What makes peer support so powerful in addiction recovery?

How peer support helps

A recent definition of peer support - which? beautifully encapsulates how peer support helps - is the one proposes by Gillard in 2019: “Peer support is what we do when we recognise our shared experiences of disadvantage and distress, make an inter-personal connection on that basis, and come together to support and learn from each other”.

Gillard also emphasizes that the three primary values of peer support are: equal power relationships; reciprocal roles of helping and learning; and a “whole of life” rather than illness-focused approach.

Peer support is distinct from professional or clinical support, as it is not based on psychiatric models and diagnostic criteria and generally aims at promoting a wellness model that focuses on strengths and recovery. “The positive aspects of people and their ability to function effectively and supportively, rather than an illness model, which places more emphasis on symptoms and problems of individuals” (Repper and Carter, 2011).

There is a considerable research evidence base exploring peer support, with most of it emerging over the last 10–15 years and from the field of mental health. The overwhelming majority of this research shows that peer support is potentially useful at any stage of a treatment and recovery journey (Reif et al., 2014, Shalaby et al., 2020, Stack et al., 2022, Tracy and Wallace, 2016 ) and that it can help people to:

• reduce harm
• engage in support, start and complete treatment
• increase feeling of empowerment and self-esteem
• improve social support perceptions and community integration
• improve social functioning (stability in employment, housing, education etc.)
• reduce rates of relapse and sustain long term recovery

Research also found that peers can offer the people they support a strong sense of personal connection, encouragement and hope, through participating in purposeful activity.

Peer support is a broad and robust strategy for reaching groups that health services too often fail to engage. The wide range of audiences and health concerns among which peer support is successful suggests that a basis for its success may be its flexible response to different contexts, including the intended audience, health problems, and setting.

A peer supporter can be very effective in providing motivation and support as an individual seeks a recovery lifestyle. When an established frame of reference reflects their own recovery process, peer supporters are valuable assets in recovery support. They can bring significant interpersonal skills to their work with individuals engaged in or contemplating recovery

The lived experience of a peer volunteer or worker helps to overcome the power difference that often exists in the relationship between a clinician and the person they are supporting (Collins et al., 2019). Peer support also links people into the recovery community and its recovery-supportive social networks and other kinds of support. It benefits not only individuals but also the recovery community and wider community when people offer peer support to each other.

Where peer support is available

Peer-delivered and peer-led interventions have been described and evaluated in a wide range of settings. This includes in:

• treatment services
• lived experience recovery organisations
• the community
• medical settings, such as hospitals and detoxification units
• perinatal services
• primary care
• homeless settings
• the criminal justice system

Peer support has been used at various stages of the treatment and recovery journey. Data from?NDTMS?shows that 17% of people in treatment accessed peer support involvement for at least 6 months during 2022 to 2023.

Adult community treatment services reporting to?NDTMS?can also now report referrals:

• into treatment by peer-led initiatives
• to peer-led initiatives by treatment services

These data items are intended to help track the pathways between treatment services and?LEROs. These routes should be active in any effective?ROSC.

Brief interventions delivered by peers

Brief interventions delivered by peers have been shown to support treatment and recovery outcomes (Bernstein et al., 2005). Research also suggests that a single peer-delivered brief intervention can:

• significantly reduce heroin and cocaine use in people presenting to a hospital walk-in clinic (Bernstein et al., 2005)
• increase the rates of detoxification completion and reduce the rates of discharge against medical advice (Blondell et al., 2008)
• increase attendance at mutual aid groups (Manning et al., 2012)
• significantly increase the likelihood of abstinence at follow up (Manning et al., 2012)

Peer support and treatment

Research has generally found peer support to be safe, beneficial and a complementary resource to professional services, improving recovery outcomes for those engaging with ti. (Suresh et al., 2021). One randomised controlled trial (RCT) looked at a peer-delivered intervention that was delivered to people with complex needs alongside alcohol and drug treatment. The intervention focused on:

• community connectedness
• problem solving
• life skills
• increasing positive social networks

The?RCT?found that this type of intervention reduced a person’s alcohol use after a year by more than treatment alone did but did not reduce a person’s drug use by more than treatment alone (Rowe et al., 2007).

Using existing reviews on evidence of the effectiveness of interventions for gambling harms (Cowlishaw et al.,2012, Merkouris et al., 2016, Petry et al.,2017, Riberiro et al, 2021) ?the NICE guidelines for identification, assessment and management of gambling related harms also highlighting the need to offer peer support as an integral part of any support and treatment programmes. NICE suggests that peer support can provide:

? an opportunity to discuss aspects of recovery (social and personal) with others who have been through the same experiences

? an opportunity to discuss topics that might feel stigmatising (for example, relapse)

? encouragement to continue with treatment.

Peer support and harm reduction

Some recent peer support research has focused on harm reduction, widening access to opioid substitution treatment and digital innovations. This has been largely driven by the opioid crisis in North America and the need to find effective ways to reduce harm and prevent death. This research has focused on peer support roles that:

• refer people from emergency departments into specialist treatment after a non-fatal overdose and offer continued support and harm reduction interventions like naloxone (Ashford et al., 2019)
• link people into opioid substitution treatment (Gormley et al., 2021)
• engage people at overdose prevention sites (Kennedy et al., 2019)

Peer support benefits the person providing it

Peer support roles not only benefit the person receiving support but also the person providing it (Du Plessis et al., 2019). This is a foundational principle in the 12-step fellowship model, in which people acting as sponsors not only help others with their recovery, but in doing so strengthen their own recovery. The benefits for people in peer support roles can include:

• the good feeling they get from seeing other people benefit from their input
• increased confidence and self-esteem
• increased stability and structure
• increased income, where appropriate
• an opportunity to gain workplace skills
• increased recovery capital for individuals and communities

Challenges for people providing peer support

There are also challenges for people working in peer support roles. These include:

• unclear job descriptions, indistinct role boundaries and limited understanding of peer support roles across teams (Englander et al., 2019)
• becoming integrated into hierarchical structures in the workplace (Englander et al., 2019)
• stigma and discrimination, including devaluing of their lived experience compared to acquired learned experience (Englander et al., 2019; Stack et al., 2022)
• fast-paced work with high demands and the risk of emotional strain and stress (Collins et al., 2019)
• no or poor supervision (Englander et al., 2019; Stack et al., 2022), support including coping with triggers to alcohol and drug use, role support, maintaining boundaries and training (Englander et al., 2019; Greer et al., 2021)
• low pay and the related view that peer support roles require less skill and deliver less benefits than treatment workers do (Gagne et al., 2018; Stack et al., 2022)
• lack of clear career pathways and training and development models (Stack et al., 2022)

The?10-year strategic plan for the drug and alcohol treatment and recovery workforce (2024 to 2034)?for England reported that peer support workers were:

undertaking the roles and responsibilities of keyworkers, such as conducting initial and comprehensive assessments, developing and supporting treatment and recovery care plans and delivering treatment interventions.

It also reported that training for peer support workers was:

“inconsistent… with some [employers] providing detailed internal training packages with multiple modules, including some that are accredited, whereas others reported minimal internal or external training being offered to them in their role.”

Hence, it is crucial that any future plans include actions for government, service providers, employers and commissioners to recruit, train and develop peer support workers.?

In conclusion…

The evidence is clear: Peer support plays a transformative role in addiction recovery.

By creating spaces where individuals can connect over shared experiences, peer support brings a unique blend of empowerment, empathy, and resilience. As addiction professionals, there’s a valuable opportunity to expand and deepen our understanding of how peer support can complement and enhance other recovery methods, ultimately creating a stronger, more connected recovery community.

By bridging the gap between treatment services and lived experience, it provides a flexible, meaningful layer of support that promotes lasting change. Whether we’re working directly with clients or designing programs, it’s essential to consider how peer support might be woven into recovery journeys to foster hope, connection, and sustainable recovery.

P.S. In your experience, what are the most effective ways to embed peer support approaches and enhance their impact in recovery settings?

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