Providing Peer Supports and Services for People with Substance Use Disorder: Connecticut’s Community of Addiction Recovery

Advocates for people with substance use disorder (SUD) long have pushed for expanding community support services for people entering recovery and maintaining recovery, because the road to recovery is often difficult and uneven. These services are widely seen as key elements to recovery, in conjunction with greater access to addiction treatment, mental health care, and other clinical services. Advocacy groups and people in recovery started opening recovery community centers (RCCs) around the country over the last 20 years to create a hopeful, healing environment led by people with lived experience with addiction, who serve as role models. But the centers often have had to operate on a shoestring, and some lower-income areas of the country with large numbers of people with SUD lack RCCs. Meanwhile, the need for recovery support has grown, as overdose deaths from drug use including opioids have risen, with 107,000 people dying in 2021 — six times more than in 1999.

Background

In the 1990s, advocacy organizations for people with SUD emerged seeking to raise awareness about the national issue of alcohol and drug addiction, expand access to treatment, and eliminate the stigma associated with these conditions. The federal Substance Abuse and Mental Health Services Administration (SAMHSA) encouraged these advocacy groups to start delivering services themselves, according to Michael Askew, deputy director of SAMHSA’s Office of Recovery.

The Connecticut Community of Addiction Recovery (CCAR), which formed in 1998, launched the nation’s first recovery community center in 2004. Since then, it has opened five more, with plans for two additional centers.

There are now about 300 RCCs around the country, available in most states and with rapid expansion in the New England states and New York in particular, said John Kelly, PhD, professor of psychiatry in addiction medicine at Harvard Medical School and director of the Recovery Research Institute.

“These centers provide a rich social and therapeutic environment, populated by people with lived experience themselves, that offer linkages to a whole array of services, including clinical services,” Kelly said. “There is great warmth and positivity and encouragement, which helps to de-stigmatize addiction and make people feel they belong and have a future unencumbered by addiction.”

RCCs receive funding through SAMHSA, state agencies, and philanthropy, though in many places they struggle to survive financially. Massachusetts has 33 RCCs, operating with substantial state funding. CCAR received $4.3 million last year from the state and federal government, plus generating $1.1 million in service fees and contracts, largely from offering training to other organizations in peer coaching.

In its 2025 budget request, SAMSHA has proposed setting aside 10% of the Substance Use Prevention, Treatment, and Recovery Block Grants for RCCs and other recovery support services, an agency spokeswoman said.

In addition, there is momentum building for insurance reimbursement for recovery services, with many state Medicaid programs now paying for peer support services delivered in RCCs, Askew said. But RCC leaders are wary of the amount of work and red tape that goes into billing insurers.

“Spending time identifying the right billing codes and documentation means time not spent supporting someone in recovery,” Askew said.

CCAR’s six centers are located in central urban areas accessible by public transportation. They are each about 5,000 square feet and offer space for support group meetings, community events, recreational programs, and training sessions, according to Brian Robbins, CCAR’s program manager.

Each of the RCCs is staffed by a center manager, a manager of volunteers, and two program coordinators. Meetings and programs generally are led by volunteers, including people who have gone through training to become a peer recovery coach. The centers are open every day except Sunday, with evening hours on most weekdays.

CCAR also has a public advocacy office, which trains people in recovery how to effectively speak to policymakers and the public about expanding recovery services. “I hope that by putting a face on recovery, we’ve been able to reduce some of the stigma people experience and make it easier for them to seek out help,” said Rebecca Allen, CCAR’s director of recovery advocacy, who has been in recovery herself for 26 years.

Intervention

The RCCs in Connecticut support multiple pathways of recovery. At the Hartford Recovery Community Center, there are meetings of Alcoholics Anonymous, Narcotics Anonymous, Phoenix, and Sound Healing groups, along with yoga, meditation, physical fitness, and other activities, all led by volunteers in recovery, said Cathy Bergren, the center’s manager.

There also are daily all-recovery meetings and support groups at each RCC. They cover topics including acceptance, trust, forgiveness, relationships, and commitment. There is a monthly community meeting where staff and volunteers discuss expectations and goals for the coming month, plus volunteer recognition events and holiday parties.

In addition, RCC staff and volunteers connect participants with a wide range of outside resources, including housing, detoxification services, outpatient and residential SUD and mental health treatment, medical care, sober homes, job counseling and placement, and enrollment help for public benefits. Besides staff and volunteer recovery coaches, this work is done by volunteers handling telephone support, reception, greeting, maintenance and operations, and group facilitation.

There are no SUD treatment programs or treatment staff in the RCCs. The staff and volunteer recovery coaches refer people to outside SUD and mental health treatment organizations. “CCAR allows the people we serve to make determinations about what they need,” said Tamara Steele, the organization’s director of recovery centers. “If they say that’s something they feel they need, we will support them in that. Whether it’s yoga, mental health support, karate, faith-based recovery or whatever, we want them to explore those options.”

Many RCC staffers and volunteers are trained in overdose prevention, and Narcan is available at the centers, Robbins said.

Anyone is welcome to walk in and participate in the scheduled activities; there is no registration required and no charge for any services. But the RCC is not a drop-in center or clubhouse. “People can’t just come in and get a cup of coffee and hang around,” said Bergren, who’s been in recovery from alcohol addiction for many years. “We tell the person, ‘If you’re here to work on recovery and want to join a meeting, you are welcome.’”

If people aren’t ready, she added, they are asked if there are other resources they need, such as housing or a shower. The staff and volunteers use motivational interviewing to draw people out. “That maybe plants a seed so that when they are ready, they know this is a welcoming place and they’ll think of us,” Bergren said.

People who come into an RCC under the influence of drugs or alcohol are not necessarily turned away if they are able to participate in a meeting, Robbins said. But they are turned away if they are belligerent or causing a safety issue. That’s an uncommon occurrence, however.

“We aren’t going to shame someone because they might be exhibiting symptoms of their disease,” he said. “We handle them with love and empathy and care. They usually return and want to give back because of the way they were treated.”

Anya, a volunteer peer recovery coach at the Hartford RCC who wanted to be identified only by her first name, said the warmth and nonjudgmental treatment of people is critical for her and others who have walked in.

“Someone told me about the recovery center and I tried it,” Anya said. “I love this place, and I started volunteering as a recovery coach to give to other people what was given to me. I relapse with alcohol once in a while, and coming here even for an hour or two keeps me sober. It helps me to be with other people who have the same experience.”

A key service is telephone recovery support. Trained volunteer TRS coaches make calls from a computerized list of people who have requested these calls.

“I follow up with people who come out of hospitals, detoxes, and rehab centers, and see how their recovery is going,” Anya said. “Sometimes it’s a just a few minutes, sometimes they’re struggling and have questions, or they need some sort of support and resources, like help getting into detox. I’m their cheerleader. I’ll say, ‘I’m happy for you, you made it 24 hours.’”

Implementation

Each CCAR recovery center also has space for staff and participants in CCAR’s recovery coaching programs in hospital emergency departments, the correctional system, jail diversion in the courts, as well as its youth and families program, said Tamara Steele, CCAR’s director of recovery centers.

CCAR provides staff recovery coaches in all 32 hospitals in the state, available to emergency department (ED) patients with SUD who request a coach. The coach goes to the patient’s bedside and speaks to the patient about recovery and next steps, and stays in contact as long as the patient wants. The coach uses CCAR’s telephone recovery support system to provide regularly scheduled support calls. After hospital discharge, people are encouraged to come to the nearest RCC for the full array of recovery support services. Last year, 5,653 people in hospital EDs in Connecticut were served.

CCAR offers a similar service for people with SUD in the correctional system. It makes staff recovery coaches available to people in prisons, jails, parole offices, halfway houses and sober homes. CCAR’s coaches train people in serving as recovery coaches and help people access resources for housing, jobs, and treatment. People in this program also are encouraged to participate in activities at the nearest RCC after they are released. Last year, the program served 509 people.

Another CCAR recovery coaching program helps people with SUD who have active criminal court cases, typically non-violent misdemeanor and narcotics charges. The coaches see people in the courts and detention facilities, to provide support and resources while they are going through the legal process. Last year, CCAR served 177 people in five courts across the state.

Finally, each of the RCCs offers a young people and family services program serving people from 18 to 34 and their family members. Programs include open mic performances, poetry slams, movies, Nintendo games, creative arts groups, and basketball.

“Having fun in recovery is very important to younger people,” Bergren said. “A lot of people feel that if they stop drinking and partying, life will be boring and horrible. This brings the new perspective that it’s still possible to have fun when they are not using.”

The young people and family services program offers all-recovery meetings; family, friends, and allies group meetings; creative arts; and parents in recovery groups. The family program is also valuable because family members often don’t understand why their loved ones don’t just stop using, she said. “They think, ‘If you loved me, that would be enough,’ but that’s not how addiction works. We help them understand they are powerless over that person’s addiction, and that can help people trying to recover.”

Impact

For too long, clinical services for people with SUD have been siloed and not connected with recovery support services, said Harvard’s Kelly. RCCs are important hubs in creating “a more recovery-oriented system of care” that help people gain access to “recovery capital.” The goal, he said, “is creating a fluid system where people can get supported in communities as well as when necessary get more formal clinical services.”

But because RCCs are relatively new, there aren’t yet any rigorous studies of their effectiveness, he said. “My bet is these entities will be very helpful, particularly for people with high addiction severity, more complicated lives and problems, comorbidities, and very low financial resources, but we can’t prove that yet,” he said.

“These are loving places, where you feel so nurtured, welcomed, and valued,” said Askew, who managed CCAR’s Bridgeport RCC for 11 years and identifies as a person in recovery. “RCCs can connect [people] to a community. That’s very important for people leaving prison or other systems where they’ve been disconnected.”

A 2020 study co-authored by Kelly, based on site visits to 32 RCCs in the Northeast, suggested that they provide major benefits to participants. “The longevity and continued growth of RCCs, and the fact that they appear to offer a variety of services deemed important to sustaining recovery to high numbers of individuals across a broad range of recovery stages, suggest RCCs play a valued community role that may facilitate the accrual of social, employment, housing and other recovery capital,” the study concluded.

The study found that most RCCs offered social/recreational, mutual help, recovery coaching, employment, and educational assistance services. Medications for addiction treatment support, overdose reversal training, and mental health support were less frequently offered, despite being rated as important by staff.

Kelly said RCCs may downplay the importance of clinical treatment, just as clinical providers may downplay the importance of community-based recovery support services. “It’s as if they’re competing against each other,” he lamented. “But both are incredibly valuable. We have to play in the same sandbox and realize we are part of the same system.”

At the same time, the study reported that RCCs offer more formal linkages to social services, employment, training, and educational agencies than do mutual-help organizations such as Alcoholics Anonymous (AA), Narcotics Anonymous, and SMART Recovery.

Bergren echoed that, based on her personal experience in recovery, during which she said she greatly benefited from AA meetings. “When I was in early recovery, I had to get therapy and take anti-depressants,” she said. “AA doesn’t address that. Coming into CCAR, it’s whatever you need, let’s talk about the areas of your life where you are having trouble. We help the whole person get what they need. You won’t get that in a 12-step program.”

Insights

• RCC programs and activities must be driven by the volunteers in each center. “This isn’t cookie cutter,” Robbins said. “The calendars are created by the participants and volunteers utilizing those supports. I know that works.”
• More real-time measurement and feedback are needed. “We don’t know what best practices are yet for RCCs,” Kelly said, who’s working with federal officials to create guidelines for data collection and use. “Measurement-based practice would enable RCCs to identify whose needs are not met by the current approaches.”
• Getting funding to start and sustain an RCC is difficult, especially in underserved, under-resourced communities. “We see momentum building for (insurance) reimbursements, and many state Medicaid programs reimburse for recovery services such as peer support delivered in RCCs,” Askew said. “One thing to address is taking a look at eliminating or somehow streamlining the billing codes.”

Acknowledgements

Thank you to Tamara Steele, Brian Robbins, Cathy Bergren, John Kelly, Michael Askew, and Anya for helping to inform this blog post.

*Author Harris Meyer is a freelance journalist who has been writing about health care policy and delivery since 1986.