‘For the first time in My life, My past is an advantage’: the perceived effects of professional peer work on wounded healers in the field of drug addiction

Abstract

As part of the evolution of the strengths-based approach in the criminological field in recent decades, various countries in the world operate peer-based programs in prisons and in the community. These programs utilize the personal knowledge and live experience of convicts and addicted people, that is, wounded healers, to promote recovery and rehabilitation processes. Studies point to the many advantages inherent in such peer work, especially for the aid providers. However, little is known about the perceived effects of professional peer work for people with a history of addiction and incarceration, as the current study suggests, the first of its kind in Israel. The respondents were 23 trained men and women with a history of traumas, addiction, and incarceration, all are formally employed in peer worker positions in various therapeutic settings, in prison and/or in the community. The findings indicate that peer work enhances the participants’ social capital, and promotes their positive change and recovery process, albeit with some difficulties and challenges. The paper discusses these findings from the emerging Convict Therapy perspective and related approaches of positive criminology and desistance from crime. Specifically, our findings expand the literature on wounded healers in the criminological field and reinforce the culture of ‘giving back’ embodied in the role of peer supporters.

Keywords:

• Convict therapy
• wounded healer
• peer-support
• peer work
• recovery
• desistance
• positive criminology

Introduction

Researchers in the field of desistance from crime highlight the need for new rehabilitators, with actual opportunities to practice pro-social behaviors (McNeill 2012). Indeed, as part of the strengths-based approach established in the criminological field in recent decades, peer-based projects are currently being implemented in various Western countries—including the United States, the United Kingdom, Canada, Australia, and Israel (Devilly et al. 2005; Burnett and Maruna 2006; Einat 2017; Clute et al. 2019; Wincup 2019). Based on their personal knowledge and lived experience, these previously incarcerated people assist other people in coping with addictions and the aftermath of incarceration, and with changing their ways and rehabilitating.

Peer work (also known as peer support, peer-to-peer program, or peer-mentoring), which is carried out in formal therapeutic settings on a voluntary or paid basis, enables people recovering from addiction and ex-prisoners to re-integrate into a normative framework and to practice prosocial and productive behavior for the benefit of others (Maruna 2002; Buck 2021). These efforts fall within the emerging Convict Therapy perspective (Elisha 2023). Convict Therapy is a unified and inclusive term denoting formal constructive, peer-support activities that are performed by reformed ex-convicts and addicted individuals, dubbed wounded healers, based on their own lived experience. Convict Therapy encompasses several related theories and approaches, in an effort to promote the discourse and research on professional peer work in the field of criminology. These include the theories of the wounded healer (LeBel et al. 2015); positive criminology (Ronel and Elisha 2011, 2020); and desistance from crime (Laub and Sampson 2001; Maruna et al. 2004). It should be noted, however, that Convict Therapy is not a substitute but a complement to existing rehabilitation approaches (for more details, see Elisha 2023).

Although the benefits of peer work in the criminological field are known, little research has been done specifically on formerly addicted ex-convicts who are now professionally employed as peer workers. In addition, while most studies have focused on the advantages of peer work, almost none have made note of their potential challenges and problems (Elisha 2022). The present study seeks to address that gap, by examining the advantages and disadvantages of peer work in the field of criminology.

Peer supporters as wounded healers in the field of criminology

Peer support is founded on the principle of the wounded healer, namely, a former sufferer who assists other wounded individuals, based on his own personal knowledge, and lived experience (Conti-O’Hare, 1998). According to this paradigm, the conscious and unconscious inner needs of self-healing prompt such individuals to harness their personal suffering to help others (Laskowski and Pellicore 2002). Thus, the process of caring for another can also be seen as a form of self-care (Barnett 2007).

The wounded healer principle is evident especially in self- and mutual-help groups for addicts, such as AA and NA, that operate on the principles of the 12-step program (Borkman 1990). In these groups, the recovering mentors serve as role models for newly recovering addicts and offer them emotional support and insights from their own experience (White 2009; Wincup 2019; Borkman et al. 2020). In turn, the mentors also receive support from their peers, that is, the other group members, while bolstering their own recovery (Perrin and Blagde 2016).

Peer-work programs aim to provide emotional, educational, and practical assistance, through various roles, such as rehab instruction, mentoring, counseling, modeling, and guidance (Devilly et al. 2005; Perrin and Blagde 2016). These programs draw on the existing human capital of former convict individuals, to promote recovery and rehabilitation of peers (Dhaliwal and Harrower 2009; Bellamy et al. 2012). Indeed, it has been found that organized generative activities for others, such as volunteering and peer-mentoring, allow ex-convicts to restore their relationship with society, and to atone and redeem themselves from their past misdeeds (Maruna 2002; Brown and Ross 2010; LeBel et al. 2015).

Overall, studies point to many advantages inherent in peer work, especially for the aid providers. These include improved mental well-being; an enhanced sense of meaning, purposefulness, empowerment, and satisfaction; improved social and family ties; and a stronger commitment to recovery (e.g. White 2009; Marsh 2011; LeBel et al. 2015; Heidemann et al. 2016; Einat 2017; O’Sullivan et al. 2020; Woods 2020). Similarly, studies of NA sponsors who voluntarily provide support and guidance to other recovering addicts indicate that these activities enhance their own rehabilitation and recovery, increase their feelings of empowerment, and reduce their stigmatization (Marsh 2011). Such generative activities enable former convicts to establish a positive self-identity of a wounded healer, and to gain further validation of their rehabilitation efforts (Maruna 2002; Maruna et al. 2004; Esping 2014).

Yet, other studies point to mixed evidence on the effectiveness of peer mentoring. This is, in part, due to the diversity of peer-based mentoring which makes it difficult to determine the promising aspects of such interventions (e.g. Brown and Ross 2010; Creaney 2020; Wong & Horan, 2021). For example, there is limited evidence regarding the effect of peer coaching on improving coping skills and relationships with family and friends (Brown and Ross 2010; Taylor et al. 2013). It has also been suggested that this practice may not be relevant to all people involved in the criminal justice system (Wadia and Parkinson 2015). Another issue relates to insufficient supervision on peer workers, which may have a negative impact on their mentees.

However, most of these studies referred to informal mentoring performed within voluntary organizations, whereas the current study focuses on paid peer workers formally employed in institutionalized organizations (e.g. prison treatment wards, community therapy), which may lead to different results. There is a distinction between peer work on a voluntary basis (such as the mutual and self-help programs for addicts, e.g. those of the AA and NA), and projects where peer support is carried out on a salaried basis within a formal therapeutic setting (Clancy et al. 2006). In the field of drug rehabilitation, both approaches have been employed. The present study focuses on the second form of peer work, that of paid peer work.

Peer work in the field of addiction

Currently, peer-based programs are formally operated in various settings, in prisons and in the community, for convicts and drug addicts (which are often overlapping populations). Such programs are founded on the premise that peer workers in the field of addiction have a visceral and authentic understanding of addiction and recovery, in a way that no professional has (Maruna 2002; LeBel et al. 2015; Heidemann et al. 2016). These peer mentors share their personal experience through confessions and accounts, so that new recovering peers may learn from their experience and overcome similar problems they encounter in their own recovery path (Borkman 1976; White 2000).

Studies of peer mentors in self-help groups for addicts have also found positive outcomes—such as empowerment, a sense of worth, reduced negative stigma, and a boosting of their own recovery process (Aresti et al. 2010; Marsh 2011). Other studies have highlighted the positive effects of recovering peers encountering newly recovering addicts. For example, in a UK study, Best et al. (2008) found that what enabled former drug addicts to maintain their recovery largely involved shifting away from substance-using peer networks to recovery support ones. Similarly, in a study of former alcoholics and heroin addicts in Glasgow, Best et al. (2011) found that engaging with other recovering people, and being involved in various generative activities (such as parenting, volunteering, education, training, and employment) was associated with a higher quality of life. Engaging in beneficial activities for others allows ex-convicts to practice self-acceptance and social acceptance, which are essential to recovery and rehabilitation—as highlighted by the positive criminology perspective (Ronel and Elisha 2011, 2020).

Many studies have shown that drug use increases the chance of offending (Lo and Stephens 2002; Peugh and Belenko 1999) and reoffending (e.g. Best et al. 2001, 2003; Bennett et al. 2008), and vice versa—drug abstinence reduces the incidence of criminal behavior (Best and Laudet 2010; Gossop et al. 2000). It has been estimated that around half of those suffering from addiction problems will eventually recover (White 2012). Yet little is known about the factors that strengthen or hinder recovery, when examined solely through the narrow lens of abstinence from drugs. The positive criminology perspective (Ronel and Elisha 2011) suggests that the focus be shifted to factors that are experienced as positive, and that distance an individual from crime and addiction. Engaging in peer support and receiving support from one’s peers is a good example of this, as indicated by convict therapy (Elisha 2023).

However, while most studies have focused on the benefits of peer work, very few have noted the difficulties it entails, such as professional conflicts, problems of countertransference, role confusion, and relapses (Elisha 2022; White 2000). The present study seeks to address this gap, as well, and to examine the potential challenges inherent in peer work in the field of addiction recovery.

Peer work as social capital

Social capital refers to the resources an individual develops through families, communities, and other social networks (Wincup 2019). There are two types, often referred to as “bridging” and “bonding.” Bridging social capital is information sharing through external networks and sources. Bonding social capital refers to the values of social and emotional support and reciprocity generated within peer groups and communities (White and Cloud 2008).

It has been argued that a history of incarceration represents negative recovery capital for those seeking to rehabilitate, resulting in a loss of personal and social capital, compounded by discrimination and negative labeling (Cloud and Granfield 2008). In contrast, peer work is considered as a means of enhancing one’s social capital. Peer work provides an opportunity to establish ‘bridging social capital’ (McNeill and Weaver 2010, p. 20), by connecting aid providers and recipients to social networks that can expand their social connections with a wider range of people and organizations, thereby gaining more social capital.

Social capital is essential to the processes of recovery, rehabilitation, and abstention from crime (Farrall 2004; Best and Laudet 2010; Brown and Ross 2010; McNeill 2012). Social relationships expand the support networks, involvement, and commitment of ex-convict individuals with others, thus promoting processes of positive change and rehabilitation. This is the opposite of the well-known revolving door phenomenon, which heightens the social exclusion and negative stigma faced by ex-prisoners (Wincup 2019).

The present study

The present study is part of a larger study designed to explore the effects of peer work in the field of criminology. Specifically, it aims to examine the effects of peer work from the perspective of professionally trained individuals with a history of drug addiction and incarceration, who are formally employed in peer-work positions, that is, wounded healers. Its novelty lies in the fact that it is the first study of its kind in Israel.

Method

The study was designed on the principles of qualitative research, with the aim of understanding meanings and experiences from the subjective point of view of people experiencing the phenomenon in question. Qualitative research relies on open-ended questions that encourage participants to provide thick descriptions, their thoughts, and feelings on the topic at hand. This approach allows researchers to reveal insights, complexities, and contexts of the research topic, and to think about new directions of inquiry (Denzin and Lincoln 2000).

Participants

The participants in this study were twenty-three individuals with a history of addiction and incarceration for various offenses (such as drug use and trafficking, burglary, theft, fraud, and violence). All were formally employed in peer work positions such as rehab instructors, team guides, counselors, and coordinators, in various therapeutic settings for addicts, in prison and/or in the community (e.g. the rehabilitation section in prison, at a therapeutic community, hostel, or municipality rehab unit). Some had also worked in the past or at present with at-risk youth. The duration of the participants’ engagement in such peer work ranged from three to thirty years.

Nineteen of the participants were men, and four were women. Their age at the time of the study ranged from 42 to 72. In terms of marital status, 17 were married, five were divorced, and one was single. All but one had children. The time that had passed since their release from their last imprisonment ranged from 5 to 35 years; Their recovery period ranged from 3 to 32 years; Their years of education ranged between 8 to 17 years. All had been formally trained (in certificate studies) in one or more of the following areas: group therapy; counseling; guidance; facilitating the 12-step program; psychodrama; or psychotherapy. Five had acquired a bachelor’s degree (in social sciences, criminology, law, or social work); one held a master’s degree in criminology.

Tools

Our research tool was a semi-structured in-depth interview based on an interview guide comprising questions derived from the research objectives: 1. Tell me how and why you decided to engage in peer work? 2. How do you perceive peer work? 3. What are the advantages and disadvantages of peer work? and 4. What helps you maintain your recovery over time?

Procedure

The IBR of the Max Stern Yezreel Valley College Israel approved the study’s ethical standards. The participants were recruited through purposeful sampling based on personal acquaintance; through these, we reached additional interviewees using the snowball sampling method (Dragan and Isaic-Maniu 2013).

The interviews with the participants were conducted by the authors in the course of 2022. Each interview began with an explanation of the study, followed by questions about the interviewee’s personal background. The respondents were then asked to answer open questions about their positions as peer workers. After receiving the transcripts of the recorded interviews, we conducted a thematic content analysis to identify the main themes and their meanings.

Findings

The main themes identified from the interviews pertained to: 1. The decision to recover and change lifestyle; 2. The motivations for engaging in peer work; 3. The positive effects of peer work; 4. The difficulties and challenges of peer work; and 5. Maintaining the recovery. These themes are accompanied by direct quotes of the respondents, under pseudonyms. It should be noted that the participants referred to themselves as “recovering addicts,” in keeping with the 12-step program that they claim to implement on daily basis.

The decision to recover and change lifestyle

The respondents reported growing up in troubled environments and dropping out of school early, due to behavioral disorders and/or academic difficulties. Most of them had experienced traumatic events in their past that included physical or sexual abuse and/or emotional neglect in childhood. Some reported a lack of parental supervision or boundaries, excessive indulgence, or extreme rigidity. Most had led a criminal lifestyle from an early age onward—including drug abuse, detention, and incarceration. All indicated that their sincere desire to recover from drugs and to change their lifestyle stemmed from their weariness of the crime and humiliations they had experienced (‘reaching rock bottom’)—such as near-death experiences, living on the street (‘in a dustbin’), or beggary.

Simon, for example, described his weariness with crime, recognizing the heavy price it entailed, and the fact that drugs had stopped working for him—that is, they no longer had any effect on his feelings, and only created new problems:

The drugs stopped working. I began to feel suffocated; I was tired, I began to realize the price of using… For a few good years, the drugs did the job, but then they stopped doing this job of covering up all kinds of emotions. I was reaching rock bottom and suffering all kinds of humiliations of things I would do for the drugs—whether it’s sleeping on the streets, in abandoned houses, or burned cars, and asking others for money. Things I wasn’t willing to do when I started using, but did by the end of it… (Simon, recovering addict for 5 years)

The respondents also noted that what had prompted them to rehabilitate was an offer to take part in a formal rehabilitation program (‘opportunity for change’) and/or an encounter with recovering peers, who inspired them and whom they perceived as a role model for recovery.

Suddenly, I saw clean addicts all around me. Some of them were addicts I knew; I saw them arrived in cars, they were well-dressed, clean shaven, and had put on some weight. It affected me subconsciously. That’s where the first seed was planted… After that, I got jaundice. I was dying. People were already eulogizing me… Then a miracle happened: I recovered. It was in 1993. It was my first clean day. After six months, I started working as an instructor at a rehab center—someone who knew me recruited me to work there. (Uri, recovering addict for 28 years)

The motivations for engaging in peer work

Most respondents reported that prior to their current position as peer workers, they had never held a stable, normative job. Their decision to engage in peer work was often in response to an offer they received at the rehabilitation setting where they were being treated, as part of the NA approach and the 12-step program of peer support (‘addicts for other addicts’). Their work as peer supporters includes group facilitation, personal counseling, emotional aid, and conducting urine tests for the newly recovering. Their primary motivation, they said, for engaging in formal peer work, was to help other addicts to recover, as part of their new worldview:

It was very fulfilling for me to help other addicts and give them some of the strength I had gotten from friends, members in NA. It fills me up, recharges me all over again… I’ve been dealing with this issue of peer support for almost 20 years now. Today it’s my job. I used to work with youth at the Malkishua Therapeutic Community for many years. Today I work at a prison as a mentor of recovering addicts. (Erez, recovering addict for 27 years)

Other reasons reported by the respondents including holding down a stable and normative job that provides them with a livelihood and satisfaction; gaining professional value and status; and being in a healing environment:

There are small motivations around me that keeps me going: you make a living, develop, study, and are surrounded by educated people. It has added value. 31 years ago, I was sitting with people in the streets; today I sit with psychologists, social workers, who also consult me. I appreciate it. But the main thing is that I’m in a healing environment. (Eli, recovering addict for 31 years)

Additional incentives cited by the respondents were transcending self-centeredness; practicing goodness by helping others, in gratitude for the help that had been given to them; reconciliation with their troubled past; an opportunity to atone and redeem themselves of their past misdeeds; increased commitment to recovery; and maintaining their own rehabilitation. This may be seen as a combination of instrumental, altruistic, and spiritual inducements:

I started working with at-risk youth. I felt I owed this to society. I had done so much harm to society, and I wanted to teach teenagers from my experience. So, I started volunteering at ELEM, working with at-risk youth. They saw that I was able to make good connections with the youths, so after a while, they offered me a paid job there as a coordinator. (Ziv, recovering addict for 13 years)

God helps those who help others. So, I give back to God for the kindness he has done to me, because I don’t take for granted that I’m talking to you here today, that I’m alive, that I’m a grandfather, that I have everything that I have. (Oren, recovering addict for 15 years)

Positive effects of peer work – for the aid providers and recipients

The respondents reported multiple positive effects of engaging in peer work, for themselves and for their recipients as well. The benefits for the aid providers include gaining a new meaning and purpose in life by being beneficial to others; gaining a sense of pride, respect, self-worth, self-confidence, and satisfaction; increased commitment to recovery; professional development; and improving familial and social ties.

Being meaningful to others was the most beneficial by all respondents. This includes the development of a new meaning in life and changes in self-perception, which sharpen considering their good deeds for others at present as opposed to their negative actions in the past. Oren, for example, described this well:

I went to tell my personal story to inmates and prison staff, to convey a message. Then one of the prison officers stood up and said: “Man, maybe to the rest of the world, you’re just some guy—but for an addict, you’re the whole world.” I’m telling you: that was the first time in my life I got “high” without drugs or alcohol… I experienced something inexplicable. It lifted me up, it’s like—where I was back then and where I am today, [suddenly] has meaning and importance… It revives me. I know how much I needed a person like me in life. (Oren, former prisoner and recovering addict for 15 years)

Similarly, Rikki, a rehab instructor in a women’s prison, and Avi, a rehab instructor in a rehab unit in the community, described their sense of meaning and importance in the eyes of their aid recipients:

First and foremost, it fills my soul, to be in this giving. It gives me a feeling of a lot of meaning in this world, a feeling of making amends… It solves a lot of unresolved issues in my life. (Rikki, recovering addict for 5 years)

Over time I felt that I was becoming significant to the guys I was working with. It mainly made me feel that I’m worth something, something that I’ve been looking for all my life, I think. People are consulting me—my knowledge is important to them. (Avi, recovering addict for 19 years)

Some respondents noted that, above all, their peer efforts filled them with satisfaction, derived from their ability to be helpful and useful for others. For example:

At the end of a working day, I feel very satisfied, I feel that I’ve expressed myself. The day I feel like I’m helping one or two prisoners get some insights, that’s a good day for me. (Yehuda, recovering addict for 16 years)

Another significant benefit reported by the respondents, is that peer work increases their commitment to their own recovery. Their continual encounter with recovering addicts is a reminder of their aversion from who they used to be, and what they don’t want to return to:

There’s a commitment to the recovery path. Today, I’m committed to being “clean”, and not just for me: I’m also clean for my family’s sake, and for a new friend who looks up to me and is inspired by me. (Ronny, recovering addict for 26 years)

Working with addicts mainly helps me remember what not to go back to. It helps me understand that if I go back to drugs, I’ll end up in prison, in institutions—or in a grave. (Limor, recovering addict for 3 years)

Besides the personal benefits of peer work, the respondents—who themselves were supported by peers at the start of their own recovery journey—reported that their clients also benefit from it. The advantages for the aid recipients, they said, include gaining emotional and practical support, and being inspired by a living role model that instills faith and hope in them about their ability to recover. Simon, for example, a rehab instructor in prison, described it as follows:

I feel that this is my mission: to help others, to give them hope. To give a client direction and put him [back] on his feet…. You give him hope and faith, show him and teach him, and he listens to you. That’s a very great gift, to give hope to a broken man. To be a role model and tell him: I was like you and even worse, and if I can get out of it, you can too. (Simon, recovering addict for 5 years)

Some also noted that while they may have got more out of it at first, over time, their clients ultimately gained more:

It works both ways: both I and my mentees benefit from it. I also tell them this when they tell me that I saved them. I keep telling them: You don’t understand how much strength I’ve gotten from you, how much I take from you. That’s what keeps me going. (Effi, recovering addict for 13 years)

At first, it helped me a lot—and today, I feel that it helps them more. (Aharon, recovering addict for 32 years)

Meni, a rehab instructor in prison and at a therapeutic community for addicts, pointed out that, ironically, peer work is the only place where his past has a positive meaning—for him and for others as well:

This is the only workplace where my past helps me. Usually, my past only hurts my prospects, but this is the only place where, without my past, I wouldn’t be accepted. It’s absurd, but that’s the reality. (Meni, recovering addict for 17 years)

Difficulties and challenges of peer work

Along with the positive effects, the respondents highlighted quite a few challenges inherent in their peer work, including low pay, poor incentives, professional conflicts, role confusion, emotional overflow, and risk of relapse. However, the main problems pointed out by the respondents related to their work conditions, referring to low pay, peer incentives, professional barriers, and lack of promotion prospects. These were particularly irksome given the great effort and hard work they put in. They noted that many peer workers have left the profession, or moved on to management positions, as a result. Examples:

We feel like subcontract workers, that the system is doing us a favor by letting us work, even though we work a lot, and hard. Not to mention the pitiful [financial] incentive we receive… This suggests that we’re not valued enough, although the staff here do appreciate us, and tell us that without us, the treatment departments wouldn’t exist (Sammy, recovering addict for 28 years)

The salary is a disgrace. Many instructors are leaving. There’s no professional promotion, either. Many instructors at the municipal welfare offices have left and moved on to other departments, some have gone on to management positions. (Aharon, recovering addict for 32 years)

The participants, however, stated that the main thing keeping them in the field, is the emotional benefit - in particular, the satisfaction derived from their efforts:

Honestly, I wouldn’t stay here for a minute if it was for the salary. My reward is seeing people recover and inviting me to their wedding. When you see an ex-addict who is “clean,” married, and working, and you know you have a part in it. That’s my gain. (Oren, recovering addict for 15 years)

Some respondents cited more internal problems at work, such as barriers put up by care personnel, i.e. social workers, at the therapeutic community where they work. For example, Erez noted that they feel threatened by peer workers who manage to connect with patients more easily and more naturally than them:

Most of us are not accepted as equals among equals—although outwardly, they say they are, but not really. Why? Because we’re probably threatening the system. We have experience that no other professional has in the therapeutic community. Our ability to talk with patients is different, they also have more trust in us. (Erez, recovering addict 27 years)

Another challenge pointed out by some respondents is the risk of emotional overload, due to exposure to their clients’ difficult stories. For someone who has experienced traumas themselves, this can be unnerving:

All the time, I hear difficult stories—people who want to commit suicide, and such. It weighs heavy on the soul. You must stop and say: “Enough, I can’t take on any more on myself.” That’s where the difficulty lies, drawing a line between work and one’s personal life. (Meni, recovering addict for 17 years).

However, the respondents also noted that they manage to deal with this through conversations with colleagues and ongoing care, which provides them with emotional relief:

To be a good therapist, you need to be a good patient. If things are being processed with you, you can hear and contain any story… I go to NA meetings, share, and discuss with co-workers, and little by little, things are processed, and I become more available for others. (Eli, recovering addict for 31 years)

Some respondents also spoke about the risk of relapse due to the daily interaction with former prisoners and addict people. However, most of them stated that they managed to deal with this, thanks to the strict restrictions and supervision in their workplaces.

There’s a disadvantage to working with addicts, in the sense that the instructor may go downhill and start all kinds of ruses, or that kind of thing… I know instructors who, because of such things, no longer work at the IPS [Israel Prison Service], they were dragged into all kinds of nonsense… (Natan, recovering addict for 30 years)

Maintaining the recovery

All the respondents, without exception, stated that what helps them maintain their recovery is the daily practice of the 12-step principles, and attending NA meetings. In keeping with the 12-step program philosophy, it is clear from the participants’ accounts that addiction is a chronic illness and as such, recovering addicts should continue to apply the 12-step principles on daily basis, and attend NA meetings, where they practice emotional and social support with peers:

I continue to treat myself. Even after 20 and 30 years, you should continue to attend NA meetings, practice the steps, consult others, and talk about things. Addiction is a chronic illness that never ends. There are instructors who suddenly disconnect and stop taking care of themselves, and then go back to using. (Ronny, addict in recovery for 26 years)

Participants also noted that they know of many peer workers who have relapsed and gone back to drugs, prison, or even died, because they neglected these principles:

I know some who, after 15 or 20 years, went back to drugs. No one has a guarantee, not even me. First, they stopped coming to NA meetings and stopped implementing the 12 steps. They lost control of their lives… I constantly filled my life with meaning and things. It was very important to me not to stop for a moment; if I did, I would fall back to drugs. I’m making progress every day. (Tali, recovering addict for 10 years)

The respondents reported needing continual emotional and social support to deal effectively with hardships and difficulties in life, instead of resorting to drugs, as in the past. This is how Rikki described the help she gets from peers and family members, who ease the pain she is experiencing since her divorce:

I’ve been going through a difficult time in the last two months, because of the divorce. I cry a lot and break down, but I’m holding myself together. It’s clear to me that using drugs is not an option. I talk about my feelings, I get help from my family, I go to therapy and to NA groups. I share things, I don’t hide, and I’m not ashamed. (Rikki, recovering addict for 5 years)

Ziv summed things up well, saying that his self-perception as a wounded individual means that he is still in the process of recovery, and therefore needs to keep working on his healing, in part, by helping in the healing of other addicts:

I feel wounded. That’s also what’s good about recovery, because when you feel wounded, you realize you still need to heal. If I say, “that’s it, I’m already recovered", I’m starting to leave recovery. So, it keeps me alert. (Ziv, recovering addict for 13 years)

Discussion

The purpose of this study was to examine the effects of peer work as perceived by “wounded healers” with a history of addiction and criminality. The respondents were formerly addicted and incarcerated individuals from Israel, with a history of past traumas, who are currently formally employed in peer support position in various drug rehabilitation treatment settings, in prisons and/or in the community. Some also work with at-risk youth.

Inspired by the 12-step program they have been implementing to date, the participants referred to themselves as “recovering addicts.” They all have undergone formal training of guiding groups and instruction in the field of addiction rehabilitation and related fields. Some of them have academic degrees in criminology, social work, and law. The peer-support positions that they hold include group facilitation and personal supportive intervention of recovering males and females.

As found in previous studies of formerly addicted and incarcerated people, the respondents in our study reported on traumatic events in their childhood and growing up in a distressed neighborhood, as well as learning difficulties, behavioral disorders, and drug abuse at a young age (e.g. Martin et al. 2015; Bowler et al. 2018; Dalsklev et al. 2021). Many had served several sentences in prison and had endured years of addiction, mainly to drugs and alcohol. The decision to change their lifestyle came in the wake of a personal crisis and prompted by an encounter with someone who inspired them to recover, usually a recovered peer whom they identified with and therefore made them believe in their own ability to recover, as well. As implicit in the term identity transformation coined by Maruna et al. (2009), personal transformation from addiction involves an element of reflection, as people begin to believe in their ability to change and recover when others around them project this belief upon them, whereupon it becomes a self-fulfilling prophecy.

The respondents cited several motivations for their desire to engage in peer work, some of which can be seen as instrumental, and some as altruistic and spiritual. The personal motivations included gaining normative and stable employment, and professional status. The altruistic and spiritual motives included a desire to help others, and a wish to amend and atone for their errant past, as part of the gratitude they feel for the good they themselves have encountered. This may be a manifestation of positive emotions such as gratitude and altruism that develop in those wishing to reform (Bathje et al. 2020), as highlighted by self-help groups for addicts (Ronel 1998), and in the positive criminology perspective (Ronel and Elisha, 2011, 2020).

As found in previous studies, providing social, emotional, and instrumental support to one’s peers (i.e. people with the same values, experiences, and lifestyle), clearly improves the emotional skills of the aid providers and enhances their feelings of motivation, empowerment, and self-efficacy (Maruna 2002; Dhaliwal and Harrower 2009). In addition, instrumental personal motivations appear to change over time and become more altruistic in nature. As Einat (2017) found in his study of peer-mentoring in prison, the selfish-utilitarian motives (such as material gain and personal growth) that initially induce prisoners to serve as peer-support workers, gradually became altruistic. This, in turn, bolsters their desire to persist in their position, and deepens their own transformation (Einat 2017).

Overall, no differences were found in the respondents’ reports of the effects of peer work between veterans of the recovery process (10 years or above), and more recent ones. The respondents reported multiple positive advantages of their peer work, such as gaining new meaning and purpose in life; satisfaction; practice goodness; being helpful to others; gaining a sense of pride, respect, self-worth, and self-confidence; increased commitment to their own recovery; professional development; and improving their family and social ties. These findings are consistent with previous studies conducted on ex-convicts serving as peer-support workers (e.g. Maruna 2002; White 2009; Marsh 2011; LeBel et al. 2015; Heidemann et al. 2016; Nixon 2019; Creaney 2020; Jang et al. 2020; O’Sullivan et al. 2020; Woods 2020).

The respondents stated that their clients also benefit from their efforts, mainly in terms of the emotional and practical help and inspiration they receive from a living role model, which instills in them faith and hope over their own ability to heal. Since the present study did not examine the effects of peer work on the aid recipients, the validity of those findings is unverified. Nonetheless, these findings echo those of the very few studies that have been conducted on the effects of peer support on its clients, in terms of their emotional relief and their perception of the aid providers as sources of inspiration, and as models of self-improvement to be emulated (Buck 2017; Jang et al. 2020).

Along with the positive effects, our respondents highlighted several difficulties and challenges they face in their peer work, such as low pay, poor incentives, professional conflicts, role confusion, emotional overflow, and risk of relapse. Some participants noted that this was the only job they could get as ex-convicts. Others pointed out that, ironically, it is the only job where their past is an advantage. These findings echo those found in previous studies conducted with similar individuals (e.g. White 2009; Bathje et al. 2020; Wong and Horan 2021; Duvnjak et al. 2022). However, most of our respondents claimed that they manage to overcome these challenges by focusing on the positive, and by highlighting their difficulties, either through therapy, or through the support networks they have formed. Moreover, they noted that despite these difficulties, they intend to continue with such peer work, mainly because of the great satisfaction they gain from being helpful to others. Similar findings emerged in a study by LeBel et al. (2015) of male and female ex-prisoners who worked in peer support positions in the community.

The participants’ accounts revealed that their peer-work position enhanced their social capital: their social circles have expanded, and that they have been able to form positive relationships with various people—therapists, criminal justice professionals, researchers, students, etc.—which enriches their world and increases their self-worth. This is in marked contrast to their past, when their social connections were limited to other addicts and criminals. As noted by researchers in the field of desistance, being engaged in activity that is generative and productive for others allows ex-convicts to practice goodness, to give back to the community, and to feel a sense of belonging (Maruna 2002; Flores 2018). In other words, peer work strengthens the sense of belonging and the social capital of formerly addict and convict individuals, thereby strengthening their positive change and rehabilitation (e.g. Farrall 2004; Best and Laudet 2010; McNeill and Weaver 2010; Wincup 2019).

In keeping with the 12-step philosophy, our participants view their addiction as a chronic illness, noting that the way to maintain recovery is through daily application of the 12-step principles and by attending NA meetings, for ongoing emotional and social support. Those who failed to do so, they noted, have relapsed, and gone back to drugs and to prison, or have died. There is a very limited evidence base about the pathways of successful recovery from drug addiction. Hser (2007), for example, suggested that in addition to professional care, addressing psychological issues and boosting self-efficacy may improve the chances of long-term recovery. Our findings about the contribution of peer work to increased self-efficacy and maintaining emotional and social recovery by attending NA meetings and applying the 12-step principles, corroborate that claim. In general, the resources and strategies described by our respondents, tally with the tenets of positive criminology (Ronel and Elisha 2011, 2020) and desistance approaches (Maruna et al. 2004), whereby the focus should be on increasing opportunities for change and learning from success cases, coupled with providing support and expanding social networks, rather than focusing on risks and deficits (Best and Aston 2015).

In sum, our findings support the principle of the wounded healer and the culture of peer support, as expressed in the moral virtue of ‘giving back to others’. That principle states that those who manage to recover feel a moral obligation to help others (Maruna 2002; Walker 2015; Heidemann et al. 2016), which in turn improves their social networks and bolsters their own recovery and rehabilitation.

The present study’s novelty lies in the fact that it is the first of its kind to be conducted in Israel. In terms of theory, our findings support the convict therapy perspective, that focuses on the healing value of peer work (Elisha 2023), as well as the positive criminology perspective (Ronel and Elisha 2011, 2020), and desistance theory (Maruna 2002; McNeill 2012; LeBel et al. 2015), which highlight the individual’s ability to recover and rehabilitate by developing personal and social strengths. Our findings additionally emphasize the contribution of peer work to increasing social capital and promoting processes of recovery.

In practical terms, we recommend expanding peer-based programs, in prison and in the community, which, despite their acknowledged effectiveness, are still limited in scope (Bathje et al. 2020; Elisha 2022). Moreover, most of the existing peer programs, in Israel and worldwide, are directed at recovering addicts. In view of the contribution of such programs to strengthening recovery and rehabilitation, it is recommended they be applied to more diverse populations of convicts and at-risk individuals. Also, given the lack of evidence on the perceived benefit of peer work for its clients, it is recommended that studies also be conducted of that aspect, to verify the validity of the findings. Lastly, as our respondents noted, there are many peer-workers who have relapsed and gone back to drugs and prison, even after many years of sobriety. Therefore, it is recommended that studies also be conducted on withdrawals, to better identify and address the factors that hinder recovery and rehabilitation among wounded healers in the field of criminology.

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