Sarah Wright stops by her peer support specialist’s hotel room-turned-office in the Denver suburb of Centennial in Colorado, United States, several times a day.
But her visit on a Wednesday morning in mid-October (2022) was one of her first with teeth.
The specialist, Donna Norton, had pushed Wright to go to the dentist years after homelessness and addiction had taken a toll on her health, down to the jawbone.
Wright was still getting used to her dentures.
“I haven’t had teeth in 12-and-a-half, 13 years,” she said, adding that they made her feel like a horse.
A new smile was Wright’s latest milestone as she works to rebuild her life, and Norton has been there for each step: opening a bank account, getting a job, developing a sense of her own worth.
Wright’s voice started to waver when she talked about Norton’s role in her life during the past few months.
Norton wrapped her arms, adorned with tattoos of flames, spiderwebs and a zombie Johnny Cash, around Wright.
“Oh, muffin,” she said. “I’m so proud of you.”
Helping while recovering
Norton, 54, is a Harley-riding, bulldog-loving, eight-years-sober grandmother, and professionally, “a cheerleader for the people that look bad on paper”.
People like her.
“If you were to look me up on paper, you wouldn’t be in this room with me,” she said.
“You would not let me near your house.”
If she were a therapist or social worker, hugging and sharing her experiences with drugs and the law might be considered a breach of professional boundaries.
But as a peer support specialist, that’s often part of the job.
“I have no boundaries,” she said.
“F*** off,” she said, “is a term of endearment here.”
Norton works for the Hornbuckle Foundation, which provides peer support to participants in the SAFER Opportunities Initiative.
SAFER provides short-term shelter in the hotel for people in Arapahoe County who are homeless and have mental health or substance use disorders.
Peer support specialists are themselves in recovery and are employed to help others.
As billions of dollars in opioid settlement funds roll out to US states and localities, local leaders are deciding what to do with the money.
Supporting and training peer specialists, whose certification requirements vary by state, are among the options.
US states, counties, municipalities and tribes filed thousands of lawsuits against drug companies and wholesalers that are accused of fuelling the opioid crisis in the country.
Many of those cases were lumped together into one mega-lawsuit.
This year, four companies settled out of court, agreeing to pay US$26 billion (RM117.72 billion) over 18 years.
Participating states must follow guidelines for how the money can be spent.
In Colorado, hundreds of millions of dollars from that settlement (and a few others) will go to local governments and regional groups, several of which submitted plans to use some of the money for peer support services.
Plugging a gap
David Eddie, a clinical psychologist and a research scientist at the Recovery Research Institute at Massachusetts General Hospital, Boston, said peer recovery support services have “been gaining a lot of traction in recent years”.
According to the US Substance Abuse and Mental Health Services Administration, “mounting evidence” shows that working with a peer specialist can result in better recovery outcomes, from greater housing stability to reduced rates of relapse and hospitalisation.
A report by the US Government Accountability Office identified peer support services as a promising practice in treating adults with substance use disorders.
In many states, peer specialists are reimbursed through US national insurer Medicaid.
“They can plug a really important gap,” Eddie said.
“They can do things that we as clinicians can’t do.”
They can, for example, help navigate the bureaucracy of the child protective services system, about which clinicians might have little knowledge, or take someone out for coffee to help build a relationship.
If a person stops showing up to therapy, he said, a peer support specialist “can physically go and look for somebody and bring them back to treatment – help them reengage, reduce their shame, destigmatise addiction”.
Norton has, for instance, picked up a client who called her from an alley after being discharged from a hospital stay for an overdose.
‘Stop, drop, roll’
“Some people will tell you, ‘I decided I was going to get in recovery, and I never had to drink, drug, or use again.’
“That’s not my experience. It took me 20 years to get my first year clean and sober.
“And that was trying every day,” said Norton from her office, her Vans shoes planted just inches from a basket that lives under her desk.
The basket contains three opioid overdose reversal kits stocked with naloxone.
Her office, warmed by the sunlight coming through a south-facing window and the nearly constant rotation of people plopping onto the couch, contains a shelf of essential items.
There are tampons, for whoever needs them – Norton will “never forget” the time she got a ticket for stealing tampons from a grocery store while she was homeless – and urine analysis kits, for determining whether someone is high versus experiencing psychosis.
She teaches “stop, drop, and roll” as a coping mechanism for when people are feeling lost and thinking about using substances again.
“If you’re on fire, what do you do?” she said.
“You stop immediately, you lay on the ground, you roll and get yourself out.
“So I’m like, ‘Go to bed. Just go to sleep.’
“People are like, ‘That’s not a wellness tool.’”
“It is,” Audrey Salazar chimed in.
Once, when Salazar was close to relapsing, she stayed with Norton for a weekend.
“I literally just slept,” she said.
The two rested and ate Cocoa Puffs and Cheez-Its by the box.
“It was so bad,” Norton said of the junk food binge.
But the weekend got Salazar back on track.
Working with a peer support specialist who has “walked the same walk,” Salazar said, “holds you accountable in a very loving way.”
That October day, Norton pivoted from nagging one person to make a doctor’s appointment, to getting someone else set up with a food pantry, to figuring out how to respond to the bank that told a third client that an account couldn’t be opened without a residential address.
She also worked on lowering the defences of a newcomer, a sharply dressed man who seemed sceptical of the programme.
Some people come to Norton after being released from the county jail, others by word of mouth.
And Norton has recruited people in parks and the street.
The newcomer applied after hearing about the programme in a homeless shelter.
Norton decided that sharing a little about herself was the way to go with him.
“‘My experience is jails and hospitals and institutions. I’ve got an old number’ – meaning a convict number.
“‘And I have eight years drug-free,’” she recalled telling him.
“‘My office is down the hall. Let’s get some paperwork done. Let’s do this.’”
Working on the ground
Norton is one of seven peers on staff with the Hornbuckle Foundation, which estimates that it costs about US$24,000 (RM108,660) a month to provide peer services to this group of residents.
Peer specialists working full time make about US$3,000 (RM13,583) a month, plus US$25 (RM113.19) an hour per client.
Norton’s office is the hub of activity for a floor in one hotel where about 25 people participating in the SAFER Opportunities Initiative live while recovering from substance use disorders until they “graduate” to another hotel, located next door.
From there, they’ll move on to their own housing, which staffers often help them find.
While in the programme, residents meet at least once a week with a case manager, a therapist and a peer support specialist.
In addition, they attend group meetings, which take place every day except Sundays and are all run by peers.
Kyle Brewer, based in Arkansas, is the peer specialist programme manager for NAADAC, the Association for Addiction Professionals (formerly the National Association for Alcoholism and Drug Abuse Counselors).
Brewer, who said his life derailed after he started using prescription opioids to manage the pain from a wisdom tooth removal, said opioid settlement funds present an opportunity to support the people who work on the ground.
“When we’re working and talking and troubleshooting different approaches to solve the opioid crisis, we should have the people that have been directly affected by those issues in the room, guiding those conversations,” he said.
Toward the end of the day, Norton ran into the new guy in the hallway again, this time on his way back from the ice machine.
“Eight years clean. My hat goes off to you,” he said.
“I started with one day,” said Norton.
“Well, I’ll start with one hour,” said the new guy.
He said he needed to clean out his car, where he’d been living.
He said he has trouble putting his jeans on in the morning after losing a thumb to frostbite.
He wanted to find a part-time job.
He has trauma to work through in therapy.
His mother died about a year and a half ago.
“Friday night, we’re going to the movies,” said Norton.
“Oh, cool,” he said. “I want to see Top Gun, the new one.” – By Rae Ellen Bichell/Kaiser Health News/Tribune News Service
Kaiser Health News (KHN) is a US national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programmes at Kaiser Family Foundation (KFF). KFF is an endowed non-profit organisation providing information on health issues to the US.