The Flawed Case for an Abstinence-Based Peer Recovery Support Specialist Model

David Marlon’s recent article, The Need for an Abstinence-Based Peer Recovery Support Specialist Model, pushes an abstinence-only framework that is outdated, exclusionary, and unsupported by science. While he attempts to make the case that abstinent-only Peer Recovery Support Specialists (PRSS) provide the best outcomes, his argument relies on mischaracterizations, logical fallacies, and personal moral beliefs rather than actual evidence.

To put it bluntly: abstinence is not the only path to recovery, and restricting the PRSS workforce to those who conform to a rigid abstinence-only model is not only ineffective, it’s harmful. Let’s break down exactly why.

1. Recovery is a Spectrum, Not an Abstinence-Only Club

Marlon argues that allowing individuals to self-identify as in recovery creates inconsistency in peer work. What he fails to acknowledge is that recovery is not one-size-fits-all—it exists on a spectrum.

• SAMHSA’s official definition of recovery describes it as “a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential.” Notice what’s missing? Any mention of abstinence.
• The Global Commission on Drug Policy (2021) and extensive peer-reviewed research confirm that harm reduction and recovery are not opposites. Many individuals improve their health, reduce risks, and find stability without total abstinence.

By excluding qualified, effective peer workers who may still use substances in a non-chaotic way, Marlon’s model removes the very people who can best connect with those in need.

2. Global Best Practices Do Not Require Abstinence

If requiring PRSS workers to be abstinent actually worked, you’d expect to see global recovery models implementing it. But they don’t. In fact, most effective international programs recognize that abstinence is not the only measure of recovery.

• Portugal’s decriminalization model successfully integrates peer workers regardless of abstinence status because research shows that people with lived experience—including current substance use—build trust more effectively. (Gon?alves et al., 2015, Journal of Drug Policy)
• Canada’s Peer Engagement Principles (CAPUD, 2022) emphasize that peer support workers who use drugs are often the most effective in reaching individuals who are actively using, as they share relevant and current lived experience.
• A 2021 study in the International Journal of Drug Policy (Greer et al.) found that peer workers who still use drugs—but are not in chaotic use—help bridge the gap between traditional services and marginalized populations, improving engagement and health outcomes.

If global best practices do not require abstinence, why should PRSS in the U.S. be forced into an outdated model that excludes the very people best equipped to help?

3. The “Normalization of Use” Argument is a Strawman

Marlon claims that allowing non-abstinent PRSS workers will “normalize continued use” and enable clients. This is a strawman argument—a distortion of what peer support actually does.

The reality is that peer workers, including those who use substances—reduce harm, increase engagement, and save lives.

• A Johns Hopkins study (Schatz & Nougier, 2012) found that peer support, even from individuals who use substances, reduces overdose risk, increases engagement in care, and improves long-term health outcomes.
• A 2020 study in Substance Abuse: Research and Treatment found that excluding non-abstinent individuals from peer work worsens outcomes because it drives distrust in services and pushes people further away from support.

The true risk isn’t “normalizing use” it’s excluding the very people who could provide effective, life-saving support.

4. PRSS is Not a Clinical Role, So Why Apply Clinical Standards?

One of the biggest flaws in Marlon’s argument is that he misrepresents PRSS as a clinical position.

• PRSS work is non-clinical by design. The National Harm Reduction Coalition (2023) defines peer support as “a person-centered approach focused on improving quality of life, engagement in care, and self-directed recovery.”
• PRSS is built on lived experience, mutual support, and harm reduction not enforcing clinical abstinence models.

If PRSS is not a clinical role, why should it be bound by clinical abstinence requirements? The entire purpose of peer support is to meet people where they are not to impose rigid, exclusionary standards.

5. The Credibility Myth: Why Lived Experience is an Asset, Not a Liability

Marlon argues that non-abstinent PRSS workers lack credibility. The research says otherwise.

• A 2018 study in the Journal of Substance Use and Misuse (Eddie et al.) found that people in active substance use are more likely to trust and engage with non-abstinent peer workers than those who present an abstinence-only model.
• The lived experience of people who use drugs—including those in managed, non-chaotic use enhances credibility rather than diminishing it. Trust is built through authentic connection, not arbitrary abstinence timelines.

If the goal is engagement and support, why exclude the very people best suited for the job?

6. Marlon’s Argument is Built on Morality, Not Science

Let’s be clear: Marlon’s abstinence-based PRSS model is not based on research; it’s based on moral panic. His article cites zero peer-reviewed studies supporting his claims.

At no point does he provide: ? Any research on peer support effectiveness ? Any data comparing abstinence-based vs. harm reduction models ? Any global examples of successful PRSS programs requiring abstinence

Instead, he relies on fear-based assumptions, logical fallacies, and personal bias.

7. The “Addictionologist” Title is a Red Flag

Marlon calls himself an “addictionologist”—a title that doesn’t actually exist in any recognized medical or scientific field.

• It’s not a board-certified medical specialty (unlike Addiction Medicine, which requires an MD/DO).
• It’s not a public health credential (unlike an MPH or PhD in addiction science).
• It’s not a recognized discipline in addiction research.

It’s a self-proclaimed title one that sounds more like a marketing gimmick than actual expertise.

If we’re going to talk about who should shape peer recovery policy, it should be people with actual research credentials, not self-appointed addiction gurus.

Conclusion: Recovery Must Evolve, Not Regress

Marlon’s abstinence-based PRSS model is scientifically unfounded, globally outdated, and dangerously exclusionary. Instead of progress, it pushes peer support backward—reinforcing stigma rather than improving care.

If we want a truly effective PRSS model, we must embrace: ? Recovery in all forms, not just abstinence ? PRSS workers judged by effectiveness, not an arbitrary “clean time” ? A workforce that reflects lived realities, not outdated moralism

For too long, recovery services have been dictated by abstinence-first ideology rather than evidence. It’s time to move forward, not backward.

If we want a PRSS model that actually works, it must be: inclusive, flexible, and evidence-based not abstinence dogma disguised as professionalism.

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