The wages of peer recovery workers: underpaid, undervalued, and unjust

ABSTRACT

Peer-based recovery support services are evidence-based practices used to achieve long-term recovery. Fundamental to these services are peer recovery workers, who use their lived experience of long-term recovery to form trusting, supportive relationships with individuals initiating self-directed journeys to mental health or substance use recovery. However, peer recovery workers report low salaries and workplace environments that cause unnecessary stress, burnout, compassion fatigue, and suboptimal service provision. We compare mean state peer recovery worker wages with prevailing state living wages by utilizing a living wage calculator and assembling data on wage offers from a national job-posting platform in the US. Our results suggest significant wage insufficiency. Among single-worker households with children, the living wage exceeds mean peer wages in every state. We conclude with guidance to public health researchers and practitioners to address the social justice implications of wage insufficiency.

KEYWORDS:

• Substance use
• mental health
• peer recovery
• workforce
• just wages

Introduction

Peer Recovery Workers (PRWs) are individuals with a lived experience of long-term recovery and specialized training to provide services and support people entering substance use or mental health recovery. PRWs are known by different occupational titles such as ‘peer recovery coach’ and ‘peer recovery support specialist’. This article discusses workplace challenges PRWs face in delivering these services in the US. We focus on PRW wages, an understudied topic in the literature.

There are no official state or federal government statistics on PRW wages (Chen, 2017). Data from two US surveys are available, but they are too limited in sample size and scope to determine wage sufficiency. As an alternative, we source wage offers from a national job-posting platform. The result is a purposive sample of US wage data from all 50 states for PRWs who support mental health or substance use recovery. We contribute to the growing peer workforce literature by exploring whether PRW wages are sufficient to meet the basic needs of life, gauging the magnitude of insufficient wages, and considering the potential implications for both PRWs and the peer recipients of their services. We present recommendations for new regulations and reimbursement policies to mitigate workplace stressors and improve the financing of PRWs in community-based settings.

Background

Peer recovery support services

Recovery is defined as ‘a process of change through which individuals improve their health and wellness, live self-directed lives, and strive to reach their full potential’ (US Department of Health and Human Services, 2022). PRSS programs aim to promote long-term recovery by focusing on personal growth, self-direction, and reaching one’s full potential. PRSS emphasizes four pillars for recovery: stable housing, wellness and healthcare, employment and education, and community (Substance Abuse and Mental Health Services Administration [SAMHSA], 2023c). The last pillar addresses the stigma and social isolation often experienced by individuals in substance use and mental health recovery.

PRWs deliver PRSS based on foundational principles and values a set of core competencies for which they receive training and certification (SAMHSA, 2023b). They provide support through goal setting, mentoring, skill building, advocacy, and resource sharing (SAMHSA, 2023b) with program participants entering or maintaining recovery.

One foundational principle that sets PRSS from a medical approach to recovery is that PRWs are relationship-focused. According to SAMHSA (2023a):

The relationship between the peer worker and the peer is the foundation on which peer recovery support services and support are provided. The relationship … is respectful, trusting, empathetic, collaborative, and mutual. It encourages the formation of new relationships in a community of mutual support.

Ideally, a PRW can become a trusted companion in the PRSS program participant’s recovery journey. However, unlike the social worker-client or drug counselor-patient relationships, the peer-participant dyad is a relationship among equals who are open about their past experiences, some potentially painful and traumatic. PRWs cultivate trust-filled relationships through their self-disclosure of lived experience (Sarabia, 2023) and by maintaining mutual respect and shared responsibility (Mead et al., 2001). The relationship has therapeutic value in the same way mutual self-help groups have therapeutic value, by fostering vicarious learning and instilling the hope individuals need to sustain recovery (Kelly & Yeterian, 2011).

Researchers estimate that approximately 30,000 PRWs are currently employed in the US (Fortuna et al., 2022). While workplace settings vary, evidence suggests a large fraction work in community-based organizations. In a survey of 597 PRWs in the mental health workforce, 66.3% reported having worked at a community and/or peer-run organization (Cronise et al., 2016). The Foundation for Opioid Response Efforts (FORE) conducted an 11-state survey of 1,117 peer workers who supported recovery from opioid use disorder (Foundation for Opioid Response Efforts, 2023). Fifty-nine percent of the respondents reported working at a recovery community organization (RCO, a community-based and often peer-run organization focused on substance use recovery), and another 6% reported employment in a community-based organization (CBO). Other workplaces include residential facilities, pre-crisis or crisis centers, behavioral health programs, emergency departments, physician offices, criminal justice programs, and corrections settings (Cronise et al., 2016; FORE, 2023).

PRSS recovery outcomes

The Centers for Medicare and Medicaid Services recognizes PRSS as an evidence-based practice (Smith, 2007). PRSS is associated with beneficial outcomes related to health and wellness, reduced utilization of unnecessary and costly services, the provision of supports to maintain recovery, and other social outcomes. Mercer et al. (2021) found evidence that PRSS can help prevent overdose (Mercer et al., 2021), and Ashford et al. (2021) found evidence that PRSS delivered at RCOs can improve recovery capital, the internal and external resources that an individual can draw upon to sustain long-term recovery (Best & Hennessy, 2022). Two systematic reviews present studies showing associations between PRSS and reduced re-hospitalization, reduced use of alcohol and other substances (e.g. opioids), fewer emergency department visits, and greater treatment adherence (Eddie et al., 2019; Gormley et al., 2021). While both research teams suggest positive findings for PRSS, they also note the need for further research given the diversity of methods, study populations, and methodological limitations.

Similar research shows the value of PRSS for people in mental health recovery. For example, Smit et al. (2023) conclude that there is a moderate level of evidence for the benefits of PRSS for ‘people with mental illness’. Their systematic review found significant evidence of research studies demonstrating a positive association between PRSS and feelings of empowerment and improved recovery based on measures from the Recovery Investment Scale (Smit et al., 2023). In some cases, evidence is lacking for PRSS for mental health recovery. For example, whereas S. White et al. (2020) meta-analysis shows one-on-one peer support can improve mental health recovery, Lyons et al. (2021) systematic review suggests only group peer support is effective in mental health recovery. Several studies highlight the value of PRSS for people with co-occurring mental health and substance use disorders, including positive changes in utilization, treatment engagement, community tenure, and social functioning (Magidson et al., 2021; Min et al., 2007; O’Connell et al., 2017). Finally, there is evidence that peer support work can improve the mental health of PRWs (Firmin et al., 2015; Poremski et al., 2022).

Workforce challenges

PRWs in the US report high levels of overall job satisfaction. For example, Cronise et al. (2016) report that 89% of PRWs surveyed reported being very or somewhat satisfied overall with their jobs. Their regression analysis identified the following five top statistically significant (p ≤ 0.01) determinants of satisfaction: job responsibilities reflecting training and lived experience, feeling respected by colleagues and supervisors, feeling respected by the peers who receive service, perception of having sufficient training, and working in a community setting and/or peer-run program.

The lack of these qualities might account for growing reports in the literature of PRWs experiencing stress, emotional strain, and symptoms of burnout (Ahmed et al., 2015; Mercer et al., 2021; Pasman et al., 2022; Williams, 2021). In FORE’s (2023) survey, 23% reported being under stress or having symptoms of burnout. These respondents reported high caseloads (23%), long work hours (24%), lack of support at work (26%), and emotional strain from working with participants as sources of burnout.

The occupational health literature suggests that high job demands and inadequate control over work tasks can lead to stress, which affects health, job satisfaction, work performance, and job tenure (Van der Doef & Maes, 1999). The literature on PRW work experience suggests that stress is intrinsic to relational work and boundaries and self-care time are critical to wellness, especially since PRWs are in recovery themselves (Miler et al., 2020; Vandewalle et al., 2016; Williams, 2021).

The literature points to organizational factors that further limit the ability of PRWs to be effective service providers while maintaining their own recovery. Themes include issues of power/hierarchy (Alavi et al., 2024; Voronka, 2015), credibility, and role confusion (Moran et al., 2013). Myrick and Del Vecchio (2016) suggest that PRWs often lack clear job descriptions and face ambiguity regarding their roles. The resulting uncertainty may lead to boundary issues and a reluctance to self-disclose with their assigned participants. This could impede a PRW from performing the duties in which they are trained, and lead to feelings of vulnerability, a lost sense of belonging, cynicism about one’s identity as a peer worker, and further emotional strain (Mourra et al., 2014; Voronka, 2019). Stigma and discrimination (Miler et al., 2020; Myrick & Del Vecchio, 2016) could be at play without active leadership to create and maintain a welcoming and accepting culture. Co-worker support, a supervisor who is in recovery, and a supervisor who understands recovery and how to supervise PRWs can help reduce worksite stressors (Foglesong et al., 2022).

PRW wages

Cronise et al. (2016) estimated a mean wage of $14.96/hour or $19.09/hour in 2023 dollars from survey data. This is the only nation-level estimate and was based on a sample of 597 PRWs. In the FORE (2023) survey, 67% of 1,174 respondents reported Very Satisfied (19%) or Somewhat Satisfied (48%) with their financial compensation, although an equal measure (69%) reported Somewhat Concerned (39%) or Very Concerned (30%) about potential budget cuts or loss of funding in the next two years. However, these results cannot be generalized to all PRWs because the survey included only peers in 11 states who focus on recovery from OUD.

There is empirical evidence for the relationship between low wages and workplace productivity. For example, Zeng and Honig’s (2017) research suggests the provision of a living wage is associated with greater worker commitment and lower turnover. In the American Psychological Association’s (2021) Work and Well-being Survey, 56% of respondents indicated that low salaries impact stress levels at work, and 59% reported that work-related stress negatively impacts performance. Given the documented stressors, ensuring decent compensation may be an important strategy for sustaining the effectiveness of PRSS.

Methods

This analysis utilized wage data from ZipRecruiter, a nationwide job-posting platform. Leveraging its partnership with Automatic Data Processing, Inc. (ADP), ZipRecruiter developed a compensation wage estimator based on ADP’s extensive administrative payroll and human resource data.

Technically, the data consists of wage offers, which may be higher than those negotiated before a hire. Thus, ZipRecruiter data is akin to a convenience sample of wages. Despite that, policymakers, labor economists, and advocates are increasingly sourcing these data for research and analysis (Cullen, 2023). For example, Driver (2022) uses ZipRecruiter data in his analysis of the ethical implications of low-wage healthcare work.

Following Driver (2022), we used ZipRecruiter’s publicly available online data to explore PRW wages. The ZipRecruiter compensation estimator provides state-level wage information in current (2023) dollars for specific occupational titles. Employers use multiple occupational titles when advertising for PRWs, and none of them can clearly distinguish PWRs who focus on substance abuse from PWRs who focus on mental health recovery. This enables us to make comparisons with Cronise and colleague’s (2016) estimates which include both types of PRWs.

We identified the most prevalent titles for PRWs and chose ‘Peer Recovery Coach’ (PRC) because its mean salary was closest to Cronise and colleague’s (2016).¹ We collected the mean state hourly wage rates for PRCs for all 50 states and the District of Columbia in November 2023.

Next, we determined whether a state’s mean wage for PRCs meets a living wage for households in that state. A living wage represents the full-time wage rate that would cover basic needs like food, housing, healthcare, and transportation. We utilized the Massachusetts Institute of Technology’s online calculator living wage calculator, which researchers designed to show the gap between living wages and state minimum wages (Glasmeier, 2023; Nadeau, 2021).

This living wage calculator offers separate estimates for 12 different household types based on the number of working adults (one working adult, one non-working adult, or two working adults) and number of children (zero, one, two, or three). We adjusted the living wages for each state to 2023 prices and compared them to PRC wages. For each state, we determined whether the PRC mean hourly wage rate exceeds the living wage for any of the twelve categories.

Results

ZipRecruiter provides the mean salary for occupations based on a 2080-hour year as a frequency distribution of salary ranges for lower to higher percentiles. The mean annual salary for Peer Recovery Coaches (PRCs) was $40,551 ($19.50/hour). (see Table 1). We annualized the hourly wage estimated by Cronise et al. (2016) based on a 2080-hour year and inflated it to 2023 dollars (U.S. Bureau of Labor Statistics, n.d.). This yielded an estimated annual salary of $39,705/year, which is only 2.1% lower than the PRC salary and very close to the median, suggesting a relatively normal distribution.

Table 1. Peer recovery coach annual salary distribution.

Percentile	Salary Range
Lower 4%	$27,500–$29,999
Next 7%	$30,000–$31,999
11%	$32,000–$34,499
12%	$34,500–$36,499
12%	$36,500–$38,999
10%	$39,000–$40,999
14%	$41,000–$43,499
7%	$43,500–$45,499
5%	$45,500–$47,999
4%	$48,000–$49,999
Upper 8%	$50,000–$52,000
Median	$39,799
Mean	$40,551

All data were accessed on November 30, 2023. All salaries are based on a 2,080-hour year. Due to rounding errors, percentages may not add to 100.

Source: ZipRecruiter salary data for peer coaches and specialists.

In most states, the PRC mean hourly wage exceeded the living wage for single adults with zero children (see Table 2). The mean hourly wage exceeded the living wage for this group in 31 states and the District of Columbia. States in which the mean hourly wage was lower than the living wage for this group include New York, California, Maryland, Virginia, Oregon, Hawaii, New Jersey, Minnesota, Rhode Island, Arizona, Connecticut, Georgia, Utah, Tennessee, Kansas, Louisiana, West Virginia, Alabama, and Florida.

Table 2. Comparison of mean hourly wages with living wages for single adults with and without children by state.

State	Peer Coach Hourly Wage	Number of Children in Household
		0	1	2
DC	$22.96	$22.85	$43.96	$57.28
Alaska	$22.78	$17.70	$36.59	$47.01
Massachusetts	$22.46	$22.03	$47.02	$63.54
Washington	$21.61	$20.20	$39.91	$51.29
Nevada	$21.54	$17.56	$36.95	$48.02
Colorado	$21.18	$19.83	$41.49	$54.38
New York	$19.97	$22.14	$42.91	$56.12
Delaware	$19.89	$17.91	$36.87	$47.22
Illinois	$19.62	$18.68	$37.44	$48.30
Virginia	$19.59	$19.65	$39.33	$50.80
Vermont	$19.51	$17.35	$36.40	$47.36
Maryland	$19.26	$20.23	$40.48	$52.21
Nebraska	$18.84	$16.23	$34.79	$44.68
Missouri	$18.74	$16.27	$33.71	$42.62
California	$18.60	$21.92	$44.82	$58.28
Oregon	$18.58	$20.00	$39.34	$49.75
South Carolina	$18.58	$17.26	$32.33	$40.37
North Dakota	$18.58	$15.84	$33.42	$43.17
Pennsylvania	$18.29	$16.93	$35.55	$45.83
Oklahoma	$18.25	$15.98	$34.01	$43.28
Hawaii	$18.23	$22.75	$45.14	$56.85
New Jersey	$18.23	$19.30	$40.91	$54.72
North Carolina	$18.20	$17.37	$36.87	$47.88
Maine	$18.16	$17.06	$35.95	$46.42
Wisconsin	$18.05	$16.57	$36.11	$47.76
Idaho	$17.80	$16.58	$34.26	$43.25
New Hampshire	$17.79	$17.78	$37.12	$48.19
Kentucky	$17.73	$15.94	$33.39	$43.10
Texas	$17.69	$17.32	$35.00	$44.17
South Dakota	$17.56	$15.63	$33.15	$42.37
Michigan	$17.53	$16.79	$37.98	$52.54
Wyoming	$17.51	$16.14	$32.84	$42.83
Minnesota	$17.42	$17.52	$36.74	$47.33
New Mexico	$17.34	$16.58	$34.04	$43.37
Indiana	$17.27	$16.28	$32.86	$41.46
Rhode Island	$17.21	$18.08	$36.74	$47.55
Ohio	$16.94	$15.82	$34.97	$46.05
Arizona	$16.91	$18.35	$35.98	$44.66
Connecticut	$16.78	$18.32	$38.93	$50.56
Arkansas	$16.75	$15.73	$32.82	$41.96
Montana	$16.66	$16.22	$35.38	$46.26
Mississippi	$16.66	$15.91	$32.01	$40.06
Iowa	$16.65	$16.23	$33.78	$43.74
Alabama	$16.45	$16.15	$32.86	$41.57
Utah	$16.18	$17.97	$36.96	$47.14
Tennessee	$16.17	$16.50	$32.27	$40.64
Kansas	$15.69	$16.19	$33.77	$43.35
Georgia	$15.32	$18.28	$35.24	$44.24
Louisiana	$15.21	$16.36	$33.80	$42.92
West Virginia	$14.13	$16.07	$34.45	$44.73
Florida	$13.56	$18.28	$37.12	$47.42

All data were accessed on November 30, 2023. Hourly wages are in current (2023) dollars. Living wages below the mean hourly wage for a PRC are bolded.

Sources: ZipRecruiter and Living Wage Calculator.

The mean living wage for single adults with one or more children exceeded the mean hourly wage for PRCs in all states and the District of Columbia. This is mostly because of the added expenses associated with children. For example, adding a non-working adult to the household is associated with an increase in the living wage from $21.54 to $28.47 in Nevada (see Table 2).² However, if a child is added to a household with one working adult in Nevada, the living wage will be $36.95. This suggests that the problem is not necessarily in the wage offer but in the financial costs of caring for children.

Except for Florida, the mean PRC wage exceeded the living wage for PRCs in households with two adult workers and zero children (see Table 3). Curiously, the PRC hourly wage exceeded the living wage for households with 1 child, so long as the second adult earns no less than the PRC. This occurred only in Nevada, Alaska, and South Carolina. A second adult worker sufficiently reduces the burden on the PRC salary that a child becomes affordable – but only one.

Table 3. Comparison of mean hourly wages with living wages for households with two working adults with and without children by state.

State	Peer Coach Hourly Wage	Number of Children in Household
		0	1	2
DC	$22.96	$16.38	$23.91	$30.39
Alaska	$22.78	$14.20	$20.46	$25.81
Massachusetts	$22.46	$16.37	$25.51	$33.49
Washington	$21.61	$15.40	$22.12	$27.79
Nevada	$21.54	$14.23	$20.65	$26.28
Colorado	$21.18	$15.37	$22.92	$29.27
New York	$19.97	$16.10	$23.47	$29.95
Delaware	$19.89	$14.07	$20.35	$25.76
Illinois	$19.62	$14.68	$20.81	$26.42
Virginia	$19.59	$14.77	$21.61	$27.48
Vermont	$19.51	$13.60	$20.20	$25.85
Maryland	$19.26	$15.50	$22.26	$28.19
Nebraska	$18.84	$13.50	$19.41	$24.60
Missouri	$18.74	$13.10	$18.85	$23.62
California	$18.60	$16.66	$24.57	$31.02
Oregon	$18.58	$15.52	$21.94	$27.30
South Carolina	$18.58	$13.45	$18.11	$22.47
North Dakota	$18.58	$13.00	$18.72	$23.84
Pennsylvania	$18.29	$13.62	$19.84	$25.22
Oklahoma	$18.25	$13.21	$19.03	$24.01
Hawaii	$18.23	$17.14	$24.79	$30.51
New Jersey	$18.23	$14.92	$22.50	$29.34
North Carolina	$18.20	$13.90	$20.44	$26.19
Maine	$18.16	$13.36	$19.92	$25.36
Wisconsin	$18.05	$13.48	$19.94	$26.00
Idaho	$17.80	$13.61	$19.29	$24.08
New Hampshire	$17.79	$13.99	$20.57	$26.19
Kentucky	$17.73	$12.99	$18.74	$23.94
Texas	$17.69	$13.85	$19.48	$24.37
South Dakota	$17.56	$13.05	$18.60	$23.50
Michigan	$17.53	$13.43	$21.05	$28.33
Wyoming	$17.51	$13.26	$18.58	$23.86
Minnesota	$17.42	$14.07	$20.30	$25.77
New Mexico	$17.34	$13.63	$19.20	$24.15
Indiana	$17.27	$13.37	$18.52	$23.11
Rhode Island	$17.21	$14.08	$20.37	$25.93
Ohio	$16.94	$13.08	$19.52	$25.31
Arizona	$16.91	$14.58	$20.16	$24.76
Connecticut	$16.78	$14.57	$21.52	$27.32
Arkansas	$16.75	$12.86	$18.31	$23.21
Montana	$16.66	$13.38	$19.79	$25.48
Mississippi	$16.66	$13.01	$17.94	$22.32
Iowa	$16.65	$12.98	$18.91	$24.15
Alabama	$16.45	$13.18	$18.49	$23.18
Utah	$16.18	$14.28	$20.65	$25.95
Tennessee	$16.17	$13.19	$18.12	$22.64
Kansas	$15.69	$13.26	$18.89	$23.98
Georgia	$15.32	$14.09	$19.61	$24.47
Louisiana	$15.21	$13.50	$18.88	$23.72
West Virginia	$14.13	$12.97	$19.28	$24.78
Florida	$13.56	$14.29	$20.54	$25.87

All data were accessed on November 30, 2023. Hourly wages are in current (2023) dollars. Living wages below the mean hourly wage for a PRC are bolded.

Sources: ZipRecruiter and Living Wage Calculator.

Even when the mean hourly wage exceeded the living wage for a state, up to half of the PRCs in the state still received an hourly wage less than the living wage (assuming a normal distribution). In summary, PRC wages fell short of the living wage for a significant number of workers, even in states with relatively high wages. PRCs with children, unless they have a partner earning much higher wages, are likely to struggle with the cost of living and associated stress levels.

As a sensitivity analysis, we repeated the analysis for Peer Recovery Specialists but found the same pattern, suggesting that these findings are robust to title selection. This is not surprising given the overlap in job descriptions and relative similarities in national salary distributions. Indeed, they appeared to reflect the same occupation. The main finding is that while most states offer an adequate living wage for single adults (for at least half the population in a state), wages in the majority of states may be too low to cover the costs of a child or non-working adult.

Discussion

Limitations

This study had several limitations. First, the actual wages may be higher than those in the ZipRecruiter database. PRWs could negotiate higher based on years as a peer worker or other marketable traits (e.g. experience with a dual diagnosis). Second, the analysis only considered hourly wages, not annual income. However, the presence of part-time work may provide further evidence for low compensation levels unless PRWs have a lucrative second job, which cannot be captured in the ZipRecruiter data.

Third, we did not account for job benefits that could lower the cost of living and, thus, reduce the effective living wages for PRW households. This may have led to inaccurate perceptions of wage insufficiency. The BLS estimated that the average hourly cost of benefits for those who have them is $13.39/hour for the civilian workforce (Bureau of Labor Statistics, 2023). If this hourly amount were added to the wages of single adult earners with children, the sum would still not exceed the living wage. Furthermore, families may still face high inflation and inaccessibility to childcare, housing, and healthcare.

Third, the analysis does not capture non-pecuniary benefits such as family leave, flexible work schedules, self-time, and other organizational factors that could mitigate PRW workforce challenges. However, employment settings could potentially capture variation in workforce outcomes. Cronise et al. (2016) found a statistically significant relationship between overall job satisfaction and employment in community settings and/or peer-run programs, potentially because such settings may offer social support to alleviate the impact of stress in high-demand, low-control jobs (Häusser et al., 2010; Van der Doef & Maes, 1999). The ZipRecruiter data provide information to capture the type of employment setting, which could be used in future research.

Finally, the data did not distinguish between mental health and substance use PRSS. This is unfortunate because mental health and substance use PRSS have different approaches (Myrick & Del Vecchio, 2016) and different historical origins in the US (W. L. White, 2009). As a result, the systems that have emerged to regulate and structure the delivery of PRSS for substance use point to potential strategies to mitigate workforce challenges for all PRWs.

Implications

In their review of the literature, Myrick and Del Vecchio (2016) note that ‘much of the responsibility for maintaining successful employment as a peer support specialist falls to the workers themselves’. PRW training and certification are the only legal methods for ensuring PRSS delivery in fidelity with PRSS values, principles, and competencies (e.g. ‘model fidelity’). Organizations that fail to create work environments consistent with PRSS values and principles are likely sites where PRWs face the workforce challenges discussed above. One way to ensure that organizations implement PRSS in fidelity to the model is through the development of practice guidelines, such as the National Association of Peer Support (NAPS) practice guidelines for peer specialists and supervisors (National Association of Peer Supporters, 2013). However, the implementation of these guidelines is voluntary.

Another approach is organizational accreditation. The Council on Accreditation of Peer Recovery Support Services (CAPRSS) is the only accrediting body for peer recovery services providers in the US. CAPRSS was formed to accredit recovery community organizations (RCOs), independent, non-profit organizations led and governed by members of local communities of recovery (Valentine et al., 2007). RCOs connect with and advocate for people in recovery, which may provide a more supportive environment for PRWs. CAPRSS provides asset-based accreditation based on recovery principles and ‘inclusive of information and data from peers, leadership, and the recovery community served’, which serves as marker for model fidelity (Council on Accreditation of Peer Recovery Support Services, n.d.).

CAPRSS accreditation is voluntary and offers a potential avenue for regulating PRSS providers. CAPRSS accredits both programs and organizations regardless of the recovery community served, including those focused on mental health recovery. Mandating or financially incentivizing CAPRSS accreditation through state laws or Medicaid reimbursement could create a new mechanism facilitating consumer involvement in the delivery of PRSS.

Even in states where advocates are successful at increasing reimbursement rates, this is not a long-term solution. Given tight state budgets, indexing reimbursement rates for inflation is not politically feasible. While state advocates must decide which policy targets are most feasible, our research suggests that national policies that reduce the costs of childcare and housing can benefit all workers, not just PRWs. Future research should examine the costs and benefits of mandatory or incentivized accreditation policies, assess the politics of successful state reimbursement reforms, and investigate the impact of national social policies on PRWs.

Conclusion

While additional research describing workforce challenges can further the academic field of substance use and mental health recovery, public health researchers and practitioners, particularly in the US, should keep in mind the discipline’s commitment to health equity and social justice (American Public Health Association, 2018; National Association of County and City Health Officials, 2018). Many of the workplace stressors PRWs face are similar to other low-wage care occupations, and bioethicists have recognized low-wage work as a health equity and social justice issue (Duffy, 2022). Public health can become more engaged with the complex systems that structure inequities and sustain injustice through advocacy, action research, and public health practice (Flood, 2010; Hofrichter & Bhatia, 2010).

Public health historians Brown and Fee (2014) noted the importance of social movements in motivating population health advances and recommended public health workers make common cause with social activists. The professionalization of peer recovery support in the US is historically linked to the Consumer-Survivors and New Recovery Advocacy Movements that continue to advocate for policy and systems change. By engaging with these social movement organizations and making common cause with movements for a living wage and universal basic income, public health can support PRWs while furthering its mission to advance the health of all.

Author contributions

The author was entirely responsible for this manuscript’s data collection, analysis, and drafting.

Acknowledgements

Sam McIntyre and Jennifer Hinson provided research assistance in finalizing the revised manuscript.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The author confirms that the data supporting the findings of this study are available within the article and its supplementary materials.

Supplementary material

Supplemental data for this article can be accessed online at https://doi.org/10.1080/09581596.2024.2332796.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.

Notes

1. We compared the salary distributions of Peer Recovery Specialists with Peer Recovery Coaches in the ZipRecruiter database. We chose the latter for analysis since it was closer to Cronise and colleague’s (2016) estimate, was less skewed, and approximated a normal distribution. The comparison of distributions is with the supplementary materials.

2. The Nevada living wage for households with 0 children and one non-working adult is $27.59. Inflated to 2023 dollars at 3.18% inflation, this yields $28.47.