Download the Peer Recovery Support: Walking the Path Together Research Update.
Friends and family members have long provided informal support for people with substance use disorders (SUDs). Peer-based recovery support places an ancillary approach to addiction treatment into the hands of those who know it best: people with "unique ways of knowing" because they have lived experience of SUD.1 The recent growth in peer support services is aligned with the recognition that, for many people, addiction is a chronic condition, requiring a shift in treatment from an acute care model to one that provides a continuum of care.2 Peer recovery support services are delivered across the diversity of locations where people with SUD are served, typically incorporated into the continuum of services offered. They may be available before, during, and in lieu of treatment.3 As a result, peer recovery support specialists work in community centers, recovery residences, drug courts, hospital emergency departments, homeless shelters, child welfare agencies, behavioral health facilities, and primary care offices.4 In 2019, 61.3% of 9,779 nonprofit, for-profit, and government facilities utilized peer support services according to the National Survey of Substance Abuse Treatment Services.5 As of 2018, 38 states reimburse for peer support services for SUDs, primarily as part of rehabilitative care.6
In addiction treatment settings, a peer recovery specialist is someone who is in recovery and uses their lived experience to help others in their recovery.7 Variations of the name include peer advocate, peer counselor, peer coach, peer mentor, peer wellness coach, and recovery coach.8 All refer to a one-on-one relationship in which someone with more recovery experience encourages, motivates, and supports a peer in establishing or strengthening his or her recovery.9
SAMHSA describes a dozen categories of core competencies to guide delivery and best practices in peer support, ranging from sharing lived experiences of recovery, engaging in recovery planning, providing links to resources and services, and help in managing a crisis.10 The list below describes the substance of what peer support specialists do.
Peer Support Specialists:
Certification is needed in order to work as a peer recovery support specialist. The National Association for Addiction Professionals requires candidates for certification to have:11
According to a national peer specialist database, 47 states and the District of Columbia had peer specialist certification programs, which vary from state to state.12
Several literature reviews have assessed and demonstrated the benefits of peer recovery support in SUD populations. A systematic review of recovery-oriented approaches for people with alcohol and SUD identified nine studies for inclusion. The goal of recovery-oriented approaches is the promotion of abstinence and improved quality of life through use of a person-centered, individualized, multisystem continuum of care. Interventions ranged from a one-time motivational meeting with a substance use outreach worker who was in recovery to home visits by a trained peer support worker who accompanied the person to community aid groups. The reviewers concluded that in the majority of studies, participation of peers in recovery services had a positive effect on substance use outcomes (abstinence and decreased drug and/or alcohol use).2
Another literature review assessed the use of peer support groups, one aspect of peer recovery support services, in community settings for the treatment of addiction. Ten studies in the U.S. demonstrated benefits of peer support groups for patients with SUD in the following areas:13
To explore the role and efficacy of peer support workers in filling the gaps in existing treatment models for SUD to facilitate long-term remission, a systematic review of the literature identified 24 studies. The findings pointed to positive results related to reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction.14
While these research reviews demonstrate benefits gained from peer recovery support services, they also reveal the work still needed to be done to establish efficacy, effectiveness, and cost benefit of these services.14 Some of these investigators pointed out that self-selection into peer support groups and recovery homes may affect the results and make it difficult to generalize the outcomes13 and suggested the need for additional research to determine the effectiveness of different peer recovery support approaches in terms of amount, intensity (frequency), skill level of the peer worker, context of the service, and use in different target populations. Other areas to be explored include discerning for whom peer support is most useful, what training and certification is needed for peer support workers, and best practice models for the implementation of peer support.14
Peer recovery support specialists are filling gaps in the continuum of care for people with SUDs that is backed by evidence of the benefit of these services, although areas still in need of research remain. Numerous studies exist that evaluate a diversity of strategies for the treatment of drug and alcohol use, but at present, very few consider the utility of implementation science in this regard. More research is needed in the context of SUDs to identify best practices for peer recovery support workers and fill gaps in the promotion into practice of the most-effective treatment strategies for people seeking recovery.
Our peer recovery support team includes licensed professionals, who are trained addiction counselors, and peer specialists, who can provide virtual relapse prevention support. Our recovery coaches utilize Hazelden Betty Ford's MORE™ (My Ongoing Recovery Experience) program of recovery support. They can help patients find specific tools and resources within the MORE online platform as well as opportunities for face-to-face support with our alumni relations network of contacts, meetings and events. Our recovery coaches are a steady source of guidance and provide: