On The Role of Peers in Addiction Recovery

Do peers have a unique way of connecting with clients?

As the treatment of addiction moves inexorably toward inclusion in the

larger healthcare system, with its standards of evidence-based care,
there is also a movement towards the use of peer counselors with lived
experience with addiction. Are peer counselors able to connect with
and help persons struggling with addiction in a unique way? Do the
outcomes achieved in employing peers suggest that they should be
more widely used and supported by public funding? Melissa Killeen
opens the conversation and highlights a case in which peer counseling
played an integral roleRichard Juman

A peer recovery support specialist has many job titles across the United
States and around the world. They may be called certified recovery
support practitioners, recovery advocates, peer mentors or recovery
coaches. They tend to be employed at recovery community support
centers, at hospitals, behavioral health agencies or addiction treatment
centers. The peer recovery support specialist may be working with
substance misusers, traumatic brain injury clients, behavioral health
clients or clients that identify with all of these diagnoses. Certified peer
recovery support specialists are generally employed by the facilities at
an hourly rate for their services; for the client, peer recovery support
services are typically free. In this article, I will focus on the peer
recovery support specialists working in the addiction field.

Recovery community support centers, financed with state and federal

funding, some with funding from churches or individuals, are slowly
taking hold and becoming more prevalent. The recovery advocacy
organization Faces & Voices of Recovery developed the Association of
Recovery Community Organizations that unites and supports a growing
membership of over 100 recovery community support organizations,
although there are many organizations which have not yet become
members of ARCO. For example, in my neck of the woods, there are
currently 12 recovery community support organizations in Pennsylvania
and 10 in New Jersey. Recovery community support centers can
provide computer training, job interviewing skills training, resume
writing, legal assistance, parenting skills training, social services
linkages, 12-step meetings and even haircuts! It is important to
highlight that these are non-clinical settings. Treatment is not
providedthese are healthy places where people with current or past
histories of addiction can go as an alternative to hanging out at a bar or
on a street corner. Recent research completed by Chyrell Bellamy,
MSW, PhD and Michael Rowe, PhD, both assistant professors at Yale
University, concluded that working with peers in a recovery community
environment may reduce charges for at-risk populations.

In my view, the most important service that a recovery community

support center offers is the assignment of a peer recovery support
specialist or recovery coach to work with each client that comes to the
center. At the outset, the peer recovery support specialist meets the
client and sets up a schedule upon which the client and peer will meet.
The format and structure varies widely, with some relationships based
on daily phone calls and others on weekly face-to-face visits. The actual
length of a coaching engagement will also vary. The McShin
Foundation suggests that, as at the community recovery support
centers run by the Virginia-based foundation, a 90-day limit is placed on
the coaching assignment. However, other organizations, like the
Hartford-based Connecticut Community for Addiction Recovery, does
not place an arbitrary limit on the length of coaching time. Instead, it
recommends that standards of goal achievement, like drafting a
recovery plan, a relapse prevention plan and/or attaining sobriety
goals, be used to determine the length of engagement.

What do peer recovery support specialists actually do for their clients?

Here is one example:

In 2013, I helped create the first community recovery center in

southern New Jersey, one of only a handful of recovery centers in New
Jersey at the time. Heather Ogden-Busch was one of the first people we
hired at the Living Proof Recovery Support Center in Voorhees, NJ. At
the time, because she had many years of sobriety and experience in
sponsorship, she naturally fell into the role of a peer recovery support
specialist, or recovery coach. On Heathers first day at the recovery
support center she received a call from a member of her 12-step group.
This member relayed the story about another member from the
meeting, Beth (not her real name), who had relapsed on heroin. Beth
was living in a trailer with her boyfriend, who was also addicted to
heroin, and she was not doing well. Beth wanted to stop using. Heather
called her immediately.

At the time, Heather was aware that there was some really powerful
heroin circulating in the Philadelphia/Camden region. Several young
people had overdosed recently, including one of Heathers sponsees.
She relayed this information to Beth, and asked Beth what she wanted
to do. Beth said she wanted to get out of her boyfriends trailer and go
into rehab. She had no job, no money and no connection with her
parents, with no possibility of financing a rehab stay. Heather and her
colleagues at the Living Proof Recovery Center jumped on the phones
to find a detox and a treatment center that would have an opening for
Beth.

Within one day, Heather had scheduled an intake appointment for Beth
at a detox hospital in New Jersey. Beth would also have a bed reserved
for her at a Christian-based treatment center in Brooklyn, NY, if she
successfully completed detox. Luckily, Heather knew of another
treatment center, also faith-based, in Chicago, with the financing
available for the treatment as well as funding for the airplane flight.

Beth was not particularly religious, but knew she needed treatment and
agreed to go to detox then to treatment in Brooklyn. Over the
weekend, Heather and Beth met together at the recovery center, called
the detox hospital and went through the intake process. The same
procedure was necessary for the Brooklyn treatment center. Heather
and Beth made those calls together. By Monday of the next week, two
days after Beth consented to go to detox, Heather had arranged for a
sober friend to drive Beth to the northern New Jersey detox hospital.
She also had arranged for the same person to drive Beth from the detox
to Brooklyn when Beth was discharged.

One week passed, and Beth was being discharged from detox.
Unfortunately, the Brooklyn treatment center did not have an
immediately available bed, but Beth was next in line for a bed as soon
as it was available, in a few days. Beth had to return to her boyfriends
trailer to wait for the call from the treatment center. Beth did not have
a phone, so it was Heather that would field the call from the treatment
center. Beth had at least three days to wait and hopefully, remain
clean. Heather pulled in all of the support she could muster. Beth had
escorts to every NA and AA meeting in the area. Members of the 12-
step community drove Beth to Suboxone maintenance appointments.
Every night, Heather and Beth talked. Every morning Heather called the
treatment center to find out if the bed was available. By Wednesday
morning, Beth and Heather were driving up the NJ Turnpike to
Brooklyn, and Beth was still clean.

The story doesnt end there, because the job of a peer recovery support
specialist is as important after the client comes out of treatment. Beth
was in Brooklyn for 28 days. While Beth was working on her sobriety,
Heather was lining up a room at an Oxford House, miles away from the
trailer and the addicted boyfriend. Within one day after being
discharged from the Brooklyn treatment center, Beth was in an Oxford
House, had a temporary sponsor and was enrolled in an intensive
outpatient program. Her parents were so proud of Beths achievements
they had paid for the first two months rent at the Oxford House.
Heather remained Beths peer recovery support specialist and required
Beth to come to the recovery center every day to volunteer. Beth
answered the phone, made copies, attended 12-step meetings, and
learned about co-occurring disorders. She participated in a resume-
writing workshop and a financial planning workshop. Beth got a job as a
waitress at a local family-style restaurant that did not serve alcohol and
for the first time she opened her own checking account. By her third
month at Oxford House, she was able to pay her own rent.

Heather guided Beth to enroll in a co-occurring program associated

with her outpatient program. Beth now sees a therapist every week,
and a psychiatrist monthly for her psychiatric disorders; because of her
low income these services and her Suboxone treatment are free. She
came to understand that her drug and alcohol usage was a form of self-
medicating her mental illness. Nine months later, Beth remains an
active participant in a local recovery support center and she is sober.
Every month, her Suboxone dosage is reduced and she will celebrate
one year clean from heroin in 60 days. Her goal is to be free from
Suboxone and after one year of total sobriety, she can begin the 156-
hour training to be a certified recovery support practitioner (CRSP),
which is the peer recovery support specialist certification in the state of
NJ

Melissa Killeen is a recovery coach, author of the first book on Recovery

Coaching:Recovery Coaching a Guide to Coaching People in Recovery
from Addictions and the recipient of the 2015 Vernon Johnson Award
from the Faces & Voices of Recovery.