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Meeting them where they are

WVU Today

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.

The results appear in the Journal of Appalachian Health.

“One unique aspect of the program is the tailoring of needs for each participant,” said Stephen Davis, an associate professor in the School of Public Health, who helped develop WV PEERS and was main author on the study. “Using this approach, peer recovery support specialists address multiple types of needs, including food, housing, and security, to reflect the fact that a participant may not be ready to enter treatment until these needs are satisfied.”

Using connections throughout the community, peer recovery coaches address individuals’ full range of needs by referring them to a variety of social services providing food, shelter, clothing, childcare and transportation in addition to drug treatment programs, overdose prevention, naloxone providers, detox and mental and physical health care.

Ascension Recovery Services recruited, trained and certified peer recovery coaches. For certification, coaches had to complete a defined course of study, gain 500 hours of experience and achieve at least two years of continuous sobriety.

“People who have lived experience with substance use disorder have an almost immediate rapport with folks who are current users,” said Herb Linn, a program director in the WVU Office of Health Affairs, who helped start the program. “They become representatives of people who have found a pathway to recovery, and we wanted to look at whether it would work to have a pool of peer recovery support specialists that could respond to requests from agencies and organizations across the county.”

Some peer recovery coaches were placed in the J.W. Ruby Memorial Hospital Emergency Department, where they could directly engage with patients with an overdose, infection due to drug use or mental health concern. Other coaches were on call to engage with users identified in a variety of locations, such as schools, the county court system or doctors’ and psychiatrists’ offices.

Users who weren’t ready to start treatment received “leave-behind” cards with WV PEERS information, so they could seek treatment in the future. Leave-behind cards were also given to several businesses and doctors’ offices and placed on community bulletin boards.

“The program is about meeting people where they’re at, addressing what their current needs are, providing a range of services and developing a relationship so that when people are ready to seek treatment, we can facilitate getting them there,” Davis said.

WV PEERS has since spread across the state and adapted to more rural locations with the use of more on-call coaches and telehealth interventions.

It has also expanded its efforts to enact policy change effecting peer recovery support at the state government level. It could even influence policy in other states as well.

Although West Virginia had the nation’s highest drug-overdose-death rate in 2019, the opioid epidemic isn’t confined to the state.

The same year, for every 100 people who lived in West Virginia, providers dispensed 59.4 opioid prescriptions. That’s higher than the national average of 46.7, but it marks a decline from previous years, and it falls short of the dispensing rates in Alabama (85.8), Arkansas (80.9), Louisiana (74.6), Tennessee (74.6) and other states.

“I think peer recovery can get to the root of the problem faster than maybe a clinician could,” said Dan McCawley, a peer recovery coach with Ascension Recovery Services. “Peer recovery meets them physically where they are — and mentally in those stages of change — and it utilizes people with lived experience and addiction in their own lives. I believe the recovery community in West Virginia is just as strong as the opioid epidemic.”

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