Situating Experiential Knowledge: A Systematic Review and Synthesis of Qualitative Evidence on Peer Support Services for Drug Addiction

Background and Purpose. Peer support services, a treatment modality that relies on the utilization of peers’ “experiential knowledge,” has been widely used in drug addiction interventions. While research has focused on demonstrating the effectiveness of such models in achieving measurable outcomes, such as reduced substance use and relapse rate, much less attention has been given to the subjective experiences of actualizing experiential knowledge in service practices. We conducted a systematic review of qualitative literature on the lived experiences of drug addiction peer support interventions with two primary aims: 1) to foreground the situatedness of “experience” and the relational nature of peer support; and 2) to enrich the concept “experiential knowledge” in peer support by attending to the sociopolitical conditions of its actualization.

Methods. The authors searched English-language peer-reviewed journal articles on three online platforms (EBSCOhost, PubMed, Web of Science) using keywords related to peer support (e.g., “peer-led/driven”) and drug addiction (e.g., “illicit drug”). Through a title-and-abstract screening step and a full-text screening step, we included studies that met the following criteria: 1) focusing on peer support as a central component of drug addiction interventions; and 2) reporting qualitative evidence from perspectives of actors directly involved in service practices. We independently conducted quality appraisal and achieved consensus through discussions. A three-step thematic analysis approach was used to extract, compare, translate, and re-analyze findings from primary studies for the purpose of conceptual development.

Results. A total of 22 studies reached the synthesis stage of this systematic review. Our findings revealed the unique positionality of peers as they created an overlapping space between two separate worlds: the social world of clients and the institutional world of service provision. The relationship between the two worlds is hierarchical as they are situated within the broader sociopolitical context where people who use drugs (PWUD) are largely marginalized, discriminated, and disenfranchised. Standing in both worlds, peers themselves embody such power hierarchy, which is manifested in their constant negotiation of boundaries and their restricted legitimacy and authority in service practices. Such embodiment is specifically manifested through three domains evident in the reviewed studies: 1) peers’ work space and schedule often extended beyond organizational boundaries to accommodate clients’ everyday living and crises, which could be challenging for peers themselves given their organizational roles; 2) the utilization of peers’ shared experiences in service practices was a combination of their (often traumatic) experiences of being a drug addict and the organizational norms and expectations, leading to the proceduralization of their lived experiences; and 3) peers experienced the tension between wanting to stay close to clients and longing for organizational recognition due to clients’ and organizations’ different, and sometimes conflicting, expectations of peers, and of recovery.

Conclusions and Implications. This systematic review of qualitative evidence contributes to existing scholarship and practices of drug addiction peer support interventions by foregrounding the experiential, relational, and processual aspects of peer support, as well as by attending to the sociopolitical conditions under which “experiential knowledge” has been interpreted, utilized, and/or legitimized in real-life institutional service settings.