Background/Objectives: By virtue of needing safe and supportive housing, individuals living in recovery residences may be among some of the more vulnerable in recovery. The COVID-19 pandemic may have exacerbated these vulnerabilities. This study examines COVID-19 vulnerability in the communities where recovery residences are located. Methods: Using geolocated data on recovery residences from the National Study of Treatment and Addiction Recovery Residences (NSTARR) database and the Community COVID Vulnerability Index (CCVI), this study used multilevel modeling to examine whether CCVI was related recovery housing availability at the county level. The CCVI is a composite measure of seven social determinants of health, encompassing modified themes from the Centers for Disease Control and Prevention's Social Vulnerability Index with COVID-19 risk factors to identify communities in need of additional support. Results: CCVI scores were positively associated with both measures of recovery housing availability: an indicator of whether the county had any recovery housing (versus none) (β = 2.56; SE = 0.36; p < 0.001) and the number of recovery residences in counties with at least one recovery residence (β = 1.66; SE = 0.36; p < 0.001). When separate subscores were entered simultaneously, minority status/language and population density were positively associated with both measures of availability. Epidemiologic factors and health care system factors were negatively associated with both measures of recovery housing availability. Housing risk factors were positively associated with presence of any recovery housing, and socioeconomic vulnerability was positively associated with recovery housing density. No associations were observed with high-risk environments, such as prison population density. Conclusions: Recovery residences tend to be located in areas that are highly vulnerable to COVID. While this may present risk for people in recovery, these communities may benefit from the support and resources provided by recovery residences that offset individual-level COVID risks. Future research should explore to what extent residents in recovery residences located in vulnerable areas were affected by the COVID-19 pandemic. Authors Katherine Karriker-Jaffe, PhD; RTI International Deidre Patterson, MPH, MSS; Alcohol Research Group at the Public Health Institute Meenakshi Subbaraman, PhD; Behavioral Health and Recovery Studies at the Public Health Institute Jason Howell, MBA; Recovery People Dave Sheridan, MBA; National Alliance for Recovery Residences Thomasina Borkman, PhD; George Mason University Jayla Burton, MPH; Alcohol Research Group at the Public Health Institute Amy A. Mericle, PhD; Alcohol Research Group at the Public Health Institute Funding Source Work on this study was funded by the National Institute on Alcohol Abuse and Alcoholism (NIAAA; R01AA027782-02S1). The funding agency had no role in the data analysis or the decision to submit to the conference. The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIAAA or the National Institutes of Health. --- Kate Karriker-Jaffe, PhD |Director|Community Health & Implementation Research Program| Center for Behavioral Health Epidemiology, Implementation & Evaluation Research|RTI International| 2150 Shattuck Avenue, Suite 800|Berkeley, CA 94704|(919)541-6291|www.rti.org/CBHEIER<https://nam04.safelinks.protection.outlook.com/?url=http%3A%2F%2Fwww.rti.org%2FCBHEIER&data=04%7C01%7Ckkarrikerjaffe%40rti.org%7Ce37986d6ff2e4c441c9608d8be638db6%7C2ffc2ede4d4449948082487341fa43fb%7C0%7C0%7C637468682147151604%7CUnknown%7CTWFpbGZsb3d8eyJWIjoiMC4wLjAwMDAiLCJQIjoiV2luMzIiLCJBTiI6Ik1haWwiLCJXVCI6Mn0%3D%7C1000&sdata=ToYeAFwVfsbZxnG8mY7FoSKeSj2Qb2Wv9v3GP6tK2ug%3D&reserved=0> Pronouns: she/her/hers|why pronouns matter<https://www.rti.org/diversity-and-inclusion#GenderIdentity>