Peer Support, or Harm Reduction, or Recovery Coaching?

A few months back I met a Peer Support Specialist who was specializing in Harm Reduction (HR). We had time for them to tell me all about what they do. They gave me a detailed overview of their training, experience, and the supervision they receive.

While listening, it seemed to me they had no background in the Recovery Coach (RC) model, and no awareness of the types of treatment settings, services, and programs that are within our field.

I gently asked. They told me they hadn’t heard of Recovery Coaching, and didn’t know what particular types of treatment are available.

I began to discuss the Recovery Coach concept, and what a Recovery Coach does — as the idea was originally developed. They said they didn’t know such a model existed, they would like to receive that training, and that I was describing a missing piece.

At that point, an image came to my mind — a peer support model consisting of both the method and style of newer HR approaches and the original RC approaches. I drew it, and my drawing clicked for them right away.

For the reader I should point out that in this version I intentionally used a jagged line, rather than a straight line. The jagged line is meant to convey the disassembly of divisions, the possibility of new structures and connections, and the relative practical uncertainty of any one particular moment (given the fact that no person’s presentation is uniform, and no helper’s response is pre-packaged).


As we talked over the often chaotic and individually unique facts and circumstances we face each time we meet with someone we are helping, one more thing occurred to me.

It occurred to me it would be helpful to have a Peer Support Specialist:

  • dually trained in HR and original RC,
  • trained in awareness of the Stages of Treatment (as adapted from Fred Osher’s work)
  • placed within all our Stages of Treatment.

I drew the diagram above and then simply named the Stages adapted from Osher:

  • Harm Reduction as a Stage of Treatment, followed by
  • Engagement/Persuasion
  • Stabilization
  • Active Treatment
  • Relapse Prevention, and
  • Recovery Management.

Then I told them I wished our field had those kinds of dually trained PS Specialists in every one of those Stages. They strongly agreed.

By the time I started to describe the stylistic differences they could take within Stages, on a “Traditional Model” to “Recovery Model” continuum (as Bill White has presented it), they took over the conversation. And I was glad to hear it.

They started talking about helping people take the long view, meeting people where they are on a per-problem basis within any place in their journey or possible level of care, and raising hope accordingly in a flexible way – no matter what the person they are helping presents.

And they said they could lean on this framework to help develop a recovery trajectory with those they serve.


A more recent conversation with a colleague inspired me to share this, in case it might be helpful to someone.


Osher F.C. & Kofoed, L.L. (1989).  Treatment of Patients With Psychiatric and Psychoactive Substance Abuse Disorders. Hospital and Community Psychiatry.  40:1025–1030.

2 thoughts on “Peer Support, or Harm Reduction, or Recovery Coaching?

  1. I’ve using harm reduction as a stage of “treatment” since probably 1980 if not before. I do, however, think engagement is ALWAYS the first step that defines the collaborative role of harm reduction interventions. People don’t often understand that effective harm reduction interventions always involve a change in consciousness, sometimes for both parties. My last project before I retired two years ago was a no barrier to entry residential opioid withdrawal management program. It is built entirely on a harm reduction model or philosophy, but so far 85% of the nearly 500 clients entering the program started substance use disorder treatment, either inpatient or outpatient, with a warm handoff. MAT is the standard intervention, but clients determine the goal: taper to zero, switch from methadone to Suboxone, stay with us through stabilization and enter treatment directly. We recently added peer support and are working directly with our community recovery organization. I’m very pleased with the results so far. We have to try things to prove them.

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    1. In truth, practicality should guide us. I’m sure many or most of us have seen different starting points for one, compared to another (stabilization first, or engagement/persuasion first, etc). The same can probably be said of the (non-linear) journey. Many thanks for your thoughtful reply.

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