NCAD East | Navigating Challenges, Peer Support Workers Help Themselves by Helping Others

Peer support workers in addiction treatment have the unique opportunity to help others while also enhancing their own recovery. But they also face challenges, from added stress to overcoming misconceptions about their role.

At the National Conference on Addiction Disorders East in Baltimore on Friday, Christian Williams, PhD, LMHC, professor of practice, Assumption University, Douglas, Massachusetts, discussed the power of connection in substance use recovery and how individuals can help themselves by helping others.

She spoke with Addiction Professional about the benefits and challenges of being a peer support worker, misconceptions about peer support, best practices for individuals who are providing peer support, and how addiction treatment provider organizations can support the supporters.

Peer support workers are in a unique position of having a dual role, both receiving and providing recovery services. What are some of the benefits of this arrangement for the peer support worker? And what are some of the biggest challenges they face?

Christian Williams: Some of the benefits of being in the role of peer support worker include increased confidence in their recovery, increased self-esteem, and a sense of control over their illness. The role of peer support worker has been reported to provide ongoing structure, responsibility, and purpose in the life of the peer support worker. Peers via the helping relationship have a greater connection to treatment providers and informal supports than many individuals at the same place in their recovery journey. These support networks are believed to be helpful should the peer start to struggle with their own recovery due to the strengthened strategies to maintain recovery effectively.

In addition, peer support workers experience a positive shift in the view of themselves as well as how they are perceived by others. The transition from service recipient to peer support worker has also been found to assist the peer worker in shifting their identity from a service user with a self-reference to an individual with sustained recovery that can make a meaningful contribution to the behavioral health system. Peers with sustained recovery are often looked upon as role models by individuals who are in early stages of recovery. Research has found that being a role model motivated the peer support worker to engage in the practices that they were teaching, thereby enhancing personal recovery and immersion in recovery-oriented activities.

Concerns have been raised in the research that peer workers are tasked with being both a provider and a receiver of services and that this can add stressors to their personal recovery process. This shift in roles has been correlated to experiences of role confusion and discrimination when one of the defining qualifications for employment is self-identification of personal recovery status. The perpetuation of stigma through the label of expert by experience may set the stage for inequity of status as well as a lack of credibility in the role of peer worker.

Challenges that have been voiced by peer support workers include: a lack of equality between themselves and their non-peer colleagues, concerns related to being accepted by coworkers, as well as feelings of stigma and discrimination from non-peers and leadership. Peer support workers regularly report a significant difference in their compensation and the value placed on their work by others, creating challenges to this role. These challenges including lower salaries and fewer work hours available than for non-peer counterparts in similar roles. Peer support workers have been reported to be at greater risk than other mental health professionals for the personalization of the client’s successes and failures. This has been attributed to the use of shared experience to influence the outcomes of individuals in recovery.

What are the biggest misconceptions around the concept of peer recovery support?

CW: Some of the biggest misconceptions about peer support workers are related to how the role is conceptualized by others. There is a misconception that peer support could be a replacement for formal treatment; however, it is designed to be an adjunct service that provides support and reinforces treatment adherence and messages learned in the treatment environment. Other misconceptions include the belief that it is meant to be a clinical service where a diagnosis and treatment plan will be generated. However, the premise and value in peer support lies in the power of this nonclinical intervention. It is not therapy, but rather a nonclinical service that can engage patients outside of the confines of traditional clinical practice. This ability to fill critical care gaps is the most probable reason for their widespread uptake across a diverse range of substance abuse treatment settings and the reason that peer support workers have emerged as a critical component of recovery management programming.

Other common misconceptions are directly related to the informal nature of the service with peer support workers being regarded as paid sponsors and friends. Peer support is not a sponsor, the role is distinct from mutual aid and is an intervention. While it is not a formal treatment intervention, it is still a helping relationship and not a personal relationship, such as a friendship.

What best practices do you recommend to individuals in recovery who are providing peer support?

CW: It is important for peer support workers to recognize that they should keep their personal recovery and their role as a peer worker separate. Peer support workers have identified the need to emphasize personal recovery in their lives and to not allow their work to become a replacement for what keeps their recovery stable. Recognizing that while one increases recovery, the other has the potential to drain energy and create stress.

There is increased concern about burnout in a role that uses shared experience as the foundation of the helping relationship. Peer workers expressed the need to be vigilant with one’s own self-care for the role of peer support worker to be sustainable on a long-term basis. Engaging in self-care includes being present in their personal lives, establishing and maintaining effective boundaries, and ensuring ongoing attention to their personal recovery. Self-care was identified as being a preventative measure against burnout and other challenges in the role of peer support worker as well as assisting in the management of crossover into one’s personal life. Boundaries are of particular importance in this role and confidence in establishing and maintaining them is critical to success.

In a system that is just beginning to understand the value and role of peer support workers in substance use recovery, it is important for peer workers to advocate for themselves and the needs that they have including supervision, training, and support in decision making.

How can addiction treatment provider organizations support these peer supporters?

CW: Being situated in a recovery-oriented system of care often places this uniquely nonclinical role amidst clinical interventions. To support this role, organizations can provide peer workers with ongoing supervision by individuals with experience in recovery, access to training on a variety of topics, such as managing the relapse of a patient, working with individuals with high acuity, recidivism, and coping with the death of a patient. Many peer workers have not had previous jobs and/or have not worked directly with individuals in early recovery, and because most of the skills that are used in this role are learned in vivo on the job, the role of supervision is crucial to ensuring success in this role.

Enhancing stakeholder understanding of the role of peer support worker can decrease confusion related to what peer workers are supposed to do and the limits of their role. Peer workers have resoundingly shared that there is a strong need to work with stakeholders to establish outcome measures that are suited to a nonclinical role and to set expectations related to documentation and service delivery that support rather than decrease fidelity to the peer support model.

Reference

Williams, Christian. The power of connection in substance use recovery; by helping others we help ourselves. Presented at: National Conference on Addiction Disorders East; November 19, 2021; Baltimore, MD.