Strengthening the Peer Recovery Workforce: Recommendations in Response to the Office of National Drug Control Policy’s Priorities

Introduction

The United States has experienced a remarkable rise in peer recovery support services (PRSS) for substance use disorder (SUD) over the past 25 years, ¹ supported by the emergence of peer certification, new funding streams for reimbursement, and the integration of peer specialists into a growing number of care settings.^2-5 Most recently, this growth has been reinforced by federal interest in expanding the workforce. In 2026, the U.S. Office of National Drug Control Policy (ONDCP) called to “expand and enhance the Nation’s (PRSS) workforce and organizational infrastructure,” ⁶ signaling continued national investment in scaling peer-delivered services. However, this call for expansion comes at a time when the PRSS workforce is under increasing pressure to conform to clinical models of care. Concerns about fraud and role clarity have led some states to emphasize clinical supervision structures and certification models patterned after professional licensure,^7-9 contributing to role drift toward clinical duties and the erosion of peer-specific values. These developments raise an important question: as policymakers seek to expand the peer workforce, how can the field avoid repeating historical patterns in which recovery support roles become absorbed into clinical paradigms, weakening the distinct contributions of lived experience?

In this commentary, we argue that social movements which birthed PRSS historically emphasized nonclinical, nonhierarchical, and person- and community-centered care, and these values should serve as a guide for contemporary workforce expansion, helping ensure that growth strengthens rather than dilutes the unique and clinically complementary role of peers in SUD care. We offer specific policy recommendations drawn on a narrative synthesis of historical, review of contemporary policy, and the authors’ collective experience as researchers and participants in workforce development initiatives.

Peer Support as a Social Movement

Professional peer support was born of 2 modern advocacy movements: the psychiatric survivors movement in mental health and New Recovery Advocacy Movement (NRAM) in the SUD field.^10-13 In the 1960s and 1970s, the efforts of former mental health service recipients (calling themselves “survivors”) and allied social workers brought to light the poor conditions of psychiatric institutions, which stripped patients of their rights and put them through abuse by clinical staff.^14-16 Survivors and their allies fought and won battles for deinstitutionalization, secured protection of patients’ rights, and introduced services operated by people with lived experience. ¹⁵ In 1986, the first professional peer roles (“consumer case aides”) were introduced in care settings in Colorado, and by 1999, Georgia requested and received the first state-wide Medicaid reimbursement for peer support services.^17,18

There was just as significant a social movement in the SUD field to champion peer support. Specialty addiction treatment emerged and grew rapidly from the 1950s to 1970s, and people with lived experience initially made up much of its workforce.^19,20 Nearly 70% of addiction counselors in the early 1970s reportedly had personal recovery experience, ¹⁰ but increased medicalization of SUD treatment and funding expansion encouraged a shift toward standardization and higher qualifications. ²⁰ As a result, recovery representation declined to about 30% of counselors by the 2000s. ¹⁰ Representation would be key for NRAM, a grassroots reaction at the turn of the 21st century to perceived failures of SUD treatment systems.^4,21,22 Like mental health advocates, NRAM leaders supported shifting the goal of treatment toward “long-term recovery.” This shift was reflected in the emerging framework of Recovery-Oriented Systems of Care, which emphasized mobilizing recovery support resources beyond acute treatment. ²³ Within this vision, peer roles were designed to bridge professional treatment systems with nonprofessional recovery communities, and NRAM produced some of the earliest designs for professional peer support roles, emphasizing values to distinguish PRSS from traditional services.^10,24,25

What were these values, and why were they emphasized? PRSS were to be nonclinical, as outlined by NRAM-era trainings and publications.^10,26,27 This boundary was not intended to position peers in opposition to clinical care, but to define a distinct contribution alongside it. As early leaders noted, peer-based recovery support services were intended to complement professional treatment, enhancing engagement and helping sustain recovery beyond formal care. Where clinically oriented SUD services often focus inward on treating trauma and intrapersonal concerns, PRSS were to focus outward, linking people in or exiting treatment to resources and relationships in the community that support long-term recovery. ¹⁰ PRSS were to be nonhierarchical or mutual, where peers saw themselves and delivered services in a way that reflected equal power between them and service recipients.^24,27 PRSS were not to involve enforcing compliance or conducting surveillance. Finally, PRSS were to be person- and community-centered, with support and “respect for diverse pathways and styles of recovery,” and appreciation for the role of community within the recovery process.^24,27 Abstinence was not to be the one and only goal, nor 12-step the only pathway. The earliest trainers of the professional peer workforce (eg, the Connecticut Community for Addiction Recovery) explicitly instilled these values into their curricula as lessons from the addiction counseling workforce.^24,26 NRAM advocates believed that over-professionalization had trained out the very qualities that had made peer-based SUD counseling originally effective. ¹⁰ They sought to avoid re-creating a bureaucratic and standardized workforce and keep PRSS focused on promoting long-term recovery.

Recommendations to Strengthen the PRSS Workforce

While the ONDCP call to strengthen the PRSS workforce is a symbol of progress, there are signs that this push threatens to replicate issues that negatively impacted addiction counseling. Peers increasingly work within clinical and regulated service environments, ²⁸ where their roles can complement and improve traditional treatment. Yet these same environments also create conditions where role boundaries can blur. Peers report they are increasingly expected to perform clinical, hierarchical, and nonperson- and community-centered duties: providing psychotherapy, collaborating in surveillance (eg, urine analysis), endorsing specific recovery pathways, and completing regulatory paperwork.^3,29,30 More alarming are examples like Kentucky, where licensure requirements for peers were recently introduced, structured on the licensing of professional counseling. ⁷ Without clear role protections, workforce expansion and integration into clinical systems may unintentionally produce scope creep, and we would again lose the value of a workforce with an intentional focus on shared lived experience and mutuality. Ultimately, the pressure to become more clinical threatens the willingness of individuals receiving care to trust and work alongside peer support workers.

If the current administration is interested in strengthening and expanding the PRSS workforce, it must support funding and policy informed by historical values meant to maintain the unique value of peer support.^3,31,32 We recognize that these values risk being lost within systems governed by reimbursement and regulatory requirements. Integration into such systems brings pressure for adaptation and trade-off. However, historical examples such as the labor movement suggest that foundational values can still function as guideposts for shaping policy and practice, even as roles evolve across different service environments. ³³ Seeking to preserve the founding values of peer support, we offer 2 overarching recommendations for future peer workforce development (recommendations summarized in Table 1):

Strategies are needed to engage employers and incentivize proper structuring of the peer role. We suggest the following funding and policy directives to support a role definition consistent with peer values:

Given the shared emphasis on community linkage, it is tempting to merge PRSS into broader health workforce roles such as CHWs, ⁴⁸ particularly as payment models seek standardized roles. While CHWs and peers may share functions such as outreach and system navigation, PRSS bring distinct forms of lived recovery expertise that could be lost in a generalist health role: mutual identification grounded in personal recovery experience, credible hope about the possibility of long-term recovery, and intimate knowledge of recovery-specific resources such as mutual aid and recovery housing.^49,50 These capacities allow peers to engage individuals with high addiction severity and low recovery capital who may not be well served by generalist health roles, and to link them to recovery communities that sustain long-term recovery beyond formal treatment. ⁵¹

To strengthen the peer workforce in ways that honors its origins, policy must support peer-led professionalization efforts while simultaneously protecting the community-rooted nature of peer support. These dual aims are necessary to prevent co-optation and to ensure that peer roles remain grounded in the values and social connections that made them effective in the first place. We offer the following recommendations to advance these goals:

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Table 1.

Peer Workforce Recommendations.

Problem identified	Policy and funding recommendations
Role drift driven by employer expectations rather than peer training or certification standards	Incentivize organizational planning and supervisor training for peer integration; establish organizational best practices for employing PRSS
Weak alignment between federal reimbursement policy and established peer support competencies	Align Medicare and Medicaid reimbursement guidance with SAMHSA’s existing peer core competencies and national standards (e.g., guide reimbursable scope of practice)
Federal funding does not consistently reinforce peer-specific values or role clarity	Require federally funded programs employing PRSS to demonstrate alignment with SAMHSA peer practice guidelines
Weak infrastructure for peer-led professional development and advocacy	Design opportunities to link federal technical assistance efforts and workforce funding to peer-led professional organizations
Erosion of the original bridging function between treatment systems and community recovery resources	Design reimbursement models that fund peer linkage to community recovery supports and mutual aid

Abbreviations: PRSS, peer recovery support services; SAMHSA, Substance Abuse and Mental Health Services Administration.

Conclusion

Social movements in the 20th century imagined professional peer support would complement and improve SUD treatment by (1) offering a menu of nonclinical, nonhierarchical, and person- and community-centered services and (2) bridging formal treatment to recovery support in the community, to create pathways to long-term recovery. The ONDCP’s call to strengthen the peer recovery workforce offers an opportunity to resist the limitations and pitfalls of professionalization, and ensure these qualities are maintained as much as possible.

To do so, policymakers should prioritize 2 complementary strategies. First, workforce expansion should be grounded in clear role definitions aligned with the foundational values of peer support. This can be advanced through policies that incentivize organizational planning for peer integration, align reimbursement with established peer competencies, and ensure workforce initiatives reinforce these standards. Second, policy should bolster the role of peer-led organizations and emphasize the community-oriented nature of peer support, through investments in peer-led professional development, RCOs, and payment models that fund peers as connectors between treatment systems and community resources. By prioritizing these strategies, federal agencies can expand the peer workforce while preserving qualities that have historically made peer support a unique and effective component of the recovery ecosystem.