The Essential Role of Peer Recovery Coaches in Addiction Treatment

September 29, 2025

Lauren Grawert, MD, FASAM, Author & Addiction Psychiatrist, Chief Medical Officer, Aware Recovery Care, Inc.

Peer recovery coaches are essential to addiction treatment. Their lived experience provides unique support. This support improves treatment engagement, retention, and long-term recovery outcomes. By offering person-centered guidance, fostering self-efficacy, and connecting individuals with community resources, peer coaches create a vital support system. They complement clinical treatment and help people navigate the challenges of sustaining a substance-free life.

The Impact of Peer Recovery Coaches

As an addiction psychiatrist, I see the powerful effect of peer recovery coaches every day. These individuals are in long-term recovery themselves. They use their personal experiences to guide, motivate, and support patients. They offer something medicine alone cannot: authenticity, credibility, hope, and a real example of resilience.

However, this vital role in recovery is now at risk. Recent federal budget proposals threaten to cut programs that directly fund peer recovery support. The State Opioid Response (SOR) grants and the Substance Abuse Prevention and Treatment (SAPT) Block Grant—two primary funding sources that support peer positions in many states—are expected to face significant cuts.

The Consequences of Funding Cuts

As reported by The Washington Post (August 2025), these reductions could result in the loss of peer jobs across the country. This is especially concerning in communities hardest hit by opioid overdoses.

Without This Support, Several Dangers Arise:

Grant Instability – When SOR funding ends or decreases, programs that depend on it have no safety net. For smaller nonprofits or rural treatment centers, this means peer staff layoffs are swift and unavoidable.

Insurance Gaps – Unlike psychotherapy or medication management, peer coaching isn't consistently billable to Medicaid or private insurers. A cut in federal grants directly leads to fewer jobs, with no reimbursement system to replace the lost funding.

Workforce Instability – Many peer coaches are hired under temporary grant-funded contracts. Budget cuts cause sudden layoffs, destabilizing not only services but also the peer workforce's very recovery.

Systemic Under-appreciation – Policymakers often see peer services as "supplementary" rather than essential. This view makes them easy targets for budget cuts—even though studies show peers lower relapse rates, improve treatment retention, and reduce emergency service use—outcomes that save healthcare costs and save lives.

From my experience at Aware Recovery Care, I understand firsthand how important peers are. I have seen patients in early recovery who previously had difficulty engaging with treatment become inspired when connected with a trained peer who can say, "I've been there, I know what those nights feel like, and here's how I got through." That kind of connection cannot be replaced by medication, doctors like me, or therapy alone.

If federal funding dries up and a sustainable reimbursement system is not put in place, we risk losing one of the most effective links between formal treatment and real-life recovery. Peer recovery coaches are not just "extras"—they are frontline staff, cultural interpreters, and vital lifelines for patients. They are indispensable.

The Need for Advocacy

As clinicians, policymakers, and advocates, we need to emphasize that peer recovery support is a critical part of addiction care infrastructure. To weaken it now would undermine the very foundation of recovery.

Peer Recovery Coach Stats

Workforce Size: More than 30,000 peer recovery specialists are estimated to be working across the U.S., many funded by federal block grants and SOR programs.

Reach: Peer coaches are integrated into emergency departments, drug courts, prisons, and community-based programs, often meeting patients at their most vulnerable and critical moments when they are hesitant to engage with traditional healthcare providers.

Outcomes: Studies indicate that peer involvement can:

• Reduce recurrence rates by up to 40% in some programs.

• Increase treatment retention, with patients twice as likely to remain engaged beyond 90 days.

• Decrease emergency service usage, lowering costs for health systems.

  
  

Cost Savings: For every $1 invested in peer recovery support, estimates suggest a return of $3–$7 in downstream healthcare savings, primarily from fewer hospitalizations and less justice involvement.

Funding Risk: Both SOR grants (currently about $1.5 billion annually) and the SAPT Block Grant (~$2 billion annually) face proposed cuts in the latest federal budget cycle. Many peer positions depend entirely on these dollars.

Lauren Grawert is an Addiction Psychiatrist, Chief Medical Officer, Aware Recovery Care.

She is a double board-certified Addiction Psychiatrist who treats both adolescents and adults struggling with mood and anxiety disorders and substance use disorders.

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