As the behavioral healthcare staffing crisis deepens, addiction treatment paraprofessionals are in high demand. Whether you refer to them as sober escorts, sober companions, recovery support specialists, peer recovery support specialists, peer mentors, or recovery coaches, these paraprofessionals generally share a few common characteristics. Chief among those common characteristics is “lived experience,” that is, a history of personal involvement with the addiction and recovery process. Although research into the efficacy of recovery coaches and peer support specialists is scant, recent studies have demonstrated that this approach contributes to a few important outcome metrics for addiction treatment patients.
Still, some in the recovery community are skeptical. Are peer mentors worthwhile investments from a payer point of view? Should there be more regulation regarding who can and cannot provide professional support to people with SUD? How can we combat persistent stigmas around addiction and honor the valuable life experience of those in recovery while still ensuring that people in treatment receive the care they deserve?
Are recovery coaches dangerous or helpful or both? What does the proliferation of paraprofessionals mean for the future of traditional addiction treatment organizations? Let’s dive into these questions.
Defining the Different Types of Recovery Support Roles
In the popular imagination, addiction treatment is typically conceived of as a formal program administered by medical doctors, nurses, psychologists, therapists, counselors and psychiatrists. Certainly these professionals do play an important role in treatment, but there’s quite a few supporting roles that are gaining in popularity.
Sober Escort/Companion - An individual who travels with a patient or alumni and ensures that they remain sober en route to their destinations. These individuals also often accompany patients to personal and professional events to support sober decision-making.
Recovery Support Specialist/Peer Mentor/Recovery Coach - These workers provide practical, “hands-on” support for setting and reaching goals in all areas of a SUD patient’s life, including recovery. These are the workers who will help patients navigate the justice system, the child welfare system, employment and job seeking activities, housing concerns, and more. Services may be provided in-home or in the community. They may also be provided virtually.
What Addiction Treatment Recovery Coaches and Peer Mentors Can and Can’t Do
Addiction treatment paraprofessionals, like coaches and peer mentors, walk alongside people who are in recovery from SUD. Their job description is pretty open-ended because it’s very client-centered and the goals of the patient ultimately directs the work providers like these do with clients on a day-to-day basis. Peer mentors and coaches, however, are not licensed clinicians. While they are eligible for insurance reimbursements in some cases, they cannot make a clinical diagnosis or provide clinical treatment for a diagnosis. Paraprofessionals like these are limited to working on general life goals and the basic physical and emotional needs of SUD patients. They stick with evidence-based change models like motivational interviewing, but they’re not qualified to deliver CBT or any other clinical intervention.
Addiction Treatment Recovery Coaching and Peer Mentorship Are on the Rise
Coaching and mentorship models are not unique to the addiction treatment community. They are also popular in general mental health treatment spaces, where people with lived experience in a variety of mental health issues connect with those who are struggling with similar diagnoses. There are roughly 300,000 people working in peer mentorship roles in the general behavioral health space, with the demand for these types of workers growing a steady clip in recent years.
What State and Federal Government Regulations are in Place for Addiction Treatment Peer Mentors and Coaches?
There are no federal regulations around addiction treatment coaches, peer mentors or support specialists at this time. However, nearly all states, with the exception of a few outliers, have recognized certification processes and standards for the peer workforce. Some have argued that increasing the standardization among these programs could lead to better reimbursement rates and coverage for peer workers.
That said, “recovery coaching,” especially in the context of self-employment, continues to be a wild west.
Are Recovery Coaches and Peer Mentors a Threat to Traditional Clinicians and Treatment Programs?
Peer mentors and other paraprofessionals are much less expensive than traditional clinicians. This fact has caused some in the behavioral health community to worry that payers will eventually push more billable hours to paraprofessionals or reduce overall reimbursements for addiction treatment services to reflect the growing involvement of peer mentors.
However, it seems unlikely that lower-paid paraprofessionals could ever replace traditional addiction treatment clinicians. For one, mentors and coaches cannot make a diagnosis or deliver treatment centered around any diagnosis. While they have valuable lived experience in addiction, peer support specialists aren’t privy to many of the insights that come with additional education. Not only do peer coaches and mentors often fall prey to their own personal biases, but they are vulnerable to gaps in understanding for patient experiences that may go beyond their own personal experience. For example, dual diagnosis patients, who are exceedingly common in the addiction treatment space, may present with additional symptoms that complicate their experience of addiction. While a lived experience in addiction may grant a paraprofessional ample insight into one element of a patient’s experience, it doesn’t guarantee an adequate understanding of the patient’s experience as a whole.
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