The conceptual framework underlying peer-to-peer recovery support services has three components:

• The role and importance of holistic community-based support services in sustaining recovery
• The conception of recovery along a change continuum and the role of peer services in supporting lifestyle change along the continuum
• The notion of social support.

McLellan and other researchers (1998)¹ have suggested that providing holistic, community-based support services enhances treatment outcomes. White (2001)² has identified ongoing peer-based community support as a critically important response to the challenge of chronicity for sustaining recovery over the long haul.

Research Base in Mental Health and HIV/AIDS Work

The value of services offered by peers is reinforced by pointing to the effective work accomplished in the mental health consumer and HIV/AIDS peer communities.³ The 65-year history of 12-step groups and, more recently, the emergence of other types of self-help programs further reinforce the principle that supportive peers can help sustain recovery.

Relation to Stages of Change Theory

The stages of change model developed by Prochaska and DiClemente (1982)⁴ shows that motivation for lifestyle change exists along a continuum of readiness. Stages of recovery from alcohol and drug use disorders are now being clarified in the development of services beyond early-stage recovery. Peers can play a supporting role along the change continuum, offering hope, motivation, and a positive role.

Social Support Research Base

One of the factors that helps people move along the change continuum is social support. RCSP projects are developing peer services to provide the four kinds of social support identified in the literature (Salser, 2002)^5,6:

• Emotional support - demonstrations of empathy, love, caring, and concern in such activities as peer mentoring and recovery coaching, as well as recovery support groups.
• Informational support - provision of health and wellness information, educational assistance, and help in acquiring new skills, ranging from life skills to employment readiness and citizenship restoration.
• Instrumental support - concrete assistance in task accomplishment, especially with stressful or unpleasant tasks such as filling out applications and obtaining entitlements, or providing child care, transportation to support-group meetings, and clothing closets.
• Affiliational support - helping people in early recovery feel connected and enjoy being with others, especially in recreational activities in alcohol- and drug-free environments. This assistance is especially needed in early recovery, when little about abstaining from alcohol or drugs is reinforcing.

References

1. McLellan, A.T., Hagan, T.A., Levine, M., Gould, F., Meyers, K.& Bencivengo, M., et al. (1998). Research report: Supplemental social services improve outcomes in public addiction treatment. Addiction, 93(10), 1489-1499.
2. White, W.L. (2001). A lost vision: Addiction counseling as community organization. Alcoholism Treatment Quarterly, 19(4), 1-30.
3. http://www.mentalhealth.samhsa.gov/consumersurvivor
4. Proschaska, J.O. & DiClemente, C.C. (1982). Transtheoretical therapy toward a more integrative model of change. Psychotherapy: Theory, Research and Practice 19(3), 276-287.
5. Salzer, M. (2002). Best practice guidelines for consumer-delivered services. Unpublished paper developed for Behavioral Health Recovery Management Project. An initiative of Fayette Companies, Peoria, IL; Chestnut Health Systems, Bloomington, IL; and the University of Chicago Center for Psychiatric Rehabilitation.
   Web site: http://bhrm.org/guidelines.htm
6. Salzer, M. (2002). Consumer-delivered services as a best practice in mental health care delivery and the development of practice guidelines. Psychiatric Rehabilitation Skills, 6(3), 355-383.