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Addictions Advisor: Social Workers as Peer Support Specialists
By Aaron M. Laxton, MSW, LMSW, and Chase A. Martinson, BSW, CPS
Social Work Today
Vol. 21 No. 3 P. 6

Increasingly, social workers employed in addiction treatment settings draw from their lived experience when working with their clients. In many states, there are opportunities to become certified peer specialists, who also draw heavily on their own lived experience as they work with clients in similar situations.

What ethical considerations and limitations exist for social workers with CPS credentials? What are the practice-based considerations and appropriate boundaries? Ethical challenges may arise based on how social workers can safeguard against ethical violations while attempting to work in both capacities. Additionally, there’s a need for a further conversation focused on the role of certified peer specialists within addiction treatment settings.

Social workers bring a broad array of technical experience and training into a therapeutic relationship. Whether it be in a traditional format or a nontraditional setting that focuses on brief symptom relief such as acute addiction or mental health situations, it is not uncommon for individuals with lived experience to draw from that knowledge when working with their clients.

However, this must be considered carefully. As professionals, social workers must grapple with how to preserve personal experience through the appropriate use of self while upholding the profession’s Code of Ethics. Social workers and certified peer specialists may share similarities; however, there is a significant difference that must be acknowledged.

Many individuals choose a career in social work either through personal experience or compassion for those around them. Personal experiences have both benefits and potential pitfalls that must be considered. For example, lived experience offers a unique perspective into a client’s substance use through empathy and understanding. While it provides that unique view into the client experience, it also may create a situation of hazard for the social worker. The social worker may relive vicarious trauma that a client shares, or, through poor self-care, the social worker with lived experience may find their own recovery jeopardized as a result of stress.

In the Recovery Realm
An emerging trend within addiction treatment and the recovery community is the use of certified peer specialists, who often walk an ethical tightrope.

Addiction treatment and recovery community agencies use certified peer specialists in various roles throughout the recovery continuum. Depending on the setting, certified peer specialists’ roles vary greatly. They can differ by the agency or even by state. In this regard, the field can be considered emerging.

For some, it may be as simple as either being a social worker or a certified peer specialist. However, it would be unwise for social workers to simplify it in this manner. As a result of COVID-19, the United States has seen a sharp increase in substance use. In rural settings, this is complicated by workforce shortages. As a result, in clinical settings, individuals with multiple credentials are increasingly working in multiple roles.

Ethical Considerations
According to the NASW Code of Ethics, when generally recognized standards do not exist with respect to an emerging area of practice, social workers should exercise careful judgment and take responsible steps, including appropriate education, research, training, consultation, and supervision, to ensure the competence of their work and to protect clients from harm.

While social work is well established, the use of self or lived experience in the therapeutic process is generally minimal. However, certified peer specialists consider this to be a primary tool. In fact, the person with lived experience is the conduit that provides hope for a client working through the recovery process—whatever that process may look like for the client. In this capacity, a person in the role of a social worker and a certified peer specialist would be expected to practice within the confines of NASW’s Code of Ethics and those of other credentialing bodies.

Role Confusion
The challenge for social workers stationed within addiction treatment or recovery is the confusion that may arise from working according to two sets of standards. The central theme of the certified peer specialist is to connect with a client who has a similar lived experience. When a person connects with another individual who is working through an issue, it is a truly powerful experience. The hope and strength that are provided leave a lasting impact.

Often, a strong connection develops between a client and someone who shares a lived experience. However, there are hurdles to clear. For example, a client may meet with a peer—not necessarily a clinician—who has different training, goals, and objectives. As a result, role confusion is created for the social worker or certified peer specialist and the client who is receiving services.

Furthermore, a social worker who is also a certified peer specialist may need to switch roles while with an individual client. There may be times when skills from a certified peer specialist are needed and then, with the same patient, there may be situations when attributes unique to social workers would be necessary.

According to the Code of Ethics, social workers should not engage in dual or multiple relationships with clients or former clients in which there is a risk of exploitation or potential harm to the client. (Dual or multiple relationships occur when social workers relate to clients in more than one relationship, whether professional, social, or business; they can occur simultaneously or consecutively.) When dual or multiple relationships are unavoidable, social workers should take steps to protect clients and are responsible for setting clear, appropriate, and culturally sensitive boundaries.

Duty to Report
Along with role confusion comes the challenge of mandated reporting. A social worker in the role of a certified peer specialist within the recovery continuum will encounter clients who may meet the criteria for mandated reporting with regard to social work standards. However, those standards may conflict with those of certified peer specialists. In those cases, which standards apply?

Take it a step further. With whom does the client believe he or she is interacting with during the intervention? For a person attempting to work in both capacities, this dual role or relationship is inherently fraught with client confusion. If a certified peer specialist/social worker is seeing a patient as a certified peer specialist and obtains information in which the patient, or another party, may be in danger from themselves or others, does the professional need to then assume the role of social worker?

Social workers need not be certified peer specialists. Social workers with lived experience have an authentic connection with clients. That experience, coupled with academic knowledge and training, provides a robust body of knowledge that cannot be ignored or dismissed.

However, it demands that the social work profession take into consideration social workers working within addiction treatment and recovery settings. Further guidance should be provided for social workers with lived experience in mental health and substance use. In short, while the Code of Ethics is the profession's guiding star, further clarity is needed regarding the intersectionality of other roles within the recovery space.

Ethical considerations, role confusion, and duty to report are just a few of the challenges for social workers who also serve in the capacity of certified peer specialists. Social workers employed in addiction treatment settings draw from their lived experience when working with their clients. In many states, there are also opportunities to become certified peer specialists. While individuals need to follow their path, the profession must examine the various roles that social workers are filling in the community, particularly in the addiction treatment and recovery settings.

— Aaron M. Laxton, MSW, LMSW, is director of behavioral health with Assisted Recovery Center of America. He is a graduate of the Saint Louis University's School of Social Work, where he received his Master of Social Work with an emphasis on Community and Organization. Laxton, who is currently working on his PhD at Saint Louis University, is a licensed Master of Social Work in Missouri and has worked in social services for more than 12 years.

— Chase A. Martinson, BSW, CPS, is the administrative lead for Assisted Recovery Center of America and a certified peer support specialist. He graduated magna cum laude with a Bachelor of Social Work degree and will be pursuing a Master of Social Work degree in the University of Missouri’s Advanced Standing program.