Despite recognition from all the major medical associations that addiction is a neurobiological disease, millions of people remain incarcerated or have criminal records for substance use and receive little to no evidence-based treatment. According to the Drug Policy Alliance, the United States arrests more than 1.1 million individuals every year, 85% of whom are apprehended solely for possession. While none of the research supports incarceration as an effective form of intervention, policies continue to criminalize substance use rather than provide access to quality medical and behavioral health care. With more than five decades of failed U.S. drug policy and no clear, agreed-upon path forward, addiction as a public health crisis remains largely unaddressed and unresolved. Twenty-three million Americans are currently addicted to alcohol and/or other drugs, but only 1 in 10 (2.6 million) receive any treatment (Substance Abuse and Mental Health Services Administration, 2020). Social workers are on the front lines dealing with addicts who get caught up in the criminal justice system.
Social workers often choose their career because of personal experience or compassion for those around them. As professionals, they bring a broad array of technical experience and training to therapeutic relationships, but when drawing from their lived experience, they also function as peer support specialists. Whether it be in a traditional format or a nontraditional setting that focuses on brief symptom relief such as acute addiction or mental health situations, it is not uncommon for individuals with lived experience to draw from that knowledge when working with their clients. Social workers and certified peer support specialists may share similarities, but there is a significant difference that must be carefully observed.
The challenge for social workers tasked to aid clients caught in the criminal justice system with addiction treatment or recovery is the confusion that may arise from working according to two sets of standards. Social workers with lived experience have an authentic connection with clients. That experience, coupled with academic knowledge and training, provides a body of knowledge that cannot be ignored or dismissed. The hope and strength that are provided through similar lived experience leave a lasting impact. However, the professional role of the social worker sometimes comes into conflict with the empathetic, mutual, sympathetic union that the peer specialist often shares with the client.
For example, when working with addiction in the criminal justice setting, social workers are often required to report information to the authorities that the addict may have considered a confidential sharing with a sympathetic peer. Role confusion, ethical considerations, and duty to report are just a few of the challenges that social workers, who also serve in the capacity of certified peer specialists, must cope with. What's more, the client is often confused about what he/she should share with a peer specialist who is also a social worker.
The social worker who is drawn to the profession through lived experience is potentially one of the most powerful tools in the social services toolbox. The social work profession, however, has not yet worked out clear ethical guidelines for these powerful professionals. Caution and clarity must prevail until the profession has thought through the professional guidelines for social workers who also function as peer support specialists.
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