Substance use disorder (SUD) recovery is a multifaceted process that extends beyond traditional clinical interventions, requiring comprehensive support systems that bridge formal treatment and personal recovery experiences. Peer recovery support services (PRSS) have emerged as a critical component in this continuum, utilizing individuals with lived recovery experience to provide non-clinical support that helps others initiate, pursue, and sustain long-term recovery from substance use and mental health challenges. While research demonstrates promising outcomes including reduced substance use, lower relapse rates, and improved treatment retention and satisfaction, the field faces significant methodological challenges including poorly defined roles, inconsistent implementation procedures, and mixed findings that limit the generalizability of results. To address this gap, the present study aimed to develop a systematic taxonomy that organizes and clarifies the diverse roles, functions, and activities within peer support services, providing a standardized framework for evaluating PRSS impact on key recovery milestones.
The study utilized a structured expert consensus approach involving a sub-group of The Consortium on Addiction Recovery Science (CoARS) Peer Recovery Support Special Interest Group. The expert panel comprised nearly two dozen scientists from universities and private research centers, SUD treatment providers, and individuals with lived recovery experience. The taxonomy was developed through a rapid narrative literature review, expert consultation, and an iterative consensus process informed by a Delphi-like approach, with refinement by a multidisciplinary task group of PRSS scientists, practitioners, and individuals in recovery. The methodology incorporated qualitative rigor principles aligned with COREQ guidelines, and the framework aligns with SAMHSA’s national standards to enhance consistency across practice settings.
The taxonomy in this study organizes PRSS components into six primary taxons: Lived Experience, Training, Support Approach, Support Settings, Support Activities, and Recovery Milestones, comprising 20 branches and 87 sub-branches. The taxonomy establishes an evaluation framework where (peer worker) lived experience functions as the core independent variable, (peer worker) training serves as a moderator, and support approaches, settings, and activities act as mediators clarifying pathways through which PRSS impacts recovery outcomes. This framework enables testing multiple hypotheses for PRSS optimization, such as examining whether Peer Workers with direct lived experience and advanced training are more effective in complex cases like MOUD adherence management, or whether effectiveness varies across different settings like emergency rooms versus residential facilities. The evaluation framework highlights that PRSS effectiveness varies with specific conditions, supporting the development of tailored interventions that align with peers’ unique needs and contexts.
Takeaway: A comprehensive taxonomy with six primary taxons and 87 sub-branches was developed to provide the first systematic framework for evaluating peer recovery support services, enabling evidence-based optimization of interventions based on specific conditions such as peer worker characteristics and service settings.