THE LETHAL LIE OF “PEER SUPPORT” FOR PROBLEM SUBSTANCE USE (“ADDICTION”)
The real, observable role of paid peers is to funnel at-risk Americans needing real treatment, along with their healthcare dollars, into sham, failed systems that generate continued substance use, harm, and profits
by Clark Miller
Published October 11, 2021
From the National Public Radio story –
The idea of using peers to help people in recovery is gaining wider acceptance around the country in places battling addiction.
“The bottom line is that peers can help improve treatment outcomes,” says Tom Hill, senior adviser on addiction recovery with the federal Substance Abuse and Mental Health Services Administration.
His agency promotes peer support as a tool for recovery, and supports peer support programs with grants. “Peers can help a person really develop what a life in recovery entails in terms of a full and meaningful and productive life,” he says.
People entering recovery may be lacking certain life skills they need to build themselves back up: resume building, looking for work, scheduling and keeping appointments, exercise or nutrition. Peer support specialists — who are trained and credentialed by the state — can assist with all of those skills.
The primary provided rationale to employ – often with public funds – peer support specialists in programs providing addiction treatment services is that they are individuals who, as demonstrated by their stopping use of addictive substances for a year or two, 1) serve as inspiring and motivating models of success in overcoming compulsive substance use and 2) have the knowledge, skills, and “lived experience” to help others do the same.
There are exceptions within this model.
If the substance of abuse is the substance whose abuse and health effects and public healthcare costs eclipse those of all other substances combined, then modeling by peer supports of continued abuse leading to high risk of illness and early death by the peer support specialists is overlooked as if it were not happening. And, if the substance of abuse is arguably our culture’s second most lethal and costly – the substance whose abuse and associated public health costs, addictive potential, and mortality (about a half million Americans each year) eclipse those costs for all illicit drugs combined – then again, exceptions are made: modeling of abuse of that substance by peer supports is supported or enabled, as is one of the primary job responsibilities of peer supports of ensuring that those they are helping are regularly placed in settings where abuse of that substance – unfortunately a gateway drug for alcohol and opioids – is socially reinforced, ritualized, and often encouraged. That substance of course is nicotine, most commonly administered by peer supports and those they are helping “in recovery” by inhalation using commercial tobacco cigarettes, at the meetings of the religious subculture Alcoholics Anonymous. At those meetings that peer supports are trained and paid to take their clients to, they will more likely than not be rewarded socially for continuing to engage in addictive use of arguably the most addictive and lethal substance among those driving America’s lethal epidemics. That bears repeating – the substance nicotine, inhaled by use of cigarettes, an established gateway drug for return to problem use of alcohol and opioids.
Okay, whatever! Lighten up!
Here’s a typical image representing peer specialists and peer support of the type found by an online search (this image near the top of results in a search for “peer support addiction recovery”) and used for branding and in support of the practice, use and employment of peers, found in an internet search –
So fun, so healthy, so happy!
Here’s another from the same search –
Cool! Active, healthy! Fit!
What could be wrong with that?
But those images look very little like actual peers
typically encountered in real treatment industry settings, interacting with their clients. Here, pictured below, are some of those real peers who are being trained to become paid peer supports. An even more accurate and journalistically responsible image would picture such peers realistically engaging in their responsibilities, inside “the rooms” i.e. at meetings of the religious subculture AA (or NA), or outside during a break, smoking tobacco cigarettes with their clients and others at the meetings, including, more likely than not, addiction “treatment professionals” who work for the local rehab or treatment program and who also are “in recovery”.
“They lead a few of their own classes in a small building next door. They drive each other to off-site meetings for Alcoholics Anonymous and Narcotics Anonymous.”
From a personal professional history that spans almost two decades with direct or indirect involvement within addiction treatment services and community mental health programs, I can say that the caption expresses accurately and generally a primary role of paid peer supports – transporting, encouraging, and otherwise ensuring that their clients get to regular meetings of the religious subculture AA (or NA) at least weekly if not daily in frequency. As explained below and in prior posts, it’s been established for decades that engagement in the bizarre, countertherapeutic prescriptions, practices, and traditions of those meetings predicts return to problem substance use, that is, predicts harm.
In 2013, I helped create the first community recovery center in southern New Jersey, one of only a handful of recovery centers in New Jersey at the time. Heather Ogden-Busch was one of the first people we hired at the Living Proof Recovery Support Center in Voorhees, NJ. At the time, because she had many years of sobriety and experience in sponsorship [in the AA religious subculture] , she naturally fell into the role of a peer recovery support specialist, or recovery coach (emphasis added). On Heather’s first day at the recovery support center she received a call from a member of her 12-step group.
. . .
Within one day, Heather had scheduled an intake appointment for Beth at a detox hospital in New Jersey. Beth would also have a bed reserved for her at a Christian-based treatment center in Brooklyn, NY, if she successfully completed detox. Luckily, Heather knew of another treatment center, also faith-based, in Chicago, with the financing available for the treatment as well as funding for the airplane flight.
. . .
Beth was not particularly religious, but knew she needed treatment and agreed to go to detox then to treatment in Brooklyn.
. . .
One week passed, and Beth was being discharged from detox. Unfortunately, the Brooklyn treatment center did not have an immediately available bed, but Beth was next in line for a bed as soon as it was available, in a few days. . . . Beth had escorts to every NA and AA meeting in the area.
That “Beth”, who was “not particularly religious” would be actively shepherded into “Christian-based” and “faith-based” treatment programs, then escorted to meetings of a religious subculture that predicts failure with about 90 percent confidence and predicts reinforcement of continued addictive, potentially lethal use of tobacco cigarettes tells us about all we need to know about the pathology and lethality of the peer support model. The terms “Christian-based” and “faith-based” for substance use “treatment” programs are, of course, oxymorons – there is nothing evidence-based or predicted to be effective or beneficial – not remotely – about the established-as-countertherapeutic bizarre prescriptions of the 12 Steps of the AA religious subculture and similar programs. That’s congruent with the 90 percent failure rate, appearing to be higher failure risk than avoidance of such programming i.e. compared to natural rates of individuals stopping problem substance use on their own.
It’s fortunate for those West Virginia peer specialists in training that the exceptions described prevent their modeling of problem substance use from being a barrier to their publicly-funded trainings and employment. Because from appearances, their training program hasn’t been effective in helping them become competent – competent enough to serve as models and advisors to help others – with exercise, diet, nutrition, with control of compulsive use of substances. They clearly are challenged by arguably the most costly and harmful substance use disorder Americans are increasingly trapped in: Food Use Disorder, leading to obesity, related health and mortality risks including diabetes and cancer, increased deaths and public health costs, problems with physical functioning. The associated risk of diabetes and physical harms and impairments will pose risk for effects on their ability to retain employment and function effectively. As with any substance use problem but especially for food use disorder, their inability to manage compulsive behaviors – impairing ability to model healthy versus harmful use of food – directly impairs their capacity to function effectively as parents versus modeling harmful and potentially lethal food use behaviors. The modeled behaviors and their health effects will continue to sap public healthcare dollars that could be used otherwise for prevention or to provide real (evidence-based) treatments for compulsive food use and other of America’s lethal substance use epidemics.
If the enormously costly, potentially lethal substance use disorder – Food Use Disorder – that these peer support specialists in training are modeling for their children and future clients is arguably America’s most costly substance use epidemic (it is), then these soon-to-be-publicly-funded addiction treatment professionals are as directly involved in supporting engagement of those they are paid to help in America’s second most lethal and costly public health epidemic – compulsive use of tobacco by smoking cigarettes, or Nicotine Use Disorder, the “addiction”, with about a half million deaths per year, that eclipses lethality and health costs of all other (excluding food) substance use disorders combined. Like other peer support specialists generally, as integral part of the culture and treatment industries they will work in, they will directly model, support and increase risk of their clients continuing or initiating compulsive use of nicotine by immersing them in regular meetings of the religious subculture where that behavior is socially reinforced, ritualized, and typically encouraged – Alcoholics Anonymous, or Narcotics Anonymous. As described in the news piece for these particular peer supports in training, “They drive each other to off-site meetings for Alcoholics Anonymous and Narcotics Anonymous.”
An essentially overlooked social and public health pathology and cost
of AA and 12-Step religious subculture are the messages to acolytes attending meetings that normalize, enable, and reward continuing problem substance use, “addiction”, of arguably the most addictive and lethal substance sapping public health funds – tobacco.
Exposure to meetings of those religious subcultures places vulnerable individuals in settings where continued addictive use of tobacco is promoted by:
– Normalization of smoking as something other than problem substance use
– Celebration of tobacco dependent individuals as “clean and sober”
– Ritualized group use of tobacco at meeting breaks, providing social reinforcement
– Exposure to psychological associations, “triggers” for continued use
Paid peer supports are, by virtue of their facilitation of addictive use of nicotine by those they are paid to help, part of a hallowed tradition. Founder of AA Bill Wilson died an early death due to his continued abuse and modeling of use of nicotine by smoking of tobacco cigarettes, and encouragement of that addictive use of tobacco is prescribed in the sacred writings of the AA religious subculture. Wilson modeled that tradition for AA members worldwide, as well as the living tradition of “13th-stepping” – the sexual exploitation of vulnerable women coming into the subculture, by men like Wilson with status in the program.
But who would dare complain, criticize Americans “working a spiritual program” in AA, a hallowed piece of American culture lionized, normalized, celebrated and idealized for decades in American popular culture, corporate media reports, entertainment?
Question or criticize those spiritual followers of Bill Wilson, proudly identifying as “in recovery”? Like the real addiction professionals I’ve known and observed, earning a monthly paycheck employed in America’s addiction treatment industry as certified addiction counselors, supervisors, managers of programs serving Americans at risk of harm and death, trapped in compulsive substance use. Like Brian, Joe, Doug, Jay. God bless them.
And God bless and help the untold victims of their pathological levels of gross incompetence, ineptitude, disordered behaviors, and entitled, benighted reckless posing as competent professionals.
But really, who can complain about those complications that are part of the provision of peer support when – as explained by one of America’s leading addiction experts, Tom Hill, senior adviser on addiction recovery with the federal Substance Abuse and Mental Health Services Administration – peer supports are “here to stay. There’s evidence on the ground that they help and the field has reached a point of maturity, in terms of training and support”.
Should it really matter that, “There’s limited research to prove peer support is effective for addiction” (actually none) when peer supports are being funded already, “here to stay”, the evidence “on the ground”?
[Wait . . . effectiveness of peer support is not supported by a body of research? – Like effectiveness of opioids for chronic pain was never supported? Like the promotion by mass media, American Medicine, and the FDA of vaping as a great idea for harm reduction and smoking cessation was never supported ? Like American Medicine’s “fix” for American Medicine’s opioid crisis has never been supported? – But it’s gaining support anyway? Increasingly applied to vulnerable Americans trapped in substance use epidemics? And paid for, with public healthcare funds? Are we in a blog post or in a really, really bad dream?]
It would be hard to make this kind of stuff up, right? As in a tragic and darkly amusing parody of America’s addiction treatment system and the useful idiots promoting it? But no need to make anything up, the parody is what’s real, as real as an overdose. As real as the 93,00 deaths of Americans by overdose last year. As real as Bill Wilson’s death by cigarette smoking. As real as the 85 to 95 percent certainty that individuals exposed to AA – to the established-as-countertherapeutic, inane prescriptions of that bizarre religious subculture – will return to problem substance use, to “addiction”.
It’s also the next step in treating addiction like a disease, Hill says. “Addiction is a chronic condition like hypertension or diabetes or any other thing that needs management,” he says. And peer support specialists can be a cost-effective approach to working with people over a long period of time to help keep their lives stabilized and prevent relapse.
But few states are funding peer services for addiction recovery, at least not through Medicaid. Back in 2007, the Centers for Medicare & Medicaid services encouraged states to start funding peer support as a part of both mental health services and substance abuse treatment.
While more than 30 states have started paying for mental health peers, Hill says only a handful pay for peers to help with addiction. Missouri is not one of them.
Hill says that historically Medicaid programs have reimbursed for mental health treatment but have covered substance use disorders much less consistently.
There’s limited research to prove peer support is effective for addiction, something Hill says the agency is working on providing.
In asserting and explaining here in the NPR piece that there is a condition, “addiction”, that is a type of disease that is chronic, and that individuals with the training and background that qualifies them to be peer supports are qualified to provide management for that disease – Mr. Hill is effectively representing the types of job duties, competencies and critical roles in America’s addiction treatment industry performed by dangerously confused and unthoughtful professionals.
Actually, it’s been inaccurate of me to suggest
that there is a lack of evidence bearing on the question of effectiveness of peer support.
There is extensive related evidence for evaluation of effectiveness of the peer support model – from the AA sponsor model of peer support, a model that has for decades exposed substance users to and provided them essentially the services that peer support specialists will be publicly funded to provide – but for free in AA.
A “sponsor” in the AA religious subculture is someone who has been in the program a year or two and stopped use of alcohol or an illicit drug while, almost predictably, continuing abuse of tobacco and/or food in ways that predict illness and early death as reliably as continued use of other substances would have.
Like publicly-funded peer supports, the main roles of AA sponsors are to ensure that those they have taken on get to meetings of the subculture; that the sponsor is available to respond to day-to-day needs, helping with “everything possible, within the limits of personal experience and knowledge, to help the newcomer get sober and stay sober”.
How effective has the quintessential, decades-old prototype AA peer support system been, having recruited and served millions of addicts over the past 5 or 6 decades?
Failure rates (rates of individuals recruited into AA and returning to problem substance use) reliably are estimated at somewhere between 85 and 95 percent. But those figures and data are grossly inaccurate as measures of success/failure rates for problem substance use. That’s because they are based on the extended abstinence versus return to problem use of alcohol, the substance exclusively focused on in the religious subculture Alcoholics Anonymous. If the 5 to 15 % of recruits remaining abstinent from alcohol and associated with the AA program were also evaluated for continued addictive use of the substance they are socially rewarded for and often encouraged to use at those meetings – addictive use of tobacco by smoking, predicted to pose equal or greater risk of illness and death than the alcohol they have given up – then “success” rates in any meaningful formulation would, with certainty, be in the range of 5 to 1 percent or less.
In any case, the range of 5 to 15 % success for problem alcohol use for individuals recruited into AA appears from available evidence to be lower than the rate for natrural remission for problem alcohol use in natural settings, with no use of supports or treatment – that is, from available evidence, exposure to meetings and associated programming in the AA subculture predicts higher risk of continued problem use of alcohol than staying away from AA.
This result, it turns out, was predictable based on longstanding evidence from the fields of psychology, human behavior, and research related to compulsive substance use.
That is, as established for decades, involvement in America’s prototypical peer support system predicts at best no benefit related to problem substance use, more likely harm to Americans trapped in American Medicine’s worsening epidemics.
“Some programs even employ state-certified peers, to coach or mentor people at various stages in the recovery process.”
Indeed they do. AND WE KNOW THAT THE PROGRAMS, THE SECURE EMPLOYMENT OF THE STATE-CERTIFIED PEERS, AND PUBLIC FUNDS USED FOR THEIR SALARIES WILL NEVER END, BECAUSE THERE IS NO END POINT FOR THE “RECOVERY PROCESS”, NO POINT AT WHICH THE PEER OR THE DISEASED ADDICT HAS RECOVERED, IS NO LONGER IN NEED OF THE GROWING ARMY OF RECOVERY “PEERS” AND THE PUBLIC FUNDS PAYING FOR THEIR SERVICES. BECAUSE, OF COURSE, THE SUPPORT WILL BE NEEDED INDEFINITELY for the chronic disease.
“It’s also the next step in treating addiction like a disease, Hill says. “Addiction is a chronic condition like hypertension or diabetes or any other thing that needs management,” he says. And peer support specialists can be a cost-effective approach to working with people over a long period of time to help keep their lives stabilized and prevent relapse.”
As the “addicts” will learn, as they are instilled with their “addict” identities at the AA and NA religious subculture meetings they will be driven to by their publicly-salaried peer support specialists, Once an addict, always an addict, in the lifetime they will face of chronic relapse and recovery – “recovery” that in fact, perversely, criminally and lethally predicts and drives relapse in America’s persistently worsening substance use epidemics.
In ways that are sick, lethal, and criminally malfeasant, it is in fact fitting and accurate that paid and publicly-funded “peer support” is something whose time has come.
For those trapped in American Medicine’s worsening epidemics, all that’s left, in a perfect triumph of pathological incompetence, profit and death, cowardly maleficence and vice, will be to provide public funds to pay “peer specialists” to drive those trapped Americans to their meetings.
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
Programs can deceptively point to hired peers as rehabilitative success stories (“They’re employed, in healthcare!”) 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, excludes, individuals with the education, training and ethical development to see, object to, and report the grossly negligent and harm-predicting practices of those systems