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Peer-Based Addiction Recovery Support Peer-based Addiction Recovery Support History, Theory, Practice, and Scientific Evaluation William L. White, MA Great Lakes Addiction Technology Transfer Center Philadelphia Department of Behavioral Health and Mental Retardation Services Dedication This monograph is dedicated to: Barbara Weiner and Rebecca Rowe of Hazelden Library, and to Stephanie Merkle and Christopher Roberts, research assistants at Chestnut Health Systems. This monograph was possible only through their tenacious efforts to procure hundreds of historical documents, scientific studies, trade journal articles, posted papers, conference presentations, and other unpublished manuscripts. Barbara, Rebecca, Stephanie and Christopher, and their counterparts around the country receive far less acknowledgment for their contributions to the field than they deserve. Thomasina Borkman, for her pioneering work on experiential learning and peer-based recovery support organizations. Those working on the front lines of peer-based addiction recovery support services. Thank you for opening your lives and your organizations to me. i ii Table of Contents Welcome from Lonnetta Albright and Michael Flaherty, PhD ................................ 1 Foreword by Arthur C. Evans, PhD and Beverly J. Haberle, MHS........................ 3 Abstract .................................................................................................................. 7 Introduction Summary of Key Points.......................................................................................... 9 The Recovery Management Monograph Series .................................................... 9 Purpose of the Current Monograph ..................................................................... 11 A Note on Language ............................................................................................ 12 A Caution to the Reader....................................................................................... 12 Acknowledgments................................................................................................ 13 Chapter One: Defining Peer-based Recovery Support Services Summary of Key Points........................................................................................ 15 Defining Peer Recovery Support ......................................................................... 16 Distinguishing Professional and Peer Support .................................................... 19 Core Characteristics of P-BRSS Specialists........................................................ 22 Varieties of Peer Recovery Support Services...................................................... 25 Core Functions..................................................................................................... 27 Treatment Adjunct or Alternative ......................................................................... 29 Chapter Two: The History of Peer-Based Recovery Support Services Summary of Key Points........................................................................................ 31 Solo Practitioners ................................................................................................. 34 Peer Recovery Support and Religious/Cultural Revitalization Movements......... 35 Secular Recovery Mutual-aid Societies ............................................................... 36 Spiritual Recovery Mutual-aid societies............................................................... 37 Religious Recovery Mutual-aid societies ............................................................. 37 Family-Focused Recovery Support Societies...................................................... 38 Occupation-based Recovery Support Groups ..................................................... 38 Shared Characteristics of Recovery Support Groups.......................................... 38 Recovery Support for Special Populations .......................................................... 39 Gender-specific mutual-aid groups........................................................................... 39 Age-specific recovery support .................................................................................. 40 Recovery mutual aid and advocacy in communities of color .................................... 40 Recovery support for and within the LGBT community ............................................ 41 Recovery support for people with co-occurring disorders......................................... 41 Recovery support for people embedded within the criminal justice system.............. 41 Recovery mutual aid in rural communities................................................................ 42 Geographical Accessibility of Recovery Mutual-aid Groups................................ 42 Internet-based Recovery Support ........................................................................ 47 Recovery Community Service Institutions and Organizations............................. 47 Recovery Social Clubs......................................................................................... 48 Recovery Advocacy Organizations ...................................................................... 49 Recovering People Working in Non-professional Support Roles in .................... 50 Addiction Treatment Recovering People Working in Professional Roles in Addiction Treatment ........ 53 Current Recovery Coaching Practices in the Public and Private Sectors ........... 62 iii Chapter Three: The Theoretical Foundations of Peer-Based Recovery Support Summary of Key Points........................................................................................ 67 “Nothing about us without us” .............................................................................. 69 The Wounded Healer Tradition............................................................................ 71 The Power of Calling (Amends in Action) ............................................................ 73 Experiential Knowledge........................................................................................ 74 Chronic Illness and Peer Support ........................................................................ 78 Charisma and Recovery....................................................................................... 80 Spirituality and Recovery ..................................................................................... 84 Storytelling and the Power of Mutual Identification.............................................. 85 Stigma and The Dynamics of Help-seeking......................................................... 88 Sharing Recovery Capital .................................................................................... 92 The Helper Therapy Principle .............................................................................. 93 Individual, Community, Culture ............................................................................ 94 Cultures of Addiction and Recovery..................................................................... 96 Preventing Harm in the Name of Help ................................................................. 97 Stewardship of Community Resources................................................................ 99 The Threats of Anti-professionalism and Professionalism ................................ 100 Primacy of Personal Recovery and Importance of Self-Care ............................ 103 Role of Risk in Recovery.................................................................................... 105 The Value of P-BRSS ........................................................................................ 105 Criticism of P-BRSS........................................................................................... 107 Testing the Theoretical Foundations of P-BRSS ............................................... 109 Chapter Four: Scientific Evaluation of Peer-based Support: Studies of the Effects of Participation in Recovery Mutual-aid Societies Summary of Key Findings.................................................................................. 113 Limited Scope of Research on Recovery Mutual-aid Societies......................... 115 Role of Mutual Aid in Recovery Outcomes ........................................................ 117 Variability of Response ...................................................................................... 119 Effectiveness across Diverse Populations......................................................... 120 Cost-effectiveness.............................................................................................. 125 The Question of Harm (Iatrogenesis)................................................................. 126 Potent Ingredients of Recovery Mutual Aid ....................................................... 128 Additive Effects of Professional Treatment and Mutual Aid............................... 130 Timing of Participation........................................................................................ 131 Linkage Procedures and Participation Rates..................................................... 132 Linking Adolescents to Recovery Support Groups ............................................ 133 Early Drop-out Rates.......................................................................................... 134 Dose and Intensity of Participation Effects ........................................................ 136 Frequency of Participation ................................................................................
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