New Licensure Law Validates the Power of Lived Experience in Healthcare

Though there’s heartening news that opioid-overdose deaths are dropping sharply in Boston and across Massachusetts, experts caution that opioid use disorder is still taking a devastating toll on patients and families. Much work remains to be done. Now, a new Massachusetts law aims to make treatment and recovery support for people with substance use disorder more accessible and affordable. 

Signed by Governor Maura Healey in December, the law not only increases access to lifesaving medications, such as naloxone, but it also helps formalize the professional status of recovery coaches — counselors with lived experience of addiction and recovery who play a key peer-support role for patients in their recovery journeys. The law mandates insurance coverage for recovery coach services and establishes recovery coach licensure. 

“The key component is that the coach has that lived experience,” says Carla B. Monteiro, MSW, LICSW, LADC-1, behavioral health director for addiction treatment services at Boston Medical Center, who oversees a recovery coach team at the hospital’s Grayken Center for Addiction. “Recovery coaches have personal experience with addiction and with recovery, which makes them more credible, more relatable to the clients. When they’re able to connect on a deeper emotional level with a recovery coach, it fosters trust and reduces isolation and shame.” 

Evidence backed benefits of peer-to-peer support 

Recovery supports delivered by peers bring a variety of positive outcomes, research shows. 

“There is mounting evidence that people receiving peer recovery coaching show reductions in substance use, improvements on a range of recovery outcomes, or both,” according to the federal Substance Abuse and Mental Health Services Administration (SAMHSA). 

The body of research is still growing, but as a whole, SAMHSA reports, it suggests that the benefits of peer-delivered recovery supports include: 

• improved relationship with treatment providers 
• increased treatment retention 
• increased satisfaction with their treatment experience 
• improved access to social supports 
• decreased emergency service utilization and criminal justice involvement 
• reduced substance use 
• reduced relapse and re-hospitalization rates 
• greater housing stability 

In addition, substance use counselors who are themselves in recovery may be more committed to their profession than counselors who are not — a not insignificant factor in a line of work that can take a heavy emotional toll and typically does not command high salaries. 

A recovery coach is ‘letting them know somebody cares about them’

Lydia Reyes is a certified addiction recovery coach (CARC) and a trained substance use disorder counselor who has been in recovery since 2001. Her career has spanned 20 years, the last seven of those at BMC, first working with young people in the CATALYST Clinic and now serving adult patients through the Grayken Center’s Rapid ACCESS  program. 

Recovery coaches work as part of the larger clinical team, she says, helping patients stay connected to their other providers and, very often, simply helping them move forward in their day-to-day journeys.  

“It’s guiding them through their recovery, and also just following up and reaching out, saying ‘Good morning, how are you today?’ A text means a lot,” Reyes says. 

That type of support is crucial for recovery, when many people feel isolated and overwhelmed, sometimes hampered by the stigma or shame associated with SUD. 

“Once you’re out of treatment, it’s like you’re doing everything by yourself,” she says. “You might have a therapist, but she’s not there with you. You might have a psychiatrist, but she’s not telling you to take your meds, so you have to take it upon yourself to reach out when you need to. You may have the services, but you need to have it within you to ask for support.” 

She mentions one patient who had a goal of completing a three-week computer training through the state’s Access to Recovery (ATR) program, but they needed support along the way.  

“She doesn’t wake up early, so I would call her in the morning. I would say, ‘OK, are you getting ready now? You have to be there by 9. You have to go downtown. You have to take the bus or ask for The RIDE,’” Reyes says. “She had a difficult time, but it was possible for her. She graduated ATR and she was proud of it. She gave me a copy of her certificate of completion. For her, it was something big.” 

While that patient still struggles with SUD, she has a network of support — though she still needs to be reminded at times to use it. 

“It’s mainly just being consistent, letting them know that somebody cares about them,” Reyes says. “Sometimes she’s like, ‘I don’t want to do anything today,’ and so I’ll suggest reaching out to her therapist, her psychiatrist, her primary care clinician. She used to be in and out of the hospital … She would go in for a week or two, sometimes it was a month. Now she doesn’t end up in the emergency room — she goes to her primary care provider.”

Formalizing the recovery coach role

The state’s new licensure requirement could help formalize and professionalize recovery coaches’ role. The law defines a licensed recovery coach as “a person with lived experience who is licensed by the department to practice recovery coaching using shared understanding, respect and mutual empowerment to help others become and stay engaged in the process of recovery from a substance use disorder.”

While the regulation details are still being drafted by the Department of Public Health’s (DPH) Bureau of Substance Addiction Services (BSAS), the bill text calls for licensed recovery coaches to have demonstrated at least two years of sustained recovery and meet DPH-defined standards of work experience, education, and training.  

Monteiro says the new insurance coverage requirement, including removing the prior authorization requirement for recovery coach services, will improve access for clients and increase providers’ billing ability, helping to keep programs more sustainable.  

In addition, a more formal credentialing process could add a level of professionalism and safety. 

“Often, people aren’t certified to provide recovery coach services, and there’s a lot of confusion about the process and requirements to make it clearer,” she says. “I think this will streamline that, so there’s a clear-cut direction of how to do this. The law gives us consistent requirements across the board. I think that that will help us increase workforce structure for the coaches, patient support and patient safety.” 

All of this adds up to ensuring recovery coaches can play their key role: “Recovery coaches model what recovery looks like,” Monteiro says. “They empower patients to reclaim agency over their own lives and their own choices. They offer patients hope that change is possible.”