Designing For Addiction

Recovery: Reflections from

an Architectural Case
Diseando para la recuperacin de la adiccin:
reflexiones de un estudio de caso arquitectnico
Brian Schermer, Caitlin Boyle, Emi Kiyota,
Matt Jaroz (University of Wisconsin
Milwaukee) and Newton DSouza (University of
Missouri Columbia)

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This paper discusses and architectural case study that

affords a unique opportunity to better understand how
physical places are implicated in addiction recovery.
The Milwaukee Alano Foundation is a club and drop-in
center for recovering alcoholics. As the owners of a historic, but rundown residence, the members sought assistance from the authors to renovate the building. The
authors proceeded to conduct scenario planning, assessment of organizational and architectural fit, pre-design
programming, and schematic design. These activities
paralleled, in a very real sense, the kind of critical selfinventory and removal of character defects associated
with addiction recovery. In addition, while places can
support and enhance recovery through instrumental
and symbolic mean, they can also play a dual role as
both the object and instrument of recovery. In other
words, people recovering from substance abuse, as suggested by this case study, may seek to rehabilitate their
physical setting in order to rehabilitate themselves. The
case study also suggests that ownership and control over
places for recovery can be a critical factor in recovering
from substance abuse.
This research stems from an architectural project for
the Milwaukee Alano Foundation, a nonprofit group
that serves as a meeting, social support, and gathering
place for recovering alcoholics. The work, which was
conducted by the authors through their affiliation
with the Nonprofit Pre-Design Assistance Center at
the University of Wisconsin-Milwaukee, consisted of
pre-design services and schematic design to help the
organization renovate the historic home that they own
and occupy. As a design case study, it affords a unique

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opportunity to better understand how physical places

are implicated in addiction recovery.
While places can support and enhance recovery
through instrumental and symbolic mean, they can also
play a dual role as both the object and instrument of
recovery. In other words, people recovering from substance abuse, as suggested by this case study, may seek
to rehabilitate their physical setting in order to rehabilitate themselves. At the same time, undertaking a project
like this is also a potential source for organizational dissension and possibly detrimental to the group cohesion
that is critical to their collaborative treatment efforts.
While this case is atypical, it does provide a unique way
to think about how places that might be utilized and
leveraged in the service of recovery from alcohol and
substance abuse.
This paper discusses current conceptions of place and
recovery in the literature, followed by a discussion of
the case, and then concludes with reflections about what
the case study suggests about places for recovery.
Literature Review
While there is an extensive design research literature
on the role of health care settings as it relates to healing,
notions about how to design places for recovery have yet
to be developed.
Studies of addiction recovery often begin by addressing questions like what is addiction? How is it
treated? And, to a lesser extent, where does recovery
happen? The place of recovery is not explicitly pursued
further than basic categories like hospital and residential, though the interrelationship among addiction,
treatment, and place is apparent (Landry). The fact that
the place of recovery is seemingly taken for granted may
be problematic. Each theoretical conception of addiction and the terminology employed to discuss addiction treatment can indicate powerful assumptions that
translate into the physical setting of recovery.
Canter and Canter (1979) categorize six therapeutic
models: custodial, for example prisons, in which the
individuals and the community are separated from one
another; medical, in which the patients are unhealthy
and are taken to a place to be treated; prosthetic, in
which physical or mental deficits are compensated, for
instance by handrails or ramps, or social prostheses
such as care-givers; normalization, which aims to
prevent the dependence of prostheses, including group

May 28- June 1, 2008 Boca del Rio, Veracruz Mxico

homes in which people retain autonomy and control;

enhancement, for example, playgrounds for handicapped children and simplified wayfinding for Alzheimers patients, in which normal may be too optimistic
a goal; and, individual growth model, which aims to
help people grow to their full potential, implying that
therapy and therapeutic milieu can change over time
with developmental changes.
With regard to recovery from substance abuse, Landry
(1996) associates the term treatment setting with the
level of treatment intensity and categorizes four main
treatment types that imply specific place types: hospitalization (hospitals, residential treatment (group homes,
correctional facilities), intensive outpatient treatment
(clinic, counseling office), and outpatient treatment
(club, drop-in center).
The physical setting in which these approaches occur
communicates the expected roles of persons within it,
and the intensity of the treatment/approach/place. One
clear example of this relationship between approach
and setting is the medical treatment in a clinic. In this
instance, addiction is considered a physical dependence.
The clinic is a sterile place where a doctor can treat and
cure the symptoms. This is an impersonal, objective
approach.
In contrast, if addiction is considered the manifestation of some deeper set of problems or instabilities that
a person is facing, the treatment will be very different.
Unlike the medical approach, in this scenario, the cause
is not as tangible, but is a complex web of mental conflict, for which the addiction is a coping mechanism. In
order to address the patients needs, the treatment will
be personalized, involving counseling that focuses on
resolving underlying issues rather than the drug abuse
itself.
There are alternative holistic approaches and combinations of the above-mentioned techniques. Alternative
medicines offer one such example. Wesa and Culliton
(2004) , for example, discuss the need to create an optimal healing environment, although the conception of
the physical environment is not well developed beyond
providing space for such activities such as meditation,
yoga, and gardening .
The Oxford House group home model for recovering
alcoholics offers a more concrete connection between
recovery and a place of healing, while also emphasizing
the importance of a larger group support. In an assess-

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ment of Oxford Houses in the United States, Ferrari,

et al (2006) note that every room in the homes they
assessed is personalized (residents had hung pictures
on the wall), the houses are well-maintained, and they
blend in with their surrounding neighborhoods. These
facts, combined with interviews of former residents and
other observations, led the authors to conclude that a
sense of home was one of the most important qualities
for a recovery environment. This merging of sense of
community, collective construction of non-dependent
patterns of living, and physical setting is significant to
the discussion of environments for recovery.
The twelve-step model associated with Alcoholics
Anonymous articulates sequential stages of recovery.
These include acknowledging ones powerlessness and
turning to a higher power for assistance, conducting
a moral inventory of ones deficiencies, and seeking
to remove all ones defects of character. Twelve-step
programs expect participants to surrender to the
group. The story-telling tradition at Alcoholics Anonymous meetings is as much a reminder for old-timers
as an act of progress for new members (Nowinski, 1992).
This relationship between people at different stages of
recovery is an important part of group recovery settings.
This treatment approach takes place in a wide range of
settings, including clubs and drop-in centers like the
Milwaukee Alano Foundation as well as in more ad hoc
meeting spaces (church basements, community centers,
and even former taverns).
Consulting Case Study
Milwaukee Alano Foundation has been a social gathering place for recovering alcoholics since 1947. It is are
the oldest club of its type in the U.S. Members meet to
share their experiences, strengths, and hopes with each
other about their common goal of achieving and maintaining a life free from the use of alcohol and drugs.
Alano is loosely connected to Alcoholics Anonymous
international, and adheres to the well-known twelvestep program for recovery described in AAs Big Book.
The members, who elect a nine-member board from
among their ranks, wholly manage the organization.
They are from every rung of the socio-economic ladder,
from poor inner city dwellers to wealthy members of
Milwaukees power elite.
Alano occupies a handsome but rundown, historic
residence on Milwaukee East Side neighborhood.

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Though it has many distinct architectural features,

the building has fallen into disrepair and subjected
to poorly executed and ill-conceived adaptations and
decorating efforts over the five decades that it has been
in the foundations possession. Ironically, the building
was built by one of Milwaukees yeast barons in the late
1800s. In 1955, he yeast barons daughter, who was a
recovering alcoholic, gifted to the house to the organization. Fifty years later, Alano members began to raise
funds to restore the building to its original condition
and to expand the range of services to its members.

residence.

such as job training, computing classes, and relationship counseling.

Jack informed us that raising enough funds would
not be a problem. Alcoholism, he explained, does not
discriminate according to socio-economic status. There
would be plenty of wealthy members who would be
willing to pay for it. The Directors had recently voted
to establish a five-member Board of Trustees to oversee
fundraising. They were looking to the authors for assistance in establishing a budget and documentation that
they could use to solicit donations.
We approached the planning for foundation as both
an organizational and architectural intervention, following a three-stage process that they utilize in working
with other nonprofit organizations: (1) scenario planning to explore alternative organizational futures; (2)
assessment of organizational and architectural fit to see
if likely scenarios could be easily accommodated by the
building; and (3) development of an strategy and architectural program to specify the scope and nature of the
project. For this case, we were also able to work collaboratively with a design team from the UW-Milwaukees
Institute for Historic Preservation to develop schematic
plans from which Alano could obtain construction estimates and also use renderings to solicit donor funds.
Throughout the pre-design programming process, we
attempted to provide a means for members to question their assumptions, and where appropriate, to point
out issues that would need to be addressed in order to
manage internal conflicts.

Over the years, the house has served as a comfortable, if disheveled place for members to congregate for
the dozens of AA meetings that are held each week. In
addition to AA meetings, the building also serves as
a drop-in center that provides camaraderie and social
support for members, especially new ones, who might
otherwise relapse.
Our involvement, through UW-Milwaukees Nonprofit Pre-Design Assistance Center, with Alano began
with an email from Jack (AA member typically maintain anonymity by using first names only), who served
on Alanos Board of Directors, asking for assistance.
Although the Board of Directors did not know where
to start, they did have a vision of what they wanted to
achieve: to restore the residence as fully as practicable
and to expand their offerings of services and programs,

Scenario planning
We pointed out that while the vision of a restored
property and full array of services might be ideal, there
were perhaps other less rosy scenarios that might unfold.
We raised the possibility that fundraising might proceed too slowly to implement big plans for a long time
to come. What would happen if the building required a
major repair, or worse, a fire? Might it be wise, we asked,
to sell the building, establish a trust and relocate to a
more manageable setting?
In a different vein, we learned that not all the members support the renovation. There are some who are
quite comfortable with the current rundown condition,
or at least are concerned about the place becoming too
stodgy and self-conscious for their liking. This tension
suggested other unhappy scenarios that we shared with

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Figure 1. Milwaukee Alano Foundations historic, but rundown

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May 28- June 1, 2008 Boca del Rio, Veracruz Mxico

the members. Even if the funds could be raised and

the building could be restored, might the renovation
create a rift between those who supported renovation
and those who supported the status quo. Additionally,
would Milwaukee Alano Foundation be able to support
its programs and afford the upkeep? Might the foundation need to establish a new executive director position
to oversee the property and operations, instead of the
current on-site manager who was paid $450 per week.
In short, we tried to point out where their plans might
go off track, and that even though their vision was a
compelling, sometimes architectural clients are not
always in a position to create the reality they seek. Nevertheless, the Board of Directors wanted to proceed.
Assessment of organizational and architectural fit
Mindful of the importance of this property to the
organization, we felt it important to encourage the
members to consider how the building could be used
to support and enhance Alanos activities and programs, and more specifically as an aid in recovery. As
we delved into the issues, we learned that architectural
changes would also necessitate operational and organizational adjustments in order to achieve the image
envisioned by the members. We prepared a document
called Decisions, Decisions to facilitate discussion
about several critical organizational issues that need to
be addressed before architectural and engineering plans
could be drawn. These included:
Accessibility: Membership to Alano is advertently
barred to people with mobility impairments because
requires traversing several step from either the front
porch or back stairs. To serve people who use wheelchairs and to accommodate members as they become
older, renovation to the property will require elevator
access to all four levels of the house.
Smoking: Many members are addicted to tobacco and
are heavy smokers., The smell in the building is overwhelming and health hazards associated with second
hand smoke, however, is overwhelmingly negative for
many non-smokers, to the point where it deters some
people from joining. Alano will need to ban smoking or
restrict it to certain areas. Designating smoking areas
will necessitate investment in some kind of air filtration
system to mitigate the impact on others.

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Figure 2. Seating Area at Building Entry

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Figure 3. Existing Interior Coffee Bar

Building image: From the exterior, the building

appears rundown, with peeling paint that covers the
stonework and original cream colored brick, sparse
landscaping, and a rusting fire escape. Plastic patio
chairs and crude benches are placed on the front porch
and a patch of concrete in the front. The interior is
furnished with a hodgepodge of mismatched built-ins,
cast-off furniture, wall colors, as well as a plethora
of posters and announcements that clutter the walls.
There are also two features that are deemed inappropriate by some members because they serve as cues for
addictive behaviors: video games consoles in the front
foyer, and a grill and counter with barstool seating on
the first floor that conveys the image of a greasy spoon
diner, if not a tavern. Alano needs to determine type of
image they wish the interior to convey, whether it being
true to the original style of the home, an contemporary

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coffee bar with club chairs, upscale hotel or some other

appropriate image.
Activities and programs: Much of the socializing occurs in bar counter area where members sit around the
counter and enjoy conversation. Alano also sponsors
special events like dinner, lectures, musical performances, and game nights. However, they may not be
able to provide activities for people in different generations, background, and intentions. Variety of activities
and program can be expanded to serve the needs of diverse population, including cooking classes, teen lounge,
physical exercise, meditation, and gardening.
Pre-design program
We attempted to frame the critical design issues associated with specific rooms, using room data sheets
and annotated plans. For each room, we described: (1)
current conditions and uses, including critical flaws and
sources of organizational conflict (2) new uses and ways
in which the design of the space can their common goal
of achieving and maintaining a life free from the use
of alcohol and drugs (3) Design considerations about
layout, furnishings, and signs; (4) preliminary plans to
illustrate various design suggestions and considerations.
The current bar and grill area provides a useful
example. We included a description of this settings current use as a place for food preparation, eating, smoking
cigarettes and chatting with others. We also pointed out
some members view the bar as a smoky, dingy hangout
for former barflies, which is all too close in character to
the kind of settings they are seeking to avoid. We suggested that this room, which was once an elegant dining
room with built in cabinetry, fireplace, and a built-in
ceramic planter, could be transformed into a friendly
coffee shop that offers a cozy atmosphere and a variety
of seating choices. The existing counter will be removed,
and replaced, perhaps by a coffee bar that is compatible
with the existing woodwork.

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Figure 4. Interior Plan Elements of Interest

Schematic design
The schematic design addressed the handicapped
accessibility and fire egress through the addition of an
elevator and stair tower. Because of the historic nature of the property and the surrounding area, it was
deemed that the only feasible option would be to locate
this tower at the rear of the building. Landscaping and a
new walkway along the south faade would link the rear
entrance to the front. This new construction, along with
upgrading mechanical and fire safety systems, restoration of floors, walls, plaster, and sandblasting paint off
the brick faade, was estimated to cost approximately
$1.8 million.
Discussion
The Milwaukee Alano Foundation case, though
unique, is significant because, unlike traditional clinical
settings, or even the Oxford House group home model,
the members own and have complete control over their
place of recovery. The choice to channel their energy in
the direction of restoration suggests that such ownership might be a heretofore overlooked factor. Common
ownership and control over a place of healing may
provide a means to facilitate group identity and cohesion. It may be a rallying point for members that may
strengthen the organization, and in turn facilitate the
recovery process.
We began our consultation with the assumption that
the rehabilitation of Alanos property would serve the

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instrumental function of supporting and enhancing

the organization activities, as a powerful symbol of the
organization, and perhaps as a concrete metaphor for
rehabilitation and recover to which the members could
aspire.
Yet, we also mindful that the project might also
exacerbate organizational tensions between those who
find comfort in the building as is and those who seek
to restore it. Since group cohesion is so important to
the twelve-step process, and because the rehabilitation
might be destructive to that cohesion, it raises the question of whether there is something is more important
than just a good metaphor.
Upon reflection, we see our process of scenario planning, assessment of organizational and architectural
fit, pre-design programming, and schematic design, as
parallel to and complementary to AAs steps for recover.
By pointing out alternative scenarios to the organizational and architectural future sought by Alano,
we were in effect underscoring that sometimes that
architectural projects unleash forces that are beyond
our power to control.
Our investigation of building problems, from peeling
paint to the acrid cigarette smell, to the lack of accessibility, constitute, in a sense, the kind of fearless moral
inventory that AA requires of its members. Our report
is as much a record of neglect and abuse on the part of
Alano in caring for their building and addressing the
needs of its members, as it is a list of issues to address in
design.
The architectural program and subsequent schematic
design, in that same sense, are an attempt to remove
what AA terms all those defects of character. If
implemented, they would restore the moral character
of the building and by extension the foundation and its
members.
For the champions of the restoration project, the
building is both object and instrument of recovery.
Their effort to restore the buildingto champion the
project through the board of directors, to sell the idea
to the members, and to raise a hefty sum in order to
achieve itis propelled by the same force that drives
individual members through the twelve-step process.
In a very real sense, the members seek to rehabilitate
the building as part of rehabilitating themselves. The
renovation itself has the urgency on a moral imperative,
and in a sense, has been the focus of a recovery process

Linking Differences / Defining Actions

that is very much parallels the addition recovery of the

membership.
As of this writing, the members have possession of
the architectural program and the schematic plans, and
they have been deliberating what to do next. They have
yet to raise the necessary funds and put the project out
to bid. Hence, we cannot know at this time whether the
process and final product will be a boon or a bane to
Alano. But, as long as the members owns and occupies
the house, even if it is never fully restored, it will serves
as a reminder, much like the stories of old-time members, or even as old-timer itself, that beneath the flaws
there is a pure, unadulterated self waiting for recovery.

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References
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