Recovery Community Services Program What Are Peer Recovery Support Services? What Are Peer Recovery Support Services?

i Acknowledgments This publication was prepared for the and Mental Health Services Administra- tion (SAMHSA), by the Altarum Institute, Inc. under contract number 270-2003-0005-0001, with SAMHSA, U.S. Department of Health and Human Services (HHS). Marsha Baker, LCSW and Linda Kaplan, M.A. served as the Government Project Officers. Other contributors include June M. Gertig, J.D. Disclaimer The views, opinions, and content of this publication are those of the author and do not necessarily reflect the views, opinions, or policies of SAMHSA or HHS. Public Domain Notice All material appearing in this report is in the public domain and may be reproduced or copied without permission from SAMHSA. Citation of the source is appreciated. However, this publication may not be reproduced or distributed for a fee without the specific, written authorization of the Office of Communi- cations, SAMHSA, HHS. Electronic Access and Copies of Publication This publication may be accessed electronically through the following Internet World Wide Web con- nection: www.samhsa.gov/shin. Or, please call SAMHSA’s Health Information Network at 1-877- SAMHSA-7 (1-877-726-4727) (English and Español). Recommended Citation Center for Substance Abuse Treatment, What are Peer Recovery Support Services? HHS Publication No. (SMA) 09-4454. Rockville, MD: Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 2009. Originating Office Office of the Director, Center for Substance Abuse Treatment, Substance Abuse and Mental Health Ser- vices Administration, 1 Choke Cherry Road, Rockville, MD 20857 HHS Publication No. (SMA) 09-4454 Printed 2009

ii Table of Contents

Introduction...... 1 for Recovery...... 2 Peer Leaders and the Peer Service Alliance ...... 2 Peer Recovery Support Service Activities...... 3 or Coaching...... 3 Peer Recovery Resource Connecting...... 4 Facilitating and Leading Recovery Groups...... 5 Building Community...... 5 Volunteer and Staff Peer Leaders...... 5 The Adaptability of Peer Recovery Support Services...... 6 Different Recovery Stages and Approaches ...... 6 Varied Service Settings ...... 7 Variations in Organizational Contexts...... 7 Some Important Cross-Project Principles...... 7 Shared Values ...... 8 Focus on Strengths and Resiliencies...... 8 Self-Direction, Empowerment, and Choice...... 9 The Many Values of Peer Recovery Support Services...... 10 References and Additional Resources...... 11

iii Introduction Aisha says she knows many people who tried treatment for a substance use disorder; they also tried 12-Step meetings. Neither worked. Her friends are back on the street, still using. Anyway, Aisha doesn’t have time to attend treatment sessions or go to meetings; she has a full-time job and is busy raising her two grandchildren because their mother is in prison.

Roger has just been released from jail. He has been clean for the 90 days of his incarcer- ation, and he thinks he can stay clean if he can just find a job and a place to live with other people in recovery.

Elizabeth tells her treatment counselor that payday is her trigger, and that she needs an alcohol- and drug-free place to go and socialize on Friday evenings. She adds that it would be helpful if she could bring her children.

Luis says he understands that his AA meeting is not the place to discuss the complica- tions he is encountering with his hepatitis C medications. But he needs someone to talk to because managing his response to the medications and his recovery at the same time is just too much for him to handle.

Bodie has been in recovery for a year. He is looking for an opportunity to be of service and to strengthen his recovery by giving back to the community. He loves gospel music and sings in his church choir.

Introduction Recovery Community Services Pro- gram (RCSP), the Substance Abuse and What do all these people have in Mental Health Services Administra- common? Although they are at differ- tion/Center for Substance Abuse Treat- ent points in the process of recovering ment (SAMHSA/CSAT) funds grant from a substance use disorder, each projects across the country to develop is expressing a need for some form of and deliver these services. social support to help them through the process. Equally important, each is The peer recovery support services also a potential source of social support developed by the RCSP projects help for others. people become and stay engaged in the recovery process and reduce the likeli- In this paper on What Are Peer Recovery hood of relapse. Because they are de- Support Services, you will be introduced signed and delivered by peers who have to a new kind of social support services been successful in the recovery process, designed to fill the needs of people in they embody a powerful message of or seeking recovery. The services are hope, as well as a wealth of experiential called peer recovery support services knowledge. The services can effectively and, as the word peer implies, they are extend the reach of treatment beyond designed and delivered by people who the clinical setting into the every- have experienced both substance use day environment of those seeking to disorder and recovery. Through the achieve or sustain recovery.

1 Social Support for Recovery or whether emotional support (such as supportive coaching to prepare for an Research has shown that recovery is interview), and/or instrumental support facilitated by social support (McLellan (such as help cleaning up a criminal et al., 1998), and four types of social record) might also be needed. In gen- support have been identified in the eral, the more robust the types of social literature (Cobb, 1976; Salzer, 2002): support available to address any given emotional, informational, instrumental, recovery concern, the more likely that a and affiliational support. RCSP projects person seeking help will walk away with have found these four types of social useful information, a new insight or support useful in organizing the com- skill, or more to help with munity-based peer-to-peer services they the tasks ahead. provide to recovering people. (Some typical examples are shown in Figure Peer Leaders and the Peer 1 below.) These four categories refer to types of social support, not discrete Service Alliance services or service models. RCSP projects use the term peer to refer to all individuals who share the For example, a project that is planning experiences of addiction and recovery, social support services to address recov- either directly or as family members or ering people’s employment needs might significant others. In a peer-helping- consider whether a job referral (infor- peer service alliance, a peer leader in mational support) by itself is adequate, stable recovery provides social support

Figure 1. Type of Social Support and Associated Peer Recovery Support Services

Type of Description Peer Support Service Examples Support

Emotional Demonstrate empathy, caring, or concern to Peer mentoring bolster person’s self-esteem and confidence. Peer-led support groups

Informational Share knowledge and information and/or pro- class vide life or vocational skills training. Job readiness training Wellness seminar

Instrumental Provide concrete assistance to help others ac- Child care complish tasks. Transportation Help accessing community health and social services

Affiliational Facilitate contacts with other people to pro- Recovery centers mote learning of social and recreational skills, Sports league participation create community, and acquire a sense of Alcohol- and drug-free socialization belonging. opportunities

2 services to a peer who is seeking help do not give advice.” Similarly, it is in establishing or maintaining his or common to hear, “You need to ask your her recovery. Both parties are helped by sponsor, not me, for help working the the interaction as the recovery of each is 12-Steps,” or “That’s a question for the strengthened. doctor or nurse.”

RCSP projects use many other titles Peer Recovery Support Service besides peer leader and peer to describe Activities the parties to the peer service alliance. The RCSP peer recovery support service On the peer leader side of the equation, projects have developed a variety of titles include recovery (or peer) mentor, peer services. Not all programs provide guide, or coach; peer services interven- all services, and some peer leaders may tionist; firestarter; and peer resource provide more than one service. The fol- specialist. (Firestarters are peer leaders lowing is a useful overview of the four responsible for building local recov- major types of recovery support services ery communities in Native American emerging in RCSP projects: (1) peer communities.) The peer who seeks help mentoring or coaching, (2) recovery also is given different titles in different resource connecting, (3) facilitating and RCSP projects, such as member (of the leading recovery groups, and (4) build- peer services organization), mentee, or ing community: simply peer. Most project leaders have consciously sought to find and use Peer Mentoring or Coaching identifying terms that distinguish their peer services and service providers from Although the name given to this service those in formal, professional treatment activity varies from project to project, programs or in mutual aid groups con- the terms mentoring or coaching refer ducted by lay persons. For this reason, to a one-on-one relationship in which a terms such as counselor, case manager, peer leader with more recovery experi- or sponsor, as well as client, consumer, ence than the person served encourages, or patient, are avoided. motivates, and supports a peer who is seeking to establish or strengthen his or The RCSP projects’ attention to lan- her recovery. guage reflects the need to clearly distin- guish the role of the peer leader from The nature and functions of mentor- the role of the treatment counselor ing or coaching vary from one RCSP or other professional and the 12-Step project to another. Generally, mentors sponsor (White, 2006). RCSP projects or coaches assist peers with tasks such as are intended by CSAT to enhance—not setting recovery goals, developing recov- duplicate, replace, or compete with— ery action plans, and solving problems valuable services already available in a directly related to recovery, including community. Thus, in addition to using finding sober housing, making new language which is not associated with friends, finding new uses of spare time, treatment or mutual aid programs, and improving one’s job skills. They axioms such as the following are com- may also provide assistance with issues monly heard: “Peers do not diagnose;” that arise in connection with collateral “Peers do not provide therapy;” “Peers problems such as having a criminal 3 justice record or coexisting physical or sional and nonprofessional services and mental challenges. resources available in the community that can help meet his or her individual The relationship of the peer leader to needs on the road to recovery. The the peer receiving help is highly sup- peer leader working in a peer setting to portive, rather than directive. The dura- provide recovery resource connecting tion of the relationship between the two services often has had personal experi- depends on a number of factors such as ence navigating the service systems and how much recovery time the peer has, accessing the resources to which refer- how much other support the peer is re- ral is being made, and can bring those ceiving, or how quickly the peer’s most personal experiences to bear. pressing problems can be addressed. Peer recovery support services provided RCSP projects distinguish the role of in RCSP projects typically can help Self-disclosure and using one’s own the peer mentor or coach from that of peers with their most pressing early story as means of enhancing the value of the service is an important a 12-Step sponsor in several ways. For recovery needs—finding a safe place dimension of the recovery mentor- example, the sponsor works within the to live and a job. Thus, peer leaders are ing or coaching role. In addition, 12-Step framework and is expected to likely to refer peers to safe housing or to a peer mentor or coach implicitly holds himself or herself out as a help the person in early recovery under- sources of information about housing recovery role model. As described by stand and follow the specific guidance and to a wide variety of resources and William White, this core competency of the 12-Step program. The typical services that provide assistance in de- entails “modeling of core recovery RCSP recovery mentor or coach, on the veloping job readiness or finding jobs. values (e.g., tolerance, acceptance, gratitude); the capacity for self- other hand, is often described as help- Peer leaders also help peers navigate the observation, self-expression, sober ing peers in early recovery make choices formal treatment system, advocating for problem-solving; recovery-based about which recovery pathway(s) will their access and gaining admittance, as reconstruction of personal identity work for them, rather than urging them well as facilitating discharge planning, and interpersonal relationships; freedom from coercive institutions; to adopt the mentor’s or coach’s own typically in collaboration with treat- economic self-sufficiency; positive program or any specific program of ment staff. citizenship and public service.” recovery. The mentor or coach is often (White, 2006) described as devoting a greater amount Peer leaders also encourage and sup- of time than the typical 12-Step spon- port participation in mutual aid sor to connecting the person in early groups and provide specific informa- recovery to community health, employ- tion about the various groups that exist ment, housing, educational, and social in the community. They encourage and services and resources and often has facilitate participation in educational more specific knowledge about a larger opportunities. Depending on the range of available services and resources. particular needs of the population they serve, they also may focus on develop- Peer Recovery Resource Connecting ing linkages to resources that address specialized needs, such as agencies pro- The service activities of peer leaders in viding services related to HIV infec- connecting peers to recovery resources tion or AIDS, mental health disorders, might be likened to case management chronic and acute health problems, in substance use disorder treatment. parenting young children, and prob- The purpose of resource connecting ser- lems stemming from involvement with vices is to connect the peer with profes- the criminal justice system. 4 Facilitating and Leading Recovery support service providers can help such Groups peers make new friends and begin to build alternative social networks. Peer In addition to conducting one-on-one leaders in RCSP projects often organize coaching or mentoring and resource recovery-oriented activities that range connecting activities, many peer lead- from opportunities to participate in ers facilitate or lead recovery-oriented team sports to family-centered holiday group activities. Some of these activi- A number of RCSP projects have celebrations and to payday get-togethers ties are structured as support groups, expanded beyond just linking people that are alcohol- and drug-free. These to existing resources and services while others have educational purposes. activities provide a sense of acceptance to creating new recovery support Many have components of both. services in the community. These and belonging to a group, as well as the efforts have ranged from active opportunity to practice new social skills. recruitment of recovery-friendly The group activities that are structured employers to the organization of a as support groups typically involve the recovery-friendly network of dentists sharing of personal stories and some Volunteer and Staff Peer who offer free or deeply-discounted degree of collective problem-solving. services to people whose early Leaders recovery is jeopardized by dental Many of these groups are formed problems developed during their around shared identity, such as belong- Peer recovery support services capi- addiction. One project has in- ing to a common cultural or religious talize on the often recognized desire creased the statewide stock of group, or shared experience related to among many in recovery to “give back” recovery housing through a techni- to their communities by providing cal assistance initiative that helps the substance use disorder, such as the peer leaders establish and operate need to re-enter the community follow- services to others. Most of the RCSP recovery homes that adhere to an ing incarceration, being HIV posi- peer leaders who give back by provid- agreed-upon set of standards. tive, or facing challenges in parenting. ing peer recovery support services Many, but not all, group activities con- have done so as volunteers. In some ducted by peer leaders have a spiritual projects, however, peer leaders are component. paid for their services as staff. In a few projects, peer leaders are not staff, but The group educational activities tend to receive stipends for their work. A number of RCSP grantees have focus on a specific subject or skill set, created recovery community cen- All recovery support programs require ters as “places where recovery hap- and may involve the participation of pens.” Many types of peer service an expert as well as peer leaders. Typi- effective management and all peer activities—such as mentoring and cal topics and activities include training leaders, irrespective of their status as coaching, connecting to resources, in job skills, budgeting and managing paid staff, volunteers, or recipients of support and educational groups— stipends, require effective supervision. take place at these centers. At the credit, and preventing relapse, as well as core of the effort is the nurturing of courses particularly targeted to people The range of supervisory tasks may vary, a caring recovery community, with in recovery, such as conflict resolution however, depending on the status of the shared norms and values, which grounded in recovery skills. peer leaders as paid or unpaid volun- is dedicated to supporting the teers or staff. Recruiting and retain- recovery of all who seek it. These centers “bring recovery to Main Building Community ing effective volunteers, for example, Street” and, by making recovery requires somewhat different techniques visible, carry a message of hope to A person in early recovery is often faced than hiring and keeping effective paid the larger community. with the need to abandon friends and/ staff. The tenure of volunteers may be or social networks that promote and shorter than that of paid staff, requir- help sustain a substance use disorder, ing constant recruiting and training of but has no alternatives to put in their volunteers. A project that relies on vol- place that support recovery. Peer recovery 5 unteers may use community organizing and organizational contexts. This adapt- strategies to develop a strong volunteer ability makes them an effective vehicle base, while a project that relies solely for extending support for recovery on paid staff will be more likely to use beyond the treatment system and into standard employee recruitment process- the communities where people live and es. Moreover, staff time is typically allo- to people following different pathways cated differently in a volunteer-oriented to recovery. On the other hand, because organization. Little staff time is devoted of the variations in settings, organiza- to direct service; staff effort is primar- tional contexts, and recovery stages and ily directed at recruiting, training, and pathways, identifying commonalities supervising peer leaders; developing and in peer recovery support services can be maintaining an organizational culture challenging. that incorporates principles of self-care; and various other tasks related to or- Different Recovery Stages and ganizational development, stakeholder Approaches development, and sustainability. Peer leaders can provide social support services to individuals at all stages on the Whether the project uses paid or continuum of change that constitutes volunteer peer leaders also may affect the recovery process. The Prochaska, how the project translates the range Norcross, and DiClementi (1995) stages of peer leader direct service roles and of change model has identified the functions into specific job or volun- stages of precontemplation, contempla- teer position descriptions. The project tion, determination/preparation, action, that relies primarily on volunteers who maintenance, and relapse. Whether can dedicate 20 hours of service each peers are familiar with these stages of month may distribute peer service change or not, most can relate to the roles and functions into volunteer po- idea that recovery takes place in stages. sitions that are narrower in scope than the roles and functions included in job RCSP projects have developed peer descriptions developed by a project recovery support services that meet that relies primarily on peer leaders in needs of people at different stages of the full-time staff positions. A paid peer recovery process. The services may: leader, for example, might be expected to provide one-on one mentoring and ■■ Precede formal treatment, facilitate groups; a volunteer position strengthening a peer’s motivation might include mentoring or facilita- for change tion, but not both. ■■ Accompany treatment, providing a community connection during The Adaptability of Peer treatment Recovery Support Services ■■ Follow treatment, supporting One strength of peer recovery support relapse prevention services has been their adaptability to ■■ Be delivered apart from treatment many stages and modalities of recovery, to someone who cannot enter the as well as to different service settings

6 formal treatment system or chooses vice needs of specific populations, in- not to do so. cluding those related to substance use; and agencies with a primary focus on Furthermore, peer services can provide challenges such as HIV/AIDS, post in- social support within the context of carceration re-entry to the community, many different pathways to recovery, or children at risk of abuse or neglect. including pathways that are predomi- Each type of organizational context nantly religious, spiritual, or secular; in- has its own culture and perspective on volve medication assistance; or focus on substance use disorders and recovery cultural survival and renewal as avenues and presents its own opportunities and to recovery. challenges in the establishment and operation of a peer recovery support Varied Service Settings service program. RCSP grant projects deliver peer These stages of recovery, pathways to services in a variety of settings includ- recovery, service settings, and organiza- ing recovery community organiza- tional contexts can present very dif- tions, recovery centers, churches, ferent challenges to the peer recovery child welfare organizations, recovery support services program. One project, homes, drug courts, pre-release jail and for example, may be a new free-stand- prison programs, parole and probation ing recovery community organization programs, behavioral health agencies, that is faced not only with the task of and HIV/AIDS and other medical or designing and delivering peer recov- social service centers. Peer leaders work ery support services, but also with the in urban and rural communities with tasks of building a board of directors many different populations, including and developing the fiscal infrastructure those defined by age (e.g., adolescents, to handle a Federal grant. Another elders), race or ethnicity (e.g., Asian/ may be housed in a host agency that Pacific Islander American, Latino or is a seasoned nonprofit that has been Hispanic American, Native American, handling Federal grants successfully for Caucasian), gender (e.g., women) or years, but is rooted in a service system by co-existing conditions (e.g., HIV/ that is inexperienced with working with AIDS and other infectious diseases, people in or seeking recovery. One may mental health disorders, homelessness, work almost exclusively with peers who or a criminal record). have completed formal treatment, while Variations in Organizational Contexts another may work with peers who have not yet acknowledged that their sub- Some RCSP projects are free-standing stance use is a problem. nonprofit recovery community orga- nizations operated by members of the Some Important Cross- recovery community. Others reside within a host agency. These host agen- Project Principles cies include those involved in the field Notwithstanding important differ- of substance use disorders, including ences among RCSP projects, certain treatment providers; agencies that core principles cut across projects. One focus on the continuum of social ser- 7 key principle is having shared values. relationship based on mutuality In the RCSP experience, shared values can be helped and empowered in have, in turn, given rise to other key the process. principles, including a preference for ■■ Leadership development—Build- strength-based approaches and a service ing leadership abilities among mem- philosophy that nurtures self-direction, bers of the recovery community empowerment, and choice. so that they are able to guide and direct the service program and de- Shared Values liver support services to their peers. RCSP project participants have identi- fied core values that inform the task of Many projects have identified addition- organizing the recovery community to al core values, but virtually all subscribe provide peer recovery support services. to at least these five. RCSP projects These include: have used these core values as a plat- form on which to build codes of ethics ■■ Keeping recovery first—Placing and as a guide to their development of recovery at the center of the effort, practice guidelines for peer leaders. grounding peer services in the strengths and inherent resiliency of Focus on Strengths and Resiliencies recovery rather than in the pathol- A peer recovery support services pro- ogy of substance use disorders. gram that incorporates a strengths per- ■■ Cultural diversity and inclusion— spective builds on people’s resiliencies Developing a recovery community and capacities rather than providing peer support services program that services focused primarily on correcting honors different routes to recovery their deficits, , or problems. and has leaders and members from Emphasis is on uncovering, reaffirming, many groups at all levels within the and enhancing the abilities, interests, organization. knowledge, resources, aspirations, and hopes of individuals, families, groups, ■ Participatory process— ■ Making and communities. This approach as- sure the recovery community di- sumes that the ability to recognize one’s rects or is actively involved in proj- own strengths and identify internal and ect design and implementation, so external resources enhances a per- that recovery community members son’s chances of success in setting and can identify their own strengths achieving goals and in realizing his or and needs, and design and deliver her aspirations. peer services that address them. ■■ Authenticity of peers helping RCSP peer recovery support service peers—Drawing on the power of programs have adopted the strengths example, as well as the hope and perspective in multiple contexts. In the motivation, that one person in relationship between a peer leader and a recovery can offer to another; pro- peer seeking help, for example, recovery viding opportunities to give back planning does not start with a process to the community; and embracing that identifies deficits and disabilities, the notion that both people in a but rather with a conversation intended 8 to uncover the peer’s interests, abili- support recovery. Peer services func- ties, and goals. One of the peer’s goals tion as a bridge to a larger network of is likely to be a sustained change in community support. As one project substance use behavior. Goals are likely director noted, “We are building our to address other life domains as well, community’s capacity to care.” such as housing, employment, educa- tion, family and social relationships, Many RCSP projects have benefited recreational opportunities, and physical, from conducting comprehensive com- mental, or spiritual health. munity strengths and needs assess- ments. This type of assessment—which As the individual’s goals become clear, may be ongoing throughout the life the peer leader can help the peer iden- of the project—identifies services and tify the resources and skills that need resources available both in the recovery Many peer recovery support to be marshaled to attain the goals. community and in the community at service programs have developed peer leader training programs to The peer may already possess some of large that can support recovery. The help peer leaders build skills in these resources, skills, and talents and assessment creates multiple opportuni- strengths-based recovery plan- may even have demonstrated them ties for people in and seeking recovery, ning. These include training in the during the active stages of a substance as well as family members, significant use of motivational interviewing techniques, adapted for peer lead- abuse disorder; he or she may need others, and stakeholders, to identify, in ers. In addition, many programs help in developing others, in some their own words, what has worked for have found it important to continu- cases seeking an external source for them, what they think is needed, and ally reinforce their commitment to help in developing new capacities. what they can contribute to the peer strength-based services through program procedures and guidelines These ingredients—the articulation of effort. In addition to helping ensure and ongoing supervision. Both peer the peer’s own goals and desires, in his that a project develops services that leaders and peers seeking help or her own words, and an enumeration fill gaps, rather than competing with may be more familiar with service and affirmation of his or her specific services and resources already available systems that are focused more on naming and reducing deficits and capacities to marshal resources to in the community, the strengths and pathologies than on naming and achieve them—form the foundation of needs assessment identifies important nurturing strengths. Moreover, the an empowering recovery plan. resources within the recovery com- stigmas associated with substance munity and the larger community that use disorders encourage patterns of shame and blame. Training and RCSP projects also have adopted can contribute to the development positive reinforcement can help pre- strengths-based approaches to the of strong peer services and/or pro- vent peer leaders from slipping back recovery community, as well as to the vide assistance that recovering people into deficit-based ways of thinking. larger community. By engaging the re- need. The assessment also facilitates covery community in all aspects of the the building of important stakeholder identification, planning, and delivery of relationships and serves as a founda- peer recovery support services, projects tion for effectively connecting people have expressly built upon the strengths to resources in the community that and insights of those who are work- support recovery. ing to achieve and sustain their own recovery goals and are willing to give Self-Direction, Empowerment, and back to the community through the Choice peer recovery support effort. Similarly, Embedded in the shared values of they actively work within the larger RCSP peer recovery support services is community to identify and strengthen a philosophy of self-direction, choice, existing services and resources that can 9 and empowerment. The many path- the medical world of today, for example, ways to recovery are acknowledged, the there is scarcely a specialty where peer person seeking recovery is assumed to support is not recognized as a valuable be fully capable of making informed adjunct to professional medical and choices, and his or her preferences are social interventions. Improved outcomes respected. are particularly notable when peer support services are provided to people In practice, carrying out the principles with chronic conditions that require of self-direction, empowerment, and long-term self-management. Thus, the choice has sometimes been challenging peer recovery support services offered by to peer leaders. In the first place, they RCSP grant projects and others stand have often needed to become well- in a long, well-documented, and copied informed about pathways to recovery evidence-based tradition. different from their own. In some cases, Several RCSP projects use asset project leaders have had to combat their Peer recovery support services can fill mapping to uncover the com- own misconceptions about, and preju- a need long recognized by treatment munity’s natural assets (people, organizations, places, and things) dices against, certain recovery modali- providers for services to support recov- that support recovery and to build ties, such as recovery assisted by medi- ery after an individual leaves a treatment stronger connections between these cation or grounded in religious belief. program. In addition, peer recovery sup- assets and people who are seeking port services hold promise as a vital link recovery. In addition, these projects seek to foster mutually beneficial re- Furthermore, the assumption that the between systems that treat substance lationships with the individuals and person seeking recovery is fully capable use disorders in a clinical setting and organizations that are responsible of making informed choices may not the larger communities in which people for these assets. These asset-map- always fit the circumstances, particu- seeking to achieve and sustain recov- ping strategies, and the asset-based community development theory larly when neurological impairment ery live. Using a nonmedical model in (Kretzmann & McKnight, 1993) on is significant or when acute or severe which social support services are provid- which they are based, are a comfort- psychiatric symptoms are associated ed by peer leaders who have experienced able fit with the strength-based phi- with an active substance use disorder a substance use disorder and recovery, losophy of most RCSP peer recovery support services. or early recovery. This can require a these services extend the continuum of peer leader to know when to strike a care by facilitating entry into treatment, delicate balance between respect for providing social support services during the peer’s rights of choice and a need treatment, and providing a posttreat- to keep the recovery process simple for ment safety net to those who are seeking the time being. to sustain treatment gains.

The Many Values of Peer These services are proving to be very Recovery Support Services adaptable, operating within diverse populations, stages of recovery, pathways Historically, the substance use disorder to recovery, service settings, and orga- and recovery field led the way in recog- nizational contexts. Notably, they build nizing the importance of peer support on resources that already exist in the services for a person seeking to come to community, including diverse commu- terms with a life-changing condition. nities of recovering people who wish to Utilization of peer support is, by now, be of service. By serving as role models a common practice in many fields. In for recovery, providing mentoring and coaching, connecting people to needed 10 services and community supports, and Salzer, M. (2002). Best practice guide- helping in the process of establish- lines for consumer-delivered services. ing new social networks supportive of Unpublished paper developed for recovery, peer leaders make recovery a Behavioral Health Recovery Manage- presence in their communities and send ment Project. An initiative of Fayette a message of hope fulfilled. Companies, Peoria, IL; Chestnut Health Systems, Bloomington, IL; and References and Additional the University of Chicago Center for Psychiatric Rehabilitation. Web site: Resources http://bhrm.org/guidelines.htm Kretzmann, J.P. and McKnight, J.L. (1993) Building Communities from the Salzer, M. (2002). Consumer-delivered Inside Out: A Path Toward Finding and services as a best practice in mental Mobilizing a Community’s Assets, Evan- health care delivery and the develop- ston, IL: Institute for Policy Research. ment of practice guidelines. Psychiatric Rehabilitation Skills, 6(3), 355-383. Loveland, D., and Boyle, M. (2005). Manual for Recovery Coaching and Substance Abuse and Mental Health Personal Recovery Plan Development. Services Administration/Center for Peoria, IL: Fayette Companies. Substance Abuse Treatment Recovery Community Services Program. (In McLellan, A.T., Hagan, T.A., Levine, press.) Emerging Approaches Conference M., Gould, F., Meyers, K. and Ben- Report. Rockville, MD. civengo, M., et al. (1998). Research report: Supplemental social services White, W.L. (2006) Sponsor, Recovery improve outcomes in public addiction Coach, Addiction Counselor: The Impor- treatment. Addiction, 93(10), 1489- tance of Role Clarity and Role Integrity. 1499. Philadelphia Department of Mental Health and Mental Retardation Ser- Prochaska, J., Norcross, J., and DiCle- vices, Philadelphia, PA. mente, C. (1995). Changing for Good. New York: HarperCollins Books. White, W.L., Kurtz, E., and Sand- ers, M. (2006) Recovery Management. Rapp, R.C. (2002) Strength-Based Case Great Lakes Addiction Technology Management: Enhancing Treatment Transfer Center, Chicago, IL. for Persons with Substance Abuse Prob- lems, in Saleebey, D., ed., The Strengths White, W.L. (2009) Peer-based Addic- Perspective in Social Work Practice, 3rd tion Recovery Support: History, Theory, ed., Allyn & Bacon, Boston, MA. Practice, and Scientific Evaluation. Great Lakes Addiction Technology Transfer Center, Chicago, IL.

11 HHS Publication No. (SMA) 09-4454 Substance Abuse and Mental Health Services Administration Printed 2009