated by individuals who had less than stellar objectives,” said Jennifer Smith, department secretary. “We also started hearing news stories about individuals who were either running a recovery house or working in a recovery house, that would die of an apparent drug overdose while living in the house, so there was just a lot of attention around this whole idea of a home situation where individuals in recovery are living together and the fact that there was no oversight into these places.”

Hillegass relapsed and overdosed during a stay in one of those houses. It was after that he was connected with Barb Williamson, founder of Way of Life recovery houses in Bucks, Montgomery and Delaware counties, and ended up moving into the Bristol Township house she runs this past August.

Williamson, who herself had spent time in a recovery house, has been working since 2013 to provide an effective recovery house model that focused on the needs of the clients, many of whom come to her with legal, mental health and other issues.

“We have the client for the longest period of time,” she said. “We're in control of the client staying safe and finding a purpose that keeps the person in recovery pointed in the right direction of staying sober.”

That’s why Williamson has been working with state, county and local lawmakers to get regulations passed to drive out some of the operators that aren’t helping those in recovery.

While the official regulations have not yet been made public, according to DDAP’s policy director Derrick Pelletier, some main policy points were listed in the legislation that are guiding the department's process to create the specific rules.

“There are … pieces that the act identifies that recovery houses will have to consider and things that we will have to include in our regulatory requirements," he said. “Those include background checks, policies that employees in the houses aren't financially involved with residents of the houses, policies around safety and protection of the residents, policies around requiring residents to participate in treatment, self-help groups or other recovery supports; policies around security and medications and policies around the physical property itself, the safety of the property itself.”

The department has until December 2019 to publish the regulations to certify the houses and then has to spend the next six months, until June 2020, certifying the houses that meet the requirements, Pelletier said.

There’s a need for the regulations, according to Smith, because right now a lot of families don’t have the information to decipher what a good recovery house is versus one that’s not run properly.

“How do we know what constitutes a good recovery house? How do we know these owners have good intentions? And the answer really even up until today is we don't know,” she said.

Fred Way, the executive director of the Pennsylvania Alliance for Recovery Residences (PARR) said that while the regulations don’t go into effect until 2020, more house operators are becoming voluntarily certified through PARR to get ahead of state requirements.

“They want to operate with standards,” he said. “They like the fact of someone coming in and inspecting their operation and giving them feedback.”

He said owners who choose to become voluntarily certified feel that it gives them a way to differentiate themselves from any old house down the street.

“A good run house with a good house manager — it’s really as simple as that,” he said. “Most of the houses that are certified have good house managers and know what’s going on with their residents.”

Micki Kaisinger, the founder of Emilie House, which runs recovery houses in Bucks County, said she and her husband, Gary, worked with the state’s task force that helped draft the regulations.

“We’ve actually been pretty instrumental in creating the laws and rules and guidelines,” she said.

She said she’s looking forward to making sure that people know what kind of home they’re sending their loved ones to.

“A lot of treatment facilities are referring people to houses that we may not consider acceptable,” she said. “They may not really be aware of what goes on within the home.”

Kaisinger also believes the regulations could help get rid of some of the unregulated houses that don’t require residents to go to outpatient treatment or meetings, or don't follow other recommended practices for helping those in recovery.

“For us, the changes they’re looking for aren’t much different than what we’re currently doing,” she said. “It’s tough to operate a recovery house today that does follow the rules and regulations that are suggested by the county, state, where there are ones right next door where people can go without rules or guidelines.”

That’s one of the things Smith said she hopes the list of those that are DDAP-certified can address in highlighting the houses that are doing things the right way and helping to isolate those that are not.

“Our hope is that people utilize the published list of houses that meet these requirements and start utilizing that list and so eventually driving out of business, some of the houses that refuse to comply with those kinds of requirements,” she said.

Having a safe place to go after an inpatient stay or hospitalization, is crucial to a person’s recovery success, Williamson said. That’s one of the reasons she was able to succeed in recovery.

“For a client to receive the proper care, 21 days (of inpatient treatment) is not nearly enough time,” she said. “So that throws the burden, the bulk of the work onto the recovery house owner and the recovery house owner is just a person like myself that typically has their heart in the right place and wants to help people, they just don’t have the proper resources or efficient ways to help the client.”

That’s why she’s added supports such as contact to social workers to help clients with their legal issues, an in-house job application system, connections with online colleges and community colleges to help those in recovery go back to school, and structure to make sure they stay on track with their meetings and house responsibilities.

A May 2018 report from the National Council for Behavioral Health and National Alliance for Recovery Residences (NARR) emphasized the need for this type of housing.

“Those in the addiction field and recovery community have recognized that recovery housing is a central component of successful long-term recovery,” the report titled “Building Recovery: State Policy Guide for Supporting Recovery Housing” reads.

Defining a recovery house is a bit trickier than it sounds, according to the council, as they’re often called recovery residences, three-quarter houses, sober living homes and alcohol/drug-free homes.

Because of this, they’re often difficult to keep track of. Estimates from NARR, which has affiliates in over 30 states, have more than 25,000 individuals in 2,500 certified recovery houses. Oxford Houses, the longest running model for recovery housing, supported more than 18,000 beds within 2,300 homes across 43 states in 2017, but there are many houses not part of either organization that call themselves “recovery houses” or “sober living facilities.”

One of the alliance's recommendations is that local and state officials define specifically what those houses are so that providers can’t just market any type of house as a “recovery one.”

“Core components that are central to a clear definition include: a safe and supportive living environment that prohibits residents’ use of alcohol and illicit drugs on and off the premises (and) direct connection to peer support and other recovery support services and, if needed, referral to clinical addiction services,” the report reads.

David Sheridan, president of NARR, said Pennsylvania is in the process of adopting a model suggested in that report.

He also noted that there’s been national movement on sober living, including in the latest bipartisan opioid package that passed the Senate in September.

According to the legislation, the Department of Health and Human Services is supposed to identify and promote best practices for running houses for people in recovery.

Sheridan said NARR has worked with HHS on this and hopes to help states implement systems to understand those best practices.

“Let’s get the expertise out under a federal seal of approval and then help states understand what steps they can take to help their systems of care,” he said.

For Zachary Kirschner, Williamson’s Bristol Township house manager, the structure of her house has been essential to his recovery.

Kirschner began using when he was 14 years old, after his mother died by suicide.

“I just got high and drank to suppress all my feelings and that led me into various rehabs and jail and I just didn't ever get it really,” he said.

Over four months ago, after Kirschner completed 29 days in an inpatient treatment center in Pennsylvania and months at Ambrosia in Florida, he came into contact with Williamson and accepted a spot in her house. Although he wasn’t exactly happy about it from the start, he said.

“I came up here, flying from sunny Florida and I wasn't the happiest person when I first got here, but I quickly started forming bonds with everybody in the house, everybody was so nice to me, helped me get to court, get to job interviews,” he said.

Williamson said she hopes her model can not only help her residents but other houses that choose to use a similar model.

“(It) is really just adding the extra services that a client needs, making sure the houses are not overcrowded and the housing is appropriate — it's nice it's clean, it's functional and it's safe for the client and that's the most important part,” she said. “DDAP is putting their stamp of approval that this is a safe house that will provide good quality care.”

Williamson said she expects change to happen quickly to the recovery house community as soon as the state rules are implemented.

“I think that recovery housing in the next 18 months is going to be a much different game,” she said. “A lot of (the rules are) going to be governed and looked over, making sure what they're doing is the most effective process for the client which is reaching out and needing our help, so I think a lot of people will fall by the wayside, because they're not able or qualified — they're not going to invest the money that it takes to actually run good recovery houses."