Skip to main content

The Recovery Agenda: The Shared Role of Peers and Professionals

Abstract

The alcohol and other drug (AOD) problems arena is extending its organizing center from knowledge drawn from the study of addiction-related pathologies and clinical and social interventions to knowledge drawn from the lived experience of long-term addiction recovery. A distinctive element within this shift is the increased use of non-clinical, peer recovery support services as an adjunct or alternative to specialized, professionally directed addiction treatment. This paper reviews the context of this shift, notes the evolution from competing to integrated service models, and outlines a decade of experience integrating peer recovery support services within the City of Philadelphia’s behavioral healthcare system. Integrated models of peer-professional addiction recovery support have the potential of capitalizing on the respective strengths of clinical and environmental interventions into severe AOD problems.

References

  1. 1.

    Clark HW. Recovery as an organizing concept. In: White, WL. Perspectives on Systems Transformation: How Visionary Leaders are Shifting Addiction Treatment toward a Recovery-Oriented System of Care. Chicago (IL): Great Lakes Addiction Technology Transfer Center; 2007. p.7–21.

    Google Scholar 

  2. 2.

    White WL. Recovery: old wine, flavor of the month or new organizing paradigm? Subst Use Misuse. 2008;43:1987–2000.

    Article  PubMed  Google Scholar 

  3. 3.

    Berridge V. The rise, fall, and revival of recovery in drug policy. Lancet. 2012; 379:22–3.

    Article  PubMed  Google Scholar 

  4. 4.

    Wardle I. Five years of recovery: December 2005 to December 2010—from challenge to orthodoxy. Drugs: Education, Prevention Policy. 2012;19:294–8.

    Google Scholar 

  5. 5.

    Krentzman AR. Review of the application of positive psychology to substance use, addiction, and recovery research. Psychol Addict Behav. 2013;27:151–65.

    Article  PubMed  Google Scholar 

  6. 6.

    Ronel N, Elisha E. A different perspective: introducing positive criminology. Int J Offender Ther Comp Criminol. 2011;56:305–25.

    Article  Google Scholar 

  7. 7.

    Humphreys K. Circles of Recovery: Self-Help Organizations for Addictions. Cambridge: Cambridge University Press; 2004.

    Google Scholar 

  8. 8.

    White WL. The new recovery advocacy movement in America. Addiction. 2007;102:696–703.

    Article  PubMed  Google Scholar 

  9. 9.

    White WL, Kelly JF, Roth JD. New addiction recovery support institutions: mobilizing support beyond professional addiction treatment and recovery mutual aid. J Groups Addict Recover. 2012;7:297–313.

    Article  Google Scholar 

  10. 10.

    Dennis ML, Scott CK. Managing addiction as a chronic condition. Addict Sci Clin Pract. 2007;4:45–55.

    Article  PubMed  PubMed Central  Google Scholar 

  11. 11.

    McLellan AT, Lewis DC, O’Brien CP, Kleber HD. Drug dependence, a chronic medical illness: implications for treatment, insurance, and outcomes evaluation. JAMA. 2000;284:1689–95.

    CAS  Article  PubMed  Google Scholar 

  12. 12.

    Kelly JF, White WL. Addiction Recovery Management: Theory, Science and Practice. New York (NY): Springer Science; 2011.

    Book  Google Scholar 

  13. 13.

    White WL. Recovery management and recovery-oriented systems of care: scientific rationale and promising practices. Pittsburgh (PA): Northeast Addiction Technology Transfer Center, Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health & Mental Retardation Services; 2008.

    Google Scholar 

  14. 14.

    Buck JA. The looming expansion and transformation of public substance abuse treatment under the Affordable Care Act. Health Aff. 2011;30:1402–10.

    Article  Google Scholar 

  15. 15.

    Davidson L, White W. The concept of recovery as an organizing principle for integrating mental health and addiction services. J Behav Health Serv Res. 2007;34:109–20.

    Article  PubMed  Google Scholar 

  16. 16.

    Gagne CA, White W, Anthony WA. Recovery: a common vision for the fields of mental health and addictions. Psychiatr Rehabil J. 2007;32:32–7.

    Article  Google Scholar 

  17. 17.

    Center for Substance Abuse Treatment (CSAT). National Summit on Recovery: conference report. DHHS Publication No. (SMA) 07-4276. Rockville (MD): Substance Abuse and Mental Health Services Administration; 2007.

    Google Scholar 

  18. 18.

    Betty Ford Institute Consensus Panel. What is recovery? A working definition from the Betty Ford Institute. J Subst Abuse Treat. 2007;33:221–8.

    Article  Google Scholar 

  19. 19.

    Scottish Government. The road to recovery: a new approach to tackling Scotland’s drug problem. Edinburgh: Scottish Government; 2008.

    Google Scholar 

  20. 20.

    United Kingdom Drug Policy Commission. A consensus definition of recovery. 2008. Available from URL: http://www.ukdpc.org.uk/resources/A%20Vision%20of%20Recovery.pdf (Accessed 24 June 2010).

    Google Scholar 

  21. 21.

    Kirk T. Connecticut’s journey to a statewide recovery-oriented health-care system: Strategies, successes and challenges. In: Kelly JF, White WL, (editors). Addiction Recovery Management: Theory, Science and Practice. New York (NY): Springer Science; 2011. p.209–34.

    Google Scholar 

  22. 22.

    Laudet A, Flaherty M, Langer D. Building the science of recovery. Pittsburgh (PA): Institute for Research, Education and Training and Northeast Addiction Technology Transfer Center; 2009.

    Google Scholar 

  23. 23.

    Hunt N. Recovery and harm reduction: time for a shared, development-oriented, programmatic approach? In: Pates R, Riley D, (editors). Harm Reduction in Substance Use and High-Risk Behaviors. Chichester: Wiley-Blackwell; 2012.

    Google Scholar 

  24. 24.

    Kellogg SH. On “gradualism” and the building of the harm reduction—abstinence continuum. J Subst Abuse Treat. 2003;25:241–7.

    Article  PubMed  Google Scholar 

  25. 25.

    White WL, Mojer-Torres L. Recovery-oriented methadone maintenance. Chicago (IL): Great Lakes Addiction Technology Transfer Center, Philadelphia Department of Behavioral Health and Mental Retardation Services and Northeast Addiction Technology Transfer Center; 2010.

    Google Scholar 

  26. 26.

    Kaplan L. The role of recovery support services in recovery-oriented systems of care. DHHS Publication No. (SMA) 08-4315. Rockville (MD): Center for Substance Abuse Services, Substance Abuse and Mental Health Services Administration; 2008.

    Google Scholar 

  27. 27.

    Laudet AB, Humphreys K. Promoting recovery in an evolving policy context: what do we know and what do we need to know about recovery support services? J Subst Abuse Treat. 2013;45:126–33.

    Article  PubMed  PubMed Central  Google Scholar 

  28. 28.

    White WL. Peer-based addiction recovery support: history, theory, practice, and scientific evaluation. Chicago (IL): Great Lakes Addiction Technology Transfer Center and Philadelphia Department of Behavioral Health and Intellectual disAbility Services; 2009.

    Google Scholar 

  29. 29.

    White WL. Slaying the dragon: the history of addiction treatment and recovery in America. Bloomington (IL): Chestnut Health Systems, 1998.

    Google Scholar 

  30. 30.

    Kaplan L, Nugent C, Baker M, Clark HW, Veysey BM. Introduction: the Recovery Community Services Program. Alcohol Treat Q. 2010;28:244–55.

    Article  Google Scholar 

  31. 31.

    Brownstein JN, Bone LR, Dennison C, Hill MN, Kim M, Levine DM. Community health workers as interventionists in the prevention and control of heart disease and stroke. Am J Prev Med. 2005;29:128–33.

    Article  PubMed  Google Scholar 

  32. 32.

    Mowbray CT, Moxley DP, Jasper CA, Howell LL. Consumers as Providers in Psychiatric Rehabilitation. Columbia (MD): International Association of Psychosocial Rehabilitation Services (IAPSRS); 1997.

    Google Scholar 

  33. 33.

    Ryan J, Choi S, Hong JS, Hernandez P, Larrison CR. Recovery coaches and substance exposed births: an experiment in child welfare. Child Abuse Negl. 2008;32:1072–9.

    Article  PubMed  Google Scholar 

  34. 34.

    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.

    Google Scholar 

  35. 35.

    Borkman T. Experiential knowledge: a new concept for the analysis of self-help groups. Soc Serv Rev. 1976;50:445–56.

    Article  Google Scholar 

  36. 36.

    Jackson SW. The wounded healer. Bull Hist Med. 2001;75:1–36.

    CAS  Article  PubMed  Google Scholar 

  37. 37.

    Riessman F. The “helper” therapy principle. Soc Work. 1965;April:27–32.

    Google Scholar 

  38. 38.

    Valentine P. Peer-based recovery support services within a recovery community organization: the CCAR experience. In: Kelly JF, White WL, (editors). Addiction Recovery Management: Theory, Science and Practice. New York (NY): Springer Science; 2011. p.259–80.

    Google Scholar 

  39. 39.

    White W, Humphreys K, Bourgeois M, Chiapella P, Evans A, et al. The status and future of addiction recovery support services in the United States: report of the BFI/UCLA Consensus Conference on Recovery Support Services; 2013.

    Google Scholar 

  40. 40.

    Achara-Abrahams I, Evans AC, Ortiz J, Lopez Villegaz D, O’Dell J, et al. Recovery management and African Americans: a report from the field. Alcohol Treat Q. 2012;30:263–92.

    Article  Google Scholar 

  41. 41.

    Evans AC, Achara I, Lamb R, White W. Ethnic-specific support systems as a method for sustaining long-term addiction recovery. J Groups Addict Recover. 2012;7:171–88.

    Article  Google Scholar 

  42. 42.

    Moore S, Coyhis D. The multicultural wellbriety peer recovery support program: two decades of community-based experience. Alcohol Treat Q. 2010;28:273–92.

    Article  Google Scholar 

  43. 43.

    Veysey BN, Grasmere J, Andersen R. Supporting peer recovery in rural New England: the RECOVER Project, Franklin County, MA. Alcohol Treat Q. 2010;28:306–25.

    Article  Google Scholar 

  44. 44.

    Klein AA, Slaymaker VJ, Dugosh KL, McKay JR. Computerized continuing care support for alcohol and drug dependence: a preliminary analysis of usage and outcomes. J Subst Abuse Treat. 2012;37:435–42.

    Google Scholar 

  45. 45.

    Cleveland HH, Harris KS, Baker AK, Herbert R, Dean LR. Characteristics of a collegiate recovery community: maintaining recovery in an abstinence-hostile environment. J Subst Abuse Treat. 2007;33:13–23.

    Article  PubMed  Google Scholar 

  46. 46.

    Jason LA, Mericle AA, Polcin DL, White WL, the National Association of Recovery Residences. A primer on recovery residences in the United States. Atlanta (GA): National Association of Recovery Residences; 2012.

    Google Scholar 

  47. 47.

    Dennis ML, Scott CK. Four-year outcomes from the Early Re-Intervention (ERI) experiment using Recovery Management Checkups (RMCs). Drug Alcohol Depend. 2012;121:10–17.

    Article  PubMed  Google Scholar 

  48. 48.

    Galanter M, Castaneda R, Salamon I. Institutional self-help therapy for alcoholism: clinical outcome. Alcohol Clin Exp Res. 1987;11:424–9

    CAS  Article  PubMed  Google Scholar 

  49. 49.

    Humphreys K, Moos R. Can encouraging substance abuse patients to participate in self-help groups reduce demand for health care? A quasi-experimental study. Alcohol Clin Exp Res. 2001;25:711–16.

    CAS  Article  PubMed  Google Scholar 

  50. 50.

    Krupski A, Campbell K, Joesch JM, Lucenko BA, Roy-Byrne P. Impact of access to recovery services on alcohol/drug treatment outcomes. J Subst Abuse Treat. 2009;37:435–42.

    Article  PubMed  Google Scholar 

  51. 51.

    Achara-Abrahams I, Evans AC, King JK. Recovery-focused behavioral health systems transformation: a framework for change and lessons learned from Philadelphia. In: Kelly JF, White WL, (editors). Addiction Recovery Management: Theory, Science and Practice. New York (NY): Springer Science; 2011. p.187–208.

    Google Scholar 

  52. 52.

    Leonard EC. The treatment of Philadelphia inebriates. Am J Addict. 1997;6:1–10.

    PubMed  Google Scholar 

  53. 53.

    The Net Consumer Council, Evans AC, Lamb RC, Mendelovich S, Schultz CJ, White WL. The role of clients in a recovery-oriented system of addiction treatment: the birth and evolution of the NET Consumer Council. Philadelphia (PA): Philadelphia Department of Behavioral Health and Mental Retardation Services; 2007.

    Google Scholar 

  54. 54.

    McSherry T. The recovery-focused transformation of addiction treatment: an interview with Terence McSherry. 2012. Available from URL: http://www.williamwhitepapers.com/pr/2012%20Terence%20McSherry%20Interview.pdf (Accessed 9 July 2013).

    Google Scholar 

  55. 55.

    Evans AC, Lamb R, White WL. The community as patient: recovery-focused community mobilization in Philadelphia, 2005–2012. Alcohol Treat Q. in press.

  56. 56.

    Ilgen MA, Moos R. Deterioration following alcohol use disorder treatment in Project MATCH. J Stud Alcohol. 2005;66:517–25.

    Article  PubMed  Google Scholar 

  57. 57.

    White WL, Kleber HD. Preventing harm in the name of help: a guide for addiction professionals. Counselor. 2008;9:10–17.

    Google Scholar 

  58. 58.

    White W, The PRO-ACT Ethics Workgroup, with legal discussion by Popovits R. & Donohue B. Ethical guidelines for the delivery of peer-based recovery support services. Philadelphia: Philadelphia Department of Behavioral Health and Mental Retardation Services; 2007.

    Google Scholar 

Download references

Author information

Affiliations

Authors

Corresponding author

Correspondence to William L. White MA.

Rights and permissions

Open Access  This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made.

The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder.

To view a copy of this licence, visit https://creativecommons.org/licenses/by/4.0/.

The Creative Commons Public Domain Dedication waiver (https://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and Permissions

About this article

Cite this article

White, W.L., Evans, A.C. The Recovery Agenda: The Shared Role of Peers and Professionals. Public Health Rev 35, 4 (2013). https://doi.org/10.1007/BF03391703

Download citation

Key Words

  • Addiction
  • recovery management
  • recovery-oriented systems of care
  • recovery support services
  • recovery community institutions