An evolving role for colleges: Training people recovering from substance abuse disorders to be part of treatment teams
By Alina Tugend, The Hechinger Report, August 2, 2022
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LaShondra Jones went through years of mental illness and alcohol addiction, and in her late 40s she was living in a women’s shelter in Brooklyn.
Finally stable and sober, she needed work — any type of work — for which her history wouldn’t count against her.
Jones Googled “free training in NYC” and learned that several area community colleges offered training for people to become certified recovery peer advocates for those coping with alcohol or drug addiction.
Her experience, in this case, would be a big plus.
There were obstacles. Jones needed special permission to stay out past the shelter bed check time because her classes at Bronx Community College ended at 9 p.m. and the subway trip back to Brooklyn could take hours. But she completed the training, passed the certification test and now works as a certified recovery peer advocate with people in, or in danger of becoming caught up in, New York’s criminal justice system.
“I enjoy the fact I never know who I’m going to meet. I never know what their story is. I get to sit down and listen to them — I might be the only person who has ever listened to them,” said Jones, 50, who now lives in and works out of her own apartment in Manhattan.
The success of Jones and others who have gone on to become recovery peer advocates shows that with the right financial and other kinds of support, and in fields where they can use their personal experiences to help others, even some of the most vulnerable can succeed at college-level training — and colleges at graduating them into good jobs.
This has become more important as the number of students over age 24 enrolled in higher education has continued to slide, down nearly 6 percent, and more than 16 percent at community colleges, since the start of the pandemic, according to the National Student Clearinghouse Research Center.
“Adults are disappearing from higher education. We have to build back their confidence,” said Van Ton-Quinlivan, chief executive officer of Futuro Health, a California nonprofit that helps train health care workers.
Futuro, in partnership with community colleges and employers, has provided training and education to more than 5,000 people for jobs such as patient care representatives, pharmacy technicians and peer support specialists. It has found that even students who have been out of school for years will come back if they have flexibility in when and how they can learn and coursework that engages them. They also need ongoing support, but that support has to be subsidized by the government or employers to be affordable.
They also need to know they’re training for jobs that are immediately available.
“Adults are skittish to commit to pursuing a degree,” Ton-Quinlivan said. “One way higher education can bring them back is through industry-valued certifications or credentials offered in a highly supportive environment.” Some of those students might continue on to a degree.
In a system that is often not very good at anticipating labor market demand, however, it can also take a confluence of events for such efforts to work.
“Adults are skittish to commit to pursuing a degree. One way higher education can bring them back is through industry-valued certifications or credentials offered in a highly supportive environment.”
While Jones got where she is through determination and hard work, national trends also helped drive her success. About 14.5 percent of Americans older than 12 have alcohol or drug use disorders, according to the federal Substance Abuse and Mental Health Services Administration, or SAMHSA; the numbers spiked during the pandemic thanks largely to opioid misuse, creating an urgent demand for more trained people to respond to the crisis.
Still, only 6.5 percent of those 12 years and older with substance use disorders had received any type of care in the last year, according to the most recent National Survey on Drug Use and Health. More than a million peer support specialists are needed, SAMHSA estimates — more than 40 times the 23,507 now at work.
This gap between supply and demand — and the increasing number of training programs provided through higher education and elsewhere — means that some of the country’s most marginalized and ignored people now have a chance to acquire skills and find fulfilling employment.
Peer support for people grappling with mental health and substance use challenges is not new, but recent developments have “radically changed the addiction field,” according to the national Peer Recovery Center of Excellence, established last year with federal funding.
“We’re seeing a growing understanding of the peer-based recovery profession,” said Keegan Wicks, national advocacy and outreach manager for Faces and Voices of Recovery, an advocacy organization. Other boosts to the field include Medicaid expansion, which allows employers to be reimbursed for recovery peer advocates’ services, and federal, state and local grants for training programs.
The City University of New York’s College of Staten Island, or CSI, launched a certified recovery peer advocate training program in 2018 in response to the opioid epidemic. Until it was recently surpassed by the Bronx, Staten Island was the New York City borough with the highest rates of opiate overdoses and deaths.
“Every resident of Staten Island could say they were impacted in some way by substance use disorder,” said Lisa Spagnola, the college’s former director of workforce development who helped develop its certified recovery peer advocate program. “Everybody can say they know someone who died of an overdose.” Staten Island is the least populated of New York City’s five boroughs.
More than a million peer support specialists are needed nationwide, according to one estimate, far more than the 23,507 now at work.
Almost all states now offer certification for peer support specialists; most combine mental health and substance use, while 12 states, including New York, offer separate credentials for the two. A national certification is available but hasn’t been widely adopted.
Other types of training programs in New York State generally charge between $500 and $1,000, said Ruth Riddick, a spokesperson for Alcoholism and Substance Abuse Providers of New York State.
CSI sought out funding — primarily from the federal government — so students training to become peer advocates could attend for free. Another CUNY school, Queensborough Community College, already had its own recovery peer advocate program, so Spagnola used some of its curriculum in the CSI course design, along with input from prospective employers.
New York State requires a minimum of 46 hours of training to become a certified recovery peer advocate. The CSI course, administrators say, takes 75 hours over about eight weeks and teaches skills such as communication, teamwork, cultural competency, note-taking and how to use electronic health records.
Raymond Jordan, 57, was part of the first group of graduates and since then has worked 25 hours per week at a local social service nonprofit called Project Hospitality.
His mother died when he was three, alienated as a young gay Black man, a drug-user since he was 15 and formerly incarcerated, Jordan had tried rehabilitation more times than he can count. He supported himself with prostitution and stealing and lived on the streets.
In 2017, he was sober and in outpatient treatment at Project Hospitality. Laura Novacek, the nonprofit’s associate area director, called him over.
“She asked me, ‘Raymond, would you be interested in becoming a peer?’ and told me about the program at CSI and said, ‘I think you’d be really good at it,’ ” Jordan said. His voice shaking, he added, “That was the first time someone had believed in me.”
Jordan enrolled in the first recovery peer advocacy training class CSI offered and took to it immediately. He loved the role-playing, which made him feel as if sharing his experience was helping someone.
“This is my first job,” Jordan said. “When Laura told me I was a valuable worker I broke down. That’s why I’ve stayed clean, because I’m so happy to be alive, so happy to help others.”
Jordan’s remaining obstacle to becoming a certified peer advocate is the state’s certification test, which he has failed twice. He can take it as many times as needed, but has to wait 90 days and pay $80 each time; Project Hospitality picks up the licensing exam fees for its employees. In the meantime, Jordan works in the residential program, which, unlike outpatient care, doesn’t bill Medicaid for recovery peer advocacy reimbursement, so the peers don’t need to be certified.
One key aspect of training for these kinds of jobs is the selection process; prospective students need a high school diploma or equivalent but often have limited work experience, so trainers have to judge the candidates primarily based on a sense of their potential.
“It was the first time in my life that my substance use history became an asset instead of a liability.”
“That means someone great at listening, able to share their recovery story in order to inspire others and able to work on a team,” said Curtis Dann-Messier, founding director of the NYC Health + Hospitals Peer Academy, which was established last year specifically to train peers to work in the city’s public health system.
At CSI’s information sessions, prospective students are told about the requirements for the program, the jobs available, including how much money they could make (barely above minimum wage, without much room for promotion, though national groups are trying hard to change this), and the demand for graduates. If they’re still interested, they sign up for a 30-minute interview.
The intake process tries to make the program sound rigorous “without making it so intimidating that you drive them away,” Spagnola said.
Many of those who apply to the peer programs never enroll once they realize the time and effort required, but, according to administrators, 70 to 90 percent of students who start the courses at the Peer Academy and at New York City’s three community colleges where they’re offered finish.
Classes usually include no more than 25 students. At CSI, 44 out of 49 students have so far completed the course, Spagnola said.
Those who join the programs say the combination of support from teachers and classmates, engaging coursework that emphasizes role-playing and the sharing of personal experiences and the realization that they can go on to meaningful careers keeps them coming back to class even when life feels overwhelming.
Kevser Ermendi, 60, said she has a long history of starting courses and not finishing them, then falling back into drugs. The CSI recovery peer advocate course was the first she’s completed since high school. She passed the certification test and now works at a community organization on Staten Island.
“It was fun to go to class. It wasn’t something I dreaded,” Ermendi said. “It was the first time in my life that my substance use history became an asset instead of a liability. It was definitely a topic I knew back and forwards.”
State certification boards decide if it’s necessary for a peer to have personally experienced substance use disorder; in some states people with family members or close friends who have been or are addicted or those who just consider themselves allies can also become recovery peer advocates.
“That was the first time someone had believed in me.”
Often trainers themselves are recovering from addiction, and many of the students in recovery said they are the best equipped to do the job.
Those who haven’t experienced substance use challenges directly can be affected “but not infected by this disease,” Ermendi said. “If I’m in a treatment facility and I’m a patient, you’re not really my peer. You don’t know what it’s like to have this voice in your head that’s telling you you have to use.”
Spagnola estimates that half her former students are employed and certified, most at about a dozen nonprofits on Staten Island. But many have difficulty staying in their jobs over the long term.
Of about 10 peers she has hired (not all from CSI’s program), said Novacek, only two — Jordan and one other — have stayed. Peers don’t last “for a variety of reasons. They don’t have their own addictions under control, or their mental health is unstable, or it’s been so long since they worked,” she said. “We’re very flexible, but sometimes they still can’t do it.”
Novacek stressed, however, that she sees CSI’s program as a success.
“Look at Raymond — he’s someone who never worked and has now successfully been working for four years,” she said. “The only time I had to write him up is when he worked too many hours.”
Dan McCawley, director of operations for West Virginia Sober Living, a residential recovery program that uses and trains recovery peer specialists, said he believes two years of abstinence is “that sweet spot” for people engaging in peer support for substance use disorder.
“We’re a vulnerable population serving a vulnerable population. I wouldn’t have trusted myself with six months in recovery to be out on the streets, under the bridges doing the kind of work I was doing. It would have been a potentially dangerous situation for my own personal recovery. And that’s the last thing we want to do, is put one more person back out there.”
Jack Chudasama, 51, for years a functional — and then nonfunctional — alcoholic, was at one point drinking a gallon of vodka a day. Five years ago, when his wife threatened him with divorce and his children told him they wished he were dead, he stopped drinking and has been in recovery for five years.
He is one of 18 (of 28) students in the first class of the Peer Academy who graduated in June, Dann-Messier said. He was recently hired by a Queens hospital as a peer.
The Peer Academy, housed in the downtown Manhattan office of NYC Health + Hospitals, is free — and intense: Students have to commit to about three months of full-time attendance, with 177 hours of classroom training, 126 hours of hospital-based internship and at least 20 hours of online workshops.
For Chudasama, the most surreal aspect was “transitioning from being in the bed to being on the other side with the treatment team. I was always used to being a patient.”
Chudasama, who was born in India but moved to the U.S. with his family as a child, appreciates that some Indian patients who won’t communicate with the medical team have opened up to him.
“I see this as a career opportunity and not just a job,” he said. “I saw this as an opportunity to do what I want to do and love.”
While employment is the end game, trainers say just taking the course — learning what drugs do to bodies and brains, how to listen and interview, how to give and receive respect — is invaluable.
“We are engaging our own community to become more empowered,” said Barbara Hart, who ran the Bronx Community College certified recovery peer advocate program from its start in 2018 until 2021, when, she said, it did not receive the grants it needed to continue.
“Adults are disappearing from higher education. We have to build back their confidence.”
LaShondra Jones was working two peer advocates jobs for a while. But then she was offered a full-time position with the Center for Alternative Sentencing and Employment Services, a nonprofit that focuses on providing services for people in or potentially involved with the criminal justice system. She makes a decent salary and gets benefits. And her bosses understand if she’s having a bad day and needs to take off or work with clients by phone.
The other peer advocates at her organization, which has branches around the city, just started their own support group. And now she has a formerly incarcerated client who wants to be a peer, who she hopes to guide down the same path she took.
Jones has now signed up for an online bachelor’s program in wellness and nutrition; she’s still sometimes amazed at where she has landed.
“I feel like I didn’t choose this profession,” she said. “It chose me.”
