Ask an Expert: Are Recovery "Coaches" Effective?

By Melissa Killeen 06/28/16

Our expert weighs in on whether recovery "coaches" are the real deal or just other fellow people in recovery... and if they can really help.

Ask an Expert: Are Recovery "Coaches" Effective?
Are recovery coaches the real thing?

Dear Expert,

A program that has been recommended to me for addiction treatment relies heavily on people called "coaches," as opposed to "counselors" or "therapists." I believe that the coaches are basically people in recovery, like the old AA sponsor model. Is this a reputable model for care?

Melissa Kileen: More and more addiction treatment facilities are using peer-based recovery support specialists or recovery coaches (sometimes known as a sober coach) to assist an individual in maintaining their sobriety. The emphasis on incorporating various forms of recovery coaching or peer-based recovery support is also found at local recovery community organizations or recovery support centers. This support is provided by “peers,” “peer recovery support specialists,” “recovery coaches,” “peer mentors,” or “peer support practitioners” who have lived and experienced personal recovery to assist others in initiating, maintaining and embracing recovery from substance use disorders (Borkman, 1999). Recovery coaches, in order to be certified, must be trained to use several models of care.

In 1998, Michael Boyle and William White formulated the Recovery Management model (RM). This model was the first to introduce the use of a peer recovery support practitioner or recovery coach into the recovery plan. The philosophy of RM is based on the thinking that drug and alcohol addictions are considered “chronic” diseases, just like diabetes or high blood pressure (White, Kurtz & Sanders, 2006). The RM model suggests a client (after a treatment stay) engage in recovery-orientated education, firmly advocating the involvement in a twelve-step community and the use of a recovery coach, therapists and doctors (White, Kurtz & Sanders, 2006).

The Recovery-Oriented Systems of Care model (ROSC) has become the accepted approach for recovery coaches to use in working with those individuals with substance use disorders. ROSC-orientated recovery coaches will encourage a client to visit their general practitioner, an OBGYN and the dentist. They suggest assessment for co-occurring disorders and encourage the client to embrace one-on-one therapy as well as group therapy. Recovery coaches advocate mutual support programs, such as AA and NA, and are to be knowledgeable about nontraditional mutual support groups like SOS, Moderation Management or Men/Women for Sobriety. A spiritual program is also encouraged by a coach. 

Another model that recovery coaches are informed of is the Harm Reduction model. An overwhelming majority of substance users are not being treated, because many are unable to commit to total abstinence as a lifelong objective. For example, they may want to kick heroin, but still want to enjoy a glass of beer or a joint every so often. Harm Reduction meets the clients “where they are” in terms of their needs and personal goals (Tatarsky, 2003, Marlatt and Kilmer, 1992). The following are Harm Reduction principles that guide coaches in their work—a) focus not on the drug, but the harm done by the drug, b) explore the possible causes of the addiction (i.e. early childhood trauma), c) focus on the client’s strengths, d) accept that any reduction in drug-related harm is a success, and e) use other models, like RM, CBT, ROSC or other special techniques to reduce resistance and increase motivation (Denning, 2000).

Your next question probably is: “Does recovery coaching work?” Studies have been completed on the effectiveness of recovery coaches aiding in individuals achieving long-term recovery since 2005. Ellen L. Bassuk, MD, Justine Hanson, PhD, R. Neil Greene, MA, Molly Richard, BA, and Alexandre Laudet, PhD began examining the 1,221 studies that analyze the effectiveness of peer-delivered recovery support services for individuals in recovery. They wrote a systematic review called Peer-Delivered Recovery Support Services for Addictions in the United States: A Systematic Review. 

This review showed peer-delivered recovery support services accomplished the following successful outcomes:

1. Decreased alcohol use 

2. Decreased drinking to intoxication, by reducing the odds of drinking to intoxication by 2.9 percent (Smelson et al. 2013) 

3. Peer participation lowered re-hospitalization rates, meaning only 62 percent of participants from the peer-based support group were re-hospitalized compared to 73 percent of those not receiving peer-based support (Min et al. (2007)  

4. Increased post-discharge sobriety time was achieved by the individuals receiving the peer intervention (O’Connell et al. 2014)

5. If peers led groups in life-skills training, those participants had 14.8 fewer days drinking

6. Peer recovery support affected those discharged from inpatient treatment by maintaining a post discharge sobriety rate of 43 percent to 48 percent as compared to 33 percent sobriety for those not receiving peer-based support (Tracy et al. 2011)

Overall, the review of these studies indicate that peers trained in recovery support interventions have beneficial effects on participants. While peers and recovery coaches are beneficial in aiding the addict seeking to maintain their recovery, peers and recovery coaches are not licensed therapists or doctors. Using a recovery coach should not be a substitute for the benefits of engaging a clinically trained counselor, therapist, PsyD or MD to help you.

Melissa Killeen is a recovery coach from New Jersey. Full Bio.

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