Costa Mesa City Council
October 6, 2026

Definitions
Various laws use the term “group homes” to refer to different types of housing for different populations. For the purposes of state fair housing and planning and zoning laws, the following terms refer to various types of residences in which unrelated persons share the residence:
• Shared Living Residences—any housing shared by unrelated persons, including, for example, group homes, recovery residences, some community care residential facilities, some supportive and transitional housing, emergency shelters, boardinghouses, and dormitories.
• Group Homes—housing shared by unrelated persons with disabilities that provide peer and other support for their residents’ disability-related needs and in which residents share cooking, dining, and living areas, and may, in some group homes, participate in cooking, housekeeping, and other communal living activities and that do not provide services that require licenses under state law. • Licensed Facilities—shared living residences that provide services that require licenses under state law.
• Recovery Residences or Sober Living Homes—group homes for persons recovering from alcoholism or drug addiction in which the residents mutually support each other's recovery and sobriety and that do not require state licenses because they do not provide alcoholism or drug addiction recovery and treatment services.1
• Alcohol or Other Drug (AOD) Facilities—residential facilities that must obtain state licenses because they provide alcoholism or drug addiction recovery and treatment services.
1 Individuals recovering from alcoholism or addiction are recognized as people with disabilities (see Gov. Code, § 12926, subd. (j)), and “sober living homes and other dwellings intended for occupancy by persons recovering from alcoholism and drug addiction are protected from illegal discrimination against the disabled.” SoCal Recovery, LLC v. City of Costa Mesa (“SoCal Recovery”) (9th Cir. 2023) 56 F.4th 802, 814.

Lori Ann Farrell Harrison, City Manager

Statutory Background
Land Use Discrimination Law
California’s Planning and Zoning Law (Gov. Code, § 65000 et seq.) prohibits jurisdictions from engaging in discriminatory land use and planning activities. Specifically, Government Code section 65008, subdivision (a)(1), deems any action taken by a city to be null and void if it denies an individual or group of individuals the enjoyment of residence, landownership, tenancy, or any other land use in the state due to illegal discrimination.

Section 65008 prohibits discrimination based on any characteristic, including disabilities, protected by other state or federal laws, while adding its own prohibitions of discrimination against individuals or households who have very low, low, moderate, or middle incomes. 2 The law further recites multiple categories of actions that are determined to be discriminatory, including enactment or administration of ordinances that prohibit or discriminate based on a protected characteristic3 and imposition of requirements on a residential use for persons with protected characteristics that are not generally imposed upon other residential uses.4
AFFH Law
Government Code section 8899.50 requires all California public agencies, including cities, “to administer their programs and activities relating to housing and community development in a manner to affirmatively further fair housing, and take no action that is materially inconsistent with [this] obligation . . . .”5 AFFH means:
taking meaningful actions, in addition to combating discrimination, that overcome patterns of segregation and foster inclusive communities free from barriers that restrict access to opportunity based on protected characteristics. Specifically, affirmatively furthering fair housing means taking meaningful actions that, taken together, address significant disparities in housing needs and in access to opportunity, replacing segregated living patterns with truly integrated and balanced living patterns, transforming racially and ethnically concentrated areas of poverty into areas of opportunity, and fostering and maintaining compliance with civil rights and fair housing laws.6
Moreover, the “duty to affirmatively further fair housing extends to all of a public agency’s activities and programs relating to housing and community development.”7 2 Gov. Code, § 65008, subds. (a)(1)(A), (b)(1)(B)-(C), (2)(B), (3). 3 Id. at subd. (b)(1)(B). 4 Id. at subd. (d)(2)(A).
5 Gov. Code, § 8899.50, subds. (a)(2)(B), (b)(1), (2).
6 Id. at subd. (a)(1).
7 Id.

Lori Ann Farrell Harrison, City Manager

Housing Element Law
In addition to the general AFFH requirements in Government Code section 8899.50, State Housing Element Law includes more specific AFFH requirements for cities.

Government Code section 65583 requires cities to thoroughly analyze fair housing issues related to housing for people with disabilities and set forth a program of actions that protect and promote such housing. Through their housing elements, cities must “remove governmental constraints that hinder . . . meeting the need for housing for persons with disabilities,” which requires “remov[ing] constraints to, and provid[ing] reasonable accommodations for housing designed for, intended for occupancy by, or with supportive services for, persons with disabilities.”8 Section 65583 also requires cities to “promote and affirmatively further fair housing opportunities and promote housing throughout the community or communities all persons regardless of . . . disability” or “other protected characteristics.”9 And cities’ housing elements must include a fair housing assessment with specific goals, implementation strategies, and “metrics and milestones” for evaluating results.10 In complying with these AFFH duties, cities are required to analyze data and set measurable objectives and milestones. 11 Resource Materials
In revising its policies, amending its ordinances, and implementing its housing element programs, the City should consider HCD’s Group Home Technical Advisory (Group Home TA)12 and its AFFH Guidance Memorandum (AFFH Memo). 13 The City should
also consider, among other things, the analysis in the amicus brief that HCD and CRD filed in the pending appeal in The Ohio House, LLC v. City of Costa Mesa, 9th Cir. Case No. 22-56181, Docket No. 25-2 (Amicus Brief). The guidance documents and Amicus Brief discuss relevant statutes, regulations, and case law, as well as HCD’s and other government agencies’ earlier guidance documents, academic papers, and demographic and statistical analyses.
8 Gov. Code, § 65583, subds. (a)(6), (c)(3).
9 Id. at subd. (c)(5).
10 Id. at subd. (c)(10)(A)(iv).
11 See, e.g., Gov. Code, § 65583, subds. (a)(5), (a)(7), (b)(1), (c)(10)(A)(ii). 12 Available at https://www.hcd.ca.gov/sites/default/files/docs/planning-andcommunity/group-home-technical-advisory-2022.pdf. 13 Available at https://www.hcd.ca.gov/communitydevelopment/affh/docs/affh_document_final_4-27-2021.pdf.

Lori Ann Farrell Harrison, City Manager

Findings
HCD’s findings include, but are not necessarily limited to, those described below.

Permitting Requirements
Ordinance Nos. 14-13, 15-11, and 17-05 establish permitting requirements for group homes.
• MC 13-311(a) requires a special use permit for unpermitted group homes of six or fewer occupants located in R1 (single-family) zones and prohibits group homes with seven or more occupants in these zones.
• MC Title 9, Chapter II, Article 23, 9-372 requires group homes of six or less to apply for an operator's permit, regardless of licensure status. • MC 13-322 requires a Conditional Use Permit (CUP) for group homes of six or less in R2-MD, R2-HD and R3 residential zones and the PDR-LD, PDR-MD, PDR-HD, PDR-NCM, PDC, and PDI (Planned Development Zones) Zones. • MC 13-323 requires a CUP for group homes in the R2-MD, R2-HD and R3 residential zones and the PDR-LD, PDR-MD, PDR-HD, PDR-NCM, PDC, and PDI (Planned Development Zones) with seven or more occupants.

The City’s permitting requirements for group homes and its application and enforcement of these requirements violate Government Code sections 65008, 65583, and 8899.50 by, among other things, discriminating against housing for persons with disabilities, constraining and failing to promote this housing, and restricting the fair housing choices of persons with disabilities (their right to housing of their choice and the housing they find most suitable for their disability-related needs).

The ordinances do not impose similar restrictions on other dwellings located in the zones listed above. The discriminatory effects and constraints these permitting requirements impose on group homes are evident through, among other things, the City’s own data showing how severely the permitting requirements have curtailed group homes in Costa Mesa. And there are considerable other discriminatory effects, including, and among other things, the costs and burdens imposed on group homes, the displacement of persons with disabilities from housing of their choice and the disruptions of their lives, and the City’s efforts to deter new group homes from opening in Costa Mesa.14
14 See, e.g., Amicus Brief at pp. 27-28; SoCal Recovery, supra, 56 F.4th at p. 806 (finding that Costa Mesa engaged in “an explicit effort to reduce the number of sober living homes operating within the City.”).

Lori Ann Farrell Harrison, City Manager

Furthermore, the City should not continue attempting to justify its group home restrictions by comparing them to its treatment of boardinghouses. Group homes are designed to provide communal living environments with peer and other support for their occupants’ disability-related needs and to help integrate their residents into local communities. Boardinghouses do not serve these same goals. Government Code sections 65008, 65882, and 8899.50 also impose specific and unique duties on cities to affirmatively promote and protect housing for persons with disabilities that do not similarly apply to all boardinghouses.

The overall problems with the City’s permitting system require the City to immediately stop enforcing its group home ordinances and repeal them. To provide additional guidance, this letter discusses below further examples of how specific provisions in these ordinances conflict with the City’s duties under Government Code sections 65008, 65583, and 8899.50.

Definition of Single Housekeeping Unit
MC 13-06 defines a single housekeeping unit as follows:
• Single housekeeping unit. The occupants of a dwelling unit have established ties and familiarity with each other, jointly use common areas, interact with each other, share meals, household activities, and expenses and responsibilities; membership in the single housekeeping unit is fairly stable as opposed to transient, members have some control over who becomes a member of the household, and the residential activities of the household are conducted on a nonprofit basis. There is a rebuttable presumption that integral facilities do not constitute single housekeeping units. Additional indicia that a household is not operating as a single housekeeping unit include, but are not limited to: the occupants do not share a lease agreement or ownership of the property; members of the household have separate, private entrances from other members; members of the household have locks on their bedroom doors; members of the household have separate food storage facilities, such as separate refrigerators.

HCD encourages the City to review pages 24-25 of the HCD Group Home Technical Advisory for policies to avoid when creating a definition of a single housekeeping unit.

These problematic policies include requiring all residents to share a common lease or deed, excluding for-profit group homes and overly scrutinizing living arrangements (e.g., not allowing for locks on rooms or having separate entrances).

Lori Ann Farrell Harrison, City Manager

Lack of Grandfathering
Typically, when a zoning code changes, preexisting, nonconforming uses are “grandfathered” in and allowed to continue operating under the requirements that were in place before the amendments.
15 Costa Mesa’s zoning code follows this wellestablished practice by allowing preexisting, nonconforming residential uses to continue operating unless they are abandoned, the dwellings they are in are declared physically unsafe, or the owner proposes structural alterations. (MC 13-203(b), 13-204.) But the City departs both from general grandfathering practices and its own grandfathering code provisions by requiring preexisting group homes to apply for permits in the same fashion as new ones to remain operational. (MC 13-311, 13-322, and 13-323.) This imposes discriminatory and constraining conditions on preexisting group homes, while creating displacement impacts that AFFH duties and State Housing Element Law require the City to consider and avoid.
16 The City should apply its generally applicable
grandfathering provisions to preexisting group homes, subject to reasonable accommodations requirements.

Occupancy Limits
The City sets special occupancy limits on group homes that prohibit group homes of seven or more occupants in R-1 single family zones, require group homes with seven or more occupants to obtain permits to operate in other zones, and require group homes with six or fewer occupants to obtain permits to operate in any residential zone. (MC 9- 372, 13-311)(a), 13-322, 13-323.) This is another example of the City imposing discriminatory and constraining restrictions on group homes. Concerns about overcrowding should be addressed through applying the generally applicable occupancy limits that apply to all residences instead of singling out specific types of housing based on occupants’ disabilities.
17 Costa Mesa’s ordinances appear to be based on a faulty application of Health and Safety Code statutes that allow local governments to subject licensed group homes with more than six residents to conditional use or other discretionary approval processes but require local governments to treat many types of licensed group homes with six or fewer residents the same as single-family homes and prohibit requiring these small, licensed group homes to obtain conditional use permits or other special approvals to locate in single-family zones.18 The City, however, cannot justify its restrictions on group homes 15 See, e.g., Edmonds v. Los Angeles County (1953) 40 Cal.2d 642, 651 (“The rights of users of property as those rights existed at the time of the adoption of a zoning ordinance are well recognized and have always been protected.”). 16 Gov. Code, § 65583, subds. (c)(10)(A)(ii), (v).
17 See Uniform Housing Code, § 503.2; see also City of Santa Barbara v. Adamson (1980) 27 Cal.3d 123, 133. 18 See, e.g., Health & Saf. Code, §§ 1566.3, 1569.85, 11834.23.

Lori Ann Farrell Harrison, City Manager

through statutes designed to protect small licensed facilities, which provide higher levels of support and care that require state licenses.19 These statutes specifically apply to licensed facilities, not to unlicensed group homes. In effect, the City is inappropriately transforming state laws designed to prevent local constraints on small, licensed facilities into constraints on group homes that do not provide services requiring state licenses.

Moreover, the City is imposing more restrictions on group homes with six or fewer residents than state law allows it to impose on licensed facilities with similar numbers of residents. To avoid imposing overly costly and burdensome constraints on group homes, the best practice is to apply the same general building, fire, and other health and safety codes that apply to other residences, subject to state health and safety code provisions specific to certain types of licensed facilities and to reasonable accommodations requirements.
20 Separation Requirement
MC 13-322, 13-323, and 13-324 require 650 feet of separation between group homes, sober living homes, or state-licensed drug and alcohol treatment facilities, new and existing.

These spacing requirements have a particularly severe impact on group homes, severely limiting where they can locate, causing group homes to close, and preventing others from opening. Yet the City has not shown that these spacing requirements are necessary or that there are health, safety, or similar justifications for the spacing requirements, or that if these were actual issues, that the City could not address them through less restrictive and discriminatory policies.

Pages 27-29 of the Group Home TA provides additional guidance illustrating why the City’s spacing requirements conflict with its duties under state housing law (e.g., Gov.

Code, §§ 8899.50, 65008, 65583, subds. (c), (1), (5), (10)), as does the Amicus Brief.

Vehicle and Parking Requirements
The City imposes special vehicle and parking requirements on group homes. MC 13- 311(a)(5) states that each dwelling resident is limited to one vehicle that must be used as the resident’s primary form of transportation. MC 13-311(a)(5) requires each dwelling resident to park their vehicle on dwelling premises or within 500 feet of the dwelling.

Concerns about parking and traffic should be addressed through generally applicable rules instead of restrictions that target housing for persons with disabilities.21 19 See Group Home TA at pp. 25-26.
20 See, e.g., Health & Saf. Code, § 13113 (requiring sprinkler systems in certain licensed facilities). 21 See Adamson, supra, 27 Cal.3d at 133; Group Home TA at p 31.

Lori Ann Farrell Harrison, City Manager

Examples of Other Permitting and Operational Requirements The City imposes the following restrictions on group homes but not on other residences:
• MC 13-311(a)(4) requires a manager to be present during all hours, seven days a week.
• MC 13-311(a)(14)(vi) requires that the operator must have a good neighbor policy directing residents “to be considerate of neighbors, including refraining from engaging in excessively loud, profane or obnoxious behavior that would unduly interfere with a neighbor’s use and enjoyment of their dwelling unit.” • MC 13-311(b) requires group homes applying for a permit to provide notice to the owner of record and all occupants within 500 feet of the group home.

Singling out group homes for restrictions like these can burden group homes with additional, unjustified costs, while perpetuating fears and stereotypes about persons with disabilities. Pages 30-33 of the Group Home TA provide additional guidance on how to avoid these and other restrictions in Costa Mesa’s group home ordinances that conflict with the City’s duties under Government Code sections 8899.50, 65008, 65583, subds. (c)(1), (c)(5) and (10), among others.
22 Reasonable Accommodations
Failing to make reasonable accommodations to rules or policies, in order to allow persons with disabilities the opportunity to access housing, is a form of discrimination.23 Making reasonable accommodations is also necessary to fulfill the City’s AFFH duties and its duties to remove constraints on housing for persons with disabilities.24 The City should review its reasonable accommodation policies in Municipal Code section 13-200.62, along with its application of these policies, to ensure compliance with state law.25 For example, the City: (i) must avoid denying requested accommodations based on fears or prejudicial assumptions about people with disabilities, such as that group home residents somehow uniquely cause problematic traffic, noise, or activity; (ii) 22 See also Oconomowoc Residential Programs, Inc. v. City of Milwaukee (7th Cir. 2002) 300 F.3d 775, 783 (finding that house manager requirement is discriminatory because it effectively mandates an “institutional” arrangement that is not “on par with” housing policies for those who are not disabled); Potomac Group Home Corp. v.

Montgomery County, Md. (D. Md. 1993) 823 F.Supp. 1285, 1296 (finding that notice requirements discriminate against and stigmatize persons with disabilities). 23 See, e.g., Gov. Code, § 12927, subd. (c)(1).
24 See, e.g., Gov. Code, §§ 8899.50, 65583, subds. (a)(6), (c)(3), (5). 25 See, e.g., Cal. Code Regs., tit. 2, §§ 12176-12185; Group Home TA at pp. 18-20; Amicus Brief at pp. 21-25.

Lori Ann Farrell Harrison, City Manager

may not place the burden on reasonable accommodation applicants to demonstrate that their requested accommodations would not create undue burdens on the City or fundamental alterations to its zoning code; (iii) may not require applicants to show that they could not find any other housing within the city that would meet their disabilityrelated needs; and (iv) must engage in good faith with reasonable accommodation requests and avoid delay or burdensome procedural requirements.26 Costa Mesa May Still Address Problems that Might Arise at Individual Group Homes
The City has resources to legally address problems that might occur at individual group homes. If group home operators are engaging in activities that constitute public nuisances; violating generally applicable building, housing, or other health and safety laws; committing fraud; or engaging in other illegal activities, the City can address these issues through the same code enforcement and other legal processes it applies to others who violate municipal codes and other laws. If the City has evidence that a group home operator is providing services that require a license without obtaining one, it can contact the state’s Department of Social Services or Department of Health Care Services, which can initiate investigations and take remedial action if appropriate.27 This may still require considering if reasonable accommodations are appropriate in some circumstances. And the City should avoid overbroad or discriminatory applications of nuisance laws, such as those basing civil nuisance actions on 911 calls for emergency services.28 But if a group home is found to have violated local or state law, the City may, for example, seek equitable relief that could include more stringent oversight and other affirmative relief to prevent further violations.

Focusing on individual group homes that are actually causing problems is a better practice than adopting overly broad, constraining, and unlawful regulations for all group homes.
26 See, e.g., Cal. Code Regs., tit. 2, §§ 12177-12179; 28. C.F.R. § 35.150(a)(3). 27 See Group Home TA at pp. 33-36, 37. 28 See. e.g., Cal. Code Regs., tit. 2, § 12162, subd. (a); see also California Attorney General Rob Bonta letter to all Cities and Counties in California re Crime Free Hosing Policies (Apr. 21, 2023), available at https://oag.ca.gov/system/files/attachments/pressdocs/Crime%20Free%20Housing%20Guidance_4.21.23.pdf.

Lori Ann Farrell Harrison, City Manager

Conclusion
Costa Mesa’s ordinances are blocking new group homes from opening, forcing existing ones to close, and imposing costs, administrative burdens, and fees that make it difficult for group homes to operate, while displacing persons with disabilities and disrupting their lives. The City is creating these restrictions and problems in the context of a shortage of adequate housing for persons with disabilities, which is a particularly acute issue within California’s broader housing crisis.

HCD has reviewed the City’s group home ordinances and found that they violate Government Code sections 65008, 65583, and 8899.50. The City must stop enforcing these ordinances, repeal them, change its reasonable accommodation policies and practices, and review other zoning practices in light of HCD’s guidance to ensure that the City is complying with state law. These actions are necessary for the City to comply with its duties under Government Code sections 65008, 65583, and 8899.50, and are among the things that the City must do to bring its 6th cycle housing element into substantial compliance with State Housing Element Law.

For technical assistance regarding the City’s 6th Cycle housing element, please contact Jose Armando Jauregui at [email protected]. If you have any questions regarding the content of this letter, please contact Bentley Regehr at [email protected].

Sincerely,
David Zisser
Assistant Deputy Director
Local Government Relations and Accountability
Enclosures: Letter from HCD regarding City of Costa Mesa’s 6th Cycle (2021-2029) Adopted Housing Element (May 9, 2023)
STATE OF CALIFORNIA - BUSINESS, CONSUMER SERVICES AND HOUSING AGENCY GAVIN NEWSOM, Governor

DEPARTMENT OF HOUSING AND COMMUNITY DEVELOPMENT

DIVISION OF HOUSING POLICY DEVELOPMENT
2020 W. El Camino Avenue, Suite 500
Sacramento, CA 95833
(916) 263-2911 / FAX (916) 263-7453
www.hcd.ca.gov
May 9, 2023
Lori Ann Farrell Harrison, City Manager
City of Costa Mesa
77 Fair Drive
Costa Mesa, CA 92626
Dear Lori Ann Farrell Harrison:

RE: City of Costa Mesa’s 6th Cycle (2021-2029) Adopted Housing Element Thank you for submitting the City of Costa Mesa’s (City) housing element that was adopted on November 15, 2022 and received for review on March 10, 2023. In addition, the California Department of Housing and Community Development (HCD) considered technical modifications from its prior review authorized by Resolution Number 2022-67.

Pursuant to Government Code section 65585, subdivision (h), HCD is reporting the results of its review. In addition, HCD considered comments from Costa Mesa First pursuant to Government Code section 65588, subdivision (c).

The adopted housing element meets the statutory requirements of State Housing Element Law (Gov. Code, § 65580 et seq.). However, the housing element cannot be found in substantial compliance until the City has completed necessary rezones to make prior identified sites available and address the shortfall of sites to accommodate the RHNA pursuant to Assembly Bill 1398 (Chapter 358, Statutes of 2021) as described below.

Pursuant to Assembly Bill 1398 (Chapter 358, Statutes of 2021), a jurisdiction that failed to adopt a compliant housing element within one year from the statutory deadline cannot be found in compliance until rezones to make prior identified sites available or accommodate a shortfall of sites, pursuant to Government Code section 65583, subdivision (c) (1) (A) and Government Code section 65583.2, subdivision (c), are completed. As this year has passed and Programs 3B (Fairview Development Center), 3C (North Costa Mesa Specific Plan), 3D (Urban plans and Overlays), and 3N (Reused sites) have not been completed, the housing element is out of compliance and will remain out of compliance until the rezoning has been completed. Once the City completes the rezone, a copy of the resolution or ordinance should be transmitted to HCD. HCD will review the documentation and issue correspondence identifying the updated status of the City’s housing element compliance.

Lori Ann Farrell Harrison, City Manager

Additionally, the City must continue timely and effective implementation of all programs including but not limited to the following:
• Program 2A (Inclusionary Housing Ordinance)
• Program 2B (Affordable Housing Development)
• Program 2I (State Density Bonus Incentives)
• Program 2J (Transitional and Supportive Housing)
• Program 2M (Parking Standards for Residential Development) • Program 2N (Reasonable Accommodation)
• Program 2O (Definition of Single Housekeeping Unit)
• Program 2P (Group Homes): Please note, HCD may follow up with additional technical assistance. Please see HCD’s Group Home Technical Advisory at https://www.hcd.ca.gov/sites/default/files/docs/planning-and-community/grouphome-technical-advisory-2022.pdf. • Program 3B (Fairview Development Center)
• Program 3G (City-wide Vote Requirements)
• Program 3R (Development of Large Sites)
• Program 4A (Fair Housing)
The City must monitor and report on the results of these and other programs through the annual progress report, required pursuant to Government Code section 65400.

Please be aware, Government Code section 65585, subdivision (i), grants HCD authority to review any action or failure to act by a local government that it determines is inconsistent with an adopted housing element or State Housing Element Law. This includes failure to implement program actions included in the housing element. HCD may revoke housing element compliance if the local government’s actions do not comply with state law.

Several federal, state, and regional funding programs consider housing element compliance as an eligibility or ranking criteria. For example, the CalTrans Senate Bill (SB) 1 Sustainable Communities grant, the Strategic Growth Council and HCD’s Affordable Housing and Sustainable Communities programs, and HCD’s Permanent Local Housing Allocation consider housing element compliance and/or annual reporting requirements pursuant to Government Code section 65400. With a compliant housing element, the City will meet housing element requirements for these and other funding sources.

For your information, some general plan element updates are triggered by housing element adoption. HCD reminds the City to consider timing provisions and welcomes the opportunity to provide assistance. For information, please see the Technical Advisories issued by the Governor’s Office of Planning and Research at:
https://www.opr.ca.gov/planning/general-plan/guidelines.html.

Lori Ann Farrell Harrison, City Manager

HCD appreciates the dedication and cooperation of the City’s housing element team provided during the review and update. HCD particularly applauds the efforts of Jennifer Le and Scott Drapkin whose collaboration, communication, expertise and public service is truly commendable. HCD wishes the City success in implementing its housing element and looks forward to following its progress through the General Plan annual progress reports pursuant to Government Code section 65400. If you have any questions or need additional technical assistance, please contact Jose Armando Jauregui of our staff, at [email protected].

Sincerely,
Paul McDougall
Senior Program Manager
EXHIBIT 5
1 Un-Licensed Facilities State Licensed Facilities
As of 2014 per City trial exhibit 1711 in Ohio House v City of Costa Mesa federal trial.

CITY TRIAL EXHIBIT 1711
Ohio
House
EXHIBIT 6
2 Un-Licensed Facilities Approved by City as of 2025
Ohio
House
Based on 2025 version of City Approved Sober Living/Group Homes WEB https://app.smartsheet.com/b/publish?EQBCT=f6f1941be3624556ab1b03e829df4639 (Apr. 25, 2025) EXHIBIT 7
~
OHIO
w~
To: City of Costa Mesa
Re: Reasonable accommodation request by The Ohio House
I am the co-founder of The Ohio House and responsible for leading the organization. I oversee all external affairs, including City permitting and government regulations. The Ohio House operates structured sober living for men at the property located at 115 E. Wilson Street, Units A-E, in Costa Mesa.

I affirm that only residents ( other than the house manager) who are handicapped as defined by state and federal law are allowed to reside at The Ohio House on Wilson Street.

I declare under penalty of perjury under the laws of the State of California that the foregoing statements are true and correct.
'The Ohio 'House 202-441-3570 Ohio-'House.com
Executed this 2nd day of May, 2025 at Costa Mesa, California.

EXHIBIT 8

EXHIBIT 9
1 HOUSING AGREEMENT
This agreement is made by and between (hereinafter referred to as “Resident” and The Ohio House (collectively referred to as “The Parties”).

RECITALS:

It is the intent of the Parties to enter into this agreement whereby Resident is seeking a clean and sober environment to reside in his continued recovery, and The Ohio House agrees to provide the Resident with a room so long as Resident continues with his sobriety and adheres to the structure detailed within this agreement.

I. COMMENCEMENT DATE
This agreement will commence and continue so long as the parties agree on a month to month basis with the rent due and payable in advance on the day of the month.

II. NATURE OF AGREEMENT
This agreement should be considered in accordance with laws pertaining to a Lodgers agreement.

Resident is fully aware that notwithstanding the mmonth to mmonth rental agreement that this agreement may terminate without the steps necessary in an Eviction Process for the Unlawful Detention of Resident in order to force Resident to vacate the residence, subject to any applicable regulations governing the relocation of the Resident at the end of his residency. This agreement by and between The Ohio House and the Resident will terminate automatically upon the breach of the terms and conditions set forth herein and will require no further legal action for The Ohio House to reenter and reclaim the room provided to Resident.

III. CONSIDERATION
This agreement shall commence upon the receipt of an initial payment of $ prior to Resident being admitted and shall cover the following for a full month and the cost of each service provided below. These services will be the same for each consecutive month so long as the terms and conditions of this agreement are strictly followed:
1) $ Furnished Room/Access to common areas of the House located at ______________________________
2) $ Food Card Services
Initials: _____ _____
2 “Food Card Service” means that The Ohio House will provide the Resident with a grocery store gift card in an amount equal to money paid for said service weekly .

The Ohio House agrees to provide the opportunity to have a safe and sober environment. This includes without limitation removing any of its residents who fail to perform his contract with The Ohio House in accordance with the terms and conditions herein.

The Ohio House does not provide for refunds of rent, which shall be paid monthly in advance.

Resident hereby acknowledges and agrees that his payment is non-refundable.

Payment for housing pursuant to this agreement is the responsibility of the Resident and does not depend on insurance benefits. This agreement is for housing only; it is separate from and independent of any other agreement to utilize the services of any laboratory or outpatient treatment program. A Resident’s housing pursuant to this agreement is not dependent on the Resident’s agreement to utilize any laboratory, treatment or recovery services by any specific service provider.

Resident further acknowledges and agrees that should this contract terminate in accordance with section III of this agreement, he waives any right to receive a refund for any unused services in connection with this agreement, subject to any applicable regulations governing the relocation of the Resident at the end of his residency.

IV. RESIDENT AGREES THE FOLLOW WILL RESULT IN IMMEDIATE TERMINATION OF THIS AGREEMENT:
a. Any criminal activity whatsoever
b. Any possession of non-approved prescription drugs, non-approved over the counter medication, alcohol, weapons, or paraphernalia
c. Any violence toward another resident, employee or guest. d. Failure to abide by house rules which have been signed and acknowledge in connection with this agreement.

V. ASSUMPTION OF RISK
Resident understands and acknowledges that based on the nature of this agreement that notwithstanding that The Ohio House will make every effort to provide a safe and sober environment. By its very nature, The Ohio House is unable to assure the actions and behavior of the other residents with the exception of ordering the removal of said residents upon the discovery of a 3 breach of its agreement with said resident. Resident understands and agrees to assume the risk of and hold The Ohio House harmless for actions of any of its residents including without limitation lost or stolen property, injuries as a result of its residents’ negligence and/or intention acts.

Resident further acknowledges and agrees that The Ohio House makes no warranties and Resident agrees that it releases The Ohio House from any and all ordinary negligence that may occur as a result of Resident’s stay at The Ohio House.

NO LIABILITY/INDEMNIFICATION/HOLD HARMLESS: The owners of the property do not assume liability for the loss, theft, or damage to their personal property. Tenants agree to indemnify and hold the owners harmless for any liabilities, theft, damage, cost or expense whatsoever arising from or related to any claim or litigation which may arise out of or in connection with tenants use and occupancy of the owner’s property, including but not limited to claims for property damage/loss.

Initials: _____ _____

PERMISSION TO USE IMAGE
Resident understands and acknowledges that Ohio House relies on the public knowledge of its success with its residents to maintain and grow its business. Accordingly, resident agrees that Ohio House has permission to display Resident’s likeness, photos (along with any associated metadata), and/or actions you take, in connection with unpaid, paid or sponsored content or promotions, without any compensation to Resident.

V. IN THE EVENT OF RELAPSE
Subject to any applicable regulations governing the relocation of the Resident at the end of his residency, if a Resident relapse for the 1st time, the Resident agrees and acknowledges that he will vacate the residence immediately and will be transferred to a detox facility, family member’s home or community resource where the Resident will spend a minimum of 72 hours. The Ohio House will transport the Resident to a detox facility or safe housing alternative. The Resident will not be allowed to return to The Ohio House until the Resident passes a urinalysis test. A “relapse” is considered a “relapse” if the Resident ingests any mind or mood altering chemical. Resident is responsible for all mind- or mood-altering chemicals that appears on their urinalysis and/or within their possession See also Section IV, above.

At the sole discretion of The Ohio House, it may readmit the Resident 72 hours after removal from the house and placement in detox or alternative housing, provided that the Resident passes a urinalysis test. Should Resident be readmitted to the house, the Resident will be required to sign a new housing agreement with The Ohio House.

In the event of a 2nd relapse during the Resident’s stay at The Ohio House, the Resident may be asked to leave Ohio house permanently. Ohio House will offer suggestions to other programs with higher 4 levels of care and will help the Resident make an informed decision as well as provide relocation assistance consistent with any applicable regulations, including the provision of information regarding housing alternative published by local social service agencies.

In the event of any relapse. the Resident will be transported directly to a family members house, Detox facility, treatment facility, or other safe housing environment. This will happen immediately upon knowledge of a relapse.

VI. COMPLETE AGREEMENT
The parties acknowledge and agree that this agreement is the complete agreement and no promises or side agreements were made in connection with this agreement. The Parties further agree and acknowledge this agreement is entered into freely, voluntarily, and without coercion, and the parties fully understand this agreement and its provisions.

Initials: ______ ______
5 Exhibit 1
RULES
• SMOKING OF CIGARETTES OTHER THAN E-CIGARETTES IS NOT PERMITTED IN THE HOUSE. Smoking is not allowed except in designated smoking areas . Anyone caught smoking in the bedrooms or house will be asked to leave, terminated and not allowed to return. No smoking in the front of the house. No exceptions. • Total abstinence from all mind altering chemicals and drugs, including alcohol, is required. Anyone caught violating this rule (by the Staff or another resident) will be asked to leave and be directed to resources for detox or safe alternative housing • Prescription Drugs: Upon joining the house pursuant to this agreement, each Resident must present Ohio House staff with prescribed and over the counter medication(s). These are documented by the house manager- both the medication itself and quantity prescribed.

The Ohio House does not administer medications, however, each house manager will lock them up and provide oversight for residents to take medications as prescribed. All over the counter and prescribed medications must be approved by Ohio House operators.

The possession or use of prescription medications shall be prohibited except for the person to whom they are prescribed, and in the amount prescribed. • By signing this agreement, Resident is agreeing to follow medical advice given by a licensed physician when it comes to medication management. Refusal or dissatisfaction with the effects of a medication prescribed by a licensed professional should be discussed immediately with the prescribing physician.
• Resident agrees to be drug tested a minimum of twice a week as well as breathalyzed randomly as deemed fit by The Ohio House upper management.
• For the first ninety days after joining the House pursuant to this agreement, the Resident is required to attend at least one Twelve Step meeting every day (including required house meetings). Following a Resident’s first 90 days, said Resident is required to attend 3 meetings weekly for the entirety of their residency with The Ohio House. A relapse of any kind is a renewal of the 90 in 90 commitments. • For the first 30 days with The Ohio house, residents are obligated to attend only meetings designated by staff. Beyond 30 days residents are allowed to attend meetings of their choosing if those meetings do not interfere with Ohio House obligations and meetings.
• Each Resident is expected, as a part of the Resident’s recovery, to attend all required house meetings as designated by your house manager and Ohio House staff.

Community meetings and designated meetings with Ohio House Staff are mandatory. 6 • Recovery means taking action, therefore each Resident is required to work, be in school, in treatment, or a training program.
• Quiet Time is observed daily from 11:00 PM to 7:00 AM- If Resident is awake during Quiet Time, the Resident is expected to be quiet and respectful of others. • Curfew hours are 11:00 p.m. Sunday through Thursday, and 1:00 A.M. Friday and Saturday.

Curfew extensions will be granted situationally by Ohio House staff and based on adherence to this agreement.

Ohio House Initials: ___________ Resident Initials: ___________ 7 Exhibit 1 (cont.)
RULES
• No overnight passes within the first thirty days of the date on which a Resident joins the house pursuant to this agreement. After thirty days, the Resident may request one overnight pass per month. After sixty days the Resident may request two overnight passes per month. After ninety days, the Resident may request three overnight passes per month. Overnight passes must be requested at least 24 hours in advance. All overnight passes must be approved by Ohio House staff.
• Absolutely no stealing will be tolerated (including cigarettes, food and clothes). • Each Resident is responsible for purchasing and preparing their own meals. House manager will familiarize each Resident with the appliances and cookware used for meal preparation. Ohio House encourages sharing meals among residents.
•
• Borrowing or loaning money is not allowed.
• Absolutely no gambling on Ohio House property
• Respect fellow residents, neighbors, staff, and the community. • Damage to the homes as the result of intended harm directly linked to the action of the resident may result in said Resident being financially responsible for the repairs. •
• No sexual contact will be allowed upon the premises.
• Friends may visit the house with the permission of the house manager. Visitors are confined to the living room and common areas and are not permitted in the bedrooms. No visitors after 10:00p.m. Sunday-Thursday and 12:00am Friday and Saturday. All visitors must check in with and be approved by the manager. No overnight visitors are allowed. • Each Resident must be fully and properly clothed (i.e., shirts and pants or shorts) in the common areas, including the living room, kitchen, and yard. • It is the responsibility of each Resident to contribute to the household, which means keeping the interior and exterior of the house neat and clean. Chores must be done daily or more often as needed. Chores will be posted and will be changed weekly. There will also be a complete house cleaning every Saturday- referred to as “Double Scrub.”. • You must do your assigned chores, make your bed and clean your room daily before 9:00 a.m. period! Dirty laundry must be properly put away and out of sight at all times. • Clean up after yourself in the kitchen area. Wash, dry and return house utensils to their proper place.
• All guests must abide by all house rules put in place. • By signing this agreement, Resident agrees to discretionary room searches as well as personal 8 property searches by Ohio House Staff
Ohio House Initials: ___________ Residents Initials: ___________

9 Exhibit 1 (cont.)
RULES
• No holding or trafficking of any drug or paraphernalia, or anything else that might suspect to be illegal.
• No racist, sexist language or propaganda will be permitted. • No weapons or violence or threats of violence will be permitted. • The Ohio House is not responsible for Resident’s personal property. Any personal property not removed at the time of Resident’s departure will be disposed of after 30 days.
• Each Resident must respect, take direction from and support the staff. • Each Resident is not permitted to remove or tamper with any safety devices or testing equipment.
• Residents are not permitted to move in furniture, large items or any other possession beyond daily living materials without the permission of The Ohio House staff. • Large stationary electronics such as tv’s, video game consoles, air conditioning units and projectors are not allowed within bedrooms.
• If the Resident is being picked up or dropped off, the Resident needs to be as quick as possible without disturbing neighbors. Avoid having cars idling outside of the houses at all times. Cars that are waiting should have headlights dimmed or turned off completely. • Each Resident, including each house managers, may store or park one vehicle at the dwelling unit or on any street within 500 feet of the house. The vehicle must be operable and currently used as a primary form of transportation for the Resident. • Each Resident must abide by all parking regulations as it pertains to street parking and street cleaning. It is the responsibility of the Resident to fully to comply with these regulations. • The Resident must provide The Ohio House with a copy of valid driver’s license, proof of insurance, and valid registration to obtain driving privileges.

Consequences:
• Each time a rule is broken the Resident may receive a consequence. These Consequences include, but are not limited to, curfew restriction, extra chore, higher level of care, community service requirements, lack of phone/electronic privileges or termination of residency. This is to the discretion of The Ohio House staff.
• Joining our house pursuant to this agreement is a contract to help hold the Resident accountable to reinforce the Resident’s recovery. Consequences for rules that are broken must be approved and administered by Ohio House staff.
10 • ANY PERSON – RESIDENT, GUEST, VISITOR, OR STAFF WHO BRINGS

DRUGS OR ALCOHOL ON THE PREMISES WILL BE ASKED TO LEAVE

IMMEDIATELY, DIRECTED TO ALTERANATIVE HOUSING/DETOXAND

MAY NOT BE ALLOWED TO RETURN TO THE HOUSE PERMANENTLY
• THESE RULES WILL BE STRICTLY ENFORCED TO PROMOTE THE SAFETY AND SECURITY OF THE OHIO HOUSE RESIDENTS, STAFF, AND NEIGHBORS. • THE RESIDENT HEREBY CERTIFIES THAT HE HAS CAREFULLY READ AND UNDERSTANDS THE RULES OF THE “OHIO HOUSE” AS STATED IN THIS AGREEMENT.

RESIDENT DATE
THE OHIO HOUSE _______________________ DATE ____
11 VII. Good Neighbor Policy
A. Each Resident shall refrain from engaging in excessively loud, profane or obnoxious behavior that would interfere with a neighbor’s use and enjoyment of their Home.

B. Television’s, radios, stereo’s etc. must be played at a level which will not disturb neighbors.

C. Quiet Time is to be observed nightly after 11:00 P.M., If the Resident is awake during quiet time, the Resident must not disturb and must respect others.

D. Keep the exterior of the house neat and clean at all times. This is a responsibility of each Resident.

E. The Resident is expected to be always an asset and positive role model in the community.
12 Initials: ______ ______

HISTORY INTAKE

DATE OF ADMIT

REFERRED BY

RESIDENT NAME
D.L. #

ADDRESS

NUMBER STREET CITY STATE ZIP
HOME PHONE ( ) S.S. #

AGE BIRTH DATE / / MARITAL STATUS
SEX

RESIDENT EMPLOYED
BY

BUSINESS

ADDRESS

OCCUPATION

CONTACT IN CASE OF EMERGENCY
RELATIONSHIP PHONE# - -

REASON FOR GETTING SOBER
PAST HISTORY WITH CHEMICALS:

EXPERIMENTAL SOCIAL REGULAR USE ADDICTED

CHEMICAL OF CHOICE LENGTH OF USE

DATE LAST USED OF EACH SUBSTANCE
13 PRIOR TREATMENT OR 12 STEP EXPERIENCE
LEGAL INFORMATION: ARRESTS DUIs Dips
ATTORNEY’S NAME PHONE# - -

PLEASE SIGN TO INDICATE THAT YOU HAVE CAREFULLY READ AND AGREE WITH THE ABOVE STATED INFORMATION.

Resident Signature Date / Time
Witness Date/Time
EXHIBIT 10

FACING ADDICTION

IN AMERICA
The Surgeon General’s Report on
Alcohol, Drugs, and Health
2016
U.S. Department of Health & Human Services
Suggested Citation
U.S. Department of Health and Human Services (HHS), Office of the Surgeon General, Facing Addiction in America:

The Surgeon General’s Report on Alcohol, Drugs, and Health. Washington, DC: HHS, November 2016.

For More Information
For more information about the Surgeon General’s report or to download copies, visit Addiction.SurgeonGeneral.gov.

Use of trade names and specific programs are for identification only and do not constitute endorsement by the U.S.

Department of Health and Human Services.

Non-discrimination
HHS complies with applicable federal civil rights laws and does not discriminate on the basis of race, color, national origin, age, disability, or sex. HHS does not exclude people or treat them differently because of race, color, national origin, age, disability, or sex.

HHS provides free aids and services to people with disabilities to communicate effectively with us, such as:
• Qualified sign language interpreters
• Written information in other formats (large print, audio, accessible electronic formats, other formats) HHS provides free language services to people whose primary language is not English, such as:
• Qualified interpreters
• Information written in other languages
If you need these services, call 1-877-696-6775.

If you believe that HHS has failed to provide these services or discriminated in another way on the basis of race, color, national origin, age, disability, or sex, you can file a grievance with the U.S. Department of Health and Human Services, Office for Civil Rights, electronically through the Office for Civil Rights Complaint Portal, available at https://ocrportal.hhs.gov/ocr/portal/lobby.jsf, or by mail or phone at:

U.S. Department of Health and Human Services
200 Independence Avenue, SW
Room 509F, HHH Building
Washington, D.C. 20201
1-800-368-1019, 800-537-7697 (TDD)
Complaint forms are available at http://www.hhs.gov/ocr/office/file/index.html.

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Llame al 1-877-696-6775.
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MESSAGE FROM THE SECRETARY
PAGE | i

MESSAGE FROM THE SECRETARY,
U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES
All across the United States, individuals, families, communities, and health care systems are struggling to cope with substance use, misuse, and substance use disorders. Substance misuse and substance use disorders have devastating effects, disrupt the future plans of too many young people, and all too often, end lives prematurely and tragically. Substance misuse is a major public health challenge and a priority for our nation to address.

Fortunately, we have made considerable progress in recent years. First, decades of scientific research and technological advances have given us a better understanding of the functioning and neurobiology of the brain and how substance use affects brain chemistry and our capacity for self-control.

One of the important findings of this research is that addiction is a chronic neurological disorder and needs to be treated as other chronic conditions are. Second, this Administration and others before it, as well as the private sector, have invested in research, development, and evaluation of programs to prevent and treat substance misuse, as well as support recovery. We now have many of the tools we need to protect children, young people, and adults from the negative health consequences of substance misuse; provide individuals with substance use disorders the treatment they need to lead healthy and productive lives; and help people stay substance-free. Finally, the enactment of the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008 and the Affordable Care Act in 2010 are helping increase access to prevention and treatment services.

The effects of substance use are cumulative and costly for our society, placing burdens on workplaces, the health care system, families, states, and communities. The Surgeon General’s Report on Alcohol, Drugs, and Health is another important step in our efforts to address the issue. This historic Report explains, in clear and understandable language, the effects on the brain of alcohol and drugs and how misuse can become a disorder. It describes the considerable evidence showing that prevention, treatment, and recovery policies and programs really do work. For example, minimum legal drinking age laws, funding for multi-sector community-based coalitions to plan and implement effective prevention interventions with fidelity, screening and brief intervention for alcohol use, needle/syringe exchange programs, behavioral counseling, pharmacologic interventions such as buprenorphine for opioid misuse, and mutual aid groups have all been shown effective in preventing, reducing, treating, and sustaining recovery from substance misuse and substance use disorders.

The Report discusses opportunities to bring substance use disorder treatment and mainstream health care systems into alignment so that they can address a person’s overall health, rather than a substance misuse or a physical health condition alone or in isolation. It also provides suggestions and recommendations for action that everyone—individuals, families, community leaders, law enforcement, health care professionals, policymakers, and researchers—can take to prevent substance misuse and reduce its consequences.

MESSAGE FROM THE SECRETARY
PAGE | II
Throughout, the Report provides examples of how individuals, organizations, and communities can partner to lessen and eliminate substance misuse. These efforts have to start now. Change takes time and long-term commitment, as well as collaboration among key stakeholders. As the Secretary of the Department of Health and Human Services, I encourage you to use the information and findings in this Report to take action so that we can improve the health of those we love and make our communities healthier and stronger.

Sylvia Mathews Burwell
Secretary
U.S. Department of Health and Human Services

TABLE OF CONTENTS

TABLE OF CONTENTS

CHAPTER 1 - INTRODUCTION

AND OVERVIEW OF THE
REPORT
Chapter 1 Preview 1-1

Substances Discussed in this Report 1-4

Prevalence of Substance Use, Misuse Problems,

and Disorders 1-7

Costs and Impact of Substance Misuse 1-12

Vulnerability to Substance Misuse Problems

and Disorders 1-15

Diagnosing a Substance Use Disorder 1-16

The Separation of Substance Use Treatment

and General Health Care 1-19

Recent Changes in Health Care Policy and Law 1-20

Marijuana: A Changing Legal and Research

Environment  1-21

Purpose, Focus, and Format of the Report 1-22

References 1-26

CHAPTER 2 - THE

NEUROBIOLOGY OF

SUBSTANCE USE, MISUSE,

AND ADDICTION
Chapter 2 Preview 2-1

Conducting Research on the Neurobiology of

Substance Use, Misuse, and Addiction 2-3

The Primary Brain Regions Involved in Substance

Use Disorders 2-5

The Addiction Cycle 2-6

Binge/Intoxication Stage: Basal Ganglia 2-8

Withdrawal/Negative Affect Stage: Extended

Amygdala 2-12

Factors that Increase Risk for Substance Use,

Misuse, and Addiction 2-21

Use of Multiple Substances and Co-occurring

Mental Health Conditions 2-22

Biological Factors Contributing to Population-based

Differences in Substance Misuse and Substance Use

Disorders 2-23

Recommendations for Research 2-24

References 2-27

PAGE | xIx

TABLE OF CONTENTS

CHAPTER 3 - PREVENTION

PROGRAMS AND POLICIES
CHAPTER 4 - EARLY

INTERVENTION, TREATMENT,

AND MANAGEMENT OF

SUBSTANCE USE DISORDERS
Chapter 3 Preview 3-1

Why We Should Care About Prevention 3-3

Risk and Protective Factors 3-4

Types of Prevention Interventions 3-7

Evidence-Based Prevention Programs 3-8

Evidence-based Community Coalition-based

Prevention Models 3-14

Evidence-Based Prevention Policies 3-17

Prevention Interventions for Specific Populations 3-27

Improving the Dissemination and Implementation

of Evidence-based Programs 3-32

Recommendations for Research 3-35

References 3-37

Chapter 4 Preview 4-1

Continuum of Treatment Services 4-3

Early Intervention: Identifying and Engaging

Individuals At Risk for Substance Misuse and
Substance Use Disorders 4-5

Treatment Engagement: Reaching and Reducing

Harm Among Those Who Need Treatment 4-8

Principles of Effective Treatment and Treatment

Planning 4-13

Evidence-based Treatment: Components of Care 4-19

Emerging Treatment Technologies 4-32

Considerations for Specific Populations 4-36

Recommendations for Research 4-40

References 4-43

PAGE | xx

TABLE OF CONTENTS

CHAPTER 5 - RECOVERY: THE

MANY PATHS TO WELLNESS
CHAPTER 6 - HEALTH CARE

SYSTEMS AND SUBSTANCE

USE DISORDERS
CHAPTER 7 - VISION FOR THE
FUTURE: A PUBLIC HEALTH

APPROACH
Chapter 5 Preview 5-1

Definitions, Pathways, and Prevalence of Recovery 5-2

Perspectives of Those in Recovery 5-4

Estimating the Number of People “In Recovery” 5-5

Recovery-oriented Systems of Care 5-6

Recovery Supports 5-7

Social and Recreational Recovery Infrastructures

and Social Media 5-16

Specific Populations and Recovery 5-16

Recommendations for Research 5-17

References 5-18

Chapter 6 Preview 6-1

Key Components of Health Care Systems 6-3

Substance Use Disorder Services Have Traditionally

Been Separate From Mental Health and General

Health Care 6-5

A Growing Impetus for Integration 6-6

Financing Systems for Substance Use Disorder

Services 6-23

Challenges Facing the Integration of Substance
Use Services and Health Care 6-27

Promising Innovations That Improve Access

to Substance Use Disorder Treatment 6-34

Recommendations for Research 6-43

References 6-45

Time for a Change 7-2

Specific Suggestions for Key Stakeholders 7-7

Conclusion 7-16

References 7-18

PAGE | xxI

TABLE OF CONTENTS

GLOSSARY OF TERMS 1
LIST OF ABBREVIATIONS 7
LIST OF TABLES AND FIGURES 11

APPENDIX A - REVIEW

PROCESS FOR PREVENTION
PROGRAMS 15
APPENDIX B - EVIDENCEBASED PREVENTION
PROGRAMS AND POLICIES 17

APPENDIX C - RESOURCE
GUIDE 41

APPENDIX D - IMPORTANT

FACTS ABOUT ALCOHOL
AND DRUGS 53
PAGE | xxII

TREATMENT
PAGE | 4-1
CHAPTER 4.

EARLY INTERVENTION, TREATMENT,

AND MANAGEMENT OF SUBSTANCE USE

DISORDERS
Chapter 4 Preview
A substance use disorder is a medical illness characterized by clinically significant impairments in health, social function, and voluntary control over substance use.2 Substance use disorders range in severity, duration, and complexity from mild to severe. In 2015, 20.8 million people aged 12 or older met criteria for a substance use disorder. While historically the great majority of treatment has occurred in specialty substance use disorder treatment programs with little involvement by primary or general health care, a shift is occurring toward the delivery of treatment services in general health care practice.

For those with mild to moderate substance use disorders, treatment through the general health care system may be sufficient, while those with severe substance use disorders (addiction) may require specialty treatment.

The good news is that a spectrum of effective strategies and services are available to identify, treat, and manage substance use problems and substance use disorders. Research shows that the most effective way to help someone with a substance use problem who may be at risk for developing a substance use disorder is to intervene early, before the condition can progress. With this recognition, screening for substance misuse is increasingly being provided in general health care settings, so that emerging problems can be detected and early intervention provided if necessary. The addition of services to address substance use problems and disorders in mainstream health care has extended the continuum of care, and includes a range of effective, evidence-based medications, behavioral therapies, and supportive services. However, a number of barriers have limited the widespread adoption of these services, including lack of resources, insufficient training, and workforce shortages.5 This is particularly true for the treatment of those with co-occurring substance use and physical or mental disorders.6,7 See Chapter 6 - Health Care Systems
and Substance Use Disorders.
1 1

TREATMENT
PAGE | 4-2
This chapter provides an overview of the scientific evidence supporting the effectiveness of treatment interventions, therapies, services, and medications available to identify, treat, and manage substance use problems and disorders.

KEY FINDINGS*
• Well-supported scientific evidence shows that substance use disorders can be effectively treated, with recurrence rates no higher than those for other chronic illnesses such as diabetes, asthma, and hypertension. With comprehensive continuing care, recovery is now an achievable outcome. • Only about 1 in 10 people with a substance use disorder receive any type of specialty treatment. The great majority of treatment has occurred in specialty substance use disorder treatment programs with little involvement by primary or general health care. However, a shift is occurring to mainstream the delivery of early intervention and treatment services into general health care practice. • Well-supported scientific evidence shows that medications can be effective in treating serious substance use disorders, but they are under-used. The U.S. Food and Drug Administration (FDA) has approved three medications to treat alcohol use disorders and three others to treat opioid use disorders. However, an insufficient number of existing treatment programs or practicing physicians offer these medications. To date, no FDA-approved medications are available to treat marijuana, cocaine, methamphetamine, or other substance use disorders, with the exception of the medications previously noted for alcohol and opioid use disorders.
• Supported scientific evidence indicates that substance misuse and substance use disorders can be reliably and easily identified through screening and that less severe forms of these conditions often respond to brief physician advice and other types of brief interventions. Well-supported scientific evidence shows that these brief interventions work with mild severity alcohol use disorders, but only promising evidence suggests that they are effective with drug use disorders. • Well-supported scientific evidence shows that treatment for substance use disorders—including inpatient, residential, and outpatient—are cost-effective compared with no treatment. • The primary goals and general management methods of treatment for substance use disorders are the same as those for the treatment of other chronic illnesses. The goals of treatment are to reduce key symptoms to non-problematic levels and improve health and functional status; this is equally true for those with co-occurring substance use disorders and other psychiatric disorders. Key components of care are medications, behavioral therapies, and recovery support services (RSS). • Well-supported scientific evidence shows that behavioral therapies can be effective in treating substance use disorders, but most evidence-based behavioral therapies are often implemented with limited fidelity and are under-used. Treatments using these evidence-based practices have shown better results than non-evidence-based treatments and services. • Promising scientific evidence suggests that several electronic technologies, like the adoption of electronic health records (EHRs) and the use of telehealth, could improve access, engagement, monitoring, and continuing supportive care of those with substance use disorders. *The Centers for Disease Control and Prevention (CDC) summarizes strength of evidence as: “Well-supported”:
when evidence is derived from multiple controlled trials or large-scale population studies; “Supported”: when evidence is derived from rigorous but fewer or smaller trials; and “Promising”: when evidence is derived from a practical or clinical sense and is widely practiced.8

TREATMENT
PAGE | 4-3
Continuum of Treatment Services
Substance use disorders typically emerge during adolescence and often (but not always) progress in severity and complexity with continued substance misuse.9,10 Currently, substance use disorders are classified diagnostically into three severity categories: mild, moderate, and severe.2
Substance use disorder treatment is designed to help
individuals stop or reduce harmful substance misuse, improve their health and social function, and manage their risk for relapse. In this regard, substance use disorder treatment is effective and has a positive economic impact. Research shows that treatment also improves individuals’ productivity,11 health,11,12 and overall quality of life.13-15 In addition, studies show that every dollar spent on substance use disorder
treatment saves $4 in health care costs and $7 in criminal justice costs.11
Mild substance use disorders can be identified quickly
and reliably in many medical and social settings. These common but less severe disorders often respond to brief motivational interventions and/or supportive monitoring, referred to as guided self-change.16 In contrast, severe, complex, and chronic substance use disorders often require specialty substance use disorder treatment and continued post-treatment support to achieve full remission and recovery. To address the spectrum of substance use problems and disorders, a continuum of care provides individuals an array of service options based on need, including prevention, early intervention, treatment, and recovery support (Figure 4.1). Traditionally, the vast majority of treatment for substance use disorders has been provided in specialty substance use disorder treatment programs, and these programs vary substantially in their clinical objectives and in the frequency, intensity, and setting of care delivery.

Substance Use Disorder Treatment.

A service or set of services that may
include medication, counseling, and
other supportive services designed
to enable an individual to reduce or
eliminate alcohol and/or other drug use,
address associated physical or mental
health problems, and restore the patient
to maximum functional ability.3
Continuum of Care. An integrated
system of care that guides and
tracks a person over time through
a comprehensive array of health
services appropriate to the individual’s
need. A continuum of care may
include prevention, early intervention,
treatment, continuing care, and recovery
support.4
1 1

TREATMENT
PAGE | 4-4
Figure 4.1: Substance Use Status and Substance Use Care Continuum Positive Physical, Social, and
Mental Health
Substance Misuse Substance Use Disorder
A state of physical, mental, and
social well-being, free from
substance misuse, in which an
individual is able to realize his
or her abilities, cope with the
normal stresses of life, work
productively and fruitfully, and
make a contribution to his or her
community.

The use of any substance in a
manner, situation, amount, or
frequency that can cause harm to
the user and/or to those around
them.

Clinically and functionally significant
impairment caused by substance
use, including health problems,
disability, and failure to meet major
responsibilities at work, school, or
home; substance use disorders are
measured on a continuum from
mild, moderate, to severe based on
a person’s number of symptoms.

Substance Use Status Continuum
Substance Use Care Continuum
Enhancing Health Primary
Prevention
Early
Intervention
Treatment Recovery
Support
Promoting
optimum physical
and mental
health and wellbeing, free from
substance misuse,
through health
mmunications and
access to health
care services,
income and
economic security,
and workplace
certainty.

Addressing
individual and
environmental
risk factors
for substance
use through
evidencebased
programs,
policies, and
strategies.

Screening
and detecting
substance use
problems at
an early stage
and providing
brief
intervention,
as needed.

Intervening through medication,
counseling, and other supportive
services to eliminate symptoms
and achieve and maintain sobriety,
physical, spiritual, and mental health
and maximum functional ability.

Levels of care include:
• Outpatient services;
• Intensive Outpatient/ Partial
Hospitalization Services;
• Residential/ Inpatient Services; and
• Medically Managed Intensive
Inpatient Services.

Removing barriers
and providing
supports to
aid the longterm recovery
process. Includes
a range of social,
educational,
legal, and other
services that
facilitate recovery,
wellness, and
improved quality
of life.

This chapter describes the early intervention and treatment components of the continuum of care, the major behavioral, pharmacological, and service components of care, services available, and emerging treatment technologies:
$ Early Intervention, for addressing substance misuse problems or mild disorders and helping to prevent more severe substance use disorders.
$ Treatment engagement and harm reduction interventions, for individuals who have a substance use disorder but who may not be ready to enter treatment, help engage individuals in treatment and reduce the risks and harms associated with substance misuse. $ Substance use disorder treatment, an individualized set of evidence-based clinical services designed to improve health and function, including medications and behavioral therapies. $ Emerging treatment technologies are increasingly being used to support the assessment, treatment, and maintenance of continuing contact with individuals with substance use disorders.

EXHIBIT 11
What Did We Learn from Our Study on Sober Living Houses and Where Do We Go from Here?
Douglas L. Polcin, Ed.D.*, Rachael Korcha, M.A.*, Jason Bond, Ph.D.*, and Gantt Galloway, Pharm.D.**
*Alcohol Research Group Public Health Institute 6475 Christie Avenue, Suite 400 Emeryville, CA 94608-1010
**California Pacific Medical Center St. Luke's Hospital San Francisco, CA Abstract
Lack of a stable, alcohol and drug free living environment can be a serious obstacle to sustained abstinence. Destructive living environments can derail recovery for even highly motivated individuals. Sober living houses (SLHs) are alcohol and drug free living environments for individuals attempting to abstain from alcohol and drugs. They are not licensed or funded by state or local governments and the residents themselves pay for costs. The philosophy of recovery emphasizes 12-step group attendance and peer support. We studied 300 individuals entering two different types of SLHs over an 18 month period. This paper summarizes our published findings documenting resident improvement on measures of alcohol and drug use, employment, arrests, and psychiatric symptoms. Involvement in 12-step groups and characteristics of the social network were strong predictors of outcome, reaffirming the importance of social and environmental factors in recovery. The paper adds to our previous reports by providing a discussion of implications for treatment and criminal justice systems. We also describe the next steps in our research on SLHs, which will include: 1) an attempt to improve outcomes for residents referred from the criminal justice system and 2) a depiction of how attitudes of stakeholder groups create a community context that can facilitate and hinder the legitimacy of SLHs as a recovery modality.

Keywords
Sober Living House; Residential Treatment; Recovery House; Social Model; Communal Living Introduction
Research continues to document the important role of social factors in recovery outcome (Polcin, Korcha, Bond, Galloway & Lapp, in press). For example, in a study of problem and dependent drinkers Beattie and Longabaugh (1999) found that social support was associated with drinking outcome. Not surprising, the best outcomes were predicted by alcohol-specific social support that discouraged drinking. Similarly, Zywiak, Longabaugh and Wirtz (2002) found that clients who had social networks with a higher number of abstainers and recovering alcoholics had better outcome 3 years after treatment completion. Moos and Moos (2006) studied a large sample of 461 treated and untreated individuals with alcohol use disorders over a 16 year period to examine factors associated with relapse. They found that social support for recovery was important in establishing sustained abstinence. Finally, Bond, Kaskutas and Weisner (2003) reached a similar conclusion in a 3-year follow up Phone (510) 597-3440 Fax (510) 985-6459 [email protected] NIH Public Access
Author Manuscript
J Psychoactive Drugs. Author manuscript; available in PMC 2011 March 15.

Published in final edited form as:

J Psychoactive Drugs. 2010 December ; 42(4): 425–433.

NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript study on 655 alcohol dependent individuals who were seeking treatment. Abstinence from alcohol was associated with social support for sobriety and involvement in Alcoholics Anonymous.

A critically important aspect of one's social network is their living environment. Recognition of the importance of one's living environment led to a proliferation of inpatient and residential treatment programs during the 1960' and 70's (White, 1998). The idea was to remove clients from destructive living environments that encouraged substance use and create new social support systems in treatment. Some programs created halfway houses where clients could reside after they completed residential treatment or while they attended outpatient treatment. A variety of studies showed that halfway houses improved treatment outcome (Braucht, Reichardt, Geissler, & Bormann, 1995; Hitchcock, Stainback, & Roque, 1995; Milby, Schumacher, Wallace, Freedman & Vuchinich, 2005; Schinka, Francis, Hughes, LaLone, & Flynn, 1998).

Despite the advantages of halfway houses, there are limitations as well (Polcin & Henderson, 2008). First, there is typically a limit on how long residents can stay. After some period of time, usually several months, residents are required to move out whether or not they feel ready for independent living. A second issue is financing the houses, which often includes government funding. This leaves facilities vulnerable to funding cuts. Finally, halfway houses require residents to have completed or be involved in some type of formal treatment. For a variety of reasons some individuals may want to avoid formal treatment programs. Some may have had negative experiences in treatment and therefore seek out alternative paths to recovery. Others may have relapsed after treatment and therefore feel the need for increased support for abstinence. However, they may want to avoid the level of commitment involved in reentering a formal treatment program. Sober living houses (SLHs) are alcohol and drug free living environments that offer peer support for recovery outside the context of treatment.

Characteristics of Sober Living Houses
Sober Living Houses are structured in a way that avoids some of the limitations of halfway houses. The essential characteristics include: 1) an alcohol and drug free living environment for individuals attempting to abstain from alcohol and drugs, 2) no formal treatment services but either mandated or strongly encouraged attendance at 12-step self-help groups such as Alcoholics Anonymous (AA), 3) required compliance with house rules such as maintaining abstinence, paying rent and other fees, participating in house chores and attending house meetings, 4) resident responsibility for financing rent and other costs, and 5) an invitation for residents to stay in the house as long as they wish provided they comply with house rules (Polcin & Henderson, 2008).

SLHs have their origins in the state of California and most continue to be located there (Polcin & Henderson, 2008). It is difficult to ascertain the exact number because they are not formal treatment programs and are therefore outside the purview of state licensing agencies.

However, in California many SLHs are affiliated with coalitions or associations that monitor health, safety, quality and adherence to a peer-oriented model of recovery, such as the California Association of Addiction Recovery Resources (CAARR) or the Sober Living Network (SLN). Over 24 agencies affiliated with CAARR offer clean and sober living services. The SLN has over 500 individual houses among it membership.

While some SLHs use a “strong manager” model where the owner or manager of the house develops and enforces the house rules, contemporary SLH associations such as CAARR and SLN emphasize a “social model approach” to managing houses that empowers residents by providing leadership position and forums where they can have input into decision making Polcin et al. Page 2
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript (Polcin & Henderson, 2008). Some houses have a “residents' council,” which functions as a type of government for the house.

Recovery Philosophy in Sober Living Houses
Central to recovery in SLHs is involvement in 12-step mutual help groups (Polcin & Henderson, 2008). Residents are usually required or strongly encouraged to attend meetings and actively work a 12-step recovery program (e.g., obtain a sponsor, practice the 12 steps, and volunteer for service positions that support meetings). However, some houses will allow other types of activities that can substitute for 12 step groups, provided they constitute a strategy for maintaining ongoing abstinence.

Developing a social network that supports ongoing sobriety is also an important component of the recovery model used in SLHs. Residents are encouraged to provide mutual support and encouragement for recovery with fellow peers in the house. Those who have been in the house the longest and who have more time in recovery are especially encouraged to provide support to new residents. This type of “giving back” is consistent with a principle of recovery in 12-step groups. Residents are also encouraged to avoid friends and family who might encourage them to use alcohol and drugs, particularly individuals with whom they have used substances in the past (Polcin, Korcha, Bond, Galloway & Lapp, in press).

Purpose
There are several primary aims for this paper. First is to summarize key outcomes from our study, “An Evaluation of Sober Living Houses,” which was a 5- year study funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA) (i.e., Korcha, Polcin, Bond & Galloway, 2010; Polcin, 2009; Polcin & Henderson, 2008; Polcin, Korcha, Bond & Galloway, 2010; Polcin, Korcha, Bond & Galloway, in press; Polcin, Korcha, Bond, Galloway & Lapp in press). Second is to expand on these findings by considering potential implications of our research for inpatient and outpatient treatment and for criminal justice systems. Third is to describe the next steps in our research on SLHs. These include plans to study the community context of SLHs by examining attitudes of community stakeholder groups (e.g., neighbors, local government officials, mental health therapists, criminal justice professionals and practitioners in substance abuse treatment programs). We also describe plans to conduct studies of resident subgroups, such as individuals referred from the criminal justice system.

Data Collection Sites
The study was designed to assess outcomes for 300 individuals entering two types of SLHs:
1) Options Recovery Services (ORS) in Berkeley, California was an adapted model of SLHs in that the houses were associated with an outpatient treatment program. 2) Clean and Sober Transitional Living (CSTL) in Sacramento County, California consisted of freestanding houses that were not affiliated with any type of treatment. The descriptions of CSLT and ORS that follow are summaries of Polcin and Henderson (2008), Polcin (2009) and Polcin, Korcha, Bond, Galloway & Lapp (in press).

Clean and Sober Transitional Living (CSTL)
CSLT is located in Sacramento County California and consists of 16 houses with a 136 bed capacity. Residency at CSTL is divided into two phases. Phase I lasts 30 to 90 days and is designed to provide some limits and structure for new residents. Residents must agree to abide by a curfew and attend at 12-step meetings five times per week. The purpose of these Polcin et al. Page 3
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript requirements is to help residents successfully transition into the facility, adapt to the SLH environment, and develop a stable recovery program.

The second phase allows for more personal autonomy and increased responsibility for one's recovery. Curfews and requirements for 12-step attendance are reduced. All residents, regardless of phase, are required to be active in 12-step recovery programs, abide by basic house rules, and abstain from alcohol and drugs. A “Resident Congress” consisting of current residents and alumni helps enforce house rules and provides input into the management of the houses. Although the owner/operator of the houses is ultimately responsible, she/he defers to the Residents Congress as much as possible to maintain a peer oriented approach to recovery. In order to be admitted to CSTL prospective residents must have begun some type of recovery program prior to their application.

Options Recovery Services (ORS)
ORS is an outpatient substance abuse treatment program located in Berkeley, California that treats approximately 800 clients per year. Most of the clients are low income and many have history of being homeless at some point in their lives. Because a large number do not have a stable living environment that supports abstinence from alcohol and drugs, ORS developed SLHs where clients can live while they attend the outpatient program. Currently there are 4 houses with 58 beds. The houses are different from freestanding SLHs, such as those at CSTL, because all residents must be involved in the outpatient program. Most residents enter the houses after residing in a short term homeless shelter located near the program. At admission, nearly all residents are eligible for some type of government assistance (e.g., general assistance or social security disability) and use those funds to pay SLH fees. To help limit social isolation and reduce costs residents share bedrooms. Like other SLH models of recovery, residence are free to stay as long as they wish provide they comply with house rules (e.g., curfews, attendance at 12-step meetings) and fulfill their financial obligations.

Also like other SLH models, each house has a house manager who is responsible for ensuring house rules and requirements are followed. ORS does not have any type of Residents Council, but house managers meet regularly with the executive director and have input into operation of the SLHs in during these contacts.

Procedures
Participants were interviewed within their first week of entering a sober living house and again at 6-, 12-, and 18-month follow up. To maximize generalization of findings, very few exclusion criteria were used and very few residents declined to participate. Primary outcomes consisted or self report measures of alcohol and drug use. Secondary outcomes included measures of legal, employment, medical, psychiatric and family problems. Some measures assessed the entire 6 months between data collection time points. Others, such as the Addiction Severity Index, assessed shorter time periods of 30 days or less.

Measures
1) Demographic Characteristics—included standard demographic questions such as age, gender, ethnicity, marital status, and education.
2) Addiction Severity Index Lite (ASI)—The ASI is a standardized, structured interview that assesses problem severity in six areas: medical, employment/support, drug/ alcohol, legal, family/social and psychological (McLellan et al., 1992). Each of the six areas is scored for 0 (low) to 1 (high).

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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript 3) Psychiatric symptoms—To assess current psychiatric severity we used the Brief Symptom Inventory (Derogatis & Melisaratos, 1983). This 53-item measure assesses severity of psychiatric symptoms on nine clinical scales as well as three global indices.

Items are rated on a 5-point scale and ask about symptoms over the past 7 days. We used the Global Severity Index (GSI) as an overall measure of psychiatric severity. 4) Six month measures of alcohol and drug use—These measures were taken from Gerstein et al. (1994) and labeled Peak Density and 6-month abstinence. Peak Density is the number of days of any substance use (i.e., any alcohol or drug) during the month of highest use over the past 6 months (coded 0-31). Six-month abstinence was a dichotomous yes/no regarding any use of alcohol of drugs over the past 6 months. 5) Arrests—This measure was taken from Gerstein et al. (1994) and was defined as number of arrests over the past 6 months.

Two additional measures were included as covariates because they assess factors emphasized by as important to recovery in SLHs.
6) Alcoholics Anonymous Affiliation Scale—This measure includes 9 items and was developed by Humphreys, Kaskutas and Weisner (1998) to measure the strength of an individual's affiliation with AA. The scale includes a number of items beyond attendance at meetings, including questions about sponsorship, spirituality, and volunteer service positions at meetings.
7) Drinking and drug use status in the social network—These measures were taken from the Important People Instrument (Zywiak, et al., 2002). The instrument allows participants to identify up to 12 important people in his or her network whom they have had contact with in the past six months. Information on the type of relationship (e.g., spouse, friend), amount of contact over the past 6 months (e.g., daily, once or twice a week) and drug and alcohol use over the past 6 months (e.g., heavy user, light user, in recovery) was obtained for each person in the social network. The drinking status of the social network was calculated by multiplying the amount of contact by the drinking pattern of each network member, averaged across the network. The same method is applied to obtain the drug status of the network member; the amount of contact is multiplied by the pattern of drug use and averaged across network members.

Hypotheses
Hypotheses suggested that we would find two types of longitudinal outcomes: 1) Individuals entering the houses with higher severity of problems would show significant improvement between baseline and 6 months and those improvements would be maintained at 12 and 18 months and 2) Individuals entering houses with low severity would maintain low severity at all follow up time points. It was expected that measures of social support for sobriety and 12-step involvement would be associated with primary outcomes.

The study design used repeated measures analyses to test how study measures varied over time. Because the two types of houses served residents with different demographic characteristics, we conducted disaggregated longitudinal analyses for each. For a more complete description of the study design and collection of data see Polcin et al. (2010), Polcin et al. (in press) and Polcin, Korcha, Bond, Galloway and Lapp (in press).

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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Data Collection
At CSTL we recruited 245 individuals within their first week of entering the houses. Most were men (77%), white (72.5%) and middle age (mean=38, se=0.65). Over 75% had at least a high school education or GED. The most common referral source was self, family or friend (44%) followed by criminal justice (29%) and inpatient treatment (15%). Over a third (35%) of the sample indicated that jail or prison had been their usual housing situation over the past 6 months and few reported any type of stable housing over the past 6 months. Just 7% reported renting an apartment as their primary housing, while 23% reported staying with family or friends and 12% reported homeless as their primary living situation ORS had 4 houses, where we recruited 55 participants. Most were African American (59%), while 30% were white. The mean age was 43 years (se=1.2). Most residents had completed high school or a GED (73%). Nearly half of the residents had been self referred of referred by family or friends. About 24% were criminal justice referrals and a third had spent some time in a controlled environment during the month before entering the house. Many of the residents had histories of homelessness. When asked to indicate their usual housing situation the past six months, a third indicated homeless or in a shelter.

Follow up rates for CSLT were 72% at 6 months, 71% at 12 months ad 73% at 18 months.

However, 89% of the sample (N=218) participated in at least one follow up interview. The proportions successfully followed up at ORS were similar at 12 and 18 months (76% and 71% respectively) but higher at 6 months (86%). To address the issue of missing data from individuals who we were not able to locate for follow up interviews, we used analytic methods that did not require participants to complete 0interviews at all time points to be include in the analysis. These included generalized estimated equations (GEE) and mixed model regressions. In addition, when we compared baseline characteristics of individuals successfully located and interviewed with those lost at follow up we did not find significant differences. However, individuals who we were not able to follow up did have shorter lengths of stay in the SLHs.

Main Findings
Detailed descriptions of analytic methods and statistical results have been reported in Polcin, Korcha, Bond, & Galloway (2010), Polcin Korcha, Bond, & Galloway (in press), and Polcin Korcha, Bond, Galloway & Lapp (in press). Our purpose here is to summarize the most salient and relevant findings for SLHs as a community based recovery option. We then expand on the findings by considering potential implications of SLHs for treatment and criminal justice systems. We also include a discussion of our plans to study the community context of SLHs, which will depict how stakeholder influences support and hinder their operations and potential for expansion.

Retention
Retention of residents in the sober living houses was excellent. Average lengths of stay in both types of sober living houses surpassed the National Institute on Drug Abuse recommendation of at least 90 days to obtain maximum benefit. The average length of stay at ORS was 254 days (se=169 days) and at CSLT it was 166 days (se=163).

Primary Outcomes
As hypothesized, there were two patterns of outcome for our primary outcome variables.

One pattern was that residents reduced or stopped their substance use between baseline and 6 month follow up and then maintained those improvements at 12 and 18 months. This was the case for both substance use measures that assessed 6 month period of time: 1) complete Polcin et al. Page 6
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript abstinence over the 6 months and 2) maximum number of days of any substance use during the month of highest use. For example, at ORS 6-month abstinence rates improved from 11% at baseline to 68% at 6- and 12-months. At 18 months abstinence was a bit lower, (46%) but still significantly better than the time period before they entered the houses. For CSLT, abstinence improved from 20% at baseline, to 40% at 6 months, 45% at 12 months and 42% at 18 months. Maximum number of days of use per month at ORS on average declined from 19 days per month at baseline, to 3 days at 6 months, 4 days at 12 months and 7 days at 18 months. CSLT declined from 19 days at baseline, to 11 days at 6 months, 9 days at 12 months and 13 days at 18 months.

Findings on the ASI alcohol and drug scales measuring the past 30 days reflected different patterns. At CSLT, residents entered with low alcohol (mean=0.16, se=0.02) and drug (mean=0.08, se=0.01) severity. Because severity was low there was limited room to improve on these measures. Nevertheless, we found significant improvement at 6 months for both alcohol (mean=0.10, se=0.02) and drug (mean=0.05, se=0.01). Those improvements were maintained at 12 and 18 months. At ORS, residents entered with even lower alcohol (mean=0.07, se=0.02) and drug (mean=0.05, se=0.01) severity that was maintained at 6, 12 and 18 month follow up. Potential reasons for low alcohol and drug severity at baseline included large proportions spending some time in a controlled environment during the 30 days before they entered the houses. In addition, many residents had begun working on a recovery program shortly before they entered the houses (e.g., attending 12-step meetings).

In fact, the ORS program typically required 30 days of abstinence before being eligible to enter the residence.

It was noteworthy that a wide variety of individuals in both programs had positive outcomes.

There were no significant differences within either program on outcomes among demographic subgroups or different referral sources. In addition, it is important to note that residents were able to maintain improvements even after they left the SLHs. At 12 months 68% had left ORS and 82% had left CSLT. By 18 months nearly all had left, yet improvements were for the most part maintained.

Secondary Outcomes
There were also improvements noted on the secondary outcome measures. At CSTL these included improvements on employment, psychiatric symptoms, and arrests. The pattern was again significant improvement between baseline and 6 months that was generally maintained at 12 and 18 months. The percent arrested 6 months pre-baseline was 42%, which dropped to 26% at 6-month follow up and 22% at 12 months. There was a light increase at 18 months (28%), which was still significantly lower than pre-baseline. Employment severity on the ASI improved from a mean of 0.76(se=0.02) at baseline to a mean of 0.53(se=0.02) at six months. At 12 months the mean was 0.54(se=0.03), which increased only slightly at 18 months (mean=0.59, se=0.02). Psychiatric symptoms improved from a mean of

0.83(se=0.05) at baseline to 0.69(se=0.05) at 6 months. By 18 months there was a bit of an increase (mean=0.72, se=0.06), which was no longer statistically significant but was still a statistical trend (p<.10).

At ORS there were similar patterns of improvement on employment and arrests. From baseline to 6 months the average score on the ASI employment scale improved from 0.61 (se=0.02) to 0.51 (se= 0.03) and was maintained at 12 and 18 months. The odds of being arrested were reduced from baseline to 6 months by 80% and even further reduced at 12 and 18 months.

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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Factors that Predicted Outcome
In addition to documenting longitudinal outcomes, we were interested in assessing factors that predicted outcomes. Using GEE models that assessed a variety of factors across data collection time points we found involvement in 12-step groups to be the strongest predictor of our primary outcomes. For CSLT, 12-step involvement was associated with being abstinent for at least 6 months (p<.001), lower maximum days of substance us per month (p<.001, and fewer arrests (p<.01). For ORS, 12-step involvement was associated with abstinent for at least 6 months (p<.05), lower maximum days of substance us per month (p<. 01), and lower ASI legal severity (p<.05).

We also examined how drinking and drug use in the participant's social network related to outcomes. At CSLT we found heavier drinking and drug use in the social network was related to worse outcome on all alcohol and drug outcome measures (p<.01 for all variables). At ORS the findings were mixed. There was a significant relationship between maximum number of days of substance use per month and drinking in the social network (p<.05) and drug use in the social network (p<.01). However, there were no significant relationships between social network variables and abstinence. In addition, for the ASI alcohol and drug scales at ORS, the only significant association with social network variables was heavier drug use in the social network predicting ASI alcohol outcome (p<. 01).

In a recent analysis of CSTL residents we looked at psychiatric severity as a predictor of alcohol and drug outcome using growth curve models (Korcha et al (2010). We found that a subgroup of about a third of the residents had significantly higher psychiatric severity than other residents and had significantly worse outcomes. Our work on identifying and describing these residents with worse outcome is continuing.

Limitations
There are several limitations to the study that are important to consider. First, we could not directly compare which type of SLH was most effective because there were demographic and other individual characteristics that differed between the two types of houses. Second, individuals self selected themselves into the houses and a priori characteristics of these individuals may have at least in part accounted for the longitudinal improvements. Although self selection can be viewed as a weakness of the research designs, it can also be conceived as a strength, especially for studying residential recovery programs. Our study design had characteristics that DeLeon, Inciardi and Martin (1995) suggested were critical to studies of residential recovery programs. They argued that self selection of participants to the interventions being studies was an advantage because it mirrored the way individuals typically choose to enter treatment. Thus, self selection was integral to the intervention being studied and without self selection it was difficult to argue that a valid examination of the invention had been conducted. In their view, random assignment of participants to conditions was often appropriate for medication studies but often inappropriately applied when used to study residential services for recovery from addiction.

Significance of the Study
Our study represents the first examination of sober living house residents using a longitudinal design. To date, our papers have looked at study findings in terms of the types of improvements residents make and factors associated with outcome, the substance of which has been summarized above. One of our aims here, however, is also to look at significance from the perspective of how SLHs might impact various service systems in the community. The promising outcomes for SLH residents suggest that sober living houses Polcin et al. Page 8
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript might play more substantive roles for persons: 1) completing residential treatment, 2) attending outpatient treatment, 3) seeking non-treatment alternatives for recovery, and 4) entering the community after criminal justice incarceration.

Treatment Systems
The two types of recovery houses assessed in this study showed different strengths and weaknesses and served different types of individuals. Communities and addiction treatment systems should therefore carefully assess the types of recovery housing that might be most helpful to their communities. Several considerations are reviewed below.

Outpatient programs in low income urban areas might find the Options Recovery Services model of SLHs helpful. Relative to the other housing programs, this model was inexpensive and the houses were conveniently located near the outpatient facility. Typically, residents entered these SLHs after establishing some period of sobriety while they resided in a nearby shelter and attended the outpatient program. A significant strength of the Options houses was that residents were able to maintain low alcohol and drug severity at 12-month follow up.

There are several significant advantages of establishing SLHs associated with outpatient treatment as apposed to traditional halfway houses. First, residents in SLHs are free to stay as long as they wish after completing the outpatient program as long as they abide by program rules. This eliminates arbitrary discharge dates determined by the program, a procedure often used by halfway houses to free up beds. Rather, the resident is able to decide when he or she is ready to transition to more independence. Among other things, this eliminates the need to move to questionable living environments that might not support recovery due to time limitations. SLHs are also less costly than halfway houses, which are usually funded by treatment programs.

SLHs combined with outpatient treatment may be especially valuable to resource poor communities that do not have funds to establish residential treatment programs or have the income levels that could support freestanding sober living houses which are more expensive.

Most of the rent for the Options SLHs was paid by General Assistance or Social Security Income, so a variety of low income residents could be accommodated. While the level of support is less intensive (and less expensive) than that offered in residential treatment, it is more intensive than the relative autonomy found in freestanding SLHs. Some residents probably benefit from the mandate that they attend outpatient treatment during the day and comply with a curfew in the evening. For some individuals, the limited structure offered by freestanding SLHs could invite association with substance using friends and family and thus precipitate relapse. This could be particularly problematic in poor communities where residents have easy access to substances and people who use them.

Freestanding SLHs
The roles that freestanding SLHs can play in communities are different from SLHs that are associated with outpatient treatment. First, freestanding houses are often used by individuals who have some previous experience with residential treatment. While some of these individuals transition directly from the inpatient program to the SLH, others enter the houses after some post-treatment period in the community. They may slip, relapse or feel vulnerable to relapse, but for a variety of reasons not want to reenter a formal treatment program.

Nevertheless, they may feel the need to take action and get support for reestablishing abstinence. Freestanding SLHs can be a good match for these individuals because they offer support for sobriety outside the context of formal treatment.

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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Freestanding SLH's offer a limited amount of structure and no formal treatment services.

Thus, they are optimal for residents who are capable of handling a fair amount of autonomy and who can take personal responsibility for their recovery. Despite these limitations, CSLT appeared to benefit many different types of residents who were referred from an array of personal and institutional sources (i.e., self, family, criminal justice systems, and inpatient treatment programs). Expansion of freestanding SLHs in communities might therefore ease the burden on overwhelmed treatment systems. In communities that are unable to fund a sufficient number of treatment programs for individuals with substance use disorders, freestanding SLHs might be a clinically and economically effective alternative. The availability of treatment slots for individuals released from jail or prison or particularly lacking. For some those offenders who are motivated for abstinence and capable of handling some degree of autonomy SLHs might be a viable and effective option for recovery that is currently underutilized.

Criminal Justice Systems
Prison and jail overcrowding in the U.S. has reached a crisis point. Each year more than 7 million individuals are released from local jails into communities and over 600,000 are released on parole from prison (Freudenberg, Daniels, Crum, Perkins & Richie, 2005).

Although the need for alcohol and drug treatment among this population is high, very few receive services during or after their incarceration. In California, studies show that few offenders being released from state prisons have adequate housing options and in urban areas such as San Francisco and Los Angeles up to a third become homeless (Petersilia, 2003). Housing instability has contributed to high reincarceration rates in California, with up to two-thirds of parolees are reincarcerated within three years. In a study of women offenders released from jails in New York City 71% indicated that lack of adequate housing was their primary concern.

Despite the enormous need for housing among the offender population, SLHs have been largely overlooked as a housing option for them (Polcin, 2006c). This is particularly concerning because our analysis of criminal justice offenders in SLHs showed alcohol and drug outcomes that were similar to residents who entered the houses voluntarily. However, as reviewed elsewhere (i.e., Polcin, 2006c), SLHs need to carefully target criminal justice involved individuals so that they select offenders that have sufficient motivation to remain abstinent and are able to meet their financial obligations.

Where do We go from Here?
There are multiple directions one could go in pursuit of additional research on SLHs. For example, studies comparing different living situations for individuals in early recovery could help highlight the relative strengths and weaknesses of SLHs. In addition, longer follow up time periods could be assessed as well as outcomes for a wider variety of subgroups. These might include minority groups, larger samples of women, and a variety of individual level characteristics not assessed here (e.g., self efficacy and interpersonal skills). However, we have opted to look at two topics that we think are of immediate relevance to communities: 1) documenting and improving outcomes for criminal justice referred residents and 2) understanding the community context within which SLHs operate.

Improving Outcomes for Criminal Justice Referred Residents Findings from our study suggested that alcohol and drug outcomes for residents referred from the criminal justice system were equivalent to that of voluntary residents. However, offenders did not fare as well as others in two areas: finding and maintaining employment and avoiding arrests. In addition, the numbers of criminal justice referred residents was Polcin et al. Page 10
J Psychoactive Drugs. Author manuscript; available in PMC 2011 March 15.

NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript relatively small and an examination of a larger sample of offenders is warranted. Among other things, the larger sample would enable us to identify predictors of outcome among offenders. The field would therefore be better equipped to identify those offenders who are more likely to do well in SLHs.

In addition to studying a larger number of offenders, we hope to explore an innovative intervention designed to improve outcomes for these residents in terms of employment, arrests, and other areas. Toward that end, we are in the process of developing a Motivational Interviewing Case Management (MICM) intervention designed to help offenders successfully transition into SLHs, avoid rearrest by complying with the terms of probation or parole, and succeed in activities that support successful transition into the community (e.g., employment). Our intervention modifies motivational interviewing to address the specific needs of the offender population (Polcin, 2006b). Specifically, it helps residents resolve their mixed feelings (i.e., ambivalence) about living in the SLH and engaging in other community based services. Thus, the intervention is a way to help them prepare for the challenges and recognize the potential benefits of new activities and experiences.

Assessing the Impact of the Community Context
The fact that residents in SLHs make improvement over time does not necessarily mean that SLHs will find acceptance in the community. In fact, one of the most frustrating issues for addiction researchers is the extent to which interventions that have been shown to be effective are not implemented in community programs. We suggest that efforts to translate research into treatment have not sufficiently appreciated how interventions are perceived and affected by various stakeholder groups (Polcin, 2006a). We therefore suggest that there is a need to pay attention to the community context where those interventions are delivered.

As a next step in our research on SLHs we plan to assess how they are viewed by various stakeholder groups in the community, including house managers, neighbors, treatment professionals, and local government officials. Interviews will elicit their knowledge about addiction, recovery, and community based recovery houses such as SLHs. Their perceptions of the strengths and weaknesses of SLHs in their communities should provide data that can be used to modify houses to improve acceptance and expand to serve more drug and alcohol dependent persons. We hypothesize that barriers to expansion of SLHs might vary by stakeholder groups. Different strategies may be needed for those who lack information about SLHs, have beliefs that they are not effective, have allegiances to other treatment approaches, have views that minimize social factors in recovery, and live in communities where public policy hinders expansion of SLHs. Drug and alcohol administrators and operators of houses might therefore need different strategies to address the concerns of different stakeholders.

Conclusion
Many individuals attempting to abstain from alcohol and drugs do not have access to appropriate housing that supports sustained recovery. Our study found positive longitudinal outcomes for 300 individuals living in two different types of SLHs, which suggests they might be an effective option for those in need of alcohol- and drug-free housing.

Improvements were noted in alcohol and drug use, arrests, psychiatric symptoms and employment. Owners and operators of SLHs should pay attention to factors that predicted better alcohol and drug outcomes, including higher involvement in 12-step meetings, lower alcohol and drug use in the social network, and lower psychiatric severity. Although criminal justice referred residents had alcohol and drug use outcomes that were similar to other residents, they had a harder time finding and keeping work and had higher rearrest rates. Areas for further research include testing innovative interventions to improve criminal Polcin et al. Page 11
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript justice outcomes, such as Motivational Interviewing Case Management (MICM) and examining the community context of SLHs. Recognizing stakeholder views that hinder and support SLHs will be essential if they are to expand to better meet the housing needs of persons suffering from alcohol and drug disorders.

Acknowledgments
Supported by R01AA14030 and R21DA025208
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Addictive Behaviors 1999;24:593–606. [PubMed: 10574299] Bond J, Kaskutas LA, Weisner C. The persistent influence of social networks and Alcoholics Anonymous on abstinence. Journal of Studies on Alcohol 2003;64:579–588. [PubMed: 12921201] Braucht BG, Reichardt CS, Geissler LJ, Bormann CA. Effective services for homeless substance abusers. Journal of Addictive Disease 1995;14:87–109.

De Leon G, Inciardi JA, Martin SS. Residential drug abuse treatment research: are conventional control designs appropriate for assessing treatment effectiveness? Journal of Psychoactive Drugs 1995;27(1):85–91. [PubMed: 7602444]
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Hitchcock HC, Stainback RD, Roque GM. Effects of halfway house placement on retention of patients in substance abuse aftercare. American Journal of Alcohol and drug Abuse 1995;21:379–390.

Humphries K, Kaskutas L, Weisner C. The Alcoholics Anonymous Affiliation Scale: development, reliability, and norms for diverse treated and untreated populations. Alcoholism: Clinical and Experimental Research 1998;22:974–8.

Korcha, RA.; Polcin, DL.; Bond, JC.; Galloway, GP. Psychiatric distress and substance use outcomes among sober living residents; 33rd Annual Research Society on Alcoholism Scientific Meeting; San Antonio, TX. Jun. 2010 p. 26-30.

McLellan AT, Cacciola J, Kushner H, Peters F, Smith I, Pettinati H. The fifth edition of the addiction Severity Index: Cautions, additions, and normative data. Journal of Substance Abuse Treatment 1992;9:199–213. [PubMed: 1334156]
Milby JB, Schumacher JE, Wallace D, Freedman MJ, Vuchinich RE. To house or not to house: The effects of providing housing to homeless substance abusers in treatment. American Journal of Public Health 2005;95:1259–1266. [PubMed: 15983278]
Moos RH. Theory-based processes that promote the remission of substance use disorders. Clinical Psychology Review 2007;27:537–551. [PubMed: 17254686]
Moos BS, Moos RH. Treated and untreated individuals with alcohol use disorders: Rates and predictors of remission and relapse. International Journal of Clinical and Health Psychology 2006;6:513–526.

Petersilia, J. When Prisoners Come Home: Parole and Prisoner Reentry. Oxford University Press; New York: 2003.

Polcin DL. How Health Services Research Can Help Clinical Trials Become More Community Relevant. International Journal of Drug Policy 2006a;17(3):230–237.

Polcin DL. Reexamining confrontation and motivational interviewing. Addictive Disorders and their Treatment 2006b;5(4):201–209.

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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript Polcin DL. What about sober living houses for parolees? Criminal Justice Studies: A Critical Journal of Crime, Law and Society 2006c;19:291–300.

Polcin DL. A model for sober housing during outpatient treatment. Journal of Psychoactive Drugs 2009;41(2):153–161. [PubMed: 19705677]
Polcin DL, Henderson D. A clean and sober place to live: Philosophy, structure, and purported therapeutic factors in sober living houses. Journal of Psychoactive Drugs 2008;40(2):153–159. [PubMed: 18720664]
Polcin DL, Korcha R, Bond J, Galloway GP. Sober Living Houses for Alcohol and Drug Dependence:
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Polcin DL, Korcha R, Bond J, Galloway GP. Eighteen month outcomes for clients receiving combined outpatient treatment and sober living houses. Journal of Substance Use. in press.

Polcin DL, Korcha R, Bond J, Galloway GP, Lapp W. Recovery from addiction in two types of sober living houses: 12-month outcomes. Addiction Research and Theory. in press.

Schinka JA, Francis E, Hughes P, LaLone L, Flynn C. Comparitive outcomes and costs of inpatient care and supportive housing for substance-dependent veterans. Psychiatric Services 1998;49:946– 950. [PubMed: 9661231]
White, WL. Slaying the dragon: The history of addiction treatment and recovery in America. Chestnut Health Systems; Bloomington, IL: 1998.

Zywiak WH, Longabaugh R, Wirtz PW. Decomposing the relationships between pretreatment social network characteristics and alcohol treatment outcome. Journal of Studies on Alcohol 2002;63:114–121. [PubMed: 11925053]
Polcin et al. Page 13
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NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author Manuscript EXHIBIT 12
1 On October 24, 2018 the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities was signed into law by President Trump. Subtitle D, Ensuring Access to Quality Sober Living (SEC. 7031), of this law mandates that the Secretary of Health and Human Services, in consultation with other specified individual stakeholders and entities, shall identify or facilitate the development of best practices for operating recovery housing. These best practices may include model laws for the implementation of suggested minimum standards that:
(1) consider how recovery housing is able to support recovery and prevent relapse, recidivism, and overdose, including by improving access to medication assisted treatment
(2) identify or facilitate the development of common indicators that could be used to pinpoint potentially fraudulent recovery housing operators The SUPPORT legislation seeks to improve resident care for individuals suffering from a substance use disorder who are in need of supportive recovery-oriented transitional housing. The Administration has dedicated time, attention, and resources to ensuring that individuals with substance use disorders have access to lifesaving medications, treatments, and services in settings throughout the continuum of care, including recovery housing. This document is intended to serve as a guidance tool for states, governing bodies, treatment providers, recovery house operators, and other interested stakeholders to improve the health of their citizens related to substance use issues.

This report identifies ten specific areas, or guiding principles, that will assist states and federal policy makers in defining and understanding what comprises safe, effective, and legal recovery housing. National organizations have contributed significant and valuable work in developing policies, practices, and guidance to improve recovery housing as an integral model of care. The guiding principles in this document are meant to provide an overarching framework that builds upon and extends the foundational policy and practice work that had guided the development of recovery housing to date. SAMHSA recommends following these Ten Guiding Principles to guide recovery house operators, stakeholders and states in enacting laws designed to provide the greatest level of resident care and safety possible.

Recovery housing is an intervention that is specifically designed to address the recovering person’s need for a safe and healthy living environment while supplying the requisite recovery and peer supports. The ten best practices and minimum standards are further described below in the following principles.
2 Ten Guiding Principles

1. Have a clear operational definition
All recovery housing should have a clear operational definition that accurately delineates the type of services offered and to what degree or intensity these services are provided.

The SUPPORT legislation defined the term ‘recovery housing’ to describe a shared living environment free from alcohol and illicit drug use and centered upon peer supports and connection to services that promote sustained recovery from substance use disorders.

Additionally, the Substance Abuse and Mental Health Services Administration (SAMHSA) official definition of recovery housing is described below:

Recovery houses are safe, healthy, family-like substance-free living environments that support individuals in recovery from addiction. While recovery residences vary widely in structure, all are centered on peer support and a connection to services that promote long-term recovery. Recovery housing benefits individuals in recovery by reinforcing a substance-free lifestyle and providing direct connections to other peers in recovery, mutual support groups and recovery support services. Substance-free does not prohibit prescribed medications taken as directed by a licensed prescriber, such as pharmacotherapies specifically approved by the Food and Drug Administration (FDA) for treatment of opioid use disorder as well as other medications with FDA-approved indications for the treatment of co-occurring disorders.

For purposes of this document, SAMHSA’s official definition will serve as the benchmark from which to ascribe best practices and suggested minimum standards. The utilization of this definition is because it encompasses the basic tenets as set forth in the statute and it stipulates the inclusion of FDA approved pharmacological interventions for substance use disorders and other co-occurring conditions.

To deliver the best care possible, recovery house operators should include to which level of care their facility delivers services to their residents. SAMHSA supports the levels of care, as identified by the National Alliance of Recovery Residences (NARR) and other stakeholder agencies depicted below, as these levels accurately reflect the basic structural blueprint of quality recovery housing and highlights the continuum of support ranging from nonclinical recovery housing to clinical and usually licensed treatment and highlights the continuum of support ranging from nonclinical recovery housing (Level 1 and II) to clinical and usually licensed treatment (Level III & IV). 3 Source: The National Alliance for Recovery Residences

2. Recognize that a substance use disorder is a chronic condition requiring a range of recovery supports:

The transition from active addiction into lasting recovery is often a difficult and emotionally trying journey for many people with a substance-use disorder. NIDA (2018) indicated that the relapse rates for substance-use disorders is approximately 40-60%, and that relapses could signify the necessity to reexamine a person’s course of treatment, as relapses can be very dangerous and in many instances deadly. The first 12 months of this transitional period prior to the onset of sustained full remission, sometimes referred to as early recovery, is a crucial period during which people contend with raw core clinical issues such as family history, unresolved trauma, grief and loss, emotional immaturity, low frustration tolerance, and other factors that make them susceptible to relapse.

However, Moos & Moos (2006) determined that individuals with more ‘social capital’ are more likely to show improved outcomes for short term remission. Therefore, recovery houses are uniquely qualified to assist individuals in all phases of recovery, especially those in early recovery, by furnishing social capital and recovery supports.

Communities support is a critical aspect of achieving and maintaining recovery. A support network comprising friends and family who are not abusing substances, peers with lived experience, trained recovery housing staff, clinical support, and access to community resources is essential to helping people maintain recovery. Community, camaraderie, empathy and guidance are necessary ingredients in helping somebody 4 remain on track as they navigate their way into a healthy lifestyle of recovery. This is true for individuals recently discharged from inpatient treatment, criminal justice custody, or people seeking a safe, drug free living environment conducive to recovery.

3. Recognize that co-occurring mental disorders often accompany substance-use disorders:

SAMHSA recommends that all recovery house operators and their designated staff should be informed about co-occurring disorders and the close association these ailments have with substance-use disorders. The 2018 National Survey on Drug Use and Health (NSDUH) produced by SAMHSA determined that 9.2 million adults live with a cooccurring mental and substance use disorder. The NSDUH also demonstrates that those with mental disorders, including serious mental illness, are more likely to engage in substance use; conversely, those with substance use disorders are also more likely to have a mental illness.

It is critical that recovery house operators, staff, and certified peers need to be informed as to how co-occurring disorders and resulting symptomology can contribute to increase a person’s susceptibility for relapse. Furthermore, SAMHSA believes that all residents and staff should be instructed to treat each other with compassion and understanding regardless of mental health status.

4. Assess applicant (potential resident) needs and the appropriateness of the residence to meet these needs:

SAMHSA recommends that all resident referrals and placement decisions be predicated upon what gives the resident the best chance for obtaining lasting recovery. To help guide placement decisions, SAMHSA strongly encourages all clinically oriented recovery house programs to accurately assess each prospective resident according to their unique needs, strengths, challenges and current recovery capital. SAMHSA maintains that proper resident placement where an individual’s needs and goals are appropriately matched to the facility including therapeutic services, recovery supports and the surrounding environment will help to ensure resident safety. To best achieve these ends, the assessment should include the prospective residence and important information about the person.

Resident assessment is an integral part of the comprehensive assessment that should be performed prior to referral and placement into a recovery house system of care. Whether the referent is a licensed clinician, concerned family member, criminal justice professional, or other stakeholder it is important to know and consider the relevant and pertinent information about a person before making impactful decisions regarding their chances for a successful recovery. Usually a licensed clinician obtains intimate knowledge of the resident throughout the therapeutic process.

State governing agencies, including law enforcement, are often important referral sources to recovery housing, it is necessary for these entities to be well versed about the 5 prospective program prior to referring a potential resident. Relevant information to be considered in determining the most appropriate setting includes:
• House Culture: such as permissiveness of unhealthy behaviors, degree of adherence to outside meeting attendance, general living environment including other peer’s investment in recovery, etc.
• Level of Care: the type, nature and intensity of therapeutic services and recovery supports provided, ability to address specific needs.
• Utilization of certified or appropriately trained peers with relevant lived experience
• Geographic area, neighborhood or external surrounding environment of the recovery house
• Physical living environment
• Current residents: welcoming, committed to sobriety, are they mostly employed, supportive of one another
• Medication Assisted Treatment: does the operator or other house staff support the use of medication assisted treatment, is the use of this medication properly monitored, are the other residents in the house also supportive of MAT, are peers with MAT experience available for residents with severe opioid use disorder (OUD)
• Level of training and professionalism of house staff (e.g., co-occurring disorder, crisis interventions, etc.)
• Reputation regarding ethical business practices, including fraud and abuse of residents
• Relapse policy
• Availability of opioid-overdose reversal drugs

5. Promote and use evidence-based practices:

Given the critical importance of stable housing and community supports to attaining recovery, it is important to ensure that residents in recovery housing are afforded highquality, evidence-based care. It is important to recognize that many in recovery housing will also need access to outpatient treatment. Polcin (2009) found significant improvements in abstinence and employment rates, as well as a reduction in the number of arrest rates for those residents who also participated in outpatient treatment for substance use disorder(s). Additionally, 76% of the residents that participated in this study remained domiciled in a recovery house for at least five months. For many, the combination of recovery housing with evidenced-based outpatient treatment is an efficacious model of care.

Medication Assisted Treatment (MAT) is a lifesaving evidence-based practice. MAT includes the use of FDA-approved medications for the treatment of opioid use disorders.

Medication therapy in conjunction with counseling, behavioral therapies, and community recovery supports provide a whole-individual approach to the treatment of substance-use disorders. The National Academies of Science, Engineering, and Medicine (NASEM) 6 notes that medications for opioid use disorders save lives and cite the use of these medications as an integral strategy in addressing opioid misuse.

Peers and recovery coaches are other essential components that model the societal and fellowship aspects of recovery, and are fully endorsed by SAMHSA as integral components of recovery houses. Peer Support Recovery Services (PRSS) and recovery coaches have emerged as an efficacious intervention to help utilize lived experience to assist others in achieving and maintaining recovery. (Smelson et al, 2013; Tracey et al, 2011).

6. Written policies, procedures, and resident expectations Recovery house operators should have clearly written and easy to read documentation for all standard operating procedures and policies. To avoid ambiguity, SAMHSA recommends that the standard operating procedures are clearly explained to each new resident by a house staff member or designated senior peer. It is also advisable for programs to establish a resident handbook to help ease transition and ensure compliance with house rules.

Each resident should sign the documents to verify comprehension; residents should be given a copy for future reference. The house should store the signed documents. The communication of these procedures should also be accompanied by an orientation process.

7. Ensures quality, integrity and resident safety:

SAMHSA is strongly recommending that all recovery houses adhere to ethical principles that place resident safety as the chief priority. SAMHSA believes that unethical practices must be acted upon very quickly. One emerging unethical issue is patient brokering.

Patient brokering is a potentially life threatening form of healthcare /treatment fraud that involves using vulnerable people with a substance use disorder as a pawn or commodity to be traded.

In patient-brokering type practices, a broker or agent refers a person, who is either in active use or has relapsed after treatment, to an unethical treatment center for a financial fee or some other valuable kickback. In many instances, the brokered individual, who is already in sobriety after completing treatment, is enticed through financial inducements and/or free drugs to resume use by the brokering agent, who then refers this person back to treatment for a kickback. The unethical treatment center is then able to bill a third party payer for services rendered, which far exceed the kickback paid making this fraudulent business very lucrative. In other brokering type scenarios, people with an active substance use disorder are lured by inducements such as free travel, rent or drugs from around the country to seek treatment in another state or location. Once these individuals arrive at treatment they are then recruited to engage in the brokering process. 7 Recovery house operators should be well aware of the existence of these types of practices and should understand that these are unacceptable and unethical practices.

Program Certification
Program or recovery house certification or accreditation is one noted remedy to some of the problems stated above. States are advised to adopt a process of certification to assure program quality.

In regards to the Fair Housing Act, it should be noted that in Bangarter v. Orem City Corp (1995) the court stated that the Fair Housing Amendments Act should not be viewed to preclude special restrictions on disabled or vulnerable people if the benefit of such restrictions for these populations clearly outweighs the burden of these restrictions.

Therefore, certification of recovery residences should not be prohibited as a discriminatory practice if the certification is narrowly tailored to benefit the needs of vulnerable populations, and these benefits clearly outweigh whatever burdens are imposed by these rules.

It is standard clinical protocol for all treatment centers and recovery houses to require clients submit to random urine analyses and breathalyzers. In other situations clients or residents may be required to submit an additional sample if they are suspected of using or after returning to the treatment center after time spent in a potentially using type of environment. This protocol is designed to ensure safety by confirming people are sober, on track in their recovery and not in need of additional therapeutic interventions. Fair Health examined claims data based on Current Procedural Terminology (CPT) codes and determined that costs associated with laboratory testing have increased more than 900 percent between 2011 and 2014. This large increase is an indication that a standard clinical practice has been exploited for financial gain. SAMHSA panelists identified 3 key areas of concern for this unethical practice:
• Testing for quantitative amounts on negative samples
• Charging exorbitant fees over and above the standard costs for lab tests • Excessive drug screenings during residential treatments (testing can also become excessive in some outpatient treatments)
In July 2017 the city of Delray Beach Florida required certification for all recovery residences housing 4 or more unrelated individuals. A year later after this rule was implemented the city of Delray Beach witnessed a significant 60% decline in overdoses from 635 to 245. The city of Delray Beach also saw another 48% decrease in overdoses for the most recent year since this ordinance became law.
8 Medication Policy:

According the NSDUH (2018) buprenorphine was the opioid with the highest rate of misuse by those with a prescription for it. The misuse of any medication in a sober living environment can have detrimental effects not just for the individual misusing but also for other members of the house. As such, the following strategies are recommended:
• Locking medication up and house staff providing medication at specified time to clients
• Medication counts with staff and resident
• Increase drug testing (if suspected of diversion)
• Communication between stakeholders, providers & staff (releases of information) • Maintain proper documentation
• Monitor specific residents as needed
• Open discussion of medications (e.g., group topic, potential triggers, etc.) • Daily dosing within a licensed facility

8. Learn and Practice Cultural Competence:

The concept of cultural competency is of extreme importance, as the disease of addiction does not discriminate along racial, cultural or socioeconomic lines.

The staff and peers who operate and work in recovery houses should treat all individuals with respect regardless of their personal backgrounds and beliefs. Staff should be trained to deal with individuals on a personal basis and respect different beliefs and backgrounds.

9. Maintain ongoing communication with interested parties and care specialists Ongoing communication is another important aspect of clinical practice that recovery houses should implement as part of their operating procedures. Provided there is a signed release of confidential information, ongoing communication between the resident’s referent, concerned loved one, treatment provider, former treatment provider, certified peer recovery coach and criminal justice professional, is essential to helping the resident stay on track with recovery. In certain vocational programs, it could also be advantageous to maintain contact with the person’s place of employment. Listed below are some topics areas that could be covered during communication between stakeholders to improve the quality of resident care.
• Level of program adherence
• Resident behavior – potential relapse indictors
• Attendance concerns at treatment
• MAT dosage changes, take home doses
• Progress reports
• Psychotropic medication changes
9 • Employment status
• Referral decisions (especially following a relapse to help alleviate any brokering type activities)
• Drug testing
• Discharge planning
• Any social network concerns
• Relapse history

10. Evaluate program effectiveness and resident success:

As recovery houses become recognized as vital components in the continuum of care, it is important to properly assess how each house is ultimately performing in delivering quality resident care. SAMHSA recognizes that program evaluation may occur at varying levels depending on the size and scope of the recovery house; however, collecting data on measures such as abstinence from use; employment; criminal justice involvement; and social connectedness would greatly assist the home in gauging the effectiveness of services provided and would also enable these entities to utilize data to justify requests for state and federal funding.

CONCLUSION
SAMHSA strongly believes in the use of recovery housing as a key strategy to assist individuals living with substance use disorder in achieving and maintaining recovery.

Providing individuals with a safe and stable place to live can potentially be the foundation for a lifetime of recovery. It is critical that these houses function with sound operating procedures which center on a safe, sober living environment in which individuals can gain access to community supports and therapeutic services to advance their recovery.
10 References
Bangarter v. Orem City Corp.; 46 F 3d 1491. Court of Appeals, 10th Circuit 1995 Moos, R. H., & Moos, B. S. (2006). Rates and predictors of relapse after natural and treated remission from alcohol use disorders. Addiction (Abingdon, England), 101(2), 212–222. doi:10.1111/j.1360-0443.2006.01310.x
National Academies of Sciences, Engineering, and Medicine. 2019. Medications for Opioid Use Disorder Save Lives. Washington, DC: The National Academies Press.

National Alliance for Recovery Residences. Recovery Residence Quality Standards.

Retrieved from https://narronline.org/wp-content/uploads/2015/10/National-RecoveryResidence-Quality-Standards-Oct-7-2015.pdf National Institute on Drug Abuse. (2018, August 09). Overdose Death Rates. Retrieved from https://www.drugabuse.gov/related-topics/trends-statistics/overdose-death-rates Polcin D. L. (2009). A model for sober housing during outpatient treatment. Journal of psychoactive drugs, 41(2), 153-61
Smelson, D. A., Kline, A., Kuhn, J., Rodrigues, S., O’Connor, K., Fisher, W. Kane, V. (2013). A wraparound treatment engagement intervention for homeless veterans with cooccurring disorders. Psychological Services, 10(2), 161–167 Substance Abuse and Mental Health Services Administration. (2018). Key substance use and mental health indicators in the United States: Results from the 2017 National Survey on Drug Use and Health (HHS Publication No. SMA 18-5068, NSDUH Series H-53).

Rockville, MD: Center for Behavioral Health Statistics and Quality, Substance Abuse and Mental Health Services Administration. Retrieved from https://www. samhsa.gov/data/
EXHIBIT 13
OH_CM000192 -1-
SUBJECT:

DATE:

FROM:

PLANNING COMMISSION

AGENDA REPORT
MEETING DATE: FEBRUARY 11, 2019 ITEM NUMBER: ..PH-I
CONDITIONAL USE PERMIT PA-17-10 TO OPERATE A SOBER LIVING FACILITY HOUSING UP TO 45 ADULTS IN FIVE UNITS; INCLUDING AN APPEAL OF THE

DENIAL OF A REQUEST FOR REASONABLE ACCOMMODATION FOR RELIEF FROM CERTAIN LAND USE REQUIREMENTS OF THE ZONING CODE; OPERATED BY THE OHIO HOUSE AT 115 EAST WILSON STREET
JANUARY 31, 2019

DEVELOPMENT SERVICES DEPARTMENT
PRESENTATION BY: JENNIFER LE, ASSSISTANT DIRECTOR OF DEVELOPMENT SERVICES

WILLA BOUWENS-KILLEEN, AICP, ZONING ADMINISTRATOR
STAFF CONTACT: WILLA BOUWENS-KILLEEN 714.754.5153
[email protected]

DESCRIPTION
Planning Application 17-10 is a request for a Conditional Use Permit (CUP) to operate a sober living facility housing up to 45 residents in five units, with up to seven male adults and a maximum of two resident managers in each unit. The applicant also submitted a request for reasonable accommodation to allow this facility to be within 650 feet of another property that contains a state-licensed treatment facility and/or sober living home, and to provide relief from certain land use requirements of the Zoning Code. The application for accommodation was denied. The applicant has appealed that decision to the Planning Commission.

APPLICANT OR AUTHORIZED AGENT
The applicant, Ryan Stump, is representing the operator, The Ohio House, and the property owners Edie Johnson, Sharon Ackerman, and Brandon Stump.

RECOMMENDATION
Adopt a Resolution upholding the Director's denial of the request for reasonable accommodation and denying Conditional Use Permit PA-17-10. 182
OH_CM000193 -2-

PLANNING APPLICATION SUMMARY
Location: 115 East Wilson St. # A - E Permit No.: PA-17-101 Request: Conditional use permit for a sober living facility with 45 occupants (seven residents and two resident house managers per unit) per the multi-family group home ordinance.

SUBJECT PROPERTY: SURROUNDING PROPERTY:

Zone: R2-MD North: (Acr. Wilson St.) PDR-MD, Apts. for Vanguard students General Plan: Commercial Residential East: R2-MD, Multiple-Family Residential, residential use Lot Dimensions: 66 FT x 323 FT West: (Across Alley) C1, Commercial uses Lot Area: 21 ,362 SF South: R2-MD, Multiple-Family Residential, residential use Existing Development: Five, two-story, four bedroom residences each with an attached two-car garage and two open parking spaces in the driveways leading to the garages

DEVELOPMENT STANDARD COMPARISON
Development Standard Code Requirement Proposed/Provided Lot Size:

Lot Width 100 FT 66 FT2
Lot Area 12,000 SF 21 ,362 SF
Densitv:

Zone/General Plan 1 DU/3,630 1 DU/4,272 SF
5 DUs 5 DUs
Building Coverage:

Residences/QaraQes NA 41% (8,741 SF)
Driveway NA 9% (1 ,979 SF)
Ooen Soace 40% (8,545 SF) 50% (10,642 SF)
TOTAL: NA 100% (21,362 SF)
BuildinQ HeiQht: 2 stories/27 FT 2 stories/26 FT
Buildina seoaration: 10 FT 10 FT
Setbacks (East Wilson Street considered the front):

Front 20 FT 20 FT
Side -- left 5 FT 5 FT
Side- right 5 FT 9.5 FT
Rear 20 FT 21 FT
Parking Totals:

Covered 10 10
Ooen 10 10
TOTAL: 20 20
Driveway width 10 FT 16 FT
Vehicular backup 25 FT 25 FT
1 Project approved under PA-02-48/T-164-16448 as a residential common interest development in 2003. 2 Prooertv existing at this non-conforming width when PA-02-48 was processed/aooroved Environmental Determination: Exempt -- Section 15301, Existina Facilities Final Action: Planning Commission
OH_CM000194 -3-

BACKGROUND/ANALYSIS
The subject property is located on East Wilson Street between Newport Boulevard and Elden Avenue. The property is zoned R2-MD (Multiple-Family Residential, Medium Density) and has a General Plan Land Use Designation of Commercial Residential. Multifamily residential uses that are also zoned R2-MD abut the site to the east and south; student housing for Vanguard University under a PDR-MD (Planned Development Residential - Medium Density) zone exists across East Wilson Street to the north; with a commercial center zoned C 1 (Local Business District) existing across the alley to the west of the subject property.

This development was approved as a five-unit common interest development in 2003. Each individual lot is separately owned; however, each individual lot owner is also part owner of a commonly-held lot and is part of a joint homeowners association. In addition, the application is for the operation of one facility by a single operator. Therefore, it is being processed under one CUP.

In the letter requesting the reasonable accommodation, the applicant's attorney states that the operation of these group homes predated the City's 2015 ordinance. However, the attorney did not include a date when the facilities were established; the City conducted its first investigations of the subject sober living facilities in early 2016. The applicant's information is inconsistent on the application forms originally submitted for the sober living homes, but it appears that each unit houses seven male residents as well as two live-in managers, for a total of 45 residents. The applicant's project description is provided as Attachment 2. Pursuant to Costa Mesa Municipal Code (CMMC) Section 13-323, group homes serving more than six residents may be permitted on sites zoned for multi-family development, subject to approval of a CUP. Therefore, a CUP is required.

The subject property is located approximately 550 feet away from another group home at 165 East Wilson Street approved under Conditional Use Permit PA-16-03; consequently, because the other facility is less than 650 feet away, there is a separation conflict for the subject application. A separation map is provided as Attachment 1.

Because the subject property is located within 550 feet of a City-approved sober living facility, approval of the requested CUP will result in an overconcentration of sober living and drug and alcohol treatment facilities in a residential neighborhood.

On October 27, 2017; the City received a request from the applicant's attorney for a reasonable accommodation to allow the facility to continue without having to apply for the reasonable accommodation to deviate from the required separation standard. This request was based on the attorney's assertion that the facility should be allowed to continue because they are a nonconforming use predating the adoption of the group home ordinance in 2015 and that each unit is considered a single housekeeping unit. (The attorney's letter was dated September 12, 2017 but the City did not receive it until October 27, 2017.) On November 27, 2017, the City denied the request; the applicant filed an appeal of that decision on 3 OH_CM000195 -4-
November 29, 2017. This request, denial, and appeal are labeled as Attachments 4, 5 and 6, respectively.

Conditional Use Permit Requirement for Large Group Homes, including Sober Living Homes, and Licensed Drug and Alcohol Treatment Facilities in Multi-Family Residential Zones
On November 17, 2015, the City Council adopted Ordinance 15-11 revising Title 13 of the CMMC to add Chapter XVI which established conditions for granting a CUP to group homes, residential care facilities, and drug and alcohol treatment facilities serving more than six residents in the City's multiple family residential zones. All group homes and residential care facilities operating in multi-family zones before the ordinance was adopted were required to come into compliance with Ordinance 15-11 by December 17, 2016.

Although the CUP application for Unit E was submitted on March 23, 2017, the application was deemed incomplete with the additional required information not submitted until December 7, 2018. The CUP applications for the remainder of the units (Units A through D) were received between October 27, 2017 and December 5, 2017.

Sections 65008(a) and (b) of the California Government Code prohibit discrimination in local governments' zoning and land use actions based on (among other categories) race, sex, lawful occupation, familial status, disability, source of income, or occupancy by low to middle income persons. Section 65008(d)(2) also prevents agencies from imposing different requirements on single-family or multi-family homes because of the familial status, disability, or income of the intended residents. Individuals in recovery from drug and alcohol addiction are defined as disabled under the Fair Housing Act. Therefore, the City is obligated to treat residents of licensed drug and alcohol facilities as it treats other residents of the City. Conditions of approval must reflect this obligation.

In addition to a CUP, an Operator's Permit application is required for group homes with seven or more occupants if the facility is not licensed by the State of California. Staff has reviewed the Operator's Permit application for compliance. The applicant submitted documentation, but the information is inconsistent with current Code. Should the Planning Commission wish to approve this CUP, the applicant will be required to submit complete information showing that the facilities meet the operational requirements for issuance of an Operator's Permit. The requirements include but are not limited to the following:
• The group home is required to have a house manager who resides at the group home or any multiple persons acting as a house manager who are present at the group home on a twenty-four-hour basis and who are responsible for the day-to-day operation of the group home. The applications include the names of six live-in house managers but not the 14 it appears they propose to provide.
• Occupants must not require and operators must not provide "care and supervision" as those terms are defined by Health and Safety Code 1503.5 and Section 80001(c)(3) of title 22, California Code of Regulations. The applicant has confirmed that they will not OH_CM000196 -5-
provide "care and supervision" in some of the units but has not confirmed this for all five of the units.
• The sober living home shall not provide any of the following services as they are defined by Section 10501 (a)(6) of Title 9, California Code of Regulations: Detoxification; educational counseling; individual or group counseling sessions; and treatment or recovery planning. The applicant has confirmed that they will not provide "care and supervision" in some of the units but has not confirmed this for all five of the units. • Upon eviction from or involuntary termination of residency in a group home, the operator of the group home shall make available to the occupant transportation to the address listed on the occupant's driver license, state issued identification card, or the permanent address identified in the occupant's application or referral to the group home. The responses provided by the applicant are unclear as to its consistency with certain Code requirements, in the opinion of staff; therefore, additional information would be required to be submitted before the Operator's Permit could be issued.

If the Planning Commission approves the CUP request for the subject property, the applicant will be required to submit additional information before the Operator's Permit could be issued. Once the correct information has been submitted demonstrating compliance with Code requirements related to the Operator's Permit, the Development Services Director could issue an Operator's Permit to the applicant. If the operator does not maintain compliance with the Operator's Permit requirements, the Operator's Permit may be revoked upon a hearing by the Director. Failure to maintain an Operator's Permit may also subject the CUP to revocation.

Property Description
Pursuant to the CMMC, "property" is defined as any single development lot that has been subdivided, bearing its own assessor's parcel number or with an approved subdivision or condominium map. The CMMC specifies that group homes and facilities providing drug and alcohol treatment in residential areas shall only occupy a single parcel. The subject site consists of five, approximately 2,400-square-foot, two-story units on individual lots ranging in size from approximately 3,800 square feet to 4,900 square feet. Each unit contains four bedrooms and three bathrooms. The five lots are held together by a common lot and is, therefore, considered a common interest development.

Facility Description
It appears the existing sober living facilities began operation in early 2016, based on the opening of cases by the City's Code Enforcement Division, after the enactment of Ordinance 15-11. It appears that each of the five units houses up to seven residents and two managers; however the applicant's submitted information is inconsistent. Staff still needs confirmation that there is a staff member/house manager present on the site at all times.

The applicant's description is provided as Attachment 2 and the site and floor plans are included in this report as Attachment 3.

OH_CM000197 -6-
A sober living home is a sub-type of group home. Article 2 of Section 13-6 (Definitions) defines a group home as follows:
•~ facility that is being used as a supportive living environment for persons who are considered handicapped under state or federal law. A group home operated by a single operator or service provider (whether licensed or unlicensed) constitutes a single facility whether the facility occupies one or more dwelling units."
With the exception of the lot width, this project satisfied all development standards when it was approved in 2003; those same development standards still apply. Consequently, with the exception of the non-conforming minimum lot width requirements, all applicable standards for developing five common interest, multiple family residential units are met on this property.

Each of the five units contains four bedrooms and three bathrooms, as well as a kitchen, family room, and living/dining room.

TABLE 1- UNIT BREAKDOWN
Unit Bedrooms Beds1 Bathrooms Total Persons per
Rooms2 room3
A 4 8 to 9 3 6 1.3 to 1.5
8 4 8 to 9 3 6 1.3 to 1.5
C 4 8 to 9 3 6 1.3 to 1.5
D 4 8 to 9 3 6 1.3 to 1.5
E 4 8 to 9 3 6 1.3 to 1.5
Totals: 20 40 to 45 15 30 1.3 to 1.5
1 Applicant's information is incomplete; cannot confirm if 8 or 9 beds per unit are provided 2 Number of bedrooms combined with family room and living/dining room 3 Based on seven residents plus one to two beds for live-in managers per unit The proposed occupancy of these units does constitute overcrowding pursuant to the Housing Element of the General Plan, page HOU-23, which states:

Overcrowding is defined as a housing unit occupied by more than one person per room. A severely overcrowded housing unit is one with more than 1.5 persons per room. A room is defined as a bedroom, living room , dining room, or finished recreation room, but excludes a kitchen or bathroom.

This definition is consistent with the Federal HUD standards, which generally define "overcrowding" to mean housing units with 1.01 or more persons per room. See 42 USCS § 5302(a)(10). Under this standard, all five units would be overcrowded.

In the past three years, Code Enforcement received one complaint related to the facility expressing concern with the number of people and type of activity that was occurring within the five group homes. The complainant also expressed concern with the amount OH_CM000198 -7-
of trash and cigarette butts, the poor condition of the alley, and homeless and other people "hanging out" in the alley next to the homes. Code Enforcement investigated the complaint and, ultimately, closed the case when it was confirmed that a CUP for the group homes was in process. The Police Department reports that, from January 1, 2016 to January 30, 2019, there have been a total of 14 calls for service in the last three years, eight of which are attributable to the property. These calls for service related primarily to theft and disturbances, with two calls for medical aid.

Separation Conflict Map
The CMMC requires a separation of 650 feet between sober living and licensed drug and alcohol treatment facilities. The following types of facilities are depicted on the map:
• State-licensed treatment facilities serving six or fewer adults, as these facilities are permitted by right under State law.
• Sober living and state-licensed treatment facilities for which the City has issued a CUP to serve more than six adults
• Sober living facilities serving up to six adults for which the City has issued a Special Use Permit (SUP)
• State-licensed facilities or sober living homes which require but have not obtained a CUP or SUP and are operating in violation of City zoning regulations The attached separation map indicates that there are four facilities within 650 feet of the subject property. The sober living facility at 165 East Wilson Street was approved by the City in 2016 under PA-16-03. In addition, facilities exist at 125 and 131 East Wilson Street (both facilities are licensed by the Department of Health Care Services and are operating without a CUP). There is also a facility at 114 Albert Place that has been cited for operating without a permit. (Refer to Attachment 1, Separation Map). Refer to Table 2 below for details.

TABLE 2-SEPARATION MAP SUMMARY
Location Status
165 East Wilson Street Sober living facility approved by the City in 2016 as PA-16- 03, serving 10 male residents plus one live-in house
manager This facility is shown as a separation conflict on the map.
125 East Wilson Street State-licensed treatment facility serving 7 or more in violation of the CMMC; CUP denied in April 2018 but use continues; Active Code Enforcement case
131 East Wilson Street State-licensed treatment facility serving 7 or more in violation of the CMMC; CUP denied in April 2018 but use continues; Active Code Enforcement case
114 Albert Place Facility cited twice for operating without a permit in violation of the CMMC
OH_CM000199 -8-
Ownership
The City Council adopted Ordinance Nos. 17-05 and 17-06 in May of 2017. These ordinances changed the submittal requirements for applications for sober living homes.

Applicants are now required to provide the following information:

If the applicant and/or operator is a partnership, corporation, firm, or association, then the applicanUoperator shall provide the additional names and addresses as follows and such persons shall also sign the application:
a. every general partner of the partnership;
b. every owner with a controlling interest in the corporation; c. the person designated by the officers of a corporation as set forth in a resolution of the corporation that is to be designated as the permit holder;
The license and permit history of the applicant(s), including whether such applicant(s), in previously operating a similar use in this or another city, county or state under license and/or permit, has had such license and/or permit revoked or suspended, and the reason therefore.

Brandon Stump has confirmed that he is the owner and sole member of Ohio House.

General Plan Conformance
The provision of a variety of housing types, including housing for the disabled, is consistent with the Land Use and Housing Elements of the City's General Plan. • Goal LU-1 F .1: Land Use and Goal HOU-1.2: Protect existing stabilized residential neighborhoods, including mobile home parks (and manufactured housing parks) from the encroachment of incompatible or potentially disruptive land uses and/or activities.

Consistency: The City's regulations are intended to preserve the residential character of the City's neighborhoods. This facility has demonstrated its compatibility with the neighborhood over the past three years.
• Goal HOU-1.8: Housing Element: Encourage the development of housing that fulfills specialized needs.

Consistency: The proposed request provides for a supportive living environment for persons who are considered disabled under state and federal law.

REQUIRED FINDINGS
Pursuant to Section 13-29(g) of the CMMC, the Planning Commission must make required findings in order to approve the CUP, based on evidence presented in the administrative record.
8 OH_CM000200 -9-
Reasonable Accommodation Findings
On October 27, 2017, the City received a request from the applicant for a reasonable accommodation to deviate from the required separation standard. (The applicant's letter was dated September 12, 2017 but the City did not receive it until October 27, 2017.) The applicant's attorney stated that the five units were each single housekeeping units and not sober living homes; therefore, they satisfied the parameters of a reasonable accommodation and were not subject to the City's group home ordinance. On November 27, 2017, the City denied the request, based on the findings below. The applicant filed an appeal on November 29, 2017. However, because a CUP was needed for the group homes, coupled with the delay on the part of the applicant to provide the necessary information to process the CUP, there was a delay in hearing the appeal of the reasonable accommodation until now. The appeal contained no justification for the Planning Commission to reverse the Director of Development Services' decision. The Director denied the request because he was unable to make all of the findings required by CMMC Section 13-200.62(f). Specifically, his decision was based on the following factors:
• The requested accommodation is not necessary to provide one or more individuals with a disability with an equal opportunity to use and eniov a dwelling.

The City recognizes that, while not in character with residential neighborhoods, when operated responsibly, group homes, including sober living homes, provide a societal benefit by providing disabled persons the opportunity to live in residential neighborhoods. These facilities provide recovery programs for individuals attempting to overcome their drug and alcohol addictions. The City has established separation criteria to ensure that an over-concentration of sober living homes and licensed drug and alcohol treatment facilities does not occur in any neighborhood, thereby, preserving the residential character for all who choose to reside there.

The application established that the waiver of the separation requirement would allow one or more individuals who are recovering from drug and alcohol abuse to enjoy the use of these dwellings. However, approval of the request is not necessary to allow one or more individuals who are recovering from drug and alcohol abuse to enjoy the use of~ dwelling within the City.

The operation of a group home is inconsistent with the City's definition of a single housekeeping unit. The City has established procedures to allow group homes in residential neighborhoods; allowing a group to be considered a single housekeeping unit is not necessary to allow the disabled to reside in residential neighborhoods.

The City has adopted standards for sober living homes and licensed treatment facilities in residential zones to ensure the disabled have the opportunity to live in a typical residential neighborhood. The permit process ensures that sober living homes and licensed treatment facilities comply with the City's standards. The City q
OH_CM000201 -10-
specifically required all existing group homes to comply with the new regulations within one year. The applicant's letter failed to provide a basis to "grandfather" this facility when all other facilities in operation at the time the regulations were adopted are also required to comply.
• The requested accommodation is not consistent with the surrounding uses in scale and intensity of use.

The subject facility does not operate as a single housekeeping unit, or even five single housekeeping units, making it dissimilar to the composition of households on surrounding properties. The facility is occupied solely by adults at a higher occupancy than is typical in Costa Mesa. Each resident is allowed to keep a car on the property, providing opportunities for parking conflicts with owners of nearby properties who also rely on on-street parking. The City's intent in adopting its group home regulations was to ensure an over-concentration of group homes did not occur in any neighborhood. The facility would contribute to over-concentration given that it includes five units on five individual lots. • Whether the existing supply of facilities of a similar nature and operation in the communitv is sufficient to provide individuals with a disability and equal opportunity to live in a residential setting.

The City has received applications for 64 sober living homes and 11 licensed treatment facilities that are subject to compliance with Ordinance Nos. 14-13 and 15-11. Twelve sober living homes serving six or fewer residents have been approved by the City, and two sober living homes serving seven or more residents have been approved by the City. In addition, there are 74 existing state licensed drug and alcohol facilities in Costa Mesa that are exempt from City regulation, or have already obtained the required Conditional Use Permit.

No evidence has been submitted to indicate that the number of sober living homes and drug and alcohol residential care facilities existing or potentially allowed in compliance with the City's standards is inadequate. • The requested accommodation will not result in a fundamental alteration in the nature of the City's zoning program.

Ordinance 15-11 established requirements for sober living homes, group homes, and licensed drug and alcohol treatment facilities in multi-family zoning districts. When the City Council adopted this ordinance, it specifically included a provision requiring a separation of at least 650 feet between such facilities.

The intent of this limitation is to ensure that sober living and drug and alcohol treatment facilities do not occupy a disproportionate number of homes in any neighborhood, and to avoid over-concentration of sober living and drug and alcohol treatment facilities in any area. The City also sought to ensure that IO
OH_CM000202 -11-
disabled persons recovering from an addiction can reside in a comfortable residential environment versus in an institutional setting. The City determined that housing inordinately large numbers of unrelated adults in a single dwelling or congregating sober living and drug and alcohol treatment facilities in close proximity to each other does not provide the disabled with an opportunity to "live in normal residential surroundings" but, rather, places them into living environments bearing more in common with the types of
institutional/campus/dormitory living that the state and federal laws were designed to avoid. The subject property consists of five units on five individual lots, which already contributes to an over-concentration of sober living homes in the area. The site's proximity to another sober living home serving more than six adults contributes to an over-concentration of sober living facilities in this neighborhood. Granting the accommodation to consider this facility as a single housekeeping unit and/or waive the separation standard will result in an overconcentration of sober living facilities in this area that is in conflict with the intent of the City's zoning program.

When the City adopted Ordinance 15-11, it specifically included provisions requiring all existing group home operators to come into compliance with the new regulations within one year of their adoption. The ordinance did not create or recognize any nonconforming uses. Given the intent of the ordinance, it is not appropriate to grant the request for reasonable accommodation to allow the subject facility to be "grandfathered" and exempted from compliance with current regulations.

The application for reasonable accommodation failed to justify any reason to waive compliance with the provisions of Section 9-37 4(b )( 11) of the CMMC that require the applicant to have a house manager; ensure all occupants, other than the house manager, are actively participating in legitimate recovery programs; prohibit the use of any alcohol or non-prescription drugs by any recovering addict; have a policy regarding use and storage of prescription medications; post house rules in a common area inside the dwelling unit; prohibit visitors who are under the influence of any drug or alcohol; and maintain a good neighbor policy.

CUP Findings
If the Planning Commission upholds the denial of the reasonable accommodation, the Planning Commission may not approve the CUP unless it makes a finding that approval of the application will not result in an over-concentration of similar uses pursuant to CMMC Section 13-323, as set forth below. Staff recommends upholding the denial of the reasonable accommodation as well as denial of the CUP based on the following assessment of facts and findings. These findings are also reflected in the draft resolution. • The proposed use is substantially compatible with developments in the same general area and would not be materially detrimental to other properties within the area.
11 OH_CM000203 -12-
The facility consists of five units on five parcels with a common lot constituting a common interest development. Approval of this request would allow 45 adults to occupy the subject facility. With the exception of minimum required lot width requirements, the site satisfies all applicable development standards.

The proposed occupancy constitutes overcrowding pursuant to the Housing Element of the City of Costa Mesa's General Plan, page HOU-23, which states:

Overcrowding is defined as a housing unit occupied by more than one person per room. A severely overcrowded housing unit is one with more than 1.5 persons per room. A room is defined as a bedroom, living room, dining room, or finished recreation room, but excludes a kitchen or bathroom.

This definition is consistent with the Federal HUD standards, which generally define "overcrowding" to mean housing units with 1.01 or more persons per room.

See 42 uses § 5302(a)(10). Under this standard, all five units are considered overcrowded.

The subject property is located within approximately 550 feet of a sober living facility located at 165 East Wilson Street.

The CMMC establishes criteria for approval of group homes in multi-family zones.

Group homes serving disabled persons as defined by state and federal law are not considered to be boardinghouses. Rather, these facilities offer disabled persons the opportunity to live in residential neighborhoods in compliance with state and federal laws. Recovering alcoholics and drug addicts, who are not currently using alcohol or drugs, are considered disabled under state and federal law. Standards for large group homes are set forth in the Zoning Code. The intent of the regulations is to preserve the residential character of the City's neighborhoods while providing opportunities for the disabled to live in comfortable residential surroundings.

The City adopted standards for group homes in response to a proliferation of drug and alcohol treatment facilities in the community. The City found that an overconcentration of sober living homes and drug and alcohol treatment facilities in the City's residential neighborhoods could be deleterious to the residential character of these neighborhoods and could also lead to the institutionalization of such neighborhoods. Drug and alcohol treatment facilities and sober living homes generally do not function as a single housekeeping unit because they house extremely transient populations; the residents generally have no established ties to each other when they move in and typically do not mingle with other neighbors; the residents have little to no say about who lives or doesn't live in the home; the residents do not generally share expenses; the residents are often responsible for their own food, laundry and phone; when residents disobey house rules they are often just evicted from the house; and the residents generally do not share the same acquaintances. The City found that the size and makeup of the households 12 OH_CM000204 -13-
in sober living and drug and alcohol treatment facilities is dissimilar and larger than the norm, creating impacts on water, sewer, roads, parking and other City services that are far greater than the average household. In addition, all the individuals residing in a drug and alcohol treatment facility are generally over the age of 18, while the average household in Costa Mesa has just 2.2 individuals over the age of 18.

Because of their transient populations, above-normal numbers of individuals/adults residing in a single dwelling and the lack of regulations, drug and alcohol treatment facilities and sober living homes present problems not typically associated with more traditional residential uses. These issues may include the housing of large numbers of unrelated adults who may or may not be supervised; disproportionate numbers of cars associated with a single housing unit, which causes disproportionate traffic and utilization of on-street parking; excessive noise and outdoor smoking, which interferes with the use and enjoyment of neighbors' properties; neighbors who have little to no idea who does and does not reside in the home; little to no participation by residents in community activities that form and strengthen neighborhood cohesion; disproportional impacts from the average dwelling unit to nearly all public services including sewer, water, parks, libraries, transportation infrastructure, fire and police; a history of residents congregating in the same general area; and the potential influx of individuals with a criminal record.

Nevertheless, the City recognizes that while not in character with residential neighborhoods, when operated responsibly, group homes, including drug and alcohol treatment facilities, provide a societal benefit by providing disabled persons the opportunity to live in residential neighborhoods. These facilities also provide recovery programs for individuals attempting to overcome their drug and alcohol addictions. The City's regulations provide group homes, including sober living homes and licensed drug and alcohol treatment facilities, greater access to residential zones than to boardinghouses or other types of group living arrangements not catering to disabled individuals. This favorable access for group homes provides a benefit to the City and its residents.

In response to the needs and concerns described above, the City established a minimum separation of 650 feet between group homes, residential care facilities and/or state-licensed drug and alcohol facilities. The City found that a separation requirement would still allow for a reasonable market for the purchase and operation of sober living homes and drug and alcohol treatment facilities within the City. The requirement still resulted in preferential treatment for sober living homes and drug and alcohol treatment facilities in that non-disabled individuals in a similar living situation (e.g., in boardinghouse-style residences) have fewer housing opportunities than the disabled. The City determined that housing inordinately large numbers of unrelated adults in a single dwelling or congregating sober living homes and drug and alcohol treatment facilities in close proximity to each other does not provide the disabled with an opportunity to "live in normal residential surroundings," but rather places them into living environments bearing more in OH_CM000205 -14-
common with the types of institutional/campus/dormitory living that the state and federal laws were designed to provide them relief from.

The Federal Housing Act Amendments (FHAA), 42 U.S.C. § 3601 et seq., provide that a city "commits discrimination under the FHAA if it refuses to make reasonable accommodations in rules, policies, practices, or services, when such accommodation may be necessary to afford [the disabled] equal opportunity to use and enjoy a dwelling." Budnick v. Town of Carefree, 518 F.3d 1109, 1119 (9th Cir. 2008).

The FHAA requires a city to provide a requested accommodation if such accommodation "(1) is reasonable, and (2) necessary, (3) to afford a handicapped person the equal opportunity to use and enjoy a dwelling." Oconomowoc Residential Programs. Inc. v. City of Milwawkee, 300 F.3d 775, 783 (7th Cir. 2002); 42 U.S.C. § 3604(f)(3)(B).

The applicant requested relief from the Zoning Code requirement that a sober living home or drug and alcohol treatment facility be located at least 650 feet from another property that contains a group home, sober living home or state-licensed drug and alcohol treatment facility. The request for a reasonable accommodation was denied by the Director of Development Services on November 27, 2017, because another sober living or drug and alcohol treatment facility exists within 650 feet of the subject property, at 165 East Wilson Street. The applicant appealed the decision on November 29, 2017 but gave no reason for the appeal.

The facility is located within approximately 550 feet of a City-approved sober living facility serving 10 occupants plus one live-in house manager at 165 East Wilson Street, approved under PA-16-03.

Because there is no need for a reasonable accommodation, the facility would contribute to over-concentration and does not comply with the City's adopted standards for separation between group homes, residential care facilities, and state-licensed drug and alcohol facilities. Therefore, this finding cannot be made. • Granting the conditional use permit will not be materially detrimental to the health, safety and general welfare of the public or otherwise iniurious to propertv or improvements within the immediate neighborhood.

The City has found that over-concentration of drug and alcohol treatment facilities and group homes changes the character of a residential neighborhood to one that is more institutional in nature. This change in neighborhood character can compound secondary effects related to noise, traffic, and parking. In these neighborhoods, street life is often characterized by large capacity vans picking up and dropping off residents and staff; staff in scrubs carrying medical kits going from unit to unit, and vans dropping off prepared meals in large numbers. The City has experienced frequent Fire Department deployments in response to medical aid calls. In some neighborhoods, Police Department deployments are a regular OH_CM000206 -15-
occurrence as a result of domestic abuse calls, burglary reports, disturbing the peace calls and parole checks at drug and alcohol treatment facilities. Large and often frequent Alcoholics Anonymous or Narcotics Anonymous meetings are held at some drug and alcohol treatment facilities. Attendees of these meetings contribute to the lack of available on-street parking and neighbors report finding an unusual amount of litter and debris, including beverage containers, condoms and drug paraphernalia in the wake of these meetings. These types of impacts have been identified in other communities as well (see Attachment 7). The facility will contribute to the over-concentration of sober living homes and drug and alcohol treatment facilities in this neighborhood, which could lead to negative impacts in the neighborhood. Additionally, Code Enforcement has received a complaint for this specific property alleging trash and cigarettes in the alley abutting this site.

There are only 20 parking spaces on the site available to serve 35 adults as well as the 10 on-site managers. Approval of this CUP could result in conflicts with residents of nearby properties for the use of on-street parking spaces. • Granting the conditional use permit will not allow a use, density or intensitv which is not in accordance with the general plan designation for the property.

The proposed use is consistent with the City's General Plan. However, an overconcentration of group homes, sober living homes and licensed treatment facilities for alcohol and drug addiction is not consistent with the General Plan. The City's regulations are intended to preserve the residential character of the City's neighborhoods. The City Council has determined that an over-concentration of drug and alcohol treatment facilities would be detrimental to the residential character of the City's neighborhoods. The proposed facility is located within 650 feet of another sober living or drug and alcohol treatment facility, contributes to overconcentration, and is therefore, not consistent with the intent of the General Plan.

Overconcentration Pursuant to CMMC 13-323(b)
Section 13-323(b) of the CMMC was amended by Ordinance 17-05 in May of 2017. As amended, it provides:

The group home, residential care facility or state-licensed drug and alcohol treatment facility is at least six-hundred fifty (650) feet from any property, as defined in Section 13-321, that contains a group home, sober living home or state-licensed drug and alcohol treatment facility, as measured from the property line, unless the reviewing authority determines that such location will not result in an over-concentration of similar uses. (Emphasis added.) The effect of this amendment is to allow the Planning Commission and the City Council to approve deviations to the separation requirement where the evidence shows that such location will not result in an over-concentration, yet all the findings necessary for a reasonable accommodation are not met or otherwise cannot be granted. Should the 15 OH_CM000207 -16-
Commission be unable to make all findings necessary to grant a reasonable accommodation, (i.e., if the finding that accommodation is "necessary" within the meaning of the federal and state fair housing laws cannot be made), the Commission retains the ability to waive the separation requirement if supported by the evidence and approve this CUP.

LEGAL REVIEW
The report and draft resolution has been reviewed and approved by the City Attorney's Office.

PUBLIC NOTICE
Pursuant to Title 13, Section 13-29(d), of the Costa Mesa Municipal Code, three types of public notification have been completed no less than 10 days prior to the date of the public hearing:

1. Mailed notice. A public notice was mailed to all property owners and occupants within a 500-foot radius of the project site. The required notice radius is measured from the external boundaries of the property. (See attached Notification Radius Map.)

2. On-site posting. A public notice was posted on each street frontage of the project site.

3. Newspaper publication. A public notice was published once in the Daily Pilot newspaper.

ALTERNATIVES
A draft resolution upholding the denial of the reasonable accommodation and denying the CUP has been provided (Attachment 10). Should the Planning Commission wish to approve the CUP and/or the request for reasonable accommodation, the hearing may be continued to a subsequent meeting in order to allow staff to prepare a resolution of approval containing the necessary findings therefore.

ENVIRONMENTAL DETERMINATION
The project is categorically exempt from the provisions of the California Environmental Quality Act (CEQA) under CEQA Guidelines Section 15301, Existing Facilities.

CONCLUSION
The applicant has requested a CUP and an accommodation to allow a sober living facility to be within 650 feet of a property that contains a state-licensed drug and alcohol treatment facility and/or sober living home. The applicant has failed to demonstrate· that all of the required findings can be made. Staff recommends denial of the appeal of the reasonable accommodation decision and denial of the Conditional Use Permit.

OH_CM000208 -17-
\I I j}-lt7~ 41...} \ ✓ ~ :/L.{WL.,v<J~ Uv? ~vvL-,

WILLA BOUWENS-KILLEEN, AICP RTIS, AICP
Zoning Administrator Director o Economic and Development Services
Attachments: 1. Vicinity, Zoning, Separation and Notification Radius Maps

2. Applicant's Project Description

3. Project Plans

4. Reasonable Accommodation Request dated September 12, 2017

5. Reasonable Accommodation Denial dated November 27, 2017

6. Appeal of Reasonable Accommodation Denial dated November 29, 2017

7. Community Context of Sober Living Houses, Douglas L. Polcin, Ed.D., et al., NIH Public Access Author Manuscript, December 1, 2012 (published in final edited form as Addict Res Theory. 2012 December 1; 20(6): 480- 491. doi: 0.3109/16066359.2012.665967)

8. Recovery Housing: Assessing the Evidence, Sharon Reif, Ph.D. at al., Psychiatric Services, March 2014 Vol. 65 No. 3

9. Residential Treatment for Individuals With Substance Use Disorders:

Assessing the Evidence, Sharon Reif, Ph.D. at al., Psychiatric Services, March 2014 Vol. 65 No. 3

10. Draft Resolution upholding the denial of the requested Reasonable Accommodation and denying PA-17-10
Distribution: Director of Economic and Development Services Assistant Director of Development Services
Assistant City Attorney
Public Services Director
City Engineer
Transportation Services Manager
Fire Protection Analyst
File (2)
Owner: Edie Johnson
115 East Wilson Street, Unit A
Costa Mesa, CA 92627
Sharon Ackerman
11567 Calle Albara
El Cajon, CA 9201
Brandon Stump
1007 Brioso Drive
Costa Mesa, CA 92627
11 OH_CM000209 -18-
Applicant:

Edie Johnson
115 East Wilson Street, Unit E
Costa Mesa, CA 92627
Ryan Stump
1007 Brioso Drive
Costa Mesa, CA 92627
18 EXHIBIT 14
OH_CM000560
RESOLUTION NO.1M1

A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF COSTA MESA,

CALIFORNIA, UPHOLDING THE DECISION OF THE PLANNING COMMISSION TO

DENY A REASONABLE ACCOMMODATION REQUEST TO DEVIATE FROM CERTAIN LAND USE REQUIREMENTS OF THE ZONING CODE; AND TO DENY CONDITIONAL USE PERMIT PA-17•10 TO ALLOW A SOBER LIVING FACILITY OPERATED BY OHIO HOUSE HOUSING UP TO 45 OCCUPANTS AT 115 EAST

WILSON STREET, UNITS A THROUGH E

THE CITY COUNCIL OF THE CITY OF COSTA MESA, CALIFORNIA HEREBY RESOLVES AS FOLLOWS:

WHEREAS, Ohio House (the "Applicant") currently operates a sober living facility serving more than six persons at 115 East Wilson Street, Units A through E, Costa Mesa; and
WHEREAS, the Applicant filed a request for a Reasonable Accommodation to allow this facility to be located within 650 feet of a property that contains a group home, sober living home or state-licensed drug and alcohol treatment faciltity; and an application requesting approval of Conditional Use Permit PA-17-10 to allow the subject sober living facility to serve up to 35 male adults with 1 O live-in managers within five existing units; and
WHEREAS, the City of Costa Mesa recognizes that while not in character with residential neighborhoods, when operated responsibly, group homes, including sober living homes and drug and alcohol treatment facilities, provide a societal benefit by providing disabled persons as defined by state and federal law the opportunity to live in residential neighborhoods, as well as providing recovery programs for individuals attempting to overcome their drug and alcohol addictions; therefore, providing greater access to residential zones to group homes, including sober living homes and drug and alcohol treatment facilities, than to boardinghouses or any other type of group living that provides a benefit to the City and its residents; and
WHEREAS, the City of Costa Mesa has adopted standards for the operation of group homes, residential care facilities and state-licensed drug and alcohol facilities that are Intended to provide opportunities for disabled persons. aa defined by state and federal law to enjoy comfortable accommodations in a residential setting; and Resolution No. 19~1 Page 1 of 12
OH_CM000561
WHEREAS, the City of Costa Mesa has found that congregating drug and alcohol treatment facilities and sober living homes in close proximity to each other does not provide disabled persons as defined In state and federal law with an opportunity to •11ve in normal residential surroundings," but rather places them into living environments bearing more in common with the types of lnstltutlonaVcampus/donnitory living that the FEHA and FHAA were designed to provide relief from for the disabled, and which no reasonable person could contend provides a life in a normal residential surrounding; and WHEREAS, the City of Costa Mesa has determined that a separation requirement for such facilities will still allow for a reasonable mar1cet for the purchase and operation of drug and alcohol treatment and sober living facilities within the City and still result in preferential treatment for sober living and drug and alcohol treatment facilities in that nondisabled individuals in a similar living situation (I.e., in boardinghouse-style residences) have fewer housing opportunities than disabled persons; and WHEREAS, the City of Costa Mesa has determined that a group home, sober living home or state-licensed drug and alcohol treatment faciltity shall be operated on a single parcel of land; and
WHEREAS, the Applicant filed an application with the City's Director of Economic and Development Services (the "Director") requesting an accommodation from the Costa Mesa Municipal Code including the requirement that a group home, residential care facility or state licensed drug and alcohol facility is at least 650 feet from another property that contains a group home, sober living home or state licensed drug and alcohol treatment facility, as well as a request to deviate from various zoning code requirements Including separation requirements the requirement to have a house manager; the need for occupants ot be actively participating in legitimate recovery programs; rules regarding use of drugs and alcohol by residents and visitors; and the requirement for a good neighbor policy as well as from single housekeeping unit standards; and WHEREAS, the request for a Reasonable Accommodation and the Conditional Use Permit application were processed in the time and manner prescribed by federal, state and local laws, and the Director denied the request for the Reasonable Accommodation in a letter dated November 27, 2017; and
Resolution No. 19-41 Page 2 of 12
OH_CM000562
WHEREAS, the Applicant appealed the Director's decision to deny a Reasonable Accommodation on November 29, 2017; and
WHEREAS, on February 11, 2019 the Planning Commission conducted a duly noticed pubtlc hearing, at which time interested persons had an opportunity to testify either in support of or in opposition to the application and voted to deny the application; and
WHEREAS, the Applicant appealed the decision of the Planning Commission In a timely manner; and
WHEREAS, a duly noticed public hearing was held by the City Council on August 6, 2019, with all persons have the opportunity to speak for or against the proposal.

BE IT RESOLVED, therefore, that based on the evidence in the record and the findings contained in this resolution, the City Council hereby UPHOLDS THE PLANNING COMMISSION'S DECISION AND DENIES the Applicant's request for Reasonable Accommodation and Conditional Use Permit PA-17-10.

BE IT FURTHER RESOLVED that if any section, division, sentence, clause, phrase or portion of this resolution, or the documents in the record in support of this resolution, are for any reason held to be invalid or unconstitutional by a decision of any court of competent jurisdiction, such decision shall not affect the validity of the remaining provisions.

PASSED AND ADOPTED this 6th day of August, 2019.

ATTEST: APPROVED AS TO FORM:

Kimberly
~~~ Hall Barlow, City Attorney
Resolution No. 19-41 Page 3 of 12
OH_CM000563

STATE OF CALIFORNIA )
COUNTY OF ORANGE ) ss

CITY OF COSTA MESA )
I, BRENDA GREEN, City Clerk of the City of Costa Mesa, DO HEREBY CERTIFY that the above and foregoing is the original of Resolution No. 19-41 and was duly passed and adopted by the City Council of the City of Costa Mesa at a regular meeting held on the 6th day of August, 2019, by the following roll call vote, to wit:

AYES: COUNCIL MEMBERS: CHAVEZ, GENIS, REYNOLDS, MANSOOR,

MARA, STEPHENS, FOLEY
NOES: COUNCIL MEMBERS: NONE
ABSENT: COUNCIL MEMBERS: NONE
IN WITNESS WHEREOF, I have hereby set my hand and affixed the seal of the City of Costa Mesa this Jlh day of August, 2019.

Brenda Greity Clerk
Resolution No. 19-41 Page 4 of 12
OH_CM000564

EXHIBIT A

FINDINGS FOR DENIAL
The City's evidence consists of a staff report with attachments. The staff report provided the factual background, legal analysis and the City's analysis supporting the denial of the Applicant's request for a Reasonable Accommodation and the Conditional Use Pennit, based on the Applicant not meeting Its burden to demonstrate compliance with all required findings per the Costa Mesa Municipal Code (CMMC).

A. The subject property is located approximately 550 feet from a sober living facility at 165 East Wilson Street. The City approved a Conditional Use Permit (CUP) in 2016 for this facility (PA-16-03). The Applicant applied for Reasonable Accommodation on October 27, 2017 to allow the subject sober living facility to be located within 650 feet of the existing sober living facility (the Applicant's letter was dated September 12, 2017 but was received by the City on October 27, 2017). The CUP application was received for Unit E on March 23, 2017 with CUP applications for the remainder of the units received between October 27, 2017 and December 5, 2017. The applicant's request for a Reasonable Accommodation to allow this sober living facility to be located within 650 feet of the sober living facility was denied by the Director of Economic and Development Services on November 27, 2017. The applicant appealed the request on November 29, 2017, but gave no reasons for the appeal. On February 11, 2019, Planning Commission upheld the Director's denial of the requested Reasonable Accommodation.

B. The Application does not meet the findings required by the Costa Mesa Municipal Code for approval of a Reasonable Accommodation:
• The requested accommodation is necessary to provide one or more individuals with a disability with an equal opportunity to use and enioy a dwelling.

The City recognizes that, while not in character with the residential neighborhoods, when operated responsibly, group homes, including sober living homes, provide a societal benefit by providing disabled persons the opportunity to live in residential neighborhoods. These facilities provide recovery programs for individuals attempting to overcome their drug and alcohol addictions. The City has established separation criteria to ensure that an overconcentration of sober living homes and licensed drug and alcohol treatment facilities does not occur in any neighborhood, thereby, preserving the residential character for all who choose to reside there.

The application established that the waiver of the separation requirement would allow one or more indMduals who are recovering from drug and alcohol abuse to enjoy the use these dwellings. However, approval of the request Is not necessary to allow one or more individuals who are recovering from drug and alcohol abuse to enjoy the use of I dwelling within the City.

Resolution No. 1941 Page 5 of 12
OH_CM000565
The operation of a group home is inconsistent with the City's definition of a single housekeeping unit. The City has established procedures to allow group homes in residential neighborhoods; allowing a group to be considered a single housekeeping unit Is not necessary to allow the disabled to reside In residential neighborhoods.

The City has adopted standards for sober living homes and licensed treatment facilities in residential zones to ensure the disabled have the opportunity to live in a typicaJ residential neighborhood. The permit process ensures that sober living homes and licensed treatment facilities comply with the City's standards. The City specifically required all existing group homes to comply with the new regulations within one year. The applicant's letter failed to provide a basis to "grandfather" this facility when all other facilities in operation at the time the regulations were adopted are also required to comply.
• The requested accommodation is consistent with the surrounding uses in scale and intensity of use.

The subject facility does not operate as a single housekeeping unit, or even five single housekeeping units, making it dissimilar to the composition of households on surrounding properties. The facility is occupied solely by adults at a higher occupancy than is typical in Costa Mesa. Each resident is allowed to keep a car on the property. With 35 residents and 10 onsite managers, the facility provides opportunities for parking conflicts with owners of nearby properties who also rely on on-street parking. The City's intent in adopting its group home regulations was to ensure an overconcentration of group homes did not occur in any neighborhood.

The facility would contribute to overconcentration given that it includes five units on five Individual lots.
• Whether the existing supply of facilities of a similar nature and operation in the community is sufficient to provide individuals with a disability and equal opportunity to live in a residential setting.

The City has received applications for 64 sober living homes and 1 1 licensed treatment facilities that are subject to compliance with Ordinance Nos. 14-13 and 15-11 . Twelve sober living homes serving six or fewer residents have been approved by the City, and two sober living homes serving seven or more residents have been approved by the City. In addition, there are 74 existing state licensed drug and alcohol facilities in Costa Mesa that are exempt from City regulation, or have already obtained the required Conditional Use Permit.

No evidence has been submitted to indicate that the number of sober living homes and drug and alcohol residential care facilities existing or potentially allowed in compliance with the City's standards is inadequate.

Resolution No. 19-41 Page 6 of 12
OH_CM000566
• The requested accommodation will not result in a fundamental alteration in the nature of the City's zoning program.

Ordinance 15-11 established requirements for sober living homes, group homes, and licensed drug and alcohol treatment facilities in multi-family zoning districts. When the City Council adopted this ordinance, it specifically included a provision requiring a separation of at least 650 feet between such facilities.

The intent of this limitation is to ensure that sober living and drug and alcohol treatment facilities do not occupy a disproportionate number of homes in any neighborhood, and to avoid overconcentration of sober living and drug and alcohol treatment facilities in any area. The City also sought to ensure that disabled persons recovering from an addiction can reside in a comfortable residential environment versus in an institutional setting. The City determined that housing inordinately large numbers of unrelated adults in a single dwelling or congregating sober living and drug and alcohol treatment facilities in close proximity to each other does not provide the disabled with an opportunity to "live In normal residential surroundings" but, rather, places them into living environments bearing more in common with the types of
institutional/campus/dormitory living that the state and federal laws were designed to avoid. The subject property consists of five units on five individual Jots, which already contributes to an overconcentration of sober living homes in the area. The site's proximity to another sober living home serving more than six adults contributes to an overconcentration of sober living facilities in this neighborhood. Granting the accommodation to consider this facility as a single housekeeping unit and/or waive the separation standard will result in an overconcentration of sober living facilities in this area that is in conflict with the Intent of the City's zoning program.

When the City adopted Ordinance 15-11, it specifically included provisions requiring all existing group home operators to come into compliance with the new regulations within one year of their adoption. The ordinance did not create or recognize any previously legally existing non-licensed group homes and/or group homes with 7 or more residents as uses that would be considered nonconforming. Given the intent of the ordinance, it is not appropriate to grant the reasonable accommodation to allow the subject facility to be "grandfathered" and exempted from compliance with current regulations.

The application for reasonable accommodation failed to justify any reason to waive compliance with the provisions of Section 9-374(b){11) of the CMMC that require the applicant to have a house manager; ensure all occupants, other than the house manager, are actively participating in legitimate recovery programs; prohibit the use of any alcohol or non-prescription drugs by any recovering addict; have a policy regarding use and storage of prescription medications; post house rules in a common area inside the dwelling unit; prohibit visitors who are under the influence of any drug or alcohol; and maintain a good neighbor policy.

Resolution No. 19-41 Page 7 of 12
OH_CM000567
C. The Application does not meet the findings required by the Costa Mesa Munfclpal Code for approval of a Conditional Use Permit:
• The prooossd use is substantially compatible with developments In the same general area and would not be materially detrimental to other properties within the area.

The facility consists of five units on five parcels with a common lot to hold the project as a common interest development. Approval of this request will allow up to 45 adults to occupy the site. With the exception of minimum required lot width requirements, the site satisfies all applicable development standards.

The proposed occupancy of these units constitutes overcrowding pursuant to the Housing Element of the General Plan, page HOU-23, which states:

Overcrowding is defined as a housing unit occupied by more than one person per room. A severely overcrowded housing unit is one with more than 1.5 persons per room. A room is defined as a bedroom, living room, dining room, or finished recreation room, but excludes kitchen and bathroom.

This definition is consistent with the Federal HUD standards, which generally define "overcrowding" to mean housing units with 1.01 or more persons per room.

See 42 uses § 5302(a)(10). Under this standard, all the units would be overcrowded.

The subject property is located within approximately 550 feet of a sober living facility located at 165 East Wilson Street. This facility is licensed to serve 11 adults and was issued a CUP by the City in 2016 (PA-16-03).

Allowing multiple group homes, sober living homes and/or state-licensed drug and alcohol treatment facilities to cluster in residential neighborhoods effects a fundamental change to the residential character of the neighborhood.

Overconcentration of drug and alcohol treatment facilities and group homes changes the residential character of a neighborhood to one that is far more institutional in nature. Strong evidence exists that a supportive living environment in a residential neighborhood provides more effective recovery than an institutional-style environment. The City's zoning regulations address overconcentration and secondary effects of drug and alcohol treatment facilities.

The goal of the regulations is to provide the disabled with an equal opportunity to live in a residential neighborhood, whlle maintaining the residential character of existing neighborhoods. Housing 40 to 45 residents in five units which operate as an Integral facility Is not In keeping with the residential character of the neighborhood.

Resolution No. 19-41 Page 8 of 12
OH_CM000568
The operator of a group home may request reasonable accommodation when compliance with all of the standards is not possible. Section 13-200.62 (f) of the Zoning Code sets forth the required findings to be used in the determination to approve, conditionally approve, or deny a request for reasonable accommodation.

The Code specifies that all findings must be made in order to approve such a request. The findings to deny this requested accommodation were enumerated above.

The CMMC establishes criteria for approval of group homes In multi-family zones.

Group homes serving disabled persons as defined by state and federaJ law are not considered to be boardinghouses. Rather, these facilities offer disabled persons the opportunity to live in residential neighborhoods in compliance with state and federal laws. Recovering alcoholics and drug addicts, who are not currently using alcohol or drugs, are considered disabled under state and federal law. Standards for large group homes are set forth in the Zoning Code. The intent of the regulations is to preserve the residential character of the City's neighborhoods while providing opportunities for the disabled to live in comfortable residential surroundings.

The City adopted standards for group homes in response to a proliferation of drug and alcohol treatment facilities in the community. The City found that an overconcentration of sober living homes and drug and alcohol treatment facilities in the City's residential neighborhoods could be deleterious to the residential character of these neighborhoods and could also lead to the institutionalization of such neighborhoods. Drug and alcohol treatment facilities and sober living homes generally do not function as a single housekeeping unit because they house extremely transient populations; the residents generally have no established ties to each other when they move in and typically do not mingle with other neighbors; the residents have little to no say about who lives or doesn't live in the home; the residents do not generally share expenses; the residents are often responsible for their own food, laundry and phone; when residents disobey house rules they are often just evicted from the house; and the residents generally do not share the same acquaintances. The City found that the size and makeup of the households in drug and alcohol treatment facilities is dissimilar and larger than the norm, creating impacts on water, sewer, roads, parking and other City services that are far greater than the average household. In addition, all the individuals residing in a drug and alcohol treatment facility are generally over the age of 18, while the average household in Costa Mesa has just 2.2 individuals over the age of 18.

Because of their transient populations, above-normal numbers of Individuals/adults residing in a single dwelling and the lack of regulations, drug and alcohol treatment facilities and sober living homes present problems not typically associated with more traditional residential uses. These issues may include the housing of large numbers of unrelated adults who may or may not be supervised; disproportionate numbers of cars associated With a single housing unit. which causes disproportionate traffic and utilization of on-street parking; excesa1ve nolse and outdoor smoking, which Interferes with the use and enjoyment of neighbors' Resolution No. 19-41 Page 9 of 12
OH_CM000569
properties; neighbors who have little to no idea who does and does not reside in the home; little to no participation by residents In community activities that form and strengthen neighborhood cohesion; disproportional impacts from the average dWelling unit to near1y all public services Including sewer, water, parks, libraries, transportation infrastructure, fire and police; a history of residents congregating in the same general area; and the potential influx of individuals with a criminal record.

Nevertheless, the City recognizes that while not in character with residential neighborhoods, when operated responsibly, group homes, including drug and alcohol treatment facilities, provide a societal benefit by providing disabled persons the opportunity to live In residential neighborhoods. These facilities also provide recovery programs for individuals attempting to overcome their drug and alcohol addictions. The City's regulations provide group homes, including sober living homes and licensed drug and alcohol treatment facilities, greater access to residential zones than to boardinghouses or other types of group living arrangements. This favorable access for group homes provides a benefit to the City and its residents.

In response to the needs and concerns described above, the City established a minimum separation of 650 feet between group homes, residential care facilities and/or state-licensed drug and alcohol facilities. The City found that a separation requirement will still allow for a reasonable market for the purchase and operation of sober living homes and drug and alcohol treatment facilities within the City. The requirement will still result in preferential treatment for sober living homes and drug and alcohol treatment facilities in that non-disabled individuals in a similar living situation (i.e., in boardinghouse-style residences) have fewer housing opportunities than the disabled. The City determined that housing inordinately large numbers of unrelated adults in a single dwelling or congregating sober living homes and drug and alcohol treatment facilities in close proximity to each other does not provide the disabled with an opportunity to "live in normal residential surroundings," but rather places them into living environments bearing more in common with the types of institutional/campus/dormitory living that the state and federal laws were designed to provide them relief from.

The Federal Housing Act Amendments (FHAA), 42 U.S.C. § 3601 et seq., provide that a city "commits discrimination under the FHAA if it refuses to make reasonable accommodations in rules, policies, practices, or services, when such accommodation may be necessary to afford [the disabled] equal opportunity to use and enjoy a dwelling." Budnick v. Town of Carefree, 518 F.3d 1109, 1119 (9th Cir. 2008).

The FHAA requires a city to provide a requested accommodation if such aocommodation "(1) is reasonable, and (2) necessary, (3) to afford a handicapped person the equal opportunity to use and enjoy a dwelling." Oconomowoc Residentjal Programs. loc, v. City of Milwaukee. 300 F.3d ns, 783 (7th Cir. 2002): 42 u.s.c. § 3604(f)(3)(8).

Resolution No. 19-41 Page 1 O of 12
OH_CM000570
The applicant requested relief from the Zoning Code requirement that a sober living home or drug and alcohol treatment facility be located at least 650 feet from another property that contains a group home, sober IMng home or state-licensed drug and alcohol treatment facility. The request for a Reasonable Accommodation was denied by the Director of Development Services on November 27, 2017 because another sober living or drug and alcohol treatment facility exists within 650 feet of the subject property. The applicant appealed the decision on November 29, 2017 but gave no reason for the appeal.

The facility is located within approximately 550 feet of a City-approved sober living facility serving 11 occupants at 165 East Wilson Street, approved under PA-16-03.

The facility contributes to overconcentration and does not comply with the City's adopted standards for separation between group homes, residential care facilities and state-licensed drug and alcohol facilities. Further, pursuant to CMMC Section 13-323(b), the Planning Commission and the City Council did not find that approval of this CUP application would not result in an overconcentration of sober living homes and licensed treatment facilities in this neighborhood. • Granting the conditional use permit wll/ not be materially detrimental to the health, safety and general welfare of the public or otherwise iniurious to property or Improvements within the immediate neighborhood.

The City has found that overconcentration of sober living homes, drug and alcohol treatment facilities, and other group homes changes the character of a residential neighborhood to one that is more institutional in nature. This change in neighborhood character can compound secondary effects related to noise, traffic, and parking. In these neighborhoods, street life is often characterized by large capacity vans picking up and dropping off residents and staff; staff in scrubs carrying medical kits going from unit to unit, and vans dropping off prepared meals in large numbers. The City has experienced frequent Fire Department deployments in response to medical aid calls. In some neighborhoods, Police Department deployments are a regular occurrence as a result of domestic abuse calls, burglary reports, disturbing the peace calls and parole checks at drug and alcohol treatment facilities. Large and often frequent Alcoholics Anonymous or Narcotics Anonymous meetings are held at some drug and alcohol treatment facilities. Attendees of these meetings contribute to the lack of available on-street parking and neighbors report finding an unusual amount of litter and debris, including beverage containers, condoms and drug paraphernalia in the wake of these meetings. These types of impacts have been identified in other communities as well. The facility will contribute to the overconcentration of sober living and drug and alcohol treatment facilities in this neighborhood, Which could lead to negative Impacts In the neighborhood. Code Enforcement has already received a complaint alleging trash and cigarettes in the alley abutting this site.

Resolution No. 19-41 Page 11 of 12
OH_CM000571
There are only 20 par1<ing spaces on the site available to serve 35 adults as well as the 10 on-site managers. Approval of this CUP could result In conflicts with residents of nearby properties for the use of on-street parking spaces. • Granting the conditional use permit will not allow a use, density or intensity which is not in accordance with the general plan designation for the proo,rty.

The proposed use is consistent with the City's General Plan. However, an overconcentration of group homes, sober living homes and licensed treatment facilities for alcohol and drug addiction is not consistent with the General Plan. The City's regulations are intended to preserve the residential character of the City's neighborhoods. The City Council has determined that an overconcentration of drug and alcohol treatment facilities would be detrimental to the residential character of the City's neighborhoods. The proposed facility is located within 650 feet of another sober living or drug and alcohol treatment facility, contributes to overconcentration, and is therefore, not consistent with the intent of the General Plan.

D. The Costa Mesa City Council has denied the requested Reasonable Accommodation and Conditional Use Permit PA-17-10. Pursuant to Public Resources Code Section 21080(b) and CEQA Guidelines Section 15270(a), CEQA does not apply to this project because it has been rejected and will not be carried out.

E. The project is exempt from Chapter IX, Article 11, Transportation System Management, of Trtle 13 of the Costa Mesa Municipal Code.

Resolution No. 19-41 Page 12 of 12
EXHIBIT 15
OH_CM000460

CITY OF COSTA MESA
P.O. BOX 1200 • 77 FAIR DRIVE • CALIFORNIA 92628 • 1200

DEVELOPMENT SERVICES DEPARTMENT
November 27, 2017

SENT VIA ELECTRONIC & US MAIL
Steven G. Polin, Esq.

Attorney at Law
3034 Tennyson St. NW
Washington, D.C. 20015
Email: [email protected]
ATTACHMENT 5
Subject: Reasonable Accommodation for The Ohio House Located at 115 E.

Wilson, Units A through E, in Costa Mesa; Conditional Use Permit PA-17- 10 filed by Edie Johnson and Brandon Stump
Dear Mr. Polin,
The City is in receipt of your letter dated September 12, 2017, requesting a reasonable accommodation. Please be advised that the City has no record of receiving this letter until October 27, 2017, when a paper copy was submitted to the City by the applicant.

Your request asks the City to treat the residents of The Ohio House facility captioned above as a "single housekeeping unit" and to treat the use of this property as a single family use, or grandfather the use of the property, or deem the use to be legal nonconforming. Your letter also requests an accommodation to allow this facility to be located within 650 feet of another facility providing services to those in recovery from addiction to drugs and/or alcohol. Finally, your letter requests a waiver of certain requirements of the Costa Mesa Municipal Code (CMMC) addressing the size of group homes; the requirement to have a house manager; the need for occupants to be actively 7>3rt1clp-ating in legitimaterecovery prog,a~ rules regardtng·use of drugsana alcohol by residents and visitors; and the requirement for a good neighbor policy, Section 13-6 of the CMMC defines a single housekeeping unit as a unit where "occupants of a dwelling unit have established ties and familiarity with each other, jointly use common areas, interact with each other, share meals, household activities, and expenses and responsibilities; membership in the single housekeeping unit is fairly stable as opposed to transient, members have some control over who becomes a member of the household, Building Division (714) 754-5273 • Code Enforcement & Community Improvement Divfsron (714) 754-5623 Housing & Communitt ~~~~'?P."2.:~t \~~~) 754-4870 ·._Planning Division (714) 754-5245 OH_CM000461
Steven Polin
November 27, 2017

and the residential activities of the household are conducted on a nonprofit basis. There is a rebuttable presumption that integral facilities do not constitute single housekeeping un,ts. Additional indicia that a household is not operating as a single housekeeping unit include but are not limited to: the occupants do not share a lease agreement or ownership of the property; members of the household have separate, private entrances from other members; members of the household have locks on their bedroom doors; members of the household have separate food storage facilities, such as separate refrigerators. '' The house rules submitted as part of the Operator's Permit for this property make it clear that the facility is not operated as a Single Housekeeping Unit as defined above. • Residents purchase and prepare their own food. Each resident has a designated area for food storage.
• Daily chores are assigned by the house manager.
• Rent is collected from each resident.
• The rental agreement covers one month, indicating that membership in the household is transient.
• Visitors must be approved by the Facility Manager.
• Residents must take direction from the staff.
• Occupancy of the units is determined by The Ohio House staff, not the residents of the facility.

The CMMC specifies that a minimum separation of 650 feet shall be provided between group homes, residential care facilities and/or state licensed drug and alcohol facilities.

The subject property is within approximately 500 feet of a sober living facility located at 165 E. Wilson. This facility has an existing CUP (PA-16-03) to serve more than six individuals and is located on the same street as the subject property, one block to the east.

Requirements of Section 13-311 of the CMMC are cited in your letter. However, this section of the Code applies to the operation of group homes located in single-family zones. The subject property is located in the R2-MD zoning district. Therefore, the regulations set forth in Section 9-374 of the CMMC regarding Operator's Permits apply to the property. Many of the requirements for operation of group homes in single family zones also apply to those operated in multi-family zones.

In single family zones, the size of a group home is limited to six or fewer occupants, not counting the house manager. In a multi-family zone, there is no such limitation on the number of residents in a group home, except that those serving seven or more residents are required to obtain a conditional use permit (CUP). Therefore, there is no need for the City to waive the provisions regarding the size of a group home, as requested in your letter.

The operator of a group home may request reasonable accommodation when compliance with all City standards is not possible. Section 13-200.62 (f) of the Zoning Code sets forth the required findings to be used in the determination to approve, conditionally approve, or OH_CM000462
Steven Polin
November 27, 2017

deny a request for reasonable accommodation. The Code specifies that all findings must be made to approve such a request. Based on the information submitted, the City cannot approve any of your requests for reasonable accommodation, as all the required findings described below cannot be made.
o The requested accommodation is requested by or on the behalf of one (1) or more individuals with a disability protected under the fair housing laws.

I accept that this application was submitted on behalf of persons who are considered disabled under state and federal law.
o The requested accommodation is necessary to provide one (1) or more individuals with a disability an equal opportunity to use and enjoy a dwelling.

The application explains the benefits of allowing those recovering from alcoholism and substance abuse to live in a setting that offers a self-paced recovery option that provides sufficient time for personal psychological growth while avoiding the use of alcohol and other substances. The City recognizes that while not in character with residential neighborhoods, when operated responsibly, group homes, including sober living homes, provide a societal benefit by providing disabled persons the opportunity to live in residential neighborhoods. These facilities provide recovery programs for individuals attempting to overcome their drug and alcohol addictions. The City has established separation criteria to ensure that an overconcentration of sober living homes and licensed drug and alcohol treatment facilities does not occur in any neighborhood, thereby, preserving the residential character for all who choose to reside there.

The application established that the waiver of the separation requirement would allow one or more individuals who are recovering from drug and alcohol abuse to enjoy the use of these dwellings. However, approval of the request is not necessary to allow one or more individuals who are recovering from drug and alcohol abuse to enjoy the use of 2 dwelling within the City.

The operation of a group home is inconsistent with the City's definition of a single housekeeping unit. The City has established procedures to allow group homes in residential neighborhoods; allowing a group home to be considered as a single housekeeping unit is not necessary to allow the disabled to reside in residential neighborhoods.

The City has adopted standards for sober living homes and licensed treatment facilities in residential zones to ensure the disabled have the opportunity to live in a typical residential neighborhood. The permit process ensures that sober living homes and licensed treatment facilities comply with the City's standards. The City specifically required all existing group homes to comply with the new regulations within one year.

Your letter fails to provide a basis to "grandfather" this facility when all other facilities in operation at the time the regulations were adopted are also required to comply.

OH_CM000463
Steven Polin
November 27, 2017

o The requested accommodation will not impose an undue financial or administrative burden on the city, as "undue financial or administrative burden" is defined in fair housing laws and interpretive case law.

There is no evidence that approval of this request will impose an undue financial or administrative burden on the City.
o The requested accommodation is consistent with surrounding uses in scale and intensity of use.

The subject facility does not operate as a single housekeeping unit, or even five single housekeeping units, making it dissimilar to the composition of households on surrounding properties. The facility is occupied solely by adults at a higher occupancy than is typical in Costa Mesa. Each resident is allowed to keep a car on the property, providing opportunities for parking conflicts with owners of nearby properties who also rely on on-street parking. The City's intent in adopting its group home regulations was to ensure an overconcentration of group homes did not occur in any neighborhood.

The facility would contribute to overconcentration given that it includes five units on five individual lots.
o The requested accommodation will not, under the specific facts of the case, result in a direct threat to the health or safety of other individuals or substantial physical damage to the property of others.

There is no evidence that approval of this request would result in a direct threat to the health or safety of anyone, or substantial physical damage to the property of others.
o If economic viability is raised by the applicant as part of the applicant's showing that the requested accommodation is necessary, then a finding that the requested accommodation is necessary to make facilities of a similar nature or operation economically viable in light of the particularities of the relevant market and market participants generally, not just for that particular applicant.

The applicant did not cite economic viability as a factor in requesting an accommodation to consider the facility as a single housekeeping unit, or to waive the separation standard between facilities serving those in recovery. No economic justification was provided to justify the waiver of compliance with other standards that apply to all sober living homes.
o Whether the existing supply of facilities of a similar nature and operation in the community is sufficient to provide individuals with a disability an equal opportunity to live in a residential setting.

OH_CM000464
Steven Polin
November 27, 2017

The City has received applications for 66 sober living homes and 11 licensed treatment facilities that are subject to compliance with Ordinance Nos. 14-13 and 15-

11. Twelve ( 12) sober living homes serving six or fewer residents have been approved by the City, and one sober living home serving 13 men has been approved. In addition, there are 63 state-licensed drug and alcohol residential treatment facilities in Costa Mesa that are not subject to the Special Use Permit requirements, or have already obtained the required conditional use permit. No evidence has been submitted to indicate that the number of sober living homes and drug and alcohol facilities existing or potentially allowed in compliance with the City's standards is inadequate.
o The requested accommodation will not result in a fundamental alteration in the nature of the city's zoning program.

Ordinance 15-11 established requirements for sober living homes, group homes and licensed drug and alcohol treatment facilities in multi-family zoning districts. When the City Council adopted this ordinance, it specifically included a provision requiring a separation of at least 650 feet between such facilities. The intent of this limitation is to ensure that sober living facilities do not occupy a disproportionate number of homes in any neighborhood, and to avoid overconcentration of sober living units in any area.

The City also sought to ensure that disabled persons recovering from addiction can reside in a comfortable residential environment versus in an institutional setting. The City determined that housing inordinately large numbers of unrelated adults In a single dwelling or congregating sober living homes in close proximity to each other does not provide the disabled with an opportunity to "live in normal residential surroundings," but rather places them into living environments bearing more in common with the types of institutional/campus/dormitory living that the state and federal laws were designed to avoid. The subject property consists of five units on five individual lots, which already contributes to an overconcentration of sober living homes in the area.

The site's proximity to another sober living home serving more than six adults contributes to an overconcentration of sober living facilities in this neighborhood.

Granting the accommodation to consider this facility as a single housekeeping unit, and/or to waive the separation standard, will result in an overconcentration of sober living facilities in this area.

When the City adopted Ordinance 15-11, it specifically included provisions requiring all existing group home operators to come into compliance with the new regulations within one year of their adoption. The ordinance did not create or recognize any nonconforming uses. Given the intent of the ordinance, it is not appropriate to grant your requested accommodation to be "grandfathered" and exempt from compliance with the current regulations.

The application for reasonable accommodation failed to justify any reason to waive compliance with the provisions of Section 9-37 4(b )( 11) of the CMMC that require the applicant to have a house manager; ensure all occupants, other than the house manager, are actively participating in legitimate recovery programs; prohibit the use OH_CM000465
Steven Polin
November 27, 2017

of any alcohol or non-prescription drugs by any recovering addict; have a policy regarding use and storage of prescription medications; post house rules in a common area inside the dwelling unit; prohibit visitors who are under the influence of any drug or alcohol; and maintain a good neighbor policy.

The City carefully crafted regulations to allow group homes, including sober living homes and licensed treatment facilities, to be located in residential neighborhoods. The intent of these regulations is to ensure that facilities maintain compatibility with the residential neighborhood in which they are situated, and to ensure that the disabled are able to live in normal residential settings. The approval of this request will contribute to an overconcentration of sober living units in this neighborhood. The application did not include adequate information to allow me to make all of the required findings set forth in the CMMC. Therefore, your request for a reasonable accommodation has been denied.

This determination may be appealed. An appeal must be filed with the City Clerk within seven (7) days of the date of this decision. A fee of $1,220.00 must accompany an appeal. If no appeal is filed by 5:00 p.m. on December 4, 2017, this decision shall be final.

Please contact Sheri Vander Dussen, consultant to the City, at (714)754-5230 if you have any questions regarding this decision or the appeal process.

Barry Curtis, AICP
Economic and Development Services Director
c: Brandon Stump, The Ohio House
234 2nd St., Huntington Beach, CA 92648
Tarquin Preziosi, Assistant City Attorney
Katie Angel, Management Analyst
Sheri Vander Dussen, Consultant
File: PA-17-10
EXHIBIT 16
Record_ID Legal Name Program Name Facility Address Type of Application Service Type Resident Capacity Target Population 300067AP NANCY CLARK AND ASSOCIATES, INC. THE RECOVERY CENTER 1110 VICTORIA STREET Licensed RES 38 CO-ED 300121AN YELLOWSTONE WOMEN'S FIRST STEP HOUSE, INC. YELLOWSTONE, WROC 3132 BOSTON WAY Licensed RES 13 MEN ONLY 300121LN YELLOWSTONE WOMEN'S FIRST STEP HOUSE, INC. YELLOWSTONE RECOVERY - EAST HOUSE 590 TRAVERSE DRIVE Licensed RES 6 CO-ED 300270CP HOTEL CALIFORNIA BY THE SEA, LLC HOTEL CALIFORNIA BY THE SEA, LLC 1509 ORANGE AVENUE, #A Licensed RES 6 CO-ED 300270DP HOTEL CALIFORNIA BY THE SEA, LLC HOTEL CALIFORNIA BY THE SEA 317 ROCHESTER STREET Licensed RES 6 CO-ED 300007LN NEW DIRECTIONS FOR WOMEN, INC. NEW DIRECTIONS FOR WOMEN 2601, 2603, 2607 WILLO LANE and 334 UNIVERSITY AVE Licensed RES-DETOX 36 WOMEN ONLY 300012BN SOUTH COAST COUNSELING, INC. SOUTH COAST COUNSELING, INC. 693 PLUMER STREET Licensed RES-DETOX 15 CO-ED 300043BP ASANA RECOVERY ASANA RECOVERY 3062 JOHNSON AVENUE Licensed RES-DETOX 6 CO-ED 300121FN YELLOWSTONE WOMEN'S FIRST STEP HOUSE, INC. THE YELLOWSTONE BRIDGE 2028 FULLERTON AVENUE, Units A, B & C Licensed RES-DETOX 16 CO-ED 300121BN YELLOWSTONE WOMEN'S FIRST STEP HOUSE, INC. YELLOWSTONE (WOMEN'S RECOVERY OF CALIFORNIA) 154, 160 EAST BAY STREET Licensed RES-DETOX 12 CO-ED 300313JP SOUTH COAST BEHAVIORAL HEALTH SOUTH COAST BEHAVIORAL HEALTH 559 PIERPONT DRIVE Licensed RES-DETOX 6 CO-ED 300313MP SOUTH COAST BEHAVIORAL HEALTH SOUTH COAST BEHAVIORAL HEALTH 3125, 3129 PIERCE AVE Licensed RES-DETOX 12 CO-ED 300326BP CASA CAPRI LLC CASA CAPRI RECOVERY 671, 675, 679, 687 GOVERNOR STREET Licensed RES-DETOX 24 WOMEN ONLY 300382BP KKB HEALTH SOLUTIONS, LLC CLEAR LIFE RECOVERY 2822 MONTEREY AVENUE Licensed RES-DETOX 6 CO-ED 300394BP TEAGLE HALL LLC WINDWARD WAY RECOVERY 395 VICTORIA STREET Licensed RES-DETOX 6 CO-ED 300394CP TEAGLE HALL LLC WINDWARD WAY RECOVERY 2136 THURIN STREET, Unit B Licensed RES-DETOX 6 CO-ED 300394FP TEAGLE HALL LLC WINDWARD WAY RECOVERY 2136 THURIN STREET, Unit A Licensed RES-DETOX 6 CO-ED 300394DP TEAGLE HALL LLC WINDWARD WAY RECOVERY 2137 DOCTORS CIRCLE, Unit A Licensed RES-DETOX 6 CO-ED Record_ID Legal Name Program Name Facility Address Type of Application Service Type Resident Capacity Target Population 300394EP TEAGLE HALL LLC WINDWARD WAY RECOVERY 2137 DOCTORS CIRCLE, Unit B Licensed RES-DETOX 6 CO-ED 300412BP RECOVERY SOLUTIONS, LLC SADDLEBACK RECOVERY 209, 211 E. 18TH STREET Licensed RES-DETOX 12 CO-ED 300028AP OPUS HEALTH, LLC OPUS HEALTH, LLC 925 VICTORIA STREET and 2738 LORENZO AVE Licensed and Certified RES-DETOX 12 CO-ED 300043DP ASANA RECOVERY ASANA RECOVERY 3073 MADISON AVE Licensed and Certified RES-DETOX 6 FAMILIES 300154RP SAFE HARBOR TREATMENT CENTER FOR WOMEN, INC. THE HARBOR 240 KNOX STREET Licensed and Certified RES-DETOX 6 CO-ED 300154NP SAFE HARBOR TREATMENT CENTER FOR WOMEN, INC. SAFE HARBOR TREATMENT CENTER FOR WOMEN, INC. 546, 548, 550A, 550B BERNARD STREET Licensed and Certified RES-DETOX 20 CO-ED 300154SP SAFE HARBOR TREATMENT CENTER FOR WOMEN, INC. SAFE HARBOR TREATMENT CENTER 236 KNOX STREET Licensed and Certified RES-DETOX 6 CO-ED 300269AP DIVINE BLISS THE HO TAI WAY 1219 PARNELL PLACE Licensed and Certified RES-DETOX 6 CO-ED 300297CP AKUA BEHAVIORAL HEALTH, INC. AKUA MIND & BODY 369 RALCAM PLACE Licensed and Certified RES-DETOX 6 CO-ED 300394AP TEAGLE HALL LLC WINDWARD WAY RECOVERY 316 HAMILTON STREET Licensed and Certified RES-DETOX 6 CO-ED 300423AP JJLT HOLDINGS LLC OCEAN COAST RECOVERY CENTER 1799 HUMMINGBIRD DRIVE Licensed and Certified RES-DETOX 6 DUAL DIAGNOSIS 300438AP EMBRACE TREATMENT LLC EMBRACE TREATMENT LLC 1912 SUMBA CIRCLE Licensed and Certified RES-DETOX 6 CO-ED 300647AP AKUA BEHAVIORAL HEALTH, INC. AKUA MIND & BODY 326, 328 UNIVERSITY DRIVE Licensed and Certified RES-DETOX 12 MEN ONLY 300647CP AKUA BEHAVIORAL HEALTH, INC. AKUA MIND & BODY 319- A UNIVERSITY DR. Licensed and Certified RES-DETOX 6 CO-ED 300647DP AKUA BEHAVIORAL HEALTH, INC. AKUA MIND & BODY 319- B UNIVERSITY DR. Licensed and Certified RES-DETOX 6 CO-ED 300778BP RENU HEALTHCARE, LLC RENU HEALTHCARE 1008 W WILSON ST., Suite B Licensed and Certified RES-DETOX 6 CO-ED 300778AP RENU HEALTHCARE, LLC RENU HEALTHCARE 1008 W WILSON ST, Suite B Licensed and Certified RES-DETOX 6 CO-ED 300626EP ELITE CARE, INC. BEGINNINGS TREATMENT CENTERS 930, 934 MAGELLAN STREET Licensed RES-DETOX 12 CO-ED EXHIBIT 17
Ohio House v. City of Costa Mesa Nancy Clark
LINDA RYAN REPORTING (714) 457-5810
2 1 UNITED STATES DISTRICT COURT
2 CENTRAL DISTRICT OF CALIFORNIA
3 THE OHIO HOUSE LLC, )
)
4 Plaintiff, )
) CASE NO.
5 vs. ) 8:19-cv-01710-JVS
) GJS
6 CITY OF COSTA MESA, a )
)
7 Defendant. )
______________________________)
8 9 UNITED STATES DISTRICT COURT
10 CENTRAL DISTRICT OF CALIFORNIA
11 INSIGHT PSYCHOLOGY AND )
ADDICTION, INC., et al., )
12 )
Plaintiffs, )
13 ) CASE NO.
vs. ) 8:20-cv-00504-JVS
14 ) (JDEx)
CITY OF COSTA MESA, et al., )
15 )
Defendants, )
16 ______________________________)
)
17 AND RELATED ACTION. )
______________________________)
18 19 Videotaped/Videoconferenced Deposition of NANCY
20 CLARK, taken on behalf of Insight Psychology and
21 Addiction, Inc., Mary Helen Beatificato, Gerald Grosso, 22 and Ohio House, commencing at 9:39 a.m. and ending
23 at 3:26 p.m. on Monday, November 15, 2021, before LAURA 24 L. CORNING, Federal Certified Realtime Reporter,
25 Certified Shorthand Reporter No. 8363.

Ohio House v. City of Costa Mesa Nancy Clark
LINDA RYAN REPORTING (714) 457-5810
7 1 Irvine, California
2 Monday, November 15, 2021
3 9:39 a.m. - 3:26 p.m.
4 (At this time Ms. Beatificato was not
5 present in the Zoom deposition proceedings.)
6 7 PLEASE BE ADVISED THAT THE DISMANTLING AND/OR UNBINDING 8 OF THE ORIGINAL TRANSCRIPT WILL VOID THE CERTIFICATION OF 9 THE CERTIFIED SHORTHAND REPORTER, FEDERAL CERTIFIED
10 REALTIME REPORTER, AND NULLIFY THE INTEGRITY OF THE
11 ORIGINAL TRANSCRIPT.
12 13 THE VIDEOGRAPHER: We're on the record. My
14 name is Gary Wade. I am a videographer employed by Wade 15 Enterprises located at 166 North Eckoff Street, Orange, 16 California. This is the video recording of the
17 deposition of Nancy Clark. We are starting at
18 approximately 9:39 a.m. on November 15th, 2021 via remote 19 videoconference. This is the matter of Insight
20 Psychology and Addiction, Inc., et al., versus City of 21 Costa Mesa, et al., and The Ohio House versus City of 22 Costa Mesa. Case numbers are 8:20-cv-00504-JVS (JDEx) 23 and Case Number 8:19-cv-01710-JVS GJS. This deposition 24 is taken on behalf of the plaintiff.
25 May we have the introductions beginning with
Ohio House v. City of Costa Mesa Nancy Clark
LINDA RYAN REPORTING (714) 457-5810
8 1 the witness? Can you please state your name.
2 THE WITNESS: Nancy Clark.
3 THE VIDEOGRAPHER: Thank you.
4 Counsel?
5 MR. LEE: This is Christopher Lee on behalf of
6 the City of Costa Mesa.
7 MS. PATTERSON: Ms. Anderson, do you want to
8 introduce yourself? Okay. I'll go next.
9 Good morning. Alisha Patterson, Rutan and
10 Tucker, on behalf of Plaintiff and Counterdefendant
11 Insight Psychology and Addiction, Inc. and
12 Counterdefendants Mary Helen Beatificato and Dr. Gerald 13 Grosso.
14 MS. HASSAN: Good morning. Zeenat Hassan with
15 Disability Rights California for Plaintiff Jane doe. 16 MS. PATTERSON: Ms. Anderson, are you there?
17 MR. LEE: Ashley Anderson for Everett Dorey,
18 also counsel for City of Costa Mesa.
19 NANCY CLARK,
20 having been first duly sworn to state the whole truth, 21 testified as follows:
22 EXAMINATION
23 BY MS. PATTERSON:
24 Q. Good morning, Ms. Clark.
25 A. Good morning.

Ohio House v. City of Costa Mesa Nancy Clark
LINDA RYAN REPORTING (714) 457-5810
154
1 One of the -- one of the fraudulent situations
2 that's been taking place is that insurance will pay for 3 IOP -- outpatient treatment -- for a lot longer than
4 residential. So many of these facilities were using
5 insurance money to pay for the sober living of a person 6 living -- who was enrolled in their outpatient program, 7 and that's not legal.
8 Q. So I want to take these one at a time.
9 Do you think there's a sufficient amount of,
10 what you're calling, traditional sober living in Costa 11 Mesa to meet the needs of the community?
12 A. Well, when my people graduate, they're
13 hard-pressed to find an affordable living situation in 14 Costa Mesa. Many of them have to move to Santa Ana or 15 less expensive places to live.
16 Q. Are the people who graduate from your program
17 looking for traditional sober living?
18 A. Yes.
19 Q. And what about sober living connected to an
20 IOP? Do you think that there is a sufficient amount of 21 that in Costa Mesa to meet the need?
22 A. I -- I really don't know about that, because
23 those would not be sober livings to which I would refer 24 people.
25 Q. So when you have Opinion Number 4 about how
Ohio House v. City of Costa Mesa Nancy Clark
LINDA RYAN REPORTING (714) 457-5810
156
1 THE WITNESS: I don't think there's anything
2 the City of Costa Mesa could do. The reality is that the 3 price of housing in Costa Mesa has gone up so much
4 that -- I mean, they're selling million dollar condos in 5 Costa Mesa. So, you know, the days of where I rented a 6 four-bedroom house for 1200 a month are long gone.
7 Q. (By Ms. Patterson) Is that a problem beyond
8 just recovery industry housing?
9 A. Yeah. Yeah. I mean, I rented a sober living
10 home for $1200 a month, and I -- I charged 400 to 500 11 dollars per person.
12 Q. So if a facility that was operating before the
13 group home regulations went into effect was then told 14 you're going to need to move because we have regulations 15 now and you're within 650 feet of another center and 16 that's a conflict, do you think that that facility would 17 be able -- or that housing would be able to find an
18 alternate site in this market?
19 MR. LEE: Objection to form.
20 THE WITNESS: No, I don't.
21 Q. (By Ms. Patterson) And your report throughout
22 uses the term "overcrowded," and I want to understand 23 what you mean when you say "overcrowded" in your report. 24 A. You mean overconcentration?
25 Q. So I'm going to get to that one too. I want
Ohio House v. City of Costa Mesa Nancy Clark
LINDA RYAN REPORTING (714) 457-5810
182
1 Q. Was that one an area where it was
2 overconcentrated? Was there more than one recovery
3 residence?
4 A. Yes. Yes.
5 Q. Did all of the recovery residences have this
6 issue where walls and kitchens had been removed?
7 A. All the ones owned by these people did.
8 Q. Did the same people own a whole bunch of
9 different buildings on the same street?
10 A. They did.
11 Q. They did?
12 And how many buildings would you say there
13 were?
14 A. They probably owned at least three or four,
15 but they have since been shut down.
16 Q. Okay. I can't remember the name of it. Are
17 you aware of any areas in Costa Mesa that feel
18 institutionalized due to group homes?
19 A. No.
20 Q. Do you know if Insight's housing is in an area
21 that feels institutionalized?
22 A. I only drove by it once, and I -- I don't -- I
23 don't -- that wasn't my impression.
24 Q. What about Ohio House's housing? Does that
25 area feel institutionalized?
Ohio House v. City of Costa Mesa Nancy Clark
LINDA RYAN REPORTING (714) 457-5810
183
1 A. I have not driven by Ohio House, but in the
2 area where I think it is, no.
3 Q. Do you know what year you drove by Insight's
4 housing? Would it have been after 2017?
5 A. Oh, this has been within the last -- I want to
6 say, within the last year.
7 Q. Oh, okay. And I want to circle back just a
8 little more to normal residential environments.
9 I think you describe the average person being
10 somebody who goes to work and drops their kids off at 11 school. Is that what you're envisioning as a normal
12 residential environment is households like that?
13 A. Households where people, you know, get up in
14 the morning and get dressed and go to work and are gone 15 significant portions of the day, as opposed to an area 16 where people are retired and -- older people are retired 17 and home all day. To me, a normal residential
18 environment is, you know, people who live somewhere, and 19 they live there for some period of time.
20 Q. So if a household has people who are retired
21 and they don't work, does that fit into your idea of a 22 normal household?
23 A. Well, I suppose so. I -- I just -- I mean,
24 I -- I think about my street of 17 houses, and we have, 25 you know, a few retired people. We have a few people Ohio House v. City of Costa Mesa Nancy Clark
LINDA RYAN REPORTING (714) 457-5810
230
1 I, the undersigned, a Certified Shorthand
2 Reporter of the State of California, do hereby certify:
3 That the foregoing proceedings were taken
4 before me at the time and place herein set forth; that 5 any witnesses in the foregoing proceedings, prior to
6 testifying, were placed under oath; that a verbatim
7 record of the proceedings was made by me using machine 8 shorthand which was thereafter transcribed under my
9 direction; further, that the foregoing is an accurate 10 transcription thereof.
11 I further certify that I am neither
12 financially interested in the action nor a relative or 13 employee of any attorney of any of the parties.
14 IN WITNESS WHEREOF, I have this date
15 subscribed my name.
16 17 Dated: November 21, 2021
18 _______________________________________
LAURA L. CORNING
19 FCRR, CSR No. 8363
20 21
22 23
24 25
EXHIBIT 18
licensed treatment licensed treatment licensed treatment No longer licensed or operating Women only Women only
Homeless Men Homeless Men No contact information/not operating No response to calls and texts No response to calls No longer operating 112 beds in approved unlicensed sober living homes
EXHIBIT 19
5600 Fishers Lane • Rockville, MD 20857
www.samhsa.gov • 1-877-SAMHSA-7 (1-877-726-4727)
Behavioral Health is Essential to Health • Prevention Works • Treatment is Effective • People Recover January 27, 2022

CERTIFICATION OF AGENCY RECORDS
Pursuant to Rule 44 of the Federal Rules of Civil Procedure, I, CAPT. Michael King, hereby certify that I have custody of the official records for the Center for Behavioral Health Statistics and Quality. Attached are certified and authentic copies of records of the Center for Behavioral Health Statistics and Quality:
• Exhibit 733, excerpt from "2016-2018 National Survey on Drug Use and Health Substate Region Definitions." This was obtained from this link:
https://www.samhsa.gov/data/sites/default/files/reports/rpt29374/NSDUHsubstateRegion Defs2018/NSDUHsubstateRegionDefs2018.pdf
• Exhibit 732, substate data for California. This was obtained from this link:
https://www.samhsa.gov/data/sites/default/files/reports/rpt29375/NSDUHsubstateStateTa bs2018/NSDUHsubstateCalifornia2018.pdf
These records are kept in the ordinary course of the regularly conducted business of the Center for Behavioral Health Statistics and Quality.

Sincerely,
Michael King
CAPT. Michael King
Acting Director
Center for Behavioral Health Statistics and Quality
SAMHSA 5a
Case 8:19-cv-01710-JVS-GJS Document 315-25 Filed 03/09/22 Page 2 of 42 Page ID #:19121
CA-1
200213 CALIFORNIA
Table 5.1 Illicit Drug Use in the Past Month and Illicit Drug Use Other Than Marijuana in the Past Month in California among Individuals Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2016, 2017, and 2018 NSDUHs
State/Substate Region
Illicit Drug Use
in the Past Month
Illicit Drug Use Other Than
Marijuana in the Past Month
Estimate
95% Confidence
Interval Estimate
95% Confidence
Interval
California 13.33 (12.62 - 14.07) 3.75 (3.39 - 4.15)
Region 1R 20.74 (17.80 - 24.01) 4.76 (3.62 - 6.24)
Region 2R 14.92 (12.10 - 18.26) 4.02 (2.94 - 5.48)
Region 3R (Sacramento) 14.47 (12.16 - 17.15) 3.48 (2.57 - 4.68) Region 4R 14.98 (12.13 - 18.35) 3.98 (2.96 - 5.32)
Region 5R (San Francisco) 20.84 (16.86 - 25.48) 4.41 (3.20 - 6.06) Region 6 (Santa Clara) 10.17 (8.36 - 12.31) 3.13 (2.33 - 4.18) Region 7R (Contra Costa) 13.35 (11.08 - 16.00) 3.66 (2.73 - 4.89) Region 8R (Alameda) 17.08 (14.46 - 20.07) 4.45 (3.33 - 5.91) Region 9R (San Mateo) 13.23 (10.76 - 16.15) 2.92 (2.13 - 4.00) Region 10 12.56 (10.00 - 15.66) 4.16 (3.05 - 5.65)
Region 11 (Los Angeles) 13.56 (12.44 - 14.76) 3.88 (3.37 - 4.46) LA SPA 1 and 5 14.33 (11.77 - 17.33) 3.92 (2.89 - 5.29) LA SPA 2 14.04 (11.72 - 16.72) 3.80 (2.83 - 5.10)
LA SPA 3 9.80 (7.92 - 12.05) 3.02 (2.23 - 4.09)
LA SPA 4 19.22 (15.82 - 23.15) 5.62 (4.15 - 7.57)
LA SPA 6 13.91 (11.38 - 16.91) 3.64 (2.69 - 4.91)
LA SPA 7 10.74 (8.50 - 13.47) 3.44 (2.51 - 4.71)
LA SPA 8 14.45 (12.11 - 17.16) 4.11 (3.11 - 5.40)
Region 12R 13.92 (11.25 - 17.10) 4.40 (3.22 - 5.99)
Regions 13 and 19R 11.47 (9.71 - 13.50) 2.83 (2.12 - 3.76) Region 14 (Orange) 10.18 (8.56 - 12.08) 3.32 (2.55 - 4.32) Region 15R (Fresno) 11.91 (9.68 - 14.57) 3.77 (2.76 - 5.11) Region 16R (San Diego) 13.88 (11.95 - 16.06) 3.99 (3.11 - 5.11) Region 17R 10.19 (8.41 - 12.30) 3.50 (2.59 - 4.71)
Region 18R (San Bernardino) 10.61 (8.81 - 12.72) 3.28 (2.43 - 4.41) Region 20R 12.60 (10.33 - 15.30) 4.08 (3.02 - 5.50)
Region 21R 16.82 (13.90 - 20.21) 4.42 (3.28 - 5.93)
NOTE: For substate region definitions, see the "2016-2018 National Survey on Drug Use and Health Substate Region Definitions" at https://www.samhsa.gov/data/.

NOTE: Estimates along with the 95 percent Bayesian confidence (credible) intervals are based on a survey-weighted hierarchical Bayes estimation approach and generated by Markov Chain Monte Carlo techniques.

NOTE: Illicit Drug Use includes the misuse of prescription psychotherapeutics or the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Illicit Drug Use Other Than Marijuana includes the misuse of prescription psychotherapeutics or the use of cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Misuse of prescription psychotherapeutics is defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told; or use in any other way not directed by a doctor. Prescription psychotherapeutics do not include over-the-counter drugs.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2016, 2017, and 2018.

SAMHSA 5 -1-
Jennifer Le
11/5/21
Exh 732
Ohio House v City of CM
Case 8:19-cv-01710-JVS-GJS Document 315-25 Filed 03/09/22 Page 3 of 42 Page ID #:19122
CA-9
200213 CALIFORNIA
Table 5.9 Needing But Not Receiving Treatment at a Specialty Facility for Illicit Drug Use in the Past Year, Needing But Not Receiving Treatment at a Specialty Facility for Alcohol Use in the Past Year, and Needing But Not Receiving Treatment at a Specialty Facility for Substance Use in the Past Year in California among Individuals Aged 12 or Older, by Substate Region: Percentages, Annual Averages Based on 2016, 2017, and 2018 NSDUHs
State/Substate Region
Needing But Not Receiving
Treatment at a Specialty
Facility for Illicit Drug Use
in the Past Year1
Needing But Not Receiving
Treatment at a Specialty
Facility for Alcohol Use in
the Past Year
Needing But Not Receiving
Treatment at a Specialty
Facility for Substance Use
in the Past Year1
Estimate
95%
Confidence
Interval Estimate
95%
Confidence
Interval Estimate
95%
Confidence
Interval
California 2.88 (2.59 - 3.20) 5.65 (5.20 - 6.13) 7.43 (6.91 - 7.99) Region 1R 4.05 (3.07 - 5.31) 8.14 (6.39 - 10.32) 10.99 (8.95 - 13.41) Region 2R 2.82 (2.07 - 3.83) 6.11 (4.67 - 7.96) 8.11 (6.31 - 10.36) Region 3R (Sacramento) 2.91 (2.21 - 3.82) 5.95 (4.62 - 7.64) 7.91 (6.36 - 9.81) Region 4R 2.68 (1.99 - 3.60) 6.09 (4.62 - 7.99) 7.79 (6.10 - 9.90) Region 5R (San Francisco) 3.45 (2.50 - 4.73) 7.04 (5.28 - 9.32) 9.90 (7.64 - 12.73) Region 6 (Santa Clara) 2.47 (1.87 - 3.25) 4.90 (3.79 - 6.33) 6.63 (5.32 - 8.23) Region 7R (Contra Costa) 2.48 (1.87 - 3.27) 5.78 (4.47 - 7.44) 6.97 (5.38 - 8.97) Region 8R (Alameda) 3.15 (2.39 - 4.16) 5.36 (4.11 - 6.95) 7.70 (6.13 - 9.64) Region 9R (San Mateo) 2.42 (1.78 - 3.28) 5.64 (4.24 - 7.47) 6.70 (5.20 - 8.60) Region 10 3.07 (2.26 - 4.15) 5.70 (4.30 - 7.52) 7.70 (5.92 - 9.96) Region 11 (Los Angeles) 2.90 (2.51 - 3.36) 5.49 (4.89 - 6.16) 7.25 (6.49 - 8.09) LA SPA 1 and 5 2.86 (2.11 - 3.86) 5.50 (4.16 - 7.24) 6.95 (5.39 - 8.91) LA SPA 2 2.95 (2.25 - 3.86) 5.68 (4.45 - 7.22) 7.76 (6.19 - 9.69) LA SPA 3 2.33 (1.74 - 3.11) 4.62 (3.57 - 5.97) 5.69 (4.46 - 7.23) LA SPA 4 3.63 (2.67 - 4.94) 6.34 (4.83 - 8.30) 9.06 (6.99 - 11.68) LA SPA 6 3.27 (2.43 - 4.41) 4.70 (3.55 - 6.21) 6.70 (5.19 - 8.60) LA SPA 7 2.77 (2.04 - 3.75) 4.79 (3.61 - 6.31) 6.13 (4.67 - 8.01) LA SPA 8 2.85 (2.13 - 3.80) 6.64 (5.15 - 8.51) 8.41 (6.69 - 10.54) Region 12R 3.10 (2.29 - 4.17) 5.89 (4.45 - 7.74) 8.13 (6.31 - 10.42) Regions 13 and 19R 2.86 (2.24 - 3.66) 5.70 (4.58 - 7.07) 7.45 (6.18 - 8.95) Region 14 (Orange) 2.18 (1.65 - 2.88) 4.76 (3.75 - 6.02) 5.79 (4.64 - 7.20) Region 15R (Fresno) 3.04 (2.28 - 4.06) 5.58 (4.31 - 7.20) 7.20 (5.62 - 9.17) Region 16R (San Diego) 2.89 (2.24 - 3.71) 5.90 (4.77 - 7.27) 7.66 (6.35 - 9.21) Region 17R 2.91 (2.22 - 3.82) 5.38 (4.19 - 6.89) 7.10 (5.63 - 8.92) Region 18R (San Bernardino) 3.07 (2.38 - 3.96) 5.13 (4.01 - 6.55) 7.12 (5.69 - 8.87) Region 20R 3.04 (2.30 - 4.01) 5.18 (3.94 - 6.77) 6.78 (5.26 - 8.70) Region 21R 3.47 (2.61 - 4.60) 7.44 (5.79 - 9.51) 9.25 (7.32 - 11.62) NOTE: For substate region definitions, see the "2016-2018 National Survey on Drug Use and Health Substate Region Definitions" at https://www.samhsa.gov/data/.

NOTE: Estimates along with the 95 percent Bayesian confidence (credible) intervals are based on a survey-weighted hierarchical Bayes estimation approach and generated by Markov Chain Monte Carlo techniques.

NOTE: Respondents were classified as needing substance use treatment if they met the criteria for an illicit drug or alcohol use disorder as defined in the 4th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) or received treatment for illicit drug or alcohol use at a specialty facility (i.e., drug and alcohol rehabilitation facility [inpatient or outpatient], hospital [inpatient only], or mental health center). Needing But Not Receiving Substance Use Treatment refers to respondents who are classified as needing illicit drug or alcohol treatment, but who did not receive illicit drug or alcohol treatment at a specialty facility. 1 Illicit Drug Use includes the misuse of prescription psychotherapeutics or the use of marijuana, cocaine (including crack), heroin, hallucinogens, inhalants, or methamphetamine. Misuse of prescription psychotherapeutics is defined as use in any way not directed by a doctor, including use without a prescription of one's own; use in greater amounts, more often, or longer than told; or use in any other way not directed by a doctor.

Prescription psychotherapeutics do not include over-the-counter drugs.

Source: SAMHSA, Center for Behavioral Health Statistics and Quality, National Survey on Drug Use and Health, 2016, 2017, and 2018.

SAMHSA 13 -9-
Case 8:19-cv-01710-JVS-GJS Document 315-25 Filed 03/09/22 Page 11 of 42 Page ID #:19130