“Whether he tries to enter into a dislocated world, relate to a convulsive generation, or speak to a dying man, his service will not be perceived as authentic unless it comes from a heart wounded by the suffering about which he speaks.” –Henri Nouwen, 1972
During September we observed Recovery Month 2018 through sharing posts about what research tells us about supporting recovery and reducing the barriers of stigma. Choosing people-first language, aligning supportive actions with the stages of recovery, and educating ourselves about the importance of medication-assisted treatment (MAT) and how it works are all important ways of assisting or supporting recovery. Another very effective and important method of assisting recovery comes through peer recovery support services and peer recovery support workers.
The idea of peer support has its origins in the concept of the wounded physician, a term used by Carl Jung (Jackson, 2001; Jung, 2014; White, 2000a, b;), and the wounded healer addiction treatment tradition. The wounded healer concept comes from the unique potential ability of those who have been successful in the process of recovery helping others to also successfully negotiate the same types of experiences. At a time when the existing treatment system was engaging in both reform and revitalization, relying on both knowledge of the research base in treatment as well as his vast experience in the field, William White wrote that the hope for the future of the addiction treatment system might actually lie in the hands of those for whom it was created. Knowing full well that there would be both positives and negatives, strengths and weaknesses, his belief was that a new concept would move more people to enter treatment, reduce relapses, speed up the time between relapse and re-initiation of treatment, enhance recovery capital, “…the sum of resources necessary to initiate and sustain recovery from substance misuse (employment, school, housing, healthy family, etc.),” and improve quality of life for those in recovery (Granfield & Cloud, 1999, White 2004).
Peer recovery workers share a unique understanding about the recovery process that those not having experienced recovery may never know. They use their own experience in recovery from substance use, mental health, or other behavioral health disorders to help people enter and stay in recovery. Peer support services expand the impact of treatment and help people in recovery from substance use disorder (SUD) and mental health disorders apply knowledge, skills, and strategies learned in treatment to their daily lives in practical ways. In addition to having a special way of relating that only the shared experience can bring, peer recovery workers also benefit from helping others and help link treatment to recovery. Yet peer recovery workers are not treatment providers or counselors, or even professionals. They are vetted non-professional service providers who “draw their legitimacy from experiential knowledge and experiential expertise” (Borkman, 1976). Still, early in the development of the peer recovery worker concept William White wrote that they could provide some aspects of the addiction counseling field that had been largely lost at that time, including, but not limited to:
- “The Psychology of Optimism”: peer recovery support workers operate more from a fundamental base of hope and strength rather than one of assumed pathology;
- “ The Ecology of Addiction and Recovery”: the understanding that recovery takes place primarily in the client’s own environment, including the feelings, behaviors, and thoughts of the client, rather than that of an institution;
- “Knowledge of Cultures of Recovery”: providing encouragement for recovery within a variety of recovery communities rather than just treatment centers and self-help groups;
- “Decreasing Power Discrepancy”: the peer recovery specialist relates to the client with less power differential and fewer business-like qualities;
- and “Continuity of Contact in a Primary Service Relationship” (White, 2004).
Peer recovery support workers are people who have dealt effectively with their issues and are no longer controlled or impaired by their disorder (Park, 1992). According to the Bringing Recovery Supports to Scale (BRSS TACS) Technical Assistance Center Strategy, the roles of peer-based recovery support services (P-BRSS) can cover a broad range of activities.
- Advocating for people in recovery
- Sharing resources and building skills
- Building community and relationships
- Leading recovery groups
- Mentoring and setting goals
Peer support roles may also extend to the following:
- Providing services and/or training
- Supervising other peer workers
- Developing resources
- Administering programs or agencies
- Educating the public and policymakers
These examples show that peer recovery coaches provide not just emotional support, but help those new to recovery to connect to community resources, concrete support like employment and housing, and connections to activities and events within a recovery community. Testimonies point to the positive impact of peer recovery coaching, and its effectiveness is also supported by empirical research according to reviews of the research published between 1995 and 2014 (Bassuk, et al., 2016; Reif et al., 2014).
A wide variety of resources are available both for those considering becoming a peer recovery support worker and for those who are considering supervising them or adding their services to those already being offered in an agency or a treatment/recovery setting (SAMHSA, 2018). In order to provide services as members of treatment teams, peer workers in Behavioral Health need to develop or use core competencies, sets of knowledge, skills, and attitudes they will need to successfully perform these roles. Core competencies aid in developing certification standards, training programs, and job descriptions for peer recovery workers. Core competencies are founded in principles that are recognized by the mental health field, consumers, and substance use recovery communities.
Those principles are:
- Recovery-Oriented: because peer recovery workers have achieved a purposeful and meaningful life, operate from a position of hope and the belief in the ability of those they help to acknowledge their own strengths and become motivated to do the same.
- Person-Centered: the goals and preferences of the person in recovery always guide the peer recovery support services provided by workers.
- Voluntary: Peer recovery workers always serve and respond to the individual’s needs, hopes, goals, and preferences from a position of choice and partnership, helping individuals to choose kinds of services and features of recovery plans rather than dictating them.
- Relationship-Focused: The foundation for all services and support provided is base on a respectful, trusting, empathetic, collaborative, and mutual relationship between the peer and the peer recovery support worker.
- Trauma-Informed: Establishing physical, psychological, and emotional safety forms a strengths-based framework for survivors to reinstate both empowerment and control.
Category I: Engages peers in collaborative and caring relationships
Category II: Provides support
Category III: Shares lived experiences of recovery
Category IV: Personalizes peer support
Category V: Supports recovery planning
Category VI: Links to resources, services, and supports
Category VII: Provides information about skills related to health, wellness, and Recovery
Category VIII: Helps peers to manage crises
Category IX: Values communication
Category X: Supports collaboration and teamwork
Category XI: Promotes leadership and advocacy
Category XII: Promotes growth and development (SAMHSA, 2018).
Frequently asked questions about the Core Competencies for Peer Workers in Behavioral Health Services are answered on the (BRSS TACS) Technical Assistance Center Strategy website and can provide additional insight into some of the services peer recovery support workers provide, some of the terminology used, and types of service systems and providers that they would be able to collaborate with in a variety of roles. One way of ensuring standardized competency, oversight, accountability, training, and continuing education for peer recovery workers while protecting members of the public is through certification. The International Certification and Reciprocity Consortium (IC&RC) provides many states with a supportive infrastructure to accomplish all of those things while also setting standards, providing testing, and offering a process for reciprocity for 28 state and territory members boards. For Nevadans, the Nevada Certification Board (NCB) is an affiliate member board of the IC&RC to ensure public safety, accountability, and provide practitioner benefits for Nevada communities and its behavioral health workforce. Becoming an IC&RC Certified Peer Recovery & Support Specialist (PRSS) through the NCB means having a scope of practice, peer core competencies, and a code of ethics for their field. Certified Peers go through rigorous training, supervision, and examination to reach a level of competence to put their knowledge and experience to use as a Certified Peer Recovery (PR) and Support Specialist. The NCB website lists definitions, descriptions of peer workers in Nevada, a list of requirements, a Flow Chart for the certification process, a fact sheet, a Candidate Guide, and available trainings. The Nevada certification application process can be started online and PRSS Renewal can also be maintained online. The National Association for Alcoholism and Drug Abuse Counselors (NAADAC) also provides information about the process of becoming a National Certified Peer Recovery Support Specialist (NCPRSS) Those interested can visit that section of their website for reasons to obtain NCPRSS certification, eligibility requirements, details about the application process, fees, and renewals. Professional liability insurance coverage for Peer Recovery Support Specialists (PRSS) is also available through the NAADAC website.
For behavioral health providers in Nevada looking at the possibility of introducing peer recovery support workers into their practice, collaborating with them, or expanding the roles of peer recovery support workers who are already a part of the services they offer, there are a few final thoughts as you explore the resources provided. The first is: this approach is based on empirical evidence of its effectiveness. Second: the four dimensions of recovery support, managing health, having a safe and stable home, having a sense of purpose in life, and being surrounded by a community that provides social support are all grounded in hope that is primary to what peer recovery workers can provide. According to Shery Mead, founder of Intentional Peer Support (IPS) and an early leader in the peer support movement, “When people find others who have had similar challenging experiences, there is almost instant connection (finally someone who really gets it). But the real gift in peer support goes beyond initial affiliation. The real gift lies at the intersection of true reciprocity and the exploration of new meaning and possibility.” As Larry Fricks, former director of consumer relations and recovery at the Georgia Division of Mental Health stated, “I’m convinced that the greatest potential for actualizing the vision of recovery lies within each individual, not in the system. Peers can tap into this potential and nurture the hope that fosters recovery not only through role modeling, but also by being trained in skills that call forth the strengths of the individuals they serve.” (Anthony and Ashcroft, 2006). And third, in Nevada, as the systems for training, certifying, and providing professional development for are being established, behavioral health providers are empowered–through infrastructure, support, resources and tools– to provide this unique asset to the many services provided to those in treatment and recovery. The resource links provided in this post are just a few that have been added to the Resources and Downloads section of this site and more are being added as they become available.
Anthony, W. A., and Ashcraft, L., 2006, From Consumer to Caregiver, Behavioral Healthcare Executive, Psychiatry & Behavioral Health Learning Network retrieved May 24, 2019 https://www.behavioral.net/article/consumer-caregiver
Borkman, T. (1976). Experiential knowledge: A new concept for the analysis of self-help groups. Social Service Review, 50, 445-456.
Granfield, R., & Cloud, W. (1999). Coming Clean: Overcoming Addiction without Treatment. New York: New York University Press.
Jackson, S.W. (2001). The wounded healer. Bulletin of the History of Medicine, 75, 1-36.
Jung, C. G.. Practice of Psychotherapy : Practice of Psychotherapy, edited by Gerhard Adler, and R. F. C.
Hull, Princeton University Press, 2014. ProQuest Ebook Central, paragraph 239. https://www.amazon.com/Practice-Psychotherapy-Psychology-Transference-Bollingen/dp/0691018707.
Mountain Plains ATTC, Building Recovery Capital, slideDecks4U, retrieved 03.26.2019 from https://attcnetwork.org/media/689
Nouwen, H.J.M.,  1979, The wounded healer: Ministry in contemporary society, Doubleday, NewYork.
Park, J. (1992). Shrinks: The Analysts Analyzed, London: Bloomsbury.
SAMHSA, 2015. Core Competencies for Peer Workers in Behavioral Health Services. Retrieved 4.23.2019 https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers/core-competencies-peer-workers
SAMHSA, 2018. Peers: Who Are Peer Workers? Retrieved 11.07.2018 from: https://www.samhsa.gov/brss-tacs/recovery-support-tools/peers
Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance abuse and rehabilitation, 7, 143–154. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5047716/
White, W. (2000a). The history of recovered people as wounded healers: I. From Native America to the rise of the modern alcoholism movement. Alcoholism Treatment Quarterly, 18(1), 1-23.
White, W. (2000b) The history of recovered people as wounded healers: II. The era of professionalization and specialization. Alcoholism Treatment Quarterly, 18(2), 1-25.
White, W. (2004). The history and future of peer-based addiction recovery support services. Prepared for the SAMHSA Consumer and Family Direction Initiative 2004 Summit, March 22-23, Washington, DC.