Abstract
Peer recovery support services (PRSS) are increasingly being employed in a range of clinical settings to assist individuals with substance use disorder (SUD) and co-occurring psychological disorders. PRSS are peer-driven mentoring, education, and support ministrations delivered by individuals who, because of their own experience with SUD and SUD recovery, are experientially qualified to support peers currently experiencing SUD and associated problems. This systematic review characterizes the existing experimental, quasi-experimental, single- and multi-group prospective and retrospective, and cross-sectional research on PRSS. Findings to date tentatively speak to the potential of peer supports across a number of SUD treatment settings, as evidenced by positive findings on measures including reduced substance use and SUD relapse rates, improved relationships with treatment providers and social supports, increased treatment retention, and greater treatment satisfaction. These findings, however, should be viewed in light of many null findings to date, as well as significant methodological limitations of the existing literature, including inability to distinguish the effects of peer recovery support from other recovery support activities, heterogeneous populations, inconsistency in the definitions of peer workers and recovery coaches, and lack of any, or appropriate comparison groups. Further, role definitions for PRSS and the complexity of clinical boundaries for peers working in the field represent important implementation challenges presented by this novel class of approaches for SUD management. There remains a need for further rigorous investigation to establish the efficacy, effectiveness, and cost-benefits of PRSS. Ultimately, such research may also help solidify PRSS role definitions, identify optimal training guidelines for peers, and establish for whom and under what conditions PRSS are most effective.
Highlights
Substance use disorder (SUD) is one of the most pervasive and intransigent clinical and public health challenges facing the United States (Office of the Surgeon General, 2016)
It is difficult to parse out the independent effect of peers—because with the exception of Sisson and Mallams (1981) and James et al (2014) these studies lacked the necessary control groups—overall these findings suggest peer recovery support services (PRSS) may have the ability to sure up treatment attendance and help individuals engage with treatment
This study demonstrates the synergistic potential of integrating peerbased approaches and evidence-based SUD interventions
Summary
Substance use disorder (SUD) is one of the most pervasive and intransigent clinical and public health challenges facing the United States (Office of the Surgeon General, 2016). “Patient navigator” models have played important roles for several decades in the professional coordination of care for chronic medical conditions such as cancer (e.g., RobinsonWhite et al, 2010; Freeman, 2012), and later included peers with lived experience to aid engagement (e.g., Giese-Davis et al, 2006). Such navigator models have been developed in the care of individuals with severe mental health conditions (e.g., Corrigan et al, 2017). There is a long tradition of community-based 12-Step mutual-support (e.g., “sponsors”), that can provide free ongoing recovery monitoring and management using peers with lived experience, though this class of peer support should not be conflated with more structured PRSS that are increasingly being incorporated into clinical settings and can support multiple pathways to recovery
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