Peer support workers (PSWs) have emerged as a central component of recovery-oriented substance use disorder (SUD) treatment models, offering emotional support, resource navigation, skill-building, and community connection based on their lived experiences. However, prior studies on PSWs have largely concentrated on mental health service delivery and have often overlooked the perspectives of PSWs themselves, leaving gaps in understanding the scope of their roles, responsibilities, and boundaries. This limitation is especially significant given the confusion and resistance among health professionals and the diversity of service settings in which PSWs work, each with varying policies and practices. To address these gaps, the present study aims to center the voices of PSWs working in SUD recovery to more accurately define their perceived roles and responsibilities across different service contexts.
This study recruited 25 peer support workers (PSWs) from substance use disorder (SUD) recovery-oriented organizations and agencies across South Carolina. Eligible participants were 18 years or older and had at least three months of experience working as a PSW in the recovery field. A semi-structured interview guide, developed in collaboration with a paid PSW consultant, was used to elicit participants’ perspectives and experiences. Interview topics included PSWs’ current roles, personal recovery journeys, mental health, and available or desired supports and resources. The present analysis focused on responses to two guiding questions: (1) “Describe your roles and responsibilities as a peer support worker for people with substance use,” and (2) “Is there anything else you would want others to know about being a peer support worker?” Interview transcripts were analyzed using a team-based, rapid qualitative analysis approach.
Eight themes were identified under “roles and responsibilities” and three under “messages for others.” PSWs described their core work as providing individualized one-on-one support through appointments and peer coaching (theme 1), facilitating recovery groups and creating curricula (theme 2), and delivering SBIRT screening and referral services (theme 3). They also served dual roles as both supervisees and supervisors for fellow PSWs (theme 4), leveraged social networks to connect clients to essential resources like housing and transportation when organizational services were unavailable (theme 5), and integrated harm reduction activities throughout their work (theme 6). Beyond direct clinical services, PSWs engaged in administrative and managerial tasks such as documentation and training (theme 7), as well as systems-level activities including grant writing, policy development, and organizational improvement initiatives (theme 8). Participants emphasized wanting others to understand the value and efficacy of peer support work to promote advocacy for the field.
Takeaway: Peer support workers perform a wide range of duties that extend from direct recovery support to administrative and organizational functions, underscoring the necessity for clear role definition and appropriate recognition of their varied contributions in SUD treatment settings.