Expert recommendations for training peer workers to provide non-abstinent recovery support: A real-time Delphi study

Peer workers-nonclinical service providers with lived experience of recovery-are a growing sector of the substance use workforce whose professional practices are intertwined with their own personal recovery pathways. While research has documented stigma toward harm reduction among peers and the ways peers' attitudes affect their interactions with clients, little is known about effective strategies to prepare peers to serve people in non-abstinent recovery. This study used Delphi methodology to develop expert recommendations for training peers to provide non-abstinent recovery support.

A national panel of experts, including certified peers, peer supervisors, service recipients, and researchers, was surveyed using real-time Delphi software (N = 72). Delphi statements captured experts' recommendations for target outcomes and training methods on a 5-point scale, supported with open-ended comments. The real-time format allowed for independent anonymous responses followed by immediate review of group consensus and comments. For each Delphi statement, an interquartile range of ≤1.25 served as the consensus threshold.

The experts reached consensus on 16 of 20 Delphi statements regarding training outcomes (n = 7/10, e.g., peers should educate clients about safer drug use strategies) and methods (n = 9/10, e.g., training should include role play activities). Where consensus was not achieved (e.g., peers should initiate conversations about medications for opioid use disorder), desired training outcomes varied significantly by experts' attitudes toward harm reduction, professional background, and racial-ethnic identity.

These findings provide a framework for the first empirically developed training for peers to improve the provision of non-abstinent recovery support. A national panel of experts in harm reduction and recovery services clarified peers' roles and responsibilities and recommended theory-informed strategies to develop peer competencies. Differences in recommendations by personal and professional backgrounds may indicate the need for tailored training protocols.