CONSISTENT EVIDENCE AFFIRMING THE PREDICTED HARM OF “PEER SUPPORT”
Vulnerable individuals are recruited, branded, and used as peer “mentors” or “supports” or “support specialists” to help funnel Americans at risk of harm and death into and generate revenues for the lethal, sham addiction “treatment” systems perpetuating epidemics
by Clark Miller
Published September 22, 2021
In West Virginia, whose residents are dying in increasing numbers – not just due to compulsive opioid use but, as in the nation, by increasing problem use of methamphetamine and other substances – reports for success of use of paid “peers” to direct those Americans trapped in worsening substance use epidemics into services rely almost entirely on a single outcome measure: numbers of individuals who engage in traditional “treatment” or treatment as usual (TAU) for compulsive substance use like “rehab” or “Medication Assisted Treatment” (MAT) for problem opioid use. Not evidence of success in avoiding compulsive substance use and associated problems long term, instead funded engagement, often with peers assisting to enroll the new paying clients in publicly funded insurance programs, in the programs that have been providing “treatment” to Americans in increasing numbers over past decades, while rates of problem substance use, deaths and associated illness and healthcare costs mount ominously. And predictably, it turns out.
About 90% of Americans who need treatment for a substance use disorder don’t get it. West Virginia University researchers have developed a program that allows people who have already walked the path of substance use disorder through recovery to be their guides to a healthier life.
In 2017, the WVU School of Public Health responded to this problem by partnering with PSIMED, the WVU School of Medicine, the WVU Collegiate Recovery program, Ascension Recovery Services and the Monongalia County Court System to develop a program to connect individuals who have substance use disorder with peer recovery coaches who can get them the help they need, where and when they need it.
The pilot program they launched—called WV Peers Enhancing Education, Recovery and Survival, or WVPEERS—showed promise. Overall, almost two-thirds of the people that WV PEERS served in Monongalia County (63.9%) accessed services for substance use disorders or mental health problems. More than half (52.3%) entered substance use or mental health treatment. And nearly a third (30.4%) were still in treatment six months later.
Amazing News! Something has been found that “proves effective” in reversing America’s increasingly lethal substance use epidemics. That would be remarkable (astounding) indeed if something as simple (and economical!) as using individuals with essentially no training in the provision of behavioral health services could result in success in efforts to effectively treat Americans trapped in decades-long, lethal substance use epidemics.
The “peer” professionals have little training even compared to individuals constructed as “addiction counselors” or “drug and alcohol counselors” and who essentially form the paid workforce for America’s addiction treatment system. And those “professionals” ? They have levels of training for the treatment of the complex, life-threatening behavioral condition of compulsive substance use that are recognized as grossly inadequate by experts in the field and observers, something that’s been apparent for decades.
In Anne Fletcher’s seminal book “Inside Rehab”, citing information from a comprehensive and damning review and analysis (2012 The National Center on Addiction and Substance Abuse at Columbia University – Addiction Medicine: Closing the Gap between Science and Practice) of quality of provided substance use services she writes that:
“Addiction counselors provide most of the treatment in programs, and “states have widely varying requirements in both educational level and training for a person to become a drug and alcohol counselor. Some states don’t require any degree . . . and many require just a high school diploma, general equivalency diploma (GED), or associate’s degree . . . Although there’s been a movement to professionalize treatment, much counseling still is provided by minimally trained addiction survivors-turned-counselors whose own rehabilitation forms much of the basis for their expertise.”
From interviews with healthcare professionals and other observers in the remarkable new documentary film The Business of Recovery (view trailer below in this post), frank voices like that of Dr. Lance Dodes, author of The Sober Truth:
“The idea that only an addict can treat an addict has led to the rise of thousands of “addiction counselors” whose only credential is their status as recovering addicts. At minimum, this treatment community does a disservice to addicts by practicing therapy without formal education; at worst, some of these recovering addicts may be seriously unfit to perform this work.” – The Sober Truth.
Dr. Dodes notes that Hazelden, the premier treatment center featured in The Business of Recovery on its website encourages individuals “in recovery” (that is, struggling with a substance use problem, to “Become an addiction counselor in as little as one year”.
William Miller is the developer, with Stephen Rollnick of the therapy approach, Motivational Interviewing.
“So we developed this history of providers being people who are themselves in recovery ‒ originally with no educational requirement at all. In New Mexico, we now have a Bachelors degree required to be a substance abuse counselor and it was quite controversial to do that. I don’t know of any other life‒threatening illness where it’s controversial if you should have a college education to treat it, but it has been in the addiction field.”
“If you go to your doctor to be treated for cancer or heart disease you expect your doctor to be doing what the science says is the best treatment available for what you have. That has not been the standard in addiction treatment.”
– William R. Miller, PhD in “The Business of Recovery”
“The even more honest people will tell you that the [treatment] system as it’s currently set up and construed is incapable of ever delivering meaningful and worthwhile service.”
– Rick Ohrstrom, Chairman of C4 Recovery Foundation in “The Business of Recovery”
“There is no mandatory national certification exam for addiction counselors. The 2012 Columbia University report on addiction medicine found that only six states required alcohol and substance-abuse counselors to have at least a bachelor’s degree and that only one state, Vermont, required a master’s degree. Fourteen states had no license requirements whatsoever ‒ not even a GED or an introductory training course was necessary ‒ and yet counselors are often called on by the judicial system and medical boards to give expert opinions on their clients’ prospects for recovery.”
– Gabrielle Glaser ‒ The Irrationality of Alcoholics Anonymous (The Atlantic)
Those observations are about “addiction counselors”, the treatment professionals responsible for diagnosis, clinical formulation, treatment planning, and provision of treatments for the complex, potentially lethal condition of compulsive substance use in America’s substance use system.
They are highly trained, compared to peer specialists.
But none of that matters in the harm-predicting worlds of rehab and other forms of residential and outpatient “treatment” for substance use problems, where paying someone with essentially no effective training in psychology or behavioral health to facilitate “treatment” in groups of 12 or more paying customers makes all the sense it needs to, in a culture lacking accountability and watchdog journalism. The treatment industry and its use of these individuals as employees constitutes a criminal scam, a profit-generating revolving door greased by the fabrication that “addiction” constitutes a lifelong, relapsing disease. For an introduction to one of the only pieces of truth-telling journalism about this lethal scam, watch the trailer to “The Business of Recovery” –
We know that America’s substance use epidemics are worsening, have been over past decades, with mounting deaths despite decades of assurances from the medical/media complex of cures just around the corner, as long as additional billions of public health funds are provided them, and despite increases over decades of capacity for and provision of treatment as usual (TAU). See, for example, here and here.
If peer support is effective and successful, then claims for that benefit should be supported by some outcome measures that demonstrate reductions in numbers of Americans developing substance use problems, or dying from them, or suffering harm from them.
Right. Ha! That would be funny, if it weren’t tragic and a criminal outrage. Because instead, the outcome measures of success – necessarily so to avoid consistent measure of failed outcomes – are indicators that with the help of peer professionals Americans who desperately need effective treatment are instead funneled into the same harm-predicting systems that for decades have been contributing to the mounting deaths and public health costs. The necessity, of course, for recruiting and paying “addiction counselors” and “peers” instead of professionals with real training and clinical and ethical competence in the related fields, is to ensure that from within the systems, there is little enough understanding or awareness of the ineffective practices, protective fabrications and lack of credible, evidence-based approaches, delivered competently, to pose risk of exposure. Little enough understanding and less motivation to risk loss of a monthly paycheck for individuals whose training and competence would have little value in competitive, rather than protected, cronyism settings.
So instead, the measures for success of use of peers are, as in the West Virginia report, recruitment of Americans in need of real, effective treatment, into the highly profitable, lethal systems helping drive America’s substance use epidemics. “Success” that is a measure of predictable harm. It has been established for decades that TAU is ineffective, and we know exactly why. Peer supports are, of course, hired, employed, and paid by the “treatment” programs whose existence depends on keeping a steady stream of vulnerable, trusting and naïve substance users in the system.
The constructed role of “peer” professional is a natural and integral outcome of the history and evolution of America’s substance use treatment system and industry, tied tightly to the influential role and participation of hired professionals in the religious subculture Alcoholics Anonymous (AA). Practically, the protective understandings and preferences continue to result in programs functioning at times as closed shops and sheltered workshops. The tight loyalty developed among acolytes in “the program” and admonitions that success in sobriety requires “giving it back” to fellow acolytes in need has cultured the protective infiltration of the profession and design of systems. And the American treatment industry has been driven by implementation in treatment programs of the, typically primary, application of the 12-Steps and AA treatment prescriptions as programming. That’s despite AA and its prescriptions being established for decades as not constituting an evidence-based form of treatment at all, instead its practices and prescriptions countertherapeutic and predicting increased risk of return to problem substance use.
See this recent post for a more detailed consideration of peer support in substance use treatment and “lived experience”.
Here’s how one program cashing in on the manufactured position of “peer support specialist” describes the duties and responsibilities of the work, inviting potential employees to pay for training to become credentialed.
Responsibilities of a Peer Support Specialist Job
A peer support specialist is dedicated to improving the lives of their clients in a variety of ways:
- Devising recovery goals
- Formulating action plans
- Helping clients learn life skills
- Teaching coping strategies and techniques
- Nurturing client strengths
- Crisis management
- Fostering community relationships
- Locating and connecting clients to local services
- Connecting the client with career services
You’ll be a friend and mentor to your clients, with an active caseload of 10-20 individuals being expected. You may organize and run support groups as part of your role.
After identifying the areas that your client has the most difficulty with, you can work on these goals first. An isolated person who suffers from depression may need support getting out into the community more. As a role model for your client, you’re living proof that they can achieve their goals, and you encourage them to stay the course.
Let’s take a cursory look at this.
Devising recovery goals
Formulating action plans
That is a description of what is known as “treatment planning”, a core and ongoing challenge of professional development for behavioral health professionals that begins over the course of a graduate education. It is challenging because for the formulations to be effective – that is, to provide benefit instead of harm – requires clinical insight and skills to transform complex client histories and mental health profiles into clear understandings of vulnerabilities underlying the compulsive behavior (“addiction”) and to accurately apply the appropriate evidence-based therapies and supports. Implementation of the idea that someone with the training provided to be a peer support (or an addiction counselor) would be within scope of practice for this challenge represents criminal negligence.
In a tragic and lethal way though, that description and assignment of responsibility is perfectly apt and fitting within current, harm-predicting “treatment” settings, for TAU, where treatment planning is to a large extent pre-determined by the peer and other professionals with loyalty, “lived experience” and retained enmeshment “in recovery”, that is, in the world of AA meetings in which you see your addiction counselor at the AA meetings that your peer mentor makes sure you get to. Treatment planning is easy and ensures that you’ll be back in the system, again and again: get to “your meetings” of AA (“90 meetings in 90 days”); get a “sponsor” (someone to work you through the bizarre, countertherapeutic 12 Steps of AA); and go to group therapy sessions at your community treatment program – group therapy never supported as effective treatment for compulsive substance use.
You’ll be a friend and mentor to your clients, with an active caseload of 10-20 individuals being expected. You may organize and run support groups as part of your role.
That sounds very much like what an AA sponsor does. Because it is, and with the same predictable results.
In any legitimate behavioral health program or organization, an interviewee for a position as therapist, case manager, or other position in direct practice with clients, offering in the interview that they see part of their role as becoming “a friend” to their clients, would be eliminated from consideration for employment on that response alone. This isn’t the space to lay that out, explain it, to explain what should be obvious.
In the distant, invisible world of actual treatment – evidence based therapies that are effective for compulsive substance use – “support group” is not a thing; there is no form of effective treatment that remotely is represented by what happens in “support groups”.
The evolution of American treatment systems driven by cronyism and identification with the bizarre, countertherapeutic practices of a religious subculture is congruent with the gross violations of clinical and ethical standards of practice represented by those peer professional training and certification promises and descriptions of job duties. That’s because at base, it’s all the same self-serving system and points to and represents something fundamental: that the cultural and institutional construction of a fictional professional role as a “peer” is not related to the needs of problem substance users, or America’s raging lethal drug epidemics, or treatment approaches for substance use at all, instead meets other, more important needs. “There’s limited research to prove peer support is effective for addiction“, but that’s irrelevant, that’s not the point –
FUNCTIONS AND VALUES OF THE CONSTRUCTED FICTION OF “PEER SUPPORT”
The manufactured position provides sheltered employment for individuals within an organized cronyism system tied to the religious subculture AA and euphemized as “Recovery” – strengthening the lock that system has on public treatment funds
Those preferentially-hired, vulnerable individuals are exploited to funnel at-risk Americans and their insurance payer and public funds into sham treatment systems including “rehab”, community mental health, “addiction treatment” programs, and MAT
Multidisciplinary programs can deceptively point to hired peers as rehabilitative success of their sham treatments, while lethal epidemics worsen
The manufactured employment positions provide revenues for “education programs” providing the sham training for sham services
Hiring peers and addiction counselors enmeshed in histories of “recovery”, AA, and TAU – who depend on the stability of those systems for their monthly paycheck – filters out individuals with the advanced education and training to much more likely lead to observation of, objection to, and reporting of the grossly negligent and harm-predicting practices of those systems
That’s how it works.
Everyone gets a piece of the pie, of the private and public healthcare dollars. Everyone gets something, except the substance users funneled into and trapped in America’s worsening, lethal epidemics and revolving door of harm-predicting “treatment”.