It’s hard to describe the deep connections that peers at Boulder form with our patients. Instead of telling you how Peer Recovery Specialists do their work, we thought it would be better to just show you one example of many.
Justin is the Director of Peer Services at Boulder––this is his story with “Scott.”
A patient in his mid-twenties we’ll refer to as Scott (not his real name) asked Justin S., a Boulder peer, for a favor. Justin and Scott recently reconnected after Scott abruptly stopped showing up for treatment. Scott fell off the map for three months after a year of regularly meeting with Justin and seeing a Boulder clinician for Suboxone.
“He was completely on his feet for the first time as a young adult,” Justin said. “Then, he suddenly disappeared.”
After three long months, Scott popped back up in Boulder’s app and scheduled a video chat with Justin. Scott explained to Justin that he returned to using illicit opioids. The use started off slow and then escalated quickly. In rural southern Oregon, where Scott lives, synthetic opioids like fentanyl had taken over the local drug market. Scott badly wanted to stop using. With limited in-person resources in his hometown, Scott came back to Boulder, which in the past had worked to help him be stable.
Scott told Justin that he had been isolating from his friends and family since his return to use.
Scott said he was afraid of letting everyone down. The people who cared about him were so proud of the year of recovery he had achieved. Now Scott felt like he had just thrown it all away and had to start over again. These were the loud thoughts echoing in Scott’s mind that prevented him from reaching out for help sooner.
“You’re not letting me down,” Justin said. “And you didn’t throw anything away. You’re here now — that’s what’s important.”
Substance use disorder is a chronic condition, and that means temporary returns to use are common, even expected. That’s why Boulder has never dismissed patients when they do so. Justin told all this to Scott. But Justin wanted Scott to know, and to feel, that all the work he did over the past year still mattered. Scott was not starting back at square zero, Justin told him.
Now, what was that favor Scott asked for after reconnecting?
After re-starting Suboxone and seeing Justin regularly again, Scott said he was still dodging his dad’s calls. “Could you be on the line with me when I tell my dad?”
Justin said yes.
The day finally came. Justin logged on to their scheduled call and in the app he saw Scott sitting next to his dad on a bench. Scott started the call saying, “This is Justin, the guy from Boulder I told you about.” He then told his dad how he started struggling again. “I just wanted to show you that I went back to Boulder, that I’m getting the help I need,” Scott said. “I’m back on my meds and I’m feeling a lot better. I just wanted to show you.”
Scott’s dad thanked Justin. He then turned to Scott and said that he knew something was off lately. “You’ve just been different,” he said. “You stopped talking to me so I figured something must’ve happened. But I didn’t know what was wrong or know how to bring it up. I didn’t say anything because I was afraid to push you away.”
In the moment, they both realized that their own fears had kept them from saying what they wanted to say to each other. In the future, they don’t want to let that get in the way of reaching out. Scott’s dad said he was thankful that Scott was okay. Justin watched Scott and his dad turn toward each other and hug on the bench. That’s when Justin signed out of the session.
“As a peer, it’s my role to help create the space for the patient to tell me what they need help with,” Justin said.
“With Scott, all I had to do was show up, be supportive, and let him take care of the rest. I got to witness a beautiful moment out of it.”
The Peer Perspective at Boulder: A White Paper
Peer Recovery Specialists are not therapists. They are not clinicians, coaches, mentors, or crisis counselors. They are not case workers or case managers. They are not 12-step sponsors. They neither dispense medical advice nor tell patients what to do or how to live their life. In some ways, it’s easier to define peers by all the things they are not. It’s more difficult to articulate all the things peers are and the special work they do.
That’s why Boulder is publishing a new white paper, “Peers: A Critical Part of Virtual SUD Care Teams,” about the centrality of peers in Boulder’s telehealth model. The paper shines a light on the literature and efficacy of peers, the challenges that peers have encountered in the field, and the innovative ways that Boulder integrates peer recovery into its virtual model. The paper details the organizational structures that support the crucial work that peers do for our patients, and provides actionable insight for the field as telehealth continues to grow.
Peers were woven into the fabric of Boulder’s telehealth model from the start. Data from Boulder visits shows increased retention for patients who meet with a peer. The white paper delves into the science behind peers, showing strong evidence that peers enhance patient outcomes:
- Fewer ED and acute care visits
- Increased engagement with primary care
- Improved relationships with providers and social supports
- Reduced return to use events
- Increased satisfaction with the overall treatment experience
- Increased treatment retention
In both health care and in society, addiction is still viewed through a moralistic framework. People with substance use disorders face stigma and judgmental attitudes, even from those who care about them. Peers are a positive social force in the lives of our patients, and they chip away at negative perceptions that many of us internalize over a lifetime without even knowing it. Take Scott’s experience with Justin. Scott was afraid to tell his dad that he returned to using opioids. Shame kept him away from his family. But Scott felt comfortable speaking his truth to Justin, and he wasn’t scolded or punished for it. By first talking to Justin in a safe space, Scott could then work up the courage to tell his dad, which ultimately helped the father and son reconnect. Justin’s experience with Scott exemplifies the special bond that peers and patients develop over time. Peers approach patients with openness, curiosity, and kindness. As the white paper puts it:
“Peers describe having power with, not over a patient; they ‘walk alongside,’ help to process past and future decisions without putting their thumb on the scale or steering with a heavy hand.”
“Peers help patients find the leading edge, and together they uncover old patterns and discover new ways of thinking and being in the world.” The white paper is rooted in the everyday experience of peers who work at Boulder. They discuss their own philosophy and practice. At Boulder, peers share consistent messages with patients:
- Sometimes it's just nice to know you aren't alone and that there are others who have walked a similar path. We are here to listen.
- If you are having a stressful time, or feel like you might need a little support, you can message a peer or video chat in the Boulder app however often you would like.
- You’re in the driver’s seat of your experience here. I’m in recovery, too, and I’m here to listen. As of today, you have a small army of support beside you.
- I’m not here to tell you what to do or how to live your life. This is your treatment and your recovery. I’ll be here to support whatever pathway works best for you. We will encourage and support you in your recovery no matter what you want your recovery to look like.
- We can help you set goals for your future, we can help you find local recovery support in your area, we can help you with barriers or challenges you might be facing.
Peers also compare and contrast their previous positions with their work today. In previous roles, often in face-to-face settings, peers at Boulder were tasked with administering drug tests or kicking people out of treatment programs for petty infractions. Such activities undermined the crucial work of building trust and rapport with patients. Instead of working collaboratively and forming an alliance with patients, peers in prior roles felt they were an extension of the program’s disciplinary and punitive philosophy, which cut against their ability to build rapport and trust.
“If you broke rules, my job was to uphold those rules and it didn’t align with my belief system. It was during the time fentanyl hit and I’m losing not only my friends, I’m mandated by the company I work for to put people back out on the streets, and then I’m getting phone calls that the people I just put out — they’re now gone. And doing that for three and a half years, I couldn’t do it any more.” —Peer A
In other roles, peers felt like they became glorified chauffeurs, driving patients to and from appointments. Peers were sometimes tasked with busy paperwork and administrative jobs like billing and calling insurance companies. In contrast, at Boulder, peers can focus on their primary purpose of connecting with and supporting patients on their path to recovery. They feel like their insight into the recovery experience is truly valued by the Boulder Care Team.
People might think that telehealth lacks the human touch and connection of face-to-face treatment. At Boulder, that is not the case, largely thanks to the crucial work that peers do everyday. Peer Recovery Specialists are integral to Boulder’s virtual-only care model, where peers can still make a big impact on patients and share novel insights with care teams despite the physical limits of virtual settings (e.g. limited visual and non-verbal cues, lack of hands-on assessment).
Peers play a vital role at Boulder. By providing a warm, welcoming, and approachable presence, peers are essential for reducing stigma, enhancing patient connection, and providing patients with a collaborative approach to SUD treatment. Their role is unique and cannot be replaced or replicated by traditional clinical staff. Peers have a depth of shared experience, and that experience is invaluable to patients and our teams who treat them.
To learn more about the role of Peers in telehealth SUD care, download the white paper below.
