On The Role of Peers in Addiction Recovery

Do peers have a unique way of connecting with

clients?

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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 Hartfordbased 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 cooccurring 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
(www.certboard.org).
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.