How recovery coaches are filling the gaps in addiction treatment
“There is no one right way to recover from addiction,” is a well-worn cliche in recovery communities. When we say it, we tend to mean “don’t judge other peoples’ recovery,” but it’s also a literal truth: There are a plethora of ways to “do” recovery. The addiction recovery field is growing in tangent with the opioid epidemic, and it’s confusing to parse through the myriad of options. Treatment can be medication-assisted or not. It can cost anywhere from zero to a billion dollars. You can recover with the support of 12-step groups or in a residential treatment facility. When treatment fails, people die. If this reality sounds daunting to parse through, imagine what it feels like if you’re strung out or in already in withdrawal.
When it comes to something as personal and socially stigmatized as addiction, it can feel a little weird to consider calling on a “coach” to provide support. But recovery coaching is a field that was developed in order to address the often-neglected needs of people managing addiction (and the people who love them). Coaches’ primary job is to help a person get and stay clean, but the most salient part of that is helping them figure out where to start. Because the last thing you need when you’ve hit rock bottom is to leaf through a pile of informational literature and trying to make sense out of medical jargon that even sanest, soberest person would find confusing.
“[Recovery coaches] are professionally trained people who are helping those with addiction find or stay in good evidence-based treatment, get motivated to change, and to sustain a productive recovery process,” says Mike Pantalon, professor at Yale School of Medicine and founder of The Center For Progressive Recovery, an organization that trains recovery coaches.
The fact that coaches are not medical clinicians creates what can be a more trusting and non-judgmental dynamic between them and a person struggling with addiction. They serve as an advocate for their client. People struggling with addiction may find official treatment providers intimidating; they’re also often negotiating a lot of difficult relationship dynamics, so it can be incredibly important to have someone “on their side.”
Recovery coaches also reinforce the crucial concept of community for their clients. The concerned friends and family of those struggling with addiction are often unsure how to intervene and a coach can either mediate or find the most appropriate counselor to mediate an intervention, if necessary. They can walk everyone involved through the steps of the recovery process, talk to the client about their goals, and determine both long- and short-term treatment plans. Some recovery coaches offer concierge level services that doctors and peer mentors probably don’t have time for. A friend told me that her brother’s recovery coach even walked with him through the neighborhood he used to buy drugs in to figure out which streets to avoid.
But not everyone in the recovery world is a fan of recovery coaching. The field has been criticized for being a largely unregulated profession and 12-step old timers tend to be suspicious of for profit recovery enterprises. Out of respect for the 12-step tradition of anonymity, I will only use the first names of the 12-step folks I spoke with.
“I have conflicting feelings about recovery coaches and people monetizing recovery,” says Denise, a graphic designer in New Orleans. “It feels like there’s a lot of privilege wrapped up in recovery coaching.” In other words, coaching can be expensive, anywhere from $300 a month to $1,000 a day, depending on the kinds of services provided; the cost is prohibitive to a lot of middle- and lower-income folks. On the other hand, coaches are often self-employed and able to set their own rates, so there is often potential to negotiate for services.
Other experts in the field of addiction recovery are proponents of coaching because they see that this type of rehabilitation is generally considered a multi-step process, and people need resources depending on where they are in that process. “I think coaching is great when it’s one of the many tools used to treat people,” says Arwen Podesta, a New Orleans-based psychiatrist who specializes in addiction recovery. “Accountability and coaching increase success in chronic disease management and lifestyle changes.”
The concept of accountability, however, varies in definition depending on who you talk to. Denise was concerned about the lack of regulatory standards, but noted that the same criticism could apply to the 12-step tradition of peer mentoring (sponsorship), who she says often, “have no formal training aside from their own personal experiences with addiction and recovery.”
The only requirement of becoming a sponsor in a 12-step program is having worked the steps. People choose their own sponsors, and most sponsors are driven by an attitude of service, but they are not (usually) addiction professionals, and the advice they give you often comes from their own experience, their own biases, and the limits of their time and energy to volunteer. They are, at their core, helpful peers with other professions.
Peer mentorship is important, but as Denise points out, it often means that the mentor helping you is biased towards the program that worked for them. They may not be able to separate what they needed from the recovery process from what you need.
Also, peer mentors — as well meaning as they may be — might not have specialized knowledge about the full scope of treatment options in your area. Recovery coaches stay informed like it’s their job (because it is their job). And while some may be critical of recovery coaches getting paid, they are paid by the client, not the provider, says Dawn Nickel, author and founder of SheRecovers, a coaching program for women in recovery. “Professional recovery coaches refer clients to clinical practitioners and treatment providers, they don’t provide those services themselves,” she says. In other words, recovery coaches may be less biased about treatment options because they are working on behalf of the client.
Criticism regarding recovery coach pricing seems like more evidence that professionals working in helping professions are notoriously underpaid and undervalued. “Just like anyone else who provides a professional service, it is fair and right for recovery coaches to be compensated for their time,” Pantalon says. Coaches also provide much needed care and support at a delicate moment in peoples’ lives, when frustrated loved ones are likely to find it difficult to deal with them kindly.
Denise went on to say that while she’s a little dubious about recovery coaching, she’s open to anything that helps people. “We need as many resources as possible to help people find recovery and get well,” she sfays. “Some people struggle with traditional peer-led support groups, and I don’t want to begrudge anything that may help save lives. I’m all for whatever we can use to help save the most people from addiction.”
If you or a loved one is struggling with addiction, please call the SAMHSA (Substance Abuse and Mental Health Association) helpline at 1-800-662-HELP (4357).