The Historical Emergence of Peer Recovery; Conditions and Contradictions

A Genealogical Reading of Peer Recovery and Present Dilemmas

Last week, I gave a presentation on peer recovery work and the science thereof. Part of that process involved reviewing the history of peer recovery in the modern context. This prompted me to go further and to examine how peer recovery first emerged as a practice on the horizon of possibility around a hundred years ago. I am fascinated by how things appear in the world and by the conditions that make their emergence possible. There are historical preconditions that suddenly coalesce into new realities, and from those coalescing events, we can learn a lot about the present. Peer recovery is no different.

Peer recovery is often described as a moral advance in the history of addiction care, a corrective to clinical distance and an overdue recognition that lived experience matters. While this account is not inaccurate, it tends to flatten the conditions under which peer recovery became possible. A genealogical approach suggests that peer recovery did not emerge primarily because institutions listened more carefully or became more humane, but because existing systems reached the limits of what expertise, discipline, and treatment could accomplish without transforming themselves. To understand peer recovery today, it is necessary to look just before it becomes visible as a formal practice and to examine the failures, contradictions, and pressures that made peer recovery thinkable in the first place.

By the late nineteenth and early twentieth centuries, addiction had become fully absorbed into expert systems. Medicine, psychiatry, and emerging forms of social work had established jurisdiction over substance use, rendering it legible through diagnosis, classification, and treatment protocols. This expansion of expertise produced an unintended effect. As professional authority accumulated, the distance between institutions and subjects grew. Treatment increasingly became something administered rather than negotiated, and knowledge proliferated without producing corresponding gains in trust or in the durability of change. Clinicians knew more about addiction than ever before, yet people continued to cycle through institutions, complying temporarily while remaining unconvinced that these frameworks spoke meaningfully to their lives. Authority persisted, but persuasion weakened.

At the same time, disciplinary systems revealed their limits. Confinement, compulsory treatment, moral reform, and surveillance were expected to correct behavior and produce lasting transformation. In practice, they regulated conduct only while control was present. When institutional pressure receded, old patterns returned. Relapse became a structural feature rather than an exception, signaling that while institutions could manage bodies, they struggled to reshape subjectivity in enduring ways. This recognition quietly destabilized confidence in coercive approaches and created space for forms of influence that did not rely on force or surveillance.

Within these institutional spaces, experiential knowledge circulated long before it was named or valued. Patients talked among themselves, exchanged advice, and developed informal understandings of addiction that did not pass through professional language. Initially, this speech was treated as a threat. It was seen as denial, contamination, or resistance that undermined treatment. Over time, however, it became increasingly clear that people listened to one another in ways they did not listen to experts, and that informal knowledge sometimes sustained change more effectively than formal instruction. Institutions did not embrace lived experience because they valued it intrinsically, but because they could not suppress its effects or ignore its influence.

This development coincided with a broader cultural shift toward narrative forms of self-understanding. Confession, testimony, and autobiography became dominant ways of organizing truth, and addiction became narratable not only as a diagnosis but as a story with a past, a turning point, and a possible future. For peer recovery to become possible, the addicted subject had to be intelligible not merely as a patient, but as someone capable of articulating knowledge about their own condition. Narrative capacity preceded peer authority. Lived experience could become legitimate only when it could be articulated in a form that institutions could hear and recognize.

Progressive reform movements further shaped this terrain by attempting to humanize care while retaining institutional control. Rehabilitation and reintegration were emphasized over punishment, yet addiction exposed a contradiction at the heart of liberal reform. Liberal systems rely on autonomous subjects, while addiction was understood as the erosion or loss of autonomy. This tension could not be resolved internally. The peer emerges here as a third figure, someone who had once lacked autonomy and now appeared to embody its restoration, making it possible to model change without invoking punishment or coercion. The peer did not resolve the contradiction, but made it manageable.

Before peer recovery was a role, it was a function. Recovered or stabilizing individuals were informally relied upon to explain rules, calm conflicts, translate expectations, and encourage adherence within institutions such as hospitals, shelters, temperance homes, and therapeutic communities. This labor was relational, emotional, and often exhausting. It was framed as a moral duty or personal growth rather than recognized as work. Peer recovery did not emerge because institutions suddenly valued lived experience, but because they needed relational labor they could not formally perform or account for within existing professional frameworks.

In the moment just before peer recovery becomes explicit, the figure of the former user who helps others occupies a liminal position. They are trusted informally yet lack authorization, relied upon without protection, and valued without recognition. This instability is not accidental. Peer recovery becomes formalized only when systems decide they need this figure permanently and begin to regulate, credential, and delimit the role. Professionalization arrives as both recognition and containment, stabilizing a function that had already become structurally necessary.

Understanding this prehistory clarifies many tensions that shape peer recovery today. Peers are introduced into already strained systems, not because those systems are complete, but because they have reached their limits. Peer recovery is often framed as an ethical enhancement that humanizes care, and while this is partly true, genealogically, peers function as structural supports tasked with addressing engagement gaps, trust deficits, and cycles of noncompliance that institutions cannot resolve on their own. When peers are treated only as moral goods, they are burdened with repairing structural failures they did not create and cannot fully control.

The informal relational labor that preceded peer roles has not disappeared. It has been professionalized without being fully secured. Peers are expected to absorb emotional intensity, translate institutional logic into human terms, and maintain credibility with clients while operating within system constraints. This labor is now documented and audited, but its costs are rarely addressed. Professionalization risks legitimizing extraction rather than transforming the conditions that make such labor necessary.

Peers derive authority from lived experience, while institutions depend on predictability, standardization, and risk management. This creates a structural tension that is often treated as an implementation problem but is, in fact, rooted in the role’s genealogy. Peers are valued for authenticity while constrained by professional norms, invited to speak while limited to approved narratives, and trusted precisely because they are not professionals, yet evaluated as though they were. These contradictions are not incidental. They are embedded in the conditions that enabled peer recovery.

Historically, peers emerged as translators before they emerged as helpers, making institutions legible to clients and clients legible to institutions. That boundary position remains central. Peers encounter contradictions early and often, carrying ethical strain that systems displace onto them. Burnout frequently follows when peers are held responsible for stabilizing tensions that exceed their authority or mandate.

Because peer recovery originated in response to institutional insufficiencies, it is particularly vulnerable to co-optation. Peers can be used to improve metrics without changing practices, to humanize systems without transforming them, and to manage dissent by absorbing it relationally. This does not require bad faith; it is merely how institutions work. It reflects how institutions preserve themselves. Genealogy reveals that co-optation is not an anomaly but a recurring risk inherent to the role.

If peer recovery is to retain integrity, it must preserve the capacity to unsettle institutions rather than merely serve them. Its most important contribution is not inspiration or role modeling, but epistemic disturbance, the ability to make visible what systems cannot see from within their own logics. This function is fragile and easily neutralized by excessive standardization and narrow outcome measures that prioritize compliance over truth-telling.

The most pressing question facing peer recovery today is therefore not whether it works, but what problems peers are being asked to solve that institutions are unwilling to confront themselves, and what becomes of peer recovery when it succeeds at making those problems temporarily manageable. Remembering the conditions under which peer recovery emerged may be the most important step in protecting its future.