Addressing Substance Use Disorder in Primary Care: The Role, Integration, and Impact of Recovery Coaches
Jack, Helen E.
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CitationJack, Helen E. 2018. Addressing Substance Use Disorder in Primary Care: The Role, Integration, and Impact of Recovery Coaches. Doctoral dissertation, Harvard Medical School.
AbstractPurpose: Only 10% of people with substance use disorder (SUD) receive treatment,
partially due to inadequate access to specialty SUD care and limited management within
primary care. “Recovery coaches” (RCs), peers sharing the lived experience of addiction
and recovery, are increasingly being integrated into primary care to help reach and treat
people experiencing SUD, yet little is known about how their role should be defined or
about their clinical integration and impact.
Methods: Semi-structured interviews with RCs (n D 5) and their patients (n D 16) were
used to explore patient and RC perspectives on the RC role. Maximum variation sampling
was employed to select patients who displayed diversity across gender, RC, housing status,
and number of contacts with an RC. Patients were sampled until no new concepts emerged
from additional interviews, and a semi-structured interview guide was used for data
collection. To analyze interview transcripts, the constant comparative method was used to
develop and assign inductively developed codes. Two coders separately coded all
transcripts and reconciled code assignments.
Results: Four core RC activities were identified: system navigation, supporting behavior
change, harm reduction, and relationship building. Across these activities, benefits of the
RC role emerged, including accessibility, shared experiences, motivation of behavior
change, and links to social services. Challenges of the RC model were also evident: patient
discomfort with asking for help, lack of clarity in RC role, and tension within the care team.
Conclusions: These findings shed light on RCs in primary care. Many patients and coaches
perceived that RCs play a valuable role within primary care, providing both tangible system
navigation and intangible, social support that promote recovery and might not otherwise be
available. Enhanced communication between RCs and health center leadership in defining
the RC role may help resolve ambiguity and related tensions between RCs and care team
Citable link to this pagehttp://nrs.harvard.edu/urn-3:HUL.InstRepos:41973531