Recovery coaches are individuals, who may or may not be in recovery themselves, who help people along the path of recovery—either before, during, after, or instead of treatment. That broad definition is based on interviews with and information from Faces & Voices of Recovery, the Substance Abuse and Mental Health Services Administration (SAMHSA), the International Certification and Reciprocity Consortium (IC&RC), NAADAC, the Association for Addiction Professionals (NAADAC), the Medication Assisted Recovery Support (MARS) program, managed care company Optum Behavioral Solutions, and others.
Who a recovery coach is and what his/her roles are varies, depending on the source. But there are some constants in the field's thinking about recovery coaches:
Recovery coaches are not therapists. They do not provide clinical help; rather, they help the person engage with treatment, and also help with various skills needed for recovery.
Recovery coaches are professionals who should be paid for their work. The payer, whether Medicaid or commercial insurance, is likely to make all decisions about role definitions and requirements.
Each state has its own rules for credentialing of recovery coaches.
One of the first groups to make recovery coaches a reality, albeit as volunteers at the time, was the Hartford, Conn.-based Connecticut Community for Addiction Recovery. By setting up telephone recovery support more than a decade ago, CCAR showed how a peer staying in touch with patients helped them meet recovery goals.
“Peer work is done in the community,” says Patty McCarthy Metcalf, executive director of Faces & Voices of Recovery, the Washington, D.C.-based organization representing recovery community organizations and people in recovery. “The model we’re advocating for is that treatment providers and health insurers will contract with peer recovery organizations” to provide recovery coaches, says Metcalf.
Recovery coaches focus on non-clinical issues such as housing, employment, proceeding through drug court, and dealing with probation officers, says Metcalf. Recovery coaches also can help engage people who are waiting to get into treatment. “That’s where we lose so many people,” she says.
Colorado's Faces & Voices affiliate, Advocates for Recovery, has a SAMHSA grant (like many recovery community organizations). So the organization has to record how many people are served. “Right now we are probably serving 200 people,” says Advocates for Recovery executive director Tonya Wheeler, adding that this number includes people served by partners with which her organization (which has only three staff members) collaborates. Advocates for Recovery requires that individuals have a year of uninterrupted recovery before they can be trained as recovery coaches.
Wheeler, sober for the past 25 years, stresses that she was able to maintain her recovery mostly because of support. “I came from the 12-Step rooms; that’s where I got and maintained my recovery,” she says. But she adds that there’s a “huge difference between a sponsor and a recovery coach.” A sponsor is a 12-Step title, for the person who “works the Steps” with the recovering individual, she says.
Tom Coderre, senior advisor at SAMHSA, says the goal of a recovery coach is to help the person sustain recovery. “The entire system of recovery coaches and other peer-type recovery supports has grown organically, because our healthcare system hasn’t always responded to the needs of people with [substance use disorders],” says Coderre, whose roles prior to joining SAMHSA included board chair for Rhode Island Communities for Addiction Recovery Efforts (RICARES). “Our goal is to figure out where those gaps are, and fill them.”
Peers or not?
At IC&RC, the recovery coach credential is called Peer Recovery, and is for both addiction and mental health specialists. “Subject matter experts from both sides came together to develop core competencies and standards,” says Mary Jo Mather, IC&RC executive director.
Ultimately, IC&RC left the decision of whether the recovery coach has to be a peer to the credentialing and licensing board in each state.
In many states, Medicaid determines what the recovery coach will be reimbursed for. About half of the states require credentialed coaches to have a “lived experience” in addiction or mental illness, says Mather. This lived experience is determined by self-report—the “honor system,” she says. There is an assumption that recovery coach training is open only to peers anyway, says Mather—and based on comments from Faces & Voices, that is the case.
Metcalf believes recovery coaches in the addiction field need to be peers. SAMHSA does not include peer status in any formal definition of a recovery coach. However, peer status is required in grant programs such as the Targeted Capacity Expansion Peer-to-Peer grants, which are specifically geared toward peer development. In addition, some of SAMHSA’s Recovery Community Services Program is geared toward peers.
New York state has two separate certifications for recovery coaches—one for addiction and one for mental health. In the addiction arena, the coach does not have to be a peer in recovery. Rather, he/she can be a counselor in a treatment program, or a parent of a child with an addiction, basically anyone with “lived experience” related to addiction, explains Walter Ginter, project director of MARS, which has a project funded by a SAMHSA Recovery Community Services Program grant.
Ginter frequently reassures addiction counselors that recovery coaches aren’t going to steal their jobs. “It’s a different skill,” he says. “Recovery coaches aren’t counselors.”