When you have a bad day, a good friend can turn everything around. That’s true for most of us, and it’s also true for someone in recovery from alcohol use disorder (AUD) or substance use disorder (SUD). Some days in recovery are tough – and on those days, the support of peers can be the difference between staying in recovery and relapse. If you’re in addiction recovery, a trusted peer can help keep you on your program.
Sometimes a kind word, a piece of good advice, a helping hand, or maybe a hug gives you what you need to change your attitude and change that bad day into a good day.
That’s no exaggeration.
In the addiction recovery world, peer support has a long tradition, beginning with the simple structure of Alcoholics Anonymous (AA) and Narcotics Anonymous (NA) meetings, which led to the the well-established role of AA/NA peer mentors. If you’ve never heard of an AA or NA mentor, they are what they sound like: individuals with experience in recovery who help people new to recovery manage the ups and downs of recovery.
While a peer mentor – in context of addiction recovery – is not exactly the same thing as the archetypal good, supportive friend we mention above, they can have the same effect: they can change a bad day in recovery into a good day in recovery, or at least – as we also mention above – they can help a person at risk of relapse make it through the day without relapsing.
By recovery metrics, that counts as a good day.
This article will discuss the role of peer support in the recovery process, with a focus on a recent development: the formalization of the peer support role in professional, clinical AUD and SUD treatment. Individuals who offer peer support in the clinical context are now called Peer Recovery Support Specialists (PRSS) and offer what’s called Peer Recovery Support Services (PRSS).
Peer Support: An Essential Component of Long-Term Addiction Recovery
There’s evidence behind the power of peer support in addiction recovery, too – not just our anecdotes about how a good friend can cheer us up on a bad day.
We’ll share more below, but we’ll start with one thing we found particularly persuasive that appeared in a meta-analysis published in 2019 called “Lived Experience in New Models of Care for Substance Use Disorder: A Systematic Review of Peer Recovery Support Services and Recovery Coaching.”
Researchers found the following:
- Patients in detoxification programs who receive at least one peer counseling session were more likely to complete their detox program
- One peer-led intervention for individuals at a hospital-based, walk-in clinic was associated with reduced substance use 6 months later
That’s powerful: just one interaction can do more than brighten a person’s day – it can change the course of their lives. If you know someone with severe AUD or SUD, you know that completing a detox program is a challenging first step on the road to recovery, and six months without alcohol or substance use is a major accomplishment.
Let’s dive deeper, though, so we can understand the value of peer support in addiction recovery on a granular level. A publication released by the Substance Abuse and Mental Health Services Administration (SAMHSA) identifies the following evidence-based benefits of peer support for people in recovery from AUD and or SUD:
- Decreased criminal justice involvement
- Improved relationship with treatment providers
- Decreased engagement with emergency services
- Reduced rates of relapse to alcohol or substance use
- Increased time in treatment
- Reduced rates of alcohol or substance related re-hospitalization
- Increased satisfaction with treatment
- Reduced use of alcohol and substances
- Improved access to social services and support
- Increased housing stability
Here’s how two people interviewed for that publication described the function of peer support in their recovery journey:
“Peer support helped me see that I was not hopeless. It gave me my voice back and bolstered my self-worth.”
“When I needed someone to walk beside me, peer support was there.”
When we talk about the benefits of peer support for people in recovery – or the benefits of anything for people in recovery – it’s important to listen to the people in recovery, themselves. Those two quotes are representative: talk to anyone in recovery, and – with very few exceptions – they’ll echo those sentiments.
In a nutshell, peer recovery support (PRSS) works.
We’ll address those questions now.
The Role of the Peer Support Specialist in AUD and SUD Treatment
First, we’ll answer the why to the best of our ability. We qualify that because every person in recovery has a slightly different why, but we can identify big-picture reasons that explain its effectiveness. The essence of why peer support works is twofold:
- The name says it: peer. Humans are funny. They listen to doctors and teachers and people with official authority on subjects all the time. But when they want to know what might be called the real deal or have questions like what does all this have to do with me, they go to their peers for the answers. They trust them in a personal way that, in some cases, is more meaningful than the trust they place in official authorities.
- Shared experience. The opinion of a peer carries weight in a way the opinions of others don’t: most of us know this from experience. The opinion of a peer who’s been through almost the same thing as you – in this case, recovery from AUD/SUD – carries exponentially more weight. The reason is easy to understand. They speak from direct experience that matches ours. They’ve been there, made it through to the other side, and are ready to help.
That leads us to an important question, which we need to answer before we describe how peer support specialists do what they do.
Here’s the question:
Help with what?
Help with recovery.
Because recovery is not easy – and the process is more complex than people think. We’ll take a look at all the things recovery is, then circle back to discuss how peer support specialists help people with recovery.
What is Recovery?
Here’s how SAMHSA defines recovery from AUD and/or SUD:
“Recovery is a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential.”
SAMHSA indicates there are many paths to recovery, and foreground the concept that “complete symptom remission is neither a prerequisite of recovery nor a necessary outcome of the process.” With that in mind, experts identify several paths to recovery, including, but not limited to:
- Professional Clinical Treatment:
- Intensive outpatient (IOP)
- Partial hospitalization (PHP)
- Use of Medication-Assisted Treatment (MAT):
- Individual/Group Therapy and Counseling:
- Cognitive behavioral therapy (CBT)
- Motivational Interviewing (MI)
- Dialectical behavior therapy (DBT)
- Family and School Support:
- Family engagement in the recovery process can improve outcomes
- Schools can identify need for treatment and connect students – either teens, young adults, or adults – to resources for treatment and support
- Faith Based Approaches:
- Evidence shows spirituality has a positive impact on recovery, whether in a formal context – i.e. people who participate in an established religion – or informal – i.e. people who identify as spiritual, but not religious
- Peer support:
- Alcoholics Anonymous (AA) meeting
- Narcotics Anonymous (NA) meetings
- Peer support specialists: the topic of this article
That’s a lot for a person in recovery to handle. Remember: when a person starts their treatment journey, they’re often off-balance. Their personal relationships may be rocky, their health may be poor, and they may face vocational, food, and housing instability. Handling those issues while participating in all – or some – of the above paths to recovery can be challenging, and in some cases, overwhelming.
That’s where peer support specialists come in.
Peer Support Specialists: How They Help People in Addiction Recovery
SAMHSA identifies four major dimensions that support a life in recovery:
- People in recovery work to reduce, overcome, eliminate, or live successfully with the symptoms of their alcohol, substance use, or mental health disorder. They make choices that support physical, psychological, and emotional wellness
- People in recovery work to establish or re-establish a safe, healthy, recovery-friendly home environment.
- People in recovery work to return to daily activities that give life meaning. These include work, school, volunteering, or expressive, creative hobbies or passions. People in recovery work to re-establish their ability to lead life on their own terms and contribute to their communities in a meaningful way.
- People in recovery work to build relationships and social networks that provide support, friendship, hope, and one ingredient we don’t talk about enough: love.
The goal of peer support specialists is to support people in recovery in their efforts to restore their health, home, sense of purpose, and feeling of connection to their community. But they don’t make it up as they go. Their work has a solid conceptual and theoretical framework. The peer support specialist role operates from the following foundational principles.
Principles of Peer Support in Addiction Recovery
1. Recovery First
PRS specialists prioritize hope, and work to help each person in recovery achieve their personal vision of a meaningful life. PRS specialists identify the inherent strengths in each person in recovery, meet them where they are, and validate and work to support their individual recovery path.
2. Person First
PRS specialists follow the lead of the person they support. They align their support with the individual goals of the person in recovery. They collaborate with the person in recovery to identify what works them and what doesn’t, then help them engage in more of the former and less of the latter. The support services offered are always based on a goal, desire, or interest of the person in recovery.
PRS specialists function as consultants to the people they support. A PRS specialists does not arbitrarily determine the type of support they provide or decide which elements of the recovery/treatment plan they’ll engage in: all that comes from the person in recovery, on a voluntary basis. Participation in a PRS program is an intentional, proactive choice: it’s never forced, never mandatory, and never a condition of the ongoing receipt of other types of support.
4. Relationships First
The role of the PRS specialist revolves around the quality and authenticity of their relationship with the person in recovery. The relationship is the foundation that makes everything else work. It’s based in trust, respect, empathy, honesty, and collaboration. This foundation allows the PRS specialist a window into the personal world of the individual in recovery, and helps them identify real areas of need. From the perspective of the person in recovery, this foundation of trust means they’ll listen to and lean on the PRS specialist in tough times, and follow their suggestions about how to enhance their recovery journey when things are going well.
PRS specialists operate from strength-based perspective. They understand the role of trauma in both the development of and treatment for AUD and SUD. They prioritize emotional, psychological, and physical safety, and work to find ways to empower trauma survivors and restore a sense of control in their life and agency in the recovery process.
Principles in Action: Peer Support Specialists, AUD and SUD
Peer recovery support specialists apply these principles in their work with people in addiction recovery every day. They start by establishing an open and honest connection and build from there. Then they listen to their goals and may help them elucidate or envision them. They focus on those goals and find ways to help the person in recovery achieve them. The goals may be related to any of the four core components of recovery: health, home, purpose, or community.
To help provide motivation, a PRS specialist shares their personal knowledge of recovery in a way that helps the person in recovery believe in their vision of the future and believe they’re on the right track to making that vision a reality.
Once they learn what the person in recovery wants, and inspires them to commit to the journey, they begin liaising with providers and social support services to personalize their care, eliminate barriers to that care, and facilitate interaction with public and private resources that support recovery. This phase of their support includes helping the person in recovery make lifestyle changes that contribute to overall health and wellness, such as improved nutrition, increased activity and/or exercise, and incorporating stress-management/self-care techniques into their daily routine.
The next step is to help the person in recovery achieve independence, which means that gradually, they’ll rely less and less on the support of the PRS specialist, and more and more on themselves and other recovery peers, such as AA or NA mentors. However, PRS specialists have a critical role in this phase of recovery: crisis management and relapse prevention. They should be the first number the person in recovery calls when things get tough and risk of relapse increases.
That’s when a person in recovery most needs their PRS specialist.
That’s also when the PRS specialist performs a role similar to the role of a good friend, which we describe in the beginning of this article. Since they put time and energy into learning everything they can about the person in recovery – the person who needs their support – they often have the ability to say the right thing in the right way at the right time.
That’s how good friends can turn your day around.
And if you’re in recovery, that’s how a recovery peer – a PRS specialist or an AA/NA peer – can turn your risk of relapse into another successful day in recovery. They lean who you are and where you want to go, and help you get there. When you lose your way, they know how to help you get back on track.
You helped them draw the map.