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Incorporating Peer Support Into Substance Use Disorder Treatment Services [Internet]. Rockville (MD): Substance Abuse and Mental Health Services Administration (US); 2023. (Treatment Improvement Protocol (TIP) Series, No. 64.)
Peer specialists are becoming an increasingly important part of the substance use treatment workforce, and they provide services in a growing range of settings.
Peer specialists draw on their lived experience with problematic substance use, behavior change, and recovery—plus their training—to improve outcomes for other people entering or in recovery.
People interested in becoming peer specialists should understand the potential benefits and challenges of this work to make informed decisions about pursuing this path.
The peer specialist position can be an end goal, a first step in reentering the general workforce, or a steppingstone in a career in the addiction and recovery fields.
States have different education and training requirements for peer specialist certification. Obtaining certification has become increasingly important to securing work in this field.
People who have lived experience with a family member in recovery from problematic substance use can become family peer specialists who work with other families affected by such use.
Peer support services (PSS) have become an important part of health care as the substance use disorder (SUD) treatment field increasingly understands that SUDs are long-term illnesses. Peer workers play a valuable role in supporting people with problematic use to seek, engage in, and maintain recovery and wellness.619,620
Peer workers are individuals who use their lived experience with problematic substance use, behavior change, and recovery to provide recovery support to people with problematic substance use. The broad term “peer workers” refers to peers who may be paid or unpaid, with or without formal training, and certified or uncertified. Peer specialists are paid and have training; peer specialists may or may not be certified. Family peer workers, who have experience supporting a loved one who is in or seeking recovery, also work in some treatment programs.
Chapter 6 will help people who are interested in working with people with problematic substance use in an SUD treatment setting understand the benefits and challenges of being a peer specialist. The chapter also discusses the training, certification, and credentialing processes involved in becoming a peer specialist. It offers education, information, and resources on topics such as:
What a peer specialist does.
The benefits and challenges of working as a peer specialist.
The roles, settings, and practice standards of peers who support recovery from problematic substance use.
The training requirements and skills needed to become a peer specialist.
The steps to take to become a peer specialist, including how to become a certified peer specialist.
Chapter 6 is for anyone interested in becoming a paid or volunteer peer specialist, especially someone who wants to work as part of an SUD treatment program. A description of Chapter 6 follows:
The first section explains who peer workers are, what they do, the settings in which they work, and their core practices. This section briefly introduces the roles of peer workers. Chapters 1 and 2 provide more information about PSS and the roles of peer workers.
The second section helps potential peer specialists decide whether the role is right for them by first describing some general characteristics of peer specialists. It then presents questions to help them explore their own motivations for becoming a peer specialist, which is an important step in seeking this line of work. The section also describes benefits and challenges of being a peer specialist.
The third section outlines the steps and requirements for becoming a peer specialist. It includes information about education, training, and credentialing.
The fourth section begins by discussing the principles of family peer support. It then explains the benefits and challenges of serving as a family peer worker supporting families affected by problematic substance use as well as how to become trained, and in some places certified, as a family peer specialist.
The fifth section presents additional resources on peer specialist training and certification. The chapter appendix includes a number of other resources, including a sample job description and case studies to help potential peer specialists learn more about becoming a peer specialist.
A NOTE ON THE TERM “PROGRAM CLIENT”.
No universal definition of a peer worker exists. Many agencies, organizations, and experts in the SUD treatment and recovery fields have slightly different definitions. For example:
The Substance Abuse and Mental Health Services Administration (SAMHSA) has described peer workers as people with the lived experience of recovery from an SUD who provide nonclinical, strengths-based support to others experiencing similar challenges.621
William White, a well-known and highly respected writer in the recovery field, has referred to peer workers as “recovery coaches.” He has described recovery coaches as people who are “experientially credentialed” and who “provide outreach to people in need of recovery, assertively link people to professional treatment and to communities of recovery, and provide long-term, stage-appropriate recovery education and support.”622
The term “recovery coach” is frequently used in the same sense as the terms “peer worker” or “peer specialist.” These positions differ somewhat from that of the professional recovery coach, which this Treatment Improvement Protocol doesn't cover. Professional recovery coaches have training and experience in coaching and may have certification from a professional coaching organization such as the International Coaching Federation or the International Association of Coaching. Also, professional recovery coaches often work in fee-based private practice and may not be directly involved in the local recovery community.623
Confusion persists about the roles of peer specialists, sponsors, and SUD counselors because they overlap somewhat.624 But important differences exist between these roles. For example:
SUD counselors (and other SUD treatment providers, like addictions nurses and clinical social workers):
Have specialized educational degrees and clinical training.
Are certified and licensed to provide clinical services.
Are clinically supervised when working in SUD treatment programs (but not when in solo private practice).
Provide SUD-related assessments, diagnoses, and treatments.
Mutual-help sponsors:
Typically work through 12-Step programs like Alcoholics Anonymous® and Narcotics Anonymous.
Are always unpaid and unsupervised.
Mainly focus on helping their sponsees follow the 12-Step program.
Don't need formal training or certification.
Peer specialists:625,626,627,628
Have formal training on how to use their lived recovery experience to help others enter or maintain recovery, and often have certification. (The section “Peer Specialist Training and Certification Requirements” contains helpful information and resources on certification.)
Provide support to people to help them achieve their recovery goals in the ways they choose. (The different ways that people enter, work on, and achieve recovery are often referred to as “recovery pathways.”)
Receive supervision. Depending on the setting and program, peer specialists may have more than one supervisor. Some supervisors have themselves worked as peer specialists.
Have many roles and responsibilities, such as working with people seeking or in recovery on building their recovery capital, linking to the recovery community (including mutual-help programs) and other resources, developing and carrying out a recovery plan, advocating for themselves, and navigating healthcare, behavioral health, child welfare, criminal justice, and other systems. (Recovery capital means the internal and external resources available to establish and maintain an individual's recovery, like access to health care, supportive relationships, work/schooling, self-esteem, and safe housing.)
Typically serve in an SUD treatment, mental health services, healthcare, social services, corrections, court, or recovery organization setting (although some work may take place in the community).
Peer specialists working in SUD treatment programs offer nonclinical support and services to help people who experience SUDs and their families engage in and maintain recovery. They can work for pay or volunteer. They may work directly for a treatment program or for an organization that contracts to provide PSS to treatment programs. Their daily responsibilities are broad and require flexibility to allow them to help individuals with a range of physical, emotional, spiritual, and functional recovery needs.
A peer specialist serves as:629,630
A person who offers support, caring, and guidance.
A resource expert who can link the treatment program's clients to services by providing information and going with them to appointments. Such services include:
Housing.
Transportation.
Child care.
Health care.
Employment.
Education.
Social services.
Legal aid.
A motivator or cheerleader (for example, celebrating program clients' achievements).
A provider of honest feedback to help the individuals they work with develop healthier thoughts and behaviors.
A role model for recovery and wellness.
A role model for effectively communicating boundaries.
A person who supports the individuals they work with in gaining recovery capital and overcoming barriers to recovery.
An advocate for program clients with their SUD treatment team (such as during staff meetings in which treatment providers discuss cases).
An advocate for PSS in the local community (by, for example, educating the general public about the importance of these services).
A key figure in assessing community recovery support needs.
Peer specialists are central to SUD treatment, not an add-on, and can contribute across the continuum of recovery. They do so by:631,632,633,634
Going into the local community to work with people seeking recovery and welcoming them into treatment or the recovery community.
Modeling recovery and imparting recovery skills to new clients of the treatment program.
Educating program clients about SUDs and coaching them on using social skills, finding other recovery role models, learning to ask for help, and avoiding or navigating risky situations.
Accompanying individuals they work with to mutual-help group meetings and participating with them in organized activities.
Supporting people in sticking with their recovery plans and new healthy behaviors.
Helping individuals they work with understand how family relationships can affect and be affected by a family member's problematic substance use.
Checking in with people in longer term recovery to support and encourage them.
Peer specialists work in many different settings, including, increasingly, SUD treatment programs. These types of settings include:635
Outpatient SUD treatment programs.
Programs that provide medication for opioid use disorder.
Inpatient hospital addiction units.
Partial hospitalization programs.
Residential treatment programs.
Peer specialists may also work in a variety of other settings, especially settings that provide recovery services. The wide range of settings where potential peer specialists may find PSS include:636,637
Recovery community organizations (RCOs). (Chapter 1 of this Treatment Improvement Protocol [TIP] contains a description of RCOs.)
Recovery homes/recovery housing.
College recovery programs.
High school recovery programs.
Problem-solving courts.
Jails and prisons.
Primary care and other physical health clinics.
Emergency departments and inpatient medical units.
Mobile crisis units.
Harm reduction centers.
Social services agencies (such as child welfare agencies).
Homeless shelters.
Telephone or online PSS programs, including mobile apps.
No matter where peer specialists work, part of the job involves connecting individuals with resources available in the recovery community.
WHAT RESEARCH SAYS ABOUT PEER SPECIALISTS.
Peer workers support people with a history of substance use–related problems in working on many aspects of recovery and wellness, such as:649,650
Having hope, motivation, and a positive and realistic outlook on recovery.
Learning ways to reduce substance use and related problems or to achieve and maintain abstinence from substances, depending on their personal goals.
Increasing skills to prevent a return to problematic use or any use.
Developing recovery plans.
Finding and linking to needed resources.
Building and keeping healthy, supportive relationships.
Developing effective coping strategies and problem-solving techniques.
Having a sense of meaning and purpose in their lives.
Setting and meeting short- and long-term goals.
Maintaining good health and well-being and reducing stress by:
Eating a healthy diet.
Exercising.
Taking steps to prevent illness or health problems. (Quitting smoking,651 addressing hepatitis C, and keeping up with immunizations are examples of such steps.)
Meditating.
Developing healthy sleep habits.
Putting new problem-solving skills into practice.
The day-to-day practices of peer specialists can range from conducting “street outreach” to people with problematic substance use to organizing recreational activities for people in sustained recovery. Depending on the setting and organization, peer specialists' responsibilities can include:652,653,654
Checking in with people on a treatment program's waiting list.
Welcoming and helping orient new clients of the treatment program to put them more at ease, introducing them to recovery concepts, and explaining PSS and other services offered.
Facilitating wellness groups.
Teaching classes on budgeting and finding employment.
Coaching individuals on locating resources and navigating healthcare and social service systems.
Helping connect people to mutual-help groups.
Accompanying individuals, if requested, to medical and other types of appointments to provide support, especially in first-time situations.
Documenting delivered peer services (especially by peer specialists whose services could be billed to Medicaid).
Communicating with the rest of the recovery team on behalf of or alongside a program participant.
Offering one-on-one emotional support to program participants.
Helping people transition from one level of SUD care to another.
Reaching out to program clients who left SUD treatment early.
Performing recovery checkups with former program clients who were successfully discharged.
The list above provides only a sampling of the many different responsibilities that peer specialists may carry out as part of their daily work. Peer specialists may also educate other organizations and the general public about the treatment program, recovery organization, or other setting where they work or about peer services and recovery generally.
RESOURCE ALERT: MANUALS AND TOOLKITS.
In addition to learning day-to-day practices, peer specialists will also need certain core competencies that will help them follow practice standards. Practice standards describe how they should perform their job to ensure that they are acting in an ethical, respectful, and responsible manner.
Peer specialists should always act in an ethical and appropriate manner, although ethical guidelines and codes of conduct can differ depending on the organization and state. Ethical issues include situations involving potential harm to people seeking help, the peer specialist, the organization through which PSS are being delivered, the larger PSS and SUD field, and the recovery community. Whether harm will be done to any of these people or entities should be the primary consideration when peer specialists face an ethical dilemma. Potential issues include the personal conduct of peer specialists outside of the work arena, conduct in relationships with people seeking PSS, conduct in relationships with other service providers, and the responsibility to report threats to public safety.655
The organization a peer specialist works for likely will have a set of policies describing acceptable and unacceptable peer specialist actions. These policies derive from an overall ethical framework that guides ethical decision making. Two national organizations have developed ethical guidelines that other groups have adopted:
NAADAC, The Association for Addiction Professionals, developed the National Certified Peer Recovery Support Specialist (NCPRSS) Code of Ethics (https://www
The National Association of Peer Supporters offers its National Practice Guidelines for Peer Specialists and Supervisors (https://www
Chapter 8 includes additional resources in its “Ethical Guidelines” section.
Part of behaving ethically as a peer specialist means respecting and maintaining appropriate boundaries with the individuals that the peer serves.656 Potential peer specialists will learn through training and supervision how to recognize when boundaries could get blurred or crossed—and how to avoid or respond to those situations. Such situations include:657,658
Engaging in nonsexual touching.
Receiving sexual comments from someone the peer specialist serves.
Acting on or being influenced by romantic feelings for someone the peer specialist serves.
Having someone receiving PSS from a peer specialist show romantic feelings for that peer specialist.
Providing personal services outside those appropriate to the peer support role; examples of inappropriate services are babysitting, carpentry, car repair, and hairstyling.
Loaning money to someone the peer specialist serves.
Accepting gifts from someone the peer specialist serves.
Blurring the line between being friendly and being friends.
Blurring the line between providing professional recovery support and working on the peer specialist's own personal recovery.
Inappropriately sharing highly personal information with someone the peer specialist serves, especially early on (for example, sharing in detail one's own experience with trauma with a new program participant who has a trauma history).
Potential peer specialists may wonder what characteristics and skills make a good peer specialist. People with many different personality traits and experiences can succeed in this work. But here are some things to keep in mind when considering this field:
Effective peer specialists genuinely care about individuals seeking or in recovery. They enjoy connecting with people and often speak about their jobs with enthusiasm. These are important qualities to have to do this kind of work. This might not be the right work for a potential peer specialist if he or she is not a “people person.”
A healthy peer specialist is an effective peer specialist. The number of years in recovery that a peer specialist has is less important than their current state of health and wellness. A potential peer specialists should be honest with themselves about where they are in their own recovery. If they're still experiencing an SUD or other problematic use, they should focus on getting themselves well before trying to support others. The same advice applies if a potential peer specialist has a serious co-occurring medical or mental disorder that needs addressing, including posttraumatic stress disorder. Learn about the eight dimensions of wellness at https://www
This job can be deeply rewarding, because peer specialists provide a critical service to those seeking or in recovery. However, many peers express disappointment with the relatively low pay they receive.659
People who succeed in the peer specialist role often feel “called” to serve. Peer specialists have a unique set of skills and experiences, attitudes, and desire to help others, and they often see their work as a way to give back to the recovery community.
Peers need thorough knowledge of local recovery community resources. A peer specialist is knowledgeable about SUD treatment programs, mutual-help programs, recovery housing, RCOs, and other resources in their area. They are willing to invest the time and effort to develop such knowledge.
Effective peer specialists learn when and how to offer trauma-informed support. People with problematic substance use often have a history of trauma. Because a person's trauma history can affect their ability to cope with stress, including the stress of recovery, peer specialists should have training on working with people who have this kind of personal history.
TRAINING AND WORK LIFE OF PEER SPECIALISTS SUPPORTING PEOPLE WITH OPIOID USE DISORDER.
Potential peer specialists should explore their motivations for becoming a peer specialist as well as their feelings about what this position can involve. Doing so can help them clarify the strength of their interest and stay committed to the training and the work if they pursue this path. The following questions can be considered:
What are the potential peer specialist's reasons for wanting to become a peer specialist?
What does the potential peer specialist hope to get out of this position?
How does the potential peer specialist feel about working with individuals who may be actively using substances?
How does the potential peer specialist feel about working with individuals whose recovery pathways differ from their own?
How does the potential peer specialist feel about being supervised in this position?
How does the potential peer specialist feel about working with individuals who have histories of trauma? Could this be triggering, and if so, how does the potential peer specialist feel about that?
How does the potential peer specialist feel about working with individuals with mental disorders?
How does the potential peer specialist feel about working with someone who has been or is involved in the criminal justice system because of their problematic substance use?
Is the potential peer specialist accepting of individuals with convictions for other types of crimes?
How willing (and able) is the potential peer specialist to spend time and money on peer specialist education, training, or both?
What does the potential peer specialist think this work will be like day to day?
How might working as a peer specialist make one's life different?
How might serving as a peer specialist affect one's own recovery? Could it be helpful? Could it be harmful?
What are the potential peer specialist's current recovery/self-care practices, and how might each affect their ability to perform this role effectively?
A peer specialist's work has many upsides. It can allow a potential peer specialist to:
Share the valuable knowledge and lived experience they have gained in their own recovery.
Show people with problematic substance use, their coworkers, outside professionals and organizations that they interact with, and the general public that recovery is possible for everyone and happens often.
Enter or reenter the workforce, if they don't have previous or recent employment.
Develop a variety of skills, such as facilitating meetings and leading classes.
Start building a career within the PSS field, the larger SUD treatment and recovery field (such as by becoming a certified drug and alcohol counselor or addictions nurse), or a different field.
Maintain, expand, and deepen relationships within the recovery community.
Find purpose and meaning in their work.661
Improve their confidence and self-esteem, which can enhance their own recovery and well-being. (However, working as a peer provider is no substitute for doing one's own recovery work.)
Interview-based research has found that peer work:
Enhanced peers' own recovery.662
Increased peers' self-acceptance.663
Increased peers' confidence.664
Gave peers a sense of accomplishment.665
Decreased stigma in peers' workplaces.666
THOUGHTS ON THE INTERVIEW PROCESS.
Although becoming a peer specialist can be rewarding, potential peer specialists may encounter challenges to getting hired and thriving in the position. Awareness of these possible challenges can help them decide whether they want this type of work. Problems peer specialists might encounter include:668,669,670
Lack of understanding among staff of SUD treatment programs about the purpose of and need for these positions.
Negative attitudes by coworkers toward peer specialists and their contributions to the organization (for example, not valuing peer specialists' work or lived experience).
Requirements of state credentialing bodies and hiring organizations, especially regarding education and in-the-field experience. Such requirements may be barriers for people who lack a high school education or a GED or who can't access or make time for the required training and work experience.
Lack of funding for training and certification fees. People often need to pay for training and certification expenses on their own; however, not everyone can afford to do so.
Criticism from others in recovery that peer specialists are exploiting their recovery experience. Some people in recovery believe strongly that peer mentoring is part of recovery and should always be provided on a volunteer basis.
Low pay, insufficient working hours, or both.
Difficulty getting certified or hired.
Difficulty getting hired if there is past criminal justice system involvement. How much of a barrier this involvement presents depends on such factors as the nature, number, and recency of any crimes; the state; and the employer. Many peer workers with lived experience in the criminal justice system find success getting hired in forensic and diversionary settings like drug courts, jails, and prisons.671,672
Lack of a recovery orientation at an organizational level and among coworkers.
Token peer positions. For example, a treatment program might establish peer positions to be able to say it offers PSS, but not provide appropriate supervision, training, and work assignments to the peers.
Difficulty setting boundaries with someone for whom they are providing PSS. This situation can happen when the peer specialist and the individual already have a connection (for example, they are friends or they know each other from participating in the same treatment program).
Difficulty setting boundaries with work colleagues. This can happen when, for example, the peer specialist is expected to take on clinical functions or entry-level clerical tasks. Such deviation from the peer role can lead to the peer specialist identifying more with the treatment team and less with program participants, and to exploitation of the peer.
Few career options or opportunities for advancement within the workplace, if serving as a peer specialist is not the end goal.
Burnout or stress, which can occur because of, for example:
Understaffed programs.
The demanding nature of peer support work, including the emotional demands of working closely with individuals with trauma histories.
The frequent lack of affordable housing, mental health services, and other resources needed by individuals a peer is working with.
A lack of effective supervision and leadership support for the peer position.
The process of becoming a peer specialist can take time and may vary depending on where the potential peer specialist lives and wants to work. Here are steps a potential peer specialist can take to ensure that they're prepared for this role.
Step One: Get informed—Potential peer specialists should seek as much information as possible to ensure that they want to pursue this line of work. This process may include:
Talking to providers, including peer specialists, in the recovery community about the day-to-day work of peer specialists. (The appendix at the end of this chapter contains case studies that show how such conversations can be helpful.)
Talking to people in the recovery network, especially anyone who has experience working as a peer, about how the peer specialist role may affect one's own recovery (positively and negatively).
Attending recovery events in the area, such as recovery fairs. Recovery organizations and treatment programs may have representatives there who can speak to the availability of and requirements for peer specialist positions.
Talking to a trusted friend or adviser.
Researching what peer training the state requires for certification by going on the websites for, or calling, the state behavioral health agency or peer specialist certification organization. Doing this research will help the potential peer specialist avoid spending money on training that they don't need or that doesn't meet their state's requirements, and will also let them know the time commitment involved.
Researching how many peer specialist educational hours the state requires for certification.
Looking into whether organizations in the area provide scholarships for peer training or certification or both, or provide the needed training in-house as part of internships or peers-in-training positions.
Researching what types of jobs are available for peers in the area and how many jobs are advertised.
Reading online job descriptions. These can help give the potential peer specialist an idea of the work to be performed and what employers are looking for in a paid peer specialist, including level of education. A sample job description is included in this chapter's appendix.
Looking at the salaries/hourly rates and benefits being offered to make sure they meet one's needs.
Checking whether organizations for peer specialists exist in the state and local area. Such organizations may have helpful information on their websites. They can also be sources of information on any scholarships or other funding available to help pay for peer specialist training, education, and certification. Potential peer specialists may need to become a member to access certain types of information.
Attending peer conferences and networking events to learn about the peer workforce, the experiences of peers working at different organizations, and the ways peer jobs vary by setting (for example, outpatient clinic, hospital, RCO) to get a sense of what might suit the person best. A potential peer specialist may also be able to learn about how, and for how long, peer positions at different organizations are funded. (Potential peer specialists also should consider asking about this during peer specialist job interviews.)
Reading Chapter 3 of this TIP.
Checking out the many online peer resources available, including manuals and toolkits. These resources will give the potential peer specialist an idea of requirements and expectations as well as what the work might be like. YouTube also has videos about the role of peer specialists, including training videos and personal stories.
Step Two: Get involved—Potential peer specialists should search out volunteer opportunities at local RCOs, SUD treatment centers, mental health service centers, or other places providing PSS.
Step Three: Get trained—Training, including work experience, will help ensure that the potential peer specialist develops the necessary knowledge, skills, and attitudes to succeed in the peer position. It also shows future employers that the person takes the job and their professional development seriously. Although many training courses are offered in person, some training may be available online. Potential peer specialists will probably need formal training before an organization will hire them to join their staff. If possible, they should use a training entity that offers work experience hours as well as education hours. Potential peer specialists should build their computer skills as part of this effort.
Step Four: Get certified—Potential peer specialists should research certification requirements in the state (and in other states where the person might seek work) and in the organizations where the person wants to work. For example, some will require a certain number of peer work or volunteer hours, which often must be supervised.673 Also, potential peer specialists should determine whether additional education is required and accessible. Certification bodies often have additional requirements, such as passing a written test, completing an application, and getting professional or personal reference letters, or both. Some programs include training and certification as part of the hiring process and cover the costs for peer workers. A potential peer specialist might need to complete an internship before getting certified.
Step Five: Get hired—Potential peer specialists should look for job openings.
For potential peer specialists who started out by volunteering, they should find out whether the organization has any openings for paid positions, and not get discouraged if nothing is open. Potential peer specialists can communicate their interest in a paid position to their supervisor and continue to work as a volunteer, if they can afford to do so.
Potential peer specialists should check the website of the state-specific certifying body to see whether it publicizes job openings.
Potential peer specialists should see whether there is a statewide peer specialist organization that shares job announcements. A potential peer specialist may need to join the organization to obtain its information on job openings.
Potential peer specialists should use connections in the recovery community to express interest in paid work as a peer provider. Informal networks are a great resource for learning about job openings.
Potential peer specialists should search traditional job outlets for openings, like job websites (for example, Indeed
Job announcements are also often available through:
Peer training organizations.
RCOs.
Nonprofit organizations.
Colleges and universities.
Community centers.
Faith communities.
Mutual-help groups.
Outreach events.
Senior centers.
Youth centers.
Treatment alumni groups.
Social media platforms.
State vocational rehabilitation offices.
Potential peer specialists should ask whether an organization is hiring, even if an opening isn't listed on the organization's website. People who work there may remember who inquired about job positions if an opening becomes available.
COMMON QUESTIONS ABOUT BECOMING A PEER SPECIALIST.
Obtaining certification can help a potential peer specialist get a paid position. Some states and organizations require certification before starting paid work. Certification gives confidence to employers and the public that the person has the expertise needed to deliver PSS. In some cases, SUD treatment programs will hire people in recovery and pay for some or all of the costs of their peer specialist training and credentialing as part of the employment package.
SAMHSA collaborated with federal, state, tribal, and local partners to develop SAMHSA's National Model Standards for Peer Support Certification, covering substance use, mental health, and family and youth peer certifications. The National Model Standards, released in 2023, will accelerate universal adoption, recognition, and integration of the peer workforce across all elements of the healthcare system. The Model Standards can be viewed here: https://www.samhsa.gov/about-us/who-we-are/offices-centers/or/model-standards.
As of this TIP's publication, no single peer certification standard is accepted nationwide; however, national peer certifications do exist. Exhibit 6.1 lists the certification requirements of NAADAC and the International Certification and Reciprocity Consortium (IC&RC). Each has slightly different requirements and steps to certification.
EXHIBIT 6.1. Peer Certification Requirements From NAADAC and IC&RC.
As of this TIP's publication, nearly all states have training and certification programs, although the majority of these states offer a single, integrated certification for peers in the substance use recovery field and peers in the mental health recovery field.
State certification programs have different requirements on training, supervised peer work experience (paid or volunteer), and lived experience. Certifying bodies also differ from state to state. For example, some states have certification boards, some use third parties, and some certify peers through the state behavioral health agency.674
RESOURCE ALERT: PEER SPECIALIST TRAINING AND CERTIFICATION PROGRAMS BY STATE.
Some states offer reciprocal credentials, meaning that peer specialists in other states with qualifying credentials could potentially move to and work in those states with reciprocity arrangements.675 IC&RC hosts a webpage that describes the reciprocity process for peer specialists holding the IC&RC peer recovery credential (https://internationalcredentialing.org/reciprocity).
If a potential peer specialist has a history of criminal justice system involvement, this won't necessarily keep them from becoming certified and working as a peer specialist. Recognition is growing that such lived experience can help peers better understand, relate to, and work with people seeking or in recovery who have criminal justice system involvement too. However, some states require criminal background checks or self-disclosure of criminal history as part of the certification process. Depending on the state and the category of offense, a criminal history could be grounds for denying an application for certification as a peer specialist, either permanently or for a number of years. Some states make these determinations on a case-by-case basis.
Examples of the types of convictions that can be disqualifying include the following:676,677,678,679,680
Murder
Manslaughter
Assault
Sexual offense
Domestic violence
Child abuse or neglect
Elder abuse or neglect
Kidnapping
Stalking
Arson
Burglary
Potential peer specialists should research their state's requirements, then check the hiring requirements of the organizations where they want to work if they have specific employers in mind. Not all state certifying bodies have criminal history–related information available on their public-facing websites.681 Also, keep in mind that state laws in this area can and do change.
Few people understand the difficulty of dealing with a family member's problematic substance use as well as members of similarly affected families. In recent years, the role of family peer specialist has emerged as a way to provide PSS to family members of people with substance use–related problems. Family peer specialists gain their lived experience by participating in their own recovery and wellness journeys as a result of a loved one's substance use–related problems. Drawing on their knowledge and lived experience of caring for those family members, family peer specialists can support other families in similar circumstances and provide education and linkages to resources to individual family members.682,683
Family peer specialists have lived experience as a family member of a person in recovery. Before becoming qualified to work with families, family peer specialists must learn the core principles of family-based PSS. This knowledge helps support the use of services that are safe, effective, respectful, and ethical. High-quality family peer support reflects the following standards and values:684,685,686,687
Individualized services: Family peer specialists don't use the cookie-cutter approach of offering the same services in the same ways to all families. They tailor support to the specific needs of each family and family member.
Connectedness: Family peer specialists focus on helping families engage with and use services, resources, and support from other families, rather than just helping them access these tools.
Respectful and culturally responsive services: Family peer specialists should have an open and nonjudgmental attitude that honors rather than objects to differences in viewpoints, opinions, or cultural outlooks.
Skill-based approaches: Family peer specialists teach, mentor, and coach families on how to build the necessary skills to help themselves and family members in or seeking recovery during their recovery journeys.
Knowledge-based techniques: Family peer specialists help educate families and answer questions to help them make informed decisions.
Engagement: Family peer specialists work closely with families to ensure that they feel knowledgeable, confident, and supported.
Solution-focused support: Although some families find it helpful to vent about their problems and frustrations, family peer specialists help them try to find solutions to their difficulties.
Person-driven support: Family peer specialists support affected family members by helping them develop a wellness plan based on their own personal needs and goals. The plan reflects the idea that all affected family members have their own wellness journey, regardless of where the person in or seeking recovery is in their recovery journey.
Outcome-based services: Rather than focusing on problems and weaknesses, family peer specialists offer families hope and encouragement, help them identify their unique strengths and resiliencies, and support them as they find solutions and work toward positive outcomes.
Expanded opportunities: Family peer specialists help families get involved in the recovery community at multiple levels, such as through local or national recovery events.
Advocacy: Family peer specialists teach families how to stand up for their own rights and the rights of the individual in or seeking recovery. They also promote recovery to the local community, providers, and policymakers.
FAMILY PEER SPECIALISTS: WHAT PEOPLE IN RECOVERY NEED TO KNOW.
Family peer specialists are qualified nonclinical providers trained and supervised to make sure they:
Have the necessary skills and education to effectively help affected families.
Offer services that are:
Person centered.
Strengths based.
Trauma informed.
Culturally responsive.
Follow rules and guidelines for ethical behavior.
Have the required certification that reflects their experience, training, and supervision (where available—not all states offer family-specific peer certification).
Having lived experience with supporting a person in or seeking recovery is important for family peer specialists. This experience helps family peer specialists empathize with the experiences of other families of individuals in or seeking recovery. It also means that family peer specialists have personal knowledge of how to address the problems families face and can offer ideas for how to cope with their struggles. Because of this lived experience, family peer specialists serve as role models for other families and offer living proof that families touched by problematic substance use can recover. Entities that certify family peer specialists typically require them to have lived experience.
Training to become a family peer specialist usually includes a combination of:
In-person or web-based training courses, lectures, or seminars offered through local, regional, national, or online training programs. Some states include family recovery support specialist training as part of their peer support training (for example, Arizona, Colorado [in 2020]).693
Volunteer or paid work experience as a family peer specialist.
Training isn't only critical to making sure family peer specialists understand how to perform this type of work, it also helps them understand how to provide support that is family driven, trauma informed, and culturally responsive.
Most states require that family peer specialists be supervised, and all state and national certification programs require that family peer specialists receive supervision as part of the certification process.694,695 Supervision is often provided by someone licensed and qualified in the area of substance use or mental health, such as a psychologist, counselor, or social worker. Supervision helps family peer specialists build and improve peer support skills while ensuring that services are of the highest quality possible.
Supervision also protects and guides the family peer specialist when facing challenging situations like working with reluctant family members or answering medical or legal questions. A supervisor steps in when a family member asks the family peer specialist to do something beyond their scope of training, abilities, or certification. This will help keep the family peer specialist from accidentally doing or saying something that could negatively affect the family or themselves.
Because family peer support is an emerging practice, family-specific peer support certification is not yet widely available. Some states' peer specialist certification programs allow family members to qualify as peers, but don't offer a separate certification. Fewer states offer family-specific certification.696,697 Exhibit 6.2 lists which states offer family peer specialist certification.
EXHIBIT 6.2. Family Peer Specialist Certification.
Currently, the National Federation of Families offers the only national family peer specialist certification, but it differs from the family peer specialist certification described above. The National Federation of Families certification is for parents or caregivers of children and emerging adults with emotional, developmental, behavioral, substance use, or mental disorders. Information about the certification is available online (https://www.ffcmh.org/certification).
The peer specialist position can be a rewarding career choice for individuals wanting to help others recover from SUDs and achieve health and wellness. People and families who are interested in becoming peer specialists should continue to educate themselves on the benefits as well as the challenges of working in this capacity. They should make sure they understand their motivations and expectations. Also, potential peer specialists can familiarize themselves with the certification requirements for the state or states where they might want to work and look at the qualifications and duties listed in online peer specialist jobs posted by the types of organizations that interest them.
Peer specialists make up an increasingly important part of the SUD treatment and recovery workforce, and the settings where they work continue to expand. Positions in the emerging field of PSS offer plenty of opportunity to learn, to contribute, and to grow.
Sample Functions:
Providing vision-driven hope and encouragement, supporting people in their recovery, and assisting them in connecting to the recovery community
Providing opportunities for individuals receiving services to direct their own recovery process (self-determination) and acting as an advocate for people served
Working with individuals one-on-one and in groups to provide recovery training, and reaching out to individuals who use SUD services in the local community
Sharing personal recovery experiences and developing authentic peer-to-peer relationships
Offering instruction and support to help people develop the skills they need to facilitate their individual recovery
Informing people served of available service options and choices while promoting the use of natural supports and resources within the local community
Providing peer mentoring and support for individuals who are receiving SUD services
Assisting individuals in navigating the SUD services system and in achieving resiliency and recovery as defined by the person
Sample Responsibilities:
Assisting in the orientation process for people who are new to receiving services for substance use and/or co-occurring disorders
Proactively contacting individuals to ensure they are making a successful transition to community integration and continuing their progress toward recovery goals
Supporting individuals in seeking to connect/reconnect with family, friends, and significant others and in learning how to improve or eliminate unhealthy relationships
Providing education and advocacy within the local community that promotes awareness of SUDs, while reducing misconceptions, prejudices, and discrimination
Keeping treatment team informed about individuals' strengths, accomplishments, and obstacles in relation to their recovery goals
Completing all required documentation in a timely, legible manner
Educating professional staff about the recovery process and the damaging role that stigma can play in undermining recovery
Visiting community resources with people using services to assist them in becoming familiar with potential opportunities
Facilitating the transition from a professionally directed service plan to a self-directed recovery plan
Modeling personal responsibility, self-advocacy, and hope by drawing on one's recovery story, as appropriate
Ensuring confidentiality of individuals' information
Assessing emergency situations, notifying supervisor or appropriate clinical and administrative personnel of actual or potential problems
Exhibiting a nonjudgmental approach, effective listening, good eye contact, and positive interactions
Source: Adapted with permission.698 Job descriptions and materials collected by P. Swarbrick and P. Nemec, 2011, The Transformation Center (Boston, MA), and Collaborative Support Programs of New Jersey. Edited by Achara Consulting; adapted from job descriptions and materials from Pennsylvania, North Carolina, Recovery Innovations of Arizona, Florida Peer Network Inc., the Transformation Center (Boston, MA), and Collaborative Support Programs of NJ.
Summary: The Peer Support Specialist works with program participants onsite and in the local community to provide recovery support. Peer Support Specialists provide individual and group support in multiple settings and provide referrals for resources like housing, clothing/food, and overdose prevention/naloxone training. They also provide educational outreach to providers and community groups.
Job Responsibilities:
Providing individual recovery support on a regular basis
Facilitating recovery support groups
Connecting program participants to community-based resources
Assisting program participants in finding community services to meet basic needs
Empowering program participants by supporting them in identifying and removing barriers to their recovery
Supporting program participants in developing a self-directed plan for advancing their recovery
Working with program participants on acquiring daily living skills, such as taking the bus
Advocating for program participants and helping them develop self-advocacy skills
Completing all required documentation clearly and on time
Assisting in planning and conducting recreational activities for program participants
Coaching program participants on problem-solving techniques and coping skills
Accompanying program participants to appointments, meetings, and other activities, while maintaining ethical boundaries and communication with supervisor
Providing outreach to and follow-up with nonresidential program participants where they live or in the community
Providing community outreach
Maintaining contact by phone/text/email with program participants after they leave the program to provide support and encouragement
Communicating effectively and respectfully with all program participants and coworkers and with community partners
Maintaining positive relationships
Completing all trainings as assigned
Completing additional duties and responsibilities as assigned
Qualifications: To perform this job successfully, one must be able to perform each essential duty satisfactorily:
Demonstrating an understanding of, and belief in, the recovery process
Being a person with lived recovery experience, with a minimum 2 years of continuous recovery
Having positive communication skills
Having the ability to maintain confidentiality
Having the ability to relate to people from diverse backgrounds
Being 21 years old or older
Education and/or Experience:
High school diploma or GED required
Associate's degree or higher preferred
State-certified Recovery Coach or working to complete this within 6 months of hire
Understanding of local community resources and recovery-oriented systems of care model
Certificates, Licenses, Registrations: Must have a valid driver's license, registration, positive driving record, and proper auto insurance (provide a copy to the manager)
Other Skills and Abilities:
Knowledge of basic crisis intervention and motivational interviewing techniques
Ability to act as an advocate for the needs of the individual
Physical Demands: The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
While performing the duties of this job, the employee is regularly required to stand, walk, use hands, feel objects and/or controls, talk, hear, and smell.
The employee frequently must be able to reach with hands and arms, climb or balance, stoop, kneel, crouch, and sit.
The employee may need to lift up to 25 pounds.
Work Environment: The work environment characteristics described here are representative of those an employee encounters while performing the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
Source: Adapted from material in the public domain699 and available for free online (https://rizema
The Academy for Addiction Professionals Blog. Features a posting on “A Day in the Life: Peer Support Specialist” (https://www
SAMHSA's Bringing Recovery Supports to Scale Technical Assistance Center Strategy (BRSS TACS). Offers an extensive list of video trainings (pre-2019) on many aspects of PSS (https://www
BRSS TACS. Offers a list of certification requirements for all 50 states and the District of Columbia, as of 2018 (https://c4innovates
Doors to Wellbeing Peer Specialists Database. Features a searchable database of program descriptions and certification requirements of peer specialist programs in each state (https:
IC&RC. Includes information about the certification process for their peer recovery credential (https:
NAADAC. Includes information about the certification process for becoming a national certified peer recovery support specialist (https://www
National Association of State Alcohol and Drug Abuse Directors Member Directory. Provides links to state and territory Single State Agencies for SUD treatment and prevention where potential peer specialists can find information about certification of peer specialists in their state (https://nasadad
These case studies contain the stories of two people in recovery who are thinking about becoming peer specialists. Each story consists of an introduction outlining the person's story (including recovery history), learning objectives for readers, a dialog, and a summary.
The two stories incorporate key concepts discussed in this chapter:
The first case study demonstrates the importance of knowing why someone would want to become a peer specialist and what motivates them to seek this work.
The second case study shows how a person in recovery interested in becoming a peer specialist learns about the nuts and bolts of entering this field from a current peer specialist.
Both case studies also touch on some of the rewards and challenges of being a peer specialist.
CASE STUDY 1—SARAH: EXPLORING MOTIVATION FOR SEEKING WORK AS A PEER SPECIALIST.
CASE STUDY 2—SAM: USING PEER SPECIALISTS AS A SOURCE OF INFORMATION AND SUPPORT.
This is an open-access report distributed under the terms of the Creative Commons Public Domain License. You can copy, modify, distribute and perform the work, even for commercial purposes, all without asking permission.
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