What are Peer Support Specialists? What Do We Know About Them?
Most Americans think it’s difficult to find care for substance use issues. In fact, less than one-third of the U.S. population (28%) lives in an area where there are enough mental health professionals to meet the needs of the population. More people know someone with a substance use disorder (SUD) than ever before, but workforce shortages mean that even those ready for help often face long wait times, or find no resources at all.
Hope can be found in the emergence of peer support specialists (sometimes called recovery coaches, peer workers, or lived experience professionals) who work in the treatment and recovery field. While training and certification requirements vary by state, these roles are united by one core element: lived experience. Peer support specialists draw on their personal (or family) histories with substance use challenges to provide support in a way that is authentic and sensitive to the experience of using drugs and finding recovery.
Since the first state certification in 1999, the peer workforce has grown to over 30,000 individuals working in behavioral health. Specific roles for peer specialists include helping to create recovery plans, linking individuals to services, providing harm reduction supplies, delivering education, supervising other peer support specialists, and less formal assistance, like lending an empathetic ear during a crisis.
Science has investigated peer specialists to better understand how they help others and under what conditions they work best. What has this science told us about peer support specialists? We know a good amount about their ability to improve outcomes for the people they serve, cost-effectiveness of their services, and the workforce challenges they encounter. Much of this work has been described in three recent reviews that summarize the evidence on peers.
Peer support specialists are effective at helping people engage with treatment, but it’s less clear whether they directly improve substance use outcomes. Researchers at Harvard’s Recovery Research Institute1 recently updated their review of evidence of the effectiveness of peer specialists to support individuals with SUD. They found strong evidence that peers are effective at linking people to care and helping them stay engaged, largely due to their ability to “build trust and rapport”. However, the evidence on whether peer support specialists reduce substance use or improve recovery outcomes on their own remains inconclusive. It’s still unclear whether their benefits come from the support they provide directly, or from their success connecting people to additional services.
Cost Effectiveness of Peer Specialists
Peer support specialists seem to be a cost-effective way to address workforce challenges, but the verdict is still out. Castedo de Martell and colleagues2 recently reviewed the economics of peer support, focusing on studies that examined program costs and potential savings. Peer support specialists are generally less expensive to employ than clinicians and, in some cases, have helped reduce costly hospitalizations when working in emergency departments. However, few studies have thoroughly evaluated the overall cost of integrating peer specialists into treatment systems or the long-term financial impact of their work.
Workforce Challenges Faced by Peer Specialists
Employment for peer specialists is rarely easy. Our team,3 recently reviewed studies on the experiences of peer workers and highlighted several common issues. Many peer specialists report feeling misunderstood or undervalued by supervisors and colleagues, often being assigned tasks unrelated to their training or lived experience (like sitting at a desk or filling out spreadsheets). These issues contribute to issues of burnout, high turnover, and persistently low pay across the peer workforce.
What Do We Still Need to Learn?
There’s still a lot we don’t know about how to best support and implement peer specialists. First, we need to understand which roles and responsibilities they are most effective in. That starts with recognizing that peer specialists are not an “intervention” in themselves; they are trained professionals who bring a unique skillset shaped by lived experience, self-reflection, and formal training. Second, we need more accurate data on the costs of peer programs. While peers may help reduce system costs, we also need to ensure they’re paid a fair, livable wage, something many still do not receive. Finally, we need to learn how to support peer specialists as employees. This includes how to best integrate and supervise peers as part of diverse healthcare teams, how inequities in pay and resources affect them, and how factors such as these impact their job performance and personal recovery. A significant step in the right direction that is occurring at Chestnut Health Systems is the use of reflective supervision, which helps peers process job stresses that can lead to burnout and gives supervisors the tools to support their wellbeing.
1. Eddie, D., O’Connor, J. B., George, S. S., Klein, M. R., Lam, T. C. S., Abry, A., Hoffman, L. A., Hennessy, E. A., Vilsaint, C. L., & Kelly, J. F. (2025). Peer Recovery Support Services and Recovery Coaching for Substance Use Disorder: A Systematic Review. Current Addiction Reports, 12(1). https://doi.org/10.1007/s40429-025-00645-8
2. Castedo de Martell, S., Wilkerson, J. M., Ranjit, N., Holleran Steiker, L., McCurdy, S. A., & Shelton Brown, H. (2025). What We Know About the Peer Workforce and Economic Evaluation for Peer Recovery Support Services: A Systematic Review. Substance Use & Addiction Journal, 46(1), 90–102. https://doi.org/10.1177/29767342241281009
3. Bell, J. S., Watson, D., Griffin, T., Castedo De Martell, S., Kay, E. S., Hawk, M., Ray, B., & Hudson, M. (2024). Workforce Outcomes Among Substance Use Peer Supports: A Scoping Review of Individual and Organizational Influences. Frontiers in Public Health, 12. https://doi.org/10.3389/fpubh.2024.1515264