Livia Gershon | Longreads | June 2019 | 8 minutes (1,883 words)
On a Tuesday morning in May, Priscilla Matos was at Revive Recovery Center, an art gallery-turned substance use recovery hub on Main Street in Nashua, New Hampshire, organizing supplies and filling out paperwork. Around her, hand-lettered signs offered advice: “Find Your Purpose,” “Love Yourself Everyday.” On a nearby bulletin board, flyers advertised support groups that borrowed wisdom from Christianity and Buddhism. A man with tattoos wearing a New England Patriots shirt came by; Matos showed him how to make tea with a plug-in pot and congratulated him on landing in a sober housing program. Matos, who is 28, with dark-rimmed glasses and a warm smile, helps visitors at Revive find whatever resources they need—food pantries, treatment centers, places where they can take a shower and wash their clothes. She’s good at it in part because, for much of the past decade, she’s needed those kinds of things herself.
Two years ago, Matos was a chronic heroin user and a dealer. Standing at four foot one, she was born with achondroplasia dwarfism. Her height, she says, enabled her to escape suspicion from the cops. But it also left her vulnerable to armed robbery. “I had guns,” she told me. “But it takes a special type of person to use a gun, so that never helped.”
Matos’s transition from a victim and perpetrator of the opioid epidemic to a front-line defender against it is a common one. Increasingly, medical providers and community groups are hiring rehabilitated people to help those coming up behind them.
State and federal authorities responsible for addressing drug abuse and mental illness are recognizing the value in training peer recovery support workers to offer emotional, social, and logistical support—and in paying them for their efforts. These workers provide a variety of services, including one-on-one coaching, group meetings, and regular phone calls to check on those who may have few social links. Embraced by Revive and organizations across the United States, the peer recovery model operates on the idea that the people most qualified to address the problems of substance abusers are those who have faced the same challenges themselves. Doing the work of helping others can also be a crucial part of one’s recovery.
Matos’s drug use began at 13, when she was prescribed Vicodin for chronic leg pain that arose from her achondroplasia dwarfism. They were big white pills with little red dots. The first time she tried them, she fell in love with the numbing sensation. They eased more than just physical pain; she felt emotionally comforted, too. When conflicts arose with her family, Matos said, she left her home and began to build a social life centered on drugs.
She tried powder cocaine, crack, and meth, but opioids remained her drug of choice. When black-market Percocet became too expensive, because of enforcement crackdowns, she turned to heroin. She also started dealing to support her habit. By the time she was 18, she couldn’t imagine life without drugs. “I had guns to my head,” she said. “I had people breaking into my house. I woke up to 150 text messages and calls every day. It gives you that sense of importance.”
Some years before, Matos had toyed with the idea of being a veterinarian or a writer. But by now, she could no longer envision a path toward either goal. “The society we live in, you have purpose or you don’t,” she said. “You’re part of the community or you’re not. I put my hands up and was, like, ‘drugs are easy.’”
More and more state and federal agencies have come to embrace peer services.
Matos couldn’t escape police scrutiny forever. In April 2017, she was arrested (for a second time) on charges of selling heroin, a crime punishable by more than a decade in prison. She was offered an alternative: drug court, an intensive 18-month process that involves counseling sessions and judicial review of treatment, but no jail. She made the obvious choice.
During her time at drug court, a staff member suggested that Matos get help from a peer recovery coach at Revive. The experience was unlike anything Matos had tried before. “You sit down with the person who’s been through it and they say, ‘What are your goals? What do you want?’” she recalled. “It’s almost, like, ‘Whoa, you care what I want?’”
Figuring out an answer took her some time. “I spent from 13 to 27 using drugs and alcohol,” Matos said. “I didn’t have any idea what Priscilla loved or what Priscilla wanted to do. It turns out Priscilla really likes helping people.”
The origins of peer recovery go back to the eighteenth century, when Native Americans created “circles,” offering mutual support for sobriety and growth. Starting in the 1830s, white Americans began forming their own mutual aid groups as part of the temperance movement. Then came 12-step programs, developed with the formation of Alcoholics Anonymous, in 1935, which were run by volunteers, not medical professionals. “The medical field didn’t have any idea how to treat these people, so they began to treat each other,” Austin Brown, associate director of programming and research at Kennesaw State University’s Center for Young Adult Addiction and Recovery in Georgia, told me.
Over time, the number of addiction recovery groups grew. In the 1970s, people with mental illness began organizing to transform the system for psychiatric health in the United States—they found it stigmatizing and unwilling to address their needs—and in the 80s, activists founded an annual Alternatives Conference, which brings people together to discuss peer-to-peer support and advocacy. In the decade that followed, people with substance use disorders sought similar structures for drug recovery work. Adopting the slogan “nothing about us without us” from the disability rights movement, they pushed back against the expansion of criminal penalties for drug use. These advocates won federal seed grants to establish the first community rehabilitation centers and, in 2001, they formed Faces and Voices of Recovery, a national organization that brings together grassroots recovery groups and individuals to build peer support programs.
Since then, more and more state and federal agencies have come to embrace peer services both as an effective idea for recovery and as a solution to staffing shortages. In 2007, inspired by the success of Medicaid-funded peer support programs in Georgia, the Center for Medicare and Medicaid Services issued new guidance encouraging state Medicaid programs to pay for peer support services for people with mental illness and substance use disorders. Peer recovery programs proliferated, offering help at community centers like Revive, in hospital emergency rooms, and elsewhere.
Those policy developments are backed by scholarship. Brown, for instance, is working on an academic approach to recovery that goes beyond stopping drug use and instead focuses on helping people find a new sense of meaning and power in the world. That often involves helping others, whether as an AA sponsor or as a professional peer recovery worker. “Altruistic service is a big element of recovery—the idea that you’ve been spared, you are a wounded healer, and you go out into the world to avert devastation,” he said. “Just from your own experience and just from your suffering, you’re going to have tools to help other people.”
David Eddie, a licensed clinical psychologist and instructor at Harvard Medical School who recently led a review of peer recovery programs, said that they appear to be filling a significant gap in treatment. Different patients have different needs, of course, and peer support often works best when combined with medical approaches, such as the use of methadone or buprenorphine for opioid addiction. But the effect of one former drug user supporting a person seeking rehabilitation can be profound. “If you look at population averages, for a substance use disorder, 12-step does as well as clinically delivered cognitive behavioral therapy,” he said. “Which is a bit sobering as a clinician.”
In addition, Eddie said, there are services outside the medical establishment that only one rehabilitated drug user can offer another. “It would be really inappropriate for me as a licensed psychologist, to go meet with somebody and have a coffee, really inappropriate to take them to a 12-step meeting,” he explained. “Peer support can literally meet people where they’re at in the world.”
The peer recovery model has been embraced by Revive, which was opened three years ago by Harbor Homes, a social services nonprofit in New Hampshire that received state funding to address the opioid crisis. (New Hampshire is one of the states that’s been hit hardest in recent years.) Cheryle Pacapelli, a project director at Harbor Homes, told me that, at places such as Revive, Harbor Homes provides back-end support—payroll, technical assistance—and the centers handle the rest on site. Harbor Homes now supports 12 centers, all of which offer peer recovery coaching and phone support for people with substance use disorders; beyond that, each outpost is free to offer whatever services locals want. Revive hosts yoga classes.
“Some people need treatment but other people just need help finding housing or finding some other service,” Pacapelli said. “Everybody that walks in needs something different. It’s not cookie cutter.” Over the first three months of this year, the centers conducted more than 1,000 recovery coaching sessions with some 300 people and had 800 phone check-ins with more than 200. “I think it can only get bigger because it’s a low cost way for people to get help,” Pacapelli told me. “There’s more and more places where we can use peer recovery support in different settings.”
I’m helping somebody who wants to do the right thing right now.
Matos arrived at Revive six months ago, as a volunteer, greeting visitors and making folders for recovery coaches. Then she signed up to work full-time, through a peer recovery training program created by a collaboration between Harbor Homes and AmeriCorps. The work uses some of the same talents she cultivated as a dealer—organizational skills, having a good memory for names and faces, and getting a quick, accurate read on people’s motivations. She receives a stipend of $1,144 a month and has an opportunity to receive certification as a recovery worker. Soon, she may go on to pursue formal education in the field. “When somebody comes in and is, like, ‘I want to go to a treatment,’ you have a very short window of time to get that person into a treatment center before their sickness creeps in, before their mental health problems creep in, or the fear creeps in, and they’re right out the door,” she said. “I’m helping somebody who wants to do the right thing right now, and I want to help to the best of my abilities.”
The position works well for Matos, too. Since quitting opioids, her leg pain often gets bad—“I don’t think I’m ever going to be able to successfully use pain medication,” she explained—and her colleagues are understanding. “Some days, I have to go home, or I have to ask somebody, ‘Can you go up the stairs and grab this?’”
In addition to working on-site at Revive, Matos volunteers for a local syringe service program, distributing clean needles and Narcan, the overdose reversal drug. On a recent call, a client told her that the Narcan she provided had saved four lives in the past two days. Matos was moved. “I was a dealer, I was helping people ruin their lives,” she said. “And now I’m kind of getting my karma right.”
Editor: Betsy Morais
Fact-checker: Ethan Chiel