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.