Peer recovery programs are an integral part of addiction treatment, recovery

I still remember the charge nurse looking at me when I walked into the hospital four years ago for my first assignment as a peer recovery specialist.

“Hey,” she said. “Are you the overdose guy?”

I nodded.

She pointed me toward the far corner of the emergency department, where a man lay in a hospital bed. “He’s a real winner,” she said wryly.

I glanced over at him, paused, and replied, “Once upon a time, I was that winner. The only difference between him and me was that I was also handcuffed to the bed.”

When I think back on that night, I realize how much progress we’ve made in increasing access to addiction treatment and support services. I also think about how much more work we have ahead of us in combating the opioid epidemic, which has been overshadowed but made worse by the coronavirus pandemic.

More than 40 states have reported increases in opioid-related deaths in 2020. In my home state of New Jersey, the overdose death rate was 17% higher in the first half of 2020 compared to the first half of 2019.

It’s evident that something has to change, and peer recovery programs are an important part of that change. Created to holistically serve patients, these programs combine personalized peer support and medical treatment to address substance use disorders. The peer recovery specialists who staff these programs are individuals who have personally experienced addiction and who have been in recovery for four years or more. They have been where their patients are, and have felt what they are feeling.

I work with RWJBarnabas Health, New Jersey’s largest academic health care system. In our system, and in others like it across the country, peer-delivered support is associated with an improvement in recovery outcomes. Peer recovery specialists draw on their unique experiences and personal understanding of addiction to engage with individuals who are often on the brink of desperation and show them firsthand that there is a way out.

As a person in recovery who became a peer recovery specialist, and who is now the assistant director for recovery support services, I know from experience that the decision to implement a peer recovery program is just one piece of the puzzle. But it’s an important piece.

My first weeks working in a hospital were defined by a sense of stigma and inferiority. There I was, a high school dropout with a GED who worked construction in Manhattan and who had spent 15 years battling addiction, surrounded by people who had spent many years in school and on the wards, honing the craft of healing others. They called me the “overdose guy,” and even though I was open about my journey and open to discussing it, that wasn’t easy to hear.

It was a rocky transition. But those initial connections with nurses and doctors eventually became meaningful relationships. We learned from each other, and we continue to do so every day. For peer recovery specialists, being vulnerable and sharing our stories allows us to change the narrative surrounding substance use disorder.

Because this kind of program is built on relationships, it can be difficult to establish — particularly during a global pandemic. How do you empower people from all walks of life, each with a personal understanding of addiction, to engage with highly trained doctors and nurses and feel equally valued? How do you create an environment of mutual respect where recovery specialists and medical staff learn from each other’s methods and skillsets? How do you take a recovery specialist’s empathy and personal life experiences and transform them into a clinical treatment protocol?

At RWJBarnabas Health, peer recovery specialists have not only been valued, but have also been given a seat at the table. We have helped our medical colleagues humanize statistics, providing context to care for patients who, frankly, can be incredibly challenging. We conduct system-wide presentations, attend department meetings and nursing huddles, and interact with patients at their bedsides. After only four years, our team of more than 90 full-time peer recovery specialists has become an integral part of the clinical care team.

This approach to recovery has helped expand and enhance treatment services for patients. It has also begun to reduce the stigma associated with the disease. When doctors work alongside someone who was once trapped in active addiction, they see the underlying truth: that no one suffering from substance use disorder planned to be in that situation or wants to be it, whatever it may look like at the time.

Throughout the pandemic, our team has been challenged in ways I never could have predicted. The peer recovery model thrives on social interaction and connection — components that were completely upended this year. But in addressing our new circumstances, we’ve strived to maintain a sense of community. We’ve donned PPE and continued to engage with patients at their bedsides, speaking hope in their darkest moments. In-person meetings have transitioned to virtual recovery meetings, and text messages have become a new go-to. Telehealth has been a lifeline — rather than directing patients to the nearest hospital, we’ve been able to offer resources over the phone, helping with everything from housing applications to insurance forms.

We’re learning and adapting, figuring out how care for substance use disorder should look, both now and in the future. There’s no replacement for a hug or a handshake, for just spending time with people. But some of the Covid-19 restrictions that have limited our ability to gather in person have actually expanded the reach of our program. People who were previously unable to attend meetings because of transportation constraints or child care responsibilities now find support through a phone or video call. At our virtual All Recovery meetings, we reach more than 3,000 attendees per month, four times our average from before Covid-19.

As the program continues to evolve, our numbers continue to grow. We have experienced increases in the number of patients who accept care, the number of patients in recovery, and the number of clinicians who have changed how they treat patients with substance use disorder. But it’s the stories behind the numbers that propel what we do.

A few months ago, I connected with a patient who would have otherwise fallen through the cracks. He was from out of state and he was out of money. He didn’t have an ID or insurance. He was also on buprenorphine, which made securing safe housing a challenge, since about 90% of New Jersey’s sober-living facilities don’t allow patients taking medication to control substance use disorders.

Using phone, text, and video, and working with peer navigators to provide practical resources, we were able to find support for him. I met him in person at one of our hospitals, and was able to find funding for his medications until his New Jersey Medicaid became active. We found him a place to live, and made ourselves available 24/7. He’s in a safe place now and, more than that, he’s on our radar for the future.

Even during a pandemic, recovery is a long-term journey that requires community. Now more than ever, peer recovery specialists see every day that what we do matters. The hospitals and health systems that have made the decision to integrate peer recovery into their facilities see that, too.

Eric McIntire is assistant director for recovery support services at the RWJBarnabas Health Institute for Prevention and Recovery in Eatontown, N.J.