Addressing substance use disorder in primary care: The role, integration, and impact of recovery coaches

ABSTRACT

Background: Only 10% of people with substance use disorder (SUD) receive treatment, partially due to inadequate access to specialty SUD care and limited management within primary care. “Recovery coaches” (RCs), peers sharing the lived experience of addiction and recovery, are increasingly being integrated into primary care to help reach and treat people experiencing SUD, yet little is known about how their role should be defined or about their clinical integration and impact. Methods: Semistructured interviews with RCs (n = 5) and their patients (n = 16) were used to explore patient and RC perspectives on the RC role. Maximum variation sampling was employed to select patients who displayed diversity across gender, RC, housing status, and number of contacts with an RC. Patients were sampled until no new concepts emerged from additional interviews, and a semistructured interview guide was used for data collection. To analyze interview transcripts, the constant comparative method was used to develop and assign inductively developed codes. Two coders separately coded all transcripts and reconciled code assignments. Results: Four core RC activities were identified: system navigation, supporting behavior change, harm reduction, and relationship building. Across these activities, benefits of the RC role emerged, including accessibility, shared experiences, motivation of behavior change, and links to social services. Challenges of the RC model were also evident: patient discomfort with asking for help, lack of clarity in RC role, and tension within the care team. Conclusions: These findings shed light on RCs in primary care. Many patients and coaches perceived that RCs play a valuable role within primary care, providing both tangible system navigation and intangible, social support that promote recovery and might not otherwise be available. Enhanced communication between RCs and health center leadership in defining the RC role may help resolve ambiguity and related tensions between RCs and care team members.

KEYWORDS:

• Patient acceptance of health care
• patient care team
• qualitative research
• substance-related disorders

Acknowledgments

The authors thank Grace Herman and Dr. Roy Ahn.

Funding

This work was supported by the Harvard Medical School Scholars in Medicine Office and Massachusetts General Hospital (strategic plan funds). Dr. Magidson's work on this manuscript was supported by the National Institutes of Health (K23DA041901). The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Author contributions

H.J. and S.W. conceived of the study. H.J., S.W., and J.K. designed the study. H.J. collected the data. H.J. and D.O. conducted data analysis. H.J. drafted the manuscript. S.W., D.O., J.K., and J.M. provided input and edits on the manuscript.