Professional Perspectives from 50 States: Devastation, Inspiration, and Innovation in SUD Treatment

The Addiction Recovery Place Podcast Report shines a light on the state of substance use disorder (SUD) treatment across the nation by highlighting the devastation professionals confront from emerging drug threats and championing the inspirational individuals delivering innovative solutions in their communities. Through in-depth interviews with one addiction professional from each of the 50 states, spanning private practices, nonprofit organizations, and a diverse range of roles and specialties, this report captures a snapshot of today’s most urgent SUD trends. From harm reduction and strategies to improve recovery to prevention efforts and community-based solutions, the insights presented here reflect the frontline realities and forward-thinking responses shaping SUD care in America today.

The report is divided into 2 sections: Devastation and Inspiration.

The devastation section dives into details of the harm frontline workers discussed, including the rising problem of

• cannabis laced with fentanyl,
• new naloxone resistent synthetic drugs,
• human trafficking,
• and stigma.

The inspiration section details some successful projects, treatments, and ways SUD professionals improve recovery

• harm reduction
• Save a Life Stations
• Recovery-Friendly Workplaces
• Peer Support Specialists

Message from Chris Langley: Report creator with the help of many remarkable SUD Professionals
For the past year, I have had the privilege to interview some of the country's most dedicated professionals in the recovery and addiction field. When we first embarked on creating this podcast in January 2024, we set a goal of interviewing at least one professional from every state, so we could get an overview of what is happening around the country, and in April 2025, I interviewed our last state, Alaska.

As you will read in this report, there are examples of some incredibly innovative and thought-provoking models of care, which I also learned a great deal from hearing. 

I would like to thank each and every one of the amazing professionals who came on the podcast to speak with me about their vital work, which saves lives every day. You are the real heroes, because what the world is now dealing with is something quite stark, when compared to just 20 years ago, when drug use was managed without the risk that 'any drug use' can result in someone's death. The opioid and fentanyl crisis has ramped up risk more than tenfold, and what we are witnessing since the crisis took a grip on this country, is nothing we have ever seen before. 

In every podcast, we discuss this unfiltered in real detail.

Chris Langley
Podcast Host, Addiction Recovery Place Podcast
Co-Founder OfficeHounds
Report published June 2025

Devastation drives continued need for investment in SUD treatment

Substance Trends and Concerns

The rise of fentanyl and other dangerous synthetic substances, often found laced in other drugs, is a significant concern mentioned by guests from many states.

Dr. Alicia Shirakbari-Leslie from Kentucky explains how we have entered the “third phase of the opioid crisis.
“We’ve moved into what I call the third phase. And this is now what we call the synthetic opioids. This is the phase now where we started seeing this shift into fentanyl and other synthetic opioids on the street. … We are seeing now garage-pressed pills where people can actually take fentanyl, and they can press pills to look like oxycodone or hydrocodone or Norco or even Valium. They garage-press them, and they make them look like real pills. Then they sell them on the street. So now people are really in a dangerous zone because we have people that think they’re buying pills and then the pills aren’t what they think they are.” 

Many professionals discussed how clients would be surprised when their drug tests turned up positive for fentanyl. They had not purposely taken fentanyl and believed they had ingested or injected a safer drug. People using drugs may mistakenly believe they know the risks, which contributes to unexpected overdoses.

Mitch Prager from Arizona
“When I was a teenager, we used to call it experimenting with drugs…If the experiment didn’t go well, you had a hangover the next day, maybe there was a blackout, and you forgot what you said. Maybe there was a dent in the car, but some of those were negative consequences from experimenting with drugs. So is it more serious now? 100%. Now the experiment ends in death.”

He continued to recount a story of a 16-year-old boy in his local community, “who literally just experimented with drugs one time, and it was fentanyl, and he died.” As an expert said at the memorial event at the boy’s High School, “this one case was just one case out of the hundreds,” and Mitch added that tragically, “this is going on in every city across the country.”

Cannabis Laced with Fentanyl

With many states having legalized medicinal cannabis or legalized it for recreational use, an increasing number of Americans are more familiar with cannabis. They may have tried a mild CBD product or had a family member with cancer, epilepsy, or chronic pain report that cannabis helped their symptoms. The cultural acceptance of cannabis and "minimalization of marijuana" (Jarred Weems, Kansas) in many states makes it important to raise awareness about the rising trend of fentanyl-laced street cannabis.

The problem is so concerning in Missouri that Deborah Babbit now sees legalization in their state as a form of harm reduction because people know what they are buying in a dispensary.

Nick Pecenica from Indiana had a client disclose to him that, as a dealer, he chose to add fentanyl to cannabis to sell more drugs. “I’ve had one client in particular come to mind who was talking about getting new customers as they were switching to other kinds of drugs and things and talking about putting fentanyl in weed, in hookahs or weed hookahs, getting friends and things otherwise addicted to other substances.”

Jeffery Harvey from Mississippi explains further the financial incentives for dealers to put fentanyl in cannabis.
“They’re putting fentanyl in everything because it’s very addictive, and they don’t want you to come back and just buy some weed. They want you to come back and buy their weed.”

He continued to confirm that a large quantity of cannabis contaminated with fentanyl had been seized by law enforcement in Mississippi. “I had a friend work with the Mississippi Bureau of Narcotics… He called me one day and said they had busted a large quantity of high-grade marijuana…When we tested it, it didn’t come back positive for only THC. It came back positive for fentanyl.” Jeffery Harvey, Mississippi

Garret Biss, who works with veterans with SUD in North Carolina, said, “I’ve worked with individuals who had a pot addiction and come to find out they were being exposed to fentanyl. They couldn’t understand why this one guy’s pot was so amazing. And then come to find out that they’re getting fentanyl along with it.”

Corey Markisich from Utah talks about how they are getting UA urine analysis results from clients who report smoking cannabis or other drugs that are testing positive for fentanyl. He told the story of this happening with a specific client and added, “Most people that come in now, even the marijuana-people are coming positive for fentanyl with smoking cannabis.”

“There’s so much more danger to using today than there was because, like with marijuana, no one suspects to overdose on marijuana, but it just takes the tiniest bit of fentanyl to be placed in a bag of marijuana, and you wouldn’t know. That’s just, that’s dangerous to me.” Jess Wilson Oklahoma

Of the 50 states, 26% had a professional who mentioned concerns about fentanyl in cannabis in their state. That doesn’t mean it’s not a problem in more states, but these professionals chose to bring it to attention.

Professionals concerned about fentanyl-laced cannabis in these states

1. Arizona
2. Georgia
3. Idaho
4. Indiana
5. Kansas
6. Mississippi
7. Missouri
8. Nevada
9. North Carolina
10. North Dakota
11. Oklahoma
12. Texas
13. Utah
    

Synthetic Drugs

Xylazine, street name tranq, a tranquilizer used by veterinarians, was also a growing concern for guests from 20% of states who chose to mention it. Delaware is supplying Narcan kits that include fentanyl and xylazine testing strips. There are different approaches to harm reduction and testing strips across the country. One guest confirmed that Pennsylvania supplies xylazine testing strips, but another guest confirmed that carrying a test kit in Idaho is considered paraphernalia. “We’re a little bit behind the trend, but we’re starting to see that fentanyl and the xylazine flare up here at Wichita and in central Kansas, too.” Jarred Weems, Kansas

Professionals concerned about xylazine in these states

1. Delaware
2. Georgia
3. Idaho
4. Iowa
5. Kansas
6. New Hampshire
7. New Jersey
8. New York
9. Pennsylvania
10. Washington

Additional Substances of Concern to SUD Professionals

Medtomidine

“Medetomidine, which is similar to Xylazine, is an animal, a veterinary tranquilizer, and my understanding is that it’s not approved for human consumption, so there are no clinical trials or any data to suggest how it affects the human body. That’s something new that we’re experiencing in Delaware.” Kim Jones, Delaware

Dangerous Drug Combinations

“ I don’t have tests for most of the new things that are out there…One of the big things that’s going on in Philadelphia is tranq, which is mixing xylene with fentanyl. It’s a deadly combination. If you happen to overdose, and you go to the hospital, Narcan may not work because Tranq does not work with Narcan. It’s a very dangerous combination, and it actually rots people’s skin…I’m also concerned about Meth use in the area increasing. Howard Schier, New Jersey

Alaska has been seeing “In the last six months an increase of fentanyl and meth…heroin in fentanyl co-occurring.” Dr. Caitlan Hegwood said it’s important to provide Narcan training and re-train to remind professionals that depending on the doses of fentanyl, it may require up to four Narcan doses.”

Jeffery Harvey from Mississippi sums up how the risk from buying street drugs has never been higher. "If a drug is not from a dispensary or pharmacy, assume it has fentanyl."

Dark web, DUI, and Vapes

Dan Tallman from Iowa mentioned that one of “The biggest trends that I’ve seen is just access to more and more substances bought through the dark web. Teenagers are incredibly tech savvy, and they literally can get on the dark web and have any drug in the world on their doorstep in a few days.”

Gus Raymond notes that in rural Iowa, while fentanyl is not as prevalent, there is an astounding amount of cannabis use and THC use in vape pens among youth, as young as 10-12 years old. “Many children are taking just one hit and needing emergency services because they have no idea the strength of what they are putting into their bodies, often 90% THC from dispensaries.”

Pat Tucker from New Hampshire discussed youth prevention work and emphasized that vaping is seen as the first potential health problem to address. She highlights that her office is located across from and next to vape shops, noting the "unbelievable" traffic there.

Increased cannabis and nicotine vaping is certainly a concern for young people, but Lena Sheffield from Florida pointed out that for some adults, vaping cannabis or nicotine can be harm reduction if the vaping products are purchased from safe sources.

Problems arise when purchasing counterfeit black market vapes. Through her work at a halfway house, Kylee Cline from North Dakota learned of contamination of black market vapes being laced with fentanyl. She said, “People mistakenly think, ‘Oh, it’s a vape. There’s nothing in there.’ But people can put methamphetamine into disposable vapes. They can put fentanyl. They can put anything anywhere, right? And even like when fentanyl first started coming on the line, people who are longtime methamphetamine users were all of a sudden popping hot for fentanyl. And they’re like, ‘I’ve never used fentanyl.’ …So there are testing strips that I’ve heard of clients using where they can test the potency of their breath. It’s whatever drug they’re using, and a lot of people who I’ve heard that are testing it, like a lot of the methamphetamine is already laced with fentanyl which is really unfortunate, but I have heard of it, yes, where people will like, use marijuana, or vapes or a different drug and it’s laced with something else.”

Although the prevalence and overdose risks with fentanyl were a frequent concern of professionals, the harms of alcohol addiction are ever-present in society, and can still be dangerous and lethal, especially when individuals struggling with SUD drive while intoxicated. Several guests discussed mandated treatment following arrest for DUI or OWI, as it is called in some states. Professionals from Nevada and Michigan discussed how judges opt for jail diversion programs for those committing DUI offences. When appropriate, the aim is to focus on treatment instead of making recovery more challenging with the complications, life disruptions, and stigma from incarceration. Further innovative solutions to working with justice-involved individuals will be explored in the inspiration section of this report.

Addressing Bias in SUD Treatment

LGBTQ+

Gus Raymond from Iowa highlights the challenges faced by LGBTQ+ individuals in group recovery, especially in rural areas. He describes some of the possible concerns they may be feeling. “Is this a safe space for me to be open about my partner or my life or, the fact that we are same sex parents or the fact that we’re queer or the fact that I’m trans? There’s all this juggling you have to do when you’re really there to deal with whatever addiction and/or mental health concern that you are struggling with.”

Gus pointed out that there are few LGBTQ+ SUD professionals and even fewer trans SUD professionals.
“Having worked in the industry as a clinician and having been a client as well, and again, this isn’t just for behavioral health, it’s also for health care. It is imperative that we educate agencies, clinics, businesses, corporations, and the entities that own these places how to appropriately care for and offer services to LGBTQ+ individuals, especially when we add in layers of intersectionality.

Our first priority is to do no harm. If we’re faced with an individual, such as someone from the LGBTQ community, that simply who they are makes us feel uncomfortable. As a clinician, that’s not a referral reason. That’s a ‘you need to do some work issue.’ That’s not a get rid of the client issue, and as a human and as an LGBTQ individual, I am not a specialty. I’m a human, and I needed to be treated as such. I would appreciate you learning something about my community and my culture, and I would appreciate you learning about me as a human, but you don’t need to know everything there is to know about the gay community in order to understand how to treat me.”

As a trans man, Gus shared his personal story of being denied routine health care at an Iowa hospital. Since his podcast episode was recorded, Transgender men and women, gender-nonconforming, nonbinary, and intersex people (TGNCNBI) may feel more vulnerable, confused, or anxious about the Executive Order making the “policy of the United States to recognize two sexes, male and female.” Many trans men and women fear traveling with their driver's licenses and passports or are concerned about renewing and getting a misgendered passport. If anxiety increases for the LGBTQ+ community, the need for more support from SUD professionals also increases.

Some progress is being made, but overall, the absence of services makes clear that recovery for LGBTQ+ individuals is an area for improvement for SUD professionals.

In total, guests from only four states chose to mention SUD services for the LGBTQ+ community; Nevada, Minnesota, Oregon, and Iowa.

Guests from Nevada and Minnesota have existing groups that support the LGBTQ+ community, and a guest from New Jersey hopes to open an LGBTQ+ sober living home in the future.

Doug Smith from Oregon developed an EABT Emotional Attachment Behavioral Therapy workbook specifically for the LGBTQ+ community.

After meeting through the Addiction Recovery Place Podcast, Doug and Gus collaborated to create a free webinar, “An Affirming and Effective Substance Use Disorder Curriculum for the LGBTQ+ Community.” NAADAC members get free CEs. If you are not a member, you will need to set up a free NAADAC account to access the learning materials.

The information for this webinar states that “Studies have shown that people in the LGBTQ+ community are four times more likely to struggle with a substance use disorder. Although this population is at much higher risk, there has been a significant shortage of affirming services explicitly designed to meet their needs. This presentation will show how the new EABT substance use disorder curriculum designed specifically for the LGBTQ+ community is helping to fill that void.”

Implicit Bias

In response to his local communities, “cries for social justice,” Larry Davis of Michigan was tasked with creating Implicit Bias Training “for health care providers to educate on bias, to bring attention to racial disparities, but also using that as a platform to bring attention to disparities within, people that have addiction.”

Implicit bias training helps ensure professionals provide a safe place for all individuals to focus on their recovery work. To build on Gus Raymond’s point, you don’t have to be part of a community to provide effective treatment.
Larry explains, “There’s lots of things you really can’t control with stigma and how people are perceived, but I know, at least for me, I want to make sure I treat every person I meet with respect…I’m going to make sure that I communicate in my language where value is instilled into them. And that’s slowly how you can break that stigma within court. Probation officers, our judges [at their Drug Court] do an excellent job of instilling value in our participants, because a lot of times our participants are used to that negative stigma, the stereotypes, and they’re at a point where they’re just tired of fighting against it. So being able to create that safe space, I think, is so important.”

Increase in Opioid Use in African American Women

Jeffrey Harvey from Mississippi confirmed that, “Opioids among African American women is skyrocketing because they’re passing pills around.” He explains that many women are not addicted. They are sharing medications. They may think they are taking a Percocet or Hydrocodone from a pharmacy, but it actually has fentanyl and can lead to overdose.

Increase in Stimulant Use in African Americans in Rhode Island

Lisa Peterson confirms that “There are no currently FDA-approved medications for the treatment of stimulant use disorder, but we are seeing that surge here in Rhode Island. It’s disproportionately affecting black and brown communities. We’re seeing overdose rates in that community increase while simultaneously our overall rates are decreasing.”

Underrepresentation of Races and Cultures in Addiction Professionals

There was a limited mention of trends or drug use related to particular communities or races, but a few professionals expressed concern about the need for better cultural representation in the SUD profession. Ryan Currothers from Nebraska tackled this disparity head-on in his interview, “The addiction professional field is very under-representative of the population of the United States. We have a whole lot of people that look like me, so I’m white…So, the facility I’m at right now is actually in Omaha, Nebraska. We’re located in the middle of the inner city in Omaha, and a very diverse area, yet the staff is nowhere near as representative, especially the professional-level staff. I think that’s an issue, that our approach is not necessarily culturally representative of where people are coming from.”

Although not from the USA, George (Kev) Dertadian who is a Social Researcher and Senior Lecturer in Criminology at the University of New Sout Wales, Australia, discusses how the coloniality of drug prohibition specifically targeted First Nations people in early colonial eras in both North America and Australia, and people who were enslaved to build the new world. He emphasizes that the war on drugs can be reframed as a "war on black and brown people" or a significant form of "racialized violence". He also mentions that Nixon officials explicitly admitted the war on drugs was used to invade the homes and lives of "African American or black communities" who were not supportive of them.

Shortage of Women-focused Treatment

The innovation section of this report will detail positive support being provided specifically to women. Several professionals acknowledged the need for more services tailored for women in their communities.

Eric Ekberg, with treatment centers located in New Hampshire and Maine, said, “We see a lot more men come to treatment than women. Why is that? Is it because women aren’t supposed to have these problems, and they don’t want to admit to it? That’s probably part of it, which doesn’t make sense because they suffer from this…just as much as men do, but they’re not coming to treatment. We’ve got to fix that. That still bears itself up if I look at the Green Mountain census. It’s typically 20 to 30% female, and the rest, 70% are male. It seems to me it should be 50/50, people that need treatment.”

Julie Wockenfus from Wisconsin explained that they are trying to raise funds for women-only sober living to avoid having to “treat and street” the women they support.

Dan Tallman of Iowa said that a women's group was "desperately needed." Since recording the podcast, his counselling service now has a female colleague running a weekly women’s group that is a “safe place for women to process trauma and addiction.”

Human Trafficking and Body Brokering

Emily LaVigne discusses how "body brokering [also called patient brokering] has run rampant in Southern California…In terms of its impact in behavioral health care, they’re severe. We’re talking about relapse rates at an incredibly high rate. There is often sexual abuse and inappropriate relationships happening between the female or the male clients and these brokers or marketers. We’re talking about an increase in homelessness. When you are hopping between facilities with hopes that you’re going to get covered and paid, and you’re not, you will have nowhere to go.
Families are caught in the crossfire of this. There is no family integration happening in treatment because the facility is afraid that the family will find out what’s going on, so they just don’t incorporate them at all. Frequent HIPAA and 42 CFR violations.”

She describes another type of human trafficking where facilities hire brokers or even employees who are often unlicensed and uncredentialed to obtain "fraudulent insurance policies" by creating "fraudulent residence documents" in different states like Oklahoma, Alaska, and New York. “They’re all over the place, and they will just go obtain residence documents to prove the client lives there with a falsified address, and therefore obtain a state insurance policy that is then covered in California as an out-of-network or in-network policy.”

Corey Markisich from Utah first heard about body brokering when he relocated from Utah to Florida. “I had heard rumors of that happening, of people being paid to go to treatment or people finding people with good insurance and basically selling them, right?
You’re like, ‘hey, I’ll give you 20 bucks for this guy.’ I’m almost kind of naive thinking, “Yeah, that doesn’t happen, like it probably happened a couple times, but whatever.’ until I actually had it happen to me. I had a client that came in. He had checked into treatment, and he came to me literally like with no shame or anything.
He just came and said, ‘So when do I get paid?’ And I was like, ‘What do you mean?’

I thought he was joking with me… he thought he was being paid to be here, and what had happened is actually a misunderstanding. He was being paid to go to treatment, but he ended up going to us instead of this other place…So I got to know this kid really well, and he just laid it out for me. He was from New York. He had gone down to treatment and got wrapped up in that whole game and was making a living out of it. It was unfortunate because he learned to make money out of it, and also prolonged, like he wasn’t getting clean. He wasn’t getting the help he needed, and unfortunately, that kid actually ended up passing away. I moved back to Utah, and he would go in and out of sobriety and ended up overdosing and passing away.

It was wild. People would go into paying for people literally in detoxes. They would go into detox as a patient and then find people that were there and say, ‘Hey, I’m going to X treatment center, and if you come with me, it’s going to be fun. I’ll give you 200 bucks.’ And then it just trickled down from there…
It happens here in Utah still. Our admissions person… told me how he got a call, just a few months ago, about somebody that needed treatment…This person wasn’t like a family member or a friend, and so he [the admissions person] backed off. The guy got mad at him and said,’ I’ve been working on this, and who’s going to pay me for all this?’
We don’t pay for referrals. To me, that’s crazy that somebody is so blatantly, no shame, like upset with the person on the phone that you wasted my time, which means there are people that are paying for it, right?

And we, we’ve passed laws here in Utah against body brokery. You can’t. If there’s anything, any monetary means that’s tied back to a client, then that’s body brokering. Obviously, exchange for money, but even if it’s gifts, there are plenty of things that fall under it.”

Shelby Taulbee from Ohio, “When I first actually heard anything about human trafficking, I remember I was finishing up my graduate program and they were mentioning that the human trafficking was about to surpass the pill-mill trafficking…
It’s prevalent. It’s around everywhere…Ohio’s been in the top five of the states of human trafficking for a while now, and I do believe it’s because of the reasons our system and our highway, the routes. It’s easy to get to different states pretty quick, and with the three C’s that we have, Cleveland, Columbus, and Cincinnati, I also believe they’re the top three of trafficking inner cities…When I looked at the statistics, I believe it was between the ages of like 20 and 59, the majority of the average victims…

Shelby continues by telling a harrowing story of "two individuals from each end of human trafficking.”

One of them had such a bad experience and started having things come back through EMDR. Which, when they do EMDR, I usually process right after, with the things that they’ve been feeling or thinking. One of his first memories was being in a hole that was dug out. And he was so hungry that he was eating on a corpse.
And the corpse was of a woman, and this was one of many stories he had, and she was trafficked. She was not from the United States.

The other person involved with trafficking, “He had a lot of guilt, a lot of shame for what he did. He was on the other end of it [meaning he was a human trafficker] for drugs. And some of the things that he witnessed and did, it was primarily to support his family, but entirely, he got hooked on drugs, separated from his family, and just the amount of guilt and shame of things he did, went against his moral compass, and, and both of those individuals are not even from Ohio, and it’s really hard to get them to open up, right? They know that they’re in a safe place, but we’re talking years of trauma, and that’s really hard.”

Stigma and Signs of Change

Addiction can lead people to behaviors that they never thought they would do. Many professionals talked about the devastation caused by shame and stigma. The devastation section of this report ends with stigma because many professionals interviewed acknowledged how the sting of stigma slows down societal progress in addressing addiction, but they see signs of cultural attitudes toward stigma.

Still, stigma consistently emerges as a pervasive and deeply problematic issue in addiction treatment and recovery.

Several common themes regarding stigma are discussed:

• Misconception of Addiction as a Moral Failing: A recurring idea is that stigma is deeply rooted in the societal view of addiction as a moral failing, a personal choice, or a sign of weak character, rather than a recognized chronic brain disease. This outdated thinking leads to blame and shame, which are powerful deterrents to seeking help.
• Impact of Stigmatizing Language and Stereotypes: The use of derogatory terms perpetuates negative stereotypes and contributes to shame. The media and entertainment often reinforce these negative depictions, influencing public perception in the absence of direct experience. Stereotypes can also affect specific groups, such as the "perv" label associated with sex addiction.

Jeff Jones from Colorado, “We’re still using language and thought process and understanding from hundreds, if not thousands, of years ago. Many centuries ago, the Egyptians thought flogging was a cure for drunkenness…Turks thought a cure would be pouring molten lead down the throat, and that was a cure, lead poisoning, potentially death. But it’s crazy stuff. Then it was a moral issue, and it was a choice. Now it’s a disease. There’s still a lot of that old thinking, which results in shaming and stigma, and “that’s a bad person” and “that’s a bad family.”

• Fear of Judgment and Discrimination: Individuals with addiction often fear being judged, discriminated against, or losing their jobs, children, or social standing if their struggle becomes known. This fear can lead to secrecy and isolation, which go against the principles of recovery. This issue is particularly pronounced for military personnel, first responders, and law enforcement, who may fear being perceived as weak or incapable.
• Broad Impact on Families and Professionals: Stigma extends beyond the individual, affecting family members who may experience blame, shame, and isolation. Even healthcare professionals can exhibit discomfort or bias, and a lack of diversity within treatment teams can further alienate clients who do not see themselves represented.
• Strategies for Reduction: Education, Language, and Openness: Many guests emphasize that increased education about addiction as a disease is crucial for destigmatization. Adopting person-first language, such as "person in recovery" instead of "addict," is highlighted as a simple yet impactful change. Open conversations, podcasts, and sharing success stories (e.g., "Recover Out Loud") are seen as vital tools to normalize addiction and recovery, thereby creating a safer environment for others to seek help.
• Harm Reduction as an Anti-Stigma Approach: Harm reduction is frequently presented as a non-judgmental approach that meets clients "where they're at," prioritizing saving lives and reducing negative consequences, regardless of immediate abstinence. This approach fundamentally works to lessen stigma by fostering acceptance and hope.

Lisa Peterson from Rhode Island, “I think stigma is almost too gentle of a word… People have a general sense of what we say when we say stigma. But over the last, maybe decade, and I have to give credit to the former director of the Department of Behavioral Health, who really championed this change in language, we’ve started to call it what it is, which is fear, bias, and discrimination.

Our clients are discriminated against because they have a substance use disorder. That is so important to call out and to name specifically because stigma is vague, like, “Oh, I might judge you.” But that judgment in turn creates real, tangible harm in how we act and how people are perceived, and whether or not people get care.
So it’s a real challenge.

I think about when people have a cancer diagnosis in the family, they share that with people, and they get, rightfully, lots of support, and people are there for them and creating meal trains. When people have a substance use disorder in the family, they’re secretly reaching out to me and not telling anyone.

It’s really unfortunate because the more we talk about it, the more we normalize it; it’s not just about other people. These are our friends, our neighbors, our moms, our loved ones. I think that even within the behavioral health system, there remains discrimination that our clients have experienced and felt, and it is off-putting.

And if you had a bad experience in treatment, and you are already a very vulnerable person, why on earth would you try again? I think that we need to be really mindful.

I think of it as there’s the umbrella of healthcare. Under that umbrella is behavioral health care, within which we’ve made some strides in terms of talking more openly about mental health, and it’s okay to not be OK.

Under that umbrella is substance use treatment, which still has an element of, “I’m a mental health counselor. I don’t deal with that, or I don’t work with those people.” Then, even within the substance use treatment realm, being on medication that assists or supports your recovery goals is still frowned upon in some circles. So we’ve got all of these layers of intersection of bias that lead to discrimination.”

As this report transitions into the positive progress being made by dedicated SUD professionals across the country, we’ll end this section with words from Brittany Santillo from Nevada: “We just need more community outreach and less stigma.”

Inspiration and Innovation in Addiction Treatment

Established Treatment Approaches and Models

As would be expected from qualified addiction professionals, many of the established evidence-based models were mentioned when discussing their services.
These included:

• Cognitive Behavioral Therapy (CBT)
• Dialectical Behavioral Therapy (DBT)
• Medical Assisted Therapy (MAT)
• Motivational Interviewing
• Group Therapy
• 12-Step
• Family Therapy
• Trauma-Informed Care
• Relapse prevention

Professionals also shared their belief in the importance of “meeting the clients where they are,” allowing self-determination in their care through harm reduction, and providing a holistic and individualized approach to care. Additional therapeutic activities, such as mindfulness, yoga, art therapy, and animal-assisted therapy, were mentioned, especially in inpatient treatment facilities.

Adapting Treatment Approaches and Models

Garrett Biss from North Carolina works with veterans, but his message about individualizing treatment is useful for all professionals.
“One thing I always encourage people that I talk to is understand that every individual that struggled either with their mental health challenges, or addictions or just compulsive behaviors or any behavior that’s showing up in a way that’s creating a consequence in their life that they would like to change or would like to avoid. There’s an estimated 28 to 30M adults in America that are struggling with some kind of substance or behavior. It’s creating a negative impact on their life. That’s 28 to 30 million different life stories or life paths that got them to that place, a combination of biopsychosocial, spiritual elements, but for everybody, it’s a different combination.
The reason I bring that up is because for every person that’s seeking a road to recovery or a road to a better place in their life, it’s going to be a different combination of tools, resources, processes, and support to get them to that better place. And I only mentioned that because for some people, unfortunately, that if they struggle in their life and they reach out for, maybe they listen, they read a book to hear some program or some therapist or some, some retreat center that they can go to and they go to it and it doesn’t create that transformation that they were hoping for. One potential consequence of that is that the veteran or the individual can internalize that as though they’re so defective, they’re helpless, like the things aren’t ever going to get better. Especially if you go to a program or, if you’re involved in a support group, where you see everybody else around you having positive change and growing and experiencing the change that they want, and you’re not experiencing that. Sometimes we can internalize that I’m just so defective, I’m not good enough for this, or there’s nothing that can help me. To take somebody in a dark place and then put them into a darker place where they feel less hopeful, that’s a very negative consequence.

So I like to encourage individuals to find what feels right for you. And if you’ve tried something in the past and it didn’t really work, try something else. Or maybe it’s going to be a combination of different things that need to come together.”

Garrett’s point that treatment may need to be individualized to be effective is one that professionals discussed, with leaders of treatment centers ensuring that professionals are trained in different models and offer a range of therapeutic treatments. Some inpatient treatment centers have groups like 12-Step and SMART visit the inpatient facility to familiarize their clients with community support.

Harm Reduction

Summary of Harm Reduction Views

Many guests define harm reduction primarily as a strategy to save lives. They emphasized in the context of the fentanyl crisis, where drugs are more dangerous and second chances are rare. The goal is to keep people alive long enough so they can eventually embark on a path to change. As Aaron Bitter succinctly put it, "If we can’t keep someone alive, how can we treat them?".
A central tenet for many is meeting the client where they are at. This means providing compassionate services and resources even if individuals are not ready for complete abstinence. It's about opening the door to recovery. Ryan Carruthers highlights that this approach fosters relationships, which can speed up the process of getting help when clients are ready.

Several professionals, including Tommy McCann, Dan Tallman, Victoria Nagel, and Emily LaVigne, emphasize that harm reduction is not adversarial to abstinence-based approaches; rather, it complements them.

Eric Eckberg, who was "old school" abstinence-based, evolved his view after being educated by other providers about the evidence-based effectiveness of MAT.

Many guests view Medication-Assisted Treatment (MAT) as a crucial form of harm reduction. Howard Schier, initially against MAT, changed his opinion after witnessing people on Suboxone "function at a very high level" and rebuild their lives. Jeffery Harvey asserts that putting someone out of treatment for failing drug tests, especially with fentanyl, is an "automatic death sentence" and that harm reduction is about reducing the risk of harm, even if someone continues to use, stating, "If we can get you down to three days a week, we reduce the risk of you harming yourself more than 50%".

Gus Raymond points out that harm reduction helps "eliminate the concept of shame" often associated with recovery.

While generally supportive, some express nuances or caveats:

• Sharon Prager is "not a personal advocate" of harm reduction, believing in addressing the underlying issues that cause use in the first place.
• Brittney Santillo notes it's not a "one size fits all model," suggesting it's less effective for substances like methamphetamine due to the nature of their use.
• Nancy Johnston questions alcohol harm reduction for individuals with underlying genetic predispositions to addiction. She also cautions therapists to be aware of their own codependency to avoid disempowering clients when implementing harm reduction.

Harm Reduction Innovations - Save a Life Station

"Save a Life Stations" is an innovative project launched by Naloxone Access Now, co-founded by Jim Barrett, in Minneapolis, Minnesota. These stations are repurposed newspaper vending machines that are stocked with Naloxone (Narcan) kits. The initiative was inspired by the alarming statistics that a significant percentage of opioid overdoses occur with a bystander present (46%), primarily in private residences (69%), and affect various age groups (one-third over 50), indicating a critical opportunity for intervention.

The stations are designed to be low-tech and simple to use, with nothing that can easily break. Naloxone Access Now donates the transformed boxes to businesses and community locations, which then take responsibility for supplying them with Narcan kits and often fentanyl test strips. This collaborative model, which involves working with other nonprofits and community partners for training and supplies, aims to increase access to life-saving medication. Jim Barrett's ultimate goal is for Narcan to be as ubiquitous and unthought-of as fire extinguishers or AED machines.

Harm Reduction Innovations Saving Lives Across the USA

• Medicaid Coverage for Recovery Services (Massachusetts): In Massachusetts, the state's Medicaid program covers recovery support services, including recovery coaching and recovery support navigator services (case management for basic needs like homelessness, food insecurity, legal issues).
• Overdose Response Teams (North Carolina): Peer support specialists accompany law enforcement to overdose calls, offering immediate help, connections to MAT, rehab, or contact numbers like "Never Use Alone."
• MAT in Jails & Post-Release Naloxone (New York): Many jails in New York offer MAT and provide a 30-day injectable naloxone to individuals upon release, addressing the high risk of overdose due to reduced tolerance post-incarceration.
• Embracing Families Program (New York): A program designed to involve families in the recovery process, building allies within the family through practical steps and education, viewed as a form of harm reduction.
• Recovery Friendly Workplaces (Maryland, New Hampshire): Initiatives, first started in New Hampshire, where companies declare themselves "recovery friendly" and implement policies (e.g., paid leave, benefits) and provide overdose response training to support employees in recovery.
• Wound Care & Needle Exchange (Maryland): Voices of Hope, where Don Mathis works, provides wound care services, peer support, safe sex services, and needle exchange programs.
• Project Hope (Alaska): Provides Narcan overdose kits to individuals using opiates or their friends/family members, along with training.
• Fairbanks Reentry Service (Alaska): Helps stabilize the lives of individuals after prison.
• Sobering Centers (Nebraska): A different approach to addressing substance-related crimes, allowing individuals to stay until safe for release, treating them with dignity and respect.
• Mobile Outreach Programs (Virginia): Trucks come through town providing medications, services, and training in rural communities.
• Comprehensive Harm Reduction (Virginia): The Virginia Department of Health is committed to providing a broad set of public services, including peer support, education, HIV/Hepatitis testing, and linkages to medical and mental health services.
• Billboards for Good Samaritan Law (Arkansas): Billboards inform the public that they won't be arrested for dropping off someone who has overdosed at a hospital.
  "Recover Out Loud" Movement (Arkansas): A shift in the peer community to openly share recovery stories to help others, moving away from traditional 12-step anonymity.
• Doorways Program (New Hampshire): Located in hospitals, this program offers immediate assessments, referrals for treatment (including MAT), and can help with financial assistance for sober living and transportation, enabling same-day access to treatment.
• Police Station Referrals (New Hampshire): Police receive presentations on Narcan and offer to call recovery coaches for individuals they are booking, providing an opportunity for immediate treatment connection.
• Peer Recovery Support Specialists (West Virginia): Embedded with police officers to reduce stigma and divert people from the criminal justice system.
• Overdose Prevention Centers (Maine): Renee Lewis mentions OPCs and clean needle exchanges in Maine.
• Opioid Home Health (Maine): An all-women team including MAT providers, CADC, nurses, and Peer Recovery Coaches.
• Pre-consumption Drug Checking (Rhode Island): VICTA, where Lisa Peterson works, offers pre-consumption drug checking for samples of believed fentanyl to check for cross-contamination.
• Legalization of Cannabis (Missouri, Nevada): Deborah Babbitt and Brittney Santillo discuss how regulated cannabis dispensaries can act as a form of harm reduction by providing a known, tested source without fentanyl, which is safer than unregulated street drugs.
• Cannabis and Vaping as "Stepping Down" (Ohio): Shelby Taulbee noted that some clients might reduce harm by choosing to smoke marijuana rather than use heroin, viewing it as a safer, more productive option.
• Weekend Recovery (Treatment Courts): Larry Davis mentioned "weekend recovery" as an option for participants struggling, allowing them to go to an inpatient for a weekend instead of a full 14 days, to reduce disruption to family/work.

Technology and Modernizing Treatment

An emerging theme discussed by several professionals was that an increasing number of young clients want an alternative group experience to 12-Step. For some, it’s because they are not religious. For others, they don’t like in-person meetings and feel more comfortable with online groups.

The general public's familiarity with video calls because of the Covid-19 pandemic has made it easier for inpatient treatment centers to have support groups online for family members. This is especially useful because some family members may be in different states, making it easier to include them.

Another new development that two professionals mentioned was younger clients self-diagnosing because of videos from influencers they watched on social media. One professional saw that as a concerning new trend, but the other thought it was a positive thing that they are taking an interest in their mental health, and by asking in a therapy session, it affords the opportunity to discuss it.

One positive example of an innovative new use of technology was shared by Tommy McCain (New Mexico and Massachusetts). Mindshift Recovery™ is a non-profit organization that utilizes a digital therapeutic app and the Mindshift Method of Mindfulness Training for Reward-Based Learning, developed by neuroscientist Dr Judson Brewer, to "hack" the brain's reward system for addiction recovery. This method employs mindful awareness and curiosity to help individuals update the reward value of substances, and is complemented by peer community support and an 8-week training course.

Telephone - Old Technology That Still Works

The process of finding and inviting guests for the Addiction Recovery Place Podcast involved calling hundreds of treatment centers throughout the country. It was noted that a high majority of treatment centers did not have phone cover, even during office hours. Missing out on the chance to be a podcast guest isn’t a life or death matter, but for a person with a SUD reaching out for help, it could be.

Dori Haddock from Arkansas stated that previously, their organization could only access calls or admissions from Monday to Friday, 8 AM to 5 PM. Recognizing that substance use is not limited to these hours, she changed the admissions process to be 24/7, with phones answered around the clock and admissions available seven days a week.
The results speak for themselves. “We’ve actually doubled our admissions, and we have decreased our AMA [Against Medical Advice] rate by about 23%.

Positive Results from Addiction Treatment Models

These three models are being highlighted because professionals mentioned their effectiveness.

EMDR

Many professionals who treat trauma, complex trauma, and PTSD mentioned the effectiveness of EMDR. David Woldtvedt from Washington explains that, unlike traditional talk therapy, EMDR sessions are "a lot quieter" because the client does not have to verbally describe the trauma for the therapy to be effective. They only need to "hold it in the mind's eye" while receiving bilateral stimulation. The core mechanism helps reduce the "emotionality" and "vividness" of distressing memories.
EMDR uses bilateral stimulation, which can include:

• Eye movement
• Tapping (e.g., the "butterfly hug" or tapping on kneecaps)
• Light bars
• Vibrating paddles
• Headphones providing bilateral audio sound

Brittney Santillo from Nevada also finds EMDR beneficial for non-trauma support in therapy. “EMDR for individuals is my go-to approach. So the great thing about EMDR is, I know that it’s been coined really for the people who have PTSD and more severe trauma, but I really use it for anything like a super small stressor to anything like really big.”

EABT

Emotional Attachment Behavior Therapy was developed by Doug Smith from Oregon.
Over a 12-month period, a total of over 700 clients were split between EABT groups and control groups using other evidence-based practices.

EABT Results

• 11% higher completion of treatment percentage
• 13% higher transition to the next level of care rate
• 46% lower Atypical Discharge rate
• 18% higher completion rate with history of trauma
• 21% higher completion rate ages 25 and under

Grounded in attachment theory, EABT focuses on decreasing insecure attachment styles while increasing secure attachment, recognizing that replacing negative behaviors with positive ones is crucial for long-term recovery and healing unmet needs.

Doug Smith said, “My belief is if you take a negative out of the equation, and don’t replace it with a positive, you’re leaving that void empty, and eventually the negative is going to fall right back into place.”

BEMT

Belief Eye Movement Therapy (BEMT), founded by Stan Dokmanus from Hawaii, is a method designed to change limiting and hurtful core beliefs. Modifying these underlying beliefs is crucial for long-term behavioral change in addiction and criminal thinking.

Regarding results, Stan Dokmanus notes that in his work with Drug Courts in Maui, a judge acknowledged his methods produced results they had "never seen" in over 10 years, and encouraged him to write a book. He has now written several books and has developed MCLE training for Attorneys and continuing education training for addiction professionals through NAADAC.

Additional Recovery Concepts & Approaches

Although professionals and organizations interviewed discussed many different models, treatment modalities, and services, the following key recovery concepts are worth noting to show the breadth and depth of the profession.

Key recovery concepts

• Purpose & Meaning in Life
• Self-CareAbstinence
• Harm Reduction
• Spirituality
• Personal Responsibilities & Self-Direction
• Resilience
• Community & Belonging
• Emotional Agility
• Boundaries
• Authenticity
• Unconditional Love
• Recovery Capital (internal and external resources to help recovery)

Modalities

• Detoxification & Residential Care
• First stop in the recovery journey
• MAT during detox
• Focus on comfort
• Aftercare planning
• Transport to the facility

Outpatient Services

• Intensive Outpatient Programs (IOP)
• Partial Hospitalization Programs (PHP)
• Individual Counseling
• Group Therapy
• Aftercare / Alumni Groups
• Domestic Violence Programs
• Anger Management
• Alcohol & Drug Safety Action Program

Medication-Assisted Treatment (MAT)

• Buprenorphine (Suboxone, Subutex)
• Vivitrol
• Methadone
• MAT reduces cravings
• Allows the brain to heal
• Not replacing one addiction with another

Recovery Housing / Sober Living

• Safe environment
• Community & support
• Case management services
• Helps with transition to independent living
• Financial assistance (scholarships, family, religious)

Peer Support

• Lived experience
• Bridges the gap between clinician/medical
• Recovery coaching
• Connects to resources
• Builds trust
• Diverts from the Criminal Justice system

Family Programs & Support

• Family nights
• Education on addiction
• Communication skills
• Setting boundaries
• Understanding family roles
• Support for betrayal trauma
• Sibling groups

Focused Treatment

• Adolescent Treatment
• Stimulant Use Disorder Program
• Women’s Programs
• Seniors Recovery (Age-specific groups
• LGBTQ+ Support
• Veterans Programs (Valient Path™)

Community Outreach & Collaboration

• Sobering Centers
• Recovery-Friendly Workplaces
• Drug Courts
• Overdose Prevention Centers (OPC)
• Syringe Services Programs
• Save a Life Stations (naloxone vending machines)
• Quick Response Teams (QRTs)
• Mobile Crisis Teams
• Partnerships with Law Enforcement & EMS
• Community Coalitions
• Recovery Allyship Training

Therapeutic Activities

• Equine Therapy
• Art & Music Therapy
• Surf Therapy
• Physical Activity (Devon’s Rec Room)
• Mindfulness & Yoga
• Breathwork Journey Sessions

Professional Development Training

• Clinical Supervision
• Staff Training (HIPAA, confidentiality, ethics)
• Certified Peer Recovery Support Specialists (CPSS)
• Chemical Dependency Associate (CDA) Credential
• Dual Licensure (Mental Health & Substance Use)
• Importance of Continuing Education
• Free CEUs with NAADAC membership
• Mentoring

Additional Recovery Concepts & Approaches

When professionals shared their own stories of why they initially became addicted to substances, several explained that they began using as a way to manage their neurodivergency. This was mostly the case with professionals with ADHD.

Megan MacKay from Montana works with young adults who often have some kind of neurodivergency or trauma, and she hopes to develop a “workbook, in terms of autism and intimacy behaviors, so a little more specialized niche.”

Supporting Seniors with SUD

Christine Martinek from Minnesota works for one of the only older adult treatment centers in Minnesota. It began in the late 1970s when St. Joseph’s Hospital noticed an increase in seniors with substance use disorder, primarily alcohol.

A key distinguishing factor of the program is that seniors are in group therapy with people their own age, fostering camaraderie and connection based on shared life experiences, music, era, and beliefs (e.g., historical events like wars, and cultural norms like the importance of church 70 years ago).

Key Issues Faced by Older Adults:

• Medicare generally does not cover the cost of SUD treatment for individuals aged 65 and older.
• The Senior Recovery Center, being a non-profit organization, addresses this funding gap by drastically reducing the cost of its treatment program to one-third and allowing seniors to make payments instead of requiring a lump sum.
• Increased physical health problems (e.g., high blood pressure, diabetes, memory issues, pain).
• A significant trigger for addiction in this demographic is grief, which can stem from the loss of loved ones (e.g., a spouse of 40 years), the loss of a sense of purpose upon retirement, loss of independence, or loss of friends.
• The service connects clients with grief counseling and support to navigate these profound life changes.

Treating Non-substance Addictions

People are increasingly seeking help for non-substance addictions.

Sex Addiction

Gary Kat from New York explains that sex addiction is the problematic use of sex or sexual pursuits to numb out, feel better, or regulate emotions, often as a solution to deeper issues like trauma that then becomes a problem itself. Unlike substance abstinence models, the goal for sex addiction recovery is to achieve a healthy relationship with sex.

He emphasizes that 30% - 50% of individuals with SUD have an unhealthy relationship with sex, making sexual recovery an often unaddressed component of overall addiction treatment.

Eating Disorders

Jess Wilson from Oklahoma
“My background is in addiction work, and we work through process addiction. In the addiction world, we classify eating disorders under process addictions, and then eating disorders doesn’t look at it as an addiction, and I bring a wealth of knowledge of how to bring both of those informations together…
I use harm reduction both with addiction individuals, as well as my eating disordered individuals, because not everybody comes into therapy and is “yes, I’m ready. Let’s go on this. Harm reduction says, “Okay, what if you were to do this? What would happen to your life if you did this, right? What are you willing to work on?” Let’s start there.” I think harm reduction is another aspect that saves lives. Why wouldn’t we do it?... The whole purpose that we’re in here is to help save lives and help people get on their recovery path. For me, if you’re using heroin, meth, and marijuana, I’m not going to start with the marijuana. Let’s get you off the heroin and meth, Let’s start there. Eating disorders, diet culture is so prevalent, and it’s so hard, and so it’s like calling out the diet culture. It’s okay, I understand calorie counting has been a thing you’ve done for the majority of your life. Well, what if we just didn’t do it one day? What if we just didn’t do it for two days?” Working with that and letting some of that go. The greatest part of harm reduction for me is coming into a session and a client saying, ‘Guess what? I didn’t do it today. I didn’t use at all. I didn’t use any of it. Or ‘I didn’t calorie count in the last week.’ And that’s phenomenal.”

Gambling Addiction

Six professionals mentioned gambling addiction, with some offering treatment and others commenting that there is a risk that people with SUD will replace gambling addiction with their substance of choice. Only one professional was offering services, including prevention services for gambling.

Kay Guire from Wyoming, “ I think gambling addiction or problematic gambling is something that's not talked about a lot…I think it's like the unseen addiction. You know, people don't necessarily get diagnosed with gambling addiction…We don't have any kind of program in our community. We're kind of a rural community in Wyoming…And to not have those kinds of resources, I wanted to pioneer us being the first to be able to say, “Hey, we're gonna breach this subject and we're just gonna get prevention out there, and then provide treatment.”

They have a 6-week prevention program for high school and college kids.
She also mentioned that, “in the population I serve, I'll see people that are getting clean from alcohol and drugs. But they still are looking for a certain type of high. And they turn to gambling. And now that's a prevalent thing in our community that they can do. And especially with our population on probation and stuff. They can do that legally, right? But it can also cause them as much harm as the substance itself.”

Professional Development

The professionals interviewed ranged from student to retiree, from Peer Support Specialist to PhD, from Medical Director to Tech, from CEO to Therapist, and thought leaders who have authored books and developed their own therapies. These are some of the common themes that help their success.

Continuing Education and Learning

One common theme is valuing training and continual professional development. Victoria Nagel from New Jersey shares how the New Jersey Prevention Network provides professional development along the continuum of care for prevention, treatment, and peer recovery support for the addiction workforce throughout the state. They listen to the training needs of the workforce and develop and deliver new training. They act as a "middleman" between researchers and frontline teams, conceptualizing and disseminating current research, policy developments, and other crucial information through trainings, "one-pagers," and "Beyond the Classroom Videos."

The love for learning and continuing education is evident by the volume of post-nominal letters following some of the professionals' names that were interviewed. Post-nominal letters were deliberately omitted not to distract and add to the length of this report. Many of the interviewees have chosen to be members of associations for addiction professionals, and many talked about the benefits of joining NAADAC for the free continuing education credits they offer that help expand their knowledge.

Those in leadership positions also share the value of quality training for their employees.

Debbie Thomas from Idaho ensures that all of their staff, including the administrative and dietary teams, receive de-escalation and motivational interviewing skills.
“We talk about, you've got to dance with this addiction, don't get mad at the person. They're going to do all kinds of behaviors. At times, it's going to get hard, and they're going to try and do things and be like, Hey, you don't love me or care about me. I'm going to get thrown out.

Our team has this way of just being connected and sharing these hopefulness conversations like, ‘Hey, it's really hard. I know you want to leave. Let's sleep on it and wait one more day.’ The other thing that I would brag about my team is that they continually are learning. They are bringing in new knowledge to each other.”

Continuing Education and Learning

Another common value is collaboration. Victoria Nagel from New Jersey networks in national associations like NAADAC to “ figure out what are other people doing? How can we collaborate together? Because I know what we’re struggling with in with New Jersey and our barriers, but other states might have the same struggles, but not the same barriers, because they’ve solved things.”

Victoria also shared an interesting story about how she used networking with her educators to get her current role. Networking with other professionals can help professionals learn, find mentors, discover new career paths, find speaking opportunities, or even get solidarity and support to help with self-care.

CEOs and Executive Directors discussed the benefits of collaborating with local services instead of looking at them as “competitors,” they can become referral partners. Collaborating with community organizations, local courts, businesses, and law enforcement can help bring about innovative projects that matter.

Erik Eckberg from New Hampshire and Maine said, “Granite Recovery is the largest provider of residential inpatient SUD in the state. So over the years we’ve developed really good relationship with, again, I just mentioned on the mental health side, EDs, hospitals, many police departments, many of the local politicians, right up at higher levels at the state house, places like Neami, which helps us on the mental health side.
Many folks we call friends, including other treatment providers. We talk a lot. At a certain level, it’s business, and maybe there’s some sort of competition. There’s plenty of people that need help. So it really, it’s a matter of making sure we’re all doing the right thing.”

Corey Markisich from Utah explains the benefit of treatment center leaders meeting monthly in his state to collaborate. "We have a good treatment world out here in Utah, too. There’s a lot of treatment centers, but technically we’re in competition because we’re all in the same space, but we all get along pretty well and we work together, and we know, if I know that, something that we’re not doing well with that. Someone might need something like, for example, someone with a severe eating disorder, that’s not something that our place specializes in. And it’s not fair to keep a client here if they need that help. And I know three places I can call and say, Hey, I’ve been treating this person. We need them to do this. I’m not fearful of losing a client. We’re all on the same team of helping, and Utah is a unique place in that we have these monthly meetings where we all get together. We’re all friends. We’re all pretty close."

Certified Peer Support Specialists

Certified Peer Support Specialists (CPSS) and peer professionals are consistently highlighted across the country as a vital and growing component of addiction recovery services. Professionals emphasize that recovery from substance use profoundly depends on social support and engagement.

Here’s a summary of what professionals had to say about Certified Peer Support Specialists and peer roles:

Definition and Role

• Peer mentors are individuals with lived experience in addiction and long-term recovery who act as a "guide" or "tour guide to recovery".
• They are uniquely positioned to bridge the gap between clients and counselors, as well as the court system and probation.
• Their responsibilities include helping clients with day-to-day needs, organizing their lives, connecting them to 12-step meetings, assisting with homework, and managing challenging behaviors in group settings.
• Peers also provide practical support, such as helping individuals apply for Medicaid, food stamps, legal services, housing, and job assistance.
• They are increasingly integrated into various community efforts, including being embedded with police officers to reduce stigma and divert people from the criminal justice system, and serving on "quick response teams" that respond to overdose calls within 72 hours.
• Many organizations hire staff who are themselves in recovery, including peer support specialists, recognizing the value of shared experience.

Effectiveness and Benefits

• The primary reason for the effectiveness of peer support is trust. Clients often connect more quickly with someone who has "been where they're at".
• Peers demonstrate that “recovery is possible” and provide a powerful sense of hope, especially when clients feel they cannot achieve long-term sobriety.
• This role is considered invaluable for treatment, particularly given the shortage of traditional counselors, as they provide essential connection and support that enhances care.
• Peer support contributes to harm reduction by connecting with individuals and promoting safe practices.
• Many peer professionals, having successfully navigated their own recovery, become inspiring role models in the community.
• They offer an important lifeline for clients, helping them navigate stressors and remain engaged in their recovery journey long-term.

Challenges and Professional Development

• Despite their crucial role, the peer professional movement can still be underfunded and underutilized, particularly family peers who promote harm reduction and family engagement.
• Maintaining self-care and healthy boundaries is essential for peer recovery professionals to prevent burnout and vicarious trauma, as they are deeply involved in clients' lives.
• The professionalization of peer roles is increasing, with structured peer certification training and tiered models in some states.
• Professional organizations like NAADAC and New Jersey Prevention Network play a significant role in promoting the peer workforce, offering training, and advocating for their inclusion in treatment systems.
• New Jersey Prevention Network offers a free monthly Zoom call for CPSS to get confidential support.

"The best thing that an addict or an alcoholic can do when they’re struggling is get in the presence of another addict or alcoholic and to be of service, right? This could be one of the highest aspirations of the human heart, you could say is to help others. And so when you do that, you leave yourself and all the drama and minutia that happens there. You’re not at the center of the universe, and you’re able to become a part of something bigger." Drew Amburn from North Carolina

Sober Living and Alumni Aftercare

One effective way that addiction treatment centers are managing the risk of relapse is to offer sober living to their alums to better prepare them for starting their new sober life.

Kim Jones of Delaware, who had her story featured in the New York Times to help others, shared her personal experience trying to rebuild her life after incarceration.

“In 2014, when I got released from prison, I was fortunate enough that a friend of my sister’s hired me to work at her bagel shop and, I, didn’t think that I was institutionalized coming out of prison, but I really was, and I remember the first conversation I had with a regular customer and he asked me like, what are you doing here?
It just, it seems like, this isn’t the right place for you to be working, and I was scared to death to tell him why I was there. He was a retired state trooper. And I thought, “Oh gosh, like, why does he have to be the one asking me? He’s definitely going to judge me, and we’re probably never going to have a conversation again.”
So I just told him, “I was a drug addict, and I just got out of prison and this is my first job,” and he was so incredibly supportive, and that kind of gave me the confidence to be a little more open with other people about what I was experiencing.

And at the same time I was participating in an outpatient program at an organization called Gaudenzia, and they’re a pretty large treatment provider out here on the East Coast, mostly in Pennsylvania, but they had a couple of Delaware programs as well, and at that time, they were launching a peer certification course, and they had selected several individuals from Delaware to participate.
And I went to them and asked them if I could participate too. I had a career prior to my drug addiction and was working in the pharmaceutical industry, and so I knew what it was like to be in a professional role and thought that, this peer certification might be a way for me to get back into something more professional,
and something that, where I might be able to support my kids again. Certainly, a minimum wage job wasn’t going to pay the bills, and provide a lifestyle for my kids that I felt like they deserved. Guardenzia was gracious enough to allow me to participate in that program. And then once the courses were over, they hired me on as an admin in one of their Delaware programs,
and so that was how I got into this field, and eventually I worked my way up and became the Division Director for their Delaware programs. And then in 2019, friends of mine were starting Community Collaboration of Delaware, and they wanted to run a sober living program. They knew that based on the experience that I had through
my professional experiences with Gaudenzia and as well as some of the volunteer work I had done in sober living in the community that I could help them get that program up and running.”

Not everyone who enters a Sober Living home has the previous work experience that Kim had prior to their addiction and/or incarceration. When Sober Living is combined with an Alumni program, needs such as work readiness can be identified and met in a way that sets the client up for success upon leaving Sober Living.

Caitlin Hegwood from Alaska explains how Sober Living and aftercare work together

“We have 50 beds available in our sober living, our recovery residence, and. As our clients are transitioning out of residential, knowing that they have a space where they can go, that is, yes, absolutely free of substances, is with other individuals who are free of substances, but also is a program in and of itself.

And so our recovery residents come with peer support. When they’re in treatment and are outpatient, they have case managers, they have counselors, and they’re working with that team to get jobs, get IDs, get connected with healthcare, all of the basic things that we need in life to form a foundation and then jump from that.

And so our housing program is 6 to 12 months. There’s no maximum stay, but we are helping people get out on their own. And, we do that in many ways. But a big part of that is working with that peer support specialist and finding out what recovery, like living recovery, looks like and I would say that is a part of people’s success in the program is that they’re able to go to treatment, have a safe place during their outpatient experience, and then as they get their own independent life, they’re starting to titrate down into our, One hour, two hours, three hours, maybe one group a week in our outpatient before they discharge from us successfully.

So it’s really a neat program.”

Prevention

This report ends where the work begins, with prevention. Several professionals interviewed highlighted the growing recognition and implementation of diverse prevention strategies, ranging from early childhood education and social-emotional learning provided during free before and after-school child care to large-scale community outreach, naloxone distribution and training, and legislative advocacy, all aimed at reducing the incidence and impact of addiction.

Several states mentioned having Certified Prevention Specialists to work with teenagers through referrals from schools. Drew Amburn from North Carolina sends adolescent prevention specialists into schools and runs an educational program called S.C.I.P. (School Intervention Program), a 12-hour curriculum over six weeks, which is a recognized program with federal folks called Project Towards No Drugs. S.C.I.P. aims to spark conversations with kids about their behavior and feelings, encouraging them to think differently. The Department of Juvenile Justice and the Juvenile Crime Prevention Council provide referrals to try to prevent youth from entering the system. They have a more substantial 40-hour curriculum and can set treatment plans, goals, and recommendations.

Dori Haddock from Arkansas confirmed that most colleges and high schools in the state have naloxone boxes.

Nicole Dawsey from Alabama worked with law enforcement, educators, churches, first responders, and businesses to distribute 350 emergency opioid overdose reversal kits (ONEbox), which include video training.

Nicole, “I think harm reduction, recovery, treatment, prevention, they were all pitted against each other. We’re all fighting for dollars. And it’s ‘Oh, you can’t be for recovery and for harm reduction. You can’t be for harm reduction and be for prevention.’ Guess what? You could be for all the things.”

Jimmy Jones from Kansas describes their Early Intervention Program, designed for individuals who might have only gotten into trouble once or are new to diversion/probation. This program is a drug education program with some CBT.

Their youth program’s goal is to catch addiction early before it worsens. They emphasize family involvement, with family members able to attend group sessions and monthly family nights for bonding and team building. They also help young people with coping mechanisms for cravings and who to associate with to avoid triggers, especially in school settings.

Making people feel they belong, to turn tragedy into triumph

This section on prevention ends with Tara Ballinger from Virginia. Tara founded her own prevention organization after certifying as a Certified Peer Support Specialist. She funds her work by making and selling prevention bracelets wth the message, “one pill can kill,” and other motivational messages like “worthy” and “be still.”

Tara tells her story, “ Being a product of my environment, coming from dysfunction, going through addiction, I was emancipated at 14. I've used every type of drug, had no purpose, found purpose, messed the purpose up due to no solid foundation, and then finally just kept going. I just said, let me give this one more chance. Let me try to go back to get my peer certification. And when I did that, I broke into a lot of things that I really didn't expect, for me personally, and then also professionally, with where I like I was being driven to, to help. Being a child of alcoholism, drug addiction, abuse, neglect, every, sexual abuse, every kind of abuse, anything that was, that I think that's what kind of makes my story unique and why I really feel like I have a talent, a purpose for this….
 So six years ago, so my main story, my main Big pitch, to draw people in is where I've turned tragedy to triumph. I overdosed with my kids six years ago in the car. It was my last use. I will never forget that day. That was my rock bottom. I had many before that. But that journey, I went through so many treatment centers, and I wanted it quite a few times…I'm being told there's 27 pathways. There's this. There's that. But I wasn't getting any tight-knit treatment to really help explore those options. They were just like a commercial I would see on TV, right? Like a quick snippet. And I would never get to dive into those things.

So over the years, speaking with other people in recovery, speaking with the youth, speaking with professionals that are medical professionals in addiction, law enforcement, the general consensus I have gained is there's a lot of gaps. There's a lot of gaps and it's one, all types of pillars. It's communication. It's networking. It's availability. It's so many things that if you really, if I take my story and use that to dissect where my gaps were, so simple and small because all they require is compassion, empathy, understanding, prevention, and awareness, and literally those things can be done by a community.”

Tara’s tragic overdose story, which thankfully, she transformed into triumph, is one story. Many of the professionals have their own recovery stories that fuel their purpose to help others. All addiction professionals, whether in recovery themselves or who are doing the work because their lives were touched by addiction from a loved one, or professionals who chose to do the work because they care about people, are needed to ensure that we stop losing the potential of our nation to overdose.

Teaching the Next Generation of Professionals

Jon Dower from West Virginia shared his inspiring addiction story, recounting how he became an addiction professional and was even elected to West Virginia’s Opioid Abatement Board that decides how the opioid settlement money will be spent in West Virginia. He now gives back by educating the next generation of professionals.
“The honor of being able to do that at the graduate level across the whole country at Wesleyan allows me to leave a legacy, and to me, that’s important. I’m not going to, to the best of my knowledge, I’m not going to do anything that truly changes the world. But what I can say is that I’ve made an impact that’s changed a mom. She didn’t have to hear that her son died or daughter died. I have worked with people who have been reunited with their children so they don’t have to go home tonight, not having mom or dad there, and living in foster care, or living in a group home. They get to go home to mom and dad. I have helped individuals that testifying in court that we’re going to go back to a jail cell and not receive care, and instead go find adequate treatment and then have multiple years of recovery. Now those are their wins. They’re not my wins, but it’s really humbling and quite an honor to have played a sentence or two in one chapter of their lives that may be the pivotal chapter and may turn them into, the best the trajectory towards the best version of themselves to live wholly full self-directed lives. And what more can we ask for out of this thing that we call life than to have something full and find love and find purpose and have hope and have a better tomorrow than we have today. And that’s what teaching does for me. It allows me that legacy. It allows me that ripple effect. It allows me to know that the pain that I experienced through two decades of substance use isn’t in vain. It was preparing me to help the next generation help prevent this in another generation.”

Conclusion

Professionals from all across America shared their knowledge, experience, and personal stories on the Addiction Recovery Place Podcast. Overarching themes have been shared in this report, giving a snapshot of the state of addiction treatment, but each podcast episode reveals even more details that are worth learning from.