6. Recovery support services and lived experience initiatives
Recovery support services and lived experience initiatives provide practical and emotional support and help people build long-term recovery. They have an essential role in a recovery-oriented system of care and include peer support, mutual aid groups and other resources.
Recovery support services and lived experience initiatives are community services and interventions that can provide emotional and practical support for a person to work towards ongoing recovery.
Most recovery support services are run by a combination of staff with learnt experience and people with lived experience. Some peer support services are run entirely by people with lived experience.
Recovery support is important throughout a person’s treatment and recovery journey and is vital when the person has finished structured treatment. Some people never attend treatment but use peer support and other recovery support services to achieve their recovery goals.
It is important that keyworkers know what services and support are available in their local area and help a person access their preferred service or support as part of their treatment and recovery plan.
Alcohol treatment services should have active working relationships and agreed pathways with all the recovery support services and lived experience initiatives in their local area.
You should read this chapter alongside section 5 on structured support in chapter 5 on psychosocial interventions.
Alcohol treatment services and recovery support services should work closely together, both contributing to a recovery-oriented system of care. You can read more about a recovery-oriented system of care in section 2.6 in chapter 2 on principles of care.
6.2.1 What recovery support services and lived experience initiatives are
Recovery support services are community services and interventions that can provide emotional and practical support for ongoing recovery from alcohol dependence and harmful drinking. These services and interventions help people build on their strengths to develop recovery resources.
Recovery resources (sometimes called recovery capital’) are the healthy life resources that people can use to begin to recover and maintain recovery, including:
- housing
- education
- employment
- supportive family and social networks
- community and cultural resources and networks
- improved health and wellbeing
Recovery support services include health and care services, community services and lived experience initiatives.
In this guidance, any service and support which people with lived and living experience are involved in delivering or leading is described as a lived experience initiative. Where a treatment (or other service) provider employs peer workers or volunteers, we describe the services or support they offer as peer-delivered. We describe the services and support provided by a lived experience recovery organisation (LERO) as peer-led.
A 2017 systematic review on recovery support services in the USA found evidence that recovery support services help people to begin and maintain recovery and improve their quality of life.
6.2.2 Supporting treatment and recovery
Recovery support is important throughout a person’s treatment and recovery journey and is vital when the person has finished structured treatment. Some people never attend treatment but use peer support and other recovery support services to achieve their recovery goals. Recovery support services can also be a first point of access to support for people and can later introduce people to structured treatment.
Recovery support services can contribute to a person’s recovery journey by:
- engaging the person in treatment and supporting their engagement
- complementing treatment as part of the person’s treatment and recovery plan
- offering continuous recovery support after the person finishes formal treatment
- helping the person re-enter treatment if they need to
- increasing opportunities for the person to volunteer or seek employment
- offering harm reduction advice and information to people outside treatment
- offering peer support services for family members
Recovery support services offer a wide range of interventions, but they all have a sense of social connection and community. They can help people and their families make links with wider communities of people in recovery, which help to sustain recovery in the long term.
It is important that keyworkers know what services and support are available in their local area and help people access their preferred service or interventions as part of their treatment and recovery plan. Alcohol treatment services should have active working relationships and agreed pathways with all the recovery support services and organisations in their local area. You can read more about co-ordination between treatment services and recovery support services in section in section 2.6 in chapter 2 on principles of care.
The 2017 review found evidence of effectiveness for the recovery support services described in this chapter.
Most of these services are run by a combination of staff with learnt experience and people with lived experience. However, some peer support services are run entirely by people with lived experience.
These services and interventions are organised in different ways across different areas and are known by various names, so these might be called something slightly different in your area. They include:
- peer support services
- mutual aid
- recovery community centres
- recovery housing
- recovery support services in educational settings
- recovery management check-ups
6.3.1 Groups and organisations
Peers are people who share an experience. In the context of recovery support, peers with lived experience of alcohol dependence and of recovery use this experience to offer non-clinical support to others who are working towards recovery.
Peer support services include a broad range of peer-delivered interventions and organisations that support people to develop their recovery resources and take part in a recovery community. These services offer a positive culture that can help to reinforce recovery-oriented norms. A peer support service extends beyond representing people attending the treatment service (often known as service user involvement) and provides a range of support for people who are currently attending, who are no longer attending, or who have never attended structured treatment.
Peer-delivered recovery services are often provided by people who are volunteering or employed by an alcohol treatment service. The peer-delivered service may be distinct from but supported by the rest of the alcohol treatment service and have a dedicated co-ordinator who might be a volunteer peer or a member of staff. The support they offer ranges from a specific intervention, such as individual peer support to introduce a person to the service, to a full programme of individual and group peer support and activities.
A LERO may also provide peer support services. These are autonomous organisations led by people with lived experience of alcohol dependence and recovery. LEROs also differ in the interventions they offer and often have a focus on promoting and developing recovery support services. Their activities include:
- offering physical space for recovery-related activities and service delivery
- offering peer-based recovery support services
- organising and engaging in advocacy efforts to improve policy and increase the availability of recovery resources and services
- educating the local community on alcohol dependence and the recovery process and potentially reducing stigma
In many areas, there are also peer support services specifically for families, partners and friends. Some peer support activities for people in recovery are also open to family and friends.
In some areas there are peer support groups or activities led by and tailored to the needs of particular groups of people, including minority ethnic groups, faith groups, women, LGBTQ+ people and older people. You can find some examples of tailoring services to particular groups in section 25.11 in chapter 25 on developing inclusive services.
The 2017 review found evidence that peer-based recovery support can help reduce alcohol use, reduce relapse and support and maintain treatment engagement.
6.3.2 Individual peer support
Peer support organisations often offer support to individuals as well as offering group activities. Local areas vary in the range of individual peer support that is available. As people gain experience and stability in recovery, they can volunteer to offer peer support, which can be beneficial to both the person offering the support and the person receiving it. Individual peer support can be thought of in 3 broad categories, which may overlap.
Peer support in treatment
A person may offer peer support to others while they are still in treatment. They can represent the views and concerns of individuals or groups of people in treatment to the treatment service staff and commissioners. They may also be active in organising community events involving people in treatment and their families. They could also be involved in commissioning, designing and monitoring the service. Role titles for this kind of peer support include:
- lived experience advocate
- service user representative
Peer support while in recovery
A person who is in recovery (often in early recovery just out of treatment) may take on a peer support role (often as a volunteer) drawing on their own lived experience. They show that recovery is possible. They also help others:
- into treatment
- to progress in treatment
- to establish themselves in early recovery
People in this role can offer practical and emotional support such as:
- introducing people to a service
- accompanying people to mutual aid or other recovery support groups (‘buddying’)
- accompanying people to healthcare and other appointments
- representing their wishes (‘peer advocacy’)
Role titles for this kind of peer support include:
- peer supporter
- peer volunteer
- recovery champion
Mentoring or coaching
A person who has been in stable recovery for some time may choose to supplement their lived experience by gaining some formal training and certification in a mentoring or coaching role. People in this peer support role are trained to offer informational, emotional, social and practical support to people with problem alcohol use. They may offer this as a volunteer or in a paid role. They show that recovery is possible and help people to build on their recovery resources. They will often work with people in early recovery after they have left treatment but may work with people at different stages of the recovery journey. Role titles for this kind of peer support include:
- recovery coach
- peer mentor
Mutual aid groups offer a specific programme to support recovery that people follow together. Groups such as Alcoholics Anonymous (AA) or SMART Recovery provide a recovery-oriented support network with a focus on abstinence.
There is evidence that where practitioners in alcohol treatment services actively facilitate access to mutual aid for people in treatment, their treatment outcomes are better (Kelly and others, 2020). There is more detailed guidance on facilitating access to mutual aid in section 5.5.4 in chapter 5 on psychosocial interventions.
6.4.1 Alcoholics Anonymous
AA is the most widely established form of mutual aid with active groups all over the UK, online and internationally. They describe the organisation as “a fellowship of men and women who share their experience, strength and hope with each other that they may solve their common problem and help others to recover from alcoholism”.
The Alcoholics Anonymous website provides information on local in-person and online groups. Groups are organised based on the principles of 12 steps to build recovery and on supporting each other. People can use groups at any stage of their recovery journey and some people achieve recovery through AA without ever entering treatment. People may drop into groups on an occasional basis according to need or follow the 12-step programme in a structured way with the support of a sponsor (another member of AA who is further on in recovery). Some AA groups are open to family members or professionals who are interested in understanding more about AA.
A 2020 review of the effectiveness of AA and 12-step programmes for alcohol use disorder (Kelly and others, 2020) found evidence for the effectiveness of AA and facilitating access to mutual aid in supporting abstinence and other alcohol related outcomes.
While AA is the most studied mutual aid model, researchers have argued that, since mutual aid models are similar, it is likely that participating in other mutual aid models is similarly beneficial to people’s recovery (Kelly and Yeterian, 2012).
Other 12-step fellowships based on the same principles as AA include Narcotics Anonymous, Cocaine Anonymous and Al-Anon (for families and friends of alcoholics).
Twelve-step fellowships maintain independence from professional bodies and make sure they remain led by people in recovery in a volunteer capacity. They do not accept funding from external sources. However, many fellowships have links with alcohol treatment services and some AA groups take place in treatment services or in LEROs.
6.4.2 SMART Recovery
Self-management and recovery training (SMART) Recovery groups are alternative mutual aid groups informed by rational emotive behaviour therapy principles. Their approach is based on group discussion and support and learning practical skills and using tools to manage various addictive behaviours and lead fulfilling lives. SMART Recovery groups are usually run by a combination of staff with learnt experience and people with lived experience. The availability of SMART Recovery meetings has grown over recent decades and there are many groups in the UK.
The SMART Recovery website provides information on local in-person and online groups and training materials. SMART Recovery groups are open to anyone considering or aiming to achieve abstinence and people can join directly. SMART Recovery also works in partnership with treatment services, including residential and prison services which often host meetings. SMART Recovery champions work with people in treatment to develop peer-led SMART Recovery groups. There is a SMART veterans programme in the UK.
A recovery community centre is a physical base or hub that provides space for a recovery-oriented community and a wide range of individual and group peer support. Recovery community centres may offer recovery focused groups and relapse prevention support groups. They can also offer a structure and a programme of meaningful activities such as:
- sports
- recreational activities
- activities in green spaces
- alcohol and drug free social activities
- education
- employment support
They might also host mutual aid groups. The centres may have links with local community activities and groups such as community gardening projects, local food banks and community kitchens. They may also offer individual peer support, often called peer mentoring or recovery coaching.
Recovery community centres are usually run by LEROs but may also be run by treatment providers. They usually have a mix of employed staff with learnt experience (often peers) and peer volunteers. Some community centres are open to the public, such as recovery cafes. Recovery community centres support people in recovery and help to build local recovery communities. They also promote recovery communities as contributors to wider local communities.
Recovery housing is stable accommodation that provides an alcohol and drug free environment. This can be a vital element of recovery support for people who have previously experienced homelessness, inadequate housing or who were living in an environment where heavy drinking was the norm. Recovery housing usually involves sharing accommodation and so provides a recovery-focused community. People may live in recovery housing while in treatment or after the end of structured treatment. Treatment staff in prisons should consider the option of recovery housing for people leaving prison.
Most (though not all) recovery housing has some level of staffing, but the level of available support varies widely across different schemes, as do standards of care. Some recovery housing is registered with the Care Quality Commission or equivalent national regulator. It is important for the keyworker and the person to understand the level of available support and regulation so they can consider whether the project meets the person’s needs.
Recovery support services in educational settings are well established in the USA, but there are currently very few in the UK. These provide an alcohol and drug free social network and activities in a university or college setting. This is an important support in an environment where regular alcohol and drug use is normal. These programmes can provide:
- peer support
- advocacy
- support to access alcohol treatment
- help with problems affecting people’s studies
Recovery housing may also be available on campus.
Recovery check-ups are an agreed series of scheduled in-person, phone or online appointments with the person after they leave a treatment service. Recovery check-ups provide encouragement, identify and address any problems and help people to rapidly return to treatment if they have relapsed.
Keyworkers from alcohol treatment services should provide recovery check-ups. You can find guidance on recovery check-ups in section 4.10.6 in chapter 4 on assessment and treatment and recovery planning.
Some peer support services provide recovery check-ups later in the person’s recovery journey or where the person has never attended a treatment service.
Recovery support services and lived experience initiatives provides detailed guidance on supporting lived experience initiatives and recovery support services to help people start and sustain recovery from problem drug and alcohol use.
Kelly JF, Humphreys K and Ferri M. Alcoholics Anonymous and other 12‐step programs for alcohol use disorder. Cochrane Database of Systematic Reviews 2020: issue 3.
Kelly JF and Yeterian JD. Empirical awakening: the new science on mutual help and implications for cost containment under health care reform. Substance Abuse 2012: volume 33, issue 2, pages 85 to 91 (registration and subscription required for full article).