Peer recovery specialists in the drug treatment court: impact on participant outcomes from a randomised controlled trial

Background: Peer recovery specialists (PRS), who use their lived experience to assist their peers in attaining recovery, are being increasingly used in community-based behavioral health treatment settings. Some drug treatment courts are beginning to use PRS in different ways. Peer support can facilitate recovery, but research to date has shown inconsistent results in community addiction and mental health treatment settings. Prior to the current study, the PRS model has not been systematically tested in any criminal justice setting, and there has been no research on the role and impact of PRS in the drug court setting. This paper presents findings from a feasibility and acceptability study and randomized controlled trial (RCT) that developed, implemented, and tested the efficacy of integrating PRS into the Philadelphia Treatment Court (PTC).

Methods: This mixed methods study had two primary phases. The first phase included key informant interviews and key stakeholder focus groups to assess the perceived feasibility and acceptability of the PRS model, and provide guidelines on how to integrate the PRS into drug court operations. The second phase was an RCT in which 76 newly admitted clients were consented and randomized to be assigned a PRS (in addition to regular case management and addiction treatment (experimental condition), or receive treatment as usual in the drug court. Clients were followed up for nine months from the time of admission into the PTC, and extensive data were collected on drug court participation, treatment program attendance, relapse, and recidivism. It was hypothesized that having a PRS would improve drug court participation, relapse, and recidivism.

Results: Findings from the RCT indicated that PTC clients assigned a PRS had half the recidivism prevalence as clients in the control group (17% rearrested over nine months compared with 35%), and spent fewer days in jail. PRS clients also had a lower proportion of positive or missed urine drug screens, and a lower percentage of missed treatment sessions. PRS clients also made more progress toward completion of the drug court program. There were no differences in the number of sanctions imposed by the drug court judge.

Conclusions: This project demonstrated the feasibility and acceptability of integrating a PRS into the drug court model. PRSs were hired and worked with drug court clients to support their recovery and serve as a peer mentor and facilitator, as clients move through the drug court process. Findings from the RCT indicate positive impacts on recidivism, treatment participation, drug curt progress, and relapse. Implications and suggestions for expanding the PRS model into other drug courts and criminal justice settings will also be discussed.