Peer Support – does it make a difference?

Recovery-Capital

In many places peer support has been integrated into addiction treatment services, often with enthusiasm. What do we know about the effect of peer support though? In my own service, introduction of a structured peer support programme was associated with a sharp increase in retention (treatment completion) rates – but that’s not evidence in the scientific sense.

So what does the evidence actually say? I’ve been looking at two complimentary reviews on the subject which have filled in some of the gaps.

In 2016 researchers Kathleen Tracy and Samantha P Wallace from the New York University School of Medicine undertook a review (1) of the published literature to try to identify the impact of peer support interventions. They noted that ‘despite the recent surge in the adoption of peer support services within addiction treatment systems, there are relatively limited data rigorously evaluating outcomes.’ No surprise then to discover that they had to whittle over 2000 papers, initially identified,  down to only 10 which met their (reasonable) criteria.

Despite the 10 studies’ limitations (including few randomised controlled trials, all the studies being from the USA, methodological difficulties and the confounding effect of self-selection into peer support groups and residential treatment settings), they found evidence of benefit. Those benefits covered areas of:

  • Substance use
  • Treatment engagement
  • HIV and hep C virus risk behaviours
  • Craving and self-efficacy (self-belief)

Tracy and Wallace call for more rigorous research of course – and who can argue with that?

A few days ago, a further literature review (2) was published online in the Journal of Substance Use. The focus of this review was different from the 2016 paper in that it homed in more on the lived experience of the peer support workers rather than on treatment outcomes. In her paper, Courtney du Plessis of the Southern Cross University in Australia, distilled more than 600 relevant papers down to 24 that met her criteria for inclusion. Although the average sample sizes were small, studies from the UK, Australia, Hong Kong, South Korea, Canada and the USA were included in the largely qualitative review. She looked at both benefits and challenges in peer support.

There were benefits:

  • To peer support workers’ careers
  • From the nurturing experience of the workplace
  • To self, including greater confidence
  • Personal, occupational and social wellness
  • A positive shift in identity
  • Those of altruism/giving back

Challenges included

  • From colleagues (not feeling integrated, tokenism, stigma, exclusion)
  • Unclear job descriptions
  • Lack of support and training
  • Low pay
  • Conflicting with traditional treatment models – particularly medical settings where decision making may be the domain of doctors who may spend the least time with patients
  • Boundaries (this section looks like a minefield)
  • Wellbeing – paradoxically a benefit and a challenge

A lot of this rings true from personal experience. I couldn’t imagine how our service would get by without our peer supporters and am aware that across treatment services, we need to tackle the issues above and others. Bill White has written helpfully on this issue before. It seems likely that the benefits of peer support (both to self and others) outweigh the negative impacts, but it would be good to have more solid evidence.

A last thought, for the moment at least, on peer support: In light of the drug deaths crises both here in Scotland and in North America, wouldn’t it be nice to see a well-designed piece of research exploring whether peer support interventions can help us to reduce drug deaths. Such research would be challenging to do, but almost certainly worthwhile.

  • Tracy, K., & Wallace, S. P. (2016). Benefits of peer support groups in the treatment of addiction. Substance abuse and rehabilitation7, 143–154. doi:10.2147/SAR.S81535
  • Courtney du Plessis (2019): Peer support workers in substance abuse treatment services: A systematic review of the literature, Journal of Substance Use, DOI: 10.1080/14659891.2019.1677794

Picture credit: Edinburgh recovery banner, personal photograph.