Peer support workers — often called peer recovery coaches, peer mentors, or peer specialists —are non-clinical professionals who use their lived experience with substance use disorder (SUD) and/or overdose to connect with and support others. Expanding peer recovery services is a proven strategy to address the overdose and mental health crises in the United States. Evidence shows peer support increases treatment engagement, reduces hospitalizations, and improves recovery outcomes. While most state Medicaid programs reimburse for these services, more can be done to fully integrate and sustain peer roles in care delivery.

This evidence roundup highlights studies on the impact of peer support and offers recommendations for embedding and supporting peer workers across care settings — from emergency departments to community programs.

How can peers support adults with SUD?

Peer recovery coaches, a common term for peers supporting individuals with SUD, draw on personal or family experience with SUD, are committed to their active recovery, and are trained to provide recovery-oriented services. They can support individuals with SUD at every stage of recovery across diverse clinical and community settings, including primary care clinics, emergency departments, mobile units, and recovery community centers. As members of multidisciplinary care teams, peer recovery coaches bridge gaps between clinical treatment and social supports, fostering engagement in care and improving outcomes. Below are the types of support a peer recovery coach may provide:

• Engagement and Care Navigation: Peers are vital in engaging individuals who are actively using a substance or in crisis. By building trust and reducing stigma, they help people take the first steps toward recovery and foster a willingness to engage in treatments and/or supports. Peers help individuals navigate complex health care and SUD programs, facilitate communication with providers, and co-develop recovery goals tailored to individual needs.
• Advocacy: Peers offer guidance and embody the possibility of recovery. Their lived experience of successful recovery provides proof that change is possible, inspiring individuals still facing SUD. Peers can advocate for individuals’ needs across treatment and social service systems, helping to empower individuals on their path to recovery.
• Connection to Resources and Community: People with SUD often lack social support and access to resources essential for recovery. They may face added risks, such as housing instability and unemployment. Peers help address these gaps by connecting individuals to community-based resources and social supports, such as housing, employment services, and mutual-help groups.

What is the evidence behind peer recovery support services?

Robust evidence demonstrates the impact of peer recovery support services in medical settings, offering valuable insights to inform interventions across a range of settings as well as effective staffing models to support people with SUD.

• Inpatient Addiction Medicine Consultation and Post-Hospital Substance Use Disorder Treatment Engagement: A Propensity-Matched Analysis – This study evaluates the impact of a hospital-based addiction medicine consultation team, which includes peer recovery coaches, on post-discharge SUD treatment engagement. Patients receiving care from the interdisciplinary team engaged in treatment at nearly twice their prior rate, with the greatest gains among those with opioid use disorder.
• The Effect of Peer Support on Treatment Engagement for Opioid Use Disorder – This study examines the role of peer support in treating opioid use disorders. It compares outcomes for individuals enrolled in a certified recovery services program — receiving both peer-based support and medication-assisted treatment in an outpatient setting — with those receiving treatment, but no peer support. Individuals who received peer support demonstrated greater engagement in recovery services.
• Association Between Peer Support Services, Treatment Engagement and Overdose Risk Among Kentucky Medicaid Beneficiaries with Opioid Use Disorder – This study examines claims data from Kentucky’s Medicaid managed care program to assess the impact of peer support services. Medicaid members who received peer support were more likely to engage in buprenorphine treatment, showed reduced reliance on intensive service delivery settings, and experienced a slight decrease in opioid overdose risk.
• Peer Support to Reduce Readmission in Medicaid-Enrolled Adults with Substance Use Disorder – This study analyzed Pennsylvania Medicaid claims data (2016-2019) to assess peer support services for adults with SUD. Individuals receiving peer support had fewer acute care readmissions, maintained lower rates 90 days post-discharge, and were more likely to engage in outpatient and community-based services than those without peer supports.
• Recovery Coach Program Implementation Across an Integrated Health System – This study describes a peer recovery coach program for patients with SUD at Massachusetts General Hospital and Mass General Brigham health system. The program embedded peer coaches in bridge clinics, primary care, behavioral health care, and street medicine. Evaluation indicates improved treatment engagement, reduced acute care utilization, and positive patient outcomes. The authors outline key facilitators, barriers, and opportunities for integrating peer coaches across medical settings.

What do peer recovery services look like in practice?

The following resources highlight how organizations can integrate peer recovery support services into a continuum of care for individuals with SUD. These examples illustrate peer roles in various settings — including emergency departments, crisis response programs, housing programs, and recovery community centers — and offer practical models for peer-led support programs:

Hospital Settings:

• Integrating Bridge Clinics into Emergency Departments to Facilitate Access to Opioid Use Disorder Care – This webinar explores the CA Bridge model, which integrates addiction care into hospital settings using a substance use navigator — often with lived experience of behavioral health conditions. A blog post offers additional insights on the Bridge model and its use of peer support.
• Tools to Support Hospital-Based Addiction Care: Core Components, Values, and Activities of the Improving Addiction Care Team – This case example outlines components of a hospital-based addiction care consultation team that includes peer mentors and provides tools to help hospital systems develop addiction interventions tailored to local needs.

Outpatient Settings:

• Integrating Peer Support Services into Primary Care-Based OUD Treatment: Lessons from the Penn Integrated Model – This resource summarizes the peer support program within the University of Pennsylvania Health System’s primary care network, including challenges encountered and lessons in integrating peer support specialists into clinical teams.

Community-Based Settings:

• Providing Peer Supports and Services for People with Substance Use Disorder: Connecticut’s Community of Addiction Recovery – This blog post highlights how Connecticut’s Recovery Community Centers provide peer-led support services for individuals with SUD. A related blog post features insights from a recovery advocate about the impact of peer support.
• Expanding Peer Support Roles in Homeless Services Delivery: A Toolkit for Service Providers – This toolkit, shaped by insights from peer support specialists and individuals with lived experience of homelessness, provides strategies and guidance for effectively integrating peer recovery support services into homeless service systems.
• Integrating Peer Recovery Support Services into Substance Use-Related Crisis Care: A Brief for States – This brief offers examples of successful implementation of peer recovery support services into substance use-related crisis care from various states and provides practical tools, such as service outlines, operational policies, and staffing guidelines, to aid in integrating peer support and crisis services.

What is the policy landscape affecting peer recovery support services?

Peer support services are increasingly recognized as essential to recovery-oriented care, with 48 state Medicaid agencies covering these services for individuals with mental health and/or SUD. Despite states’ commitment to supporting the peer workforce through Medicaid, significant opportunities remain to strengthen these services. Below are common challenges cited in the literature, along with strategies to support peer services.

• Supervision Needs: Peer-to-peer supervision is considered best practice, promoting role clarity, recovery-oriented practices, and collaboration between peers and clinicians. However, many state Medicaid agencies require supervision by a licensed mental health professional. Recent CMS guidance gives states flexibility to define supervision requirements, including allowing experienced non-licensed peers. Further clarification permitting peer-to-peer supervision could encourage adoption of these models.
• Billing Complexity and Administrative Burden: To receive Medicaid reimbursement for peer recovery services, providers must enroll and meet billing requirements, including documentation and supervision. These requirements can create significant administrative burdens, particularly for community-based and peer-run organizations that often lack the necessary IT systems and billing expertise, as well as the clinical partnerships. As a result, some organizations may choose not to pursue Medicaid reimbursement for peer services. Capacity-building and technical assistance may help these organizations better leverage Medicaid to support their peer workforce.
• Scope of Practice: States define which peer services qualify for Medicaid reimbursement, often requiring training, credentialing, and alignment with clinical guidelines. Many restrict delivery of those services to clinical treatment settings, leading to some peer services outside of covered codes. This may discourage provider organizations from implementing peer services and/or seeking reimbursement. Adopting a standardized, federally defined set of peer services informed by the peer workforce could help states establish consistent, comprehensive coverage.
• Financing: States typically reimburse peer services through a fee-for-service model, which can be challenging since activities like relationship-building and outreach do not fit neatly into 15-minute billable units. Shifting to alternative payment models, such as bundled payments, would allow reimbursement for the full range of peer supports and activities. Provider organizations may also braid funding from grants, contracts, and other sources to sustain these services. For example, opioid settlement funds — earmarked to address the harms of the opioid crisis — offer an alternative pathway that many states use to expand peer recovery programs.
• Provider Buy-In: Integrating peers into collaborative care teams requires training on workflows, roles, and supervision. Without this infrastructure, gaps between clinicians’ treatment models and peers’ recovery approaches can undermine communication and care planning. Tools like this organizational self-assessment can help health systems and behavioral health organizations identify next steps to ensure readiness for integrating peers into clinical teams.